Citation Nr: 18149508 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 18-31 877 DATE: November 9, 2018 REMANDED Entitlement to service connection for a psychiatric disorder, claimed as posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1981 to February 1982 and August 1982 to August 1986. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a December 2015 rating decision. VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). “An opinion is adequate where it is based upon consideration of the Veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s evaluation of the claimed disability will be a fully informed one.” Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (internal citations and quotations omitted). The Veteran has been provided two VA examinations related to his claimed PTSD. The June 2015 examiner diagnosed the Veteran with intermittent explosive disorder based on reported physical and verbal outbursts throughout the Veteran’s Naval career. The examiner found that the Veteran reported adequate stressors and symptoms to support a PTSD diagnosis, but he questioned the validity of the reported symptoms, determining that the reported symptoms were not congruent with the Veteran’s non-verbal behavior during the examination. The examiner’s rationale was entirely based on observations during the examination and failed to address evidence in the Veteran’s record that goes toward supporting his claims, including VA treatment records that show prior diagnoses of PTSD, dysthymic disorder, and schizophrenia as early as August 2014, as well as multiple lay statements from the Veteran’s spouse, friends, and individuals who witnessed his reported violent behavior. A subsequent December 2017 examination found diagnoses of a specified trauma- or stressor-related disorder, persistent depressive disorder (dysthymic disorder), and moderate alcohol use disorder. The trauma-related disorder was found based on a reported symptomology of PTSD accompanied by MMPI-2 data reflecting the invalid over-reporting of symptomology. The examiner remarked that the Veteran’s MMPI-2 profile was not valid for interpretation and that individuals with similar profiles tend to overreport and exaggerate concerns, which is often related to actual psychological distress and disturbances. The examiner provided no nexus opinion for the Veteran’s dysthymic disorder, and while the examiner seems to indicate a connection between the Veteran’s reported stressors and his current psychological condition, these findings are ultimately ambiguous. For these reasons, the Board finds the examinations of record are inadequate and do not provide sufficient information to make a decision on the claim. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (“It is the factually accurate, fully articulated, sound reasoning for the conclusion...that contributes probative value to a medical opinion.”). Furthermore, the Board must obtain a medical opinion that resolves the discrepancies between the competing medical opinions of record, to include those in the Veteran’s VA treatment records. See Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The matter is REMANDED for the following action: 1. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder, to include persistent depressive disorder (dysthymic disorder), posttraumatic stress disorder (PTSD), intermittent explosive disorder, and schizophrenia. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to an in-service stressor. The examiner must answer the following questions: (a.) Has the Veteran at least as likely as not (50 percent or greater probability) met the diagnostic criteria for an acquired psychiatric disorder at any point in the appeal period (i.e., since August 2014)? If it is determined the Veteran has not met the diagnostic criteria for an acquired psychiatric disorder at any point in the appeal period, an explanation must be provided as to why the diagnoses of dysthymic disorder, schizophrenia, intermittent explosive disorder and PTSD reflected in treatment records during the appeal period are not valid diagnoses. (b.) Is it at least as likely as not (50 percent or greater probability) that any acquired psychiatric disorder present in the appeal period had its onset during or is otherwise related to the Veteran’s service? If PTSD is diagnosed, the examiner must identify the stressor or stressors upon which the diagnosis is based. The examiner must specifically address the lay statements in the record regarding the Veteran’s behavior and symptomatology since service, including those provided by the Veteran, his spouse, and others with direct knowledge of his history and behavior since service. The examination report must include a complete rationale for all opinions provided. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and explain why an opinion cannot be provided without resorting to speculation. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Pitman, Associate Counsel