Citation Nr: 18156528 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 15-10 450A DATE: December 10, 2018 ORDER As new and material evidence to reopen the claim for service connection for posttraumatic stress disorder (PTSD) has been received, to this extent, the appeal as to this matter is granted. As new and material evidence to reopen the claim for service connection for right ankle disability has been received, to this extent, the appeal as to this matter is granted. Reconsideration of a previously denied claim of entitlement to service connection for lumbar spine disability is granted. Reconsideration of a previously denied claim of entitlement to service connection for right knee disability is granted. Reconsideration of a previously denied claim of entitlement to service connection for left knee disability is granted. Reconsideration of a previously denied claim of entitlement to service connection for right shoulder disability is granted. REMANDED The claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. The claim of entitlement to service connection for a right ankle disability is remanded. The claim of entitlement to service connection for a lumbar spine disability is remanded. The claim of entitlement to service connection for a right knee disability is remanded. The claim of entitlement to service connection for a left knee disability is remanded. The claim of entitlement to service connection for right shoulder disability is remanded. FINDINGS OF FACT 1. In a December 2005 rating decision, the agency of original jurisdiction (AOJ) denied the Veteran’s claim for service connection for a right ankle condition; although notified of the denial in a letter dated that same month, the Veteran did not initiate an appeal, and no pertinent exception to finality applies. 2. In a June 2007 rating decision, the AOJ denied the Veteran’s request to reopen her claim for service connection for PTSD; although notified of the denial in a letter dated that same month, the Veteran did not initiate an appeal, and no pertinent exception to finality applies. 3. New evidence associated with the claims file since the December 2005 and June 2007 rating decisions relates to unestablished facts necessary to substantiate the claims for service connection for a right ankle disability, and for PTSD, and raises a reasonable possibility of substantiating each claim. 4. In an August 2010 rating decision, the AOJ denied service connection for a joint condition, to include involving the right shoulder and knee. Although notified of the denial in a letter dated in that same month, the Veteran did not initiate an appeal; however, new and material evidence pertinent to the right shoulder, and right and left knee claims was received within one year. 5. An October 2010 rating decision denied service connection for a lumbar spine condition. Although notified of the denial in a letter dated that same month, the Veteran did not initiate an appeal; however, new and material evidence pertinent to the claim was received within one year. CONCLUSIONS OF LAW 1. The December 2005 rating decision in which the AOJ denied the Veteran’s claim for service connection for a right ankle condition is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. 2. The June 2007 rating decision in which the AOJ declined to reopen the service connection claim for PTSD is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. 3. As additional evidence received since the December 2005 rating decision, pertinent to the right ankle disability claim, is new and material, the criteria for reopening the service connection claim are met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 4. As additional evidence received since the June 2007 rating decision, pertinent to the claim for service connection for PTSD, is new and material, the criteria for reopening the service connection claim are met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. As evidence received since the August 2010 denial of service connection for a joint condition, which also considered right shoulder and knee disabilities, includes new and material evidence received prior to the expiration of the appeal period, the criteria for reconsideration of those claims is met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 6. As evidence received since the October 2010 decision that denied service connection for a lumbar spine condition includes new and material evidence received prior to the expiration of the appeal period for that claim, the criteria for reconsideration of the claim is met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1982 to September 1985. She additionally had Army National Guard service through March 1987. This appeal to the Board of Veterans Appeals (Board) arose from a June 2012 rating decision, in which the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, inter alia, reopened, but denied on the merits, the Veteran’s claim for service connection for PTSD; confirmed previous denials of service connection for a lumbar spine condition, right and left knee conditions, and a right ankle condition, and considered and denied service connection for a shoulder condition on the merits. The Veteran disagreed with the RO’s decision and this appeal ensued. In November 2014, the Veteran testified during a hearing before an RO Decision Review Officer (DRO). In January 2018, the Veteran and her sister estified during a Board hearing before the undersigned Veterans Law Judge (VLJ) held at the RO. Transcripts of both hearings are of record. Regarding characterization of the PTSD and right ankle disability claims, it is noted that, regardless of the RO’s actions, the Board has a legal duty under 38 U.S.C. §§ 5108 and 7104 to address the question of whether new and material evidence has been received to reopen previously denied claims for service connection. That matter goes to the Board’s