Citation Nr: 21026696 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 17-52 251 DATE: May 3, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depressive disorder, adjustment disorder, and anxiety disorder, is remanded. Entitlement to service connection for obstructive sleep apnea (OSA) as secondary to a psychiatric disorder is remanded. REASONS FOR REMAND The Veteran had active duty service from May 1988 to May 1997. The Veteran's period of service from May 3, 1988 to May 2, 1992 is considered to be under conditions other than dishonorable under the conditional discharge criteria pursuant to 38 C.F.R. § 3.13 (c). The period of service from May 3, 1992 to May 8, 1997 has been determined to be dishonorable for Department of Veterans Affairs (VA) benefits purposes other than excepted insurance benefits for this period; he is entitled to VA health care in accordance with Title 38 U.S.C. Chapter 17 for any disability deemed to be service connected for this period. See July 2014 VA Administrative Decision. This matter is on appeal before the Board of Veterans' Appeals (Board) from a VA Agency of Original Jurisdiction (AOJ) rating decision dated in June 2016. The Veteran testified at a Board hearing in April 2020. A copy of the transcript has been associated with the claims file. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depressive disorder, adjustment disorder, and anxiety disorder, is remanded. The Board finds that the Veteran's claim is not ready for adjudication and additional development is required. First, additional development is needed to attempt to verify the Veteran's reported stressors. A claim seeking entitlement to service connection for PTSD may not be granted without credible supporting evidence that a claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). Second, the record reflects that the Veteran has additional diagnoses other than PTSD for which a nexus opinion must be obtained before a decision may be made on the claim. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004) (the grant of service connection requires evidence of "a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement."). The record reflects that the Veteran has reported four potential stressors, whether to his mental health treatment providers, during testimony, or in written statements in the claims file. First, the Veteran reported that he witnessed a helicopter crash. Second, the Veteran reported that he feared for his life flying in and exiting helicopters and doing "sky rigging," especially after the helicopter crash. Third, he reported that he witnessed shipmates drown in Korea. Fourth, the Veteran reported that in Korea, he witnessed a Marine get "run over" by an amphibious vehicle, and he patched him up in the bitter cold and was bivouacked. Fifth, in addition to the above, he reported that he generally witnessed and was involved in treating numerous traumatic injuries, including amputations, accidents, and death, as part of his military occupational specialty (MOS). The AOJ has only attempted to verify two of these stressors. The AOJ sought information regarding the reported helicopter crash and drownings. However, the remaining stressors have not been verified. The AOJ is requested to send the Veteran a notice letter requesting additional information, to include names, dates, and locations, involving the remaining stressorswitnessing a Marine having been run over by a tank, and the numerous incidents or accidents involving amputations and death within his MOS. If sufficient evidence is obtained, the AOJ should attempt to verify the stressors with the appropriate records repositories. Moreover, the Board notes that the Veteran was not afforded a VA examination for his claim, and one is warranted in this case. The Veteran's outpatient records show that the Veteran has or has had diagnoses of adjustment disorder, anxiety disorder, and depressive disorder, in addition to PTSD. A VA examination should be afforded, and an examiner must explain if the Veteran meets the criteria for these diagnoses or why the acquired disorders are not related to service. Therefore, on remand, an examiner must address these annotations. 2. Entitlement to service connection for OSA as secondary to a psychiatric disorder is remanded. The Board finds that a VA examination for the Veteran's sleep apnea claim is also warranted. The evidence of record demonstrates that the Veteran's OSA may be linked to a psychiatric disability. Therefore, a VA examiner must provide a fully reasoned opinion on the Veteran's claim. The matters are REMANDED for the following action: 1. The AOJ must contact the Veteran and request additional specific information (including names, dates, and locations, if possible) regarding his claimed stressors of witnessing a Marine having been run over in Korea, fearing for his life flying in and exiting helicopters and doing "sky rigging," and any treatment provided for traumatic injuries, including amputations, accidents, and death, as part of his MOS. (a.) If sufficient identifying information is received from the Veteran, the AOJ must undertake efforts to verify these stressors with the appropriate records repository. (b.) The Veteran must be notified that his failure to respond to any request for information may result in a denial of his claim. (c.) The AOJ should specifically use the articles submitted in June 2020 in order to verify the reported stressor of the helicopter crash, and document in the claims file whether additional information is required and if the stressor cannot be verified with the articles. (d.) All attempts to verify the identified stressors must be documented in the claims file. If the AOJ is unable to request verification, or the stressor cannot be verified, it must also be documented in the claims file. 2. THEN, schedule the Veteran for a VA examination to determine the nature and etiology of his acquired psychiatric disorders, including PTSD, adjustment disorder, anxiety disorder, and depressive disorder. If an in-person examination is not feasible, the Veteran must be afforded an examination by other means. All necessary tests should be conducted. The entire claims file and a copy of this remand should be made available to the examiner for review. The examiner should respond to the inquiries below: (a.) As to PTSD, if the AOJ is able to corroborate any of the stressors identified in remand directive (1) above, then the VA examiner should indicate: (1) whether the identified stressor is adequate to support a diagnosis of PTSD under the appropriate criteria; and (2) whether it is at least as likely as not that the Veteran's current symptoms are related to any of the claimed stressors. (b.) The examiner must opine as to whether it is at least as likely as not (50 percent or greater) that the Veteran's depressive disorder, adjustment disorder, or anxiety disorder, as diagnosed in the various medical records, is etiologically related to his active duty service, to include his claims of witnessing a Marine that was "run over", fearing for his life when exiting helicopters, being a first responder to traumatic situations in service, or witnessing a helicopter crash or drowning. (c.) The examiner must review and address the following records: (1) military personnel records showing the Veteran was recommended for retention and promotion prior to 1995; (2) a June 2014 record showing "Axis I: Alcohol Dependence with Physiological Dependence in Early Sustained Remission. Other possible rule-outs include PTSD, MDD;" (3) a July 2014 psychiatry note showing "Axis I. Adjustment disorder with anxious and depressed mood. R/O PTSD;" (4) an August 2014 record indicating that helicopter sounds trigger flashbacks and a diagnosis of persistent depressive disorder; (5) the Veteran's ex-wife's September 2014 statement describing how his behavior changed in service; (6) a September 2014 record diagnosing anxiety disorder; (7) the Veteran's report of onset of nightmares, depression, irritability, anxiety, and anger during service and persistence since; (8) the Veteran's report that he went AWOL and used drugs and alcohol during service to numb and avoid feelings related to military trauma; and (9) the Veteran's contention that his acquired psychiatric disorder is related to the sheer number of incidents involving injuries he was involved in. (d.) If the examiner finds that the Veteran does not meet the relevant criteria to establish a diagnosis of depressive disorder, anxiety disorder, or adjustment disorder (as indicated in the records) the examiner must: (1) indicate what criteria/symptoms for such a diagnosis are lacking; and (2) expressly address the diagnoses contained in the records (and identified above), and explain whether the diagnosis has since resolved, or whether the examiner disagrees with those diagnoses and why. 3. Schedule the Veteran for a VA examination to determine the nature and etiology of his obstructive sleep apnea. If an in-person examination is not feasible, the Veteran must be afforded an examination by other means. All necessary tests should be conducted. The entire claims file and a copy of this remand should be made available to the examiner for review. The examiner should respond to the inquiry below. (a.) The examiner must review and address the September 2015 clinical note indicating that alcohol and other sedatives make sleep apnea worse. (b.) The examiner must opine as to whether it is at least as likely as not (50 percent likelihood or greater) that the Veteran's obstructive sleep apnea is proximately due to, the result of, or aggravated beyond its natural progress by a service related acquired psychiatric disability, including any medications used for treatment of this disability. A complete rationale must be provided for all expressed opinions. A clearly stated rationale must not be based solely on lack of documentation or records. The reasons for any opinion must include a discussion of the relevant evidence. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Smith, 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.