Citation Nr: 21065224 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 14-14 811 DATE: October 25, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder to include post-traumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served active duty from December 1973 to June 1977. In a June 2020 decision, the Board denied the Veteran's service connection claim for an acquired psychiatric disorder to include PTSD. Subsequently, the Veteran appealed his service connection claim to the United States Court of Appeals for Veterans Claims (Court). In a May 2021, the Court granted a Joint Motion for Remand (JMR) vacating and remanding the June 2020 Board decision noting that the Board erred when it did not discuss the Appellant's contention that his psychiatric condition was related to his military occupational specialty (MOS) as a missile crewman; and that the Board also erred when it failed to provide adequate reasons and bases addressing the credibility of the Appellant's account of the in-service incidents. The matter is again before the Board for actions consistent with the Court's December May 2021 JMR. Entitlement to service connection for an acquired psychiatric disorder to include post-traumatic stress disorder (PTSD) is remanded. The Veteran contends that his acquired psychiatric disorder to include PTSD is related to his MOS as a missile crewman while serving in Germany. He asserts that he worked in an intense environment at a nuclear missile site, that he was regularly on terror threat alert, and that his psychiatric symptoms began during service. See July 2017 Hearing Transcript. The Veteran's service personnel records show that he served in Germany and was a Hercules Missile Crewman. The Board finds the claimed in-service stressors are consistent with the places, types, and circumstances of the Veteran's service. As such, the Board believes there is sufficient evidence to concede the Veteran's in-service stressor. Hayes v. Brown, 5 Vet. App. 60, 66 (1993); see also 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.304 (f). Treatment records show that the Veteran is receiving mental health treatment for symptoms of PTSD. See Medical Treatment Record - Non-Government Facility. The Board cannot make a fully informed decision regarding the Veteran's service connection claim, as a clarifying medical nexus opinion is needed for PTSD. In evaluating psychiatric disorders, VA has adopted and employs the nomenclature in the rating schedule based upon the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, of the American Psychiatric Association (DSM-5). See 38 C.F.R. § 4.130. Prior to August 4, 2014, VA regulations governing service connection for PTSD reference DSM-IV criteria. See 79 Fed. Reg. 149, 45094 (August 4, 2014). As the Veteran initiated his claim for service connection in May 2006, both DSM-IV and DSM-V criteria will be used to determine the diagnosis of PTSD. See 38 C.F.R. § 4.125 (a). The Board finds that the medical evidence of record is inadequate to decide the appeal. Here, an April 2014 VA PTSD examination report reflects that the Veteran did not meet the DSM-4 criteria for a diagnosis of PTSD. Thus, the examiner did not provide a nexus opinion for PTSD. However, a February 2010 letter from the Veteran's attending psychiatrist, Dr. J.G.O., states that the Veteran does have a diagnosis of PTSD per the DSM-4 criteria. Nevertheless, Dr. J.G.O also did not provide a nexus opinion regarding the diagnosed PTSD. Therefore, given that the Veteran has a current diagnosis of PTSD and his in-service stressor related to his duties as a missile crewman is now conceded by the Board, another VA examination is warranted to determine whether the Veteran's diagnosed PTSD is related to the conceded stressor. Accordingly, another VA examination is warranted to determine the etiology of the Veteran's psychiatric disorders to include PTSD. The matters are REMANDED for the following action: 1. Obtain all relevant outstanding VA treatment records, and any private treatment records identified by the Veteran. All records and/or responses received should be associated with the claims file. 2. After all outstanding treatment records have been associated with the claims file, schedule the Veteran for a VA examination to determine the nature and etiology of any diagnosed psychiatric disorder, to include PTSD. The VA examiner must review the complete claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. All necessary tests and studies should be accomplished, and all clinical findings reported in detail. The examiner must address the following: (a) If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not (50 percent or greater probability) related to his duties as a missile crewman. The Board acknowledges that VA has transitioned to use of the DSM-5 criteria although regulations governing service connection for PTSD still reference DSM-IV criteria. Therefore, if the examiner applies the DSM-V criteria and a diagnosis of PTSD is not rendered, then the examiner should reevaluate using the DSM-IV criteria. (b) If any other acquired psychiatric disorders are diagnosed, including anxiety and depression, the examiner must opine whether each diagnosed disorder is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. 3. After undertaking any additional development deemed necessary, the Agency of original Jurisdiction (AOJ) must readjudicate the claim on appeal. If the claim remains denied, the Veteran and his representative should be furnished a supplemental statement of the case and afforded the requisite opportunity to respond DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. M. Rogers, 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.