Citation Nr: 18153339 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 16-36 720 DATE: November 27, 2018 REMANDED Entitlement to service connection for a psychiatric disorder to include PTSD is remanded. Entitlement to service connection for left shin splint/stress fracture is remanded. Entitlement to service connection for a right shin splint/stress fracture is remanded. Entitlement to service for a back disorder due to shin splints/stress fracture is remanded. Entitlement to service connection for a left knee disorder due to shin splint/stress fracture is remanded. Entitlement to service connection for a right knee disorder due to shin splint/stress fracture is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1982 to March 1985 and from March 1987 to May 1988. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. 1. Entitlement to service connection for a psychiatric disorder to include PTSD is remanded. The Veteran attended a VA examination for this issue in December 2012. This examination was conducted according to the guidelines set forth under the DSM-IV; however, the Board notes that this case is governed by the DSM-V, as the matter was certified to the Board in October 2016. See Schedule for Rating Disabilities-Mental Disorders and Definition of Psychosis for Certain VA Purposes, 80 Fed. Reg. 14,308 (Mar.19, 2015) (noting that effective August 4, 2014, the diagnosis of a mental disorder must conform to DSM-5, not DSM-IV, but this change does not apply to claims that were certified for appeal to the Board on or before August 4, 2014). Thus, the Board finds that a remand is necessary in order to obtain an examination that conforms to the criteria set forth in the DSM-V. 2. Entitlement to service connection for left shin splint/stress fracture is remanded. 3. Entitlement to service connection for a right shin splint/stress fracture is remanded. The Board notes that the Veteran attended a VA examination for this issue in September 2012. After a review of the examination, the Board finds the opinion provided by the examiner to be inadequate. The Board has reached this conclusion because the examiner did not provide an opinion that accounted for the Veteran’s in-service complaints of shin pain or the Veteran’s lay statements. The examiner simply provided an opinion based on the Veteran’s body mass index. Thus, a remand is required to obtain a more complete medical opinion as to the nature and etiology of the Veteran’s bilateral shin disability. See 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.310 (2015); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Bloom v. West, 13 Vet. App. 185, 187 (1999) (a medical opinion without supporting clinical data or other rationale does not provide the required degree of medical certainty). 4. Entitlement to service for back disorder due to shin splints/stress fracture is remanded. 5. Entitlement to service connection for a left knee disorder due to shin splint/stress fracture is remanded. 6. Entitlement to service connection for a right knee disorder due to shin splint/stress fracture is remanded. The Board notes that the Veteran attended a VA examination for these issues in September 2012. After a review of the examination, the Board finds the opinions provided by the examiner to be inadequate. The Board has reached this conclusion because the examiner did not provide thorough and well-reasoned opinions as to why the Veteran’s conditions were not related to her military service. Specifically, the examiner did not account for the Veteran’s lay statements, relied on the absence of treatment records, and then simply provided an opinion based on the Veteran’s body mass index. Moreover, the Board notes that these conditions are inextricably intertwined with the Veteran’s claim for service connection for shin splints/stress fractures. Thus, a remand is required to obtain thorough and well-reasoned opinions as to the nature and etiology of the Veteran’s back condition and bilateral knee conditions. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from February 5, 2013, to the present. 2. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of her psychiatric disability. After a review of the claims file and an examination of the Veteran, the examiner should provide answers to the following questions: (A). Does the Veteran have a current psychiatric disability to include PTSD? If any previously diagnosed disorder is no longer present, please provide an explanation (e.g., whether the condition was misdiagnosed, whether it dissipated, etc.). (B) As to each current psychiatric disorder, is it at least as likely as not that (50 percent or greater probability) the psychiatric disability manifested in or is otherwise related to the Veteran’s military service? If the Veteran does not meet the criteria for a diagnosis of any acquired psychiatric disorder to include PTSD the examiner must specifically say so. (C) Is it as least as likely as not (50 percent or greater probability) that a current acquired psychiatric disorder had its onset within one year of the Veteran’s discharge from active duty? 3. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran’s back disorder. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all back disorders that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s back disorder, had its onset in service or is caused by or related at least in part to her active service? (C). If service connection is granted for bilateral shin splints/stress fractures, is at least as likely as not (50 percent probability or higher) that any back disability was caused or aggravated by the Veteran’s service-connected right and/or left shin splint/stress fracture disability? 4. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran’s left and right knee disabilities. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all knee disorders that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral knee disorder, had its onset in service or is caused by or related at least in part to her active service? (C). If service connection is granted for bilateral shin splints/stress fractures, is at least as likely as not (50 percent probability or higher) that any bilateral knee disability was caused or aggravated by the Veteran’s service-connected right and/or left shin splint/stress fracture disability? In providing the requested opinions, the examiner should consider the Veteran’s competent lay claims regarding the observable symptoms she has experienced. In providing the requested opinions, the examiner cannot rely exclusively on the absence of relevant treatment in the Veteran’s medical history. The examiner should offer a complete rationale for any opinions that are expressed and should cite to the appropriate evidence to support his or her conclusions. If the examiner feels that any of the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Rescan, Associate Counsel