Citation Nr: 1321071 Decision Date: 07/01/13 Archive Date: 07/12/13 DOCKET NO. 10-32 610 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of service connection for an acquired psychiatric disorder other than posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for an acquired psychiatric disorder other than PTSD. 3. Entitlement to service connection for PTSD. REPRESENTATION Appellant represented by: J. Michael Woods, Attorney ATTORNEY FOR THE BOARD Jennifer Hwa, Counsel INTRODUCTION The Veteran served on active duty from January 1981 to September 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 2009 and March 2011 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee, which reopened the Veteran's claim for service connection for an acquired psychiatric disorder other than PTSD and denied the claim on the merits, and denied the Veteran's claim for service connection for PTSD. In December 2012, the Board requested an independent medical expert (IME) opinion, and the IME opinion was obtained in January 2013. The Veteran was advised of her right to provide additional evidence or argument in response to that opinion. She submitted additional medical evidence in support of her claim on appeal with a waiver of initial RO consideration of the evidence. See 38 C.F.R. § 20.1304 (2012). The Board notes that, in addition to the paper claims file, there is a paperless, electronic (Virtual VA) claims file associated with the Veteran's claims. A review of the documents in such file reveals that they are either duplicative of the evidence in the paper claims file or are irrelevant to the issues on appeal. The issue of entitlement to service connection for PTSD is addressed in the REMAND portion of the decision below and is REMANDED to the Department of Veterans Affairs Regional Office. FINDINGS OF FACT 1. The April 2004 rating decision that denied service connection for an acquired psychiatric disorder other than PTSD was not appealed and is final. 2. Some of the evidence received since the April 2004 rating decision bears directly and substantially upon the specific matter under consideration, is neither cumulative nor redundant, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim for service connection for an acquired psychiatric disorder other than PTSD. 3. The evidence is at least in relative equipoise on the question of whether the Veteran's current acquired psychiatric disorder other than PTSD is related to her period of active service. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen the claim for service connection for an acquired psychiatric disorder other than PTSD. 38 U.S.C.A. § 5108 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156(b) (2012). 2. The criteria for establishing service connection for an acquired psychiatric disorder other than PTSD have been met. 38 U.S.C.A. §§ 1110, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304(b), 3.306, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012)) redefined VA's duty to assist a claimant in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). Given the Board's favorable disposition to reopen and grant the claim for an acquired psychiatric disorder other than PTSD, the Board finds that no discussion of VCAA compliance is necessary at this time. Analysis 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 the appellant 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 claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). New and Material Evidence A decision of the RO becomes final and is not subject to revision on the same factual basis unless a notice of disagreement is filed within one year of the notice of decision. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2012). If a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C.A. § 5108 (West 2002); see Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). New evidence means existing evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a) (2012). Furthermore, the Court of Appeals for the Federal Circuit has indicated that evidence may be considered new and material if it contributes "to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it will not eventually convince the Board to alter its ratings decision." Hodge v. West, 115 F.3d 1356, 1363 (Fed. Cir. 1998). VA must review all of the evidence submitted since the last final rating decision in order to determine whether the claim may be reopened. See Hickson v. West, 12 Vet. App. 247, 251 (1999). For purposes of determining whether new and material evidence has been received to reopen a finally adjudicated claim, the recently submitted evidence will be presumed credible. See Kutscherousky v. West, 12 Vet. App. 369, 371 (1999) (per curium) (holding that the "presumption of credibility" doctrine continues to be precedent). Service connection for an acquired psychiatric disorder other than PTSD was originally denied by a rating decision in July 1984. The Veteran attempted to reopen her claim thereafter, but the RO declined to reopen the claim in March 1985. The Board reopened the claim in April 