Citation Nr: 21064074 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 15-05 763 DATE: October 19, 2021 REMANDED The claim of entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. The claim of entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service with the United States Navy from August 1972 to October 1973. The instant matter is on appeal from a September 2011 rating decision. The Board previously remanded this issue in September 2020 for additional evidentiary development, to include obtaining an updated VA examination. 1. The claim of entitlement to a rating in excess of 50 percent for PTSD is remanded. The Board regrets the additional delay, but remand is again necessary in order to obtain a medical opinion more adequately assessing the severity of the Veteran's PTSD throughout the period on appeal. To note, this claim commenced in May 2011. A VA examination in September 2011 documented only a diagnosis of PTSD with overall occupational and social impairment with reduced reliability and productivity. The only symptoms reported were depressed mood and anxiety. Subsequent VA treatment records, however, reflect a history of anger issues, as well as involvement with a court and mandated community service. Individual and couples' therapy noted problems with treatment compliance and personality issues. In August 2012, the Veteran suffered a seizure from serotonin syndrome after taking too many Tramadol in a manic episode. He continued to experience angry outbursts at that time, and the manic response may have been associated with his antidepressants at that time. Clinicians diagnosed the Veteran with bipolar disorder "swinging into depression", alcohol abuse, past drug abuse, and a possible personality disorder. Other treatment records reflect a diagnosis of an anxiety disorder. The March 2021 VA examination, however, fails to comment on this much more significant history. Only a diagnosis of PTSD was rendered without addressing the previous diagnoses of bipolar disorder, depression, and an anxiety disorder. Similarly, there is no discussion of the potential manic episode in August 2012 that may have caused an overdose. Thus, remand is again necessary in order to obtain a more thorough medical opinion that addresses these significant mental health symptoms. 2. The claim of entitlement to a TDIU is remanded. As entitlement to TDIU has been previously raised, the Board finds that this issue is inextricably intertwined with the resolution of the remanded issue. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to defer the claim on appeal pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, this issue is remanded for readjudication following evidentiary development. The matters are REMANDED for the following action: 1. Obtain any relevant, outstanding VA treatment records that are not already associated with the claims file, to include any mental health treatment records from the Vet Center or other VA-affiliated facilities. If no records are available, the claims folder must indicate this fact and the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). All attempts to contact the Veteran should be documented in the record. 2. Contact the Veteran and the representative of record in order to identify any outstanding non-VA treatment records regarding the issues on appeal. If non-VA providers are identified, obtain releases for those records. Make all reasonable attempts to obtain the non-VA treatment records and associate them with the claims file. If such records cannot be obtained, inform the Veteran, and afford an opportunity to provide these outstanding records. 3. After the aforementioned evidentiary development is complete, obtain a medical opinion to assess the present nature and severity of the Veteran's PTSD. A new examination may be ordered if deemed necessary and may be conducted via telehealth or other electronic means if practicable. A complete copy of the claims file must be made available to the examiner. After a thorough review of the medical and lay evidence of record, the examiner should discuss the following: (a.) Any and all mental health diagnoses since May 2011. (b.) For each diagnosis, indicate whether is related to, or an extension of, the Veteran's service-connected PTSD, and if the symptoms may be differentiated. (c.) For each identified diagnosis, discuss the present severity of the disability, including any occupational impairment caused by the condition. (d.) If possible, provide a retrospective opinion of its severity since May 2011. The examiner should also provide an assessment of the Veteran's occupational impairment in this period of time. (e.) The examiner is specifically asked to discuss the Veteran's history of anger outbursts, potential manic episode in August 2012, and legal entanglements. (f.) To note: the examiner is asked to differentiate any distinct periods of time in which the overall severity of the service-connected disability waxed or waned with approximate dates of any such periods. The examination report should specifically state that a review of the record was conducted. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. (Continued on the next page) 4. Following completion of the foregoing, the AOJ should review the record and readjudicate the claims on appeal. If any remain denied, the AOJ should issue an appropriate supplemental SOC, afford the Veteran an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Fisher, 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.