Citation Nr: 18151041 Decision Date: 11/19/18 Archive Date: 11/16/18 DOCKET NO. 16-39 260 DATE: November 19, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), including as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from August 7, 1990 to September 10, 1990. This matter comes before the Board of Veterans’ Appeals (Board or BVA) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The Veteran testified before the undersigned Veterans Law Judge at a September 2017 Board videoconference hearing. A copy of the transcript is associated with the claims file. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD, including as secondary to service-connected disabilities, is remanded. The Board notes that the Veteran asserts that he has an acquired psychiatric disorder, to include PTSD, related to his service, including as secondary to his service-connected disabilities. In this regard, the Board observes that the Veteran has submitted statements and testified that he witnessed a fellow service member undergo hazing and feared that he would also be hazed; the Veteran testified that his service-connected left knee disorder was incurred as a result of trying to avoid being hazed. The Board notes that the Veteran is service-connected for left traumatic patellofemoral syndrome with degenerative joint disease, as well as lumbar strain and left hip strain as secondary to the service-connected left knee disability. The Board also notes that, at the time of the Veteran’s claim for service connection for the left knee, the Veteran alleged that he injured his left knee while falling out of his bunk and a fall while participating in physical training; service treatment records confirm treatment for the left knee in conjunction with these falls. The Board observes that the Veteran’s private treatment records from CW Counseling and Consulting reflect a diagnosis of PTSD by history and a diagnosis of major depressive disorder by history; treatment records from Hartsville Medical Group also reflect a diagnosis of PTSD by history. However, the basis for the diagnosis of PTSD, including the nature of the confirmed stressor event, is not of record. Additionally, the Board observes that the record does not indicate the nature and etiology of the Veteran’s major depressive disorder. To this point, a July 2014 VA examination report noted that the Veteran had feelings of anxiety and depression related to his orthopedic concerns, and statements from the Veteran’s wife indicate that the Veteran is depressed due to pain. Nevertheless, it is unclear whether the Veteran’s pain is the cause of the Veteran’s major depressive disorder or if the Veteran’s major depressive disorder is worsened by the Veteran’s pain. The Veteran has not yet been afforded a VA examination in connection with the claim for service connection of an acquired psychiatric disorder, to include PTSD. Accordingly, the Board finds that the Veteran should be afforded a VA examination regarding the claim for service connection of an acquired psychiatric disorder, to include PTSD. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A(d)(1); 38 C.F.R. § 3.159(c)(4). VA adjudicators may consider only independent medical evidence to support their findings; they may not rely on their own unsubstantiated medical conclusions. If the medical evidence of record is insufficient, VA is always free to supplement the record by seeking an advisory opinion, or ordering a medical examination to support its ultimate conclusions. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). Furthermore, VA must make all necessary efforts to obtain relevant records in the possession of a Federal agency. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; Bell v. Derwinski, 2 Vet. App. 611 (1992). Any remaining, available VA treatment records related to the Veteran’s claimed left knee disorder should be associated with the Veteran’s claims file. The matter is REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for the disability on appeal. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. If the records are unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. The RO should schedule a VA examination to determine the presence and etiology of an acquired psychiatric disorder, to include PTSD. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner should indicate whether it is as least as likely as not (50 percent probability or more) that the Veteran has PTSD which is caused or aggravated by his service. The examiner is requested to identify the stressor that serves as the basis for any PTSD diagnosis and note the diagnostic criteria utilized to support the diagnosis under DSM-IV/V. If the VA examiner finds the diagnostic criteria is not met, the VA examiner is to provide an explanation for such a finding. If the Veteran does not have PTSD, the VA examiner is requested to provide any opinion as to whether it is as least as likely as not (50 percent probability or more) that the Veteran has an acquired psychiatric disorder (i.e., depression) which was caused or aggravated by his service. If the Veteran’s acquired psychiatric disorder is not related to his military service, the VA examiner should provide an opinion as to whether his acquired psychiatric disorder or PTSD is proximately due to or the result of the Veteran’s service-connected left knee disability, lumbar strain, and left hip strain. If the Veteran’s acquired psychiatric disorder or PTSD is not proximately due to or the result of the Veteran’s service-connected left knee disability, lumbar strain, and left hip strain, the VA examiner should provide an opinion as to whether the Veteran’s PTSD or acquired psychiatric disorder has been aggravated by any of the Veteran’s service-connected disabilities, including service-connected left knee disability, lumbar strain, and left hip strain. The requested determination should also consider the Veteran's medical history prior to, during, and since his military service. The VA examiner is advised that the Veteran is competent to report symptoms, treatment, events, and injuries in service, and that his reports must be taken into account, along with the other evidence of record, in formulating the requested opinion. A complete rationale should accompany each opinion provided. 3. After completing all indicated development, the RO should readjudicate the claim of entitlement to service connection for an acquired psychiatric disorder, including PTSD, on appeal, in light of all the evidence of record. If the benefit sought remains denied, the case should be returned to the Board after compliance with requisite appellate procedures. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel