Citation Nr: 21012410 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 11-06 559 DATE: March 4, 2021 REMANDED Service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1977 to July 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2008 decision by the Department of Veterans Affairs (VA). This case was remanded in December 2017 and December 2019 for further development; it has since been re-assigned to the undersigned. Unfortunately, the Board finds that remand is required to comply with the December 2019 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The December 2017 Board remand sought development to clarify the Veteran’s contended in-service stressor. The December 2019 Board remand noted that contended in-service event, a November 1978 collision of the USS Saratoga, was confirmed. The December 2019 Board remand characterized the Veteran’s service connection claim to encompass all pertinent psychiatric symptomatology. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board remand ordered for a VA examination to be obtained to determine the nature and etiology of any acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD). The Board noted that the examiner should provide an opinion as to whether the Veteran’s diagnosis of PTSD is supportable solely by the stressor that has been verified or established in the record. Further, the examiner should opine as to the etiology of any acquired psychiatric disorder. The examiner should consider ongoing treatment and medication management for depression, PTSD, anxiety, and insomnia; the Veteran’s reports of ongoing nightmares, difficulty sleeping, anger, avoidant behaviors, and mood symptomology since service; and increased anxiety and startle response due to difficulty sleeping while stationed on the USS Saratoga. The Veteran underwent a VA examination in December 2020. The examiner found that the Veteran did not have a diagnosis of PTSD that conforms to DSM-5 criteria. The Veteran was diagnosed with depressive disorder. The examiner stated that he could not diagnose PTSD because the Veteran was unable to describe effectively any traumatic experience and did not appear to fully understand the nature of these symptoms when they were described to him. Since the Veteran has been diagnosed with Werneke’s encephalopathy which does appear to have caused distortions in his presentation, clarification regarding his potential for PTSD would require significant improvement in this condition. A February 2021 correspondence from the Veteran’s representative notes that the VA examiner did not indicate that he considered the Veteran’s psychiatric history and requested a new, adequate examination. The examiner did not provide an opinion regarding the etiology of the Veteran’s diagnosed depression, nor did the examiner acknowledge the Veteran’s confirmed in-service event. The examination notes: “[The Veteran] was given several chances to clarify stresses that occurred when he was in the military, but said only that ‘maybe I saw four guys getting blown off the ship from the jet engines when airplanes were taking off…maybe some of them didn’t get found.’ This is clearly inconsistent with his previous statements and it did appear that he might’ve been making this up to describe a trauma because he could not remember, but was trying to comply with the request.” The examiner did not appear to consider the Board’s finding that the Veteran’s contended in-service event, a November 1978 collision of the USS Saratoga, was confirmed. Further, the examiner did not explain the inconsistency regarding the Veteran’s reported history of stressors in the military. The Board finds this opinion inadequate for appellate review. As such, remand is necessary for a new VA examination and opinion to determine the etiology of the Veteran’s acquired psychiatric disorder. The matters are REMANDED for the following action: 1. The AOJ should obtain updated VA and non-VA treatment records. 2. After the above development is completed, the AOJ should arrange for a VA examination of the Veteran, by a different clinician than the December 2020 examination, to determine the nature and likely cause of any acquired psychiatric disability to include PTSD, depressive disorder, anxiety, and insomnia. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record and examination of the Veteran, the examiner should provide an opinion with detailed rationale that responds to the following: (a) Please identify, by diagnosis, all acquired psychiatric disabilities present during the appeal period, pursuant to the DSM-5 criteria. (b) If the Veteran is diagnosed with PTSD, is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s PTSD is caused by traumatic events in active service to include an in-service injury or disease, including a November 1978 collision aboard the USS Saratoga? The examiner must identify the stressor(s) supporting the diagnosis. The examiner should provide an opinion as to whether the Veteran’s diagnosis of PTSD is supportable solely by the stressor that has been verified or established in the record. (c) If the Veteran is diagnosed with any other acquired psychiatric disorder, is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s identified acquired psychiatric disorder is caused by active service to include an in-service injury or disease, including a November 1978 collision aboard the USS Saratoga? (Continued on the next page)   For the purposes of these opinions, the November 1978 USS Saratoga collision has been verified by the JSRRC. The examiner should consider and discuss ongoing treatment and medication management for depression, PTSD, anxiety, and insomnia; the Veteran’s reports of ongoing nightmares, difficulty sleeping, anger, avoidant behaviors, and mood symptomology since service; and increased anxiety and startle response due to difficulty sleeping while stationed on the USS Saratoga. Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Tiffany Dawson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. Kerner, 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.