Citation Nr: 1328581 Decision Date: 09/06/13 Archive Date: 09/16/13 DOCKET NO. 08-13 004A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD A.E.H. Gibson, Associate Counsel INTRODUCTION Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The Veteran served on active duty from November 1959 to February 1962. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which denied the above claim. In April 2012, the Board remanded this matter for further development. 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 Unfortunately, another remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. The Veteran had a VA examination in July 2013, but an addendum is needed because the current report is inadequate for adjudicatory purposes. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (if the VA provides an examination for the purpose of eliciting evidence, then the examination must be adequate). Specifically, the examiner did not address all of the Veteran's psychiatric diagnoses. McClain v. Nicholson, 21 Vet. App. 319 (2007). She also did not address all of the items listed in the Board's remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions). Finally, she indicated that she could not opine on whether any of his psychiatric diagnoses are related to service without resorting to speculation, but she did not indicate what information she would need in order to form an opinion, or whether the inability to provide an opinion was based on the limits of medical knowledge. Jones v. Shinseki, 23 Vet. App. 382 (2010). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Make arrangements to obtain any updated VA treatment records from February 2013 forward. Request the Veteran identify any private treatment he has received for his psychiatric disorders, and make arrangements to obtain all records identified that are not already of record. 2. Schedule the Veteran for a VA psychiatric examination by a psychologist or psychiatrist. Any indicated tests and studies, to include psychological studies, are to be conducted. The examiner is asked to address the following items, and to provide a full explanatory rationale for all opinions rendered. i. Provide a diagnosis of any acquired psychiatric disorder found to be present. Specifically determine whether the Veteran has PTSD. ii. If PTSD is found, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that his PTSD was caused by (a) service during the Cuban Missile Crisis and/or the Bay of Pigs, (b) guilt from training soldiers who were sent to Vietnam, or any other stressor he endorses during the examination. Please address whether either of these stressors resulted in fear of hostile military or terrorist activity. iii. In regard to any other psychiatric disorder found during the examination or during the pendency of this claim, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any current psychiatric disorder had its clinical onset during service or is related to any in-service event or injury, including the stressors listed directly above. iv. In regard to whether a pre- existing psychiatric condition was aggravated, please answer the following questions: a. Is it undebatable that the Veteran had a psychiatric disorder that pre-existed his entry into active service? b. If any diagnosed psychiatric disorder undebatably pre-existed entry into active duty, was it aggravated during service, i.e., did it undergo a permanent increase in severity? c. If any diagnosed psychiatric disorder was aggravated by service, was the increase in severity due to the natural progression of the disorder, or was the increase beyond the natural progression of the disorder? Although required to review the entire claims file, including electronic records, the examiner's attention is called to the following: i. The Veteran was on active duty from February 1959 to February 1962. ii. At a September 1958 pre-induction examination, the Veteran received an abnormal clinical evaluation and the report notes "Nervous individual - anxiety nervousis." At his November 1959 induction and January 1962 separation examinations, he had a normal clinical evaluation. iii. Records show the Veteran was prescribed Serax for anxiety from at least June 1979 through June 1994; and has been taking trazodone to treat his mood and insomnia from at least October 2003 through the present. iv. The Veteran has a history of alcohol dependence from at least September 1975 to July 1994. v. Treatment providers have noted that his symptoms consistent with PTSD tend to "wax and wane" (VA treatment dated January 2006, March 2011, October 2011). During the pendency of this claim, he has also been diagnosed with anxiety, depression, major depression, dysthymic disorder, and adjustment disorder. vi. A May 2006 VA treatment record notes that test results indicate that he probably experienced trauma, which continues to cause distress and anxiety. The examiner is asked to consider the Veteran's statements regarding incidents experienced in service, and to provide an opinion on each of the Veteran's diagnosed psychiatric disorders that cites to the medical findings leading to the conclusions. If an opinion cannot be expressed without resort to speculation, discuss why such is the case. Indicate whether the inability to provide a definitive opinion is due to a need for further information or because the limits of medical knowledge have been exhausted regarding the etiology of the disability at issue or because of some other reason. 3. Review the medical examination report obtained to ensure that the remand directives have been accomplished, and return the case to the examiner if all questions posed are not answered. 4. Finally, readjudicate the claim on appeal. If the claim remains denied, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate time for response. The Veteran has the right to submit additional evidence and argument on the matter 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). _________________________________________________ P.M. DILORENZO 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).