Citation Nr: 21068371 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 19-23 640 DATE: November 10, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a cerebrovascular accident (CVA) and residuals, as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1963 to August 1989. This matter comes before the Board of Veteran's Appeal (Board) on appeal from an October 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran selected a hearing with a Veterans Law Judge on his August 2019 VA Form 9. In July 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. Entitlement to service connection for an acquired psychiatric disorder, hypertension, and CVA residuals is remanded. After reviewing the evidence of record, the Board finds that a remand is warranted for further development, including a VA examination and medical opinion. Specifically, the Veteran has not been afforded a VA examination for his claims for service connection for an acquired psychiatric disorder, hypertension, and residuals of a CVA. VA must provide an examination or obtain a medical opinion in a claim of service connection when the record contains competent lay or medical evidence of (1) a current diagnosed disability or persistent or recurrent symptoms of disability; (2) evidence establishing that the veteran suffered an event, injury or disease in-service; (3) an indication that the claimed disability or symptoms may be associated with the established event, injury, or disease in-service or with another service-connected disability; and (4) insufficient competent medical evidence for VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The threshold for finding that the disability may be associated with service is low. Id. A Veteran is competent to report his observable symptoms and history, including the onset and timing of symptoms, and such reports must be considered. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). With regard to the Veteran's acquired psychiatric disorder, the Board finds that there is sufficient indication that the Veteran's acquired psychiatric disorder is associated with his service. Specifically, the Veteran stated that he experienced three in-service stressor events that have caused his recurrent nightmares, occasional memories, and intrusive thoughts. See July 2021 Board Hearing Trans. pg. 7. The Veteran detailed that his experience in Haiti recovering decayed bodies after a monsoon caused these symptoms. Id at 5. The Veteran also stated that the in-service shooting that resulted in his gunshot wound also contributed to the abovementioned psychiatric symptoms. Id. at 4. Lastly, the Veteran contended that an in-service motor vehicle accident, where the other driver was killed, also contributed to his symptoms. Id.at 7. Thus, the record reflects that the Veteran provided PTSD stressor information that may be capable of verification. On remand, an attempt to corroborate the Veteran's reported stressors should be made. Relatedly, the Board finds that there is sufficient indication that the Veteran's hypertension is associated with his service. The Veteran contended that his hypertension disability was caused and/or aggravated by his PTSD disability. See July 2021 Board Hearing Trans. pg. 9. Alternatively, the Veteran asserted that his hypertension was related to the high sodium foods he consumed during service. Id. The Veteran also stated that he believes that his hypertension disability is related to his obesity, which was caused by his service-connected orthopedic disabilities. Id. Specifically, the Veteran stated he could no longer jog after he hurt his right lower extremity in service. Id. Further, the Board finds that the service treatment records lend some support to this assertion, insofar as they reflect that the Veteran gained approximately 46 pounds in service after he hurt his right leg. See STRs dated July 1973 and March 1987. Lastly, the Board finds that there is sufficient indication that the Veteran's CVA is associated with his service. The Veteran contends that his CVA residuals should be service connected because they were caused by his hypertension disability. See July 2021 Board Hearing Trans. pg. 11. Since the Veteran has contended that his hypertension disability is related to service, the Board finds that a VA examination is warranted to determine the relationship between the Veteran's hypertension and CVA residuals. Accordingly, the Board finds that the issue of service connection for the Veteran's acquired psychiatric disability, hypertension disability, and CVA residuals must be remanded to obtain a VA examination. See, McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006); see also, 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the examiner on remand consider the Veteran's own descriptions of the history of his acquired psychiatric, hypertension, and CVA disabilities. See, Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). The matters are REMANDED for the following action: 1. Contact the appropriate records facility to attempt to corroborate the Veteran's statements regarding the deployment to Haiti, the in-service shooting incident, and the motor vehicle accident. 2. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder, to include PTSD. The entire claims file must be made available to and be reviewed by the examiner. The examiner must address the following: (a.) Please identify any current acquired psychiatric disorder by diagnosis. (b.) For any disorder identified, please state whether it is a least as likely as not that the disorder had its onset in or is otherwise related to service. (c.) If the Veteran has a current diagnosis of PTSD, please identify the particular stressor(s) upon which PTSD is based. The Veteran reported the following stressors: 1. the deployment to Haiti following the monsoon in 1982 or 1983; 2. the in-service shooting incident; and 3. the in-service motor vehicle accident. (d.) Please comment, to the best of your ability, whether the prodromal period for any currently diagnosed psychotic disorder as likely as not had its onset during the Veteran's period of active service or within one year following discharge. 3. Schedule the Veteran for an examination to determine the nature and etiology of his hypertension disability and CVA residuals. The entire claims file must be made available to and be reviewed by the examiner. The examiner must address the following (a.) Please state whether it is a least as likely as not that the Veteran's hypertension had its onset in or is otherwise related to service. (b.) Please state whether it is at least as likely as not (50 percent or greater probability) that the in-service high sodium foods caused the Veteran's hypertension. In providing this opinion, please review the July 2021 Board Hearing Transcript. (c.) Please state whether it is at least as likely as not (50 percent or greater probability) that the Veteran developed obesity as a result of impaired ability to exercise associated with his right leg condition (inability to jog), and, if so, whether his obesity may be considered to be an intermediary step between his development of hypertension and a CVA. (d.) Please state whether it is at least as likely as not that the Veteran's hypertension was caused by his acquired psychiatric disability, to include medication prescribed therefore. (e.) Please state whether it is at least as likely as not that the Veteran's hypertension was aggravated by his acquired psychiatric disability. Here, aggravated means worsened beyond the natural progression of the condition. The examiner's opinion should reflect consideration of the Court's holding in Ward v. Wilkie that aggravation need not be permanent in nature. Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019); 38 C.F.R. § 3.310(b). (f.) Please state whether it is at least as likely as not that the Veteran's CVA and its residuals were caused by his hypertension disability. (g.) Please state whether it is at least as likely as not that the Veteran's CVA and its residuals were aggravated by his hypertension disability. Here, aggravated means worsened beyond the natural progression of the condition. The examiner's opinion should reflect consideration of the Court's holding in Ward v. Wilkie that aggravation need not be permanent in nature. Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019); 38 C.F.R. § 3.310(b). For the purpose of providing the opinion requested, please accept as valid the Veteran's statements that his acquired psychiatric condition is related to the abovementioned in-service events and state whether a nexus between the Veteran's acquired psychiatric disorder and service is medically consistent with the information provided by the Veteran. Also, please accept as valid the Veteran's statements that his hypertension disability is related to his orthopedic disabilities and/or psychiatric disability and state whether a nexus between the Veteran's hypertension and service is medically consistent with the information provided by the Veteran. Please accept as valid the Veteran's statements that his CVA and its residuals are related to his hypertension disability and state whether a nexus between the Veteran's CVA and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements) A discussion of the underlying reasons for any opinion expressed must be included in your report, to include reference to pertinent evidence of record and medical literature or treatises where appropriate. If you cannot provide the requested opinion without resorting to speculation, please expressly indicate this and state why that is so (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). The examiner should provide a complete rationale for any opinion rendered. If the examiner's opinion is negative, he or she must clearly explain why. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Foster, 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.