Citation Nr: 21012938 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 17-44 721 DATE: March 8, 2021 REMANDED Entitlement to service connection for acquired psychiatric condition, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to special monthly pension is remanded. Entitlement to special monthly compensation based on the need for regular aid and attendance is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from July 1968 to April 1972. In November 2018, the Veteran and his sister testified at a Board hearing. The transcript is of record. In May 2019, the Board remanded the case for further development, which has been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for acquired psychiatric condition, to include posttraumatic stress disorder The Veteran contends that his current psychiatric condition is a result of his service in the Air Force. The Veteran’s service treatment records reveal his induction examination dated June 1968, found the Veteran fit for duty with no reported preexisting psychological conditions. The treatment notes from January 1971 reported that the Veteran displayed moderate, diffuse chronic anxiety and appeared to be a passive-dependent type personality and that the Veteran was seen at the psychiatric clinic in November 1968 for anxiety related to an upcoming assignment with different duties but did not have any problems since that time. In March 1972 the Veteran was seen for anxiety and reported being nervous all his life; however, the April 1972 separation examination did not report any psychological abnormalities. The military personnel records contain positive performance reports from 1969 to 1971. In June 1969 the Veteran was described as having a cheerful attitude that promoted harmony with his fellow airmen. In November 1970, the records reported that he was able to perform all his duties in an exceptional manner with his strengths being his pleasant personality and steadfast manner in completing assigned duties. In April 1971 he was described as alert with personal pride and that his duty performance had never been impaired even under hazardous conditions and he received the Air Force commendation medal for his outstanding professional skill and initiative from January 1970 to January 1971 as part of the Security Police Squadron in the Republic of Vietnam. Notably, there was a significant change in the training records reports after 1971. Specifically, in February 1972 the Veteran was described as experiencing numerous problems since his return, being extremely nervous and having a hard time dealing with people. In March 1972 he was non selected for reenlistment due to being easily excited, extremely nervous around officers, unable to readily understand verbal and written instruction and exercising poor judgment. The Board notes that the Veteran’s in-service stressors occurred during his service in Vietnam and that the training record reports suggest a substantial change in the Veteran’s performance after his return. The Veteran underwent several VA examinations for his claim. The October 2007 VA examiner diagnosed obsessive compulsive disorder, the October 2011 examiner diagnosed schizoaffective disorder, and the February 2015 and September 2020 examiners diagnosed schizotypal personality disorder that preexisted service. Review of the medical records reveals several diagnoses such as schizoaffective disorder, schizophrenia, features of schizotypal personality disorder and depression. As such, the history presents a number of unique difficulties in adjudicating the case. The February 2015 and September 2020 VA examinations suggest that the Veteran has a personality disorder; thus, there is a question of whether the Veteran has a disability that can be service connected. See 38 C.F.R. § 3.303 (c) (providing that personality disorders are not subject to service connection). Additionally, because the Veteran’s enlistment examination did not report any preexisting psychiatric disorder; therefore, he is considered to have been in sound condition at the time of his enlistment. 38 C.F.R. § 3.304 (b). Rebutting this presumption requires clear and unmistakable evidence that the Veteran had a psychiatric disorder that preexisted his service and was not aggravated therein. Neither the February 2015 VA examiner nor the September 2020 examiner’s provided sufficient evidence of the pre-service existence of the Veteran’s disability that rises to the level of clear and unmistakable evidence. Furthermore, none of the examiner’s addressed the service treatment records revealing no reported preexisting psychiatric conditions on induction and the military personnel records consistently reporting exemplary work and attitude with an abrupt change occurring shortly after his return from Vietnam. As such, the Board finds that further development is required for adjudication. 2. Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance and special monthly pension The Veteran's claims for SMC aid and attendance and special monthly pension are inextricably intertwined with the claim for service connection for PTSD on appeal. Therefore, the Board finds that the claims for SMC aid and attendance and special monthly pension must be remanded as well. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined when a decision on one issue would have a significant impact on another issue). The matters are REMANDED for the following action: 1. Acquire updated VA and/or private treatment records. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran’s claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: (a.) Identify all psychiatric disorders present during the time period of the claim, to include any personality disorders. (b.) For any identified psychiatric disorder or personality disorder, is it clear and unmistakable (i.e., undebatable) that the Veteran had a psychiatric condition prior to commencement of active duty in July 1968? If a disorder is found to be preexisting the examiner must provide the evidence that establishes the disorder’s preexistence and include a well-reasoned medical explanation to support the finding. The examiner is advised that “Clear and unmistakable” is defined in applicable regulations to mean “obvious or manifest.” 38 C.F.R. § 3.304 (b). (c.) If a preexisting condition is found, is it clear and unmistakable that the preexisting psychiatric condition was not aggravated (i.e., permanently worsened) during the Veteran's military service? (d.) For any non-preexisting diagnosed psychiatric disorders, is it at least as likely as not that these disorders had their onset during or are otherwise related to active service? (e.) If the Veteran is diagnosed with a personality disorder, the examiner must state whether there is a separate acquired psychiatric disorder that is superimposed upon the personality disorder. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. For each of the above questions, the examiner must consider and address the following: 1) the Veteran’s positive performance reports in his military personnel records from approximately 1969 to 1971 noting his mental alertness, efficiency, and pleasant personality among many other positive traits attributed to him and his work ethic to include the Air Force commendation medal for his outstanding professional skill and initiative; 2) the induction examination dated June 1968, which found the Veteran fit for duty with no reported preexisting psychological conditions, 3) the service treatment records from January 1971 stating that the Veteran was seen for anxiety due to concern of different duties at his next assignment in November 1968 but has not had any problems since that time; 4) the service treatment records noting anxiety in February 1971 and March 1972; and 3) the performance reports in the military personnel records from 1972 indicating that the Veteran was extremely nervous, had a hard time dealing with people and was unable to readily understand verbal and written orders In all opinions rendered, the examiner is advised that the Veteran and his sister are competent to report his symptoms and treatment history. The examiner must specifically consider and discuss the Veteran’s stressors while stationed in Vietnam, particularly in relation to the varying performance reports (noting the dates of these reports) located in the military personnel records. The examiner should also consider and address the sister’s contentions that the Veteran had exemplary service in Vietnam with a noticeable change after his return. If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. (Continued on the next page)   A complete rationale containing clear conclusions with supporting data and a reasoned medical explanation connecting the two is required for all medical opinions. The examiner should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. A. Prinsen 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.