Citation Nr: 21005394 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 16-26 937 DATE: February 1, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), also claimed as depression, as secondary to service-connected right knee degenerative joint disease, status post knee replacement, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1981 to November 1985. These matters come before the Board of Veteran’s Appeals (Board) on appeal of an August 2016 and a February 2018 respective rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in July 2019 at which time it denied the Veteran’s claims. The Veteran, through his attorney, appealed the Board’s denial to the United States Court of Appeals for Veterans Claims (Court) in April 2020, and thereafter the Board's decision with respect to these claims was vacated pursuant to a September 2020 Joint Motion for Partial Remand (JMPR), and the matters were remanded for further proceedings consistent with the Motion. 1. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), also claimed as depression, as secondary to his service-connected right knee degenerative joint disease, status post knee replacement is remanded. With regards to the Veteran’s acquired psychiatric disability, the JMPR determined that vacatur was warranted because the Board erred by relying on the July 2018 VA medical opinion that failed to adequately opine on the issue of whether the Veteran’s acquired psychiatric disability was aggravated by his service-connected right knee degenerative joint disease, status post knee replacement. Specifically, that the examiner failed to provide an adequate rationale for his finding of a lack of aggravation. As to background, the Veteran filed a service connection claim for depression in June 2016, and in his subsequent statement in support of his claim contended that he had to seek psychological treatment for PTSD/depression/neuro-cognitive dysfunction resulting from the electrocution of his right metal knee in 2011 (post service), including his service-connected right knee replacement, and this in turn led to a myriad of health complications. See, July 2016 VA 21-0781, Statement in Support of Claim for PTSD. As such, the Veteran is claiming service connection on a secondary basis only. A June 2018 Disability Benefits Questionnaire (DBQ) reflects diagnoses of PTSD and mild neurocognitive disorder, secondary to his high voltage electrical injury, and alcohol abuse disorder, deemed to be in early remission. During his August 2018 VA examination, the Veteran’s diagnosis of PTSD was confirmed, with his 2011 electrocution accident while working as a private contractor in Afghanistan, post service, identified as his only stressor. The record reflects a January 2020 notation of ongoing chronic PTSD symptoms and treatment for moderately severe depressive symptoms. See, January 2020 Capri Records. Based on the findings of the JMPR, the Board is remanding this issue for a new VA examination concerning whether Veteran’s acquired psychiatric disability was aggravated by his service-connected right knee degenerative joint disease, status post knee replacement, as the Veteran contends. 2. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. As to the Veteran’s claim for TDIU, the JMPR determined that the Board also erred by failing to provide a statement of reasons or bases addressing this claim in its July 2019 decision, even though the Veteran filed a formal claim for TDIU in September 2017. The Board has subsequently determined that the Veteran’s TDIU claim needs to be further developed before it can be adjudicated on its merits as it is unclear from the record when the Veteran became unemployed (no verification) and the degree of impact of his service-connected disabilities on the Veteran’s ability to secure and/or maintain employment, especially in light of his recent service-connected left knee replacement (100 percent from 2/13/20; 30 percent from 4/1/21). The matters are REMANDED for the following action: 1. Further develop the Veteran’s claim for TDIU, to include a request for the Veteran to submit an updated 21-8940 Veterans Application for Increased Compensation Based on Unemployability, and for a completed VA Form 21-4192 Request for Employment Information in Connection with Claim for Disability Benefits from the Veteran’s identified employer(s). 2. Schedule the Veteran for an appropriate examination by a VA psychiatrist or psychologist (other than the examiner that conducted the July 2018 examination) to determine whether Veteran’s acquired psychiatric disability, was aggravated by his service-connected right knee degenerative joint disease, status post knee replacement. The examiner should provide an opinion on whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s acquired psychiatric disability was caused or aggravated by his service-connected right knee disability, including his status post knee replacement. The claims file, including all pertinent VA and private medical reports of record and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the claims folder and the Remand have been reviewed. The examiner must explain the rationale for all opinions given, citing to supporting factual data and medical literature, as deemed appropriate. In rendering the requested opinions, the examiner should also specifically consider and discuss the Veteran's contentions, lay statements of record, and medical records regarding the conditions and their effect on the Veteran, especially a June 4, 2018 Disability Benefits Questionnaire (DBQ) report. If the examiner cannot provide an opinion without resorting to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. 3. Schedule the Veteran for an appropriate VA examination to provide a functional assessment of the Veteran’s compensable service-connected disabilities (currently, right knee degenerative joint disease, status post knee replacement; bunionectomy, left great toe; left knee replacement associated with right knee degenerative joint disease, status post knee replacement) on his ability to secure or follow a substantially gainful employment consistent with his education and occupational experience, and without consideration of the Veteran’s age or any nonservice-connected disabilities. The examiner should specifically state which functional limitation with respective to the Veteran’s bilateral knee disability is prior to or post his respective knee replacement surgeries and the extent of their respective impacts on the Veteran’s occupational and employment activities. The claims file, including pertinent VA and private medical reports of record and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the claims folder and the Remand have been reviewed. The examiner is asked to consider all the Veteran’s lay statements regarding the impact of his service-connected disabilities on his ability to work. A complete rationale is required for all opinions rendered. 4. After the above development, and any additional development deemed necessary has been completed, the RO should readjudicate the Veteran’s claims on appeal. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.B. King, Associate 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.