Citation Nr: 21005702 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 17-27 707 DATE: February 2, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), major depressive disorder, and anxiety disorder, is remanded. Entitlement to service connection for erectile dysfunction (claimed as secondary to an acquired psychiatric disorder), to include the question of whether new and material evidence has been submitted to reopen the claim, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1974 to October 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from February 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) which declined to reopen the Veteran’s claims for entitlement to service connection for PTSD and erectile dysfunction. In March 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In an April 2020 decision, the Board reopened the Veteran’s claim for entitlement to service connection for PTSD and remanded it for additional development. The Board also remanded the Veteran’s claim for entitlement to service connection for erectile dysfunction, including the question of whether new and material evidence has been submitted to reopen the claim. These matters have now returned to the Board for further appellate review. A claim for service connection for a psychiatric disability is deemed to encompass all psychiatric diagnoses reasonably presented in the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Pursuant to Clemons, the Board has expanded the service connection claim for PTSD as reflected on the title page of this decision. Regrettably, additional development is necessary before the issues on appeal can be adjudicated. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), major depressive disorder, and anxiety. The Veteran contends that his psychiatric disorders manifest during active service or are otherwise related to active service. The Board notes that prior development for this claim was mostly limited to attempting to verify the Veteran’s claimed non-combat PTSD stressors. However, despite unsuccessful efforts to confirm his claimed stressors, the record also suggests that the Veteran may be entitled to service connection for non-PTSD psychiatric disorders. In this regard, the Board recognizes that the Veteran has not been afforded a VA examination for mental health disorders. A medical examination or medical opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but: (1) contains competent evidence of a current diagnosed disability or persistent or recurrent symptoms of a disability; (2) establishes that an event, injury, or disease occurred in service or certain diseases manifested during an applicable presumptive period for which the claimant qualifies; and (3) indicates that the disability or symptoms may be associated with the established event, injury or disease in service or with another service-connected disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the Veteran post-service treatment records show a long history of mental health conditions, substance abuse, and homelessness. The Veteran has been diagnosed with major depressive disorder, depressive disorder, PTSD, substance abuse disorders, anxiety disorder, and personality disorder. A service treatment record from May 1975 shows complaints of anxiety and nervousness; a provisional diagnosis for an adjustment disorder; and referral for mental health assessment. The Board notes that this treatment entry is quite difficult to read and may have been previously overlooked during the development of this claim. Considering the above, the Board finds that a VA examination is necessary to determine the nature and etiology of the Veteran’s acquired psychiatric disorders. Entitlement to service connection for erectile dysfunction (claimed as secondary to an acquired psychiatric disorder), to include the question of whether new and material evidence has been submitted to reopen the claim. The Veteran contends that his erectile dysfunction is related to his acquired psychiatric disorders and/or caused by the medication used to treat his acquired psychiatric disorders. As such, the application to reopen the claim for entitlement to service connection for erectile dysfunction is inextricably intertwined with the claim for service connection for acquired psychiatric disorders. See Harris v. Derwinski, 1 Vet. App. 180(1991) (two issues are “inextricable intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). Therefore, the adjudication of such claim must be deferred pending the outcome of the Veteran’s claim for service connection for acquired psychiatric disorders. The matters are REMANDED for the following action: 1. Obtain the Veteran's updated VA treatment records and associate them with the evidence of record. If possible, the Veteran himself should submit these records (if any), and any other new treatment for this problem, himself, to expedite the case. Any assistance on this issue would be appreciated. 2. Obtain an opinion from an appropriate clinician to determine the nature and etiology of the Veteran's acquired psychiatric disorders, to include posttraumatic stress disorder (PTSD), major depressive disorder, and anxiety disorder. Specifically, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's acquired psychiatric disorders had their onset during active service or are otherwise related to active service. A complete rationale for any opinions expressed should be provided. The report should set forth all complaints, findings, and diagnoses relating to the Veteran's acquired psychiatric disorders and provide a rationale for all conclusions reached. If the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 3. After completion of the aforementioned, the AOJ should readjudicate the issues on appeal. If the benefit sought on appeal is not granted, then the AOJ should provide the Veteran with a supplemental statement of the case and afford him the appropriate opportunity to respond thereto. Thereafter, the case must be returned to the Board for further appellate review. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. VanValkenburg, 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.