Citation Nr: 21063688 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 18-32 369 DATE: October 15, 2021 ORDER Service connection for a psychiatric disability, diagnosed as Other Specified Trauma and Stressor Related Disorder, is granted. REMANDED Service connection for Parkinson's disease is remanded. Service connection for ischemic heart disease is remanded. Service connection for hypertension is remanded. Service connection for sleep apnea is remanded. FINDING OF FACT The Veteran's psychiatric disability had its onset in service. CONCLUSION OF LAW The criteria for service connection for a psychiatric disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1969 to January 1971, including service in the Republic of Vietnam, with additional service in the Army Reserve and National Guard. 1. Service connection for a psychiatric disability The Board finds that service connection for a psychiatric disability is warranted. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). The Veteran's claim of service connection for PTSD has been recharacterized to include all psychiatric disorders reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran has a diagnosis of other specified trauma and stressor-related disorder. See April 2017 VA PTSD Examination. The Board finds that the evidence shows the Veteran's other specified trauma and stressor-related disorder began during service and has been recurrent since that time. The Veteran is competent to report psychiatric symptoms that began in service and the Board finds the Veteran's statements credible. See 38 C.F.R. § 3.159 (a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno. The Veteran essentially contends that he developed a psychiatric disability that had its onset in service and is due to his Vietnam experiences. The Veteran stated that he felt a change in his personality after his return from the tour of duty in Vietnam in 1971, resulting in mood swings, irritability, difficulty sleeping and flashbacks. See November 2014 Statement in Support of Claim. He recalled experiencing combat while in Vietnam, spending time under moderate file, having to be cautious to avoid being hit by friendly fire, avoiding truck mines in the road and seeing others suffer injuries, and also being nervous and losing sleep due to the enemies traveling through the tunnels to attack their base. See February 2015 Statement in Support of Claim. In light of his Vietnam service, the RO has already acknowledged the occurrence of in-service stressors. See June 2015 Rating Decision. Thus, the critical issue is whether the Veteran has a psychiatric disability that is related to or had its onset in service. The Veteran was afforded a VA examination for PTSD in June 2015. Veteran was not found to have a diagnosis of PTSD that conforms to DSM-5 criteria but did have a persistent depressive disorder with anxious distress, that resulted in "occupation and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress." The VA examiner found that Veteran endorsed three symptoms attributable to his reported stressors in Vietnam and denied those symptoms cause significant distress or impairment. The VA examiner opined that these symptoms are not attributable to the reported stressors in Vietnam. A review of VA treatment records showed Veteran reported he believed he has PTSD but did not show any treatment for or a diagnosis of PTSD. The Veteran was again provided a VA examination for PTSD in April 2017. Again, the Veteran's symptoms did not meet the diagnostic criteria for PTSD under DSM-5 criteria, but he was found to have another mental disorder diagnosis and was diagnosed with other specified trauma and stressor-related disorder. Veteran's symptoms included depressed mood, anxiety, chronic sleep impairment and mild memory loss. The VA examiner opined that the Other Specified Trauma and Stressor Related Disorder is at least as likely as not caused by the fear of hostile military activity during service. There appeared to be a causal connection between the endorsed trauma symptoms and combat-related trauma. The Board acknowledges the lack of service records containing any psychiatric disability complaints and the negative nexus opinion from the June 2015 VA examination. The Board finds, however, that the competent and credible lay evidence shows that the Veteran has had a psychiatric disability with symptoms that have been recurrent since service and a positive nexus opinion from the April 2017 VA examination supports the Veteran's claim for service connection for his psychiatric disability and is great probative value. The medical treatment records, together with the current diagnosis and the competent and credible statements of the Veteran attesting to the onset and continuation of his psychiatric disability are sufficient to link the condition to service. As such, service connection for psychiatric disability, diagnosed as Other Specified Trauma and Stressor Related Disorder, is warranted. REASONS FOR REMAND 1. Service connection for Parkinson's disease is remanded. 2. Service connection for ischemic heart disease is remanded. 3. Service connection for hypertension is remanded. 4. Service connection for sleep apnea is remanded. The Veteran contends that his Parkinson's disease, ischemic heart disease (IHD), hypertension and obstructive sleep apnea conditions are related to service, including due to exposure to herbicides while he was stationed in Vietnam. See March 2016 Notice of Disagreements; see also July 2021 Statement in Support of Claim. As for his sleep apnea, he additionally contends that the condition is secondarily related to his service-connected psychiatric condition. See September 2017 Statement in Support of Claim. The Veteran served in Vietnam from September 1970 to January 1971. See Military Personnel Records. Therefore, exposure to herbicides is conceded. Service treatment records however do not contain any complaints, treatment or diagnoses for Parkinson's disease, IHD, hypertension or sleep apnea. The Veteran was provided VA examinations for the service connection claims on appeal in November 2015 and January 2016 for his IHD. The Veteran was diagnosed with restless leg syndrome instead of a diagnosis for Parkinson's disease; additionally, he was diagnosed with transient ischemic attack (TIA), obstructive sleep apnea, and hypertension. However, these VA examinations did not provide etiological nexus opinions to determine whether there is a link between the diagnosed conditions and service, to include exposure to herbicides. Since the November 2015 and January 2016 VA examinations were administered approximately six years ago and did not provide medical nexus opinions, the Board finds that the Veteran must be afforded contemporaneous VA examinations with the opportunity to obtain responsive etiological opinions, following a thorough review of the entire claims file, as to his claim for service connection for Parkinson's disease, IHD, hypertension and sleep apnea. In light of the lay statements and medical treatment records including medical diagnoses of the aforementioned conditions that have not been addressed etiologically through a VA medical opinion, to include a nexus opinion on a link between the conditions and his in-service asbestos exposure or his service-connected psychiatric disability, a remand is necessary in order to make fully informed decisions in adjudicating these claims. The matters are REMANDED for the following action: 1. Identify and obtain all outstanding treatment records regarding the Veteran's claims. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service Parkinson's disease/restless leg syndrome, IHD/TIA, hypertension and sleep apnea. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) by an appropriate clinician, to determine the nature, onset and etiology of any current Parkinson's disease, restless leg syndrome, IHD/TIA, hypertension and obstructive sleep apnea conditions. The examiner must consider all lay statements, military personnel records, and medical treatment records provided. The examiner should assume that the Veteran was exposed to asbestos during service. The examiner must opine whether any diagnosed Parkinson's disease, restless leg syndrome, IHD, TIA, hypertension or obstructive sleep apnea found to be present is at least as likely as not related to an in-service injury, event, or disease, to include the Veteran's in-service exposure to asbestos. The examiner should also provide a medical opinion in regard to secondary service connection and discuss whether the diagnosed conditions are secondarily related to the Veteran's service-connected psychiatric disability. The examiner must provide reasons for all opinions, addressing the relevant evidence. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor 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.