Citation Nr: 20043786 Decision Date: 06/29/20 Archive Date: 06/29/20 DOCKET NO. 17-58 558 DATE: June 29, 2020 ORDER Entitlement to service connection for a major depressive disorder (MDD) is GRANTED. Entitlement to service connection for posttraumatic stress disorder (PTSD) is DENIED. REMANDED Entitlement to service connection for a skin condition is REMANDED. Entitlement to a total disability rating based on individual unemployability (TDIU) is REMANDED. FINDINGS OF FACT 1. The evidence is in relative equipoise as to whether the Veteran’s current major depressive disorder (MDD) was incurred during active duty in the United States Air Force. 2. The weight of the evidence does not establish that the Veteran has a current PTSD disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a major depressive disorder (MDD), and concomitant polysubstance and alcohol abuse disorder, have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2019). 2. The criteria for Entitlement to service connection for PTSD have not been satisfied. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran’s certificate of release from active duty (DD214) reflects that the Veteran served in the United States Air Force from February 1975 to May 1976. The DD214 reflects that the Veteran’s service was “honorable.” In July 2019, the Veteran’s military personnel records (MPRs) were associated with the claims file. After review, the Board observes that the Commander of England Air Force Base, Louisiana recommended discharge in April 1976, because the Veteran did not demonstrate “the desired qualitied demanded of satisfactory airmen, i.e., responsibility, conduct, integrity, duty performance and appearance.” The recommended discharge was due to charges levied under Articles 15, 86, 91, 92 of the Uniform Code of Military Justice. The MPRs reflect that, on May 7, 1976, the honorable discharge of the Veteran was finalized. In July 2019, the Board addressed the four entitlement claims listed on the title page. At that time, the Board remanded the claims to the agency of original jurisdiction (AOJ) for additional development. The Board directed that, “(s)end the Veteran a letter asking him to identify and authorize VA to obtain all private treatment records from the physicians or facilities the Veteran contends treated him for anger management, and notifying him that, in the alternative, he can obtain these records and submit them to VA. Document all efforts and any negative responses. 3. Obtain the Veteran’s medical records from the Atlanta VAMC from October 2017 to the present. 4. ONLY AFTER the above-listed records have been obtained to the extent possible, conduct any other development deemed necessary, to potentially include obtaining new or addendum medical examinations and/or opinions, and readjudicate the claims. In doing so, the RO should consider whether receipt of any additional service personnel records mandates reconsideration of the claims, rather than requiring the submission of new and material evidence.” In August 2019, correspondence from the Veteran’s attorney was associated with the claims file. Therein, counsel relayed that, “the Veteran only treats for his claimed conditions with the Atlanta VA Health Care System. Therefore, a VA Form 21-4142 is not necessary as these records are easily attainable by VA.” In January 2020, correspondence from the Veteran’s attorney was associated with the claims file. Therein, counsel relayed that, “the July 10, 2019 Board of Veterans’ Appeals decision, which remanded the issues of entitlement to service connection . . .. The remaining remand instructions include to obtain outstanding VA treatment records and schedule the Veteran for examination if deemed necessary. At this time, please move forward with the completion of the remaining instructions.” In March 2020, correspondence from the Veteran’s attorney was associated with the claims file. Therein, counsel relayed that, “the Veteran only treats his claimed conditions at the Atlanta VA Medical Center in Decatur, Georgia. Therefore, a VA Form 21-4142 is not necessary as these records are easily attainable by VA.” In April 2020, the Veteran’s treatment records from the Atlanta VA Medical Center were associated with the claims file on multiple occasions. After review, the Board observes that the medical records document the Veteran’s treatment from April 2003 to February 2020. In May 2020, correspondence from the Veteran’s attorney was associated with the claims file. Therein, counsel relayed that, “the July 10, 2019 Board of Veterans’ Appeals decision, which remanded the issues of entitlement to service connection . . .. The remaining remand instructions include to obtain outstanding VA treatment records and schedule the Veteran for examination if deemed necessary. At this time, please move forward with the completion of the remaining instructions.” The Board observes that the agency of original jurisdiction (AOJ) secured the updated treatment records from the only facility identified by the Veteran and his counsel, the Atlanta VA Medical Center. The Board also observes that neither the Veteran nor his attorney have specifically