Citation Nr: 18157520 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 16-27 516A DATE: December 12, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. The Veteran’s claimed disability has been recharacterized to include other psychological disabilities that may have been acquired as a result of military service. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran was afforded a VA PTSD examination in October 2014. The examination report reflects that the examiner found the Veteran did not meet the criteria for a diagnosis of PTSD under DSM-5 criteria. The examiner noted that the Veteran’s reported stressors would be adequate to support a diagnosis of PTSD, as they relate to a fear of hostile military activity, but concluded that the reported symptoms were not of sufficient significance to meet the criteria for a PTSD diagnosis. Instead, the examiner diagnosed the Veteran with persistent depressive disorder with anxious distress. However, this disability too was found to be less likely than not related to military service, although the examiner did not provide a thorough discussion of why he reached this conclusion. Nevertheless, the Board notes that the 2014 VA examiner acknowledged the Veteran’s reported in-service stressor, finding that the stressor meets Criterion A, and is related to the Veteran’s fear of hostile military or terrorist activity. Furthermore, the Board has reviewed the lay evidence of record, including the Veteran’s June 2014 statement regarding his in-service stressor, and finds the Veteran to be credible. The Board thus concedes the Veteran’s in-service stressor relating to fear of hostile military or terrorist activity. The Board further acknowledges the argument set forth by the Veteran’s representative in an October 2018 brief. Specifically, the Veteran’s representative submitted a report of private medical examination of the Veteran conducted in September 2018, which contains a diagnosis of both PTSD and depression, as well as a positive nexus opinion. That examination report reflects the private psychologist’s opinion that the Veteran’s PTSD and major depressive disorder are at least as likely as not related to the traumatic experiences the Veteran encountered while in the military. By way of rationale, the private psychologist reasoned that a review of the Veteran’s medical records revealed no evidence of any psychiatric disorders prior to or subsequent to military service that would account for his mental illness. As the evidence of record is reflective of differing medical conclusions and analyses, an examination for a medical opinion that reconciles the apparently conflicting evidence is necessary. The Veteran’s claim is remanded in order to obtain an addendum medical opinion—or a new VA examination, if such is deemed necessary—to clarify the Veteran’s diagnosis or diagnoses and determine the nature and etiology of any acquired psychiatric disorder found to be present. See 38 C.F.R. § 3.304(f)(3). The matter is REMANDED for the following action: 1. Obtain and associate any outstanding VA or private medical records with the claims file. 2. Then, arrange for the claims file to be reviewed by an appropriate VA psychiatrist or psychologist to ascertain the nature and etiology of the Veteran’s claimed psychiatric disability, to include his currently diagnosed depressive disorder and PTSD, based on a fear of hostile military action or terrorist activity in service. The entire record must be reviewed by the examiner. If the examiner determines that an in-person examination is necessary, one must be scheduled. Upon examination of the Veteran and review of his record, the examiner must provide opinions that respond to the following: (a) Identify by diagnosis each psychiatric disability entity found to be present at any point during the appeal period. The Board notes that the Veteran’s in-service stressor is conceded, and that he has been diagnosed with both PTSD and depression at various points during the appeal period. (b) Specifically indicate whether the Veteran meets the diagnostic criteria for PTSD and if so, offer an opinion as to whether it is at least as likely as not that PTSD is related to the Veteran’s conceded in-service stressor. (c) For each diagnosed disability other than PTSD, the examiner must offer an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the disability had its onset in service or is otherwise related to service. The examiner must specifically address the findings and opinion of the October 2014 VA examiner, and reconcile them with the findings of the September 2018 private examiner. The examiner must also address the Veteran’s lay statements of record, which the Board has found to be credible. The examiner must include a complete rationale with all opinions. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G.C., Associate Counsel