Citation Nr: 18155442 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 18-28 386 DATE: December 4, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Navy from September 1986 to September 2007. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The Board notes that the psychiatric claim on appeal was adjudicated by the RO as entitlement to service connection for PTSD. However, in light of the Veteran’s assertions and the evidence of record, the Board has recharacterized the issue more broadly to include any acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6, 8 (2009). The Veteran has alleged that, in January 1996, high winds caused the USS Nassau’s mooring lines to snap and the ship drifted away from its pier at Norfolk Naval Station. The Veteran has reported that fell onto a fender and bounced into the water, losing consciousness. He has stated that he was pulled from the freezing water and placed into a car to warm up. The Veteran has indicated that he began drinking heavily and became anxious and depressed after the incident. He submitted lay statements from his ex-wife, L.S. (initials used to protect privacy), and two others, D.P. and K.C., in support of his claim. The January 1996 command history and deck logs confirmed that the USS Nassau broke away from the pier due to high winds; however, there was no record of a man overboard. There were no injuries reported, and there is no reference to the Veteran. The Veteran’s service treatment records also do not show any evidence of treatment for the alleged incident. Therefore, the RO determined that the alleged stressor could not be verified. The Veteran was afforded a VA examination in May 2015 in connection with his claim. The examiner found that the Veteran did not meet the DSM-V diagnostic criteria for PTSD. Instead, he diagnosed the Veteran with alcohol use disorder and found that the Veteran’s depression and anxiety are subsumed under his alcohol abuse. The examiner did not relate any of the Veteran’s reported symptoms, including depression, anxiety and chronic sleep impairment, to service, noting that his service treatment records were silent for any psychological complaints. During his September 2007 separation examination, the Veteran had reported a history of hearing loss, low back pain, and a left ankle sprain, but denied any psychological problems. The Veteran’s VA treatment records document diagnoses of PTSD, depressive disorder not otherwise specified (NOS), and alcohol dependence. The VA examiner did not specifically address these diagnoses in his report. In addition, service treatment records from July 2007 were added to the claims file in June 2015, after the VA examination. These service treatment records are from the mental health outpatient clinic at the naval hospital in Yokosuka, Japan, and document complaints of intermittent depressive symptoms, sleep problems, crying spells, and decreased appetite. The Veteran also reported significant alcohol use for several years, increasing over the last several months, and he was diagnosed with alcohol dependence. The VA examiner was unable to review these records. Therefore, the Board finds that an additional VA medical opinion is needed to determine the nature and etiology of any acquired psychiatric disorder that may be present. Moreover, the Board notes that the claim for service connection for hypertension is inextricably intertwined with the claim for service connection for an acquired psychiatric disorder given the theory of secondary service connection. For this reason, the issue of entitlement to service connection for an acquired psychiatric disorder must be resolved prior to resolution of the claim for service connection for hypertension. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that the prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). The matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all healthcare providers who have provided treatment for a psychiatric disorder and hypertension. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA treatment records. 2. After the foregoing development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any current acquired psychiatric disorder that may be present. 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, including the Veteran’s service records, post-service medical records, and statements. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should identify all current psychiatric disorders. If any previously diagnosed disorder is not found on examination, the examiner should address whether it was misdiagnosed or has resolved. For each disorder identified other than PTSD, the examiner should state whether it is at least as likely as not that the disorder manifested in service or is otherwise causally or etiologically related to the Veteran’s military service. In rendering this opinion, the examiner should consider the service treatment records indicating that the Veteran was seen at a mental health outpatient clinic at the naval hospital in Yokosuka, Japan. The records document complaints of intermittent depressive symptoms, sleep problems, crying spells, and decreased appetite. The Veteran also reported significant alcohol use for several years, and he was diagnosed with alcohol dependence. With respect to PTSD, the AOJ should provide the examiner with a summary of any verified in-service stressors, and the examiner must be instructed that only these events and any stressors related to fear of hostile military or terrorist activity may be considered for the purpose of determining whether exposure to an in-service stressor has resulted in PTSD. The examiner should determine whether the diagnostic criteria to support the diagnosis of PTSD have been satisfied. If the PTSD diagnosis is deemed appropriate, the examiner should then comment upon the link between the current symptomatology and any verified in-service stressor. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find favor of the conclusion as it is to find against it.) A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing these actions, the AOJ should conduct any other development as may be indicated by a response received as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.S. Chilcote, Associate Counsel