1986, but denied the claim on the merits. Most recently, in April 2004, the RO again declined to reopen the claim for service connection for an acquired psychiatric disorder other than PTSD based on the fact that there was no evidence linking the Veteran's psychiatric disorder other than PTSD to her period of service. In October 2008, the Veteran filed her request to reopen the claim for service connection for an acquired psychiatric disorder other than PTSD. In the June 2009 rating decision on appeal, the RO determined that new and material evidence had been submitted to reopen the claim, but denied the claim on the merits. The evidence received subsequent to the April 2004 rating decision includes, in relevant part, VA and private medical records dated from February 2007 to February 2013, May 2009 and April 2013 VA examination reports, a January 2013 IME opinion, and the Veteran's statements. When determining whether the claim should be reopened, the credibility of the newly submitted evidence is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). As pertinent here, the Veteran asserted in an October 2008 statement that her acquired psychiatric disorder other than PTSD was due to or aggravated by her service-connected right salpingo-oophorectomy. Additionally, a February 2013 private medical opinion found that the stress experienced by the Veteran in regards to her right salpingo-oophorectomy resulted in her subsequent development of an acquired psychiatric disorder other than PTSD, namely bipolar disorder. Presuming the credibility of the evidence for the sole purpose of determining whether new and material evidence has been received, and after resolving all doubt in the Veteran's favor, the Board finds that the new evidence relates to an unestablished fact necessary to substantiate the claim. In this regard, the Veteran has essentially argued that her current acquired psychiatric disorder other than PTSD is secondary to a service-connected disability. The RO previously considered only whether service connection for an acquired psychiatric disorder other than PTSD was warranted on a direct basis. However, service connection may also be established for disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a) (2012). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Whereas the Veteran's claim for service connection for an acquired psychiatric disorder other than PTSD was previously adjudicated on a direct basis, this is a new theory of entitlement to service connection based on secondary service connection. Therefore, as the threshold for reopening a claim is low, the Board will resolve all doubt in the Veteran's favor and find that new and material evidence has been submitted to reopen the claim for service connection for an acquired psychiatric disorder other than PTSD. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Moreover, where a veteran served continuously for ninety (90) days or more during a period of war, or during peacetime service after December 31, 1946, and psychosis becomes manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). In order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Service connection may also be established for disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a) (2012). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran contends that she developed bipolar disorder, or some other acquired psychiatric disorder other than PTSD, in service. She alternatively contends that she developed a psychiatric disorder due to her already service-connected right salpingo-oophorectomy (which occurred during her service). Service treatment records show that in September 1982, the Veteran was admitted to the psychiatry department for three days and diagnosed with an adjustment disorder with anxiety. She later received an administrative separation from service, effective September 10, 1982. In May 1983, the Veteran complained of problems with insomnia in service and an approximately 1/2 month history of intermittent insomnia, mild anxiety, decreased libido, and occasional forgetfulness. The Veteran reported drinking eight cups of coffee a day. The examiner diagnosed her with caffeinism and adjustment disorder with anxious mood, recent. There are several VA medical records from January 1984 to January 1985 that document treatment for several disorders, including psychiatric complaints. In April 1984, the Veteran complained of increased irritability and stress as well as decreased sleep. The VA clinical psychologist diagnosed her with generalized anxiety disorder with depressed mood versus dysthymic disorder versus major depressive episode (not probable). A June 1984 VA narrative summary documented that the Veteran had complained of nerves since service. The examiner found her to present with symptoms of anxiety and depression. Subsequent VA medical records document continued treatment for psychiatric treatment that year, but no new psychiatric diagnoses. A January 1986 VA medical record documents the diagnosis of bipolar disorder, manic with psychosis and