Citation Nr: 21002433 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 18-50 089A DATE: January 13, 2021 REMANDED Entitlement to a change in the Veteran’s Individualized Written Rehabilitation Plan (IWRP) under Chapter 31, Title 38, United States Code (Chapter 31), to include pursuit of a Doctor of Medicine (M.D.) degree, is remanded. The issue of whether discontinuance of the Veteran’s Vocational Rehabilitation and Employment (VR&E) services under Chapter 31 was proper, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from November 2004 to November 2008. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from July 2018 and October 2018 determinations by the VR&E division of the Department of Veterans Affairs (VA) Regional Office in St. Louis, Missouri. 1. Entitlement to a change in the Veteran's IWRP under Chapter 31, to include pursuit of a M.D. degree, is remanded. At issue in this appeal is the Veteran’s wish to change her rehabilitation plan. The objective of a 2015 Rehabilitation Plan was to obtain a degree in Biomedical Engineering. In May 2018, she was accepted into the St. Louis University program for Electrical and Computer Engineering. Her vocational rehabilitation counselor (VRC) approved an entitlement extension and the cost of St. Louis University so the Veteran could finish her degree. In doing so, the VRC drafted a proposed IWRP in June 2018 with a goal of obtaining a degree in the field of engineering. The Veteran objected to the VRC’s rehabilitation goal and indicated that she wished to change the objective to obtain employment as a medical doctor. See June 2018 correspondence; June 2018 proposed IWRP. She asserted that her then-current disabilities prevented her from working within the fields in which she was qualified. Id. She contended that working as a medical doctor would not impact her disabilities and was in line with her aptitudes, abilities, and interests. Id. The purpose of VA’s rehabilitation program is to provide services and assistance necessary to enable Veterans with service-connected disabilities to achieve independence in daily living and, to the extent possible, become employable and obtain and maintain suitable employment. 38 U.S.C. § 3101; 38 C.F.R. § 21.70. As directed by 38 U.S.C. § 3106(e), in determining whether the achievement of a vocational goal currently is reasonably feasible, the Secretary shall resolve any reasonable doubt in favor of determining that such achievement is reasonably feasible. Critical here, “[a] change in the statement of a long-range goal may only be made following a reevaluation of the Veteran’s rehabilitation program by the [counseling psychologist] or [VRC].” 38 C.F.R. § 21.94(b). The Veteran’s interests and capabilities must be considered when determining “suitable employment.” See, e.g., 38 C.F.R. § 21.50(c). In the instant case, it appears that the Veteran’s rehabilitation program was not reevaluated in the manner contemplated by the regulation following her request for a long-term goal change. Here, following that request, the Veteran’s VRC made the decision to refer her case to a VR&E panel. The panel determined that she was not progressing and therefore found it was not reasonably feasible for her to successfully complete a training program or obtain and maintain suitable employment until she was able to process her posttraumatic stress disorder trauma and develop appropriate coping mechanisms. As such, the decision was made to interrupt and subsequently discontinue her program. In making their determination, it does not appear that the panel evaluated the merits of her request to change the objective of her program to obtain employment as a medical doctor. The Board acknowledges that in November 2018, the Veteran’s private therapist wrote in support of her appeal, noting that she had the intellectual capacity to be trained and to engage in work activities of some kind. Likewise, in July 2019, the Veteran’s former professor wrote that the Veteran had the academic ability to complete a pre-med undergraduate degree. However, these individuals are not the “counseling psychologist” or the VRC as required by § 21.94(b). In view of the foregoing, the Board finds that the Veteran’s program was not fully reevaluated following the proposed change in the statement of her long-term goal, as contemplated by § 21.94(b). No final decision can be made as to whether the achievement of her proposed long-range goal is reasonably feasible until such an evaluation is conducted. 2. The propriety of the discontinuance of the Veteran's VR&E services under Chapter 31 is remanded. The Veteran also challenges a determination by the VR&E office to interrupt and subsequently discontinue her vocational rehabilitation program. Discretion for changing the Veteran’s case status is left to the case manager, subject to certain restrictions and duties. 38 C.F.R. § 21.180(b), (c). The Veteran’s argument essentially amounts to a disagreement with her case being placed in “discontinued” status. 38 C.F.R. § 21.198. As noted above, the VR&E panel determined that she was not progressing and therefore found it was not reasonably feasible for her to successfully complete a training program or obtain and maintain suitable employment until she was able to process her PTSD trauma and develop appropriate coping mechanisms. As such, the decision was made to interrupt and subsequently discontinue her program. Here, the Board notes that following the above-noted November 2018 private therapist letter, the VRC indicated that the Vet appeared to have improved/stabilized her condition. However, prior to continuing her program, a feasibility determination needed to be made. As such, the Board finds this issue is inextricably intertwined with the issue of the change in the Veteran’s IWRP, as the vocational rehabilitation program was interrupted and ultimately discontinued because she was not making progress in the program and it was infeasible to continue. A favorable resolution of the issue of change in the Veteran’s IWRP may render the issue of program discontinuance moot. 38 C.F.R. § 21.198(c); Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined when a decision on one issue would have a significant impact on another issue). As such, this issue is likewise remanded. These matters are REMANDED for the following action: 1. Ensure the entire vocational rehabilitation and employment folder has been scanned and associated with the electronic claims file. 2. Obtain copies of records pertaining to any relevant VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 3. After the foregoing development has been completed to the extent possible, arrange for the Veteran to be afforded vocational rehabilitation and functional capacity evaluations that ascertain the current limitations caused by her service-connected disabilities and their effect on her ability to perform in both her current occupational field and the occupational fields she desires. Specific attention should be given to the areas of the practice of medicine as a medical doctor and a career as an engineer. The evaluations should specifically consider the training and professional requirements of the designated specialties. It is noted that the Veteran is service connected for PTSD, rated as 70 percent disabling; migraine headaches, rated as 30 percent disabling; thoracolumbar strain, rated as 20 percent disabling; left wrist carpal tunnel syndrome, rated as 20 percent disabling; right lower extremity sciatic nerve radiculopathy and femoral nerve radiculopathy, each rated as 20 percent disabling; tinnitus, rated as 10 percent disabling; left wrist tenosynovitis, rated as 10 percent disabling; left hip strain, rated as 10 percent disabling; left knee strain, rated as 10 percent disabling; right knee meniscal tear, rated as 10 percent disabling; left lower extremity sciatic nerve radiculopathy, rated as 10 percent disabling; GERD, rated as 10 percent disabling; and cystic acne, left hip strain (limitation of extension), left hip strain (impairment of thigh), right knee scars, and left thumb wart, each rated as noncompensable. The evaluation should include: (a.) Any clinically indicated medical examinations and testing for the service-connected disabilities; and (b.) Evaluation by an appropriate vocational rehabilitation counselor to determine: 1. Whether the achievement of employment by the Veteran pursuant to her current education, work experience, and transferable skills are reasonably feasible under 38 C.F.R. § 21.53; and 2. Whether the Veteran’s requested change of the vocational rehabilitation education and employment goal to positions requiring a medical degree is warranted in accord with 38 C.F.R. § 21.94. The evaluation should specifically address whether the Veteran’s aptitudes and abilities are consistent with both her current education and transferrable skills and the degree requirements and skills of her proposed career and educational changes. A thorough rationale for all opinions afforded, considering all of the evidence of record, would be of significant assistance to the Board. 4. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and her representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Kettler, 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.