reported treatment after the AOJ secured the medical records in April 2020. Consequently, the Board finds that the AOJ has substantially complied with the July 2019 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial compliance would be required, not strict compliance). Service Connection In general, a service connection claim may be granted for a disability resulting from a disease or injury incurred in, or aggravated by, active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). “To establish a right to compensation for a present disability, a Veteran must show: ‘(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In each case where service connection for any disability is sought, due consideration shall be given to the places, types, and circumstances of such Veteran’s service as shown by such Veteran’s service record, the official history of each organization in which such Veteran served, such Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154 (a). Additionally, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a major depressive disorder (MDD) is granted. In January 2012, the Veteran submitted a VA Form 21-4138. Therein, the Veteran initiated an entitlement claim for service connection for MDD. Again, service connection generally requires a currently diagnosed disability, an in-service incurrence of a condition and/or disability, and a competently identified nexus between the first and second requisite elements. See Holton, 557 F.3d at 1366 (quoting Shedden, 381 F.3d at 1167)). In February 2013, the Veteran submitted a VA Form 21-0781. Therein, the Veteran relayed that, “it started when I ask my roommate to take me to get some chicken off base. On the way back, the M.P.’s stop the car, they check it inside and under the seat they found an empty bag of weed. They charge me for it . . .. We were lock up. Master Sgt (B) made my life hell every day. Taking money every pay day. One day he walk up to me and said I can get out with all my benefits, long as I leave now or I will another way. He lost all of his stripes and I still had mine. (emphasis added)” In December 2014, the Veteran’s military personnel records (MPRs) were associated with the claims file. Therein, in a February 1976 Airmen Performance Report, it was relayed that, “(the Veteran) has been under my supervision and observation for the past six months of duty while assigned to the Parachute Shop. (The Veteran) performs his duties in a satisfactory manner. He has successfully passed his CDC Course and now is in the process of completing his STS and should be ready for upgrade to a five level in the near future. STRENGTHS: (the Veteran) always maintains a calm disposition even during occasional time of stress. His greatest strength is his agreeable personality and his ability to maintain harmonious working relations with his co-workers. His personal appearance, military bearing and behavior has greatly improved during this period.” In December 2014, the Veteran’s service treatment records (STRs) were associated with the claims file. The Board observes that, during the October 1974 enlistment examination, the Veteran did not report “nervous trouble.” Additionally, the military medical examiner did not note any psychological conditions and/or symptoms. However, during the April 1976 separation examination, the Veteran reported “nervous trouble.” The military medical examiner reported that, “(p)atient states he gets nervous when people yell at him.” In September 2016, the Veteran’s affidavit was associated with the claims file. Therein, the Veteran relayed that, “I was issued an Article 15 for having had possession of marijuana and failing to report to a drug test, as I vehemently denied that the marijuana was mine and continue to deny this notion to this day. Upon my refusal to comply with something I was not guilty of, my commanding officers began to severely persecute me as if they had a vendetta against me. I was constantly berated and verbally abused by them and was always subjected to having to complete unnecessary extra duties which no one else in my unit was required to complete. This constant harassment by my superiors, as well as the false accusations by the police led me to not trust authority whatsoever and I also began to have difficulty trusting other people at all. . . . After enduring many threats to my person and enduring the continued abuse by my superiors and clashing with them during this time, I was eventually recommended for discharge and was honorably discharged from the service. (Emphasis added.) Upon returning home from the military, it was immediately noticeable to those around me that I had changed significantly. I do not trust other people and I struggle severely in my ability to maintain effective emotional relationships with other people. I do not let anyone become intimate with me and I feel as though I am emotionally despondent. . . . also continue to struggle with a long history of intense anger. Prior to my traumatic experiences in the Air Force, I was never confrontational and was even commended by the Air Force for my ability to work with others and for my agreeable personality. Since