Citation Nr: 21072819 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 17-60 074 DATE: December 6, 2021 ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), depression and anxiety. 2. Entitlement to service connection for cataracts in both eyes. 3. Entitlement to service connection for a lower back disability. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depression and anxiety is remanded. Entitlement to service connection for cataracts in both eyes is remanded. Entitlement to service connection for a lower back disability is remanded. REASONS FOR REMAND The Veteran served in the Navy from December 1990 to February 1998. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May and August 2017 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified before the undersigned Veterans Law Judge in a virtual video conference Hearing. A transcript of that hearing is of record. At his August 2021Hearing, the undersigned Veteran's Law Judge agreed to leave the record open for 60 days to allow time for the Veteran to submit additional evidence in support of his claim of entitlement to service connection for cataracts. The record was held open for 60 days. However, no additional evidence was submitted. Upon review of the evidence of record, including the Veteran's August 2021 Board Hearing testimony, the Board is expanding the Veteran's PTSD claim to include entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depression and anxiety. See Clemons v. Shinseki, 23 Vet. App. 1 (2009); see also 38 C.F.R. § 3.304 (f). As will be explained in further detail below, these matters are remanded to the agency of original jurisdiction (AOJ) to undertake further development. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depression and anxiety. The Veteran asserts that his PTSD is related to in-service stressors. The Veteran's DD-214 shows that his military occupational specialty (MOS) was Boatswain Mate and his other service personnel records, including his performance evaluations show that he served aboard the USS Camden AOE-2 from April 1991 to December 1994. See Enlisted Performance Record & History of Assignments. There are particular requirements for establishing service connection for PTSD in 38 C.F.R. § 3.304(f), that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343 (Fed. Cir. 2010). In order to be entitled to service connection for PTSD, there must be medical evidence of PTSD, medical evidence that establishes a link between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In this case, there is medical evidence of PTSD. In a February 2017 VA Initial PTSD examination, the Veteran was diagnosed with PTSD. The examiner noted that the stressors identified by the Veteran were adequate to support the diagnosis of PTSD in conformance with the DSM-V. See February 10, 2017 Initial PTSD examination, pgs. 1, 5-8. With respect to the Veteran's in-service stressors: In his Statement in Support of his claim for PTSD, the Veteran indicated that on June 20, 1993, while serving on the USS Camden AOE-2, his crew was making preparations for tying ships to the pier during mooring execution when one of mooring lines snapped and cut one of his fellow service members in half. The Veteran reported that he witnessed this incident. The Veteran reported that this incident occurred in Singapore. See May 17, 2017, VA Form 21-0781. During his August 2021 Board Hearing, the Veteran clarified through his testimony that his fellow service soldier was "sliced" (not cut in half) whereby the service member's intestines were exposed. The Veteran testified that he is not certain whether the service member survived this incident. See August 2021 Board Hearing transcript, pg. 15. Additionally, on his May 2017 Statement in support of his PTSD claim: The Veteran reported that on December 12, 1994, in Guam, while serving on the USS Camden AOE, during a supply evolution, as soon as he pulled out of the pier of the naval base, approximately 600-700 yards out to sea, a helicopter carrying 12 sailors malfunctioned and fell into to the sea, killing everyone onboard. During his August 2021 Board Hearing, the Veteran testified that his best friend was killed during this multi-fatality helicopter crash. Significantly, the Board notes that the Veteran provided both the first and last name of this service member. See May 17, 2017, VA Form 21-0781. See also, Board Hearing transcript, pgs. 16-19. The Veteran testified that after this helicopter crash, drinking became a problem for him, ultimately resulting in an other than honorable discharge at separation. The Veteran further testified that he is in treatment with a psychiatrist and has been treated for anxiety. See Board Hearing transcript, pgs. 19-21; See also November 3, 2017 treatment record re: treatment for PTSD, anxiety and depression. The Board underscores that while the Veteran does have a diagnosis of PTSD, his alleged stressors have not been independently corroborated. See June 22, 2017 Defense Personnel Records Information Retrieval system (DPRIS) finding re: review of 1993 command history and the June July 1993 deck logs for the USS CAMDEN (AOE-2) do not document any Sailors getting cut in half by pier lines during this time period. No casualty information could find pertaining to the case. With respect to the helicopter crash, the Board notes that the RO has requested from the Veteran the name (s) of the sailors killed in the helicopter accident while he was assigned to the USS Camden in Guam. See July 10, 2017 VA correspondence re: development. In view of the Veteran's August 2021 Board Hearing testimony providing further details about the multi-fatality helicopter accident in Guam, including the full name of a fellow service member who is also alleged to be the best friend of the Veteran, and clarifying language on the nature of the injury associated with mooring lines snapping in 1993, the Board finds that further efforts should be taken to corroborate the Veteran's claimed stressors, particularly with respect to the multi-fatality helicopter accident. Additionally, in view of the Veteran's Board Hearing testimony regarding drinking after this multi-fatality helicopter accident and post-service treatment for anxiety, the Board finds that he should be provided a VA examination to determine whether any acquired psychiatric disability, including PTSD, depression and anxiety is related to his active-duty service. Entitlement to service connection for cataracts in both eyes. The Veteran contends that his current eye disability is related to exposure to gasoline fumes while he refueled naval ships during service on the USS Camden. Alternatively, the Veteran asserts that his service-connected hypertension aggravates his cataracts. See August 2021 Board Hearing transcript, pgs. 4-6. At his August 2021 Board Hearing, the Veteran testified that he did not have any pre-existing eye condition when entering service nor was he aware of family members who had eye diseases or eye conditions. The Veteran further testified that on April 8, 1998, two months after his separation from the Navy, he was treated for hypertension, eye and knee problems. See Board Hearing transcript, pgs. 4-6. The Veteran testified that he never thought to see anyone about his eye problems during service. The Veteran testified that he has continued suffer from these eye conditions. The Veteran testified that he has lost vision in his left eye. The Veteran further testified that he can only see through his right eye and that he had a cataract operation. Id. at pg. 7. The Board notes that the Veteran's July 1996 service treatment records show that the Veteran complained of blurred, distant vision. The July 1996 service treatment record reports that bifocals were discussed. There was no history of prescription wear (normal ocular habits). See July 9, 1996 STR. Post-service treatment records show that the Veteran has a diagnosis of dense white cataract of the right eye. Post-service treatment records also show a diagnosis of left eye cataracts. See December 15, 2016 treatment records re: cataract of the right eye; See also, February 16, 2021 treatment records re: cataracts of the left eye. In view of the above, and with consideration of the Veteran's new theory of entitlement based on secondary service connection, the Board finds that the low threshold for VA to provide the Veteran a VA examination to determine the nature and etiology of his eye disability has been met. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 C.F.R. § 3.159 (c)(4)(i). Entitlement to service connection for a lower back disability. The Veteran contends that he incurred a low back disability due to the rigors of completing his duties and assignments associated with his in-service military occupational specialty, which involved the refueling of naval ships. At his August 2021 Board hearing, the Veteran testified that his current low back disability is the result of lifting heavy fueling hoses and nozzles during service. The Veteran testified that in one incident, during the refueling of an aircraft carrier (USS Carl Vincent), his back snaped, and the mooring line as well. The Veteran testified that he started tugging on the mooring line, which made it worse. The Veteran testified that his back problems began at this time. The Veteran testified that he did not see anybody about his back problem because the incident occurred during the Gulf War. The Veteran testified that he currently receives treatment at the VA for his back condition and attends physical therapy. See Board Hearing transcript, pgs. 12-14. As referenced above in this decision, the Veteran's service personnel records confirm the Veteran's MOS as a Boatswain Mate, which included responsibility for maintenance and preservation of six fuel rigs, seven cargo stations and various divisional spaces. See Evaluation Report & Counseling Record. Post-service VA treatment records reflect a diagnosis of low back pain and moderately severe degenerative disc disease at L4-L5. See October 31, 2017 medical records re: diagnosis of low back pain. See also, July 22, 2019 treatment records re: moderately severe degenerative disc disease at L4-L5 and L5-S1, with mild posterior disk bulging. The Board notes that the Veteran has not been provided a VA examination to determine the nature and etiology of his low back disability. In view of the Veteran's August 2021 Board Hearing testimony in connection with his in-service duties, the Board finds that the low threshold for VA to provide the Veteran a VA examination to determine the nature and etiology of his low back disability has been met. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 C.F.R. § 3.159 (c)(4)(i). Accordingly, these matters are REMANDED for the following action: 1. PTSD claim: Make an additional attempt to corroborate the Veteran's alleged in-service stressors via National Personnel Records Center (NPRC) and Defense Personnel Records Information Retrieval System (DPRIS), including affording the Veteran an opportunity to provide any additional information regarding his claimed in-service stressors, to include specific names, dates, and locations. See also, August 27, 2021 Board Hearing transcript/testimony, pgs. 14-18. If the claimed PTSD stressors cannot be corroborated, issue a formal finding and notify the Veteran and his representative of such finding. 2. Thereafter, schedule the Veteran for VA examination by an appropriate medical professional to prepare an opinion with respect to the nature and etiology of any acquired psychiatric disability, including PTSD, depression and anxiety. The electronic claims file must be made available to the examiner for review, and such review should be noted in the examination report. Following a review of the claims file and medical history, the VA examiner must offer an opinion as to the following: a. Does the Veteran currently have a psychiatric disorder that conforms to DSM 5 criteria? b. If so, the examiner should identify the specific disorder (other than PTSD) and whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disorder is caused by or a result of his military service. c. If PTSD, the examiner should identify the corroborated stressor (s) that provide (s) the basis for the diagnosis, and whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disorder is caused by or a result of his military service. See February 10, 2017 VA Initial PTSD Examination. A complete rationale must be provided for all opinions offered. Any opinion should reflect consideration of the Veteran's lay statements regarding ongoing symptomatology since service, and discuss the significance, if any, of prior psychiatric diagnoses including PTSD. 3. Next, identify and obtain any outstanding VA and private treatment records that are not already associated with the claims file pertaining to the Veteran's cataracts and low back disability claims. If any record identified cannot be obtained, the Veteran and his representative should be notified of this in writing, to include all efforts taken by VA to attempt to obtain any such record. The Veteran should also be offered the option to provide any such record himself. 4. After obtaining any outstanding records pertaining to the Veteran's cataracts claim, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any eye disorder. The Veteran's claim file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed. The examiner must opine whether any diagnosed eye disorder is at least as likely as not related to an in-service injury, event, or disease. The examiner must address the Veteran's statements and reports in relation to the claimed disability. Please see August 27, 2021 Board Hearing transcript, pgs. 6-8 re: exposure to gasoline fumes causing eye problems. Additionally, the examiner must address all pertinent medical evidence. In consideration of all of the Veteran's statements and reports and all pertinent medical records, the examiner is also asked to offer an opinion as to whether it is at least as likely as not that any currently diagnosed eye disorder, including cataracts in both eyes, was either caused or aggravated beyond the natural progression by the Veteran's service-connected hypertension. The examiner is requested to address causation and aggravation separately. The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 5. Next, after obtaining outstanding records pertaining to the Veteran's low back pain, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any lower back disability identified during the appeal period. The complete electronic record must be made available to, and reviewed by, the VA examiner prior to conducting the examination. All necessary studies and tests should be conducted. The examiner must opine whether any diagnosed lower back disability, to include low back pain, is at least as likely as not related to an in-service injury, event, or disease. The examiner must address the Veteran's statements and reports in relation to the claimed disability. Please see August 27, 2021 Board Hearing transcript/testimony, pgs. 12-14 re: back snapped during refueling of aircraft carrier. The examiner is advised that the Veteran is competent to report his medical history including symptoms and treatment, and that his reports must be taken into account. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner is not to improperly discount the Veteran's lay statements or rely solely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 6. After completing all indicated development, the Veteran's claims should be readjudicated based on the entirety of the evidence. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case (SSOC) and afforded the requisite opportunity to respond before the case is remanded to the Board. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Little, 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.