Citation Nr: 18156582 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 16-51 999 DATE: December 10, 2018 REMANDED Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1967 to November 1968. Service connection for PTSD The Veteran contends that his current psychiatric symptomatology is attributable to PTSD. Notably, he has been in receipt of service connection for bipolar II disorder (previously characterized as schizophrenia, schizo-affective type), at a rate of 100 percent, since October 1977. The Veteran asserts that he has been misdiagnosed, however, and that traumatic experiences in service led to undiagnosed PTSD which is the true cause of his symptomatology. As an initial matter, the Board notes that there are particular requirements for establishing entitlement to service connection for PTSD in 38 C.F.R. § 3.304(f) that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) and 38 C.F.R. § 4.125. Notwithstanding, VA is obligated to consider all pertinent symptomatology, regardless of how that symptomatology is diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1, 5, 9 (2009). At the outset, the Board notes that VA has conceded that the Veteran experienced in-service stressors. Notably, a November 1977 hospitalization treatment note reflects that the Veteran had a psychotic break in service aboard the USS Tiru. At that time, clinical notes show that the Veteran’s doctors contacted a member of the Naval Investigative Service, who confirmed that the Veteran was subjected to extreme stress in service, the precise nature of which could not be disclosed for national security reasons. (These stressors were later determined by VA to be the basis of his award of service connection for schizophrenia.) Additionally, the record clearly shows that the Veteran has suffered from a variety of psychiatric symptoms during the instant appeal. However, the Board finds that the question of whether the Veteran has a PTSD diagnosis remains unresolved. On review, the record reflects that the Veteran has been treated and diagnosed primarily with schizophrenia, schizoaffective disorder, bipolar disorder, and adjustment disorder. In February 2013 and April 2013, the Veteran submitted letters from psychologists indicating that while the Veteran may have met the criteria for PTSD during the 1970s and 1980s, his current symptoms were consistent with adjustment disorder with mixed anxiety and depressed mood. (A letter from 2009 indicated that the Veteran presented with no psychiatric impairment.) In July 2014, a VA examination indicated a diagnosis of bipolar II disorder; the examiner noted that there was “no evidence to support a diagnosis of [PTSD].” In November 2016, the Veteran submitted an additional letter from his treating psychologist which stated the following: Given what we have observed in our extensive contact with [the Veteran] since 2009, we have also found it probable that the symptoms he presents today have had their basis in his previously [un]diagnosed PTSD, from which he has largely recovered, but which, in no uncertain terms, remains present. PTSD is an anxiety disorder which will continue to impact an individual as long as the memories of the events which precipitated the disorder are intact and intrusive. [The Veteran’s] case is unusual, in that he indicated he has never been permitted to share these memories in detail, apparently due to the national security concerns of the U.S. Navy Submarine Force. He credits his rather unusual recovery to the training and experience provided by his service in that organization. . . . The psychologist continued: Underlying the symptoms of [the Veteran’s] current adjustment disorder, including anxiety and depressed affect, we do recognize the presence of survivor guilt (associated with PTSD) in his personality functioning, a feeling at least partially generated by his failure to bring his experience to the attention of the Department of Veterans Affairs. Although the Board respects the findings of the Veteran’s psychologist, VA is bound by the law pertaining to PTSD service-connection claims. Here, the November 2016 letter quoted above contains no indication as to whether the actual diagnostic criteria for PTSD were met. Furthermore, the psychologist made no attempt to reconcile his new positive diagnosis with the substantial prior evidence of record indication negative PTSD diagnoses. In short, the Board is unable to find at this time that the requirements of 38 C.F.R. § 3.304(f) have been met in this case. In light of the acknowledged in-service stressors discussed above and the conflicting medical evidence of record with respect to the Veteran’s psychiatric diagnoses, the Board finds that an updated VA examination is required to determine if the Veteran meets the diagnostic criteria for PTSD pursuant to 38 C.F.R. § 4.125(a). See Barr v. Nicholson, 21 Vet. App. 303 (2007) (when VA undertakes to provide an examination or obtain an opinion, it must ensure that the examination or opinion is adequate). The matter is REMANDED for the following action: Schedule the Veteran for a psychiatric examination with an appropriate specialist. The examiner should determine whether the diagnostic criteria to support a diagnosis of PTSD have been satisfied. If a PTSD diagnosis is deemed appropriate, the examiner should then comment upon the link between the Veteran’s current symptomatology and his documented in-service stressors, to include traumatic events the Veteran experienced while serving aboard the USS Tiru. Please note that the specific nature of these events have not been disclosed for national security reasons. In addition, the examiner should discuss and, if necessary, reconcile the November 2016 letter submitted by the Veteran’s private psychologist indicating a positive diagnosis of PTSD with prior evidence indicating diagnoses of schizophrenia, schizo-affective disorder, bipolar disorder, and adjustment disorder. (Continued on the next page)   The examiner is advised that the Veteran is competent to report symptoms, treatment, events, and injuries in service and that his assertions must be taken into account, along with the other evidence of record, in formulating the requested medical opinion. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Minot, Associate Counsel