Citation Nr: 21011741
Decision Date: 03/02/21	Archive Date: 03/02/21

DOCKET NO. 13-26 054
DATE: March 2, 2021

REMANDED

Entitlement to a rating in excess of 10 percent for residuals of left ankle/foot strain (“left ankle disability”) is remanded.

Entitlement to service connection for a psychiatric disorder is remanded.

REASONS FOR REMAND

The Veteran had active service from September 1976 to September 1979 and November 1980 to April 1983.  He had additional service from April 1983 to September 1987 under dishonorable conditions.  

The record indicates that the Veteran failed to report for a VA examination in January 2020 for the claim for service connection.  The record indicates that the Veteran has had unstable housing, particularly in 2020.  The Veteran recently reported for examinations near his current domicile.  The Board finds the matter should be remanded to afford him the opportunity to report to an examination.

Regarding the claim for increased rating, the Board finds the record would benefit if additional information were obtained from the December 2020 VA examiner, notably the Veteran’s ranges of motion with passive motion and with and without weight-bearing.  

The matters are REMANDED for the following action:

1.  Schedule the Veteran for a VA examination to determine the nature and etiology of any current acquired psychiatric disorder.  The examiner should identify all current acquired psychiatric disorder(s).  If any previously diagnosed psychiatric disorder is not found on examination, the examiner should address the prior diagnoses of record and indicate whether they may have resolved or been misdiagnosed.

For each diagnosis identified other than posttraumatic stress disorder, the examiner should state whether it is at least as likely as not that disorder manifested in or is otherwise related to the Veteran’s military service, including any symptomatology therein.

With respect to posttraumatic stress disorder (PTSD), VA should provide the examiner with a summary of any verified in-service stressors and instruct the examiner that only these events may be considered for the purpose of determining whether exposure to an actual 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 address whether it is at least as likely as not (i.e. probability of 50 percent or more) that PTSD is due to military service, specifically to include his reported in-service personal assault. 

A complete rationale should be given for all opinions and conclusions expressed.  If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made.

2. Provide the claims file to the December 2020 VA examiner (or if unavailable an appropriate medical professional).  If possible, the medical professional must provide the ranges of passive motion and motion with and without weightbearing from the December 2020 VA examination.  

If the examiner is unable to provide these ranges of motion, the Veteran should be scheduled for another VA examination to obtain the necessary information.  

 

 

T. REYNOLDS

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	N. Snyder, 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.