Citation Nr: 18147703 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 16-33 754 DATE: November 5, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, diagnosed as adjustment-like disorder, is granted. REMANDED Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a nerve disability of the bilateral lower extremities, to include as secondary to a low back disability, is remanded. Entitlement to service connection for a left hand disability is remanded. Entitlement to service connection for a right hand disability is remanded. FINDING OF FACT It is at least as likely as not the Veteran’s adjustment-like disorder is related to his active duty service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, diagnosed as adjustment-like disorder, have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION On August 16, 2018, the Federal Circuit ordered the appeal of Procopio v. Wilkie, No. 17-1821 (U.S. Fed. Cir.). The order stated that the questions before the Federal Circuit include the following: “Does the phrase ‘served in the Republic of Vietnam’ in 38 U.S.C. § 1116 unambiguously include service in offshore waters within the legally recognized territorial limits of the Republic of Vietnam, regardless of whether such service included presence on or within the landmass of the Republic of Vietnam?” As of the date of this decision, Procopio is pending. As the issue of entitlement to service connection for a heart disability, to include coronary artery disease, may be affected by the resolution of Procopio, the Board will “stay” or postpone action on the matter. The United States Court of Appeals for Veterans Claims has held that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, the Board has characterized the claim on appeal to entitlement to service connection for an acquired psychiatric disorder. Entitlement to service connection for an acquired psychiatric disorder The Veteran contends that his current acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD), anxiety, and depression, is related to his active duty service. See, e.g., July 2018 representative brief; May 2014 Veteran statement; December 2013 Veteran statement; December 2013 claim. First, entitlement to service connection for PTSD in particular requires medical evidence diagnosing PTSD in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM). 38 C.F.R. §§ 3.304(f), 4.125(a). A June 2014 VA examiner opined the DSM criteria for a diagnosis of PTSD were not met, and the Veteran’s VA and private treatment records do not indicate a diagnosis of PTSD. Accordingly, the criteria for service connection for PTSD have not been met. However, the Board finds that it is at least as likely as not the Veteran’s current acquired psychiatric disorder, diagnosed as adjustment-like disorder, is related to his active duty service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(d). Following an interview and examination of the Veteran, a June 2014 VA examiner diagnosed adjustment-like disorder with prolonged duration of more than six months without prolonged duration of the stressor. The Veteran’s symptoms include depressed mood and anxiety. The VA examiner noted the Veteran’s reports regarding incidents during his service on the U.S.S. Brister, as well as service treatment records noting depression, excessive worry, and excessive drinking. See also November 1967 Reserve Report of Medical History (reports of depression, excessive worry, and a drinking problem); August 1966 Consultation Sheet request (Veteran drinking quite frequently); Abstract of Serve and Medical History (service aboard the U.S.S. Brister from June 1964 to September 1966); July 1965 Administrative Remark (Armed Forces Expeditionary Medal (Vietnam)). The VA examiner opined that the Veteran’s current adjustment-like disorder can be related back to his traumatic stressors while in service, as his service treatment records indicated he experienced some depression and excessive anxiety after his service on the U.S.S. Brister before his discharge from service, and his heavy periods of alcohol use around that time could be understood as attempts to self-medicate his mental health symptoms. Accordingly, the Board finds there is medical evidence of record establishing a link between the Veteran’s current adjustment-like disorder and his reported mental health symptoms and alcohol use during active duty service. Therefore, the Board finds that a grant of service connection is warranted for an acquired psychiatric disorder diagnosed as adjustment-like disorder. 38 C.F.R. § 3.303(d). REASONS FOR REMAND 1. Entitlement to service connection for a left hip disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. 3. Entitlement to service connection for a right knee disability is remanded. 4. Entitlement to service connection for a low back disability is remanded. 5. Entitlement to service connection for a nerve disability of the bilateral lower extremities, to include as secondary to a low back disability, is remanded. 6. Entitlement to service connection for a left hand disability is remanded. 7. Entitlement to service connection for a right hand disability is remanded. The Veteran contends that his musculoskeletal disabilities are related to his Military Occupational Specialty of Engineman, as he had to work in tight spaces, climb up and down ladders, stand for long periods of time, perform repetitive motions due to the use of hand tools, and lift and carry heavy tools and parts. See December 2013 representative letter; see also DD Form 214. The Veteran further contends that he fell off ladders on several occasions and hurt his left hip and bilateral knees, and although he never reported his injuries he has experienced symptoms since service. See, e.g., July 2018 representative brief; May 2016 Veteran statement; December 2013 representative letter; see also March 2015 VA telephone encounter note; October 2014 addendum to VA anticoagulation interim note. The Veteran’s VA treatment records include current diagnoses of left hip, left knee, right knee, and low back disabilities. The Veteran has also reported experiencing numbness and weakness in a finger on his left hand, as well as tremors of the right hand. See April 2015 VA primary care nursing triage note; September 2014 VA primary care physician E&M note. A remand is required to afford the Veteran VA examinations to determine the nature and etiology of any current left hip, left knee, right knee, low back, left hand, and right hand disabilities. See 38 U.S.C. § 5103A(d) (2012); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). As the Veteran contends he has a current nerve disability of the bilateral lower extremities secondary to a low back disability, the VA examiner should also address the nature and etiology of any current nerve disaiblity of the bilateral lower extremities. See, e.g., December 2013 representative letter. Finally, as an examination is required, on remand the Veteran’s updated VA treatment records should also be obtained. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from June 2016 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any current left hip, left knee, right knee, low back, right hand, and left hand disabilities, as well as any nerve disability of the bilateral lower extremities. After a review of the claims file, and interview and examination of the Veteran, the examiner is asked to respond to the following inquiries: a) Please identify with specificity all disabilities of the left hip, left knee, right knee, low back, left hand, right hand, and any nerve disability of the bilateral lower extremities, which are currently manifested, or which have been manifested at any time since December 2013. The examiner should address the reports in the Veteran’s VA treatment records of numbness and weakness in a finger on the left hand, as well as tremors of the right hand. b) For each left hip, left knee, right knee, low back, left hand, right hand, and bilateral lower extremity nerve disability, is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current disability is related to his active duty service? The examiner should specifically address the Veteran’s contentions regarding the physical requirements of his duties as an Engineman, as well as his reports of injuries from falling off ladders on the ship. The examiner should also address the Veteran’s reported reasons for not reporting his injuries during service, and his reluctance to seek medical attention since service, but that he has experienced symptoms since service. c) For each nerve disability of the right and/or left lower extremity, is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current disability was caused or aggravated by a low back disability? Aggravation indicates a worsening of the underlying condition as compared to an increase in symptoms. If aggravation is found, the examiner should attempt to identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If any benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Delhauer, Counsel