Citation Nr: 21077050 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-61 804 DATE: December 28, 2021 REMANDED The claim for service connection for an acquired psychiatric disability, to include persistent depressive disorder is remanded. The claim for an increased disability rating in excess of 20 percent for left upper extremity neuropathy prior to March 30, 2015, is remanded. The claim for an increased disability rating in excess of 30 percent for left upper extremity neuropathy beginning March 30, 2015, is remanded. The claim for an increased disability rating in excess of 30 percent for gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1992 to September 1995. He provided testimony during a hearing before the undersigned in August 2021. A transcript has been associated with the claims file. 1. Entitlement to service connection for an acquired psychiatric disability During the Board hearing, the Veteran asserted that his acquired psychiatric disability(s) were proximately due to his service-connected disabilities, both from symptoms such as pain and fatigue as well as effects from the medications taken to treat them. Moreover, as noted below, the evidence demonstrates that some of his service-connected disabilities have recently worsened. As such, the Board finds that a VA examination and opinion is warranted in order to assess any connection between an acquired psychiatric disability and his service-connected disability(s). 2. Entitlement to an increased disability rating in excess of 20 percent for left upper extremity neuropathy prior to March 30, 2015 3. Entitlement to an increased disability rating in excess of 30 percent for left upper extremity neuropathy beginning March 30, 2015 4. Entitlement to an increased disability rating in excess of 30 percent for GERD During the Board hearing, the Veteran reported that his left upper extremity neuropathy and GERD disabilities have worsened since the last VA examination in March 2017. In light of his reports, the Board finds that a new VA examination is necessary to assess the current severity of each disability. See Green v. Derwinski, 1 Vet. App. 121 (1991) (VA has a duty to conduct a thorough and contemporaneous examination of the Veteran in an increased rating claim); Schafrath v. Derwinski, 1 Vet. App. 589 (1991). All outstanding records of ongoing VA treatment should be associated with the claims file prior to the VA examinations ordered herein. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Once all outstanding and relevant VA treatment records have been associated with the claims file, provide a VA examination to assess the nature and etiology of the Veteran's acquired psychiatric disability(s). Specifically, the examiner is requested to address the claim of a secondary or proximate connection between the Veteran's acquired psychiatric disability(s) and his service-connected disabilities, either alone or in combination and either directly from the disabilities or treatment thereof. The examiner must review the claims file. The examiner should list all acquired psychiatric disabilities currently present or diagnosed during the pendency of this claim. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is any acquired psychiatric disability(s) at least as likely as not proximately due to any service-connected disability(s), either alone or in combination, and either directly from the disability(s) or as a result of treatment thereof? Is any acquired psychiatric disability(s) at least as likely as not aggravated, i.e., worsened beyond its natural progression, by any service-connected disability, either alone or in combination, and either directly from the disability(s) or treatment thereof? 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left upper extremity neuropathy disability. 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. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected GERD. 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. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. B., 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.