Citation Nr: 21013569 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 14-39 866 DATE: March 9, 2021 REMANDED Service connection for a psychiatric disorder. Service connection for a right knee condition. Service connection for a left knee condition.   REASONS FOR REMAND The Veteran served on active duty from August 1997 to December 1998. The case is on appeal from a February 2013 rating decision. In March 2018, the Veteran testified at a Board hearing. In an October 2018 decision, the Board granted service connection for scoliosis. At that time, the Board also remanded the claims for a psychiatric disorder and bilateral knee condition for further development. 1. Service connection for a psychiatric disorder. The Veteran contends that he has a current mental health disorder that is a result of his military service. At the March 2018 Board hearing, he testified that going into the Marine Corps at a young age and training for his particular MOS resulted in declined mental health and subsequent “self-medicating” with alcohol. He also stated that he was informed the specific reason he was being discharged from service in 1998 was due to the liability of his sleepwalking condition. Service treatment records (STRs) include the notes of a July 1998 psychiatry evaluation after referral for multiple episodes of sleepwalking. His mental status was listed as a depressed mood with a congruent affect, and with indications that his sleepwalking may be associated with the onset of stress. The assessment listed alcohol dependence, a probable sleepwalking disorder, and the existence of antisocial personality traits. At his separation examination in November 1998, he was noted as having a sleepwalking disorder and alcoholism, and in the physician’s summary of the report of medical history, it is also listed that he has overall difficulty sleeping, with “depression/excessive worry - frequent down moods.” Pursuant to the Board’s remand, the Veteran was afforded a VA psychiatric examination in September 2019. The examiner found that the Veteran met the DSM-5 diagnostic criteria for an adjustment disorder with mixed disturbance, which causes occupational and social impairment with occasional decreases in work efficiency. However, the psychologist did not provide an opinion as to whether his adjustment disorder was related to his military service, instead focusing on the Veteran’s history of sleepwalking, alcohol dependence, and antisocial personality traits. The examiner opined that it was less likely than not that the Veteran’s sleepwalking, alcohol abuse, and antisocial personality traits are due to military service. In July 2020, the Veteran submitted a statement in support of his claim describing events during service that caused him fear, anxiety, and depression, and resulted in his drinking alcohol to self-medicate, domestic disturbances, and suicidal thoughts. He contends that many of these symptoms continue to the present, to include possible PTSD symptoms, and impact his current relationships and functioning. Treatment records indicate that the Veteran sought help for mental health problems at the VA in July 2019. He was diagnosed with depressive disorder, and currently takes medication for depression and anxiety. Further, he describes that while he has experienced depression and anxiety “for years,” he only recently decided to “get help,” voicing issues with trusting mental health specialists. See March 2020 medical CAPRI document. The Board finds that a new psychiatric examination and medical opinion is warranted as the July 2019 examiner did not provide an adequate opinion as to the Veteran’s currently diagnosed mental health disorders, to include depressive disorder and adjustment disorder. The examiner should also consider the Veteran’s lay statements describing in-service events and symptoms experienced. In light of the remand, updated VA treatment records should be obtained. 2. Service connection for a right knee condition. 3. Service connection for a left knee condition. The Veteran seeks service connection for both the right and left knee, which he claims he began experiencing pain during basic training. At the March 2018 Board hearing, the Veteran contended that, while there was no direct trauma, there could have been bilateral injury to his knees given his MOS as a TOW missile gunner, including going “up and down any type of motorized vehicle, repelling, on terrain, walking around on terrain, mountains, road marches.” He states that he pushed through any pain to avoid going to sick call and being a “complainer.” He also asserts that his knee issues continued throughout service, and have continued since discharge, with pain on an everyday basis. See July 2020 Statement in Support. The Veteran’s STRs show that at the time of his separation examination in November 1998, he had “chronic [bilateral] knee pain” and “crepitus.” However, the VA examiner in 2012 made the determination that “Veteran’s bilateral knee condition is less than likely as not related to his military service,” with the rationale that he did not have a current diagnosis for his knees at that time. Following the October 2018 Board remand, the Veteran underwent a new VA examination in September 2019. The examiner listed bilateral “intermittent knee pain” under the diagnosis section. The Veteran described functional loss as soreness without the loss of range of motion, but the examiner marked that there was no functional impact on the Veteran’s current employment status. It was then opined that the Veteran’s right and left knee conditions were less likely than not incurred in or caused by an in-service injury or event. The rationale provided was that there was only a “brief mention” of knee crepitus and joint pain at the time of separation, he has not required medical attention for his knees since leaving service, and he is currently asymptomatic without a chronic bilateral knee condition. VA treatment records indicate that in March 2020, the Veteran sought treatment for his bilateral knee pain, and that x-rays had been ordered. Additionally, in his July 2020 statement in support, he indicates that “recently I was diagnosed with pre-patella bursitis. I am currently undergoing physical therapy for my knees.” It is unclear whether the claimed knee diagnoses and therapy were provided by VA or private treatment providers, but are potentially relevant to the Veteran’s claim and are not currently available in the claims file. A remand is required to allow VA to obtain authorization and to request these records. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Subsequently, a new medical opinion should be obtained with consideration of any new evidence acquired, and with consideration of the Veteran’s lay statements of events in service and suggested continuity of knee pain since separation. The matters are REMANDED for the following action: 1. Ask the Veteran to identify any VA or private treatment providers relevant to his bilateral knee claims, and to provide authorization to VA to request the records. Request any so identified records, and associate them with the claims file if they exist. 2. Notify the Veteran that he may submit additional lay statements from himself and/or other individuals with first-hand knowledge of the claimed incidents and the impact such may have had on the Veteran, for both his psychiatric disorder and bilateral knee conditions. 3. Obtain updated VA treatment records since April 2020. 4. Thereafter, schedule the Veteran for an examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology any psychiatric condition. The record, including a complete copy of this remand, should be made available for review. (a) Identify all of the Veteran’s psychiatric disorders experienced during the claims period, to include whether he meets the criteria for PTSD. If PTSD is not diagnosed, it should be explained why this diagnosis is not appropriate. (b) If PTSD is diagnosed, identify the stressor(s) upon which the diagnosis is based. This should include an opinion as to whether the in-service stressor(s) is adequate to support a diagnosis of PTSD and whether the Veteran’s symptoms are related to that claimed stressor(s). (c) For each currently diagnosed psychiatric disorder other than PTSD, the examiner should offer an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any psychiatric disorder had its onset during, or is otherwise related to, active service. (d) The examiner is asked to specifically consider and discuss: (1) the Veteran’s lay statements of events in service and continued mental health symptoms since service; (2) the July 1998 STR diagnosis of a sleepwalking disorder and November 1998 separation examination noting depression/excessive worry; and (3) past and current periods of treatment to include medication for depression and anxiety. If the absence of treatment before or after service plays a role in the formation of the opinion, the medical importance of this should be explained. The examiner should provide rationale for all opinions expressed, including by citing to the record. 5. Forward the claims file to an appropriate clinician for a medical opinion as to the nature and etiology of the Veteran’s right and left knee conditions. The need for an in-person clinical examination of the Veteran should be determined by the examiner. The record, including a complete copy of this remand, should be made available for review. First, the examiner should determine whether the Veteran has any current knee condition, which may include pain alone that rises to the level of functional impairment. The examiner is then asked to opine as to whether the Veteran’s right and left knee condition at least as likely as not (50 percent or greater possibility) had its onset during or within one year of service, or is otherwise related to, his active military service. The examiner is asked to specifically consider and discuss: (1) the Veteran’s lay statements of knee pain that began during service and continued since discharge; and (2) the November 1998 separation examination diagnoses of chronic knee pain and crepitus. If the absence of treatment before or after service plays a role in the formation of the opinion, the medical importance of this should be explained. The examiner should provide rationale for all opinions expressed, including by citing to the record. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morford, 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.