Citation Nr: 21004173 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 19-25 560 DATE: January 26, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include depression, anxiety, and posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1999 to September 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2020, the Board docketed the Veteran’s appeal and, in September 2020, within 90 days of such notification, she elected a new representative, Disabled American Veterans (DAV). While DAV has not been provided with an opportunity to submit an Informal Hearing Presentation prior to the Board’s review of the case, the Board finds no prejudice to the Veteran in proceeding with the issuance of this Remand because, following the completion of the requested development, her representative will be given an opportunity to submit additional argument prior to the case’s return to the Board. Entitlement to service connection for an acquired psychiatric disorder, to include depression, anxiety, and PTSD. The Veteran contends she has an acquired psychiatric disorder, to include depression, anxiety, and PTSD, due to serving at Walter Reed Army Medical Center on September 11, 2001, and/or as a result of military sexual trauma (MST) when she was sexually assaulted during basic training by a drill instructor, which was described as inappropriate kissing and touching. The Veteran’s service treatment records (STRs) and service personnel records (SPRs) are silent as to any complaints, treatment, or diagnoses referable to an acquired psychiatric disorder. However, in her November 2015 notice of disagreement, she reported that she did not report her sexual assault or seek treatment in service for fear of being perceived as “crazy.” The Veteran’s SPRs also reflect that she was stationed at Walter Reed Army Medical Center as of October 1999 and her military occupational specialty (MOS) was Operating Room Specialist and Health Care Specialist. Additionally, in August 2020, the Veteran submitted a letter from AT, a fellow service member who served with her in basic training, who indicated that, while she was not aware of the sexual advances their drill instructor made towards the Veteran, he did favor her over others. In another letter, MC, a childhood friend, reported that the Veteran told her in 1999 that her drill instructor kissed and touched her, and afforded her special privileges as he felt bad about his behavior. The Veteran’s mother also reported that, in 2005, the Veteran disclosed her MST. MC and the Veteran’s mother further indicated that her behavior and personality changed after she returned from her military service. The Veteran’s post-service treatment records indicate she has been diagnosed with an acquired psychiatric disorder, to include generalized anxiety disorder (GAD), depression, dysthymic disorder, and PTSD, as well as a history of unspecified personality disorder. See July 2014, March 2016, and October 2019 VA treatment records. Such records further indicate the Veteran’s report that she subject to MST by her drill instructor, but also was previously sexually molested by her brother and raped as a freshman in high school. See April 2013 and October 2016 VA treatment records. In December 2016, the Veteran submitted a PTSD Disability Benefits Questionnaire (DBQ) completed by a private psychologist, which reflected diagnoses of PTSD, depressive disorder (dysthymia), and GAD. At such time, the psychologist noted the Veteran’s report of childhood sexual abuse by her brother, but indicated that trauma-related symptomatology in the form of reexperiencing symptoms was stated not to have been apparent. The Veteran also reported that she experienced MST during basic training, but began to deliberately self-isolate and drink regularly after 9/11, and never returned to her baseline social functioning. The psychologist found the Veteran met the criteria for a diagnosis of PTSD, listing both her reported MST and service on 9/11 at Walter Reed Army Medical Center as stressors. However, she did not address whether there were any markers, to include behavioral changes, that indicated that the Veteran’s claimed in-service personal assaults occurred, or delineate the impact her pre-service trauma had on her psychiatric disorders. Therefore, the Board finds that, in light of the Veteran’s reported in-service stressors, the submission of evidence supporting such stressors, and current diagnosis of an acquired psychiatric disorder, a remand is necessary in order to afford her a VA examination so as to determine the nature and etiology of her acquired psychiatric disorder. The matters are REMANDED for the following action: Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of her acquired psychiatric disorder. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and all indicated tests should be conducted. Thereafter, the examiner should address the below inquiries: (A) Identify all of the Veteran’s acquired psychiatric disorders that meet the DSM-5 criteria that have been present at any time proximate to her October 2014 claim, to include generalized anxiety disorder (GAD), depression, dysthymic disorder, and PTSD, even if such is asymptomatic or resolved. (B) Indicate whether the Veteran meets the DSM-5 diagnostic criteria for PTSD and, if so, whether such diagnosis is the result of an in-service stressor, to include serving at Walter Reed Army Medical Center on 9/11 and/or MST, described as inappropriate kissing and touching by a drill instructor during basic training. The examiner should identify any markers, to include behavior changes, that support such a diagnosis based on personal assault. In this regard, the examiner should consider the aforementioned lay statements of record and the December 2016 PTSD DBQ completed by a private psychologist. However, if PTSD is diagnosed based on childhood trauma in light of the Veteran’s report of sexual molestation by her brother and rape as a freshman in high school (rather than military trauma) is diagnosed, the examiner should opine whether such clearly and unmistakable pre-existed the Veteran’s military service. If so, is there is clear and unmistakable evidence that such pre-existing disorder did not undergo an increase in the underlying pathology during service, i.e., was not aggravated during service? If there was an increase in the severity of the pre-existing disorder, was such increase clearly and unmistakably due to the natural progress of the disease? (C) For all other currently diagnosed acquired psychiatric disorders, opine whether it is at least as likely as not (i.e., a 50 percent or greater degree of probability) that such had its onset in, or is otherwise related to, the Veteran’s military service. (D) If a personality disorder is diagnosed, opine whether there was an additional disability due to a disease or injury superimposed upon such disorder during service? If so, please identify the additional disability. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. M. Kelly 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.