Citation Nr: 18145554 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 16-35 005 DATE: October 29, 2018 REMANDED The issue of entitlement to service connection for hypertension, is remanded. The issue of entitlement to service connection for erectile dysfunction, as secondary to hypertension, is remanded. The issue of entitlement to service connection for an acquired psychiatric disorder, to include depression, anxiety, and posttraumatic stress disorder (PTSD), and to include as secondary to the service-connected left knee disabilities, is remanded. REASONS FOR REMAND The Board finds that a remand is necessary to provide the Veteran with VA examinations for his service connection claims on appeal. The Veteran, who is the appellant in this case, served on active duty from November 1984 to April 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision dated September 2014 of the Department of Veterans Affairs (VA) Regional Office (RO) in Decatur, Georgia, which denied service connection for a depressive disorder, hypertension, and erectile dysfunction, secondary to hypertension. As reflected herein, the Board has broadened the claim for service connection for a depressive disorder to include depression, anxiety, and PTSD, and as secondary to service-connected left knee disabilities, and consideration of any currently diagnosed acquired psychiatric disorders. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Acquired Psychiatric Disorder, to include PTSD The Veteran asserts that he has PTSD, and that it was caused by a severe injury to his left knee and lack of proper medical care for the knee during service. See Statement in Support of Claim for Service Connection for PTSD dated August 20, 2015. To date, the Veteran has not been afforded a VA examination in response to this claim. Here, the Veteran’s post-service private and VA outpatient treatment records reflect psychiatric diagnoses that include depression and anxiety, as well as a positive VA PLC-C screening for PTSD. See Private outpatient record from C.G.I.M. dated May 13, 2009; VA primary care nurse practitioner notes dated February 6, 2013 and February 5, 2014; VA mental health outpatient notes dated April 11, 2014 and June 26, 2014. There are numerous references in the Veteran’s service treatment records to an in-service left knee injury and subsequent surgery. Additionally, post-service treatment records reflect a potential PTSD stressor arising from fear of hostile military or terrorist activity, as the Veteran reported being agitated, anxious, and depressed arising from his service in Sicily when the island was being threatened with attack by Libya. See VA mental health consult dated April 11, 2014; 38 C.F.R. § 3.304(f)(3). Indeed, the Veteran’s service personnel records reflect that he was stationed at Comiso Air Force Base in Sicily from August 1986 to August 1987. The Board takes judicial notice of the fact that the U.S. bombing of Libya took place in April 1986. Thus, the record includes competent evidence of current psychiatric disabilities, evidence establishing that an event and/or injury occurred in service, an indication that the disabilities or symptoms thereof may be associated with the Veteran’s service, and insufficient competent medical evidence on file to allow VA to adjudicate the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the Board finds it necessary to remand the matter to obtain a medical examination and opinion to ensure that the Board’s evaluation of the Veteran’s claim is a fully informed one. Hypertension and Erectile Dysfunction The Veteran asserts that his hypertension is related to service, or, alternatively, was caused or aggravated by PTSD; and that his erectile dysfunction was caused or aggravated by his hypertension or by PTSD. See Applications for Disability Compensation (VA Form 21-526EZ) received March 31, 2014 and August 20, 2015. Since the Veteran seeks service connection for hypertension and erectile dysfunction secondary to PTSD, medical examinations and opinions for these claims are necessary to ensure that the Board’s evaluation of these claims is a fully informed one. The matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently diagnosed acquired psychiatric disability, to include PTSD. The claims file, and a copy of this remand, should be made available to the examiner. Although the entire claims file should be reviewed, the examiner’s attention is directed to the following: Service treatment records reflecting the diagnosis and treatment of the Veteran’s service-connected left knee disabilities or injuries leading thereto (See VBMS 04/22/2014 STR - Medical; 04/24/2014 STR - Medical); and VA mental health consult dated April 11, 2014 (See VBMS 07/31/2014 CAPRI at PDF pg. 6). After reviewing the claims file, conducting an examination, and obtaining any necessary studies, the examiner is asked to respond to the following: (a) Indicate all psychiatric disorders currently shown, to include PTSD, since the date of the claim. (b) If PTSD is diagnosed, provide an opinion as to whether the following claimed stressors are adequate to support a diagnosis of PTSD and whether the Veteran’s symptoms are related to the claimed stressors: (1) The service-connected in-service left knee injury and in-service treatment (or lack thereof); and (2) Fear of Libya attacking Sicily while the Veteran was stationed at Comiso Air Force Base in the 1980s. (c) Provide an opinion as to whether any psychiatric disorder currently shown is at least as likely as not (50 percent or higher degree of probability) CAUSED or AGGRAVATED by, the Veteran’s service-connected left knee disabilities. (d) If not, provide an opinion as to whether any psychiatric disorder currently shown is at least as likely as not (50 percent or greater probability) a result of the Veteran’s military service. A complete rationale should be provided. 3. Schedule the Veteran for a VA examination to determine the etiology of his hypertension. The claims file, and a copy of this remand, should be made available to the examiner. After reviewing the claims file, conducting an examination, and obtaining any necessary studies, the examiner is asked to respond to the following: (a) Provide an opinion as to whether the Veteran’s hypertension is at least as likely as not (50 percent or higher degree of probability) CAUSED or AGGRAVATED by any psychiatric disorder currently shown. (b) If not, provide an opinion as to whether the Veteran’s hypertension is at least as likely as not (50 percent or greater probability) a result of the Veteran’s military service. A complete rationale should be provided. 4. Schedule the Veteran for a VA examination to determine the etiology of his erectile dysfunction. The claims file, and a copy of this remand, should be made available to the examiner. After reviewing the claims file, conducting an examination, and obtaining any necessary studies, the examiner is asked to respond to the following: (a) Provide an opinion as to whether the Veteran’s erectile dysfunction is at least as likely as not (50 percent or higher degree of probability) CAUSED or AGGRAVATED by any psychiatric disorder currently shown. (b) If not, provide an opinion as to whether the Veteran’s erectile dysfunction is at least as likely as not (50 percent or greater probability) CAUSED BY or AGGRAVATED by the Veteran’s hypertension. (c) If not, provide an opinion as to whether the Veteran’s erectile dysfunction is at least as likely as not (50 percent or greater probability) a result of the Veteran’s military service. If the examiner cannot offer an opinion without resort to speculation, he or she should explain why and state what additional evidence, if any, would be required to offer an opinion. A complete rationale should be provided. 5. Thereafter, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brad Farrell, Associate Counsel