Citation Nr: 18160169 Decision Date: 12/27/18 Archive Date: 12/26/18 DOCKET NO. 17-02 067 DATE: December 27, 2018 REMANDED Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), major depressive disorder, and alcohol or other substance use disorder, is remanded. REASONS FOR REMAND The Veteran had active military service in the Marine Corps from June 1993 to May 1997. This appeal comes to the Board of Veterans’ Appeals (Board) from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. Jurisdiction currently resides with the RO in Portland, Oregon. The Board notes that the Veteran has been diagnosed with various psychiatric disorders, to include PTSD and major depressive disorder. The Board has recharacterized the claim for entitlement to service connection for PTSD to include, more generally, service connection for a psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In October 2014, the Veteran requested that his case be advanced on the docket (AOD) due to financial hardship. See October 2014 Statement in Support of Claim. Therefore, the Board finds that there is sufficient cause to grant the AOD motion. 38 U.S.C. § 7107(a)(2) (2012); 38 C.F.R. § 20.900(c) (2017). 1. Entitlement to service connection for a psychiatric disorder, to include PTSD, major depressive disorder, and alcohol or other substance use disorder, is remanded. The Veteran is seeking service connection for a psychiatric disorder, to include PTSD, major depressive disorder, and alcohol or other substance use disorder. The Veteran contends that his current psychiatric disorder resulted from being exposed to inhumane treatment and hazing while stationed at the Yorktown Naval Weapons Station as well as witnessing a woman being raped and killed while on guard duty at the American Embassy in Bangui. He also asserts that these incidences caused him to become an alcoholic. See April 2014 Statement in Support of Claim, August 2014 VA examination, and November 2014 Notice of Disagreement (NOD). The Veteran’s military personnel records show that the Veteran participated in Operation Assured Response while deployed and participated in Operation Quick Response, protection of the American Embassy in Bangui. The Veterans DD-214 shows that his military occupational specialty (MOS) was Mortarman and Basic Security Guard. Further, his military personnel records show that he was charged with a DUI. As such, the Board finds the Veteran’s reported in-service stressors to be consistent with the circumstances of his service. See 38 C.F.R. § 3.304(f)(3) (2017). In August 2014, the Veteran was afforded a VA examination for PTSD. The VA examiner concluded that the Veteran did not have a diagnosis of PTSD that conformed to the DSM-V criteria. Instead, he diagnosed the Veteran with other specified trauma-stressor related disorder, major depressive disorder, other substance use disorder, and alcohol use disorder. The VA examiner opined that the Veteran’s stressor was related to his fear of hostile forces and/or terrorist activity. He further concluded that the Veteran’s alcohol use was at least as likely as not related to his other specified trauma-stressor related disorder. The VA examiner noted that the rationale for his decision included a mental health history note dated March 24, 2014, PTSD Assessment dated July 31, 2014, and the Veteran’s PTSD self-support statement. However, in January 2017, the Veteran submitted a letter, dated December 2016, from his private psychiatric mental health nurse practitioner, J.D. She diagnosed the Veteran with major depressive disorder and PTSD, struggling with mental illness for over 20 years. She also noted that he was being treated with medications and had psychiatric hospitalizations and intensive treatment in the past. Based on the foregoing evidence, the Board finds that a remand is warranted to afford the Veteran a new VA examination for a medical opinion to clarify his mental diagnoses, to fully consider the events in service that have been corroborated by the record, and explain with a more adequate rationale whether his currently diagnosed psychiatric disorders are related to his military service. The evidence of record also indicates that the Veteran has had psychiatric hospitalizations and intensive treatment. The Veteran’s nurse indicated that he was in a mental health intensive outpatient program. See January 2017 Medical Treatment Record-Non-Government Facility. Further, on the Veteran’s October 2014 VA examination for PTSD, the Veteran stated that he was in outpatient treatment at the Green Oaks Hospital until February 2014. These medical documents are not of record. Therefore, on remand, the RO should obtain such documents. Finally, the Veteran’s November 2016 statement of the case (SOC), lists that the evidence of record includes VA treatment records from Phoenix from July 1997 to March 2007. However, since these are also not of record, the RO must obtain these medical records on remand. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and/or private treatment records and associate them with the claims file. Specifically, the RO should: (a.) Obtain updated VA treatment records from January 2015 to present. Also, the RO should obtain VA treatment records from Phoenix from July 1997 to March 2007. (b.) Request the Veteran to complete and return a VA Form 21-4142, Authorization and Consent to Release Information, for any medical treatment he received related to his psychiatric conditions, to include for any outpatient treatment and hospitalizations, and for Green Oaks Hospital. (c.) If these records cannot be obtained, then the RO should note such information for the record and notify the Veteran and his representative of such findings. 2. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of any acquired psychiatric disorder, to include PTSD, major depressive disorder, and alcohol and/or other substance abuse disorders. The Veteran’s claims file (to include this decision) must be reviewed by the examiner in conjunction with the examination. The VA examiner should address the following: (a.) Psychology testing should be conducted with a view toward determining whether the Veteran in fact meets the criteria under DSM-V for a diagnosis of PTSD. However, the examiner should also identify all current psychiatric disabilities diagnosed during the examination. (b.) The examiner should review the psychological test results, examine the Veteran, and provide an opinion as to whether the Veteran has symptomatology that meets the diagnostic criteria for PTSD. If PTSD is diagnosed, the examiner must identify the specific stressor(s) underlying any PTSD diagnosis and comment upon the link between the current symptomatology and the Veteran’s stressors and must specifically address whether the identified stressors are adequate to support a diagnosis of PTSD; and whether his symptoms are related to the identified stressors. (c.) In addition to an opinion regarding PTSD, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any other current psychiatric disorder(s) had its (their) clinical onset during active service or is (are) related to any in-service disease, event, or injury. (d.) Whether the Veteran’s alcohol or any other type of substance abuse disorder is at least as likely as not (50 percent probability or greater) related to any diagnosed psychiatric disorder, to include PTSD, major depressive disorder, etc. (e.) Whether the Veteran’s alcohol or any other type of substance abuse is at least as likely as not (50 percent probability or greater) aggravated (any worsening beyond normal progression) by any of his diagnosed psychiatric disorders, to include PTSD, major depressive disorder, etc. If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and also by the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time. (f.) The VA examiner should consider the results, diagnoses, and opinion of the August 2014 VA examination. The examiner should also consider the December 2016 letter from the Veteran’s private psychiatric mental health nurse practitioner, J.D. See January 2017 Medical Treatment Record-Non-Government Facility. (Continued on the next page)   (g.) A rationale for all requested opinions should be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she should provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in the medical community at large and not those of the particular examiner. Lindsey M. Connor Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Crawford, Associate Counsel