Citation Nr: 19138363 Decision Date: 05/17/19 Archive Date: 05/17/19 DOCKET NO. 15-43 076 DATE: May 17, 2019 ORDER Service connection for residuals/scars associated with a hernia surgery is granted. REMANDED The claim for service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) and anxiety disorder, is remanded. The claim for service connection for deviated nasal septum is remanded. FINDING OF FACT The evidence shows that the Veteran was diagnosed with umbilical hernia in service and underwent an umbilical hernia repair surgery within one month after separation from service. CONCLUSIONS OF LAW The criteria for service connection for residuals/scars associated with hernia surgery have been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1991 to May1993, from October 1993 to September 1999, from April 2005 to October 2007, and from June 2009 to July 2010 (including overseas service in Kuwait/Iraq from July 2009 to May 2010). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.§ 1110; 38 C.F.R.§ 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disease manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). The Veteran is seeking service connection for residuals/scars associated with his hernia surgery. Service treatment records (STRs) documented a surgery consultation for umbilical hernia in June 2010, indicating that umbilical hernia was diagnosed in service. Records from the Army Medical Center in El Paso, Texas show that the Veteran underwent an umbilical hernia repair surgery in July 2010 (approximately five weeks after separation from active duty service). As such, service connection for residuals/scars associated with his hernia surgery is granted. REASONS FOR REMAND 1. PTSD/Depressive Disorder The Veteran was afforded a VA examination in April 2012, at which the examiner diagnosed him with anxiety disorder, but not PTSD. However, the VA treatment records suggest that he has since been diagnosed with PTSD in June 2012 and again in July 2015 by multiple VA psychiatrists. Additionally, at the December 2018 Board hearing, the Veteran reported several stressful events that he experienced in service, to include (1) a live grenade being thrown at him and exploding in a close proximity during a grenade training, which is corroborated by military accident investigation records; and (2) exposure to gun shooting during border patrol, which is corroborated by a commendation letter dated October 1994 for the Veteran’s meritorious conduct in the performance of dangerous service along the Mexico border. It is also noted that he served in Iraq as well. As such, further development is required to determine whether he has developed any acquired psychiatric disability to include PTSD based on the corroborated in-service stressors, or based on fear of hostile military or terrorist activity. 2. Deviated Nasal Septum At the December 2018 Board hearing, the Veteran reported having a lot of combat training during service, including being hit on the nose very hard during a training session shortly after he got back from Iraq and before he separated from service. VA treatment records document a diagnosis of deviated nasal septum in May 2011 which is within one year after he separated from service in July 2010; and records from Army Medical Center in William Beaumont show that the Veteran underwent a nasal septum surgery in January 2012 and the operation report noted a long history of left greater than right nasal obstruction. The Veteran was afforded a VA examination on his nose condition in August 2013 at which the examiner did not find evidence of a deviated nasal septum. However, VA treatment records in November 2013 and March 2015 list deviated nasal septum as one of his active problems. As such, further development is needed to assess the current condition of the Veteran’s nasal septum and to determine the etiology thereof. Therefore, the matters are REMANDED for the following actions: 1. Obtain VA treatment records from November 2015 to the present. 2. Schedule the Veteran for a VA psychiatric examination with a VA psychiatrist or psychologist (or a psychiatrist or psychologist that VA has contracted with). The examiner should diagnose any current acquired psychiatric disability, to include PTSD and anxiety disorder. a) If an acquired psychiatric disability is diagnosed, the examiner should opine as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s acquired psychiatric disability either began during or was otherwise caused by his military service. b) If PTSD is diagnosed, the examiner should indicate if it is the result of the corroborated in-service stressors, including - the grenade incident and the exposure to gun shots being fired during the border patrol, or whether the Veteran’s PTSD is the result of fear of hostile military or terrorist activity. 3. Schedule the Veteran for a VA examination of his nose condition. The examiner should identify any current conditions of the nasal septum, to include any residuals from the Veteran’s nasal septum surgery in January 2012, and opine whether it is at least as likely as not (50 percent or greater) that the Veteran’s nasal septum condition either began during or were otherwise caused by his military service? Why or why not? In doing so, the examiner should address the diagnoses of the deviated nasal septum in May 2011, which was within one year after separation from service, as well as the subsequent nasal septum surgery in January 2012. The examiner should also address whether the residuals of the surgically corrected septum are different than the symptomatology of the Veteran’s service connected sinusitis and rhinitis. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Q. Wang, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.