Citation Nr: 1329219 Decision Date: 09/12/13 Archive Date: 09/20/13 DOCKET NO. 12-24 643 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for a right wrist disorder. REPRESENTATION Appellant represented by: Oregon Department of Veterans' Affairs ATTORNEY FOR THE BOARD B. Rideout, Associate Counsel INTRODUCTION The Veteran had active duty service from November 2006 to September 2007. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2009 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. The Veteran's representative submitted a VA Form 9 requesting a Board hearing at the local VA office. In a May 2013 letter, the RO notified the Veteran that a hearing had been scheduled in June 2013. This letter was returned to the RO as undeliverable; however, a notation in the claims file indicates that the RO re-mailed this notice to the Veteran's correct address later in May 2013. The Veteran failed to appear for this hearing. The Veteran has offered no explanation as to why she failed to appear for the scheduled hearing. Nor has she or her representative requested that the hearing be rescheduled. Accordingly, the Board will consider the Veteran's hearing request withdrawn. See 38 C.F.R. § 20.704(d) (2012). The Board also notes that, in addition to the paper claims file, there is a Virtual VA paperless claims file associated with the Veteran's claim. A review of the documents in that file reveals that there are VA medical records dated from December 2008 to May 2012. These records were considered in the July 2012 statement of the case (SOC), and the remaining documents are either duplicative or irrelevant to the issues on appeal. 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 Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that she is afforded every possible consideration. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2012). With respect to PTSD, the record contains conflicting evidence as to whether the Veteran has a diagnosis. In this regard, the December 2008 VA examiner noted that testing had revealed two positive scores for PTSD, but he felt that the test with the best diagnostic utility showed negative results. Instead, the examiner diagnosed the Veteran with major depression and adjustment disorder, which are already service-connected. However, VA medical records indicate that PTSD is an active problem for the Veteran, and in June 2010, a VA psychiatric nurse practitioner diagnosed the Veteran with PTSD. Moreover, there is no medical opinion addressing whether any current diagnosis of PTSD may be related to her military service. Therefore, the Board finds that an additional VA examination and medical opinion are necessary to determine the nature and etiology of any PTSD that may be present. In regards to the claimed right wrist disorder, the Board notes that the December 2008 VA examiner diagnosed the Veteran with a chronic right wrist strain, yet did not provide any opinion on its etiology. Once the VA undertakes the effort to provide an examination for a service connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Therefore, the Board concludes that a medical opinion is necessary to determine the etiology of the Veteran's current right wrist disorder. Accordingly, the case is REMANDED for the following action: 1. The RO/AMC should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for her claimed PTSD and right wrist disorder, including any emergency room visits. After acquiring this information and obtaining any necessary authorization, the RO/AMC should obtain and associate these records with the claims file. The RO/AMC should also obtain any outstanding VA medical records dated from May 2012 to the present. 2. After the above development has been completed and all outstanding treatment records have been associated with the claims file, the Veteran should be afforded a VA psychiatric examination to determine whether the Veteran has PTSD related to her military service. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed, but should include psychological testing, including PTSD sub scales. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's post-service medical records, her lay statements and assertions, and prior VA examination reports. It should be noted that the Veteran is already service-connected for major depression and adjustment disorder. The Veteran has claimed that she was sexually harassed during her military service. The examiner should also note that the Veteran is competent to attest to observable symptomatology and matters of which she has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should determine whether the diagnostic criteria to support the diagnosis of PTSD have been satisfied. If the PTSD diagnosis is deemed appropriate, the examiner should then comment upon the link between the current symptomatology and any verified in-service stressor, including sexual harassment. If the examiner determines that the Veteran does not have a diagnosis of PTSD, he or she should provide a rationale that addresses the other evidence of record documenting the Veteran as having PTSD. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1, copies of all pertinent records in the appellant's claims file, or in the alternative, the claims file, must be made available to the examiner for review 3. The RO/AMC should refer the Veteran's claims folder to the December 2008 VA examiner or, if he is unavailable, to another suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of any right wrist disorder that may be present. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post- service medical records, and statements. The Veteran has contended that she currently has a right wrist disorder developed as a result of a personal assault in service. She has stated that a man grabbed her wrist and hand and twisted them. It should be noted that the Veteran is competent to attest to observable symptomatology and matters of which she has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should state whether it is at least as likely as not that the Veteran's current right wrist disorder is related to her military service, including an assault therein. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. because it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1, copies of all pertinent records in the appellant's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claims should be readjudicated based on the entirety of the evidence. If the claims remain denied, the Veteran and her representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. The appellant has the right to submit additional evidence and argument on the 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). _________________________________________________ JESSICA J. WILLS 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).