Citation Nr: 21073878 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 15-03 693A DATE: December 13, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1970 to April 1972. He also had additional service in the Tennessee Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision. The Veteran testified at a hearing before the undersigned Veterans Law Judge in June 2018. A transcript is of record In August 2018, the Board remanded the case for further development. The case has since been returned to the Board for appellate review. In May 2021, the Veteran submitted a correspondence that may reasonably be construed as a motion for advancement on the docket. In this regard, the Veteran requested a decision in his appeal "as soon as possible," and he reported that he was diagnosed with stage 4 lung cancer, kidney disease, and congestive heart failure. The Veteran's VA medical records document that he has recently received treatment for chronic kidney disease, heart failure, and stage 4 lung cancer. The Board finds that this is good or sufficient cause to advance the case on the docket due to serious illness. Thus, the motion is granted pursuant to 38 C.F.R. § 20.902(c). 38 U.S.C. § 7107(b). Upon review, the Board finds that a remand is needed prior to final adjudication of the Veteran's claims. The Veteran was afforded a VA examination in November 2019 during which the examiner diagnosed him with PTSD and a neurocognitive disorder. The examiner opined that the Veteran's PTSD was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. However, the examiner based her opinion on reported stressors related to service in the Republic of Vietnam that have not been verified. The Veteran has also reported that he has an acquired psychiatric disorder that is related to performing his military duties as a medical specialist and ambulance driver while he was stationed in Germany. The Veteran's service personnel records reflect that he was stationed in Germany in 1971 and that his principal duty was ambulance driver. His DD Form 214 also confirms that his military occupational specialty (MOS) was medical specialist. During the June 2018 hearing, the Veteran's representative stated that the Veteran's psychiatric symptoms included memory loss. See June 2018 Board hearing transcript, at 15. The November 2019 VA examiner indicated that it was not possible to differentiate the symptoms attributable to the Veteran's diagnosed mental health disorders, including his symptoms of impaired memory. However, in rendering her opinion, the examiner did not address the service treatment records that noted the Veteran experienced episodes of amnesia, as directed by the Board in August 2018. Stegall v. West, 11 Vet. App. 268, 271 (1998). Based on the foregoing, the Board finds that a remand is necessary to obtain an additional VA medical opinion. The Board also finds that the issue of entitlement to TDIU is inextricably intertwined with the Veteran's claim for service connection for an acquired psychiatric disorder. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that two issues are inextricably intertwined when the adjudication of one issue could have significant impact on the other issue). The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for an acquired psychiatric disorder. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. After completing the foregoing development, the AOJ should refer the Veteran's claims file to a suitably qualified VA examiner for an opinion regarding any current acquired psychiatric disorder. A physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner is advised that the Veteran contends that he has an acquired psychiatric disorder that is related to witnessing traumatic incidents while performing his duties as a medical specialist and ambulance driver in Germany. VA medical personnel have diagnosed the Veteran with PTSD due to in-service stressors related to service in the Republic of Vietnam. However, at the time of this remand, this alleged stressor has not been verified. The examiner should identify all current psychiatric disorders, to include any depression, PTSD, and/or a neurocognitive disorder. If any previously diagnosed psychiatric disorders are not found, the examiner should address whether they were misdiagnosed or have resolved. For each diagnosis identified other than PTSD, the examiner should provide an opinion as to whether it is at least as likely as not that the disorder manifested in or is otherwise causally or etiologically related to the Veteran's military service, to include any symptomatology therein. Regarding PTSD, the AOJ should provide the examiner with a summary of any verified in-service stressors, and the examiner must be instructed that only these events and any stressors related to fear of hostile military or terrorist activity may be considered for the purpose of determining whether exposure to an in-service stressor has resulted in PTSD. The examiner should determine whether the diagnostic criteria to support the diagnosis of PTSD have been satisfied. If the PTSD diagnosis is deemed appropriate, the examiner should then comment upon the link between the current symptomatology and any verified in-service stressor. In rendering his or her opinion, the examiner should address the service treatment record that noted the Veteran experienced episodes of amnesia in October 1970 and January 1971. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. The AOJ should ensure that there has been compliance with the foregoing directives and conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Wulff, 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.