Citation Nr: 21068412 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 15-14 324A DATE: November 10, 2021 ORDER Entitlement to service connection for post-traumatic stress disorder (PTSD) is granted. REMANDED Entitlement to service connection for diabetes is remanded. Entitlement to service connection for heart disease is remanded. Entitlement to service connection for right lower extremity neurological disability is remanded. Entitlement to service connection for left lower extremity neurological disability is remanded. Entitlement to service connection for residuals of head injury, to include hydrocephalus and brain cysts, is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. FINDING OF FACT The Veteran's PTSD began during active service. CONCLUSION OF LAW The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1962 to February 1964. He served in the Republic of Korea between July 1962 and August 1963. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2012 and July 2013 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In August 2017 and February 2021, the Veteran testified before the undersigned Veterans Law Judge. Transcripts of the hearings are included in the record and have been reviewed. These matters were previously before the Board in June 2018, when remanded for further development. Entitlement to service connection for post-traumatic stress disorder (PTSD) is granted. The Veteran contends current PTSD related to active service. The Board concludes that the Veteran has a current disability that began during active 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). An October 2019 VA examination report 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 is a probative opinion in favor of the claim and no opinions against the claim. The evidence in favor of the claim includes an October 2019 VA medical opinion. The VA examiner found that the Veteran's PTSD is at least as likely as not related to reported military service in Korea and the in-service traumas consistently reported as occurred during service. The VA examiner explained that the Veteran currently met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD and had been diagnosed by various VA and private providers with this condition and has consistently reported credible account of military service stressors and symptoms of this condition since at least 2010. The Veteran also currently meets the DSM-5 criteria for recurrent major depressive disorder and the October 2019 VA examiner was unable to differentiate symptoms from the two disorders. The Veteran reported being stationed near the demilitarized zone in Korea and was subjected to enemy fire and felt in fear for life. In October 2019, the VA examiner opined that it was at least likely as not that the Veteran's reported PTSD stressors related to hostile military activity were adequate to support the PTSD diagnosis in the VA treatment records. The Veteran testified to combat-related stressors in August 2017 and February 2021. The undersigned Veterans Law Judge found the Veteran's testimony about the reported military experiences truthful and credible. A review of the Veteran's military personnel records confirmed service in Korea from July 1962 to August 1963, earning the National Defense Service Medal and Korean Defense Service Medal. The Veteran submitted a December 1962 news article about a combat death in Korea, contemporaneous to the Veteran's service in Korea. The Veteran also submitted a July 2004 third-party statement from another servicemember with later combat duty in Vietnam that "Duty on the DMZ in Korea, back in 1958-1962 was actually more dangerous than combat duty in Vietnam." Further corroborating evidence is not required to establish occurrence of in-service stressor if: the claimed stressor is related to fear of hostile military or terrorist activity; the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service; the Veteran's symptoms are related to the claimed stressor; a VA psychiatrist confirms the stressor is adequate to support a PTSD diagnosis (see Nat'l Org. of Veterans' Advocates v. Sec'y of Veterans Affairs, 669 F.3d 1340 (Fed. Cir. 2012)); and there is no clear and convincing evidence to the contrary. The Board finds that the testimony consistent with the places, types, and circumstances of the Veteran's service and no clear and convincing evidence to the contrary. Upon review of the record, the Board finds the evidence to be at least even as to whether the Veteran's current PTSD arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for PTSD is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is granted. REASONS FOR REMAND 1. Entitlement to service connection for diabetes is remanded. 2. Entitlement to service connection for heart disease is remanded. 3. Entitlement to service connection for right lower extremity neurological disability is remanded. 4. Entitlement to service connection for left lower extremity neurological disability is remanded. 5. Entitlement to service connection for residuals of head injury, to include hydrocephalus and brain cysts, is remanded. 6. Entitlement to service connection for bilateral hearing loss is remanded. 7. Entitlement to service connection for tinnitus is remanded. The Board cannot make a fully informed decision because no VA examiner has considered all the relevant evidence of record. As a general matter, once VA undertakes to provide an examination, it must provide an adequate one or, at a minimum, notify the claimant why one will not be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In September and October 2019 and May 2020, the Veteran underwent VA examinations with medical opinions. The opinions, however, do not consider all the relevant evidence of record, including lay statements. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Dalton v. Nicholson, 21 Vet. App. 23 (2007). In February 2021, the Veteran provided additional testimony about hearing loss and tinnitus symptoms and submitted additional evidence showing that herbicide agents were used in Korea as early as 1963, during the period when the Veteran was stationed there. Addendum VA medical opinions are warranted to address this additional evidence. In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand order. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's diabetes. The examiner should review the claims folder, and then respond to the following questions. (a.) Is it at least as likely as not (i.e., probability of 50 percent or greater) that diabetes is related to a disease, event, or injury during service? (b.) If the answer to (a) is negative, is it at least as likely as not that diabetes is due to or caused by service-connected disability? (c.) If the responses to (a) and (b) are negative, is it at least as likely as not that diabetes has been aggravated (i.e., permanently, or temporarily worsened beyond the natural progress) by service-connected disability? If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the disorder found prior to aggravation; and (2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. All opinions must be fully explained and supported by a rationale. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's heart disease. The examiner should review the claims folder, and then respond to the following questions. (a.) Is it at least as likely as not (i.e., probability of 50 percent or greater) that heart disease is related to a disease, event, or injury during service? (b.) If the answer to (a) is negative, is it at least as likely as not that heart disease is due to or caused by service-connected disability? (c.) If the responses to (a) and (b) are negative, is it at least as likely as not that heart disease has been aggravated (i.e., permanently, or temporarily worsened beyond the natural progress) by service-connected disability? If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the disorder found prior to aggravation; and (2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. All opinions must be fully explained and supported by a rationale. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's lower extremity peripheral neuropathy. The examiner should review the claims folder, and then respond to the following questions. (a.) Is it at least as likely as not (i.e., probability of 50 percent or greater) that lower extremity peripheral neuropathy is related to a disease, event, or injury during service? (b.) If the answer to (a) is negative, is it at least as likely as not that lower extremity peripheral neuropathy is due to or caused by service-connected disability? (c.) If the responses to (a) and (b) are negative, is it at least as likely as not that lower extremity peripheral neuropathy has been aggravated (i.e., permanently, or temporarily worsened beyond the natural progress) by service-connected disability? If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the disorder found prior to aggravation; and (2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. All opinions must be fully explained and supported by a rationale. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 4. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's head injury. The examiner should review the claims folder, and then respond to the following questions. (a.) Is it at least as likely as not (i.e., probability of 50 percent or greater) that head injury residuals are related to a disease, event, or injury during service? In answering this question, review and consider the Veteran's assertions during his August 2017 and February 2021 Board hearings, in which he describes experiencing a head injury while serving in Korea. (b.) If the answer to (a) is negative, is it at least as likely as not that head injury residuals are due to or caused by service-connected disability? (c.) If the responses to (a) and (b) are negative, is it at least as likely as not that head injury residuals have been aggravated (i.e., permanently, or temporarily worsened beyond the natural progress) by service-connected disability? If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the disorder found prior to aggravation; and (2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. All opinions must be fully explained and supported by a rationale. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 5. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's bilateral hearing loss. The examiner should review the claims folder, and then respond to the following question. Is it at least as likely as not (i.e., probability of 50 percent or greater) that bilateral hearing loss disability is related to a disease, event, or injury during service? In answering this question, review and consider the Veteran's assertions regarding noise exposure in Korea. All opinions must be fully explained and supported by a rationale. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 6. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's tinnitus. The examiner should review the claims folder, and then respond to the following questions. 7. Is it at least as likely as not (i.e., probability of 50 percent or greater) that tinnitus is related to a disease, event, or injury during service? In answering this question, review and consider the Veteran's regarding noise exposure in Korea and post-service tinnitus symptoms. (a.) If the answer to (a) is negative, is it at least as likely as not that tinnitus is due to or caused by service-connected disability? (b.) If the responses to (a) and (b) are negative, is it at least as likely as not that tinnitus has been aggravated (i.e., permanently, or temporarily worsened beyond the natural progress) by service-connected disability? (Continued on the next page) If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the disorder found prior to aggravation; and (2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. All opinions must be fully explained and supported by a rationale. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.