Citation Nr: 21021734 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-09 037 DATE: April 13, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, claimed as post-traumatic disorder (PTSD), depressive disorder, sleeplessness, and inability to concentrate is remanded. Entitlement to service connection for a sexual disorder to include as secondary to a psychiatric disorder is remanded. REASONS FOR REMAND The Veteran was a member of the West Virginia Air National Guard from November 1995 to October 1998. He had a period of active duty for training from June 1996 to October 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina, which, inter alia, denied service connection for a psychiatric disability, to include PTSD, depression, sleeplessness, and an inability to concentrate, as well as service connection for sexual disorder. The matter was previously before the Board in December 2018, where it was remanded for further evidentiary development including affording the Veteran an examination. The matter has returned to the Board for an appellate review. Claims for service connection for psychiatric disorders, including PTSD, may encompass claims for service connection for all diagnosed psychiatric disorders. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). Here, the Veteran has asserted a claim for a psychiatric disability which is directly related to his active service and/or secondary to his service-connected bronchial asthma. However, the record indicates possible assessments of other psychiatric disorders including PTSD, depressive disorder, and anxiety disorder. Accordingly, the Board has recharacterized the issue on appeal as a claim of entitlement to service connection for an acquired psychiatric disorder. 1. Entitlement to service connection for an acquired psychiatric disorder to include post-traumatic disorder (PTSD), depression, sleeplessness, inability to concentrate is remanded. In his May 2014 Notice of Disagreement (NOD), the Veteran contended that he has a psychiatric disability which is directly related to his active service and/or secondary to his service-connected bronchial asthma. See May 2014 NOD. The evidence of record reflects a December 2014 positive PTSD screen test. The Veteran also has diagnoses of depressive disorder, anxiety, and insomnia during the current appeal period. See CAPRI. Pursuant to the Board’s December 2018 remand, the Veteran was afforded a VA Initial PTSD examination in October 2019. The examiner noted that the Veteran’s symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria. The diagnosis was unspecified Depressive Disorder. The examiner opined that the condition claimed was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner’s rationale was that the Veteran is diagnosed with unspecified depressive disorder that he stated began in 2015 following the death of his spouse. As such, it is not logically related to any reported stressors in military service. Therefore, it is less than at least as likely as not the depression is due to military service. See October 2019 C&P Examination. The Board finds the October 2019 VA examination inadequate for the following reasons: First, the examiner concluded that the Veteran’s depressive disorder was related to death of his spouse. However, the Veteran’s claim for psychiatric disorders including depression was made prior to the death of his spouse. Additionally, the examiner did not address the Veteran’s statement describing the in-service traumatic incident that he asserts, still haunts him. See January 2013 VA 21-0781 [Statement in Support of Claim for PTSD], where the Veteran stated that fear of exposure to hepatitis; and having grenade and other weapons gone off around him, has made him depressed. An examination is inadequate if it fails to consider the Veteran's self-reported lay history of symptoms, which the Veteran is competent to address. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) (finding a medical examination inadequate where the examiner "impermissibly ignored the appellant's lay assertions that he had sustained a back injury during service"); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994). Moreover, the Veteran's claim of entitlement to service connection for a psychiatric disorder includes his contentions that he suffers from psychiatric disorders caused or aggravated by his service connected asthma. The Veteran's theory of entitlement to service connection for a psychiatric disorder as secondary to his service-connected asthma, including on the basis of aggravation, was not addressed by the October 2019 medical opinion. The Board must address all theories of entitlement raised by a claimant or reasonably raised by the record. See Robinson v. Peake, 21 F.3d 545, 553 (Fed. Cir. 2008). Therefore, upon remand the examiner must also consider whether the Veteran's psychiatric disorders are related to his service-connected asthma. The Board also notes that there are potentially relevant records that are missing from the claims file. In this regard, the RO initially made a formal finding that there was insufficient information to assist in the verification of the Veteran’s stressors, including by submitting a request to the U.S. Army and Joint Services Records Research Center (JSRRC). See February 2014 VA Memorandum. The Veteran has provided more detail about his reported in-service stressors on his May 2014 NOD. Now that the Veteran has provided additional detail regarding his stressors, the RO should determine whether there is sufficient information to submit a request for verification to the JSRRC, or whether the stressors may otherwise be verified. 2. Entitlement to service connection for a sexual disorder to include as secondary to a psychiatric disorder is remanded. The Veteran contends that his sexual disorder is related to his psychiatric disorder. The Court has held that two issues are inextricably intertwined when they are so closely tied together that a final decision cannot be rendered unless both issues have been considered. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The Board finds that the pending claim of entitlement to service connection for psychiatric disorder to include post-traumatic disorder (PTSD), depression, sleeplessness and inability to concentrate is inextricably intertwined with the claim of entitlement to service connection for a sexual disorder, claimed as secondary to psychiatric disorder, in this case. Accordingly, the Board must defer adjudication of the claim of entitlement to service connection for a sexual disorder at this time. The matters are REMANDED for the following action: 1. The AOJ should obtain and associate with the claims file, any outstanding service records from the Lackland AFB, in Texas. Prepare a summary of the Veteran's stressors (fear of contracting hepatitis and fear of grenades and other weapons going off around him) and forward it to the U.S. Army and Joint Services Records Research Center (JSRRC) with a request for any information, to include quarantine/hospitalization records or any other document which would verify the alleged stressors. If no records are available, a negative reply is required. 2. Associate with the claims folder any outstanding VA treatment records that pertain to the Veteran’s claim for a psychiatric disorder. 3. After the record is determined to be complete, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his claimed psychiatric disorder(s). The entire claims file, to include a complete copy of this Remand, must be made available to the designated examiner and the report of examination should include discussions of the Veteran's documented history and assertions. The examiner should take a history from the Veteran as to the progression of his mental health symptoms. Upon review of the file, interview of the Veteran and examination, the examiner should address each of the following: (a) The examiner should clearly identify all current psychiatric disabilities. (b) Specifically, if PTSD is diagnosed, please discuss the stressor or stressors upon which the diagnosis is based. The examiner should specifically opine as to whether PTSD is at least as likely as not (i.e., a 50 percent or greater probability) related to the Veteran’s service. (c) For any acquired psychiatric disorder other than PTSD, opine as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the disability had its onset in, or is otherwise related to the Veteran’s service. (d) For any diagnosed psychiatric disorder including PTSD, opine as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) caused by a service-connected disability including asthma. (e) For any diagnosed psychiatric disorder including PTSD, opine as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) aggravated by a service-connected disability including asthma. Lay contentions must be considered and weighed in making the determination as to whether a nexus exists. **The examiner is advised that aggravation need not be permanent. See Ward v. Wilkie, 31 Vet. App. 233 (2019). (f) The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. 4. Thereafter, readjudicate the issues on appeal. Romina A. Casadei Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. M. Rogers, 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.