my traumatic experiences, however, I have struggled with becoming immediately confrontational with other people whenever I am provoked, especially in any situation where I feel stressed or frustrated. When provoked, I become quickly enraged and feel out of control. It usually takes me a few hours to calm down and I must immediately extract myself from the situation or else I will have a tremendous outburst. I have a history of threatening people who anger me with physical violence if I am pushed to the point of an outburst and I make it clear that I am to be left alone. I have attended anger management classes at least four times in my life since discharge, however I continue to struggle with my temper. As a result, I remain in isolation so that I may avoid any type of potential problem with other people. . . . Due to my difficulties with anger, I have struggled with alcohol abuse, in order to cope with my symptoms and it has also led to significant depression, as I simply do not leave my home any more to engage in things I used to like to do, such as activities and hobbies I once had. Within my home, I usually watch TV during the day and only move around to eat and bathe myself. If I do leave my home; I only leave to fulfill a routine which involves attending to items that are necessary for my survival, such as groceries or attending medical appointments. When I am out, I stay away from other people and sit in areas where I can be alone. . . . During my working career especially, I had intense interpersonal problems with my co-workers, especially my superiors. I simply do not trust that other people have my best interests in mind and this led to many clashes with them.” In September 2016, a statement from a psychologist was associated with the claims file. After review of the Veteran’s claims file and an interview with the Veteran, the psychologist relayed that, “(t)he veteran has had a long history of substance abuse since discharge, and has carried diagnoses of Depressive Disorder, among others. He stopped working in December 2015 as a self-employed maintenance worker.” The psychologist opined that, “(b)ased on my clinical interview with the veteran and my careful review of the record, I believe he has a Major Depressive Disorder (NOD) and a concomitant Polysubstance and Alcohol Abuse Disorder, both of which are directly related to his MDD. I also believe all three conditions developed in service and together have imposed very severe limitations of social and occupational functioning since at least 2011 and have rendered him unable to secure and follow substantially gainful occupation since at least 2011. In my opinion, the limitations of social and occupational functioning imposed by the veteran’s MIDD, Polysubstance Use Disorder and Alcohol Abuse Disorder are inextricably intertwined, and efforts to separate one from the other are impossible.” The psychologist relayed that, “(h)is longest job was a union cement mason from 1976-1979. ‘No steady job after that. Always tried to get along with everybody. I didn’t want the hear anybody’s problems.’ Presently, he said, ‘I paint, I do plumbing, I do electrical. A lot of people pay me cash.’” The psychologist specifically addressed how the Veteran satisfied the requisite DSM criteria for the diagnosed MDD and concomitant polysubstance and alcohol abuse disorder. Ultimately, the psychologist opined that, “based on my clinical interview with the Veteran and my careful review of the record, I believe he has a Major Depressive Disorder (MDD) and a concomitant Polysubstance and Alcohol Abuse Disorder, both of which are directly related to his MDD . . .. I also believe it is at least as likely as not all three conditions developed in service as evidenced by his documented change in behavior. Per the record, the veteran’s service performance was rated as good until about a year into his enlistment, when he began to act out. These conditions have imposed very severe limitations of social and occupational functioning since at least 2011. In my opinion, the limitations of social and occupational functioning imposed by the veteran’s MDD, Polysubstance Use Disorder and Alcohol Abuse Disorder are inextricably intertwined, and efforts to separate one from the other are impossible.” In February 2017, the Veteran underwent a VA examination that considered the nature and etiology of any non-PTSD mental disorders. The VA examiner reported a diagnosis for moderate alcohol use disorder. The VA examiner noted that, “‘(the Veteran) been through anger management with the VA four times.’ His most recent treatment was in 2009. The claimant has never been prescribed medication or been hospitalized for mental health issues.” The VA examiner relayed that, “the claimant indicates that he feels his current symptoms are due to the military because he ‘got railroaded.’ He is referring to being given the option to leave the military honorably without demotion when he was caught with marijuana.” In November 2017, correspondence from the Veteran’s attorney was associated with the claims file. Therein, counsel posited that, “VA erroneously denied (the Veteran’s) entitlement to service connection for his psychiatric conditions. In its reasons and bases, the SOC indicated that the psychiatric evaluation provided Dr. (JM) was afforded less probative value because it was conducted via teleconference and not in person. The fact that Dr. (JM’s) evaluation was not conducted in person does not diminish the probative value of the examination. While an in-person examination is a factor that may be relevant in some cases . . . . it is not required in every case. Moreover, ‘most of the probative value of a medical opinion comes from its reasoning. . . . Moreover, Dr. (JM) provided a clear, well-reasoned opinion as to whether the Veteran’s current psychiatric condition was related to his service. An opinion of this nature is based on the evidence of record and the symptoms reported by the Veteran. His evaluation was based on a thorough review of the Veteran’s claims file, as well as an interview with the Veteran to evaluate his symptoms. . . . Additionally, Dr. (JM) is an experienced psychologist with over 20 years of experience in the field of psychology. He is therefore exceptionally qualified and competent to render an opinion of this nature.’” The Board agrees with the assertion made by the Veteran’s counsel; the September 2016 psychologist’s report is adequate for this Board analysis and decision. The psychologist reviewed the claims file, interviewed the Veteran, and supplied well-reasoned and thorough analyses and opinions. Consequently, in this instance, the fact that the psychologist’s evaluation report was generated in conjunction with a telephonic interview does not reduce the probative weight of the supplied opinions. Moreover, the Board also agrees with the psychologist’s conclusion on the in-service incurrence of the current MDD disability. The Veteran’s STRs indicate the onset of a nervous condition between the Veteran’s enlistment and separation examinations. The Veteran has also competently relayed that the he endured harassment and threats to his person from a superior after they were both charged for an incident involving marijuana. The Veteran has been competently diagnosed with Major Depressive Disorder (NOD) and a concomitant Polysubstance and Alcohol Abuse Disorder, both of which are directly related to his MDD. As noted above, the Veteran’s STRs (and MPRs) support an in-service incurrence of the current acquired psychiatric disorder. In September 2016, the psychologist’s report identified a definitive nexus between the current disability and the in-service incident(s). Consequently, the Board concludes that all three requisite elements for this direct service-connection claim have been substantiated. See Holton, 557 F.3d at 1366 (quoting Shedden, 381 F.3d at 1167)). Ultimately, the evidence for, and the evidence against the Veteran’s claim is in relative equipoise. Accordingly, this service-connection claim must be granted. In reaching this determination, the Board again acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the Veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); 38 U.S.C. § 5107(b) 2. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. In January 2012, the Veteran submitted a VA Form 21-4138. Therein, the Veteran initiated an entitlement claim for service connection for PTSD. Service connection for PTSD has unique evidentiary requirements. It generally requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a) (i.e., DSM-IV or DSM-5); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304 (f); see also Cohen v. Brown, 10 Vet. App. 128 (1997). The first, cornerstone element for any service-connection analysis is the presence of a current disability. As discussed below, the Board finds that the preponderance of the evidence, to include competent medical evidence, fails to demonstrate that the Veteran endured PTSD during any portion of the claim period. On numerous occasions, the Veteran’s treatment notations from the Atlanta VA Medical Clinic (VAMC) were associated with the claims file. The Board reviewed the October 2012 treatment notations from the Atlanta VAMC. The Veteran’s treatment notations from January, March, and October 2017 were considered. The Board also considered the treatment notations from April 2020. After deliberate review of these medical records, the Board notes that PTSD was addressed in multiple screening reports; however, these records are devoid of a competent PTSD diagnosis that conforms with 38 C.F.R. § 4.125 (a). In February 2013, the Veteran submitted a VA Form 21-0781. Therein, the Veteran relayed that, “it started when I ask my roommate to take me to get some chicken off base. On the way back, the M.P.’s stop the car, they check it inside and under the seat they found an empty bag of weed. They charge me for it . . .. We were lock up. Master Sgt (B) made my life hell every day. Taking money every pay day. One day he walk up to me and said I can get out with all my benefits, long as I leave now or I will another way. He lost all of his stripes and I still had mine. I started not being around people being alone. Even right now I don’t like people because I do not play at all games + lies (). (I went to anger class completed 4 times.)” Again, in September 2016, a statement from a psychologist was associated with the claims file. The psychologist opined that, “based on my clinical interview with the Veteran and my careful review of the record, I believe he has a Major Depressive Disorder (MDD) and a concomitant Polysubstance and Alcohol Abuse Disorder, both of which are directly related to his MDD . . ..” The Board notes that the psychologist did not identify a diagnosis for PTSD. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110 ; see Degmetich, 104 F.3d at 1332. As the medical evidence of record does not demonstrate that the Veteran has a current PTSD disability, the Board must deny the claim for entitlement to service connection. In reaching this conclusion, the Board has considered the Veteran’s statements of record. The Veteran is competent to report his observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). However, he is not competent to diagnose the presence of a current PTSD disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 -77 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428, 433 n.4 (2011). Lay persons are competent to provide opinions on some medical issues. See Kahana, 24 Vet. App. at 435. However, the specific issue in this case, whether the Veteran has a current PTSD disability, falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377 n.4. Ultimately, the Board finds that the preponderance of the evidence stands counter to the Veteran’s entitlement claim for service connection for PTSD. Since the preponderance of the evidence is against this acquired psychiatric claim, the provisions of 38 U.S.C. § 5107 (b), regarding reasonable doubt, are not applicable. The Veteran's claim of entitlement to service connection for PTSD must be denied, because the preponderance of the evidence weighs against his claim. REASONS FOR REMAND Upon review of the record, the Board concludes that further evidentiary development is necessary. A remand is necessary to ensure VA provides the Veteran with appropriate assistance in developing his claim prior to final adjudication. 3. Entitlement to service connection for a skin condition is remanded. In January 2010, the Veteran submitted a VA Form 21-4138. Therein, the Veteran the initiated and entitlement claim for service connection for a skin disorder. In January 2012, the Veteran submitted a VA Form 21-4138. Therein, the Veteran requested to reopen an entitlement claim for service connection for a skin condition. The Board observes that service connection for a skin disorder was originally denied in a June 2010 rating decission. The Veteran did not submit a notice of disagreement with this action. Ordinally, in such circumstances, the June 2010 rating decision would be final, leading to a need for submission of new and material evidence to reopen the claim. However, in July 2019, additional military personnel records were associated with the claims file. Under VA regulations, if VA receives or associates with the claims folder relevant official service department records at any time after a decision is issued on a claim that had not been associated with the claims folder when VA first decided the claim, VA must reconsider the claim. 38 C.F.R. § 3.156 (c). As such, the Veteran’s entitlement claim for a skin disorder is characterized as a service connection claim, not a claim to reopen and, therefore, consideration of new and material evidence is unnecessary. In March 2010, the Veteran’s treatment records from the Atlanta VAMC were associated with the claims file. In October 2009, the Veteran requested evaluation of lesions on his hands and legs, which he relayed as present since service in the Air Force. The VA provider noted the following: “small hyperpigmented lesions to hands with larger 6mm lesion to (right) leg.” The Board observes the treatment notations report that the Veteran was prescribed daily and nightly creams to apply to the skin. In May 2012, the Veteran submitted a VA Form 21-4138. Therein, the Veteran relayed that, “While I was in the Airforce from 02/1975 to 11/1975, I was a parachute rigger. I used to have to wear this nylon equipment that aggravated my skin. I went to the clinic on base and told them about this condition. They saw me there several times. This information should be located in my c-file . . .. I have had to deal with this issue while in the service and since I have gotten out. I have warts all over my body. A new one just appeared on my toe last night. I also have them on my hands and other various areas of my body.” In December 2014, the Veteran’s service treatment records (STRs) were associated with the claims file. After review, the Board observes that, on multiple occasions, the Veteran was seen and treated for warts and rashes on the hands in 1975 and 1976. In February 2017, the Veteran underwent a VA examination that addressed the nature and etiology of any currently endured skin diseases. The VA examiner reported that the Veteran did not have or ever have a skin condition. For medical history, the VA examiner reported that, “warts on hands and feet and other parts of