Citation Nr: 18112262 Decision Date: 06/19/18 Archive Date: 06/19/18 DOCKET NO. 14-18 249 DATE: June 19, 2018 REMANDED Entitlement to service connection for a disability of the bilateral shoulders is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1979 to July 1982 and from June 1984 to October 1996. In his substantive appeal (VA Form), the Veteran requested the opportunity to testify at a hearing before Veterans Law Judge. A Travel Board hearing was scheduled for October 20, 2016. After the Veteran did not appear for that hearing, a second hearing, this time scheduled to proceed via videoconference, was arranged for April 2018. According to the Board’s case management system (VACOLS), the Veteran did not appear for either hearing. Accordingly, the Board finds that the hearing request has been withdrawn. 38 C.F.R. § 20.702(d). During earlier proceedings in this case, the State of Hawaii Office of Veterans Services acted as the Veteran’s representative. That organization withdrew from participation in this case in April 2018. In May 2018, the Board mailed the Veteran a letter, informing him that his representative had withdrawn from these proceedings and explaining to him that he had the opportunity to select a new representative. Since the Veteran did not respond to the Board’s letter or otherwise designated a new representative, the case will proceed with the Veteran acting pro se. 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. In May 2013, the Agency of Jurisdiction (AOJ) arranged for the Veteran to be examined by a VA psychologist. The psychiatric claim was later denied, in part because the examiner found that the Veteran did not have any clinically significant psychiatric disorder according to the criteria listed in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). According to the May 2013 examiner’s report, the Veteran was receiving some kind of mental health counseling at the time of the examination. No mental health counseling records are in the claims file and it is not clear whether the missing counseling records could potentially establish a current clinical diagnosis for the Veteran’s claimed psychiatric disorder. The Board will remand the psychiatric claim, so that the AOJ can make reasonable efforts to obtain copies of the Veteran’s mental health counseling records. If these records are obtained, or if new information from any source indicates a clinical diagnosis for a mental illness, then a new medical examination or opinion may be needed. 2. Entitlement to service connection for a disability of the bilateral shoulders is remanded. After a VA shoulder and arm examination in October 2012, the Veteran was diagnosed with degenerative changes of the acromioclavicular joint, bilaterally. The Veteran attributes this disability of his bilateral shoulders to the excess strain of a parachute harness against his shoulders during training and flight missions, over the course of many years. In his notice of disagreement, the Veteran explained that he did not seek treatment for this condition during service, in part because he and his colleagues were discouraged from seeking treatment – “It was instilled in us to suck it up and drive on.” To help decide whether a causal link exists between the current shoulder disability and military service, the AOJ obtained an opinion from the October 2012 VA examiner. In the examiner’s opinion, it was less likely than not that the current shoulder disability was related to service. The rationale purporting to explain the examiner’s opinion did not address the Veteran’s statements about the stressful effect of the parachute straps over time. The reason the examiner failed to address the Veteran’s contentions may have been that the AOJ’s request to the examiner appears to limit the scope of the requested opinion to the issue of whether or not the current shoulder disability was “proximately due to or the result of the left leg condition noted in service.” Even if the current shoulder condition is not related to the leg injury noted in service, the Veteran could still potentially be eligible to receive compensation for his current bilateral shoulder disability if his suggestion about the stressful impact of the parachute harness is correct. Under these circumstances, the October 2012 medical opinion is inadequate to decide the shoulder claim, and that that claim should be remanded to obtain an appropriate addendum opinion. The matters are REMANDED for the following action: 1. Write to the Veteran and ask him to identify the mental health treatment provider with whom he met to receive the mental health counseling he mentioned in his interview with the May 2013 VA examining psychologist. Ask the Veteran to complete a VA Form 21-4142 for any facility or provider he identifies. Make at least two requests for any records identified by the Veteran, unless it is clear after the first request that a second request would be futile. 2. If previously unavailable mental health treatment records are obtained due to the efforts required by the instructions above, the AOJ should consider the need for further development, including whether a new medical opinion is needed to help resolve the Veteran’s claim for service connection for an acquired psychiatric disorder. If the newly obtained records indicate a diagnosis for any DSM-IV mental disorder, the AOJ should obtain an addendum opinion from the May 2013 VA examiner concerning the nature and etiology of any diagnosed mental illness. If the May 2013 examiner is not available for any reason, the requested opinion should be obtained from another qualified person. If the examiner decides that a new examination is necessary, then a new examination should be arranged. After reviewing the claims file, including any newly obtained records, the examiner should indicate whether it is at least as likely as not (50 percent probability or more) that any current acquired psychiatric disorder had its initial onset in service or is otherwise related to any in-service disease, injury, or event, to include the stressful incident described by the Veteran in his interview with the May 2013 VA examiner, in which a “hard landing” caused a crew member to eject from the Veteran’s aircraft, causing the death of the crew member. The examiner is advised that, according to the May 2013 report, this incident met criterion A for a PTSD diagnosis. A complete rationale should be provided for all opinions requested. 3. Obtain an addendum opinion from a qualified medical professional concerning the nature and etiology of any current disabilities of the Veteran’s bilateral shoulders. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any current bilateral shoulder disability, including degenerative changes of the bilateral acromioclavicular joints, is related to any disease, injury or event during active duty service. The examiner should specifically address the Veteran’s suggestion that the stress of the straps of his parachute harness against his shoulders, over a long course of time, caused him to develop degenerative changes in his shoulders. A complete rationale should be provided for all opinions requested. The examiner is advised that the lack of records of medical treatment for shoulder complaints in service, standing alone, is not sufficient to justify an unfavorable opinion. 4. The AOJ must ensure that the requested examination reports and medical opinions are in compliance with the directives of this remand. If any report is deficient in any manner, the AOJ must implement corrective procedures at once. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Nye, Associate Counsel