Citation Nr: 18142072 Decision Date: 10/12/18 Archive Date: 10/12/18 DOCKET NO. 14-42 387 DATE: October 12, 2018 REMANDED Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran had active service, to include the period from January 1968 to October 1970. Issues 1 to 3: Entitlement to service connection for a left hip disability, right knee disability, and an acquired psychiatric disorder to include PTSD. 1. During his October 2015 Board hearing, the Veteran testified that he has had problems with his right knee since it went out during service in boot camp. He also testified that in 2010 his right knee buckled up causing him to fall and break his left hip, which resulted in him undergoing a left hip replacement. He explained that he could not protect himself from the fall as he has functional impairment in his right upper extremity (residuals of a compound fracture of the right humerus with nerve root involvement of the right axillary and musculotaneous nerves), which the Board notes is a service-connected disability. The Veteran is competent to give evidence about what he has experienced or observed. Post-service treatment records in June 2010 show the Veteran underwent an arthroscopy with tricompartmental chondroplasty, major synovectomy, partial medial and lateral meniscectomy. The preoperative diagnosis was right knee arthritis with medial meniscal tear. Private medical records in February 2013 show that the Veteran had a right knee replacement in August 2012 and a left hip replacement in August 2010. Private medical records in October 2015 show that the Veteran had osteoarthritis in hips and knees. Thus, the Board cannot make a fully-informed decision on the issues of service connection for a right knee disability and left hip disability because no VA examiner has opined whether the Veteran’s right knee disability is due to service and whether his left hip disability is secondary to a service-connected disability. As for the Veteran’s acquired psychiatric disorder, during his October 2015 Board hearing, his representative contended that his February 2013 VA psychiatric examination is inadequate. He observed that the examiner did not opine whether the Veteran has a psychiatric disorder due to trauma as a result of being shot in service. The Veteran’s DD 214 shows that he is the recipient of the Purple Heart Medal and Combat Action Ribbon. Service treatment records in August 1969 show that during service in Vietnam the Veteran incurred multiple shrapnel wounds to his right eye, right neck, right shoulder, and right chest. He is in receipt of service connection for these injuries and has a 90 percent combined disability rating. In that regard, the Veteran indicated that pain from his multiple service-connected disabilities affected him mentally. Thus, a new VA psychiatric examination is necessary to determine whether the Veteran has a psychiatric disorder that is due to service or due to a service-connected disability.   The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his right knee disability and left hip disability. The examiner is asked to do the following: a.) Opine whether any right knee disability, to include residuals of right knee replacement, is at least as likely as not (50 percent or better probability) related to an in-service injury, event, or disease. In rendering the opinion, the examiner is asked to address the Veteran’s contentions that he has had problems with his right knee since it went out during service. b.) Opine whether any left hip disability, to include residuals of a left hip disability is at least as likely as not (50 percent or better probability) (a) caused, or (b) aggravated (worsened), by any right knee disability or by the following service-connected disabilities: residuals of compound fracture of the right humerus, injury of C-5 nerve root right axillary and right musculocutaneous nerve; residuals of shell fragment wound of the right eye; degenerative disc disease and foraminal stenosis of the cervical spine; tinnitus; bilateral hearing loss; tracheal bronchitis and shrapnel due to collapsed lung; scar on chest status post shell fragment wound; scars on neck status post shell fragment wound; and scars on right upper extremity status post shell fragment wound. In rendering the opinion the examiner is asked to address the Veteran’s contentions that in 2010 his right knee buckled up causing him to fall and break his left hip, which he needed to replace. He has explained that he could not protect himself from the fall as he has functional impairment in his right upper extremity. 2. Schedule the Veteran for a VA psychiatric examination to determine the current nature and likely etiology of any diagnosed psychiatric disorder. All tests deemed necessary, including psychological testing, should be performed and all findings should be reported in detail. After reviewing the claims folder and examining the Veteran the examiner must: a.) Offer an opinion as to whether the Veteran meets the DSM-5 criteria for a diagnosis of PTSD. If so, the examiner must provide an opinion as to whether the PTSD symptoms are related to fear of hostile military or terrorist activity during service, or alternatively whether the PTSD symptoms are related to the trauma from incurring multiple shrapnel wounds during service in Vietnam. b.) Offer an opinion as to whether the Veteran has any other psychiatric disorder per the DSM-5 criteria other than PTSD that is at least as likely as not (i.e., there is a 50 percent or greater probability) related to service, to include trauma from incurring multiple shrapnel wounds during service in Vietnam. c.) Opine whether any psychiatric disorder per the DSM-5 criteria other than PTSD is at least as likely as not (50 percent or better probability) (a) caused, or (b) aggravated (worsened), by any of the following service-connected disabilities: residuals of compound fracture of the right humerus, injury of C-5 nerve root right axillary and right musculocutaneous nerve; residuals of shell fragment wound of the right eye; degenerative disc disease and foraminal stenosis of the cervical spine; tinnitus; bilateral hearing loss; tracheal bronchitis and shrapnel due to collapsed lung; scar on chest status post shell fragment wound; scars on neck status post shell fragment wound; and scars on right upper extremity status post shell fragment wound. In rendering the opinion, the examiner is asked to address the Veteran’s October 2015 testimony that pain from his service-connected disabilities frustrated him and affected him mentally. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Mac, Counsel