Citation Nr: 19195353 Decision Date: 12/19/19 Archive Date: 12/18/19 DOCKET NO. 16-38 353 DATE: December 19, 2019 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), bipolar disorder, anxiety disorder, and depressive disorder, is remanded. Entitlement to service connection for hepatitis C is remanded. REASONS FOR REMAND The Veteran had active military service from April 1978 to June 1978. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified at a Board videoconference hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. The undersigned agreed to keep the record open for 30 days to allow the Veteran additional time to submit medical test results, Social Security Administration (SSA) records, and nexus evidence to support his claims. Additional evidence was received in August 2019. See August 2019 Medical Treatment Records – Furnished by SSA; August 2019 SSA/SSI Letter; August 2019 Military Personnel Record. The Board has re-characterized the claim of entitlement to service connection for an acquired psychiatric disability, to include PTSD, bipolar disorder, anxiety disorder, and depressive disorder. Clemons v. Shinseki, 23 Vet. App. 1 (2009) (The scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record.). After a review of the record, the Board finds that a remand is necessary in order to comply with the duty to assist and to afford the Veteran adequate VA examinations. 1. Entitlement to service connection for an acquired psychiatric disability, to include PTSD, bipolar disorder, anxiety disorder, and depressive disorder is remanded. A review of the claims file reveals that further action on the claim of entitlement to service connection for an acquired psychiatric disability is needed. During the July 2019 hearing, the Veteran testified that he was repeatedly attacked by another airman in tech school and that he has had anxiety, episodes of depression, and PTSD symptoms since the in-service assaults. The Veteran stated that he did not seek medical treatment or initially report the harassment to anyone, other than his roommate, until he eventually broke down and told his staff sergeant about the harassment, but no action was taken. See July 2019 Hearing Transcript, pages 6-10. In the August 2019 attorney brief, the Veteran stated that after the assaults began, he experienced nighttime urinary incontinence and was told by other recruits that he had started screaming in his sleep. The Veteran reported that he believed he would be allowed to go home if he did not pass his training, and after he honestly failed one of his training examinations twice, he failed the third time on purpose. The Veteran testified that he has experienced mental health problems since his discharge from service. See August 2019 Military Personnel Record; see also July 2019 Hearing Transcript, pages 12-16. A review of the service treatment records (STRs) shows an April 1978 enlistment report of medical examination that is absent for findings pertaining to the Veteran’s psychiatric condition. A June 1978 record indicates that the Veteran was referred to be evaluated at the mental hygiene clinic after he failed the Block Two Measurement Examination three times. The mental health evaluation indicated that the Veteran reported that he could not remain in the service due to the fact that his father had three nervous breakdowns. He was also having problems academically due to having only a 10th grade education. Upon evaluation, there was no apparent mood or thought disturbance or mental health disorder. The diagnosis was no mental health disorder. In the June 1978 separation report of medical history, the Veteran stated that he did not have depression or excessive worry or nervous trouble of any kind and was medically cleared for separation. See March 2015 STR – Medical; May 2015 Military Personnel Record. The narrative reason for separation was “for involuntary discharge – marginal or nonproducing performer while assigned to recruit or initial skill training.” A review of the post-service treatment records shows that the Veteran has been consistently diagnosed with bipolar disorder, anxiety disorder, and depressive disorder since May 2014. See May 2016 CAPRI; June 2019 Medical Treatment Record – Non-Government Facility. A VA provider diagnosed the Veteran with PTSD, alcohol use disorder, and an unspecified depressive disorder in November 2016. During the individual session, the Veteran reported a history of physical abuse by his father, but described his childhood as generally good and stated that he did not believe his childhood has continued to have a negative impact on his life. The Veteran stated that the in-service physical assaults changed his life forever and that he never truly recovered after the attacks. The examiner noted that the Veteran reported feelings of resentment and frustration related to his inaction in service and that he has continued to feel shame related to the perception of being weak and for being discharged from the military. See April 2019 VAMC Other Output/Reports. The Board finds that the Veteran should be afforded a VA examination with respect to his claim for entitlement to service connection for an acquired psychiatric disability, to include