Citation Nr: 18148219 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 17-35 677 DATE: November 7, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression, is remanded. Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected benign prostatic hypertrophy (BPH) is remanded. REASONS FOR REMAND The Veteran had active service from July 2000 to August 2014 with subsequent Reserve duty. His awards include the Combat Action Badge. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). With regard to the Veteran’s acquired psychiatric disorder claim, the Board acknowledges that the United States Court of Appeals for Veterans Claims (Court) has held that the scope of a mental health disability claim includes any psychiatric disability that may reasonably be encompassed by a veteran’s description of the claim, reported symptoms, and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). A review of the record reveals that the Veteran has been diagnosed with PTSD and depression. In light of the Court’s holding in Clemons, the Board has recharacterized the Veteran’s claim as entitlement to service connection for an acquired psychiatric disorder, to include PTSD and depression. Service connection for an acquired psychiatric disorder and erectile dysfunction With regard to the Veteran’s claim of service connection for erectile dysfunction, the Veteran contends that he has erectile dysfunction that is related to his service, or is alternatively secondary to his service-connected BPH. See, e.g., the Veteran’s claim for VA benefits dated June 2015. The Veteran was provided a VA examination in May 2017 to determine whether he has erectile dysfunction that is secondary to his BPH. After examination of the Veteran, the VA examiner diagnosed the Veteran with erectile dysfunction and concluded that it is less likely than not that the Veteran’s erectile dysfunction is proximately due to or the result of his BPH. However, the VA examiner did not provide an opinion as to whether the Veteran’s erectile dysfunction is aggravated by the BPH. There is no medical opinion of record addressing this issue. In light of the foregoing, the Board finds that an addendum opinion should be obtained as to whether the Veteran’s erectile dysfunction is aggravated by his BPH. With respect to the Veteran’s claim of service connection for an acquired psychiatric disorder, he contends that he has an acquired psychiatric disorder that is related to service, to include his exposure to combat during his service in the Persian Gulf. See, e.g., the August 2015 VA examination report. In particular, he has reported various combat-related stressors including being exposed to constant bombing, IED blasts, mortar attacks, the loss of fellow soldiers, and witnessing dead bodies. The Board notes that the Veteran’s DD 214 verifies his service in Iraq, Saudi Arabia, and Afghanistan as well as receipt of the Combat Action Badge. As such, the Board finds the Veteran credible with regard to his reported incidents. The Veteran was provided a VA psychological examination in August 2015. After examination of the Veteran and consideration of his reported stressors, the VA examiner declined to diagnose the Veteran with PTSD but rather diagnosed the Veteran with insomnia disorder which was subsequently determined to be related to his service-connected sleep apnea. The Veteran was also provided a VA psychological examination in April 2017. After examination of the Veteran and consideration of his medical history, the VA examiner declined to diagnose the Veteran with PTSD and only diagnosed the Veteran with unspecified alcohol-related disorder. The examiner further noted that she was unable to make a determination of the presence of a trauma, sleep, or mood disorder without undue speculation given the questionable validity of the Veteran’s self-report of symptoms as evidenced by his performance on symptom validity testing which strongly suggested deliberate selection of incorrect responses. The Board acknowledges the findings of the VA examiners in the August 2015 and April 2017 reports as to the absence of a diagnosis of PTSD or other acquired psychiatric disorder. However, the Board observes that subsequent VA psychology records document provisional diagnoses of PTSD, depression, and anxiety. See, e.g., a VA treatment record dated November 2017. A February 2017 VA treatment record also notes a positive screen test for depression. These records do not indicate whether the diagnosed psychiatric disorders are related to the Veteran’s service. In light of these ambiguities, the Board finds that a medical opinion should be obtained to determine whether the Veteran’s diagnoses of PTSD, depression, and anxiety noted in the VA treatment records are related to his service. The Board finally notes that record indicates that the Veteran had Reserve duty following his discharge from active duty in August 2014. On remand, the Board finds that the agency of original jurisdiction (AOJ) should verify all periods of active duty, active duty for training (ACDUTRA), and inactive duty for training (INACDUTRA) and obtain any outstanding service treatment or personnel records. The matters are REMANDED for the following action: 1. Undertake appropriate development to verify any periods of active duty, ACDUTRA, and INACDUTRA and associate all outstanding service personnel and treatment records with the claims file. All efforts in this regard should be documented in the claims file. 2. After completion of paragraph #1, schedule the Veteran for a VA examination by an appropriately qualified examiner to determine the nature and etiology of his claimed erectile dysfunction. The claims file, including a copy of this REMAND, must be made available to the examiner for review. Based on the review and the examination, the examiner should respond to the following: a. Whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran has erectile dysfunction that is related to service. b. Whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran has erectile dysfunction that is caused or aggravated (i.e., permanently worsened beyond the normal progression of the disability) by his service-connected BPH. If the examiner finds that the erectile dysfunction is aggravated by the service-connected BPH, then he/she should quantify the degree of aggravation, if possible. A rationale for all opinions expressed should be provided. 3. After completion of paragraph #1, schedule the Veteran for a VA examination by an appropriately qualified examiner to determine the nature and etiology of his claimed acquired psychiatric disorder. The claims file, including a copy of this REMAND, must be made available to the examiner for review. Based on the review and the examination, the examiner should respond to the following: a. Identify all acquired psychiatric disorders. If the examiner finds that the Veteran does not evidence any acquired psychiatric disorders, he/she should address VA treatment records documenting provisional diagnoses of PTSD, depression, and anxiety as well as positive screen testing for depression. See, e.g., VA treatment records dated February 2017 and November 2017. (Continued on the next page)   b. If the Veteran evidences an acquired psychiatric disorder, whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that the disorder is related to the Veteran’s service, to include the Veteran’s verified combat exposure in the Persian Gulf including being exposed to constant bombing, IED blasts, mortar attacks, the loss of fellow soldiers, and witnessing dead bodies. A rationale for all opinions expressed should be provided. BISWAJIT CHATTERJEE Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Arif Syed, Counsel