Citation Nr: 18150879 Decision Date: 11/16/18 Archive Date: 11/15/18 DOCKET NO. 17-25 138 DATE: November 16, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) and unspecified depressive disorder is granted. REMANDED Entitlement to service connection for obstructive sleep apnea, to include as due to Gulf War environmental hazards is remanded. FINDING OF FACT The Veteran’s acquired psychiatric disorder is related to his active service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 2003 to May 2003, from March 2005 to June 2006, and from July 2009 to August 2010. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2014 rating decision. The Board has characterized the issue as entitlement to service connection for an acquired psychiatric disability, to include PTSD and unspecified depressive disorder due to the presence of other psychiatric diagnoses. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). The Board acknowledges that the Veteran submitted a Rapid Appeals Modernization Program (RAMP) opt-in election form that was received by VA on June 18, 2018. However, the appeal has already been activated at the Board and is therefore no longer eligible for the RAMP program at this time. Accordingly, the Board will undertake appellate review of the case. The Board observes the October 2017 rating decision which proposed a 30 percent rating for unspecified depressive disorder with anxiety symptoms. However, as noted in that decision, that appeal is active before the Board and no rating has been granted. There does not appear to be any action ongoing at the RO. As a result, the Board can not simply wait for action given this situation. Service Connection Service connection may be established for disability due to a disease or injury that was incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). The Veteran claims he has an acquired psychiatric disorder due to his active duty service. VA treatment records document current DSM-5 diagnoses of unspecified trauma and stressor related disorder and unspecified depressive disorder with anxiety. See, e.g., May 2017 San Juan VAMC treatment note. The Veteran’s August 2001 enlistment examination was negative for any psychiatric conditions or complaints. The Veteran was deployed to the Persian Gulf from 2005 to 2006. Prior to this deployment there were no complaints of, symptoms of, or treatment for any psychiatric disorder. In a February 2008 periodic health assessment, the Veteran indicated he had sometimes felt down, depressed, or hopeless and sometimes had little interest or pleasure in doing things. An August 2017 narrative summary from the Integrated Disability Evaluation System documents that the Veteran’s unspecified depressive disorder with anxiety symptoms was incurred while entitled to base pay. The report reflects that in January 2007, the Veteran began experiencing insomnia and irritability while adjusting to civilian life. In March 2008, increasing anxiety and verbal explosive behavior prompted regular psychotherapy. Following a 2009 deployment to Africa, his symptoms worsened. An August 2017 Medical Evaluation Board Proceedings report reflects the Board found the Veteran had unspecified depressive disorder with anxiety symptoms which did not exist prior to service and which were incurred while entitled to base pay. October 2017 informal findings from the Physical Evaluation Board (PEB) Proceedings reflect that the PEB determined the Veteran had unspecified depressive disorder with anxiety symptoms that was incurred or aggravated in the line of duty. The PEB noted the Veteran was deployed to Iraq in 2005-2006 and to Africa in 2009-2010. The PEB indicated the condition is attributed to the following stressors: personal knowledge of his translator being killed, being under rocket and mortar attacks, and deployment to Djibouti, Africa. After a careful review of the evidence, the Board finds that the evidence is at least in equipoise with respect to whether the Veteran’s current acquired psychiatric disability is related to his active service. Based on the foregoing, and in affording the Veteran the benefit of the doubt, the Board finds service connection for an acquired psychiatric disorder, to include unspecified depressive disorder, is warranted because it originated while the Veteran was serving on active duty. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). REASONS FOR REMAND Review of the record reveals that a remand is necessary to ensure that there is a complete record upon which to decide the Veteran’s sleep apnea claim. The Veteran seeks entitlement to service connection for obstructive sleep apnea, claimed to include as due to exposure to environmental hazards during the Gulf War. The Veteran’s most recent and pertinent VA examination for obstructive sleep apnea occurred in December 2016. However, this medical opinion is inadequate as the examiner did not discuss whether the Veteran’s sleep apnea is related to environmental hazards during the Gulf War. As such, a new opinion is warranted. On remand, all outstanding VA medical records must be requested and obtained. See Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Obtain and associate with the Veteran’s claims file any outstanding VA treatment records. If possible, the Veteran himself should submit any pertinent new evidence regarding the conditions at issue in order to expedite the claims. 2. Then, schedule the Veteran for the appropriate VA examination in regard to his sleep apnea claim. The examiner must opine whether it at least as likely as not that the Veteran’s sleep apnea is caused by or etiologically related to service, to include exposure to environmental hazards in the Gulf War. A complete rationale must be provided for the opinion proffered. 3. After completing the above development, readjudicate the issues on appeal. If any benefit sought remains denied, issue a supplemental statement of the case and return the case to the Board. JOHN J CROWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Kettler, Associate Counsel