Citation Nr: 21003548 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 19-06 679 DATE: January 21, 2021 ORDER Entitlement to an effective date earlier than December 21, 2017, for the award of service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for right ear and left ear hearing loss is denied. Entitlement to service connection for residuals of a left fifth finger injury is denied. Entitlement to service connection for nose fracture residuals is denied. REMANDED Entitlement to a rating higher than 50 percent for PTSD, from December 21, 2017, to February 12, 2020, and May 9, 2020, to the present, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran submitted an Intent to File a Claim form on December 21, 2017, and within one year he submitted a formal claim for service connection for PTSD. 2. The Veteran did not submit a formal or informal claim for benefits for any psychiatric disorder prior to December 21, 2017. 3. The Veteran is not shown to have a right ear hearing loss disability for VA compensation purposes. 4. A left ear hearing loss was not demonstrated in service, a sensorineural hearing loss was not compensably disabling within one year of the Veteran’s separation from active duty, and the preponderance of the evidence is against finding that a current hearing loss disability is related to the Veteran’s service.  5. A finger fracture was shown on entrance into military service and is not shown to have increased in severity during service, and a left hand fifth finger fracture clearly and unmistakably preexisted service and clearly and unmistakably was not aggravated during service. 6. The Veteran’s nose fracture was shown on entrance into military service and is not shown to have increased in severity during service. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than December 21, 2017, for the award of service connection for PTSD have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.155, 3.158, 3.400. 2. The criteria for service connection for right and left ear hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.385. 3. The criteria for service connection for residuals of a left fifth finger injury have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 1153, 5107; 38 C.F.R. §§ 3.102 , 3.303, 3.304, 3.306. 4. The criteria for service connection for nose fracture residuals have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1987 to January 1992. This case comes to the Board of Veterans’ Appeals (Board) from a June 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office. The Veteran was granted a temporary total evaluation (100 percent) for PTSD from February 13, 2020, to May 8, 2020, due to hospitalization. This constitutes a full grant of the benefit sought for that period, but the stages of December 21, 2017, to February 12, 2020, and May 9, 2020, to the present, remain on appeal. Effective Date for PTSD The Veteran has requested an effective date earlier than December 21, 2017, for the award of service connection for PTSD. The Veteran submitted an Intent to File a Claim on December 21, 2017, and he then submitted a formal claim for service connection for PTSD on January 29, 2018. In a June 2018 rating decision, the Veteran was granted service connection for PTSD, with a 50 percent rating, effective December 21, 2017. The effective date for an award of service connection is the day following separation from active service or date entitlement arose if the claim is received within one year after separation from service; otherwise, it will be the date of receipt of claim, or date entitlement arose, whichever is the later. 38 C.F.R. § 3.400(b)(2)(i). Effective March 24, 2015, a claim for benefits must be submitted on a VA standardized form. See 38 C.F.R. §§ 3.1(p), 3.155, 3.160. There is no evidence indicating that the Veteran submitted a claim of entitlement to service connection for any psychiatric disability within one year of his separation from service, or that he submitted any correspondence expressing an intent to file a claim of entitlement to service connection for a psychiatric disability prior to December 21, 2017. While the Veteran did submit a letter in August 2013 from a mental health counselor which indicated that he had participated in a residential PTSD treatment program, the Board does not find that this constitutes an earlier claim for benefits. The statutory and regulatory provisions in effect at that time required that VA look to all communications from the appellant, which could be interpreted as applications or claims—formal and informal—for benefits. 38 U.S.C. § 5110(b)(3); 38 C.F.R. §§ 3.1(p), 3.155(a) (2013); see Servello v. Derwinski, 3 Vet. App. 196 (1992). There is no indication, however, in any written correspondence from the Veteran, that the August 2013 letter was meant to initiate a claim for service connection for PTSD or any other disorder. VA must liberally construe all documents filed by a claimant. See EF v. Derwinski, 1 Vet. App. 324, 326 (1991). In this case, however, there was no written correspondence from the Veteran relating to this document which expressed a desire to start a claim, and the Veteran has not identified any correspondence which he believes constitutes an earlier claim. VA medical records may be construed to be an informal claim in certain situations, but this provision does not apply to private treatment records or where no claim has yet been filed for any disability. See 38 C.F.R. § 3.157 (2013); see also MacPhee v. Nicholson, 459 F.3d 1323, 1327 (2006) (“a medical examination report will only be considered an informal claim for an increase in disability benefits if service connection has already been established for the disability.”). Furthermore, VA is not required to “conjure up issues that were not raised by the appellant;” claims must be expressed by the appellant either expressly or impliedly. See Brannon v. West, 12 Vet. App. 32, 35. The Veteran has not provided any argument explaining why he believes that an effective date earlier than December 21, 2017 is warranted. He has not asserted that he actually submitted a claim for any disability prior to that date or that a prior claim had been pending. The Board is bound by applicable regulations regarding when an effective date may be assigned. In the absence of any claim, either formal or informal, of entitlement to service connection for PTSD or any other psychiatric disorder prior to December 21, 2017, there is no basis under law to assign an earlier effective date for the award of service connection for PTSD. The claim must be denied. See Sabonis v. Brown, 6 Vet. App. 426 (1994). Hearing Loss The Veteran has applied for service connection for bilateral hearing loss. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F. 3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. A sensorineural hearing loss may be presumed to have been incurred in service if it was compensably disabling within a year of a veteran’s separation from active duty. 38 C.F.R. §§ 3.307, 3.309(a). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. In this case, the Board has reviewed all of the evidence of record, and finds that the preponderance of the evidence indicates that service connection is not warranted. The Veteran attended a VA examination in April 2018. The examiner noted that the Veteran was a Landing Support Specialist in service, which had a high probability for hazardous noise exposure. The Veteran reported that he was exposed to very loud noise in service, including artillery, helicopters, and jets. He stated that since then, he has been around construction noise and some hunting, and was found to have normal hearing. Puretone threshold testing showed the following results, in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 25 25 20 20 25 LEFT 25 25 20 25 25 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 92 percent in the left ear. The Veteran reported that he could hear pretty well most of the time, but that he did have to turn the TV and his cell phone louder. The examiner discussed the Veteran’s hearing tests in service, but found that there was normal hearing for both ears with no significant threshold shifts from 1987 to 1992. She wrote that based on the evidence, it was her opinion that the Veteran’s hearing loss was less likely than not a result of military exposure. The Veteran’s VA treatment records and service treatment records do not show any evidence of a right ear hearing loss that meets the definition of a hearing loss disability under 38 C.F.R. § 3.385. There is no evidence in any of the Veteran’s past medical records that he has ever had, at any time, a hearing loss disability under 38 C.F.R. § 3.385 in his right ear. The Veteran has not indicated that he has ever been diagnosed with hearing loss by any other medical professional, and his VA treatment records show absolutely no complaints or treatment related to hearing loss. In February 2018, he reported that he could hear adequately, and in October 2018, when asked if he had any hearing impairments, he reported that he had tinnitus. In February 2020, he reported having hearing impairment, but that he did not wear hearing aids. In April 2020 he reported that his hearing was within normal limits. Throughout his treatment records, his hearing is noted to be normal. As is evident from the above, the evidence shows that the Veteran has not in the past and does not currently exhibit a right ear hearing loss disability as that term is defined by 38 C.F.R. § 3.385. The April 2018 VA examination shows pure tone thresholds and speech recognition testing results which are not of sufficient severity to be classified as a disability for VA purposes. VA regulations specifically defines the parameters of a hearing loss disability for compensation purposes, and the Veteran does not meet the criteria for establishing a current disability. Id. Congress limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. 38 U.S.C. §§ 1110, 1131. In the absence of proof of present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As the audiometric testing does not reflect a right ear hearing loss disability for VA purposes, service connection for right ear hearing loss is not warranted. Regarding the Veteran’s left ear hearing loss, he has been found to have a hearing loss disability for VA purposes, because he was found to have speech recognition of 92 percent in the left ear. See 38 C.F.R. § 3.385. While the Veteran has a left ear hearing loss disability, the majority of the evidence preponderates against finding that such a disability is related to military service, against finding that a sensorineural hearing loss was manifested to a compensable degree within one year of separation from a period of active duty, and against finding that the appellant has had a chronic disability from the time of his active duty for training to the present.  The Board acknowledges that the Veteran’s DD Form 214 shows that his Primary Specialty was Landing Support Specialist, and the April 2018 VA examiner acknowledged that this indicated that the Veteran would have had hazardous noise exposure in service. The Veteran has also credibly described being around loud noises in service, including artillery and aircraft. Such noise exposure in service, does not, however, establish on its own that the Veteran incurred acoustic trauma which damaged his ears or caused hearing loss. The Veteran’s service treatment records do not show any complaints or treatment for hearing loss. The Veteran had multiple hearing tests in service, none of which show a hearing loss disability or significant changes in hearing loss ability. Prior to entrance into service, a February 1987 audiogram found thresholds of 0 to 15 decibels in both the right and left ears. Just two days after entering service, a November 1987 audiogram found hearing thresholds of -5 to 5 decibels in the left ear and 5 to 25 decibels in the right ear. While there was slight variation in hearing test results after these examinations, there is no indication of worsening threshold shifts, and this was confirmed by the April 2018 VA examiner, who reviewed the treatment records and found no significant threshold shifts indicating hearing damage or hearing loss. The Veteran’s January 1992 separation examination showed hearing levels of -5 to 10 decibels in the right ear and -5 to 15 decibels in the left ear, which actually demonstrates some improvement since the Veteran’s entrance into service. The only medical opinion of record is April 2018 VA examiner’s opinion.  