Citation Nr: 21074971 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 18-36 511 DATE: December 16, 2021 ORDER Entitlement to service connection for a thyroid condition as a result of exposure to herbicides is granted. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder, is remanded. FINDING OF FACT The Veteran's hypothyroidism is presumed to be related to exposure to herbicide agents during his active military service. CONCLUSION OF LAW The criteria for service connection for hypothyroidism have been met. 38 U.S.C. § 1110, 1116, 5107; 38 C.F.R. § 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1969 to January 1972. This includes active service in the Republic of Vietnam. This appeal comes to the Board of Veterans' Appeals (Board) from a March 2014 rating decision of the Department of Veterans' Affairs (VA) regional office (RO). The Veteran requested a live videoconference Board hearing. A hearing was scheduled for November 19, 2021 but cancelled at the veteran's request. Accordingly, the Board will proceed with the consideration of his case. Claims for psychiatric disability encompass claims for all psychiatric disorders that are reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Therefore, the Board has recharacterized the separate PTSD and depression appeals into one issue, as reflected on the title page. Entitlement to service connection for a thyroid condition as a result of exposure to herbicides VA treatment records dated throughout the appeal period show the Veteran has a current diagnosis of hypothyroidism. VA regulations provide that a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116(f). If a Veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service-connected, even though there is no record of such disease during service unless the presumption is rebutted. 38 U.S.C. § 1113, 1116; 38 C.F.R. §§ 3.307 (d), 3.309(e). The Veteran's service personnel records confirm service in the Republic of Vietnam from 1969 to 1970, so he is presumed exposed to herbicide agent. While this issue was on appeal, the National Defense Authorization Act for Fiscal Year 2021 was enacted on January 1, 2021, and amended 38 U.S.C. § 1116(a)(2) to add hypothyroidism to the list of presumptive diseases associated with Agent Orange exposure. Here, the Veteran has been diagnosed with hypothyroidism and served in Vietnam. Thus, he has a present disability and conceded exposure to Agent Orange. Accordingly, service connection is warranted for hypothyroidism on a presumptive basis. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). The claim is granted. REASONS FOR REMAND Entitlement to service connection for an acquired psychiatric disorder The Veteran contends his acquired psychiatric disorder(s) are related to his active service. The Veteran was afforded a C&P examination in June 2013. There the examiner diagnosed major depressive disorder but stated the Veteran did not have a diagnosis of PTSD that conformed to DSM-IV criteria. The examiner explained that Even though the Veteran refers having some traumatic experiences during his military service, he does not meet the stressors criterion of response and doesn't fulfill the persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness criteria. The Veteran doesn't fulfill the DSM-IV diagnostic criteria of PTSD. The examiner did not provide a nexus opinion for major depressive disorder. VA treatment records indicate that the Veteran has a long history of mental health treatment going back to college, and he has been regularly treated for varying psychiatric diagnoses throughout the appeal period. His confirmed diagnoses during the appeal period include major depressive disorder and generalized anxiety disorder. His diagnosis of depressive disorder was most recently confirmed in July 2021. In December 2015 the Veteran was afforded a mental health diagnostic study. There the examiner noted a PTSD diagnosis was suggested. Many VA treatment records casually refers to a diagnosis of PTSD. In July 2017 the Veteran underwent a preventative medicine education note. There the examiner noted the PTSD screening test was negative. There are also instances in the record of the Veteran reporting flashbacks and nightmare episodes, experiencing frequent anger outbursts, and a depressive state. The Veteran also discussed stressors such as his base being attacked by mortars almost every night, and being attacked by a fellow soldier. The Veteran served in combat in the Republic of Vietnam. The Veteran has not been provided a VA examination to determine the nature and etiology of any psychiatric diagnosis other than PTSD and if it is related to his service. The Secretary must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms or a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4). The threshold for determining whether the evidence "indicates" that there "may" be a nexus between a current disability and an in-service event, injury, or disease is low. Treatment records show the Veteran was first treated and diagnosed with depression in June 2006. The record indicates he has consistently been treated for a depressive disorder since that time. As discussed above, the Veteran provided a personal statement discussing his time in active service and how it affected him after. The record shows an indication that a persistent or recurrent symptoms or disability may be associated with the Veteran's service. The Board finds the Veteran's reports of a depressive disorder related to his service are sufficient to warrant a VA examination. McLendon, 20 Vet. App. 79 (2006). The Board cannot make a fully-informed decision on the issue of a depressive disorder because no VA examiner has opined whether the current disability is related to his service. Therefore, a remand is necessary in order to obtain a medical opinion. Moreover, the record contains conflicting evidence as to the status of the Veteran's PTSD diagnosis. As such, on remand the examiner will assess whether the Veteran has a current diagnosis of PTSD that conforms to the DSM-5. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an appropriate clinician. The examiner should review the claims file, to include the Veteran's statements. The examiner should provide the following information: (a) Identify all psychiatric diagnoses conforming to the DSM that have been present at any time since February 2013. As part of this process, please state whether or not the Veteran meets each criterion for a diagnosis of PTSD pursuant to DSM-5. If the Veteran does not meet a required PTSD diagnostic criterion, the examiner should state a rationale for that finding. (Continued on the next page) (b) For each identified diagnosis, opine whether it is at least as likely as not (50 percent or greater probability) related to any event in service. The opinion should be supported by sufficient reasoning. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Brewer, 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.