Citation Nr: 21031862 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 17-63 212 DATE: May 24, 2021 REMANDED Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD), to include a temporary total rating (TTR) due to a period of hospitalization, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1990 to May 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2017rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In April 2021, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. 1. Entitlement to a rating in excess of 50 percent for PTSD to include entitlement to a temporary total evaluation due to a period of hospitalization. The Veteran contends that, since his last VA examination, his PTSD symptoms have worsened: his social interactions have decreased, his anxiety, irritability and depression have increased, and he has had several suicide attempts with the last one about a year and a half ago. See Hearing Transcript (April 2021). Specifically, the Veteran contends that he gets irritable and angry quicker than before and lashes out at people easily. He stated that he cannot be around people for long before needing to take medication and avoids crowds. He reported that at work people try to stay away from him, because they do not want to deal with him. He stated that he has been reprimanded at work for lashing out at people. He reported daily anxiety. He reported having to take leave via Family Medical Leave Act due to depression for a total of five or six weeks a year and relying on daily medication to be able to be around people. He also stated that not working helps him keep calmed down. Id. He reported that he underwent inpatient domiciliary care for his PTSD from February 2021 to March 2021, and requested TTR for that time period. See VA 21-526EZ, Fully Developed Claim (Compensation) (February 2021). In support of his contentions, the Veteran has also submitted several buddy statements and prior physicians, reporting the Veteran manifesting with trust issues, explosive and worsening temper, hypervigilance, worsening demeanor, and increased difficulty being around people. See Buddy / Lay Statement (August 2017 and April 2021); Medical Treatment Record - Non-Government Facility (August 2017). The Veteran's significant other reported in April 2021 that the Veteran experiences more nightmares after his inpatient treatment, jumps and talks in his sleep a lot more, and has no interest in things anymore. See Buddy / Lay Statement (April 2021). At the hearing, she stated that she noticed his symptoms worsen in the last few years. See Hearing Transcript (April 2021). To ensure that VA has met its duty assist, remand is necessary to obtain relevant outstanding treatment records and a new VA examination. 38 C.F.R. § 3.159(c). At the August 2017 VA examination, the Veteran's level of occupational and social impairment due to PTSD was described as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. At the examination, the Veteran reported suicidal ideation and was handed off to a different physician. However, in April 2021, the Veteran conveyed a worsening of his PTSD symptoms since the August 2017 VA examination as detailed above. In this regard, the Board notes an inpatient treatment from February 2021 to March 2021 for increased symptoms of PTSD. Because this evidence suggests a material worsening of the Veteran's PTSD since his last VA examination in August 2017, reexamination is necessary. See 38 C.F.R. §§ 3.326, 3.327 (reexaminations will be requested whenever VA determines there is a need to verify the current severity of a disability, such as when the evidence indicates there has been a material change in a disability or that the current rating may be incorrect); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). The Board also notes that the August 2017 VA examination did not reflect any indication or meaningful discussion of the severity, frequency, and duration of the listed symptoms. First, there are numerous incongruities within the February 2020 VA PTSD examination report. Under the header of "4. Symptoms," the report lists depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, flattened affect, disturbance of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships, which is incongruous with the information contained under the header of "3 PTSD Diagnostic Criteria." Further, although irritability, for example, was not listed as a symptoms of his PTSD under "4. Symptoms," the examination report indicates elsewhere that the Veteran's irritability associated with his diagnosis of PTSD resulted in verbal or physical aggression toward people or objects. Second, the examination does not reflect any indication or meaningful discussion of the severity, frequency, and duration of the identified symptoms of PTSD irritable behavior and angry outbursts, exaggerated startle response and sleep disturbance. Third, the August 2018 VA PTSD examination reflects that the Veteran's PTSD symptoms were productive of "Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation." This is incongruous with the finding that the Veteran's "PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning." Given the above, remand is necessary to ensure that VA has met its duty to assist. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (Once VA undertakes the effort to provide an examination it must provide one that is adequate for purposes of the determination being made.). With regard to outstanding treatment records, the Board observes that the VA treatment records reflect that medical records had been scanned into the record and note Vista-Imaging-scanned documents. However, the VA treatment records in the claims file do not include those scanned (Vist-A Imaging) documents. Given the above, remand is necessary to obtain the relevant outstanding treatment records, which should then be associated with the claims file. See 38 C.F.R. § 3.159(c)(2); Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016). 2. Entitlement to a TDIU due to service-connected disability. The Board finds the Veteran's claim for a TDIU is inextricably intertwined with the claim for increase. Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The claim is additionally inextricably intertwined with the claims pending before the AOJ, as discussed above. Therefore, adjudication is deferred pending the outcome of the claim. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from March 2021 to the Present. Associate copies of all treatment records that have been scanned into the Vist-A Imaging system with the Veteran's claims folder. 2. Thereafter, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected PTSD. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to his service-connected PTSD alone. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. M. Pesin 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.