Citation Nr: 21016060 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 15-04 280 DATE: March 19, 2021 REMANDED Entitlement to an effective date prior to March 14, 2011 for the grant of a total (100 percent schedular) rating for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an effective date prior to March 14, 2011 for the grant of special monthly compensation (SMC) at the housebound rate (HB) is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from December 1964 to September 1968. The Veteran died in August 2016, and the appellant (the Veteran’s daughter) has been substituted as a claimant for the purpose of processing his claim to completion. This case comes to the Board of Veterans’ Appeals (Board) on appeal from an April 2014 Department of Veterans Affairs (VA) rating decision granting a 100 percent rating for PTSD and SMC (HB), each effective November 5, 2013. A June 2016 Board decision granted an earlier effective date of March 4, 2011 for the 100 percent rating for PTSD and SMC (HB), which the Veteran appealed to the United States Court of Appeals for Veterans Claims (CAVC). A March 2018 CAVC Memorandum Decision vacated the Board’s decision and remanded the matters to the Board for action consistent with the Memorandum Decision, to include determining whether there was an outstanding claim for a higher PTSD rating that pre-dated March 14, 2011. In a December 2018 remand, the Board traced the lengthy procedural history of this appeal and found that an outstanding claim for increase in the PTSD rating was pending from August 31, 2005 (date of receipt of an application for a total disability rating based on individual unemployability, which is construed as an informal claim for increase for PTSD) to March 14, 2011; the Board then sent the case back to the agency of original jurisdiction (AOJ) for further development of the claims. The Veteran’s attorney has on three occasions (in June 2020, August 2020, and November 2020) requested an extension of time (90 days) to submit additional evidence in support of the claim. (The Board granted his request in July 2020 and subsequently has acknowledged the attorney’s assertion that it would be assumed the request was granted unless he received written notice from the Board to the contrary.) Purportedly, the attorney was in the process of obtaining a vocational expert opinion to aid in the appeal. To date, no records from him have been received, but in light of this remand for further development, he will have opportunity to submit additional evidence. 1. Entitlement to an effective date prior to March 14, 2011 for the grant of a total (100 percent schedular) rating for PTSD In December 2018 the Board remanded the case for a retrospective medical advisory opinion regarding the effect the Veteran’s service-connected PTSD (alone, without regard to the impact of hi service-connected coronary artery disease and any other, nonservice-connected disability) would have been expected to have on his occupational functioning from August 2005 to March 2011. The October 2019 opinion received in response appears to furnish contradictory remarks. For instance, the consulting provider stated on the one hand that, due to overlapping symptoms and interactive effects (from/between PTSD, a personality disorder, and cardiovascular symptoms), she could only speculate as to the Veteran’s functional impairment solely attributable to PTSD. On the other hand, she also concluded that it was less likely than not that PTSD symptoms alone would preclude him from gainful employment. She did not specifically, as requested, express agreement or disagreement (with supporting rationale) with a private provider’s February 2011 and November 2013 opinions. Rather, she merely highlighted deficiencies in those opinions. She also merely recited, instead of discussed (as requested), particular evidence in the file from a July 1983 VA examination report and a March 2006 social work record. Therefore, the case is returned for an addendum clarifying opinion. 2. Entitlement to an effective date prior to March 14, 2011 for the grant of SMC at the housebound rate (HB) This issue is inextricably intertwined with the other effective date claim on appeal. Therefore, a determination on the matter is deferred until the other matter is resolved. The matters are REMANDED for the following: Arrange for the Veteran’s claims file to be returned to the provider of the October 2019 medical opinion for an addendum clarifying retroactive opinion regarding the impact the Veteran’s PTSD, alone, would have been expected to have on his occupational functioning during the period from 2005 to March 14, 2011. [If that examiner is unavailable or unable to provide the opinion, arrange for the record to be forwarded to another appropriate clinician for review and the opinion sought.] The consulting provider is asked to respond to the following based on a review of the claims file: (a). Comment upon the expected impact of the Veteran’s PTSD symptoms, alone, on his occupational and social functioning during the period from 2005 to March 14, 2011. To that end, the provider please reconcile the two opinions from the October 2019 report, indicating both that due to overlapping symptoms and interactive effects (from/between PTSD, a personality disorder, and cardiovascular symptoms) the provider could only speculate as to the Veteran’s functional impairment solely attributable to PTSD, and that it was less likely than not that PTSD symptoms alone would preclude him from gainful employment. Identify any evidence in the record (other than the February 2011 and November 2013 opinions of a private provider) that tends to support that the Veteran’s PTSD alone impacted him to such extent that he was incapable of participating in employment consistent with his education and experience. (b). Express agreement or disagreement with the conclusion reached by the private provider’s opinions of February 2011 and November 2013 as to the functional impact of the Veteran’s PTSD on his employability. Include rationale for the agreement or disagreement (which cites to supporting factual data and medical principles). (c). Discuss the significance, if any, of the following records in terms of the Veteran’s social and occupational functioning from 2005 to March 14, 2011: (1) A July 1983 VA psychiatric examination report, which notes that the Veteran was already unemployed (due to factory closure that ended a 4-year period of employment) and living in an isolated location many years before the diagnosis of his PTSD; and (2) A March 2006 VA social work record, which notes the Veteran’s explanation that “he simply chooses to live more simply than most” when discussing his living situation. All opinions must include rationale that cites to relevant evidence, supporting factual data, and medical literature, as deemed appropriate. If the consulting provider cannot furnish the opinion without resort to speculation, (to satisfy legal requirements) the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (additional facts are required, or the examiner does not have the requisite knowledge or training). George R. Senyk Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Debbie Breitbeil, 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.