Citation Nr: 21067866 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 16-55 877 DATE: November 5, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is granted. FINDING OF FACT The Veteran's acquired psychiatric disorders, to include PTSD, are related to her military service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include PTSD, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from October 1987 to August 1989 and from February 1991 to April 1991. This matter comes before the Board of Veterans' Appeals (Board) from the March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in August 2020 and was remanded for further development. SERVICE CONNECTION Entitlement to service connection for an acquired psychiatric disorder, to include PTSD The Veteran contends that her acquired psychiatric disorders are related to her military service. The Board concludes that the Veteran has a current disability that is related to her military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). VA treatment records show the Veteran has a current diagnosis of PTSD. Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim. The evidence in favor of the claim includes a February 2021 VA opinion that states that the Veteran's PTSD is at least as likely as not related to her military service. The examiner stated that in the Veteran's work as a nurse during service, she was witness to and worked with multiple severely injured people and/or casualties. Also, the Veteran reported a military sexual trauma that occurred in 1988 in service when she was attacked in her room by another service member. The Veteran did not report the attack at the time. The examiner stated that the Veteran's post-trauma symptoms include social withdrawal, heightened anxiety states, intrusive memories, nightmares/poor sleep, disrupted focus, depressed mood, and arousal to/avoidance of cues/triggers. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current acquired psychiatric disorder is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for an acquired psychiatric disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a bilateral foot disability is remanded. Entitlement to service connection for allergic rhinitis is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to a total disability rating for compensation based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a low back disability is remanded. 2. Entitlement to service connection for a bilateral foot disability is remanded. 3. Entitlement to service connection for allergic rhinitis is remanded. 4. Entitlement to service connection for a right knee disability is remanded. 5. Entitlement to service connection for a left knee disability is remanded. This matter was previously before the Board in August 2020. Specifically, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain VA opinions regarding the etiology of the Veteran's claimed disabilities. Subsequently, in February 2021, opinions for these conditions were obtained. The Veteran's most recent June 2021 Supplemental Statement of the Cases (SSOC) discusses the Veteran's February 2021 VA addendum opinions. However, following the Veteran's June 2021 SSOC, additional VA treatment records were added to the Veteran's claims file regarding the claimed conditions on appeal. When pertinent evidence is submitted by an appellant or representative and is received by the Board pursuant to 38 C.F.R. § 19.37 (b), "[t]he Board will then determine what action is required with respect to the additional evidence." Here, the evidence was not submitted but rather was created by VA. In these circumstances, a remand is warranted for initial AOJ review of the updated VA treatment records and, if the claim remains denied, issuance of a SSOC to the Veteran and his representative if necessary. See Sprinkle v. Shinseki, 733 F.3d 1180, 1184 (Fed. Cir. 2013). Additionally, the Board finds that the VA opinions provided are inadequate as they do not comply with the Board's August 2020 remand directives. Specifically, the February 2021 VA back opinion does not appear to consider the Veteran's job duties of carrying 50-pound rucksacks as a nurse in-service. Additionally, the examiner did not discuss the Veteran's Line of Duty determination that her plantar fasciitis/soft tissue injury was incurred in the line of duty when providing the etiology opinion regarding the Veteran's claimed foot disability. Furthermore, the examiner impermissibly relied solely on the absence of evidence in the Veteran's claims file in providing the opinion for the Veteran's allergic rhinitis. Finally, regarding the Veteran's bilateral knee disability, the examiner simply gave the exact same rationale given for the Veteran's back disability with any additional explanation. Therefore, the Board finds that addendum opinions should be obtained on remand. 6. Entitlement to a total disability rating for compensation based on individual unemployability (TDIU) due to service connected disabilities is remanded. As the resolution of the claims above might be determinative of the TDIU claim, the issues are inextricably intertwined, and the TDIU issue must also be remanded. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain an addendum opinion to determine the etiology of any low back disability. The examiner must review the record and must note that review in the report. All appropriate tests or studies should be accomplished, and all clinical findings should be reported in detail. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any low back disability had its onset in or is otherwise related to service. The examiner is requested to consider the Veteran's report of experiencing pain in the lower back while lifting and pulling patients as a nurse and carrying 50-pound rucksacks while on active duty to be credible. If it is determined that there is another more likely etiology for the low back disability, that should be stated. A complete rationale for all opinions expressed should be clearly provided. The examiner must consider the Veteran's statements and all lay statements regarding onset in-service and statements regarding the continuity of symptomatology. 2. Obtain an addendum opinion to determine the etiology of any right and left knee disabilities. The examiner must review the record and must note that review in the report. All appropriate tests or studies should be accomplished, and all clinical findings should be reported in detail. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any right or left knee disability had its onset in or is otherwise related to service. The examiner is requested to consider the Veteran's report of injuring her knees while running while on active duty to be credible. If it is determined that there is another more likely etiology for the right and left knee disabilities, that should be stated. A complete rationale for all opinions expressed should be clearly provided. The examiner must consider the Veteran's statements and all lay statements regarding onset in-service and statements regarding the continuity of symptomatology. 3. Obtain an addendum opinion to determine the etiology of any right or left foot disability. The examiner must review the record and must note that review in the report. All appropriate tests or studies should be accomplished, and all clinical findings should be reported in detail. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any right or left foot disability had its onset in or is otherwise related to service. The examiner is requested to consider the July 1996 Line of Duty determination indicates that the Veteran's plantar fasciitis/soft tissue injury was incurred in the line of duty. If it is determined that there is another more likely etiology for the right and left foot disability, that should be stated. A complete rationale for all opinions expressed should be clearly provided. The examiner must consider the Veteran's statements and all lay statements regarding onset in-service and statements regarding the continuity of symptomatology. 4. Obtain an addendum opinion to determine the etiology of any allergic rhinitis. The examiner must review the record and must note that review in the report. All appropriate tests or studies should be accomplished, and all clinical findings should be reported in detail. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any allergic rhinitis had its onset in or is otherwise related to service. The examiner is requested to consider the Veteran's report of being exposed to chemicals while on she was on active duty. The examiner should also consider the Veteran's reports of sinusitis during service. If it is determined that there is another more likely etiology for the allergic rhinitis, that should be stated. A complete rationale for all opinions expressed should be clearly provided. The examiner must consider the Veteran's statements and all lay statements regarding onset in-service and statements regarding the continuity of symptomatology. 5. The examiner should not rely solely on the absence of evidence of in-service treatment or injury in the Veteran's service treatment records as a basis for any given opinion. If any requested opinion cannot be provided without resort to speculation, the medical professional should state and explain why an opinion cannot be provided without resort to speculation. 6. Following completion of the above, and a review of any additional evidence received, the RO should also undertake any other development it deems to be necessary, to include, if warranted, an addendum medical opinion which considers any newly received evidence. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mountford, 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.