Citation Nr: 21010519 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 16-63 428 DATE: February 25, 2021 REMANDED Entitlement to an effective date prior to April 22, 2015, for the assignment of a 50 percent rating for service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to a rating in excess of 50 percent for PTSD is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to service-connected PTSD, is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected PTSD, is remanded. Entitlement to service connection for erectile dysfunction (ED), to include as secondary to service-connected PTSD, is remanded. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected PTSD, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1970 to May 1974 in the United States Army. He was awarded the Vietnam Service Medal and Vietnam Campaign Medal for his service in support of the Vietnam War campaign. This case comes before the Board of Veterans’ Appeals (Board) from a July 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In a December 2018 decision and remand, the Board remanded the issues of entitlement to service connection for GERD, ED, OSA, and hypertension for examination and etiology opinion; and the Board denied the issue of entitlement to a rating in excess of 50 percent for PTSD. See BVA Decision (December 2018). The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court). 1. Entitlement to an effective date prior to April 22, 2015 for the assignment of a 50 percent rating for service-connected PTSD. Regarding the claim of entitlement to an effective date prior to April 22, 2015, for the assignment of a 50 percent rating for service-connected PTSD, the Veteran submitted a timely notice of disagreement with a July 2016 rating decision that assigned a rating of 50 percent for PTSD from April 22, 2015. In May 2019, the Court issued a Memorandum Decision, vacating in part the December 2018 Board decision regarding the issue of the Veteran’s entitlement to a rating in excess of 50 percent for PTSD and remanded the issue for the Board to determine the proper effective date for the Veteran’s increased rating for PTSD to 50 percent, including whether he is entitled to an earlier effective date under 38 C.F.R. § 3.400(o)(2). See Court Decision (May 2020). The Board notes that a statement of the case has not yet been issued on the issue of entitlement to an effective date prior to April 22, 2015 for the assignment of a 50 percent rating for PTSD. A remand is required for the Agency of Original Jurisdiction (AOJ) to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 2. Entitlement to a rating in excess of 50 percent for PTSD. The Veteran contends that his service-connected PTSD is more severe than the 50 percent he is assigned. Additionally, as noted previously, he and his representative argue that an effective date prior to April 22, 2015, for the assignment of a 50 percent rating for service-connected PTSD is warranted. The Veteran’s representative argues that the evidence shows that the Veteran’s PTSD disability worsened since the December 2015 VA PTSD examination, which the Board considered in its December 2018 decision. See Court Decision at 9 (May 2020). He noted that within a month of the examination, the Veteran began experiencing flashbacks, anger, lack of emotions, nervousness, panic attacks and suspiciousness. The representative argues that there is no indication that the Veteran’s PTSD symptoms have stabilized. He argues that a new examination should be ordered to assess the nature and severity of the Veteran’s PTSD. The Board agrees. Given the Veteran’s continued assertion that this service-connected PTSD disability is more severely disabling than reflected in the currently assigned rating, and in light of the amount of time since his last examination for this disability and the possible increase in severity since last examination, the Board finds that reexamination is needed to fully and fairly evaluate the conditions on appeal. See Palczewski v. Nicholson, 21 Vet. App. 174, 181-82 (2007), citing Caluza v. Brown, 7 Vet. App. 498, 505-06 (1998) (“where the record does not adequately reveal the current state of the claimant’s disability … the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination.”). Accordingly, remand is warranted to provide for reexamination. 3. Entitlement to service connection for GERD, to include as secondary to service-connected PTSD. 4. Entitlement to service connection for hypertension, to include as secondary to service-connected PTSD. 5. Entitlement to service connection for ED, to include as secondary to service-connected PTSD. 6. Entitlement to service connection for OSA, to include as secondary to service-connected PTSD. First, the Board acknowledges that the service connection issues are intertwined with the issues being remanded regarding PTSD. As noted above, the Board remanded the service connection issues in December 2018 to obtain medical opinions that address whether the conditions are etiologically related to service or were otherwise caused/aggravated by the Veteran’s PTSD disability and associated medications. The Board finds the etiology opinions that were obtained on remand do not adequately address whether the claimed disabilities were caused and/or aggravated by PTSD and associated medications, or are directly related to the Veteran’s period of service. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA provides the Veteran with an examination in a service connection claim, the examination must be adequate). As such, remand is required for addendum opinions. In this regard, the Board notes that the Veteran’s representative submitted journal articles in support of the Veteran’s claims. See Correspondence (May 2020). The Board notes that a medical article or treatise can provide important support when combined with an opinion of a medical professional if the medical article or treatise evidence discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. See Mattern v. West, 12 Vet. App. 222 (1999); Sacks v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998). In light of the foregoing, the Board finds that such materials should also be considered by the examining clinician(s). The matters are REMANDED for the following action: 1. Send the Veteran and his representative a statement of the case that addresses the issue of entitlement to an effective date prior to April 22, 2015, for the assignment of a 50 percent rating for PTSD. 2. Obtain the Veteran’s VA treatment records for the period from April 20, 2020, to the present. 3. 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. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to his service-connected PTSD alone. 4. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not that the Veteran’s claimed GERD: (a) had its onset in service or is related to service; (b) was caused by his service-connected PTSD disability and associated medications; or (c) was aggravated beyond its natural progression by his service-connected PTSD disability and associated medications. 5. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not that the Veteran’s claimed hypertension: (a) had its onset in service or is related to service; (b) was caused by his service-connected PTSD disability and associated medications; or (c) was aggravated beyond its natural progression by his service-connected PTSD disability and associated medications. 6. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not that the Veteran’s claimed erectile dysfunction: (a) had its onset in service or is related to service; (b) was caused by his service-connected PTSD disability and associated medications; or (c) was aggravated beyond its natural progression by his service-connected PTSD disability and associated medications. 7. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not that the Veteran’s claimed obstructive sleep apnea: (a) had its onset in service or is related to service; (b) was caused by his service-connected PTSD disability and associated medications; or (c) was aggravated beyond its natural progression by his service-connected PTSD disability and associated medications. For all opinions, the reporting clinician should consider all evidence, including lay statements, medical records, submitted journal articles, and other medical opinions of record. Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record. M. C. WILSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. A. Macek, 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.