Citation Nr: 21026692 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 20-17 934 DATE: May 3, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1963 to October 1983. This matter comes before the Board of Veterans' Appeals on appeal from an October 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the case in July 2020 for additional development; it now returns for further appellate review. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD. The Veteran contends that he has an acquired psychiatric disorder related to his military service in Vietnam. In this regard, he has described having flashbacks and disturbing memories of his deployment, as well as other psychiatric symptoms. As the medical evidence of record reflects positive PSTD screens in September 2017 and December 2018, to include one report of suicidal ideation, the Board remanded the claim in July 2020 to afford the Veteran a VA examination evaluating whether the Veteran has an acquired psychiatric disorder, and if so, whether such is related to his military service. The Veteran was afforded a VA examination in February 2021; however, the Board finds that examination inadequate for the purposes of determining whether service connection is warranted for an acquired psychiatric disorder. In this regard, the VA examiner stated that the Veteran does not meet the DSM-5 diagnostic criteria for PTSD or any other mental disorder. However, the examiner predicated the opinion on the lack of any psychiatric symptoms. Specifically, the examiner noted that the Veteran reported remembering his time in Vietnam when he watches military shows and that certain smells "remind him of death." The examiner also stated that the Veteran has exhibited no anxiety, suspiciousness, chronic sleep impairment, avoidance behavior, suicidal ideation, reactivity, or arousal. While the examiner stated that she reviewed the evidence of record, the Board finds that VA medical records contradict these findings of the VA examiner. In this regard, VA medical records indicate that in February 2010, the Veteran reported experiencing depression. As noted in the prior remand, September 2017 and December 2018 medical records show positive PTSD screenings based on symptoms of nightmares/intrusive thoughts, avoidance behavior, guarding, being easily startled, and feelings of detachment. VA records from November 2020 also show avoidance behavior with depression, increased irritability, and a worsening of all psychiatric symptoms. Later that month, the Veteran reported that he reexperiences Vietnam via nightmares and intrusive memories, avoids smells that remind him of cremation and death, avoids crowded and noisy places, refuses to watch violent or military-themed media, and experiences hypervigilance and hyperarousal. He also reported preferring to isolate and stay to himself, feeling down often, and suffering from amotivation and anhedonia. Finally, he reported poor sleep. Accordingly, the Board finds that a new VA opinion should be obtained that addresses the relevant medical evidence of record and supports any negative opinion with a sufficient rationale. 2. Entitlement to a TDIU. The Veteran contends that he is unable to work due to his claimed PTSD as well as his service-connected disabilities. Thus, the claim for a TDIU is inextricably intertwined with the service connection claim remanded herein. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). As such, consideration of the Veteran's TDIU claim must be deferred pending the outcome of the service connection claim. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together in order to enter a final decision on the matter). The matters are REMANDED for the following action: 1. Forward the record, to include a copy of this Remand, to the February 2021 VA examiner, or another appropriate clinician if she is unavailable, for an addendum opinion addressing the nature and etiology of the Veteran's claimed acquired psychiatric disorder. The need for additional examination is left to the discretion of the examiner. Following a review of the record, the examiner should address the following inquiries: (A) Identify all of the Veteran's acquired psychiatric disorders that have met the DSM-V diagnostic criteria at any time proximate to his January 16, 2016 claim. If the examiner finds that the Veteran does not meet the DSM-V criteria for a diagnosis of PTSD or any other acquired psychiatric disorder at any point during the period on appeal, he or she must reconcile such determination with the remainder of the evidence of record, to include VA medical records from September 2017, December 2018, and November 2020. (B) If PTSD is diagnosed, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such diagnosis is the result on a verified in-service stressor. (C) For each currently diagnosed acquired psychiatric disorder other than PTSD, the examiner should offer an opinion as to whether it is at least as likely as ot (i.e., a 50 percent or greater probability) that any such disorder is had its onset in, or is related to, the Veteran's military service. A rationale for any opinion offered should be provided. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Breckenridge, Associate 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.