Citation Nr: 18153242 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 15-07 860 DATE: November 27, 2018 REMANDED Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and anxiety, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1979 to April 1983. The Veteran had a hearing a before the undersigned Veterans Law Judge in November 2018. Service connection for an acquired psychiatric disorder is remanded. The Veteran contends that he has PTSD or an anxiety disorder due to service, including due to in-service personal assault and motor vehicle accident, reported in a March 2009 stressor report and during the November 2018 Board hearing. He has also reported witnessing shootings and suicides, and “combat” experiences in Beirut, Lebanon. The Veteran has identified relevant outstanding private treatment records in March 2009. The RO obtained responses or records from the identified facilities, except for St. Mary’s Hospital and Appalahian Hall. In Septmber 2009 the RO requested that the Veteran provide adequate information for it to obtain records from St. Mary’s Hospital and Appalachian Hall, but the Veteran did not provide the requested information. Also in a March 2009 lay statement, his mother indicated he had been treated at St. Joseph Hospital in Asheville, North Carolina. A February 1998 Universtiy Behavioral Center record documented treatment at South Seminole Community Hospital. A remand is required to allow VA to obtain authorization and request these records. Any unassociated VA medical records should be obtained. Any additional stressor development deemed warranted should be performed. The Board cannot make a fully-informed decision on the issue, because the last April 2012 VA examination (with a June 2012 addendum) was inadequate in not explaining the negative finding of PTSD with prior findings of PTSD of record. The matter is REMANDED for the following actions: 1. Obtain any unassociated VA medical records, including from the Orlando VA medical Center prior to November 2009 and records from January 2015 to the present. If no additional records exist, that fact should be noted in the claims file. 2. Ask the Veteran to complete a VA Form 21-4142 for St. Mary’s Hospital, St. Joseph’s Hospital, Appalachian Hall, South Seminole Community Hospital and any other private medical provider records not already associated with the claims file. Make two requests for the authorized records from identified private medical providers, unless it is clear after the first request that a second request would be futile. 3. Perform any additional stressor development deemed warranted, including those reported during the November 2018 Board hearing and March 2009 lay statement. In addition to reports of in-service personal assault, reported stressors have included being involved in a motor vehicle accident (March 2009 stressor report), witnessing shootings and suicides (January 2013 VA medical record), and combat experiences in Beirut, Lebanon (February 1998 University Behavioral Center record). 4. After the Veteran’s reported stressors have been developed and all record development has been accomplished, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). (a) 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 a verified in-service stressor. The Veteran has claimed to have been in a motor vehicle accident (March 2009 statement), witnessing shootings and suicides (January 2013 VA medical record), and combat experiences in Beirut, Lebanon (February 1998 University Behavioral Center record). If the VA examiner finds that the Veteran does not have PTSD, the VA examiner must reconcile or explain such findings in reference to prior findings of PTSD made by other medical professionals. (b) For the Veteran’s claimed stressor based on an in-service personal assault, the examiner must opine whether the evidence of record, including the Veteran’s lay statements, statements made by his mother, the Veteran’s service records, and other relevant evidence of record corroborate the claim that a personal assault occurred in service (38 C.F.R. § 3.304(f)(5)). If the examiner finds that evidence indicates that a personal assault occurred during the Veteran’s active service, the examiner must opine whether any PTSD is at least as likely as not related to the in-service personal assault. The Veteran has reported stressors in prior medical records, a March 2009 stressor report, a March 2011 correspondence, and the November 2011 Board hearing. (c) If the Veteran is diagnosed with a personality disorder and PTSD, the examiner must opine whether the PTSD was at least as likely as not superimposed on a personality disorder during active service and resulted in additional disability. (d) If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease. A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. (Continued on the next page)   The VA medical opinion provider should discuss the particulars of this Veteran’s medical history – to specifically include prior private treatment (such as from the University Behavioral Center received in 2009 and other facilities) and VA psychiatric treatment - and relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Lindio