Citation Nr: 1323120 Decision Date: 07/19/13 Archive Date: 07/24/13 DOCKET NO. 11-24 143 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and anxiety disorder, not otherwise specified (NOS). ATTORNEY FOR THE BOARD Devon Rembert-Carroll, Associate Counsel INTRODUCTION The Veteran had active service in the Army from May 1967 to May 1969. The matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2010 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. In Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009), the United States Court of Appeals for Veterans Claims (Court) held that a claim is not limited to the diagnosis identified by the Veteran. In this case, the Veteran has filed a claim for PTSD but the record shows other psychiatric diagnoses. As a result, the issue on appeal has been re-characterized on the title page. The Board notes that in May 2011 the Veteran revoked North Carolina Division of Veterans Affairs (NCDVA) as his representative. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran claims that he has an acquired psychiatric disorder due to his traumatic experiences in Vietnam. Further development of the evidence is necessary prior to an adjudication of the claim. At a December 2009 private examination, the Veteran reported that while stationed at Long Binh, Vietnam, during the Tet Offensive, he came under enemy fire on numerous occasions. He reported that he witnessed the deaths of fellow soldiers and others and saw wounded soldiers and others. In a January 2010 statement the Veteran reported that while stationed at Long Binh the unit received incoming fire. The Board finds that further clarification is necessary concerning the Veteran's reported in-service stressors. On remand, the Veteran should be asked to provide a two month date range of the attacks on his unit and should give the names of soldiers he witnessed being killed or injured. The Veteran was afforded a VA examination in August 2010. The examiner found that the Veteran did not meet the diagnostic criteria for PTSD but did diagnose the Veteran with anxiety disorder, NOS. The examiner stated that the Veteran reported a mix of minimal to mild anxiety symptoms and occasional but short-lived depressed mood over the past few years. The examiner stated that the Veteran's mild and occasional depressive symptoms did not appear to be related to his military service. The Board finds that the VA opinion is speculative in addressing whether or not the Veteran's anxiety disorder is related to service. Additionally, the VA examiner did not provide a rationale to support his opinion. Consequently, the opinion should be clarified on remand. Accordingly, the case is REMANDED for the following action: 1. Ask the Veteran to provide the names, addresses, and dates of treatment of all outstanding medical care providers, both VA and private, who have treated him for his acquired psychiatric disorder, to include PTSD and anxiety disorder, NOS. These should include any updated records from Louis Glogau, MA in Durham, NC. If any requested records cannot be obtained, the Veteran and his representative should be notified of such. 2. Contact the Veteran to obtain further details of his alleged stressors in service, including, but not limited to, the approximate date (within a two month range) and place of each stressor(s); the names, ranks, and units of persons involved; and the circumstances of the stressor(s). Particularly, the Veteran should provide detailed information regarding attacks on his unit. He should provide detailed information concerning the soldiers he witness being wounded or killed, including providing their names. The RO must inform the Veteran that he must be as specific as possible, and also identify potential sources of evidence to corroborate his stressors, such as copies of letters written during service and statements from individuals familiar with his claimed stressors, e.g. former fellow service members, including peers, subordinates, or superiors. The RO must notify the Veteran that failure to provide such information may result in an adverse determination. With any additional information provided by the Veteran, and with the evidence already of record, the RO must prepare a summary of the Veteran's reported service stressors. This summary must be prepared regardless of whether the Veteran provides an additional statement, as requested above. This summary and a copy of the Veteran's DD 214 and service personnel records, showing unit assignments and duties should be sent to the U. S. Army and Joint Services Records Research Center (JSRRC) for verification of the claimed stressors. It should be noted that the Veteran was part of the Vietnam Counter Offensive Phase III and that he served in Vietnam from October 8, 1967 to October 6, 1968. It should also be noted that while in Vietnam, he was with the 54th Ord Co (Ammo) (DS/GS). 3. After associating any outstanding evidence with the claims folder, send it to the VA examiner who prepared the August 2010 examination report (or if the examiner is no longer available, a suitable replacement). a) The RO must specify for the examiner the stressor or stressors which it has determined that the Veteran was exposed to in service and the examiner must be instructed to consider only those stressors in determining whether the Veteran has PTSD. The examiner should discuss whether or not the verified stressor or stressors change the conclusion that the Veteran does not meet the DSM-IV criteria for PTSD. If PTSD is diagnosed, the examiner should identify the independently verifiable in-service stressors supporting the diagnosis. If PTSD is not diagnosed, the examiner should explain why the diagnosis was not made. Additionally, if PTSD is not diagnosed, the examiner is asked to specifically comment on the favorable private medical opinions dated December 2009 and May 2010. A complete rationale is required for all opinions rendered b) The examiner should clarify whether it is at least as likely as not (at least a 50-50 probability) that the Veteran's anxiety disorder, (NOS) or any other psychiatric disorder found, is related to service, including to the Veteran's experiences while in Vietnam. The examiner should provide a complete rationale for every opinion given. An examiner's report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. As such, if the examiner is unable to offer an opinion, it is essential that the examiner provide a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. After the development requested above has been completed to the extent possible, the RO should again review the record. If any benefit sought on appeal, for which a notice of disagreement has been filed, remains denied, the Veteran should be furnished a supplemental statement of the case and given the opportunity to respond thereto. 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). _________________________________________________ K. OSBORNE Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).