That opinion weighs against the claim.  The Board finds that this medical opinion, which was based on review of the Veteran’s documented and asserted medical history and a comprehensive audiological examination, constitutes probative evidence on the medical nexus question.   See Prejean v. West, 13 Vet. App. 444 (2000). She reviewed the service personnel and treatment records which were available and performed an in-person examination of the Veteran. She discussed the Veteran’s in-service hearing test results and his lay assertions, but found that it was less likely than not that his hearing loss was related to military noise exposure. The Board finds that this medical opinion was fully supported by the evidence of record, and the examiner provided adequate rationale for her findings, including noting the lack of threshold shifts in service and the Veteran’s post-service noise exposure. There are no contradictory opinions of record which came to a different conclusion regarding the Veteran’s hearing loss. The Veteran has not actually submitted any lay statements or argument regarding why he believes his hearing loss is related to service other than his reporting at the April 2018 examination that he was exposed to loud noises in service. The Veteran has not reported having any hearing loss symptoms in service or within one year of service. There is no indication that he was ever found to have hearing loss prior to the 2018 VA examination, nor has the Veteran indicated that he had treatment or complaints of hearing loss prior to this date. The Veteran has not submitted any other medical evidence regarding the etiology of his left ear hearing loss.  To the extent that the Veteran’s claim indicates that he believes his current left ear hearing loss was caused by exposure to noise in service, such lay assertions do not constitute probative medical evidence.  The Veteran is competent to describe events that occurred during military service and any symptomatology regarding his perceived hearing loss, but as a lay person, he is not competent to provide a medical diagnosis of hearing loss, as such requires medical testing, or to determine the etiology of his current hearing loss.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  Hearing loss can have many causes, and whether the loud noises the Veteran was exposed to in service are in any way related to his current hearing loss disability requires medical expertise to determine.  See Clyburn v. West, 12 Vet. App. 296, 301 (1999).  The Veteran’s assertions are outweighed by the findings of April 2018 VA examiner.  There is also no basis to grant service connection for left ear hearing loss on a presumptive basis, as there is no evidence that a sensorineural hearing loss was manifested to a compensable degree within one year of discharge from a period of active duty.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The preponderance of the evidence is also against finding a chronic condition or chronicity of adequate symptomatology as would allow for a grant of service connection under 38 C.F.R. § 3.303(b).   See Walker v. Shinseki, 708 F.3d 1331, 1336 (Fed. Cir. 2013).  The Veteran has not asserted that he experienced hearing loss in service or had a continuity of hearing loss symptoms from the time of service to the present, and there is no medical evidence indicating that he had a continuity of symptomatology since service.  See 38 C.F.R. § 3.303(b).  For the foregoing reasons, the Board finds that the evidence demonstrates that the Veteran’s right ear hearing ability has not at any time been shown to meet the criteria for a hearing loss disability for VA purposes, and the preponderance of the evidence is against finding that the Veteran’s left ear hearing loss is related to service, that it had its onset during a period of active service, or that it has manifested with a continuity of symptomatology since service. The claim for service connection is therefore denied. In reaching this decision the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the appellant’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Left Fifth Finger The Veteran has requested service connection for residuals of a left hand fifth finger (pinky finger) fracture. The Veteran’s February 1987 enlistment examination did not find a current finger disability, but on the February 1987 Report of Medical History, the Veteran checked “yes” for broken bones. The examining physician then wrote that there was a fractured finger with no medical help sought. The January 1992 separation examination noted a history of broken nose and left pinky finger. There are no other service treatment records indicating any complaint or treatment for a left pinky finger injury. Cases in which the condition is noted on entrance to service are governed by the presumption of aggravation contained in 38 U.S.C. § 1153. This statute provides that a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless clear and unmistakable evidence shows that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. §§ 3.304, 3.306(b). A preexisting disease or