Citation Nr: 21024524 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 17-67 167 DATE: April 23, 2021 REMANDED Entitlement to a rating higher than 30 percent prior to August 25, 2015, for residuals of right eye hysterical blindness with headaches is remanded. Entitlement to a rating higher than 50 percent as of August 25, 2015, and prior to March 1, 2018, for residuals of right eye hysterical blindness with headaches is remanded. Entitlement to a rating higher than 30 percent as of March 1, 2018, for residuals of right eye hysterical blindness with headaches is remanded. Entitlement to restoration of a 50 percent rating for residuals of right eye hysterical blindness with headaches, as of March 1, 2018, is remanded. Entitlement to separate compensable rating for migraines is remanded. Entitlement to an initial rating higher than 30 percent for adjustment disorder with anxiety and depression is remanded. Entitlement to a higher level of special monthly compensation (SMC) is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1966 to May 1969. In July 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A hearing transcript is of record. Since the issuance of the December 2017 supplemental statement of the case, VA treatment records have been associated with the file. The Veteran has not waived Agency of Original Jurisdiction (AOJ) consideration of that evidence. However, as the claims are being remanded, the AOJ will have the opportunity to review those records in the readjudication of the claims. Therefore, no prejudice results to the Veteran in the Board considering that evidence for the limited purpose of issuing a comprehensive and thorough remand. 1. Entitlement to service connection for a separate rating for migraines is remanded. At the July 2020 Board hearing, the Veteran reported increased migraine headaches due to the eye disability. In addition, the Veteran indicated that the light used to assist with the visual impairment triggers the migraines. The Veteran’s representative contends a separate rating is warranted. The Board finds an updated VA examination is needed to evaluate the severity of the migraines and whether a separate rating is warranted. 2. Entitlement to increased ratings, and restoration of a 50 percent rating, for residual of right eye hysterical blindness with headaches is remanded. The Veteran’s most recent VA examination of the right eye disability was in August 2017. Additional VA and private treatment records suggest significantly decreased visual acuity in the left eye. If a Veteran is service-connected for one eye, the other eye is treated as having visual acuity of 20/40. An exception allows the nonservice-connected eye to be consider as being service-connected for rating purposes when the nonservice-connected eye impairment is not the result of willful misconduct and visual acuity in each eye is 20/200 or less or the peripheral field of vision in each eye is 20 degrees or less. Since the August 2017 VA examination, VA and private treatment records show left eye visual acuity of 20/200. The Board finds a more current VA examination is needed to rate the severity of the eye disability. 3. Entitlement to an initial rating higher than 30 percent for adjustment disorder with anxiety and depression is remanded. At the July 2020 Board hearing, the Veteran reported that he had grown more morose as his eye disability progressed. He stated that he was now always down and did not want to see people anymore. The statements suggest increased symptomatology from the August 2017 VA examination. Where the evidence of record does not show the current state of the Veteran’s disability, a more current VA examination must be conducted. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 3.327(a). The Board finds a more current VA examination is needed to rate the severity of the psychiatric disability. 4. Entitlement to a higher level of SMC is remanded. 5. Entitlement to TDIU is remanded. The claims for a higher level of SMC and TDIU are inextricably intertwined with the claims for service connection and increased ratings. Where a claim is inextricably intertwined with another claim, the claims must be adjudicated together. Harris v. Derwinski, 1 Vet. App. 180 (1991). Therefore, further consideration of the claims for SMC and TDIU must be deferred. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from July 2018 to the present. 2. Schedule the Veteran for a VA examination to assess the current severity of headaches. The examiner must review the claims file and should note that review in the report. All indicated studies deemed necessary by the examiner should be performed, and all findings should be reported in detail. All opinions must be accompanied by a rationale. The examiner is asked to describe in detail the frequency, duration, and severity of the Veteran’s headaches. In discussing the severity of the headaches, the examiner should opine as to whether the migraine headaches are characterized by: (a) Very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability; (b) Characteristic prostrating attacks occurring on an average once a month over the last several months; or (c) Characteristic prostrating attacks averaging one in two months over the last several months. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow a substantially gainful occupation due to the service-connected disabilities. If the Veteran is felt capable of work despite the service-connected disabilities, the examiner should state what type of work and what accommodations would be necessary due to the service-connected disabilities. 3. Schedule the Veteran for a VA eye examination to determine the current severity of a service-connected right eye disability. All necessary tests should be performed, and the results reported in detail. The examiner should state all examination findings, with the rationale for the comments and opinions expressed. The examiner should provide examination findings for both eyes for visual acuity and visual field. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow a substantially gainful occupation due to the service-connected disabilities. If the Veteran is felt capable of work despite the service-connected disabilities, the examiner should state what type of work and what accommodations would be necessary due to the service-connected disabilities. 4. Schedule the Veteran for a VA examination to determine the current nature and severity of a psychiatric disability. The examiner should review the claims folder and should note that review in the report. All necessary tests and studies, to include any appropriate psychological testing, should be accomplished and all clinical findings reported in detail. The examiner should identify the existence and severity of all current manifestations of the service-connected psychiatric disorder. The examiner should opine as to the levels of occupational and social impairment caused by a psychiatric disability and should describe the symptoms, to include the frequency and severity of symptoms, resulting in those levels of impairment. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow a substantially gainful occupation due to the service-connected disabilities. If the Veteran is felt capable of work despite the service-connected disabilities, the examiner should state what type of work and what accommodations would be necessary due to the service-connected disabilities. A complete rationale should be provided for all opinions. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Kass, 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.