Citation Nr: 18149314 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 15-43 987 DATE: November 9, 2018 REMANDED Entitlement to service connection for a right wrist condition is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include depression, PTSD, and anxiety disorder, is remanded. REASONS FOR REMAND The Veteran served active duty in the United States Army from April 1976 to July 1976 and from July 1980 to June 1995. 1. Entitlement to service connection for a right wrist condition is remanded. The duty to assist includes providing a medical examination when necessary to make a decision on a claim. 38 C.F.R. § 3.159(c)(4)(i). A medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81–86 (2006). See also 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). In this case, the Veteran has a diagnosis of carpal tunnel syndrome of the right wrist and a medical record that establishes tenderness in the right wrist, an old Colles’ fracture with a possibly associated injury to the scapholunate ligament, and a subtle indication of potential large-fiber peripheral neuropathy. See e.g., February 2011 and January 2014 Medical Treatment Records. In a February 2011 treatment record, the Veteran reported twisting his wrist during service after a fall at Fort Benning in 1990. During his July 2015 hearing before the decision review officer, the Veteran reported that he incurred his wrist injury during active service as a lineman. As there is otherwise insufficient medical evidence to decide the claim, the Board must remand the issue so that a medical opinion can address the etiology of any ailment that could involve the Veteran’s right wrist, to include his carpal tunnel syndrome, the old Colles’ fracture with a possible injury to the scapholunate ligament, and the potential for large-fiber peripheral neuropathy, in light of the Veteran’s report of in-service injuries. McLendon, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for an acquired psychiatric disorder, to include depression, PTSD, and anxiety disorder, is remanded. The Veteran seeks entitlement to service connection for PTSD. Initially, the Board notes that the issue of entitlement to service connection for PTSD has been expanded pursuant to the Federal Circuit’s decision in Clemons v. Shinseki, 23 Vet. App. 1 (2009). VA treatment records since service indicate diagnoses of numerous psychiatric disorders, including depression, PTSD, and anxiety disorder. See, e.g., May 2010, July 2010, April 2012 VA Treatment Records. The Board will thus consider the issue under a claim of service connection for an acquired psychiatric disorder, to include depression, PTSD, and anxiety disorder. The Board notes that the occurrence of psychologically stressful events during active service has been established by virtue of the Veteran’s service in an imminent danger pay area. A July 2010 VA mental health consult note reflects a diagnostic impression of PTSD, major depressive disorder, and polysubstance dependence in full sustained remission based on the Veteran’s reported history and symptomatology. At the time, no opinion as to the etiology of the psychiatric conditions was provided. In the April 2012 VA examination, the Veteran declined to discuss his military combat experiences. Unable to assess the PTSD diagnosis, the examiner concluded the Veteran had anxiety disorder and found that it was not related to service, in part, because service treatment records made no mention of the Veteran’s symptoms of depression, anxiety, and sleep disruption. However, the Board notes that the Veteran reported not being able to sleep through the night at his February 1995 separation examination. The Board finds the examination insufficient for service connection purposes because it did not assess the PTSD diagnosis, did not consider the evidence of record regarding the Veteran’s PTSD and military experiences, and was based, in part, on an inaccurate factual premise. When VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, in light of the inadequate opinion, the Board finds a new examination is warranted. Additionally, the Board notes that VA is now required to apply concepts and principles set forth in DSM-V, although the Secretary of VA has specifically indicated that DSM-IV is still to be applied by the Board for claims pending before it at the time of the change. 79 Fed. Reg. 45094 (Aug. 4, 2014). In this case, the Veteran filed a substantive appeal for his PTSD claim in November 2015, and it was subsequently certified to the Board. Therefore, the medical examination must apply the DSM-V criteria when it considers the Veteran’s acquired psychiatric disorder, to include depression, PTSD, and anxiety disorder in light of the Veteran’s medical record and in-service stressors. The matters are REMANDED for the following actions: 1. Identify and obtain any pertinent, outstanding VA and private treatment records not already of record in the claims file. 2. Schedule the Veteran for an examination to determine the nature and etiology of any right wrist disability, to include carpal tunnel syndrome, the old Colles’ fracture with a possible injury to the scapholunate ligament, and the potential for large-fiber peripheral neuropathy. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s right wrist disability is etiologically related to his active service. The rationale for all opinions must be provided. 3. Schedule the Veteran for an examination with an appropriate clinician to determine the nature and etiology of any diagnosed acquired psychiatric disorder, to include depression, PTSD and anxiety disorder, as set forth in the DSM-V criteria. The claims file must be made available to, and reviewed by the examiner. Based on the examination results and review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that any identified acquired psychiatric disorder diagnosed on examination or at any time during the pendency of the claim, to include depression, PTSD, and anxiety disorder, is etiologically related to his active service. In providing an opinion, the examiner should consider and address, where necessary, the Veteran’s July 2010 and April 2012 medical treatment records. The rationale for all opinions must be provided. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Muzzammel, Associate Counsel