Citation Nr: 21061278 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 17-19 582 DATE: October 1, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a disability manifested by tremors is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from January 1989 to January 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In June 2021, the Veteran testified at a virtual hearing before the undersigned. 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Veteran asserts that her psychiatric disorder began in service, as she began experiencing stress while working in an understaffed unit and had conflicts with her supervisor. Moreover, she reports that she first sought mental health treatment in 1992, within one year of her discharge from service, and the record includes private treatment records diagnosing her with a psychotic disorder. On remand, she should be afforded an examination and a medical opinion should be obtained as to the nature and etiology of her psychiatric disorder. Additionally, the Veteran reported received VA treatment, and on remand her complete VA treatment records should be secured. See Board Hearing Transcript at 19. Any relevant outstanding private treatment records should also be secured. Moreover, the record indicates that the Veteran is in receipt of Social Security Administration (SSA) disability benefits, and on remand any relevant records should be secured. 2. Entitlement to service connection for a disability manifested by tremors is remanded. The Veteran's private treatment records show the presence of tremors, and an increase in tremors during periods of stress. See, e.g., April 5, 2016 Private Treatment Note. She has reported a longstanding history of tremors, including tremors in service, with subsequent progression. The Veteran is competent to report the presence of tremors, and her report of longstanding tremors is corroborated by private treatment records. See, e.g., August 13, 2013 Private Treatment Note; October 23, 2012 Private Treatment Note. The duty to provide a medical examination and secure a medical opinion has been triggered and should be addressed on remand. The matters are REMANDED for the following action: 1. Secure the Veteran's complete VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Secure relevant records related to any disability claim filed with the Social Security Administration, to include medical records. 4. After completing #1, #2, and #3, schedule the Veteran for an examination to determine the nature and etiology of any acquired psychiatric disorder(s) found to be present. The claims file should be made available to and should be reviewed by the examiner. Any necessary tests should be performed. The examiner should address the following. (a) Identify all current psychiatric diagnoses. If the criteria for a diagnosis of posttraumatic stress disorder (PTSD) are met, please specify the stressor(s) supporting the diagnosis. In addressing sub-part (a) of this question, please state whether the Veteran's symptoms are consistent with any of the psychotic disorders listed in 38 C.F.R. § 3.384, specifically Brief Psychotic Disorder, Delusional Disorder, Psychotic Disorder Due to Another Medical Condition, Other Specified Schizophrenia Spectrum and Other Psychotic Disorder, Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, and Substance/ Medication-Induced Psychotic Disorder. (b) For each psychiatric disorder diagnosed in sub-part (a), please opine whether it is at least as likely as not (probability of 50 percent or greater) that the disability had its onset in or is otherwise etiologically related to the Veteran's active service. In addressing this question, the examiner should discuss the Veteran report of experiencing racial discrimination by her supervisor, as well as the Veteran's reported stressful working conditions in service (working in an understaffed unit as well as conflicts with her racially discriminating supervisor) and her report of anxiety in service. The examiner's attention is invited to the Veteran's statement that she did not seek treatment for her anxiety in service because she wanted to "stay below the radar" and avoid going through the system. See January 2017 Correspondence. (c) If the criteria for a diagnosis of a psychosis are met in subpart (a), please state, to the best of your ability, whether it is at least as likely as not (50 percent or greater probability) that the prodromal period for such disorder had its onset during the Veteran's active service. (d) If the Veteran is diagnosed with schizoaffective disorder or other psychosis pursuant to 38 C.F.R. § 3.384, please indicate whether it is at least as likely as not (50 percent or greater probability) that the psychiatric disability was present within one year after separation of service to a compensable degree (i.e., manifested by at least mild or transient symptoms or that required medication for control). In addressing subparts (c) and (d) of this question, the examiner's attention is invited to the Veteran's consistent reports of first seeking treatment for mental symptoms in 1992 while enrolled in medical school. See, e.g., October 23, 2012 Private Treatment Note (Medical Treatment Record Received December 28, 2016); July 2016 Psychiatric Evaluation Report (Medical Treatment Record Received July 19, 2016); February 19, 2014 Private Treatment Note (Medical Treatment Record Received January 18, 2017); June 2021 Hearing Transcript at 4. The examiner is advised that, although no records of private treatment from 1992 have been associated with the record, the Veteran has reported that the provider is deceased and that her records were not available. Thus, the examiner should not render a negative opinion based solely upon the absence of contemporaneous evidence of treatment. All opinions should be accompanied by a clear rationale. If the examiner cannot answer without resorting to speculation, he or she should explain why it would be speculative to respond (i.e., insufficient evidence in the record, insufficient state of medical knowledge, examiner's lack of expertise, etc.). 5. After completing #1, #2, and #3, schedule the Veteran for an examination to determine the nature and etiology of any disability manifested by tremors. The claims file should be made available to and should be reviewed by the examiner. Any necessary tests should be performed. The examiner should address the following. (a) Diagnose any current disorder(s) manifested by tremors. (b) For each disorder diagnosed in sub-part (a), please opine whether it is at least as likely as not (probability of 50 percent or greater) that the disability had its onset in or is otherwise etiologically related to the Veteran's active service. For the purposes of this question, the examiner should accept as true the Veteran's reported history of her tremors. In addressing this question, please address the Veteran's private treatment records showing an increase in tremors during periods of stress, the Veteran's testimony that her focus on perfection in a high-stress environment in service led to tremors, and private treatment records showing a long-standing history of tremors. See, e.g., April 5, 2016 Private Treatment Note (Medical Treatment Record Received January 18, 2017); October 23, 2012 Private Treatment Note and August 13, 2013 Private Treatment Note (Medical Treatment Record Received December 28, 2016). (c) Please state whether the Veteran's reported history of her tremors is medically consistent with the examination findings. All opinions should be accompanied by a clear rationale. If the examiner cannot answer without resorting to speculation, he or she should explain why it would be speculative to respond (i.e., insufficient evidence in the record, insufficient state of medical knowledge, examiner's lack of expertise, etc.). S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.M. Badaczewski, 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.