the body. The date of onset of symptoms is unknown. The claimant states the above condition began while on the air force base. The condition has gotten better.” The VA examiner noted that the Veteran had not been treated with oral or topical medications for any skin condition during the preceding 12-month period. The VA examiner remarked that, “(f)or claimed condition of warts on hands and feet and other parts of the body, there is no diagnosis because there is no pathology to render a diagnosis.” Ultimately, the VA examiner opined that, “the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness.” The VA examiner supplied the following rationale: “(n)o diagnosis is given for the claimed condition due to lack of exam findings, x-ray, history, and medical record evidence . . ..” The Board observes that before and after the February 2017 VA examination, the Veteran’s Atlanta VAMC records report skin lesions and/or warts. As the VA examiner’s negative opinion was based on the absence of post-service medical evidence of a skin disorder, the Board finds that it was based on an inaccurate factual premise, which renders the opinion inadequate. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (holding that medical opinions based on incomplete or inaccurate factual premise are not probative). Accordingly, on remand, an addendum opinion regarding the nature and etiology of any skin condition currently endured by the Veteran should be obtained. Barr v. Nicholson, 21 Vet. App. 303, 31 (2007). 4. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. In November 2011, correspondence from the Veteran was associated with the claims file. Therein, the Veteran reported that, “I . . . am having difficulty maintaining a full time job due to my service-connected disabilities.” A TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16 (a). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. Id. If a Veteran fails to meet the threshold minimum percentage standards enunciated in 38 C.F.R. § 4.16 (a), rating boards should refer to the Director of Compensation and Pension Service for extraschedular consideration all cases where the Veteran is unable to secure or follow a substantially gainful occupation by reason of service-connected disability. 38 C.F.R. § 4.16 (b). See also Fanning v. Brown, 4 Vet. App. 225 (1993). In March 2013, the AOJ denied Veteran entitlement to a TDIU. In the October 2017 SOC and April 2020 SSOC, the AOJ continued to deny entitlement to a TDIU. In each instance, the AOJ cited that the Veteran was not currently service connected for any disability. In light of the Board’s decision above, the Veteran is now service connected for an acquired psychiatric disability, MDD. Consequently, the Veteran’s claim for a TDIU must be reconsidered. However, the rating assigned to the Veteran’s service-connected MDD must first be addressed. Again, in September 2016, the psychologist relayed that, “(t)he veteran has had a long history of substance abuse since discharge, and has carried diagnoses of Depressive Disorder, among others. He stopped working in December 2015 as a self-employed maintenance worker.” The psychologist opined that, “(b)ased on my clinical interview with the veteran and my careful review of the record, I believe he has a Major Depressive Disorder (NOD) and a concomitant Polysubstance and Alcohol Abuse Disorder, both of which are directly related to his MDD.” The psychologist also opined that, “the limitations of social and occupational functioning imposed by the veteran’s MDD, Polysubstance Use Disorder and Alcohol Abuse Disorder are inextricably intertwined, and efforts to separate one from the other are impossible. These limitations have resulted in deficiencies in most areas, such as work, family relations and mood, due to such symptoms as nearly constant depression . . ..” The psychologist relayed that, “I believe it is at least as likely as not these limitations of functioning resulting from his psychiatric disorder have rendered him unable to secure and follow substantially gainful occupation since at least 2011.” In February 2017, the Veteran underwent a VA examination that considered the nature and etiology of any non-PTSD mental disorders. The VA examiner reported a diagnosis for moderate alcohol use disorder. The VA examiner identified the following: “occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks . . ..” The VA examiner noted that, “‘(the Veteran) been through anger management with the VA four times.’ His most recent treatment was in 2009. The claimant has never been prescribed medication or been hospitalized for mental health issues.” The VA examiner relayed that, “the claimant indicates that he feels his current symptoms are due to the military because he ‘got railroaded.’ He is referring to being given the option to leave the military honorably without demotion when he was caught with marijuana.” In April 2017, the Veteran submitted a VA Form 21-8940 with an attached statement. The Veteran relayed that, “I am unable to recall the dates my disability affected my full-time employment, when I last worked, or when I became too disabled to work due to my acquired psychiatric disability. To my knowledge, the most I have ever earned in one year is about $8,000. Within the last five years I worked, I was employed at a construction company from around 2013 to 2014 as a carpenter, however, I cannot remember the name of said company. I only worked for about 8-16 hours a week, on a flexible schedule if the outside jobs allowed. It is too difficult for me to recall these specific employment details, or any others, due to my psychiatric condition.” The Board finds that the conflicting opinions and evidence of record must be addressed by the AOJ on remand. First, the following medical evidence is in conflict: the September 2016 psychologist and February 2017 VA examiner identified vastly different levels of occupational and social impairment. On remand, the AOJ must secure a VA examination report that identifies the Veteran’s level of occupational and social impairment caused by the now-service-connected MDD. Second, the lay and medical evidence of record does not definitively identify when the Veteran’s now-service-connected MDD disability prevented substantially gainful employment. The Veteran filed his entitlement claim in November 2011; however, the statement accompanying the April 2017 VA Form 21-8940 suggests that gainful employment was maintained in 2014. Moreover, the private psychologist relays that the Veteran last worked in December 2015. The AOJ must request that the Veteran complete and submit a fully articulated VA Form 21-8940 for the claim for entitlement to TDIU. The Board observes that the Veteran’s TDIU entitlement claim is dependent upon the examination report ordered above for the now-service-connected MDD. If the resultant rating assigned for the now service-connected MDD is not above 60 percent, the AOJ must refer the Veteran’s TDIU claim to the Director of Compensation and Pension Service for extraschedular consideration. Consequently, the matter is REMANDED to the agency of original jurisdiction (AOJ) for the following action: 1. Contact the Veteran, and, with his assistance, identify any outstanding records of pertinent medical treatment from VA, Federal, or private health care providers. With the Veteran’s assistance obtain copies of any pertinent records and add them to the claims file. Follow the procedures for obtaining the records set forth by 38 C.F.R. § 3.159 (c) (2017). If VA attempts to obtain any outstanding records which are unavailable, the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). 2. Schedule the Veteran for a VA examination to determine the nature and etiology of any currently endured skin disorder. The claims file should be made available to, and be reviewed by, the examiner, and it should be confirmed that such records were reviewed. The examiner should: a) Conduct any requisite testing necessary to identify whether the Veteran currently endures a skin disorder. b) For any current skin disorder identified, indicate whether the disability is at least as likely as not (a 50 percent probability or greater) related to the Veteran’s Air Force service. An explanation for all opinions expressed must be provided. All opinions must take into account the Veteran’s own history and contentions. 3. The AOJ should secure the appropriate VA acquired psychiatric examination to ascertain the current severity and manifestations of the Veteran’s service-connected Major Depressive Disorder (MDD). Access to the VBMS and Legacy Content Manager electronic claims files must be made available to the examiner for review. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examination should include a statement about the effect(s) of the Veteran’s service-connected MDD disability on the Veteran’s occupational functioning and daily activities. The VA examiner should provide a complete rationale for any opinions provided. 4. Provide the Veteran with a VA Form 21-8940 and request that he provide all available information regarding his employment history for the period after November 16, 2011. The AOJ should request authorization to obtain employment information from any current and former employers identified by the Veteran. If the Veteran provides sufficient identifying information and the appropriate authorization, the AOJ should attempt to contact current and former employers to obtain information about the conditions of his current and former employment, including wage and hour information. An appropriate period of time should be allowed for response 5. The AOJ must ensure that the examination reports requested above are in compliance with the directives of this remand. If any report or opinion is deficient in any manner, the AOJ must implement corrective procedures at once. 6. Thereafter, the AOJ should consider all of the evidence of record and readjudicate the claims for service connection for a skin disorder and entitlement to a TDIU. If the benefits sought are not granted, the AOJ must then issue a Supplemental Statement of the Case (SSOC) and allow the Veteran and his attorney an opportunity to respond. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board RLBJ, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.