injury will be presumed to have been aggravated by service only if the evidence shows that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. See Davis v. Principi, 276 F.3d 1341, 1345; 38 C.F.R. § 3.306(a). When a disability is not “noted” at entrance to service, VA must show by clear and unmistakable evidence that the disability preexisted service, and if so, whether it clearly and unmistakably was not aggravated during service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). The Veteran attended a VA examination in March 2018. The examiner noted that the Veteran had previously had a fracture of the left hand fifth digit which was reported at enlistment. She wrote that the Veteran recalled injuring his hand when he was angry at a Sergeant and punched the headlight of a truck. The Veteran stated that this broke his finger and caused several cuts on his left hand. The Veteran also reported that over the years since service, he had many different jobs that required physical labor, and did not notice any problems with his pinky dinger. He also said that he had fractured his fingers, including the left pinky finger, while playing basketball after service. The examiner wrote that the Veteran’s service treatment records listed a fractured finger on enlistment, and that the medical notes during active duty service were silent for injury to the left hand. She also wrote that the Veteran was right-handed, and it was more likely that if he did hit a headlight, it would have been with his right hand. Range of motion testing was normal, and there were no other abnormalities found in the pinky finger. The examiner found that the condition of residuals of a left pinky finger fracture were less likely than not incurred in or caused by service. She explained that the active duty medical records were silent for fracture of the left hand, but enlistment was positive for a history of a fractured finger. There are no other medical opinions of record pertaining to the Veteran’s left hand pinky finger fracture, and the Veteran has not provided any other explanation or argument of why he believes that his left fifth finger should be service connected. Based on the evidence of record, the Board finds that the Veteran’s left fifth finger fracture was noted on entrance into service. The disorder therefore preexisted the Veteran’s service, and there is a total lack of any complaints or treatment for this disorder during service. Additionally, there were no findings of any problems with the Veteran’s finger at separation from service or even in the years following service. The March 2018 VA examination found no abnormalities in the finger at all, and the Veteran reported having many physical jobs with no problems from his finger. While the VA examiner did not use the language of whether the condition was “aggravated” by service, her findings are more than sufficient to the Board in order to apply the appropriate regulatory standard. It is very clear to the Board that this condition, which preexisted service, did not undergo any increase in severity, and therefore was not aggravated by service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Even if the Veteran were to argue that his left fifth finger fracture was not noted on entry into service, because the February 1987 Report of Medical History notes only a fractured finger, without specifying which finger, the Board finds that even under the regulations of 38 U.S.C. § 1111, service connection is not warranted. A prior finger fracture was noted in 1987, and the Veteran’s 1992 separation examination noted a broken left pinky finger, which clearly is referring to the same finger fracture as that noted in 1987, as the Veteran had no other finger fractures in service. While the VA examiner did not address the question of whether a finger fracture which preexisted service was clearly and unmistakably not aggravated by service, the Board finds that the evidence is overwhelming that it was not. The Veteran had no problems with his finger in service, he reported no problems with his finger in the years after service, and no disability was found at the 2018 VA examination. In the absence of any disability whatsoever, it is clear to the Board that the condition clearly and unmistakably was not aggravated by service. In sum, the evidence overwhelmingly shows that the Veteran had a finger fracture that was noted on entrance into service, and this finger fracture and clearly and unmistakably his left fifth finger. The evidence also shows that this condition did not undergo any increase in severity in service, and it clearly and unmistakably was not aggravated by service. The claim for service connection for left fifth finger fracture residuals is denied. The Board has again considered the doctrine of reasonable doubt, but the preponderance of the evidence is against the claim. Gilbert, 1 Vet. App. 49. Nose Fracture Residuals The Veteran has also requested service connection for nose fracture residuals. The Veteran’s service treatment records show that he marked “yes” for broken bones on the February 1987 Report of Medical History. The physician then wrote that the Veteran had a fractured nose in 1984, that he did not see a doctor, and that he denied sequelae. The Veteran attended a VA examination in March 2018. He stated that he did not recall how his nose was fractured, but that it was now hard to breathe out of the left side and that his nose felt stuffy. He reported that he had been seen at a VA clinic years ago, but never went forward with seeing a specialist. He reported that over the years he has fractured his nose about 6 or 7 times, and that he believes his happened once in the military, but could not recall the other times. The examiner wrote that the service treatment records showed a history of nose fracture in 1984 and were silent for any treatment for a nose fracture during