cannabis abuse. The examiner noted that the Veteran had presented to the VA emergency room and had been hospitalized from December 11, 1985 until January 10, 1986. Private medical records from the Whitehaven Mental Health Center document treatment from 1987 to 1996. The August 1987 initial evaluation included a diagnosis of bipolar disorder manic, in remission. VA medical records document complaints of, or treatment for, psychiatric symptoms. A September 1996 VA medical provider noted a diagnostic impression of bipolar disorder and general psychiatric complaints. For example, a September 2003 VA medical record noted that the Veteran had a history of drug abuse, including cocaine, marijuana, crack, and heroin. A February 2007 VA medical record documented that the Veteran had reported a history of bipolar disorder diagnosed in 1982 and being on medications until four years previously, but that she had since stabilized and was off her medication. An October 2008 VA psychology consultation note documented a diagnostic impression of bipolar disorder, depressed. The Veteran received a VA examination in May 2009, which included an examination of the Veteran and a review of the claims file. The examiner noted inconsistent reports of marijuana and alcohol use by the Veteran and past reports of cocaine use. The examiner noted that anxiety was a common feature of adjustment disorder (an abnormal response to a situation), but not related to or an outgrowth of bipolarity. The examiner also noted that the Veteran had a history of crack cocaine addiction, as well as marijuana and alcohol abuse, which often led to a misdiagnosis of bipolar disorder. The examiner found that the Veteran had not always been forthcoming about her substance abuse problems, and that this was likely related to other examiners' mistaking her agitation, insomnia, and irritability for bipolar disorder. The May 2009 VA examiner opined that the "Veteran does not come close to meeting criteria for Bipolar Disorder or display many symptoms associated with it, in the absence of cocaine use or to her substance abuse. Her history of drug use is the most likely explanation for the unusual behavior noted in her records. In my opinion there is no validity to the claim that this claimant's mood problems are related to the removal of her ovary in any way. This claimant has not had hospitalizations since she reportedly stopped using drugs." The examiner diagnosed her with adjustment disorder with anxiety and polysubstance dependence reportedly in full sustained remission. In an August 2010 VA psychiatry note, a VA physician examined the Veteran and reported that she had working diagnoses of: "Bipolar 1 mania, Cocaine abuse, r/o SIMD, r/o Substance induced psychosis." In January 2012, Dr. H.S. reported reviewing the claims file and noted that various health care professionals had diagnosed the Veteran with bipolar disorder, with the exception of the May 2009 VA examiner. Dr. H.S. found that although the Veteran received a diagnosis of adjustment disorder with anxiety while in service (September 1982), "with the benefit of hindsight and 20 years of examination, it is very clear that this was the beginning of her bipolar disorder...the medicines that were prescribed...trying to control bipolar symptoms." Dr. H.S. further noted that bipolar disorder "mimics many other mental illnesses and it is fairly typical not to be able to diagnose bipolar until you have examined a person several times over a long period of time." In February 2012, psychologist A.H.F. reported that he had reviewed the claims file and had interviewed the Veteran by telephone. A.H.F. found that the evidence supported continuing a diagnosis of bipolar disorder. A.H.F. further found that the Veteran "more likely than not as a consequence of events in the military, developed a bipolar disorder, which is ongoing, with substance abuse a secondary result." In a January 2013 IME opinion, the physician reviewed the Veteran's entire claims file. He found that the Veteran had developed a bipolar disorder that had been well-characterized by 1985. Her illness course was noted to be complicated by polysubstance abuse, inconsistent follow-through with mental health services, and inconsistent use of prescribed medication. The physician explained that substance abuse and inconsistent treatment were common in people with bipolar disorder, and that while they could initially make the diagnosis more confusing, the various symptoms could generally be distinguished over time. He also noted that the Veteran was 25 in 1982 during her in-service psychiatric admission and 28 in 1985 when she had well-established bipolar disorder. He explained that bipolar disorder could arise throughout this time period, and therefore, the age of the Veteran's potential disease onset was not helpful. The physician indicated that the Veteran's drug abuse could have been symptomatic of bipolar disorder, but that this was post-hoc thinking, as most people with drug abuse were not bipolar and did not go on to develop bipolar disorder. The physician opined that there was no support or evidence that the onset of the Veteran's bipolar disorder had occurred during her period of service. He explained that while one could always look back and see earlier problems as a harbinger of a later diagnosis, the pattern of the Veteran's problems did not seem to fit a bipolar picture because there were certainly no early signs of clearly manic behavior. Regarding the reports of irritability and insomnia during an April 1984 psychological consultation, the physician stated that these reports had to be considered in context, and the context did not seem to clearly fit mania. Although the Veteran had symptoms of depression, they were admixed with anxiety, substance use, and social stress. Her symptoms did not meet the criteria for a recurrent major depressive disorder that could present as the first part of what would later become mania. The physician also explained that any stress could be a potential part of the development of an illness, but opined that there was no reason to connect the particular stress of the Veteran's in-service salpingo-oophorectomy with the later development of her bipolar disorder. Finally, the physician concluded that a psychosis did not manifest within one year of discharge because the first clear description of any psychotic symptoms was in November 1995. He noted that there were vague suggestions that the Veteran may have had psychotic symptoms in 1994, but found this report to be unconvincing. In February 2013, psychologist A.H.F. responded to the January 2013 IME opinion. He asserted that there was indeed evidence of manic behavior in the Veteran's record. Specifically, he cited her intermittent difficulty with controlling her spending as well as her frequent mood variability. He stated that even though the demonstrated mania was not of a "full-blown type," given the subsequent development of the Veteran's condition, the behavior was as likely as not the first stage of bipolar development. The psychologist also noted that substance abuse, anxiety, social phobia, ADHD, and headaches were very common with people who had bipolar disorder, and that the Veteran had exhibited all of these symptoms during service. Although he agreed that most people with drug abuse were not bipolar and did not go on to develop bipolar disorder, he explained that it was quite often the case that people with bipolar disorder did go on to develop a variety of co-morbid disorders such as substance abuse, anxiety, and social phobia. The psychologist also found that the Veteran's bipolar disorder was related to the stress of her in-service salpingo-oophorectomy. He explained that the procedure involved in a salpingo-oophorectomy required 3 to 6 weeks for full recovery and that a person's reaction to the procedure depended upon a number of factors, including social support and a previous history of depression. He noted that the Veteran had become pregnant in service and that she had become stressed and found it difficult to control her emotions. She had not wanted to let others know about the pregnancy and had increased problems with mood swings. The psychologist concluded that the Veteran clearly had no real social support for her salpingo-oophorectomy and that her reactions were in the form of mood swings that continued with steadily increasing salience. On VA examination in April 2013, the Veteran reported that prior to her in-service surgery, she started being unable to sleep because she was so frightened. She stated that she began to have racing thoughts and felt as if something else had taken over her body. She also maintained that she thought people were watching her and that she heard voices. She indicated that she was subsequently hospitalized in the psychiatric ward. She complained of currently experiencing high and low moods. The Veteran was diagnosed with moderate bipolar I disorder, most recent episode depressed, and panic disorder with agoraphobia. Her panic attacks were attributed to her panic disorder, and her mood instability was attributed to her bipolar disorder. The examiner reviewed the January 2013 IME opinion and disagreed with the physician's conclusion that the pattern of the Veteran's problems in service had not seemed to fit a bipolar picture. He explained that the Veteran had reported not being able to sleep for several days, extreme agitation, and hearing voices. She had also complained of being extremely anxious about the surgery and fearing the possibility of dying. She indicated that after the surgery, she had experienced strong guilt over her previous thoughts about wanting to kill her baby. The examiner thus found that the Veteran's mental state and behavior in service were strongly suggestive of a mixed bipolar episode. Additionally, the examiner disagreed with the January 2013 physician's opinions that the Veteran's psychiatric disorder was not related to her in-service salpingo-oophorectomy or that a psychosis had not manifested itself within one year of her discharge from service. He found that the stressor of