Citation Nr: 18143531 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 16-20 876 DATE: October 19, 2018 REMANDED Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a traumatic brain injury (TBI) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from January 2008 to January 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision. 1. Entitlement to service connection for a left shoulder disability is remanded. 2. Entitlement to service connection for a right shoulder disability is remanded. The Veteran asserts that he injured his shoulders in service (due to an extreme physical training regime while stationed with the Engineer Battalion from November 2008 to November 2010 in Okinawa) and that he has had shoulder symptoms ever since. See July 2014 notice of disagreement; May 2016 substantive appeal. There is conflicting evidence as to whether the Veteran received treatment for shoulder symptoms in service. First, in his July 2014 notice of disagreement, the Veteran stated he received physical therapy for his shoulders during his period of service in Okinawa. Thereafter, in his May 2016 substantive appeal, he suggested that he first reported should symptoms as soon as he was able to obtain primary care through the VA system, adding that he did not seek in-service medical attention because going to the battalion aid station was frowned upon. VA treatment records confirm that the Veteran complained of bilateral shoulder pain during an October 2012 VA primary care treatment consultation. See CAPRI records, received March 12, 2013, at 9. A subsequent July 2013 VA neurology consult note shows a history and diagnosis of chronic shoulder arthralgia. See CAPRI records, received September 21, 2015, at 121-124. The Veteran underwent an MRI of his right shoulder in January 2016, which revealed some degenerative changes, but no acute abnormality. See CAPRI records, received October 14, 2016, at 10. The Veteran has not been afforded a VA examination for his shoulders. As he has reported shoulder symptoms since service and VA treatment records show a current shoulder disability, the Board finds that a VA examination is warranted. 3. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Veteran seeks service connection for a mental health disability, claimed as PTSD and anxiety. He has asserted that his mental health problems started and related to his combat deployment in Afghanistan. See April 2014 VA mental health treatment note, in CAPRI records, received September 21, 2015, at 141. Service treatment records include an October 2011 post-deployment health assessment showing that the Veteran endorsed feelings of depression and anhedonia over the past month. See CAPRI records, received July 30, 2013, at 6. The Veteran underwent a VA examination in June 2013. The examiner concluded that the Veteran’s symptoms did not meet the diagnostic criteria for PTSD or any other mental disorder. VA treatment records, however, show medication and group therapy treatment for a mental health disability, diagnosed as depression, anxiety, PTSD, and substance use disorder. See VA mental health treatment notes from April 2013, April 2014, June 2014, and October 2014, in CAPRI records, received September 21, 2015, at 164-169, 135-136, 97-103, & 70-71, respectively. This evidence of VA treatment for a mental health disability contradicts the June 2013 VA examiner’s conclusion that the Veteran did not have a mental health disability. As such, the Board finds that a new VA examination is necessary. 4. Entitlement to service connection for a traumatic brain injury (TBI) is remanded. The Veteran seeks service connection for residuals of a possible traumatic brain injury (TBI), to include concentration problems. See October 2012 claim. He is already service-connected for cluster headaches. See May 2012 rating decision. The Veteran has not provided details for the asserted TBI. Nevertheless, service treatment records show that, April 2011, he was treated for burns to his right index and middle finger, related to an incident involving a smoke grenade. See service treatment records, received September 19, 2014, at 9. These records also show that, in November 2011, the Veteran sought treatment for a cyst on the top of his head. He reported a six-month history of symptoms, with the cyst gradually increasing in size. The examiner diagnosed traumatic cyst. Id. at 11. VA treatment records show complaints of short- and long-term memory loss. See, e.g., CAPRI records, received September 21, 2015, at 83. As already mentioned, his claim referenced concentration issues. As discussed above, the Veteran seeks service connection for a mental health disability, and his memory and concentration issues may very well be associated with such a disability. Notwithstanding, as the evidence shows that the Veteran was exposed to a smoke grenade explosion and his service treatment records show a traumatic cyst on the top of his head, his memory and concentration issues could also be manifestations of a neurocognitive disorder, to include residuals of a TBI. The Veteran has not undergone a VA examination for his claimed TBI residuals. Based on the evidence, the Board finds that such an examination would be useful. *** VA treatment records were last associated with the claims file in October 2016. On remand, the RO should obtain any outstanding VA treatment records. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from October 2016 to the Present. 2. Thereafter, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any bilateral shoulder disability. The examiner must opine whether any shoulder disability is at least as likely as not related to an in-service injury, event, or disease. The examiner must discuss the Veteran’s contention that his shoulder disability is related to extreme wear and tear due to extreme physical training in service. The examiner must consider the Veteran’s statement that he has had bilateral shoulder symptoms since service. The examiner must also opine whether any degenerative shoulder joint disability at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. Again, the examiner must consider the Veteran’s statement that he has had bilateral shoulder symptoms since service. 3. In addition, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any mental health disability. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor or to fear of hostile military or terrorist activity. If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease. The examiner must discuss the Veteran’s contention that his mental health symptoms started and related back to his tour of duty in Afghanistan. In this regard, an October 2011 post-deployment health assessment indicates that the Veteran endorsed feelings of depression and anhedonia in the past month. 4. In addition, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any neurocognitive disorder, to include residuals of a TBI, manifesting as concentration and memory problems. The examiner should explain the likely etiology of any memory or concentration issues (either reported or observed), to include whether they are manifestations of a mental health diagnosis or whether they are manifestations of a separate neurocognitive disorder. In the case of the latter, the examiner must opine whether any current neurocognitive disability is at least as likely as not related to an in-service injury, event, or disease, to include the documented smoke grenade explosion, the documented traumatic cyst on the top of the head, and any other injury reported by the Veteran. The examiner must also opine whether any separate neurocognitive disorder is at least as likely as not caused by the Veteran’s service-connected cluster headaches, or if not, then whether it is at least as likely as not aggravated (worsened beyond the natural progression) by the headaches. If aggravation is found, the examiner should identify baseline level of disability prior to such aggravation. ERIC S. LEBOFF Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. López, Associate Counsel