PTSD, bipolar disorder, anxiety disorder, and depressive disorder. Under McLendon, VA is obligated to provide an examination when the record contains (1) competent evidence of a current disability (or persistent or recurrent symptoms of a disability), (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file to decide the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). There is no medical opinion of record as to whether the Veteran has an acquired psychiatric disorder related to service. Thus, in light of the Veteran’s reports of symptoms since service and the November 2016 VA treatment record suggesting a relationship to service, the Board finds that a VA examination is required in order to obtain an opinion addressing the nature and etiology of any diagnosed acquired psychiatric disabilities. See McLendon, supra. 2. Entitlement to service connection for hepatitis C is remanded. A review of the claims file reveals that further action on the claim of entitlement to service connection for hepatitis C is needed. During the July 2019 hearing, the Veteran testified that he developed hepatitis C as a result of air gun inoculations he received during service. The Veteran stated that he developed a fever after he was given the inoculations but reported that he did not seek medical treatment. The Veteran also stated that his hepatitis C may be related to a tattoo he received in service. The Veteran testified that he was diagnosed with hepatitis C in 1983 at St. Anthony’s Hospital and stated he had not engaged in any risk behaviors prior to his diagnosis. In the August 2019 appellate brief, the Veteran stated that he began engaging in risk behaviors, including intravenous drug use, after his 1983 diagnosis. He also reported that he sustained a ruptured aorta and a knee injury requiring reconstruction in a serious auto accident in 1999. The Veteran testified that his current hepatitis C symptoms include fatigue and joint pain. See July 2019 Hearing Transcript, page 22-26; see also May 2015 Military Personnel Record. The Veteran’s STRs are silent for any findings or diagnoses of hepatitis C. See March 2015 STR – Medical. A review of the post-service treatment records shows that the Veteran was diagnosed with HVC genotype 1a and began receiving treatment at the Oklahoma City VA Medical Center (VAMC) in June 2016. See August 2016 CAPRI. A VA treatment record dated in November 2016 lists the Veteran’s hepatitis C risk factors as IV drug use, tattoos, and air gun vaccinations. See April 2019 VAMC Other Output/Reports. Accordingly, as the evidence of record shows a diagnosis for hepatitis C, which the Veteran relates to air gun inoculations and a tattoo he received during service, the Board finds that a VA examination is necessary to determine the nature and etiology of the condition. See McLendon, 20 Vet. App. at 81. The matters are REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the claims file from the Veteran's VA treatment facilities, including all VA treatment records dated from November 2018 to the present, and all private treatment records from the Veteran not already associated with the file. 2. After completion of the above development, schedule the Veteran for a VA examination by an appropriately qualified examiner to determine the nature and etiology of any current psychiatric disorder, to include PTSD, bipolar disorder, anxiety disorder, and depressive disorder. The claims file, including a copy of this remand, must be made available to the examiner. The examiner should identify each current psychiatric diagnosis found to be present. If PTSD is diagnosed, the examiner should identify the stressor(s) upon which such diagnosis is based, including whether the stressor is a credible personal assault. For each diagnosed psychiatric disorder, provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the disorder had its onset in service or is otherwise etiologically related to his period of service, to include as due to repeated physical assaults by another airman in tech school. A detailed rationale for all opinions must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to 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. 3. After completion of the development in #1, schedule the Veteran for an examination by an appropriately qualified examiner to determine the nature and etiology of his diagnosed hepatitis C. The examiner should provide the following opinion: Is it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed hepatitis C is etiologically related to his period of service, to include as due to air gun inoculations and a tattoo he received during service? The examiner should review pertinent documents in the Veteran's claims file in connection with the examination. The examiner must specifically address the Veteran’s statements regarding the reported hepatitis C diagnosis at St. Anthony’s Hospital in 1983. A detailed rationale should be provided for any opinion rendered. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to 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. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Law Clerk for the Board K. Justis, Law Clerk 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.