Citation Nr: 19168564 Decision Date: 09/04/19 Archive Date: 09/04/19 DOCKET NO. 16-36 500 DATE: September 4, 2019 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1987 to November 1991. This appeal comes before the Board of Veterans’ Appeals (Board) from a December 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Anchorage, Alaska. Although the Veteran submitted a claim for PTSD, the Board has recharacterized the issue as a claim for an acquired psychiatric disability, generally. The Veteran cannot be required to know whether the symptoms he is claiming service connection for are related to PTSD or another psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. The Veteran, and his representative, contends that his acquired psychiatric disorder is related to his active service. Specifically, the Veteran argues that his acquired psychiatric disorder stems from, among other things, exposure to attempted suicides and in-service racism. See January 2016 Correspondence. In support of his claim, the Veteran directs the Board to a January 2016 private medical treatment record reflecting a PTSD diagnosis that is related to the Veteran being exposed to “suicide attempt of friends in the military.” The Board finds this conclusory medical opinion to be inadequate to support the Veteran’s claim. In determining the adequacy of a medical examination or opinion, an examination or opinion is considered adequate, “where it is based upon consideration of the veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s ‘“evaluation of the claimed disability will be a fully informed one.’” Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (quoting Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (quoting Green v. Derwinski, 1 Vet. App. 121, 124 (1991))). Therefore, when a medical examination or opinion is provided, the clinician must support conclusions with an analysis that is adequate for the Board to consider and weigh against contrary opinions. Id. at 124-25. Here, the examiner appears to have relied almost entirely on the reported history of the Veteran, without taking into consideration other factors that may have contributed or caused the Veteran’s acquired psychiatric disorder. A bare transcription of lay history is not transformed into competent medical evidence simply because it was transcribed by a medical professional, whether that professional is a VA or private physician. LeShore v. Brown, 8 Vet. App. 406 (1995). The opinion, in this case, makes no reference that the Veteran’s claims file was reviewed or mention of relevant service or post-service medical or lay records. Although the claims file is not a “magical or talismanic set of documents,” Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303 (2008), it provides critical pieces of information that can lend credence to the opinion. Id. at 304. Moreover, the opinion is not definitive and supported by detailed rationale when weighed against the negative evidence of record. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). In this regard, there is negative evidence regarding the Veteran’s acquired psychiatric disorder. For instance, private treatment records, dated between 2006 and 2011, reflect multiple stressors related to the Veteran’s anxiety and depression; these stressors include problems related to finances, family, and work. Furthermore, medical records dated during that period reflect that the Veteran attributed his anxiety to “growing up in a ‘dysfunctional situation.’” Service treatment records, additionally, are negative for symptoms, treatment, or diagnoses, related to the Veteran’s acquired psychiatric disorder. Post-service medical records reflect that he first complained of anxiety and depressive mood swings in 2006, approximately 15 years after service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that the Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disorder at issue). Lastly, as further discussed below, medical opinions dated after the January 2016 opinion reflects that the Veteran does not meet the diagnostic criteria for PTSD pursuant to the fifth edition of the American Psychiatric Association ‘s Diagnostic and Statistical Manual for Mental Disorders (DSM-5). In developing this claim, VA obtained two medical opinions. VA medical opinion, dated August 2016, reflects that the Veteran does not meet the DSM-5 diagnostic criteria for PTSD; the Veteran, however, was found to meet the diagnostic criteria for generalized anxiety disorder. The examiner concluded that the Veteran’s acquired psychiatric disorder predated service and therefore was not related to service. The Board finds this opinion inadequate on two bases. First, the opinion does not allude to using the correct legal standard (requiring clear and unmistakable evidence) and, second, there is insufficient rationale for finding that that the acquired psychiatric disorder preexisted service and that it was not aggravated beyond its natural progression. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306. VA medical opinion, dated October 2016, again reflects that the Veteran does not meet the DSM-5 diagnostic criteria for PTSD, but met the criteria for generalized anxiety disorder. The examiner concluded that (1) there is not clear and unmistakable evidence that the acquired psychiatric disorder preexisted service and (2) the generalized anxiety disorder is less likely than not related to service. The Board finds this opinion to be inadequate because it is not supported by detailed rationale. Prejean, 13 Vet. App. at 448-49. Medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez, 22 Vet. App. at 301. In this case, the opinion reflects some supporting data (e.g. delay onset and service treatment records negative for a mental health condition) with a clear conclusion, but no reasoned medical explanation connecting the two. Because the VA medical opinions of record are inadequate for addressing the Veteran’s claim, remand is necessary. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following actions: 1. Attempt to corroborate the Veteran’s in-service stressor(s), including stressors relating to attempted suicide by friends of the Veteran and in-service racism. If more details are needed, contact the Veteran to request the information. 2. Ask the Veteran to complete a VA Form 21-4142 for all private medical providers seen for his acquired psychiatric disorder, to include records from Providence Family Medicine Center. Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 3. Obtain all VA treatment records dated from August 2016 to the Present. 4. After the Veteran’s reported stressor(s) have been developed, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any PTSD. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor. If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include being exposed to an attempted suicide or in-service racism. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. JACOB DWORKIN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffey, 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.