Citation Nr: 21041141 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 18-27 929 DATE: July 8, 2021 REMANDED Entitlement to increases in the staged (30 percent prior to September 5, 2017, and 50 percent from that date) ratings assigned for posttraumatic stress disorder (PTSD) with insomnia disorder is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from November 2007 to October 2014. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2017 rating decision which increased the rating assigned for PTSD with insomnia disorder from 30 to 50 percent, effective September 5, 2017. A June 2019 Board decision denied increases in the staged ratings assigned for the Veteran's PTSD with insomnia disorder. [The decision also denied entitlement to an effective date prior to October 27, 2016 for the award of service connection for PTSD with insomnia disorder and granted a 20 percent rating (but no higher) for a lumbar spine disability.] The Veteran appealed the June 2019 Board decision to the U.S. Court of Appeals for Veterans Claims (CAVC). A November 2020 Memorandum Decision set aside and remanded the portion of the Board decision that denied increases in the staged ratings assigned for PTSD with insomnia. [The Memorandum Decision affirmed the Board's assignment of a 20 percent rating for a lumbar spine and dismissed the Board's denial of an effective date prior to October 27, 2016 for the award of service connection for PTSD with insomnia (as that matter was not challenged by the Veteran). Accordingly, those matters are no longer before the Board.] Entitlement to increases in the staged ratings assigned for PTSD with insomnia disorder The November 2020 CAVC Memorandum Decision found that the Board provided inadequate reasons or bases for its decision to deny ratings in excess of 30 percent prior to September 5, 2017, and in excess of 50 percent from that date. The CAVC held that the Board failed to discuss evidence potentially favorable to the Veteran's appeal, including specifically a February 2017 treatment record which discusses the Veteran's reported panic attacks. The CAVC also found that the Board failed to adequately address the April 2018 VA examination report notation of "passive and transient" suicidal ideation in light of Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017), and whether suicidal ideation (whether such is "passive" or "active") supports the assignment of a 70 percent rating. [Notably, the CAVC agreed with the Secretary that the Veteran has failed to demonstrate any error in the Board's assessment of all psychological symptoms under a single evaluation.] In an April 2021 brief to the Board, the Veteran's attorney argues that the prior examinations of record are inconsistent and incomplete for rating purposes; he specifically points to the variously assessed/diagnosed mental health disabilities noted on each report. He further argues that the Veteran "is entitled to an additional examination to ascertain the severity of his condition. An adequate examination with a qualified examiner that reviews his entire mental history." The most recent examination to assess the severity of the Veteran's service-connected psychiatric disability was in April 2018. Review of the record since suggests that symptoms of his psychiatric disability have changed (and potentially may have worsened). For example, on April 2018 VA examination, he reported only a prescription for trazadone (for sleep impairment). Symptoms associated with his psychiatric disability were depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less, chronic sleep impairment, disturbances of motivation and mood, and suicidal ideation. Since then, treatment records show that he reported "bouncing off the wall with angry outbursts," and that he has a prescription for additional medication (citalopram) for PTSD. See November 20, 2019 VA treatment record. More recently, he reported "sporadic issues" with anger and irritability, and requested "something stronger [medication] for sleep." See December 14, 2020 and March 30, 2021 VA treatment records. Considering the duration of the interval since he was last examined, treatment records which suggest a change in symptomatology, and his attorney's request for a more complete examination, the Board finds that a contemporaneous examination to assess the current severity of the disability is necessary. See Snuffer v. Gober, 10 Vet. App. 400 (1997). The matter is REMANDED for the following: 1. Secure for the record updated (to the present, any not already associated with the record) clinical records of all VA evaluations or treatment the Veteran has received for his psychiatric disability. 2. Thereafter, arrange for the Veteran to be examined by a psychiatrist or psychologist to assess the current severity of his service-connected PTSD with insomnia disorder. The Veteran's entire record (including this Remand and any newly obtained records) must be reviewed by the examiner. On review of the record and interview and examination of the Veteran, the examiner should note all psychiatric symptoms, including their frequency, severity, and impact on daily activity, social, and occupational functioning. The examiner must explain the rationale for all opinions in detail, citing to supporting factual data and/or medical literature, as deemed appropriate. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dupont, 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.