Citation Nr: 21024672 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 16-07 398 DATE: April 23, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1983 to July 1986. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) is remanded. The Veteran contends that she currently has an acquired psychiatric disorder that is the result of military service. A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. §§ 1110 (2012). Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). To establish service connection for PTSD, the evidence must satisfy three basic elements: (1) medical evidence diagnosing PTSD; (2) a link, established by medical evidence, between current PTSD symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) (2019). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and clear and unmistakable evidence demonstrates that the injury or disease was not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b); Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004) (outlining the presumption of soundness). Review of the service treatment records (STRs) reveal that the Veteran's enlistment examination does not disclose any psychiatric conditions. When no preexisting condition is noted upon entry into service, the Veteran is presumed to have been sound upon entry. The burden then falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the veteran's disability was both preexisting and not aggravated by service. 38 U.S.C. § 1111. Review of the post-service treatment records shows that the Veteran reported experiencing alcohol abuse issues, with no indication that these issues resolved prior to service. The Veteran underwent a VA examination in October 2019. See October 2019 VA Examination. She was diagnosed with alcohol use disorder, severe, in sustained remission and unspecified personality disorder with borderline traits. The examiner noted that the Veteran denied any mental health history or treatment prior to her service. The examiner then found that the Veteran’s alcohol use disorder and personality disorder were not the result of military service. The examiner noted the Veteran's longterm mental health and substance abuse history; however, he opined that this was more likely better accounted for by a genetic predisposition combined with a chronic history of substance abuse. The VA has a duty to assist veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist including providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159(c)(4). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds the opinion is of significantly reduced probative value. The examiner opined that the Veteran did not meet the criteria for PTSD. Specifically, the examiner found that the Veteran did not demonstrate persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred, as evidenced by avoidance of or efforts to avoid distressing memories, thoughts, or feelings. The examiner opined that this element of PTSD was not met because the Veteran “self-identified as an alcoholic before she entered the military.” See October 2019 VA Opinion. Based on a review of the records, the Veteran did not indicate that she had a history of cannabis use prior to her entry into service. The examiner did not render an opinion as to whether the Veteran’s privately diagnosed mild cannabis use disorder met the criteria for persistent avoidance of stimuli associated with the traumatic event. See CAPRI Records. Lastly, the examiner opined that the Veteran’s two demotions in service in April and June 1986 appeared to be disciplinary and found that meant it is less likely than not that the Veteran’s behavior during and after service are reflective of the occurrence of military sexual trauma during service. The examiner offered no further explanation. The examiner failed to render an adequate opinion on the Veteran’s in-service demotions and substance abuse following her in-service military sexual trauma (MST). An adequate rationale must be provided for any medical opinion rendered; a conclusory, contradictory or incomplete analysis is not adequate. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Since there exists insufficient competent medical evidence to decide the Veteran's acquired psychiatric disorder claim, the Board will remand this matter for a clarifying VA medical opinion that addresses all the evidence of record. The matter is REMANDED for the following action: 1. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran’s assertions. Neither the Veteran’s credibility nor any lack thereof should be presumed in this remand. 2. Return the claims file to the examiner who conducted the October 2019 VA examination and request they prepare an addendum examination report which addresses the following questions. The Veteran should only be scheduled for further examination if the examiner determines this is required in order to provide the requested opinions. If the examiner who conducted the 2019 examination is unavailable, arrange to obtain the addendum opinion from another suitably qualified health care professional. A complete copy of the record must be provided to the examiner, including a copy of this remand. The examiner must consider lay reports of observable symptomatology. After a thorough review of the record, the examiner should respond to the following: (a.) Is it at least as likely as not (i.e., 50 percent or more probable) the Veteran exhibited any behavioral changes during service or after service that are reflective of the occurrence of military sexual trauma during service? Examples of behavior changes that may constitute credible evidence of the stressor include, but not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse, including alcohol and cannabis abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. The examiner must comment on the Veteran’s two (2) demotions in April and June 1986. (b.) If the VA examiner believes that behavioral changes are reflective of the occurrence of in-service MST, is it at least as likely as not (i.e., 50 percent or more probable) any current psychiatric disorder is attributable to the occurrence of in-service military sexual trauma? In making this determination, the VA examiner should discuss whether the diagnostic criteria to support a diagnosis of PTSD based on alleged in-service MST have been satisfied. (c.) Upon examination, does the Veteran currently or during the course of the appeal have any other psychiatric disorder, to include depression and PTSD? (d.) If the Veteran is diagnosed with a psychiatric disorder is it at least as likely as not (i.e., 50 percent or more probable) that it first manifested in service or is otherwise causally or etiologically related to the Veteran’s military service, to include MST that is deemed credible? 3. If the Veteran is diagnosed with a psychiatric disorder which is found to be service connected, the examiner should also consider the Veteran’s record of substance abuse, specifically alcohol abuse, and whether the abuse is related to her PTSD, in particular, whether or not the alcohol abuse condition is: (a.) Related to or caused by a service-connected psychiatric disorder, or (b.) Was aggravated by the Veteran’s service-connected psychiatric disorder. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010). (The Agency of Original Jurisdiction should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained.) G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V. Schmidt 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.