Citation Nr: 18141610 Decision Date: 10/11/18 Archive Date: 10/10/18 DOCKET NO. 15-10 422A DATE: October 11, 2018 REMANDED Entitlement to service connection for degenerative disc disease of the lumbar spine is remanded. Entitlement to service connection for osteopenia is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), cognitive disorder, and/or depression, is remanded. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Air Force from September 1988 to September 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).   REASONS FOR REMAND 1. Entitlement to service connection for degenerative disc disease of the lumbar spine is remanded. The Veteran’s VA treatment records indicate degenerative disc disease of the lumbar spine, which he asserts began during service or arose from back injuries sustained in the course of his duty loading airplanes on the flight line. The Veteran asserted that he reported back pain on his separation examination, although he never visited sick call for back injuries during service. The Veteran’s assertion that he reported back pain upon separation indicates there might be a relationship between the current degenerative disc disease and any in-service injuries to the Veteran’s lumbar spine. Therefore, a remand is necessary to obtain an examination of this disability. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). On remand, the RO should also conduct a search for a full copy of the Veteran’s service treatment records, as the separation examination at which the Veteran reported low back pain is not currently of record. 2. Entitlement to service connection for osteopenia is remanded. The Veteran applied for service connection for osteoporosis, contending that immunizations given to him in connection with his deployment to Saudi Arabia during service. In support of this claim, he submitted an article reporting on a study linking osteoporosis to immunizations given in the British military. The Board finds that this article is sufficient to indicate that the current osteopenia, a precursor to osteoporosis, might be associated with any immunizations the Veteran received while in service. There is therefore a duty on VA’s part to obtain a medical opinion on this issue. See McLendon, 20 Vet. App. at 83 (threshold for finding a disability may be associated with service is low). 3. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, cognitive disorder, and/or depression, is remanded. The Veteran was afforded a VA psychiatric examination in February 2012, at which a cognitive disorder was diagnosed, and no diagnosis of PTSD was made. The examiner appeared to attribute the cognitive disorder to the Veteran’s reported substance abuse, despite reporting that psychotic symptoms and cognitive changes are generally viewed as acute and reversible. The examiner did not address or describe the Veteran’s reported stressors from his period of active duty service, noting only that he did not seek mental health treatment while in service. The Veteran was afforded a second VA psychiatric examination in March 2015; again, no diagnosis of PTSD was made, but the examiner did diagnose unspecified schizophrenia spectrum. The examiner opined that the schizophrenia was not related to the Veteran’s military experiences, but did not address the other diagnoses in the record, including bipolar disorder, depression, and the cognitive disorder diagnosed at the February 2012 VA examination. Further, the March 2015 examiner noted that the Veteran reported nightmares, but described these as dreams of military experiences that did not involve any threat of imminent danger. The Veteran has since asserted that he did not have the opportunity to describe the content of his nightmares during this examination. For all of these reasons, a new examination is necessary to determine whether any current psychiatric disorder is related to the Veteran’s military service. The matters are REMANDED for the following action: 1. Attempt to obtain any of the Veteran’s missing service treatment records. In particular, attempt to obtain the records relevant to the Veteran’s separation from service in September 1992, specifically any physical examinations performed in the latter part of the Veteran’s period of service and associated reports of medical history. These efforts must continue until service treatment records for this period of service are obtained or it is concluded that the records sought do not exist or that further efforts to obtain those records would be futile. If the records cannot be obtained, the Veteran must be notified in accordance with 38 C.F.R. § 3.159(e) and a formal finding of unavailability as to those service treatment records must be associated with the claims file. 2. Then, schedule the Veteran for an examination with an appropriate clinician to determine whether the current lumbar spine disability is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the Veteran’s separation examination if it is located. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 3. Schedule the Veteran for an examination with an appropriate clinician to determine whether the osteopenia is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that osteopenia began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the article in the record reporting on the British study of the relationships between immunizations and osteoporosis. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 4. Schedule the Veteran for an examination with an appropriate clinician to determine whether the any current psychiatric disorder is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all psychiatric disorders currently found. For each psychiatric disorder identified, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including (but not limited to) the diagnoses in the Veteran’s VA treatment records and VA examinations of PTSD, bipolar disorder, cognitive disorder, schizophrenia, and depression. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Josey, Associate Counsel