jurisdiction to reach the underlying claim and adjudicate the claims on a de novo basis. See Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). As the Board must first decide whether new and material evidence to reopen each previously denied claim has been received—and, in view of the Board’s favorable decision on the requests to reopen the previously-denied service connection claims—the Board has characterized as to each of these claimed disabilities as now encompassing both a request to reopen, and the underlying claim for service connection, on the merits. For reasons explained below, the Board has expanded the reopened PTSD claim to encompass other psychiatric diagnoses. Regarding characterization of the right shoulder, right and left knee, and lumbar spine disability claims, the AOJ has treated the knee and lumbar spine issues as requests to reopen previously denied claims of entitlement to service connection. However, as explained below, each of these claims are more appropriately characterized as requests for reconsideration of the claims, consistent with the provisions of 38 C.F.R. § 3.156(b). Moreover, given the favorable disposition of each reconsideration issue, as discussed below, the appeal as to each issue has been characterized to include the underlying claims for service connection. As a final preliminary matter, the Board notes that, while the Veteran also initially appealed claims for service connection for hypertension and gall stones (cholecystitis), and the denial of her request to reopen a service connection claim for depression, she withdrew her claims for cholecystitis and major depressive disorder in a November 2014 statement, before a statement of the case (SOC) was issued in March 2015. Additionally, she specifically excluded from her April 2015 substantive appeal the claim for service connection for hypertension, following issuance of the March 2015 SOC. I. Requests to Reopen The Veteran’s claims for service connection for right ankle disability and PTSD were previously considered and denied. In a December 2005 rating decision, the AOJ denied a claim for service connection for right ankle disability because of a lack of evidence showing the condition occurred in or was caused by the Veteran’s active service. In a June 2007 rating decision, the AOJ declined to reopen the service connection claim for PTSD because new and material evidence had not been submitted to reopen the claim that was previously denied because there was no evidence that the condition occurred in or was caused by the Veteran’s active service. Although notified of the December 2005 and June 2007 decisions in respective AOJ letters, the Veteran did not initiate an appeal with respect to either of these claims. See 38 C.F.R. §§ 20.200, 20.201. Moreover, no new and material evidence was received within the one-year appeal period from the date of the notice of any denial, and no additional service records (warranting reconsideration of either claim) have been received at any time. See 38 C.F.R. § 3.156(b), (c). Therefore, the December 2005 and June 2007 decisions are final as to the evidence then of record pertaining to each respective claim, and are not subject to revision on the same factual basis. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 20.302, 20.1103. However, under pertinent legal authority, VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of the Veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). For petitions to reopen filed on and after August 29, 2001, 38 C.F.R. § 3.156(a) defines “new” evidence as evidence not previously submitted to agency decision makers and “material” evidence as evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether new and material evidence has been received, VA must initially decide whether evidence received since the prior final denial is, in fact, new. This analysis is undertaken by comparing the newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The provisions of 38 U.S.C. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-83 (1996). Furthermore, for purposes of the “new and material” analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-13 (1992). Where VA has previously denied a claim because one element of service connection is missing, the case must be reopened when evidence potentially fulfilling the missing element is submitted. See Molloy v. Brown, 9 Vet. App. 513 (1996). Further, the United States Court of Appeal for Veterans Claims (Court) has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold, viewing the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court has emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” Id. The evidence of record at the time of the December 2005 rating decision consisted of the Veteran’s June 1985 separation examination report, service treatment and personnel records (STRs and SPRs) pertaining to her National Guard service, and a June 2001 private psychiatric treatment report. Additional evidence of record at the time of the June 2007 rating decision included VA treatment records dated through May 2007, and statements from the Veteran and her sister received in December 2006. New evidence pertinent to the service connection claims for a right ankle disability and for PTSD includes ongoing VA treatment records, noting ongoing diagnosis and treatment for PTSD; records from the Social Security Administration (SSA), pertaining to her claim for SSA disability benefits; statements from another one of the Veteran’s sisters and her friend, J. L. S., attesting that the Veteran contacted each of them about being raped during service; statements from the Veteran, including during her DRO and Board hearings, detailing the incident when she was raped during service and attesting to an incident where she injured her ankle on a particular nighttime training jump; an August 2009 private orthopedic evaluation, concluding that the Veteran had right ankle pain secondary to a severe sprain in the past; a March 2011 statement from a VA psychologist indicating that she has treated the Veteran for her PTSD since January 2010; and an October 2014 letter from the Veteran’s Vet Center therapist, indicating her determination that the Veteran meets the DSM-5 criteria for PTSD, and that her anxiety symptoms were greatly impacted by her military sexual trauma (MST). The Board finds that the above-described evidence is “new” in that it was not previously before decision makers, and is not cumulative or duplicative of evidence previously of record. The evidence is also “material” in that it is relevant to the claims for service connection for right ankle disability and PTSD, wherein it provides evidence of a direct link between these conditions and the Veteran’s active service, by way of her MST and her experience as a paratrooper, respectively. Thus, the evidence collectively indicates a possible nexus between the Veteran’s claimed right ankle disability and PTSD, and her active service. Moreover, given the “low threshold” standard of Shade, and presuming the credibility of the evidence, the Board also finds that the additionally received evidence pertinent to the service connection claims for right ankle disability and PTSD, received since the December 2005 and June 2007 decisions, respectively, is new and material within the meaning of 38 C.F.R. § 3.156(a), warranting reopening of these service connection claims. See Justus, 3 Vet. App. at 513. II. Reconsideration The Veteran’s claims for service connection for a joint condition, to include affecting the right shoulder and knees, as well as the claim for service connection for a lumbar spine condition, were initially denied in August 2010 and October 2010 rating decisions. The pertinent evidence then of record consisted of the Veteran’s June 1985 separation examination report, VA treatment records, SSA records, statements from the Veteran, and a September 2010 report of VA examination of the Veteran’s spine. The AOJ denied the claims based on a lack of evidence of either disability occurring during service or being caused by service. Although notified of each denial in a letter date the same month, the Veteran did not initiate an appeal. See 38 C.F.R. § 20.200. Typically, this fact would render the decision final as to the evidence then of record, and not subject to revision on the same factual basis. See 38 U.S.C. § 7105(b); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Under such circumstances, VA could only reopen and review such claims if new and material evidence is submitted by or on behalf of the Veteran. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). However, applicable regulation provides that if new and material evidence was received during an appellate period following an RO decision (one year for a rating decision and 60 days for a SOC) or prior to an appellate (Board) decision (if an appeal was timely filed), the new and material evidence will be considered as having been filed in connection with the claim that was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b); Young v. Shinseki, 22 Vet. App. 461, 466 (2009). Thus, under 38 C.F.R. § 3.156(b), “VA must evaluate submissions received during the relevant [appeal] period and determine whether they contain new evidence relevant to a pending claim, whether or not the relevant submission might otherwise support a new claim.” Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011). “[N]ew and material evidence” under 38 C.F.R. § 3.156(b) has the same meaning as “new and material evidence” as defined in 38 C.F.R. § 3.156(a). See Young, 22 Vet. App. at 468. The Board reiterates that “new” evidence is evidence not previously submitted to agency decision makers and “material” evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Here, in December 2010, the Veteran submitted statements requesting reconsideration of her claim for a back disability, and asserting that her knee, shoulder, and back disabilities are the result of multiple airborne jumps. She additionally provided a copy of a private August 2009 orthopedic evaluation, noting that she served as a paratrooper in the Army, thereby intimating her contention that her orthopedic complaints are the result of her paratrooper duties. The clinician diagnosed mild degenerative joint disease (DJD) in the bilateral knees with pain in her right knee medial compartment, and probable chondromalacia of the right knee patella; and lumbar pain with mild radiculopathy with possible disk bulging. This evidence was received within one year of the August and October 2010 rating decisions. The Board finds that the above-described evidence is “new” in that it was not before the RO at the time of the August and October 2010 denials and is not duplicative or cumulative of the evidence previously of record. Additionally, this evidence is “material” in that it is relevant to the claims on appeal, and relates to unestablished facts necessary to substantiate the service connection claims for right and left knee, right shoulder, and lumbar spine disabilities. When considered in light of the evidence previously of record, this evidence provides a reasonable possibility of substantiating the claims. Thus, as new and material evidence within the meaning of 38 C.F.R. § 3.156(a) was received within one year of the August 2010 and October 2010 rating decisions reconsideration of the claims is warranted. See 38 C.F.R. § 3.156(b). REASONS FOR REMAND The Board’s review of the claims file reveals that further AOJ action on the reopened and reconsidered claims on appeal, is warranted. At the outset the Board notes that during her January 2018 hearing, the Veteran indicated that she was submitting 97 pages of medical evidence, including private decision based questionnaires (DBQs), in support of each of her claims. At this point, however, it does not appear that these records have been attached to her electronic claims file. Remand is required for the AOJ to request the records again, if necessary, and to attach the records to the electronic claims file. See 38 C.F.R. § 3.159. The Board additionally notes that while the AOJ requested copies of the Veteran’s STRs and SPRs through a Personnel Information Exchange System (PIES), and an August 2003 response indicated that the requested records were mailed, the STRs obtained contain only a June 1985 separation examination report, some dental records and immunization records; and thus, do not appear to be a complete copy of the Veteran’s STRs pertaining to her period of active service. Moreover, the SPRs obtained pertain only to the Veteran’s National Guard service. As such, it is additional STRs and SPRs may be available. Thus, on remand, the AOJ should undertake appropriate action to ensure that a complete copy of the Veteran’s STRs and SPRs pertaining to her period of active service is associated with the claims file. With respect to the Veteran’s claimed acquired psychiatric disability, the Board notes, initially, that as the record indicates that the Veteran may suffer from additional psychiatric disability, including anxiety, the Veteran’s reopened claim has been expanded to encompass any acquired psychiatric disability, to include PTSD, consistent with Clemons v. Shinseki, 23 Vet. App. 1 (2009). Additionally, the Board notes that the Veteran’s psychiatric disability claim is solely based on an alleged incident where she was raped during her period of active service. In this regard, the record contains extensive evidence, including her own statements and statement from family members and friends, supporting her allegation that she was raped during her active service, and that she told family members and friends about the incident. She further contended that she reported the incident to her first sergeant, but that since he was friends with the perpetrator, he did not take any action. The Veteran also contends that she requested a transfer from her unit, which was ultimately granted, and she contends that her performance level diminished. She also asserted that she requested to live off-base, at her own expense, as a result of the incident. Moreover, the record contains multiple opinions from the Veteran’s Vet Center therapist and a private psychiatrist affirming that the Veteran has a PTSD diagnosis and anxiety symptoms based on her reported incident of MST. These opinions are based on the Veteran’s reports of in-service stressor. In contrast to these opinions, a private January 2001 psychiatric report described the Veteran as having PTSD symptoms due to recurrent memories of a shooting incident at work. Given the foregoing, the Board finds that further development is required in order to attempt to corroborate the Veteran’s stressor based on the alleged incident of MST, as the stressor is not confirmed by the record. In this regard, VA regulations provide that when an alleged stressor based on in-service personal assault is not confirmed by the record, VA may submit any evidence that it receives in support of the alleged stressor to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. See 38 C.F.R. § 3.159(f)(5). Accordingly, this matter must be remanded to afford the Veteran a mental health examination to obtain findings and opinions needed to resolve the claim. See 38 C.F.R. § 3.159(f); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). With respect to the Veteran’s multiple claimed orthopedic disabilities, her essential assertion as that the disabilities result from her multiple parachute jumps as a paratrooper. In this regard, while her SPRs pertaining to her period of service were not obtained, her DD Form 214 confirms that she is the recipient of a parachute badge. Moreover, she credibly testified that she made close to 30 jumps during service. Concerning the claimed right ankle disability specifically, the Veteran testified as to an incident where she injured the ankle during a night jump, where she ended up landing in a tree outside of a small drop zone. She reported that she subsequently fell from the tree, which resulted in the ankle injury. She reported that afterward she was loaded on to a truck with others from her unit, and that at some point, she fell out of the truck onto the same ankle. She noted that while she was told to get help for the injury the next morning, when she did seek permission to get medical treatment the next day, she told that she was fine and that she need to proceed with physical training, and running on the ankle. She reported that she was finally referred for emergency treatment at Womack Army Medical Center at some point later. The Veteran further asserted that she attempted to obtain records pertaining to this incident, but that the she has been told that there are no copies of her in-service treatment records. The Veteran was afforded a VA examination of her ankles and knees in December 2014. In the report, however, the examiner did not a provide a response as to the diagnosis of either disability. Thus, it is unclear whether the December 2014 VA examiner was asserting that the Veteran did not have current ankle or knee disabilities. In contrast the examination reports, the Board notes that medical evidence tends to support the existence of current ankle and knee disabilities. Namely, the August 2009 private orthopedic evaluation indicated that the Veteran had right ankle pain secondary to a past severe sprain, and VA treatment records, including a May 2012 clinical report, have noted an assessment of DJD of the knees. Given these discrepancies, remand is also required to afford the Veteran new VA examination of the right ankle and bilateral knees. The Veteran was additionally afforded a VA examination of her lumbar spine in September 2010. The examiner diagnosed lumbar spine DJD and provided the opinion that the Veteran’s low back disability was not caused by or a result of her active service. In providing the opinion, the examiner reasoned that the Veteran did not have difficulty with her low back in service, and indicated that there was no evidence of trauma or injury in the STRs. The Board notes, however, that where the majority of the Veteran’s STRs pertaining to her period of active service are not of record, the examiner’s opinion may well be based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (an opinion based on an inaccurate factual premise has no probative value). Moreover, the examiner has inappropriately relied on an absence of low back injury in the STRs, even when the STRs appear to be incomplete. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (a medical opinion based solely on the absence of documentation in the record is inadequate). Given these inadequacies, a new VA examination of the Veteran’s lumbar spine is warranted on remand. With respect to the claimed right shoulder disability, the Veteran has specifically asserted that she would frequently roll on to her right shoulder upon landing after parachute jumps. Additionally, a September 2005 VA clinical report indicated that she had mild cystic degenerative changes of the acromion of the right shoulder, which suggests a possible current disability. To date, the Veteran has not been afforded a VA examination to obtain information as to the nature and etiology of any current right shoulder disability; however, on this record, such an examination should be obtained. See 38 U.S.C. § 5103A(d); McLendon, 20 Vet. App. 79; 38 C.F.R. § 3.159. Prior to undertaking action responsive to the above, to ensure that all due process requirements are met, and the record is complete, the AOJ should undertake appropriate action to obtain and associate with the claims file all other outstanding, pertinent records, to specifically include any outstanding STRs and SPRs (as noted above). As for VA records, the claims file currently includes VA outpatient treatment records dated through January 2015. Accordingly, the AOJ should obtain all outstanding records of VA evaluation and/or treatment of the Veteran dated since January 2015. The AOJ should also give the Veteran another opportunity to provide additional information and/or evidence pertinent to the remaining claims on appeal (yo include regarding private (non-VA) treatment), explaining that he has a full one-year period for response. See 38 U.S.C. § 5103(b)(1); but see also 38 U.S.C. § 5103(b)(3) (clarifying that VA may decide a claim before the expiration of the one-year notice period). Also, if the Veteran’s 97-page submission (referenced above) is missing, the AOJ should request that she submit the documents again. Thereafter, the AOJ should attempt to obtain any additional evidence for which the Veteran provides sufficient information and, if necessary, authorization, following the procedures prescribed in 38 C.F.R. § 3.159. The actions identified herein are consistent with the duties imposed by the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 3.159. However, identification of specific actions requested on remand does not relieve the AOJ of the responsibility to ensure full compliance with the VCAA and its implementing regulations. Hence, in addition to the actions requested above, the AOJ should also undertake any other development and/or notification action deemed warranted by the VCAA prior to adjudicating the remaining claims on appeal. These matters are hereby REMANDED for the following action: 1. Undertake appropriate action to ensure that a complete copy of the Veteran’s STRs and SPRs pertaining to her period of active service from September 1982 to September 1985 is obtained and associated with the claims file. Request the STRs and SPRs from the appropriate repository(ies), following the procedures set forth in 38 C.F.R. § 3.159(c) for requesting records from Federal facilities. All records and/or responses received should be associated with the claims file. 2. Obtain complete copies of all outstanding records of VA evaluation and/or treatment of the Veteran since January 2015. Follow the procedures set forth in 38 C.F.R. § 3.159(c) regarding requesting records from Federal facilities. All records and/or responses received should be associated with the claims file. 3. Send to the Veteran and her representative a letter requesting that the Veteran provide sufficient information concerning, and, if necessary, authorization to enable VA to obtain, any additional evidence pertinent to one or more remaining claim(s) on appeal that is not currently of record. Specifically request that she furnish, or furnish appropriate authorization to obtain, any outstanding, pertinent private (non-VA) records. Also, if the Veteran’s 97-page submission is not of record, request that she furnish copies of the documents are not located, and request th Also, specifically request that the Veteran provide copies of any STRs and SPRs in her possession. Clearly explain to the Veteran that she has a full one-year period to respond (although VA may decide the claims within the one-year period). 4. If the Veteran responds, assist her in obtaining any additional evidence identified, following the current procedures set forth in 38 C.F.R. § 3.159. All records/responses received should be associated with the claims file. If any records sought are not obtained, notify the Veteran of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. 5. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo a new VA mental health examination, by a psychiatrist or psychologist. The contents of the entire, electronic claims file, to include a complete copy of this REMAND, must be made available to the individual designated to examine the Veteran, and the examination report should include discussion of the Veteran’s documented medical history and assertions. All indicated tests and studies (to include psychiatric/psychological testing, if warranted) should be accomplished (with all findings made available to the examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner should specifically consider all evidence of record related to the Veteran’s alleged in-service sexual assault, to include evidence of her reporting the incident to family and friends, evidence of her requesting a transfer from her unit and to live off base, and lay reports and assertions provide by the Veteran and her family members and friends. The examiner should additionally consider the Veteran’s history of treatment for PTSD and the multiple PTSD diagnoses of record. Thereafter, the examiner should render a determination as to whether the collective evidence indicates that the Veteran’s alleged assault occurred. If so, the examiner should address whether the Veteran currently meets—or, at any time pertinent to the current claim, has met—the DSM-5 diagnostic criteria for PTSD due to such military sexual trauma (MST) (even if now asymptomatic or resolved). If the examiner determines that the Veteran does not meet the diagnostic criteria for PTSD, he or she should reconcile such conclusion with the evidence of diagnoses of PTSD of record. If a diagnosis of PTSD resulting from the identified MST is deemed appropriate, the examiner should clearly and fully explain how the diagnostic criteria are met, to include comment upon the link, if any, between the MST and the Veteran’s symptoms. Regardless of whether PTSD due to MST is diagnosed, the examiner should clearly identify all other current acquired psychiatric disorder(s) diagnosed currently or validly diagnosed at any point pertinent to the current claim, to include anxiety, even if now asymptomatic or resolved. Then, for each such diagnosed disorder, the examiner should provide an opinion, consistent with sound medical judgment, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disability (a) had its onset during the Veteran’s active service; (b) if a psychosis, was present to a compensable degree within the first post-service year; or (c) is otherwise medically-related to the Veteran’s period of active service—to include the MST referenced above. In rendering each requested opinion, the examiner must consider and discuss all relevant medical and lay evidence and all lay assertions, to include the Veteran’s assertions and any lay statements submitted on her behalf. All examination findings/testing results, along with complete, clearly-stated rationale for the conclusions reached, must be provided. 6. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo a new VA orthopedic examination of her lumbar spine, right and left knees, right shoulder, and right ankle by an appropriate physician. The contents of the entire, electronic claims file, to include a complete copy of this REMAND, must be made available to the individual designated to examine the Veteran, and the examination report should include discussion of the Veteran’s documented medical history and assertions. All indicated tests and studies should be accomplished (with all findings made available to the physician prior to the completion of his or her report), and all clinical findings should be reported in detail. The physician should clearly identify and diagnose all current lumbar spine, right and left knee, right shoulder, and right ankle disabilities currently present or present at any point pertinent to the current claim (even if now asymptomatic or resolved). If the examiner determines that the Veteran does not have a a current lumbar spine, right or left knee, right shoulder, or right ankle disability, he or she should reconcile with evidence of diagnosis of each such disability of record. With respect to each current lumbar spine, right and left knee, right shoulder, and right ankle disability, the physician should provide an opinion, consistent with sound medical judgment, addressing whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the disability had its onset during service or is otherwise medically related to service—to include as a result of the completion of multiple parachute jumps during her duties as a paratrooper during service. In rendering each requested opinion, the physician must consider and discuss all relevant medical evidence, and all lay assertions as to the nature, onset, and continuity of symptoms, to include the Veteran’s assertions as to a specific incident where she injured her right ankle after landing in, and then falling from, a tree. Notably, the absence of documented evidence of a specific disability and/or associated symptoms during or shortly after service should not, alone, serve as the sole basis for a negative opinion. In this regard, the physician is advised that the Veteran is competent to report her injuries, symptoms and history, which the Board has generally found credible, and that her assertions in this regard must be considered and discussed in formulating the requested opinions. If lay assertions in any regard are discounted, the physician should clearly so state, and explain why. All examination findings/testing results, along with complete, clearly-stated rationale for the conclusions reached, must be provided. 7. To help avoid future remand, ensure that all requested actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. See Stegall v. West, 11 Vet. App. 268 (1998). 8. After completing the requested actions, and any additional notification and/or development deemed warranted, adjudicate the service connection claims on appeal, on the merits, considering all pertinent evidence (to include all evidence added to the electronic claims file since the last adjudication) and legal authority. JACQUELINE E. MONROE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael Wilson, Counsel