undergoing a salpingo-oophorectomy during service appeared to be clearly linked with triggering the Veteran's initial episode of problems with mood instability and anxiety that were associated with her panic disorder and bipolar disorder. He also opined that the Veteran's reported history supported the existence of a manifested psychosis prior to discharge from service. An evaluation of the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the examiner's knowledge and skill in analyzing the data, and the medical conclusion reached. The credibility and weight to be attached to such opinions are within the province of the Board as adjudicators. Guerrieri v. Brown, 4 Vet. App. 467 (1993); Gabrielson v. Brown, 7 Vet. App. 36 (1994). Greater weight may be placed on one physician's opinion over another depending on factors such as reasoning employed by the physicians and whether or not and the extent to which they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994). The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. Sklar v. Brown, 5 Vet. App. 140 (1993). Regarding whether the Veteran has a current diagnosis of bipolar disorder, the Board acknowledges that the May 2009 VA examiner found that the Veteran did not meet the criteria for a diagnosis of bipolar disorder and that her irregular behavior had been due to her substance abuse problems. He explained that the Veteran had been misdiagnosed with bipolar disorder by many physicians because the Veteran had not been forthcoming with them about her substance abuse problems. However, in January 2012, a private physician, Dr. H.S., found that although the Veteran had received a diagnosis of adjustment disorder with anxiety while in service, based on the benefit of hindsight and 20 years of medical examinations, her in-service symptoms were instead the clear beginning of her bipolar disorder. He noted that she had been prescribed medications that were used to control bipolar symptomatology. He also explained that bipolar disorder mimicked many other mental illnesses and that it was fairly common to be unable to diagnose a person with bipolar disorder until she had been examined several times over a long period of time. He further noted that other than the May 2009 VA examiner, various health care professionals had diagnosed the Veteran with bipolar disorder. Additionally, the January 2013 IME physician determined that the Veteran had developed a bipolar disorder that had been well-characterized by 1985, but that her illness course was noted to be complicated by polysubstance abuse, inconsistent follow-through with mental health services, and inconsistent use of prescribed medication. The physician explained that substance abuse and inconsistent treatment were common in people with bipolar disorder, and that while they could initially make the diagnosis more confusing, the various symptoms could generally be distinguished over time. With respect to whether the Veteran's acquired psychiatric disorder had its onset in service, the Board acknowledges the January 2013 IME physician's opinion that there was no support or evidence that the onset of the Veteran's bipolar disorder had occurred during her period of service. He explained that while one could always look back and see earlier problems as a harbinger of a later diagnosis, the pattern of the Veteran's problems did not seem to fit a bipolar picture because there were certainly no early signs of clearly manic behavior. Specifically, the April 1984 reports of irritability and insomnia did not seem to clearly fit the context of mania, and the Veteran's symptoms of depression, anxiety, substance use, and social stress did not meet the criteria for a recurrent major depressive disorder that could present as the first part of what would later become mania. However, the February 2012 and February 2013 private opinions by A.H.F. indicated that there was indeed evidence of manic behavior in the Veteran's record. Specifically, the Veteran had intermittent difficulty with controlling her spending as well as frequent mood variability, and even though the demonstrated mania was not of a "full-blown type," given the subsequent development of the Veteran's condition, the behavior was as likely as not the first stage of bipolar development. The psychologist also noted that substance abuse, anxiety, social phobia, ADHD, and headaches were very common with people who had bipolar disorder, and that the Veteran had exhibited all of these symptoms during service. Further, the April 2013 VA examiner also opined that the pattern of the Veteran's problems in service did fit a bipolar picture. He explained that the Veteran had reported not being able to sleep for several days, extreme agitation, and hearing voices. She had also complained of being extremely anxious about the surgery, fearing the possibility of dying, and experiencing strong guilt after the surgery about her previous thoughts of wanting to kill her baby. The examiner thus found that the Veteran's mental state and behavior in service were strongly suggestive