Citation Nr: 18147745 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 11-02 788 DATE: November 6, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) due to military sexual trauma (MST) is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Navy from October 1989 to October 1993. The Veteran also served from October 1995 through March 1997 and was discharged under other than honorable conditions. In a March 1998 Administrative Decision, VA determined that the Veteran’s discharge or release in March 1997 is considered to have been issued under dishonorable conditions. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In July 2012, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of this hearing is associated with the claims file. The Board remanded this case to the Agency of Original Jurisdiction (AOJ) in April 2014 for further development including obtaining outstanding service treatment records and subsequent VA and private treatment records. While outstanding records were obtained, the Veteran was unable to attend the scheduled VA examination of her mental health. The record shows the Veteran has had difficulties maintaining stable housing and receiving relevant correspondence from VA, but she has continued to pursue her claims and expressed a desire to attend a VA examination. See, e.g., Veteran’s October 2017 Statement in Support of Claim. In an April 2017 statement, the Veteran contended that she suffers from depression secondary to her painful service-connected burn scars and hepatitis C. In a July 2017 rating decision, the AOJ denied the claim for secondary service connection for depression noting the Veteran did not attend her VA examination. In August 2018, the Board remanded the broader claim for entitlement to service connection for an acquired psychiatric disorder in order to obtain an adequate VA examination and for the AOJ to consider additional treatment records in the first instance. The Board notes that the AOJ obtained a VA examination with a negative nexus opinion on the Veteran’s claimed mental health disabilities in October 2017. However, the Board finds that the opinion does not adequately address some important evidence of behavioral changes and sexually transmitted diseases in the Veteran’s service treatment records. For example, service treatment records from August 1992 show treatment for chlamydia, and service treatment records from August 1993 indicate her physical symptoms had a psychological component. The Veteran testified at the hearing that she was pressured into having sexual relations with a superior during this time, who she alleges were spreading sexually transmitted diseases. Moreover, Board notes that the VA examiner did not address the Veteran’s contention that her service-connected disabilities have caused or aggravated her psychological symptoms. The Veteran indicated she wishes to attend an examination for the purposes of developing her case for secondary service connection. See, e.g., Veteran’s October 2017 Statement in Support of Claim. On remand, the AOJ should obtain an additional examination of the Veteran’s mental health that addresses evidence of (1) treatment for diseases with psychological components in-service, (2) evidence of changes in the Veteran’s sexual behavior and associated treatment for sexually transmitted infections during service, and (3) the impact of the Veteran’s service-connected disabilities on her mental health. Additionally, the Board finds the VA examiner’s statement that the Veteran’s “current diagnosis of PTSD cannot be determined to be due to the cause of her MST at a percentage greater than 50 percent” to be inadequate. It is not clear if the examiner considers military sexual trauma is at least as likely as not a contributing cause if not the primary cause of her current symptoms. The AOJ should ensure the examiner clearly addresses the extent to which military sexual trauma is likely to have contributed to the Veteran’s current mental disability under an equipoise standard (50 percent or greater probability) rather than “greater than 50 percent.” The matter is REMANDED for the following action: 1. The AOJ should contact the Veteran and his representative and request their assistance in identifying any outstanding relevant records. The AOJ should make reasonable attempts to obtain all identified outstanding records and associate them with the Veteran’s claims file. 2. After associating all outstanding records with the Veteran’s claims file, the AOJ should obtain an addendum opinion from an appropriate examiner of the Veteran’s claimed psychiatric disorders. The AOJ should provide the examiner with a complete copy of the claims file to include this remand order. The AOJ should ensure that the examiner follows these directives: (a) The VA examiner should identify all mental disabilities the Veteran has been diagnosed with to date under the DSM-IV and DSM-5 including but not limited to depressive disorders, bipolar disorder, an adjustment disorder, borderline personality disorder, and PTSD. (b.) For each current disability identified, the examiner should opine whether the disability was at least as likely as not (50 percent or greater probability) caused or aggravated by the Veteran’s military service to include treatment for physical disabilities with psychological components, changes in sexual behavior and sexual health, substance abuse, and any other pertinent behavioral changes or stressors during the Veteran’s military service. The examiner should explain why or why not. (c.) For each current disability identified, the examiner should opine whether the disability was at least as likely as not permanently worsened beyond normal progression (aggravated) by the Veteran’s service-connected disabilities to include (1) bilateral forearm burn scars with residual pain, (2) hepatitis C, (3) scarring of the Veteran’s left ring finger with residual limitation of motion, and (4) dermatitis. The examiner should consider the Veteran’s statements about how these conditions affect her including her May 2017 statements that her scars and hepatitis C cause her pain and low self-esteem, drain her energy, and interfere with her ability to have relationships. If the examiner is unable to provide an opinion on these matters, the examiner must state whether the inability to render an opinion is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After completing the above action and any other necessary development, the claim must be readjudicated. If a claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and current representatives. After the Veteran has had adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael Duffy, Associate Counsel