active duty. She wrote that the Veteran was seen at a VA clinic for a history of fractured nose and difficulty breathing in February 1999. The examiner concluded that the condition was less likely than not incurred in or caused by service. She explained that the enlistment records were positive for a history of nasal fracture in 1984, 3 years prior to active duty, and the Veteran could not actually recall any specifics regarding a nasal fracture in service. She wrote that the earliest reports of problems with a plugged nose related to nasal fracture were from 1999, from a break that occurred in 1995. There are no other medical opinions of record pertaining to the Veteran’s nose fracture residuals, and he has not provided any lay statements, explanation, or argument regarding how this injury occurred or why he believes that that service connection is warranted. Based on the evidence of record, the Board finds that the Veteran’s nasal fracture was noted on entrance into service. The disorder therefore preexisted the Veteran’s service. There is no indication that this preexisting fracture caused any symptoms while the Veteran was in service. The service treatment records show no complaints or treatment for this disorder during service, and there were no findings of any current problems with the Veteran’s nose at separation from service. The earliest record of any further complaints related to a broken nose are from 1999, during which the Veteran reported that the problems stemmed from a broken nose in 1995, which is after the Veteran’s active duty service period. While the March 2018 VA examiner did not use the correct language when discussing whether a disorder noted at entrance into service was aggravated by service, it is clear to the Board that she did find that the condition did not undergo any increase in severity during service. The March 2018 medical opinion, read in its entirety, reflects that the examiner considered all of the evidence of record and found that it was noted on entrance into service and no further symptoms or disability occurred throughout the Veteran’s service. See, e.g., Kittrell v. Shinseki, No. 08-3001, 2010 WL 4671873 (Vet. App. Nov. 10, 2010) (“a physician’s choice of language is not error where, as here, his opinion is unambiguous and sufficient to comply substantially with the purpose for which it was sought.); See also Chavez v. McDonald, No. 13-2886, 2014 (an opinion may be adequate even if not specifically stating that a disability was “not aggravated” if when read as a whole it encompasses aggravation (citing Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012)). The Board therefore finds that the evidence overwhelmingly shows that the Veteran had a nose fracture that was noted on entrance into service, and this condition did not undergo any increase in severity in service. This preexisting disorder therefore was not aggravated by service, and the claim for service connection for nose fracture residuals is denied. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. The Board has considered the doctrine of reasonable doubt, but the preponderance of the evidence is against the claim. Gilbert, 1 Vet. App. 49. REASONS FOR REMAND PTSD The Veteran requests an initial rating higher than 50 percent for PTSD. In June 2020, the Veteran requested a temporary total evaluation due to hospitalization. His VA treatment records show that he was hospitalized from February 13, 2020, to May 8, 2020, and he has been assigned a temporary total evaluation for this period. The Veteran submitted a statement in May 2019 discussing how his PTSD has caused him to socially isolate, that he has problems with anger management, that he has panic attacks at least four times a week, and that he has memory loss and feels paranoid all of the time. The Veteran and his attorney have also submitted several briefs arguing that he has been experiencing additional symptomatology which would meet the criteria for a 70 percent rating, including angry outbursts, reckless or self-destructive behavior, and unprovoked violence. They also wrote that the Veteran had two past suicide attempts and continued suicidal ideation which was not properly acknowledged by the VA examiner. The Board finds that the Veteran’s hospitalization, at which he did report having recent suicidal thoughts and reckless behavior, and the statements from the Veteran and his attorney do indicate that the Veteran has symptomatology which is more severe than was shown on the February 2019 VA examination. The Board therefore remands this issue so that the Veteran can be afforded a new VA examination to address his current symptomatology and the severity of his disorder since service connection was granted, from December 21, 2017. TDIU The Veteran has also claimed entitlement to a TDIU.  A decision on this issue is deferred until the claim for an increased rating has been developed and adjudicated. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).  The matters are REMANDED for the following action: 1. Obtain all VA treatment records since May 2020. 2. Schedule the Veteran for an examination with a psychiatrist or psychologist, to address the severity of his service-connected PTSD.  The examination may be held via telehealth during social distancing restrictions.  The examiner must be provided access to the Veteran’s entire claims file and must specify in the report that the claims file has been reviewed.   The examiner should discuss all of the Veteran’s reported symptomatology, both currently and for the entire period since December 21, 2017. The examiner should consider the Veteran’s reports of having suicidal thoughts, sometimes with intent, past suicidal attempts, angry outbursts, violent behavior, and frequent panic attacks. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary E. Rude, 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.