Citation Nr: 1329233 Decision Date: 09/12/13 Archive Date: 09/20/13 DOCKET NO. 11-11 906 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to service connection for Post-Traumatic Stress Disorder (PTSD), with anxiety and panic attacks. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Antoinette Chance, Associate Counsel INTRODUCTION The Veteran served on active duty with the United States Marine Corps from August 1965 to April 1969, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision by the Pittsburgh, Pennsylvania, Regional Office (RO) of the United States Department of Veterans Affairs (VA), which denied service connection for Post-Traumatic Stress Disorder (PTSD), with anxiety and panic attacks. The Veteran testified at an August 2011 hearing held before the undersigned via videoconference from the RO; a transcript of the hearing is associated with the claims file. At that time the Veteran also submitted statements from his VA licensed social worker, along with waivers of initial RO consideration. The Board notes that in addition to the paper claims file, there is a Virtual VA electronic claims file associated with the Veteran's claims. A review of the documents in the electronic file reveals that they are either duplicative of the evidence in the paper files or are irrelevant to the issue 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 The Veteran contends that his combat experiences during the Vietnam War were the stressors that caused his current PTSD and that he is entitled to service connection on that basis. The Board notes that the Veteran's claimed stressors related to his combat experiences were verified by the U.S. Army & Joint Services Records Research Center (JSRRC) in July 2010. The Veteran's claim has been denied based upon the question of whether he currently has PTSD. A review of the claims file reveals that there are conflicting VA medical opinions as to that question. In view of this, the Board is of the opinion that further development is warranted prior to adjudication of the claim on the merits. Specifically, the Veteran began treatment with a VA Licensed Clinical Social Worker (LCSW) in December 2009. During that initial assessment, LCSW diagnosed the Veteran with Chronic/Moderate PTSD after the Veteran explained that he was suffering from sleep disturbance with vivid nightmares, flashbacks, exaggerated startle response, and frequently sitting in positions that face the door as a result of his combat experiences in the military. The same LCSW upheld his PTSD diagnosis in subsequent letters to the Veteran's representative submitted in May 2011 and August 2011. However, in July 2010, the Veteran underwent a VA PTSD examination by a doctorate-level licensed Psychologist who declined to render a PTSD diagnosis, or any other diagnosis on Axis I. The examiner opined that the Veteran did not meet the PTSD criterion because his accounts of stressor-related experiences lacked detail and there was no evidence of hypervigilance, hyper-alertness, or hyperarousal. Further, he opined that the Veteran appeared to have socialized normally since his separation from service. Due to the contradictory opinions, the Board finds that a new VA examination and opinion is required to reconcile the conflicting medical opinions of record and determine whether the Veteran has a psychiatric disorder due to service. Such will ensure full compliance with VA's duty to assist the Veteran in substantiating his claim. See 5103A; 38 C.F.R. §§ 3.159, 3.326. Accordingly, the case is REMANDED for the following action: 1. Schedule the Veteran for VA PTSD examination with a licensed psychiatrist to clarify the conflicting evidence in the record. The entire claims file (i.e. both the paper claims file and any medical records contained in Virtual VA) must be made available to and reviewed by the examiner in conjunction with the examination. If the examiner does not have access to Virtual VA, any treatment records contained in Virtual VA file must be printed and associated with the paper claims file. The examiner must note in the examination report that the evidence in the claims file has been reviewed. The examiner must provide an opinion as to whether the Veteran has any current psychiatric disability, to include PTSD, and if so, whether it is at least as likely as not (50 percent probability or greater) that the diagnosis is directly related to his military services, including any in- service stressor. (For the purposes of this examination, the examiner is advised that the Veteran's claimed stressors have been confirmed by JSRRC in a July 2010 report, and the examiner is referred to that document for any additional information regarding the stressors that have been confirmed.) A full and complete rationale for any opinion expressed is required. The examiner must address the allegations in the lay evidence of record in light of the fact that lay testimony can be sufficient to establish a nexus. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given the medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). Jones v. Shinseki, 23 Vet. App. 382 (2010). Also, the examiner must provide comments on the two conflicting opinions regarding the existence of a current psychiatric disability set forth in the December 2009 initial social work assessment and in the July 2010 VA PTSD examination opinion. 2. Review the claims file to ensure that all of the foregoing requested development is completed, and arrange for any additional development indicated. Then re-adjudicate the claim on appeal. If the benefit sought remains denied, issue an appropriate supplemental statement of the case and provide the Veteran and his representative the requisite period of time to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. 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). _________________________________________________ MICHAEL A. PAPPAS 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).