of a mixed bipolar episode. The Board notes that in the above opinions, the various physicians and examiners all reviewed the Veteran's claims file, considered her lay statements regarding onset and symptomatology of her disorder, performed thorough mental examinations, discussed the Veteran's pertinent medical history, considered opposing opinions, and provided detailed and adequate rationale for the differing conclusions of whether the Veteran had a bipolar disorder that had its onset during service. For these reasons, the Board cannot find the negative May 2009 VA opinion and the January 2013 IME opinion to be more probative than that of the positive January 2012, February 2012, and February 2013 private opinions or the April 2013 VA opinion. Similarly, the Board cannot find that the positive January 2012, February 2012, and February 2013 private opinions and the April 2013 VA opinion are more probative than the negative May 2009 VA opinion and the January 2013 IME opinion. Thus, the overall record is in relative equipoise as to whether the Veteran's acquired psychiatric disorder other than PTSD had its onset during her period of service. Where the evidence supports the claim or is in relative equipoise, the appellant prevails. Thus, the criteria for service connection for an acquired psychiatric disorder other than PTSD have been met. Reasonable doubt is resolved in favor of the Veteran, and the Board finds that service connection for an acquired psychiatric disorder other than PTSD is warranted. 38 U.S.C.A. 5107 (b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER New and material evidence having been received, the claim of entitlement to service connection for an acquired psychiatric disorder other than PTSD is reopened. Entitlement to service connection for an acquired psychiatric disorder other than PTSD is granted. REMAND After a review of the record, the Board observes that further development is required prior to adjudicating the Veteran's claim of entitlement to service connection for PTSD. According to a January 24, 2012 letter in the Veteran's Virtual VA file, following the March 2011 rating decision denying service connection for PTSD, the Veteran expressed timely disagreement with such rating decision. As it appears that the Veteran has filed a timely notice of disagreement with the March 2011 rating decision, the Board is required to remand this issue for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). After the RO/AMC has issued the statement of the case, the issue should be returned to the Board only if the Veteran perfects an appeal in a timely manner. See Smallwood v. Brown, 10 Vet. App. 93, 97 (1997). The Board notes that it does not appear that the Veteran's notice of disagreement has been associated with either the claims file or Virtual VA claims file. Therefore, on remand, the Veteran's notice of disagreement with the March 2011 rating decision denying service connection for PTSD should also be associated with her claims file. Reasonable efforts should be undertaken to retrieve this document, to include affording the Veteran an opportunity to provide a copy of the document. Relevant ongoing medical records should also be requested. 38 U.S.C.A. § 5103A(c) (West 2002); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). Accordingly, the case is REMANDED for the following action: 1. The Veteran should be requested to provide the names, addresses and approximate dates of treatment of all medical care providers, VA and non-VA, who have treated her for PTSD. After the Veteran has signed the appropriate releases, those records should be obtained and associated with the claims folder. Appropriate efforts must be made to obtain all available VA treatment records. All attempts to procure records should be documented in the file. If the AMC/RO cannot obtain records identified by the Veteran, a notation to that effect should be inserted in the file. The Veteran is to be notified of unsuccessful efforts in this regard, in order to allow her the opportunity to obtain and submit those records for VA review. 2. Obtain the Veteran's notice of disagreement with the March 2011 rating decision denying service connection for PTSD and associate it with the claims file. All attempts to procure records should be documented in the file. If the AMC/RO cannot obtain this record, a notation to that effect should be inserted in the file. The Veteran is to be notified of unsuccessful efforts in this regard, in order to allow her the opportunity to obtain and submit this document for VA review. 3. Issue a statement of the case pertaining to the issue of entitlement to service connection for PTSD, so that the Veteran may have the opportunity to complete an appeal on this issue (if she so desires) by filing a timely substantive appeal. This issue should only be returned to the Board if a timely substantive appeal is filed. 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). ______________________________________________ WAYNE M. BRAEUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs