Citation Nr: 1319306 Decision Date: 06/13/13 Archive Date: 06/21/13 DOCKET NO. 07-21 494 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disability other than posttraumatic stress disorder (PTSD), to include depression and anxiety. 2. Entitlement to service connection for PTSD. REPRESENTATION Appellant represented by: Florida Department of Veterans Affairs WITNESSES AT HEARING ON APPEAL Veteran and friend, J.B. ATTORNEY FOR THE BOARD T. Sherrard, Counsel INTRODUCTION The Veteran, who is the Appellant in this case, had active service from January 1973 to March 1974. This matter comes before the Board of Veterans' Appeals (BVA or Board) from an April 2006 rating decision by the above Department of Veterans Affairs (VA) Regional Office (RO). The Veteran and her friend, J.B., provided testimony at a November 2007 Travel Board hearing before the undersigned Veterans Law Judge at the RO. A transcript of the hearing is associated with the claims folder. The Board denied the claim for a psychiatric disability other than PTSD in a September 2011 decision. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court), and, in April 2012, the Court granted a Joint Motion for Remand (Joint Motion). In the April 2012 Order, the Court vacated and remanded the Board's September 2011 decision for compliance with instructions provided in the Joint Motion. The Board subsequently remanded the claim for further development in August 2012. As discussed below, the development requested has been completed, and the claim is now appropriate for appellate review. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a total review of the evidence. The issue of entitlement to service connection for PTSD is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, D.C. FINDINGS OF FACT 1. The Veteran did not have any symptoms of a psychiatric disability during active service, nor were psychiatric symptoms unremitting during active service. 2. Symptoms of an acquired psychiatric disorder other than PTSD have not been unremitting since service separation. 3. The Veteran's currently diagnosed acquired psychiatric disabilities other than PTSD, including depression and anxiety, are not related to active service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disability other than PTSD, to include depression and anxiety, have not been met. 38 U.S.C.A. §§ 101, 1101, 1110, 5103(a), 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Service Connection for an Acquired Psychiatric Disability Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. The claimed psychiatric conditions at issue are not "chronic diseases" listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.309(b) (requiring continuity of a condition after service if chronicity is not found in service) does not apply to those conditions. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Although this is not a claim for PTSD, the Board notes that if a claim for service connection for PTSD is based on allegations of in-service personal assault, evidence from sources other than a veteran's service records may corroborate a veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor and such evidence include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(5). The Board has considered such sources of evidence herein. The regulation specifically provides that VA will not deny a PTSD claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than a veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f)(5). In this case, as discussed below, in August 2012, the Board remanded the claim for further development to include requesting the Veteran's service personnel file, and the claims file, including the service personnel records, was subsequently reviewed by a VA physician to obtain an opinion. Thus, again, although this is not a claim for PTSD, the Board has considered other sources of evidence in determining whether the claimed in-service events occurred as alleged. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." See Layno, 6 Vet. App. at 469; 38 C.F.R. § 3.159(a)(2). The Court has emphasized that when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of a veteran's claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The Board has reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by a veteran or obtained on her behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran avers that she has current psychiatric disabilities - including depression and anxiety - that are related to active service. Specifically, she avers that, during active service, she was a victim of sexual harassment and assault by several individuals, and that this caused her current depression and anxiety. Further, she contends that her ex-husband, whom she married in December 1973, physically abused her, breaking things and throwing things at her when they got into arguments. Finally, she avers that she saw a dentist during active service who gave her a hard time about how she took care of her teeth and made her feel bad about herself. The Veteran's accounts of her in-service experiences have been, at best, inconsistent. Prior to claim for VA disability compensation, she denied any military sexual trauma on more than one occasion while seeking psychiatric treatment. In a 2007 statement, her ex-husband stated he had witnessed men would pick on the Veteran and grab her or try to force themselves on her. However, in a 2012 statement, it is clear that he did not personally witness these events, as he states he did not know about them until years after the Veteran left the service. His statement is also based on what friends later told him - for example, an incident where a guy waited for the Veteran in her room nude. Regardless, even if the events occurred as the Veteran alleges, the evidence must demonstrate a relationship between the in-service events and her current psychiatric disabilities. As discussed below, the Board finds that the more probative evidence does not demonstrate such a relationship. After a review of all the evidence of record, both lay and medical, the Board finds that the weight of the evidence demonstrates that the Veteran did not have any symptoms of an acquired psychiatric disability during active service, nor were symptoms of an acquired psychiatric disability unremitting during active service. Both the July 1972 enlistment and March 1974 separation examination reports show a normal psychiatric evaluation, and she did not report any psychiatric symptoms at the time of separation. Indeed, she checked "no" next to "depression or excessive worry" and "nervous trouble of any sort" on her Report of Medical History, completed as part of the separation examination. In short, the Veteran's service treatment records are negative for any signs, symptoms, reports, complaints, findings, or diagnoses of any psychiatric disabilities. Further, her service personnel records do not indicate any psychiatric problems, as her performance was noted to be good throughout her military service. Next, having reviewed the evidence of record, the Board finds that the weight of the evidence is against a finding that the Veteran's current psychiatric diagnoses other than PTSD are related to active service. Symptoms of a psychiatric disability have not been unremitting since service separation in March 1974. Following service separation in March 1974, the evidence of record shows no mention of psychiatric symptoms until April 2000, when a private treatment note lists depression in the Veteran's past medical history; no current symptoms were reported at the time, however. Moreover, at the November 2007 Board hearing, the Veteran testified that her first psychiatric treatment and diagnosis of depression was in 2002. Indeed, the first chronological documentation of treatment or diagnosis of a psychiatric disability is from April 2002, when the Veteran reported having occasional suicidal ideation and was diagnosed with anxiety and depression. Notably, at the time, she denied any history of physical or sexual abuse, stating that she was overworked and stressed out. She was psychiatrically hospitalized for one day, and, during that time, she did not report any military stressors, but rather stated that she was overwhelmed at work. Thus, there is no showing of any findings, diagnosis, or treatment of an acquired psychiatric disability for more than 25 years after service separation, which tends to weigh against a finding of unremitting symptoms of an acquired psychiatric disability after service separation. See Buchanan, 451 F.3d 1336 (the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible). Other evidence of record showing that symptoms of an acquired psychiatric disability were not continuous since service includes the April 2002 private treatment notes in which there is no indication that the Veteran related her current psychiatric symptoms to her active service and in which she denied any history of sexual or physical abuse; rather, she attributed her stress and other symptoms to being overwhelmed at work. These statements, made in the context of seeking treatment, and the lack of any report of military stressors, provide highly probative evidence against her claim. In addition, in August 2003, the Veteran underwent a psychological evaluation for the purpose of applying for Social Security Disability benefits. Again, she did not report any history of military stressors. Rather, she reported that her parents physically abused her as a child, and that her ex-husband also physically abused her. She stated that she had been suffering from depression for some time, and that she had also suffered from anxiety since the worsening of her physical condition. Again, the Veteran's failure to relate her psychiatric symptoms to military events provides probative evidence against her claim. A January 2004 VA treatment note indicates that the Veteran denied any form of abuse during her military service. The same note indicates she did report physical abuse by her husband, emotional abuse by her mother and husband, and sexual abuse by her brother and a neighbor at the age of seven. Thus, the Veteran's specific denial of any type of abuse in the military is highly probative evidence against her claim of unremitting psychiatric symptoms since service. During a March 2004 psychological evaluation, the Veteran again failed to report any military-related stressors. Rather, she reported sexual abuse by her brother and a landlord and physical abuse by her ex-husband. While the Veteran is competent to report the onset of her psychiatric symptoms, her more recent assertions made in the context of the current disability claim of unremitting psychiatric symptoms since service are outweighed by the other, more contemporaneous, lay and medical evidence of record, both in service and after service, and are not reliable. See Charles v. Principi, 16 Vet. App. 370 (2002). The Board finds that the Veteran's assertion of unremitting psychiatric symptoms after service is not accurate because it is outweighed by other evidence of record that includes the more contemporaneous service separation examination report which is negative for any psychiatric findings, symptoms, or diagnoses, the lack of any documentation of treatment or diagnosis of psychiatric disabilities until at least 2000, and the Veteran's attribution of her psychiatric symptoms to either pre- or post-service stressors including sexual abuse by her brother and landlord and to work in 2002, 2003, and 2004 private and VA treatment notes, with no mention of the military sexual harassment she now alleges. As such, the Board does not find that the evidence sufficiently supports unremitting psychiatric symptomatology since service, so as to warrant a finding of a nexus between the current psychiatric disabilities and active service. Moreover, the Board finds that no competent medical opinions are of record which support a relationship between the current psychiatric disabilities and active service. Here, the Veteran was afforded a VA examination in June 2010, and the same VA examiner reviewed the Veteran's claims file and provided an addendum opinion in October 2012. In the October 2012 report, the VA examiner opined that the Veteran's diagnosis of major depressive disorder was not caused by or exacerbated by her military service or reported sexual harassment. The VA examiner pointed to a number of medical records that indicated the Veteran was sexually abused as a child, and stated that it was more likely that the onset of any mental health condition began with this history of sexual abuse. However, because she was considered sound at the time of her enlistment, there was no loss of functioning related to any possible pre-existing mental health condition. Further, the VA examiner noted that there was no evidence in the service treatment records or military personnel records to suggest any decline of functioning or complaints of any mental health problems. In fact, the examiner noted that her performance reports indicated very good performance. The examiner further noted that there was no record indicating treatment for psychiatric reasons from the time of discharge in 1974 until 2002, when she was seen at a hospital for post-service stressors. Moreover, the Veteran's application for Social Security Disability benefits indicates her psychiatric symptoms began in September 2001, many years after separation from service. In sum, none of the early records attributed the Veteran's symptoms to sexual harassment in the military. Indeed, there were a number of records that indicated the Veteran had denied any history of military sexual trauma (e.g., the January 2004 VA treatment note mentioned above). Both VA and private treatment records noted depressive symptoms secondary to medical problems, including chronic pain, fibromyalgia, and possible chronic fatigue. It was not until 2007 that the Veteran reported the experience of military sexual trauma. The VA examiner acknowledged that the Veteran reported being physically abused by her ex-husband, noting that she married him in December 1973 and was discharged from the military in March 1974. The examiner stated that while it is completely unknown whether the Veteran was physically abused during the first three or four months of her marriage, the examiner opined that it is less likely that there were any significant relationship issues during those first few months of the marriage. Rather, the VA examiner stated the Veteran's emotional issues were more likely to have been exacerbated by the reported physical abuse received during the subsequent twelve years of marriage rather than any potential relationship issues during those first three or four months when she was on active duty. Finally, the VA examiner opined that it is unlikely that the Veteran would experience any ongoing emotional distress because a dentist got on her case about failure to maintain adequate dental hygiene during active service. The October 2012 VA opinion is competent and probative medical evidence because it is factually accurate, and is supported by an adequate rationale. The VA examiner was informed of the pertinent evidence, reviewed the claims file, interviewed and examined the Veteran in 2010, and fully articulated the opinion. Further, the VA examiner's opinion is supported by the other medical evidence of record; specifically, VA treatment records consistently list the Veteran's diagnosis as depression secondary to medical issues (while a separate diagnosis of PTSD is attributed to military sexual trauma). Thus, the Veteran's VA treatment providers have attributed the non-PTSD psychiatric diagnosis to non-military-related events/issues. Moreover, there have been no physicians who have related the Veteran's current acquired psychiatric disabilities to her active service. Thus, the probative nexus opinion on file weighs against a finding of direct service connection for acquired psychiatric disability other than PTSD. Based on the evidence of record, the weight of the competent evidence demonstrates no relationship between the Veteran's current psychiatric disabilities, variously diagnosed as depression and anxiety, and her military service, including no credible evidence of unremitting symptoms of a psychiatric disability during active service, unremitting symptomatology of a psychiatric disability following service separation, or competent medical evidence establishing a link between the currently diagnosed acquired psychiatric disabilities and active service. Therefore, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for an acquired psychiatric disability, and outweighs the Veteran's more recent contentions regarding in-service unremitting psychiatric disability symptoms and post-service psychiatric disability symptoms. For these reasons, the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The notice requirements of VCAA require VA to notify the claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. The Board notes that a "fourth element" of the notice requirement requesting the claimant to provide any evidence in the claimant's possession that pertains to the claim was removed from the language of 38 C.F.R. § 3.159(b)(1). See 73 Fed. Reg. 23,353-356 (April 30, 2008). The Court issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. In a timely October 2005 letter, the RO provided notice to the Veteran regarding what information and evidence is needed to substantiate a claim for service connection, what information and evidence must be submitted by the Veteran, and what information or evidence VA will attempt to obtain. In addition, the April 2006 rating decision described how VA determines disability ratings and effective dates. The Board finds that any untimeliness in providing Dingess notice is nonprejudicial, as the Veteran had ample opportunities subsequent to the April 2006 rating decision to submit additional evidence; moreover, the Board has not reached the issues of disability rating and effective date herein. The Board is also satisfied VA has made reasonable efforts to obtain relevant records and evidence. Specifically, the information and evidence that has been associated with the claims file includes the Veteran's service treatment records, service personnel records, post-service VA and private treatment records, a VA opinion, and the Veteran's statements. In that regard, the Board finds that there was substantial compliance with its August 2012 remand directives, in that the service personnel records were associated with the claims file, and the June 2010 VA examiner reviewed the personnel records and provided an addendum opinion. As noted above, the Veteran was afforded a VA examination in June 2010, and an addendum opinion was obtained in October 2012 with regard to the question of whether the Veteran's current psychiatric disabilities are related to active service. To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the October 2012 VA opinion obtained in this case is adequate as to the question of whether the Veteran's current psychiatric disabilities are related to active service. The opinion was predicated on a full reading of the private and VA medical records in the Veteran's claims file, as well as a complete psychiatric evaluation in 2010. The VA nexus opinion considered all of the pertinent evidence of record, to include VA treatment records, comprehensive physical examinations, and the statements of the Veteran, and provides a complete rationale for the opinion stated, relying on and citing to the records reviewed. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the claim decided herein has been met. 38 C.F.R. § 3.159(c)(4). The Board acknowledges the Veteran's June 2011 statement in which she suggests that the June 2010 VA examination is inadequate as the VA examiner spent only twenty minutes with her and did not ask many questions. She also takes issue with the statement in the VA examination report that she suffered sexual abuse at the hands of her brother and landlord. There is a presumption of the competency of the examiner and the adequacy of the opinion unless a specific challenge is made as to adequacy or competency. See Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011) (holding that the Board is entitled to presume the competence of a VA examiner and the adequacy of his opinion); Cox v. Nicholson, 20 Vet. App. 563 (2007) (holding that the Board may assume the competency of any VA medical examiner as long as, under 38 C.F.R. § 3.159(a)(1), the examiner is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Moreover, while the Board is entitled to assume the competency of a VA examiner, the "appellant bears the burden of persuasion to show that such reliance was in error." See Hilkert v. West, 12 Vet. App. 145, 151 (1999), aff'd, 232 F.3d 908 (Fed. Cir. 2000); see also Berger v. Brown, 10 Vet. App. 166, 169 (1997). The Board notes that the Veteran has not challenged the VA examiner's professional credentials. Further, a review of the June 2010 VA examination report shows that the examiner spent 90 minutes interviewing her and 130 minutes conducting psychological testing of the Veteran for an examination lasting a total of 220 minutes. In addition, private treatment notes from 2004 reveal a history of sexual abuse by the Veteran's brother and a neighbor, and the Veteran reiterated this history at the 2007 Board hearing. Thus, the Board finds that the Veteran's allegations as to the adequacy of the June 2010 VA examination are without merit. Notably, the Veteran has not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). ORDER Service connection for an acquired psychiatric disability other than PTSD is denied. REMAND The Board notes that the Veteran's post-service VA treatment records show a diagnosis of PTSD. In a precedent decision, Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Court held that the scope of a service connection claim for a mental disability is not restricted to the specific diagnosis alleged by the claimant, but includes any mental disability which may reasonably be encompassed by the claimant's description of the claim, the reported symptoms, and other information of record. Here, the Veteran has been diagnosed with PTSD by her treatment providers, which has not been included in the RO's adjudications of the claim. Thus, to assure the Veteran full due process, because there are indications of a diagnosis of PTSD in the file, the Board concludes that this matter must be remanded for consideration of this claim pursuant to the Clemons precedent. The Board defers to the RO as to whether, on remand, a medical examination is required in order to reconcile the various diagnoses of record or obtain a nexus opinion. Accordingly, the issue of entitlement to service connection for PTSD is REMANDED for the following action: 1. After completing any development deemed necessary, adjudicate the Veteran's claim for service connection for PTSD, in light of the holding in Clemons v. Shinseki, supra. If any benefit sought is not granted, furnish the Veteran and her representative with a Statement of the Case and afford a reasonable opportunity to respond. 2. If, and only if, the Veteran files a substantive appeal as to that issue, return the case to the Board for appellate review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs