Citation Nr: 21070542 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 18-10 629 DATE: November 24, 2021 REMANDED Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating due to individual unemployability due to service-connected disabilities (TDIU) is remanded. REFERRED The issue of service connection for acute myeloid leukemia was raised in a September 2020 WVU Cancer Institute note submitted by the Veteran's attorney and reflecting that the diagnosis in August 2020, as well as the physician's opinion that it is likely related to the Veteran's 'reported military service.' This is referred to the Agency of Original Jurisdiction (AOJ) for any action deemed appropriate. REASONS FOR REMAND The Veteran served on active duty in the Navy from March 1975 to March 1979. He appeals a December 2015 rating decision. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a May 2021 Board hearing. The VLJ identified these as the issues on appeal; clarified the concept of increased rating and TDIU claims; identified potential evidentiary defects; clarified the type of evidence that would support the Veteran's claims and inquired as to the existence of potential outstanding records. The undersigned also noted that the Veteran and his attorney were awaiting fulfillment of a privacy act request for a complete copy of the claims folder and granted the request to hold the record open for 60 days. Thus, the actions of the VLJ comply with 38 C.F.R. § 3.103. The copy of the claims folder was provided and the agreed upon period of time to submit additional evidence has expired. Entitlement to a rating in excess of 50 percent for PTSD and TDIU are remanded. The Veteran asserts that his PTSD is more severe than contemplated by a 50 percent rating. Additionally, the Veteran seeks a TDIU due to the combined effects of his service-connected disabilities of PTSD, hearing loss and tinnitus. The Veteran testified before the undersigned in May 2021 that his PTSD is worse than indicated in the December 2015 VA PTSD examination. That examination noted occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. In May 2021, he described significant irritability and feeling threatened and overrun, all of which impact his ability to work. He described losing his temper on the road. He noted that while he has raised his grandson and has a stable relationship with his wife, who performs most of the family's daily tasks, he does not have any friends or anyone else in his life. He reports that he does not take being criticized well and does not want to get into fights with people due to his PTSD-related anger problems. Although he is not actively in talk therapy, he is still taking medication to control his PTSD symptoms to include Trazodone and Hydroxyzine. The last person VA sent him to was a pharmacist, so he did not continue to pursue therapy. He has mostly stopped abusing substances and has stopped drinking, which he now realizes he used to help him with PTSD symptoms, but still has severe symptoms of PTSD. He does not go out to eat when his grandson and his wife go and does not go on family vacations, but he will go to remote areas. He avoids people due to PTSD. He also explained at the hearing that although he does have other medical problems to include problems with his eyes and now the leukemia, he thinks his PTSD and hearing related issues together cause him to be unable to work. He further testified that service-connected hearing loss disability has recently worsened and that this itself has a substantial occupational impact. He has not been able to get evaluated for the hearing loss at VA. He reported that he cannot understand what his wife is saying, and he has trouble talking to people on the phone. Here, we note that the Veteran last underwent evaluation to determine the severity of his service-connected hearing loss disability in November 2015. As to the TDIU claim, the Veteran has a combined rating of 60 percent, with PTSD rated 50 percent, and hearing loss and tinnitus each rated 10 percent. The fact that a VA examination is considered "stale" is not a valid basis, unto itself, to provide the Veteran with another VA examination. See Palczewski v. Nicholson, 21 Vet. App. 174, 181-83 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); VAOPGCPREC 11-95 (1995). However, given the recent suggestion of possible worsening as to PTSD in the Veteran's not inherently incredible testimony, a new examination is necessary. See Snuffer, 10 Vet. App. at 403. As to the TDIU claim, his not inherently incredible testimony that his service-connected hearing loss disability has worsened warrants further development as well. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected PTSD. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 2. Conduct any additional development needed to adjudicate the issue of entitlement to TDIU, to include scheduling the Veteran for a VA examination to ascertain the current severity of his service-connected hearing loss disability. The AOJ should also address whether extraschedular referral is warranted. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Rippel, 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.