Citation Nr: 21070782 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 17-54 176 DATE: November 26, 2021 REMANDED Service connection for posttraumatic stress disorder (PTSD) is remanded. Service connection for an acquired psychiatric disorder other than PTSD is remanded. A temporary total evaluation for hospitalization is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1983 to April 1986. This matter is on appeal from an April 2017 rating decision that denied service connection for PTSD and for unspecified depressive disorder. It also is on appeal from a June 2017 rating decision that denied a temporary total evaluation for hospitalization. On April 26, 2019, the Board recharacterized the unspecified depressive disorder issue as one of an acquired psychiatric disorder other than PTSD. Service connection for PTSD and for an acquired psychiatric disorder other than PTSD then were denied, as was a temporary total evaluation for hospitalization. In August 2021, however, the Board vacated its April 26, 2019, decision in its entirety. The Veteran and his representative were notified at that time that they had 90 days to submit any additional evidence and argument. This period is now concluded, so Board readjudication may proceed. PTSD and Acquired Psychiatric Disorder Other Than PTSD Unfortunately, readjudication cannot occur without additional development. A September 2018 VA treatment record labeled as a psychiatry note contains the Veteran's report of attending a Social Security hearing. A July 2019 psychiatric disability benefits questionnaire (DBQ) completed by a private health services provider in psychology also indicates he began receiving Social Security disability benefits in 2018 "for his difficulties." It later notes review of some Social Security records concerning his mental health. Thus, efforts must be made to obtain the Veteran's Social Security Administration (SSA) records. Efforts also must be made to obtain his outstanding VA treatment records. This includes those dated from November 2017 to September 2018, given the gap then in those that are available but all other indications suggesting continuous care since 2016. It also includes those dated after the most recent available in July 2020. Finally, efforts must be made to obtain any relevant outstanding private treatment records. After completing this records development, another VA medical examination is needed. Neither the March 2017 VA medical examination nor the July 2019 private DBQ diagnosed the Veteran with PTSD under the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). He instead was diagnosed with unspecified depressive disorder at each. However, rendering a diagnosis at the examination at least was hindered by the invalid profile produced by his test responses. VA treatment records dated in 2020, more recently than the examination and the DBQ, further include a diagnosis of PTSD per the DSM-5. They also include new diagnoses of unspecified bipolar disorder and bulimia nervosa. In sum, clarification of the Veteran's DSM-5 diagnoses is needed. Consideration of a PTSD diagnosis must take into account all alleged in-service stressors. They include being treated poorly/scapegoated, being sexually assaulted, pulling the body of a teenager who had been dead for three days out of the water, holding a gun to someone's head, and an out-of-body/near death experience variously described as him fainting or suffering carbon monoxide poisoning. Another VA medical opinion finally is needed because the two existing opinions are inadequate. The opinion rendered as part of the March 2017 VA medical examination was against service connection because the Veteran was treated only for alcohol abuse during service when his current disorder does not include any problems with alcohol and he did not receive any relevant treatment for many years after his service separation. There is no requirement for relevant treatment during service or in the years thereafter, however. Without more explanation, then, it is unclear why not getting it is dispositive. The opinion additionally was rendered without the benefit of medical as well as lay evidence now available. This is also true of the opinion for service connection rendered as part of the July 2019 private DBQ. It was noted in this regard that the Veteran's current disorder began during service and has persisted ever since. Yet how this conclusion was reached is unclear, given that lack of any real supporting explanation. Indeed, medical literature was cited but not correlated specifically to the Veteran. Temporary Total Evaluation for Hospitalization A temporary total (100 percent) evaluation is assigned when a service-connected disability has required hospital treatment in a VA or VA-approved hospital for a period in excess of 21 days. 38 C.F.R. § 4.29. Here, VA treatment records document the Veteran's participation in the Psychosocial Rehabilitation Residential Treatment Program (PRRTP) at a VA Biloxi domiciliary from February 2017 to May 2017. Whether he is entitled to a temporary total evaluation for it accordingly is contingent upon service connection being granted for PTSD or for an acquired psychiatric disorder other than PTSD. It follows that a temporary total evaluation is inextricably intertwined with these service connection issues, with the appropriate course of action being to defer adjudication until they are resolved. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). This matter is REMANDED for the following action: 1. Follow established procedure for obtaining: (a) the Veteran's SSA records, (b) his VA treatment records dated from November 2017 to September 2018 and from July 2020 to present, and (c) any outstanding private treatment records identified as relevant to his psychiatric state. 2. After completing paragraph 1, schedule the Veteran for another VA medical examination regarding his psychiatric state. The examiner specifically shall review the claims file, conduct an interview and assessment of the Veteran, and diagnose all psychiatric disorders present under the DSM-5. In determining whether or not to diagnose PTSD, all alleged in-service stressors must be considered. They include being treated poorly/scapegoated, being sexually assaulted, pulling the body of a teenager who had been dead for three days out of the water, holding a gun to someone's head, and an out-of-body/near death experience variously described as fainting or suffering carbon monoxide poisoning. (Continued on the next page) The examiner then shall opine as to whether it is at least as likely as not (a 50 percent or greater probability) that each diagnosis made is related to the Veteran's service. A detailed explanation is required to support each opinion. This means that relevant medical principles and/or medical literature should be discussed as it relates specifically to the Veteran, as shown by the medical and lay (non-medical) evidence concerning him. A citation or copy for any medical literature referenced finally must be provided. 3. Then readjudicate service connection for PTSD and for an acquired psychiatric disorder other than PTSD, followed by a temporary total evaluation for hospitalization. If any issue remains denied, follow established procedure for returning it to the Board. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Becker 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.