Citation Nr: 20039980 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 18-53 699 DATE: June 11, 2020 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for obstructive sleep apnea (claimed as sleep apnea) is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from June 1977 to June 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. 1. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. The Veteran’s VA medical records reflect a positive screening for PTSD (February 2017) and an Axis 1 diagnosis of “unspecified trauma related D/O and R/O PTSD” (March 2017). See, Capri records received December 2017. However, the VA psychiatrist also contemporaneously reported that it is unclear whether the Veteran meets the full PTSD criteria. The Board notes that the Veteran’s treatment records include references to other possible psychiatric disorders, such as generalized anxiety disorder (GAD), and adjustment disorder, for which service connection may be warranted. Thus, in accordance with Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Board has recharacterized the issue on appeal as a claim for entitlement to service connection for an acquired psychiatric disorder, to include PTSD. Consequently, the Board finds that the Agency of Original Jurisdiction (AOJ) should afford the Veteran a VA examination so that the etiology of his PTSD, including any other diagnosed psychiatric disability, can be fully evaluated using The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. 38 C.F.R. § 4.125(a) (2017); 80 Fed. Reg. 14308 (Mar. 19, 2015) (final). Barr v. Nicholson, 21 Vet. App. 303 (2007); Additionally, the Veteran has consistently described at least two stressors while he was stationed in Germany, which he indicates are the basis for his PTSD claim. To date, these stressors have not been verified. The Board cannot make a fully informed decision on whether the Veteran acquired a psychiatric disability due to service, because no VA examiner has rendered an opinion with respect to this contention. 2. Entitlement to service connection for sleep apnea is remanded. Although the Veteran has a current diagnosis of obstructive sleep disorder (OSA), there is no current medical evidence on record that addresses whether the Veteran’s sleep apnea is related to his active military service, as he contends. Therefore, the Veteran should also be afforded an examination to determine the etiology of his sleep apnea disability. Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. The AOJ should make all appropriate attempts to verify the Veteran’s claimed in-service stressors, using the detailed statements of record that have been submitted by the Veteran. All attempts to verify the Veteran’s claimed stressors should be documented. 2. Schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine whether the Veteran meets the criteria for a diagnosis of PTSD or any other psychiatric disability using the DSM-V criteria. The claims file, including a copy of this REMAND, should be provided to the examiner in connection with the examination, and the examiner should indicate that the Veteran's records have been reviewed. The examiner should then: (a) State whether the Veteran has a PTSD diagnosis and any other current psychiatric disability. (b) Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any diagnosed psychiatric disability, including PTSD, originated during, or is etiologically related to, the Veteran’s active duty service. If a diagnosis of PTSD is warranted, the examiner should provide an opinion whether it is at least as likely as not (50 percent or greater probability) that PTSD is due to exposure to an actual confirmed stressor or the fear of hostile or terrorist activity. Fear of hostile military or terrorist activity means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire; including suspected sniper fire; or attack upon friendly military aircraft, and the response to the event or circumstance involved the psychological or a psycho-physiological state of fear, helplessness, or horror. The examiner is advised that the term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. 3. Provide the Veteran with the opportunity to submit information and/or documentation in support of his sleep apnea claim, such as “buddy” statements from former fellow service members evidencing his sleep apnea related issues during service and/or others, such as family members/spouse/roommate/friend, who witnessed his sleep apnea related issues since service. 4. After giving the Veteran a reasonable opportunity to respond to item 3, above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his obstructive sleep apnea. The examiner should review the entire claims file, including a copy of this remand order, and then respond to the following question: Is it at least as likely as not (50 percent probability or greater) that the Veteran’s obstructive sleep apnea was incurred in service, or is otherwise related to service? The examiner is also directed to take into consideration sleep-related contemporaneous statements made by the Veteran while seeking medical treatment post service, including during his psychological evaluations for anxiety, and any additional statements that may be provided by the Veteran pursuant to this remand. A complete rationale for any opinion offered should be provided. If the examiner finds that he or she cannot provide an opinion without resorting to speculation, the examiner must explain why he or she is unable to provide an opinion without speculation, and sufficiently explain the reasons for that inability. 5. After all of the above development has been completed, the AOJ should readjudicate these issues on appeal. If the benefit sought is not granted, the AOJ should send the Veteran and his representative a Supplemental Statement of the Case (SSOC), provide an opportunity to respond, and then, if necessary, return the case to the Board for further appellate review. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.B. King, 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.