Citation Nr: 18150056 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-00 329 DATE: November 14, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder is granted. REMANDED Entitlement to service connection for rhinitis is remanded. Entitlement to service connection for asthma is remanded. Entitlement to service connection for a skin disability, to include as secondary to a service-connected psychiatric disorder, is remanded. Entitlement to service connection for right foot fungus is remanded. FINDING OF FACT The Veteran’s acquired psychiatric disorder is related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder are met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1968 to April 1970, including service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2015, the Veteran and his spouse testified during a hearing before a Decision Review Officer (DRO). 1. Entitlement to service connection for an acquired psychiatric disorder is granted. The Veteran asserts that his psychiatric disorder is the result of stressors from his Vietnam service. Specifically, he recalls generally being in fear of danger daily, witnessing fellow soldiers being killed and committing suicide, and working in the ammunition department and getting attacked every night and on one occasion witnessing two friends being killed and seeing their bodies afterwards. He maintains that as a result of these traumatic incidents, he returned home from Vietnam with stress, anxiety, depression, suicidal feelings, anger issues, and memory problems. See October 2012 VA examination report and January 2013 Statement. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection for PTSD requires: (1) medical evidence establishing a diagnosis of the disorder; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) a link established by medical evidence, between current symptoms and an in-service stressor. 38 C.F.R. § 3.304(f). If a stressor claimed by a Veteran is related to fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, lay testimony, alone, may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3). Here, the Veteran has a current diagnosis of anxiety disorder NOS and PTSD. See October 2012 and September 2015 VA examination reports. Thus, element one is met. Element two is also met, as the October 2012 VA examiner, a VA psychologist, confirmed that the Veteran’s reported stressors of getting attacked every night while working in the ammunition department and on one occasion witnessing two friends being killed and seeing their bodies afterwards are related to fear of hostile military or terrorist activity and adequate to support a diagnosis of PTSD. Regarding element three, the October 2012 VA examiner stated that it is at least likely as not that the Veteran’s psychiatric condition is due to his reported stressors, including Vietnam war trauma. Albeit quite brief, the Board finds that this opinion establishes a medical link between current symptoms of his psychiatric disorder and in-service stressors related to fear of hostile military or terrorist activity during the Vietnam war, as he took the Veteran’s lay statements into consideration and provided an understandable and rational basis for the opinion that relied on an accurate history. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). To the extent the September 2015 VA examiner attributes the Veteran’s PTSD to a post-service suicide attempt in 1974, the examiner did not discuss any potential relationship between that stressor shortly following service, and the Veteran’s report of feeling suicidal after his return from Vietnam. Thus, this opinion is of limited probative value, and element three is also met. REASONS FOR REMAND 2. Entitlement to service connection for rhinitis is remanded. 3. Entitlement to service connection for asthma is remanded. 4. Entitlement to service connection for a skin disability, to include as secondary to a service-connected acquired psychiatric disorder, is remanded. 5. Entitlement to service connection for right foot fungus is remanded. The Veteran asserts that his current rhinitis, asthma, skin, and right foot fungus disabilities were incurred during service. See November 2012 and January 2013 Veteran Statements and May 2015 DRO Hearing Transcript at 4-22. Additionally, he notes exposure to gas, smoke, vapors, exhaust, and herbicide agents in Vietnam and also asserts that his skin disorder is due to his service-connected psychiatric disorder. See May 2015 DRO Hearing Transcript at 20 and October 2018 Appellate Brief. The Veteran has current diagnoses of allergic rhinitis, asthma, seborrheic dermatitis, actinic keratosis, xerosis, and right great toenail fungus. Thus, the Board finds that the low standard detailed in McLendon is met and VA examinations and medical nexus opinions are warranted and should be obtained on remand. Any outstanding VA treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then schedule the Veteran for appropriate VA examinations to determine the nature and etiology of his rhinitis, asthma, skin, and right foot fungus disabilities. The claims file, including a copy of this remand, must be provided to the examiner in conjunction with the requested opinion. All indicated tests and studies should be conducted, and all findings reported in detail. The examiner should address the following: (a) For diagnosed allergic rhinitis (see July 2014 VA treatment record), please opine on whether it is at least likely as not (a 50 percent or greater probability) that such disability had its onset in service or is otherwise related to service, to include as a result of exposure to gas, smoke, vapors, exhaust, or conceded exposure to herbicide agents therein. (b) For diagnosed asthma (see April 2014 VA treatment record), please opined on whether it is at least likely as not (a 50 percent or greater probability) that such disability had its onset in service or is otherwise related to service, to include as a result of exposure to gas, smoke, vapors, exhaust, or conceded exposure to herbicide agents therein. (c) For diagnosed right great toenail fungus (see October 2013 VA treatment record), please opine on whether it is at least likely as not (a 50 percent or greater probability) that such disability had its onset in service or is otherwise related to service, to include as a result of exposure to gas, smoke, vapors, exhaust, or conceded exposure to herbicide agents therein. (d) For each skin disability diagnosed since September 2012, to include seborrheic dermatitis, actinic keratosis, and xerosis (see April 2014 VA treatment record), please opine on whether it is at least likely as not (a 50 percent or greater probability) that such disability: (i) had its onset in service or is otherwise related to service, to include as a result of exposure to gas, smoke, vapors, exhaust, or conceded exposure to herbicide agents therein; (ii) is proximately due to his service-connected psychiatric disorder; or (iii) has been aggravated (worsened beyond natural progression) by his service-connected psychiatric disorder. If any of the above diagnoses are not found, please reconcile your findings with the above cited VA treatment records and diagnoses of the same. The examiner is instructed not to rely solely on the regulatory determination that asthma, seborrheic dermatis, actinic keratosis, and xerosis, are not diseases presumptively assumed to be related to herbicide agent exposure or the opinion will be considered inadequate. The examiner should note that inquires (d)(ii) and (d) (iii) require two opinions: one for proximate causation and one for aggravation for each skin disability diagnosed since September 2012. A complete rationale must be provided for all opinions expressed. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Asante, Associate Counsel