Citation Nr: 21020692 Decision Date: 04/07/21 Archive Date: 04/07/21 DOCKET NO. 14-36 365 DATE: April 7, 2021 REMANDED Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) with traumatic brain injury (TBI) and recurrent major depressive disorder with psychotic features (hereinafter PTSD with TBI) for the period prior to June 20, 2019 is remanded. REASONS FOR REMAND The Veteran had active service from September 1969 to April 1971. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). On his substantive appeal, the Veteran requested a Board hearing. In a March 2018 correspondence, his representative withdrew that request. See 38 C.F.R. § 20.704(e) (2020). In an April 2020 decision, the Board denied entitlement to an initial rating in excess of 50 percent for PTSD with TBI. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a Joint Motion for Remand (JMR) the parties agreed that the Board failed to provide an adequate statement of reasons or bases as it did not adequately address the evidence regarding the Veteran’s reported suicidal ideation and auditory hallucinations. In a November 2020 order, the Court granted the parties’ JMR vacating the April 2020 decision and remanding the claim to the Board for further adjudication. 1. Entitlement to an initial rating in excess of 50 percent for the period prior to June 20, 2019 is remanded. The evidence indicates there may be outstanding relevant VA treatment records. A VA record from February 18, 2013 indicates that an October 3, 2012 fee basis record from “VCU Health System” had been scanned into VistA Imaging. A March 24, 2016 VA record indicates that a non-VA record from Chickahominy Family Practice from October 22, 2015 had been scanned into VistA Imaging. It does not appear that the referenced records have been associated with the claims file. A remand to obtain the outstanding records is required. See Jones v. Wilkie, 918 F.3d 922, 926 (Fed. Cir. 2019) (stating the duty to assist is not discharged "based on a mere belief that the likelihood of finding a record substantiating a veteran's claim is 'low' or 'extremely low'"). The record also indicates that the Veteran has applied for Social Security Administration (SSA) disability benefits. Specifically, a September 12, 2013 VA record notes he was “applying for SSI.” The Veteran’s SSA records have not been associated with the claims file. Such records should be requested on remand. See Murincsak v. Derwinski, 2 Vet. App. 363, 369-70 (1992). The record also indicates that there are outstanding employment records that may be relevant to the claim. Specifically, the record indicates that the Veteran took a leave of absence from work under the Family Medical Leave Act (FMLA) beginning on May 22, 2018. However, the record does not indicate the duration of the leave. Additionally, the June 2019 VA PTSD examination report and a February 23, 2012 VA treatment record note that the Veteran “almost got into 4 fights” at work in the last three years and that his coworkers had filed a complaint against him. As employment records pertaining to the Veteran’s FMLA leave and any disciplinary actions may be relevant to the claim, such records should be requested on remand. The matters are REMANDED for the following actions: 1. Obtain the VistA Imaging records referenced in the February 18, 2013 and March 24, 2016 VA record entries. If any requested records are unavailable, the Veteran should be notified of such. 2. Request all relevant documents pertaining to any application by the Veteran for SSA disability benefits, including the medical records considered in deciding the claim. 3. With any assistance required from the Veteran, request from the United States Postal Service his personnel records, to include any records pertaining to FMLA leave and disciplinary actions. If any requested records are unavailable, the Veteran should be notified of such. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Anderson 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.