Citation Nr: 21011330 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 18-29 187 DATE: March 1, 2021 REMANDED Entitlement to an increased rating in excess of 10 percent prior to August 19, 2019 and in excess of 30 percent since August 19, 2019 for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for Vitamin D deficiency to include as due to herbicide exposure and diabetes mellitus is remanded. Entitlement to service connection for a visual disability, claimed as cataracts, as due to diabetes mellitus is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served in active duty service with the Army from January 1971 to January 1974 to include service in the Republic of Vietnam. This matter is on appeal from a March 2015 rating decision. The Board remanded this appeal in November 2018 and August 2020 for further development. The Board notes that where a claimant, or the record, raises the question of unemployability due to the disability for which an increased rating is sought, then part of the increased rating claim is an implied claim for TDIU. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board notes that in a December 2020 appellate brief, the Veteran’s representative raised the issue for TDIU, asserting the Veteran’s evaluated disabilities and combined rating were sufficient to satisfy the schedular criteria for TDIU and therefore raise potential entitlement for TDIU. Accordingly, the Board finds that the record reasonably raises a claim that the Veteran’s service-connected disabilities prevents him from working or maintaining employment. The Board has therefore characterized the issues on appeal to include a claim for a TDIU. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). The Board finds that remand is warranted for additional development. Posttraumatic stress disorder (PTSD) The Board notes the most recent VA examination held for the Veteran was in August 2019. In a May 2020 appellate brief, the Veteran’s representative stated that the Veteran asserted his belief that the severity of his PTSD has increased. While the Board is not required to direct a new examination simply due to the passage of time, a new examination is appropriate when the claimant asserts that the disability in question has undergone an increase in severity since the last examination. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Given the Veteran’s assertions that his PTSD has worsened, the Board finds that a remand is necessary to ascertain the current severity of his disability. Vitamin D deficiency The Veteran asserts entitlement to service connection for vitamin D deficiency to include as due to herbicide exposure and diabetes mellitus. The Veteran is service connected for diabetes mellitus. The Board remanded this appeal in November 2018 for an addendum opinion. An August 2019 VA opinion was obtained, and the examiner found it less likely than not that the Veteran’s Vitamin D deficiency was due to herbicide exposure. In a May 2020 appellate brief, the Veteran’s representative asserted that Vitamin D was a risk factor for diabetes mellitus and also provided references and links to web articles regarding Vitamin D and diabetes; neither the statements or linked articles were addressed by the August 2019 VA opinion. As such, the Board finds that opinions regarding the issue for service connection for Vitamin D deficiency must also address the Veteran’s assertions and medical articles submitted in support of his claim. Visual disability, claimed as cataracts The Veteran asserts entitlement to service connection for visual disability, claimed as cataracts, as due to service-connected diabetes mellitus. The Board remanded this appeal in November 2018 for an addendum opinion. An August 2019 VA opinion was obtained, and the examiner found it less likely than not that the Veteran’s visual disturbance, claimed as cataracts, was related to military service and not caused or aggravated by diabetes. However, the Board notes that the examiner does not provide any rationale on why there was no aggravation by diabetes and does not identify a baseline or explain why a baseline was not found. In addition, in the May 2020 appellate brief, the Veteran’s representative also provided references to web articles discussing diabetes and visual or ocular complications that were not discussed by the August 2019 opinion. As such, the Board finds the August 2019 opinion inadequate and remand warranted to also address the identified medical articles in support of the Veteran’s claim. As the Veteran’s TDIU claim is inextricably intertwined with the remanded increased rating and service connection claims, the TDIU issue is also remanded. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated and outstanding treatment records. 2. Schedule the Veteran for a VA examination to ascertain the current severity and manifestations of his PTSD. The examiner should carefully consider the Veteran’s lay statements regarding his condition and the effects on his occupational and social functioning. 3. Return the claims file to the VA examiner who provided the August 2019 medical opinion on the Veteran’s Vitamin D deficiency and visual disability. The record and a copy of this remand must be made available to the examiner. If the examiner is not available, request an opinion from another qualified VA examiner. If the examiner determines that an examination of the Veteran is necessary to provide the requested opinions with rationale, then such examination should be scheduled. The VA examiner is asked to opine on the following: (a.) Is it at least as likely as not (a 50 percent or greater probability) the Veteran’s Vitamin D deficiency arose in service or is etiologically related to his military service, to include exposure to herbicides? For the purposes of this opinion, exposure to herbicide agents, to include Agent Orange should be presumed. (b.) Is it at least as likely as not (50 percent probability or more) that the Veteran’s Vitamin D deficiency is due to his service-connected diabetes? (c.) Is it at least as likely as not (50 percent probability or more) that the Veteran’s Vitamin D deficiency is aggravated by his service-connected diabetes? “Aggravation” is defined as any worsening beyond the natural progression of the disability. The examiner should establish a baseline level of disability prior to aggravation or explain why no baseline was established or found. (d.) Is it at least as likely as not (50 percent probability or more) that the Veteran’s visual disability is due to his service-connected diabetes? (e.) Is it at least as likely as not (50 percent probability or more) that the Veteran’s visual disability is aggravated by his service-connected diabetes? “Aggravation” is defined as any worsening beyond the natural progression of the disability. The examiner should establish a baseline level of disability prior to aggravation or explain why no baseline was established or found. (f.) In addressing any of the above, the VA examiner should discuss the Veteran’s assertions, statements and the identified medical articles in the May 2020 appellate brief. (g.) The examiner is also advised that the Veteran is competent to report in-service events and treatment, and his symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. (h.) A complete rationale for these opinions must be provided. Citation to accepted medical literature and principles would be of great assistance to the Board. If the examiner is unable to provide these opinions without resorting to speculation, he or she must explain why this is so 4. Conduct any necessary development for the TDIU claim, to include providing the Veteran with a TDIU application (VA Form 21-8940) for his completion and submission. 5. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review, if in order. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Yang, Attorney-Advisor 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.