Citation Nr: 18155795 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 16-48 219 DATE: December 6, 2018 REMANDED Entitlement to an acquired psychiatric disorder, to include PTSD and schizoaffective disorder, is remanded. REASONS FOR REMAND The Veteran had active service from January 1985 to March 1992. 1. Entitlement to an acquired psychiatric disorder, to include PTSD and schizoaffective disorder is remanded The Veteran contends the he has an acquired psychiatric disorder that was incurred in, caused by, or aggravated by his active service. As a layperson, he is not deemed competent to distinguish between competing psychiatric diagnoses, and so a claim of service connection for one is considered a claim for all. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Therefore, the Board has expanded the Veteran’s claim into a claim for service connection for an acquired psychiatric disorder, to include PTSD and schizoaffective disorder. The Veteran submitted a statement describing two separate stressor events during his time in the Saudi Arabia. His service personnel records show overseas service in Korea. Service in Saudi Arabia has been shown only through service medical records, which indicate the Veteran experienced no direct contact to the population or injury from combat or hostile fire. On VA examination in August 2013, the examiner determined the Veteran did not meet criteria for PTSD. The examiner did state that the Veteran’s schizoaffective disorder most likely existed prior to his military service, but that his stressful military experiences likely exacerbated his mental illness. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110 (West 2014); 38 C.F.R. § 3.303 (2015). “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). The term “aggravation” means an increase in the claimed disability; that is, a worsening of the condition beyond the natural clinical course and character of the condition as contrasted to a temporary worsening of symptoms. Although the VA examiner indicated that there may have been an exacerbation, aggravation is not substantiated by temporary flare-ups. See Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). Notwithstanding the foregoing, the Board notes that this opinion was based on the assumption that the Veteran’s chronic schizoaffective disorder pre-existed his military service. The Veteran’s entrance medical report indicates that he reported a psychiatric hospitalization prior to joining the service. However, there is no diagnosis or confirmation of a psychiatric condition listed on the enlistment examination, or in the service treatment records otherwise. His service treatment records do not include any reports or treatment for schizoaffective disorder, anxiety, depression, or any other mental health disorder and his current medical records do not indicate that he had any mental health symptoms until 2009., which is over 15-years post-service. For these reasons, the August 2013 examination opinion is inadequate because it lacked adequate rationale. A remand is necessary to cure this defect. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records regarding the Veteran, particularly concerning the Veteran’s mental health. Contact the Veteran to determine whether there are any additional relevant private treatment records and obtain any necessary authorizations for such records. 2. Obtain any outstanding military service personnel records, including those pertaining to the Veteran’s service in Saudi Arabia in 1991 to March 1992. If necessary, a request should be made to the Defense Finance and Accounting Service (DFAS). Document all requests for information as well as all responses in the claims file. 3. Return the claims file, to include a copy of this remand, to the examiner who conducted the August 2013 VA examination, or another qualified examiner, to render an opinion and rationale on the appropriate diagnoses and etiologies of the Veteran’s mental health condition(s). The examiner should review the claims file and indicate such on the examination report. The Veteran may be recalled for examination if deemed necessary. The following questions should be addressed: a. Identify/diagnose any acquired psychiatric disorder that presently exists or that has existed during the appeal period. The examiner should state whether the criteria for a diagnosis of PTSD has been met. b. State whether there is clear and unmistakable evidence (undebatable) that the Veteran had an acquired psychiatric disorder, to include schizoaffective disorder, that preexisted his active service. The evidence considered in answering this question should be identified and discussed. c. For any psychiatric disorder found to have preexisted active service, state whether there is clear and unmistakable evidence that it was not aggravated beyond its natural progression by service. Aggravation” means an increase in the claimed disability; that is, a worsening of the condition beyond the natural clinical course and character of the condition as contrasted to a temporary worsening of symptoms. d. For any psychiatric disorder not found to have preexisted active service, state whether it is as likely as not (a 50 percent probability or greater) that it had its initial onset in service or is otherwise should to be etiologically related to service. A complete rationale for any opinion expressed must be provided. An examiner’s report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. As such, if the examiner is unable to offer an opinion, it is essential that the examiner provide a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide the opinion is based on the limits of medical knowledge. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.E. Lee, Associate Counsel