Citation Nr: 21014112 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-30 621 DATE: March 11, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, diagnosed as persistent stressor disorder and other specified stressor disorder, is granted. REMANDED Entitlement to service connection for insomnia is remanded. Entitlement to service connection for bruxism is remanded. Entitlement to service connection for a foot condition, to include tinea pedis is remanded. FINDING OF FACT The probative and competent evidence of record supports that the Veteran’s acquired psychiatric disorder, diagnosed as persistent stressor disorder and other specified stressor disorder, is related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, diagnosed as persistent stressor disorder and other specified stressor disorder, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1967 to May 1969, with service in the Republic of Vietnam. In a September 2018 decision, the Board dismissed the claims based on responses to questioning at a prior hearing. The Veteran subsequently appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In an October 2019 order, the Court granted a Joint Motion for Partial Remand (JMPR), which vacated the Board’s decision to dismiss the claims and remanded the Veteran’s appeal to the Board for action consistent with the terms of the JMPR. The Veteran requested an additional Board hearing which was held by the undersigned Veterans Law Judge in October 2020. Entitlement to service connection for an acquired psychiatric disorder The Veteran contends that he has a psychiatric condition that is causally related to his service. The Board concludes that the Veteran has a current disability that is related to his service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). The Veteran was given a VA examination in June 2013. The VA examiner opined that the Veteran did not have a diagnosis for posttraumatic stress disorder (PTSD). The examiner did not provide any additional psychiatric diagnosis. In October 2020, the Veteran testified at his Board hearing that he was involved in combat in Vietnam and his MOS was fire direction center operator in an artillery unit. The Veteran further testified that after his deployment to Vietnam he experienced nightmares and sleep issues. The Veteran’s service personnel records show that he was deployed to Vietnam from October 1967 to September 1968. His military occupational specialty at that time was Field Artillery operator. In November 2020, the Veteran submitted an October 2020 private psychological opinion. The private examiner diagnosed the Veteran with persistent depression and other specified stressor disorder. The examiner reviewed the Veteran’s record, including service records and conducted a clinical interview and diagnostic testing. The examiner concluded that the Veteran has “persistent stressor disorder and other specified stress disorder” and that the diagnosis is “more likely than not” related to his Vietnam combat. The provider also commented that this diagnosis was made using the DSM-5 criteria as opposed to the DSM-IV criteria the June 2013 VA examiner used. The provider further stated that had the DSM-5 criteria been available, the June 2013 VA examiner would have diagnosed the Veteran with other specified stressor disorder. The private examiner found that the Veteran exhibited flattened affect, angry outburst in the community, difficulty in forming and maintaining effective relationships, even with his family. The examiner found that the Veteran suffers from subthreshold symptoms of PTSD and that he clearly meets the other specified stressor disorder criteria related to his experiences in Vietnam. The Veteran has documented service as a Field Artillery Operator in the Vietnam and the competent probative evidence supports the finding that the Veteran’s acquired psychiatric disorder, diagnosed as persistent stressor disorder and other specified stressor disorder, is related to his combat service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Accordingly, service connection is warranted. REASONS FOR REMAND 1. Entitlement to service connection for insomnia is remanded. 2. Entitlement to service connection for bruxism is remanded. The Board is unable to make an informed decision on the issues of service connection for insomnia and bruxism because the prior examinations are inadequate. The June 2013 VA examiner and March 2018 private opinion only provide opinions on theories of service connection secondary to PTSD, which the Veteran does not have a PTSD diagnosis. Given the decision above that grants service connection for a psychiatric disability, a new examination is needed. Additionally, while on remand, the VA examiner should identify whether insomnia is a symptom of the Veteran’s now service-connected acquired psychiatric disorder or a separate compensable disorder. 3. Entitlement to service connection for a foot condition, to include tinea pedis is remanded. The Board is unable to make an informed decision on the issue of service connection for a foot condition, to include tinea pedis (claimed as jungle rot) because the June 2013 VA examination is inadequate. The examiner identified that the Veteran sought treatment for foot blisters during service and diagnosed the Veteran with tinea pedis. The examiner opined that it was not related to service because these are separate conditions and the Veteran’s records do not contain treatment or complaints of tinea pedis during service. However, the examiner does not appear to consider or discuss the Veteran’s statements of having wet feet while in Vietnam which was a common condition among service members deployed to Vietnam. A March 2018 private opinion did not address nexus. On remand, a new examination should be given for the examiner to opine whether the Veteran’s exposure to constant wet conditions could have caused or aggravated his current tinea pedis condition. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate VA examiner, to determine the nature and likely etiology of the claimed bruxism and insomnia condition. Copies of all pertinent records must be made available to the examiner. Based on the examination and review of the record, the examiner is asked to answer the following questions: (a) Specifically identify all diagnoses related to bruxism and insomnia; specifically, whether either of these is a symptom of his service-connected acquired psychiatric disorder or a separate compensable disability. (b) Is it at least as likely as not (50 percent probability) that any separately diagnosed disability was incurred in or is otherwise related to service? (c) If (b) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed bruxism and insomnia has been (i) caused by or (ii) aggravated by any of the Veteran’s service or service-connected disabilities? Aggravation here is defined as any increase in disability. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner’s own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. Schedule the Veteran for a VA examination with an appropriate VA examiner, to determine the nature and likely etiology of the disability claimed as jungle rot. Copies of all pertinent records must be made available to the examiner. The examiner is asked to answer the following questions: (a) Identify all currently diagnosed foot conditions related to “jungle rot.” (b) Is it at least as likely as not (50 percent probability) that any currently diagnosed foot condition was incurred in or is otherwise related to service? In answering this question, the examiner must specifically consider the Veteran’s reports of wet feet and blisters during service were early manifestations of his diagnosed tinea pedis. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner’s own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. (Continued on the next page)   3. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.