Citation Nr: 21005071 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 18-23 609 DATE: January 28, 2021 REMANDED Entitlement to an initial disability rating in excess of 10 percent prior to December 8, 2016, and in excess of 30 percent thereafter for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for generalized anxiety disorder (GAD) is remanded. Entitlement to service connection for anxiety disorder is remanded. Entitlement to service connection for depression is remanded. Entitlement to service connection for sleep disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1990 to March 1994. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. At the Veteran’s hearing, she testified to worsening psychiatric symptoms. May 2020 Hearing Tr. at 2, 3. Given the assertion of worsening symptoms, remand is necessary for another examination to determine the current level of severity of the Veteran’s service-connected PTSD. The Veteran contends that she has GAD, anxiety, depression and a sleep disorder caused by her service-connected PTSD or due to her military sexual trauma (MST). May 2020 Hearing Tr. at 3. The records show that the Veteran has been diagnosed with GAD and anxiety. See May 2013 VA Treatment Records, February 2018 VA Examination Report. The Veteran has reported depression, although a February 2018 VA examiner attributed the Veteran’s depressed mood to her service-connected PTSD. See also February 2003 Private Treatment Record; September 2010, May 2017 VA Treatment Records. The February 2018 VA examiner also opined that the Veteran’s GAD was not caused her service-connected PTSD. However, the examiner did not address whether her GAD and anxiety were caused by her active duty service, to include MST. On remand, such an opinion should be obtained. The examiner should also address whether there are any diagnosable psychiatric disorders separate and distinct from the Veteran’s PTSD and GAD. The Veteran has been seeking treatment for his sleep difficulties for many years. See January 2014, February 2014 VA Treatment Records. During the February 2014 VA treatment, it was noted that the primary etiology of the Veteran’s sleeping difficulties was her PTSD. The Veteran has complained of sleeping troubles, and there are indications that she does not have sleep apnea. See April 2013, June 2015 VA Treatment Records. On remand, it should be determined if the Veteran has a current sleep disorder that is separate and distinct from her service-connected PTSD. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to her claims. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, schedule the Veteran for a VA psychiatric examination. The examiner is asked to address the following: (a) List all diagnosed psychiatric disorders. (b) If there are no diagnoses related to depression, anxiety, or a sleep disorder, the examiner should address whether symptoms of depression, anxiety, or sleep problems are present, and if so, if they are symptoms of the Veteran’s PTSD or another psychiatric disorder as opposed to separately diagnosed disorders. (c) Offer an opinion as to whether any diagnosed psychiatric disorder other than PTSD at least as likely as not (50 percent probability or greater) onset during service or is otherwise related to an in-service injury, event, or disease, to include as due to the Veteran’s MST. (d) Offer an opinion as to whether any diagnosed psychiatric disorder other than PTSD is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected PTSD. (e) Determine the current symptoms, level of severity, and functional impairment associated with the Veteran’s service-connected PTSD. The examiner is asked to review the claims file. A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.