Citation Nr: 18134366 Decision Date: 09/13/18 Archive Date: 09/12/18 DOCKET NO. 16-18 370 DATE: September 13, 2018 REMANDED Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. (The issue of entitlement to service connection for hypertension is addressed in a separate, concurrent decision.) REASONS FOR REMAND The Veteran had active air service from March 1965 to October 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts. In a July 2017 rating decision, the RO granted service connection for bipolar disorder (claimed as anxiety and depression), and assigned a 50 percent rating, effective April 11, 2017. In a December 2017 rating decision, the Veteran was assigned a 70 percent rating for bipolar disorder, effective December 14, 2017. However, because separately diagnosed psychiatric disorders may be service-connected as distinct disabilities, the Veteran’s claim of entitlement to service connection for PTSD remains on appeal. See Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009). Entitlement to service connection for PTSD. The Veteran has contended that he has PTSD which is related to his active service. Service treatment records are silent for any treatment for, or diagnosis of PTSD. However, at his August 1968 discharge examination, the Veteran indicated that he had symptoms of depression or excessive worry. He specifically reported that he became “depressed with people he work[ed] for.” In January 2015, a private psychologist evaluated the Veteran and determined that he met the DSM-V criteria for a diagnosis of PTSD. The Veteran had reported at least one instance where he was physically assaulted while in service by multiple fellow service members due to anti-Semitism and he identified other physical attacks as traumatic and a source of emotional distress. In a March 2015 medical statement, the Veteran’s private physician provided a summary of the mental health symptoms and “textbook characteristics of PTSD” that developed after the Veteran’s active service, to include his self-reported exposure to emotional/physical abuse by his fellow airmen. The Veteran was afforded a VA examination for PTSD in April 2015. The examiner concluded that the Veteran did not have a diagnosis of PTSD that met the DSM-V diagnostic criteria. The examiner explained that the Veteran’s claimed in-service stressor (verbal non-sexual harassment) did not involve serious injury or life threat for himself or others and he did not report another in-service stressor that would meet Criterion A for PTSD. In addition, the examiner stated the Veteran did not endorse sufficient symptoms for Criteria C (avoidance symptoms) and D (cognition and mood symptoms) of PTSD. Rather, the examiner determined that the Veteran’s symptoms met the criteria for other specified trauma- and stressor-related disorder, which most likely corresponded to a DSM-IV diagnosis of adjustment disorder with anxiety, and he had an alcohol use disorder, which was in sustained remission. The examiner opined that it was less likely than not that the Veteran had a mental disorder caused by his active service. In support of that opinion, the examiner noted that the Veteran reported that the primary service-related stressor was harassment, which the Veteran attributed to anti-Semitism among other airmen. The Veteran also stated that the harassment did not result in significant physical injury and it occurred both in the United States and during his deployment to Okinawa. The examiner opined that it was at least as likely as not that the diagnosis of other specified trauma- and stressor-related disorder was a result of harassment during the Veteran’s military service. In a February 2016 VA medical opinion, the examiner explained that although the Veteran reported PTSD symptoms at both his April 2015 VA examination as well as at other VA clinical evaluations, the Veteran’s claimed stressor of anti-Semitic harassment was not adequate for a diagnosis of PTSD, as it did not meet a Criterion A trauma. The examiner stated that the Veteran may have experienced distress that led to mood symptoms or an anxiety-related disorder during his military service, but the stressor was not sufficient for a diagnosis of PTSD. The examiner noted that the Veteran’s service-connected bipolar disorder included symptoms which could, in some cases, be similar to or overlap with those of PTSD. Additionally, the examiner noted that the depression found at the time of the Veteran’s discharge examination may have been an early indicator of his bipolar disorder. As such, the examiner opined that it was less likely than not than the claimed PTSD was due to the in-service anti-Semitic harassment. The Board finds the April 2015 and February 2016 VA examinations incomplete and as such, not adequate for adjudication purposes. In this regard, the examiners stated that the Veteran’s stressor did not meet criterion A trauma because it was verbal and non-sexual harassment. However, in 2015, the Veteran reported that he was physically assaulted by fellow service officers and physically abused. In light of the additional stressor information reported in 2015, the Board finds that the Veteran should be afforded a new VA examination to determine the nature and etiology of any currently present PTSD. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The matter is REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination by a psychiatrist or psychologist with sufficient expertise to determine the nature and etiology of any currently present PTSD. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination of the Veteran and review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present PTSD is etiologically related to the Veteran’s active service. In forming the opinion, the examiner must consider and discuss the Veteran’s lay assertion that he was physically assaulted by his fellow servicemen and that he was “depressed with people he work[ed] for” at his August 1968 discharge examination. The rationale for all opinions expressed must be provided. 3. Confirm that the VA examination report and all medical opinions provided comport with this remand and undertake any other development determined to be warranted. 4. Then, readjudicate the remaining claim on appeal. If the decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ware, Associate Counsel