Citation Nr: 18144098 Decision Date: 10/23/18 Archive Date: 10/23/18 DOCKET NO. 12-27 418 DATE: October 23, 2018 REMANDED The claim of entitlement to service connection for COPD, to include as due to asbestos exposure, is remanded. Entitlement to service connection for esophageal cancer, to include as due to asbestos exposure, is remanded. Entitlement to service connection for a psychiatric disorder, to include post-traumatic stress disorder (PTSD) and depression, is remanded. The claim of entitlement to service connection for hypertension, to include as secondary to a psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1970 to November 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).   1. Entitlement to service connection for COPD, to include as due to asbestos exposure 2. Entitlement to service connection for esophageal cancer, to include as due to asbestos exposure Remand is required to develop the Veteran’s claims that she was exposed to asbestos during her military service. The Veteran has submitted a June 2016 private opinion that attributes the development of her COPD to both her history of smoking and asbestos exposure. The private opinion is detailed, but it presupposes the Veteran’s exposure to asbestos and the evidence is unclear as to whether in-service asbestos exposure may be conceded. In a March 2010 submission, the Veteran stated that she was exposed to asbestos in her barracks while she served in the Army. Development undertaken thus far does not indicate she was exposed to asbestos in this capacity. The Veteran’s DD 214 indicates that her Military Occupational Specialty (MOS) was a Medical Specialist. In statements received in June 2016, the Veteran described serving in a hospital. The Veteran’s MOS may be analogous to the specialties of Hospitalman or Hospital Corpsman, which involve a “minimal” probability of asbestos exposure. Under such circumstances, asbestos exposure for purposes of scheduling an examination should be conceded. An opinion has already been provided, as noted above, but the Veteran’s MOS has not been addressed in any of the development undertaken for her claim of entitlement to service connection for COPD, to include as due to in-service asbestos exposure. On remand, efforts should be made to determine whether the Veteran’s MOS likely exposed her to asbestos. As the Veteran’s claim of service connection for esophageal cancer is also based on her contention that she was exposed to asbestos during service, this claim should also be remanded.   3. Entitlement to service connection for a psychiatric disorder, to include PTSD and depression Remand is required to provide an examination for the Veteran’s claim and for stressor development. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017). VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The RO did not provide the Veteran with an examination. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). In March 2010, shortly after submitting her service connection claim, the Veteran submitted a statement from CRW, a licensed clinical counselor. CRW had closed her practice in 2002 and no longer had records of her treatment of the Veteran. However, CRW stated that she worked extensively with the long-term effects of the trauma the Veteran experienced as a medical technician assigned to assist victims of prison riots at a penitentiary near Santa Fe, New Mexico. Regarding the prison riots stressor, the RO has denied the Veteran’s claim on the basis that her service during the prison riots was as a member of the National Guard and was not federally activated, but activated by the Governor of New Mexico pursuant to Title 32 U.S.C. However, the Veteran has since asserted that a psychiatric disorder is related to events that occurred during her active duty in the United States Army. In a statement received in July 2016, the Veteran asserted that she witnessed burn patients returning home from Vietnam, dead bodies, and working in a psychiatric hospital with soldiers who had returned home from Vietnam. In a June 2016 private opinion, Dr. MW opined that the Veteran has PTSD as a result of her exposure to the Santa Fe, New Mexico, prison riots during her state controlled National Guard service, but also opined that PTSD and depression originally started from trauma sustained during service. This opinion is inadequate to decide the claim because Dr. MW made no discussion of the traumas purportedly suffered during the Veteran’s active service. In addition, the Veteran’s VA treatment records do not document treatment for any psychiatric disorders. However, the Veteran does have a history of mental health treatment, she has described witnessing in-service events, and a private opinion does suggest a causal element. As such, the Board finds that remand is appropriate to provide an examination for the Veteran’s claim. 4. Entitlement to service connection for hypertension, to include as secondary to a psychiatric disorder The Veteran asserts she has hypertension due to her psychiatric disorder. As such, the Board finds that the issue of service connection for hypertension is inextricably intertwined with the issue of service connection for an acquired psychiatric disorder. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a veteran’s claim for the second issue). Remand of this issue is thus appropriate pending the adjudication of the Veteran’s psychiatric claim. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his or her representative. 2. Undertake appropriate efforts to determine the probability (minimal, probable, highly probable) the Veteran’s MOS (Medical Specialist) as a member of the United States Army exposed her to asbestos during her service from September 1970 to November 1971. 3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the nature and etiology of her claimed psychiatric disorder. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. First, the examiner must determine what psychiatric disorder is present, to include depression and PTSD. Second, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that each diagnosed psychiatric disorder had onset in, or is otherwise related to, active military service. The examiner must specifically address the following: 1) the Veteran’s July 2016 statement regarding witnessing burn patients returning home from Vietnam, dead bodies, and working in a psychiatric hospital with soldiers who had returned home from Vietnam; 2) Dr. MW’s opinion linking PTSD and/or depression to unspecified in-service traumas; and 3) lay statements from the Veteran’s sisters. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Steve Ginski, Associate Counsel