Citation Nr: 21024667 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 11-27 572 DATE: April 23, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1968 to January 1970. In January 2021, the Board most recently remanded the current claim for additional development. 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. In the January 2021 remand, the Board requested that a VA examination and medical opinion be procured to assess the etiology of any diagnosed acquired psychiatric disorder. The Board specifically instructed that the examiner should indicate whether the Veteran met the diagnostic criteria for posttraumatic stress disorder (PTSD) and, if not, the examiner should reconcile such findings with the VA treatment records. In January 2021, the Veteran underwent a VA examination to determine the etiology of his acquired psychiatric disorder. The examiner found that the Veteran did not meet the diagnostic criteria for PTSD because there were no intrusion symptoms, no avoidance of stimuli associated with the traumatic events, no negative alterations in cognition and mood with traumatic events, and no marked alterations in arousal and reactivity associated with the traumatic event. Significantly, however, the examiner did not reconcile these findings with the contemporaneous VA treatment records that indicate that the Veteran has nightmares, flashbacks, avoidance behavior, intrusive thoughts, and hypervigilance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, the Board finds that the January 2021 VA examination does not comply with the Board’s prior remand directives and another remand is warranted for a new VA examination and medical opinion consistent with the directives herein. The Board also notes that a review of the Veteran's claims file reveals there are relevant outstanding private psychiatric records which have not been associated with the claims file. In pertinent part, throughout the appeal period, the Veteran’s VA treatment records continually indicate that the Veteran has continued private psychiatric treatment with Dr. E.P. Accordingly, reasonable efforts must be undertaken to attempt to obtain the missing private treatment records in accordance with VA's duty to assist. See 38 C.F.R. § 3.159(c)(1). The matter is REMANDED for the following actions: 1. With the Veteran's assistance, attempt to obtain updated private treatment records from Dr. E.P. All reasonable attempts to obtain such records should be made and documented. If VA attempts to obtain any outstanding records which are unavailable, the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). 2. Following the record development above, obtain a VA examination and opinion from an appropriate examiner to determine the nature and etiology of the Veteran's acquired psychiatric disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished and all clinical findings reported in detail. a) The examiner should provide a diagnosis for any current psychiatric disorder. In rendering such diagnosis, the examiner should specifically consider and discuss any previous psychiatric diagnoses of record, to include the PTSD diagnoses in September 2012, January 2018, and November 2020. When assessing whether the Veteran meets the diagnostic criteria for PTSD, the examiner must also reconcile any findings with the VA treatment records that show symptoms of nightmares, flashbacks, avoidance behavior, intrusive thoughts, and hypervigilance. b) The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that any diagnosed psychiatric disorder had its onset in or is otherwise related to the Veteran's active duty service, to include his service in Vietnam. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner 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. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Metzner, Paul 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.