Citation Nr: 21065716 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 15-08 457 DATE: October 27, 2021 REMANDED Entitlement to an initial compensable rating prior to July 25, 2019, to a rating greater than 10 percent before July 15, 2021, and a rating greater than 70 percent thereafter, for residuals of traumatic brain injury is remanded. REASONS FOR REMAND The Veteran served in the United States Army from July 2003 to November 2005. This case has an extensive procedural history. Most recently, the Veteran's claim was remanded by the Board in June 2021. This appeal is in VA's legacy appeals system and has been advanced on the docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. § 7107. Although the Board sincerely regrets the additional delay, a remand is again necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Board has remanded this matter four times in an attempt to obtain, if possible, a list of which of the Veteran's symptoms are caused by his TBI and which are caused by his PTSD. This information is essential to rating each of the Veteran's service-connected conditions under the appropriate diagnostic codes without violating the prohibition against pyramiding found in 38 C.F.R. § 4.14. The record now contains VA opinions on this matter from February 2013, July 2019, December 2019, January 2020, February 2020, October 2020, March 2021, and July 2021. They contain multiple mismatched lists of which symptoms should be attributed to which condition. None of the opinions addresses the lists in the other opinions. The February 2013 examiner opined that it is not possible to estimate the degree to which each of these symptoms is attributable to each condition without resorting to mere speculation, and one of the July 2021 examiners stated that "[w]hether or not [the Veteran's] current symptoms are directly caused by the TBI or due to the psychological trauma and resultant PTSD stemming from the incident is beyond my area of expertise to differentiate." Only the January 2020 examiner provided a well-reasoned rationale in support of the opinion that the Veteran's TBI had resolved, but then they did not discuss specific psychiatric symptoms or the fact that the Veteran's service-connected migraines, caused by his TBI, had clearly not resolved. The remaining examiners provided lists with no supporting rationale. A remand is required to obtain an opinion that considers the conflicting medical opinions of record and provides a well-reasoned rationale explaining whether, and to what extent, the Veteran has residual symptoms of TBI that are not better assessed as part of his PTSD or migraine conditions. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate medical professional regarding the symptoms and severity of the Veteran's service-connected TBI. Only if the required opinions cannot be provided based on the evidence of record, schedule the Veteran for an appropriate examination. The examiner should answer the following questions: (a.) Is it possible to differentiate what symptoms are attributable to the Veteran's TBI and what symptoms are attributable to his PTSD? (b.) If the answer to (a.) is "no:" a. Is this because of a lack of knowledge or expertise among the medical community at large, or because of insufficient information, unprocured testing, or a lack of expertise on the part of the examiner? (c.) If the answer to (a.) is "yes:" a. Which symptoms, if any, are attributable to TBI? b. Which symptoms, if any, are attributable to PTSD? As it is impossible to provide an opinion on the above questions without disagreeing with at least one of the previously obtained VA opinions, the examiner must explain how they reached each answer provided above and explain why they disagree with any previous VA opinion or opinions that reached a different conclusion. Previous relevant VA opinions are contained in disability benefit questionnaires for TBI and PTSD from the following examiners: (d.) G. Ott. Psy.D. (February 2013) (e.) C. Masters, M.D., M.B.A. (July 2019) (f.) B. Palermo, Psy.D. (July 2019) (g.) R. Baptiste-Boles, Psy.D. (December 2019) (h.) P. Bharatkumar, M.D. (January 2020) (i.) M. Ayala-Feliciano, Psy.D. (February 2020) (j.) E. Oben-Cuadros, Psy.D. (October 2020) (k.) R. Frank, M.D. (March 2021) (l.) R. Friend, M.D. (July 2021) (m.) J. Cohen, Ph.D. (July 2021) 2. Only if the answer to question (b.) a. above indicates that an opinion cannot be provided because of insufficient information, unprocured testing, or lack of knowledge or expertise on the part of the examiner: (a.) attempt to obtain the required information and document the file accordingly; (b.) provide the necessary testing, and; (c.) obtain the opinions required in 1. from a qualified examiner. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If any benefit sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zimmerman, Micah 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.