Citation Nr: 18142639 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 16-24 620 DATE: October 17, 2018 REMANDED ISSUES Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include bipolar disorder is remanded. REASONS FOR REMAND The Veteran had active service from July 1992 to May 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision by the Department of Veterans (VA) Regional Office (RO) in Phoenix, Arizona. In May 2017, the Veteran appeared at a videoconference hearing before the undersigned. A transcript of the hearing is of record. Entitlement to service connection for PTSD and an acquired psychiatric disorder, to include bipolar disorder. VA’s duty to assist a claimant includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on the claim. 38 U.S.C. § 5103A(d)(1) (2012); 38 C.F.R. § 3.159(c)(4) (2017). The medical examination provided must be thorough and contemporaneous and consider prior medical examination and treatment. Green v. Derwinski, 1 Vet. App. 121 (1991). To that end, when VA undertakes to provide a VA examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). An examination is adequate if it “takes into account the records of prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one.” Id. Moreover, an examination must be based upon consideration of the Veteran’s prior medical history and examinations. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran claims that his current psychiatric disorders, to include PTSD, are warranted because they developed as a result of his experience while on deployment in Kuwait. The Veteran submitted VA medical treatment records, which provide psychological diagnoses including PTSD and bipolar disorder. The Veteran was afforded a PTSD VA examination in April 2016. The examiner indicated that the Veteran did not have a diagnosis of PTSD, finding that the Veteran’s reported stressor event, “[d]eployment to Kuwait following the cessation of hostilities in 1992,” was not adequate to support a diagnosis of PTSD. The examiner provided diagnoses of stimulant (MDMA) use disorder and other specified bipolar and related disorder. The examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that there were no mental health reports in the Veteran’s service treatment records and no PTSD diagnosis. Moreover, the examiner indicated that the Veteran may have underreported his substance abuse, which, in the examiner’s opinion, could have contributed to his reported symptoms. However, the April 2016 VA examiner failed to specifically address certain evidence, including a June 2015 VA mental health evaluation performed by the Veteran’s treating psychiatrist which provided a diagnosis for PTSD. This evaluation notes that the Veteran was in control of the air combat squadron and worked as security patrol, training in the desert in Kuwait. The Veteran reported during that time, he witnessed SCUD missiles crashing into bunkers and always feared possible gas attacks. The psychiatrist found the Veteran’s reported stressor to be adequate to support the diagnosis of PTSD. In light of the above, a new VA examination and opinion is needed to address the nature and etiology of the Veteran’s claimed psychiatric disorders, to include PTSD and bipolar disorder. The matters are REMANDED for the following action: Schedule the Veteran for a new VA examination regarding the nature and etiology of his claimed psychiatric disabilities. If possible, an examiner different from the April 2016 examiner should conduct the examination. The electronic claims file must be made accessible to the examiner for review in conjunction with the examination. The examiner must complete the following: (a.) The examiner should identify all of the Veteran’s current psychiatric disorders. If any previously diagnosed disorder is not diagnosed, the examiner should provide a supporting explanation. (b.) If PTSD is diagnosed, the examiner should specify the stressor event on which the diagnosis is based, and in any event should indicate whether such diagnosis is related to a fear of hostile military or terrorist activity. (c.) For any other psychiatric disability diagnosed, the examiner should indicate whether it is at least as likely as not (50 percent or greater probability) that each currently diagnosed psychiatric disorder had its onset in service or is otherwise related to the Veteran’s military service. (d.) The examiner’s opinion should specifically consider the Veteran’s VA medical treatment records, which provide a mental health evaluation by the Veteran’s treating VA psychiatrist. An explanation for all opinions expressed must be provided. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Hite, Associate Counsel