Citation Nr: 21026936 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 16-34 458 DATE: May 4, 2021 ORDER Entitlement to service-connection for acquired psychiatric condition, diagnosed as social anxiety disorder, is granted. REMANDED Entitlement to service-connection for left hip condition is remanded. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, the Veteran's acquired psychiatric condition, diagnosed as social anxiety disorder, is at least as likely as not related to the Veteran's active service. CONCLUSION OF LAW The criteria for entitlement to service-connection for acquired psychiatric condition, diagnosed as social anxiety disorder, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Army from July 2001 to May 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision issued by a Department of Veterans' Affairs (VA) Regional Office (RO) denying service connection for an acquired psychiatric condition besides the Veteran's service-connected post-traumatic stress disorder (PTSD) with social anxiety. This matter was previously before the Board in October 2018, where it was remanded to the Agency of Original Jurisdiction (AOJ) for further development. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also 38 C.F.R. § 3.303, Hickson v. West, 12 Vet. App. 247, 252-53 (1999). The diagnosis of a mental disorder must conform with the diagnostic criteria outlined the Fifth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-V). 38 C.F.R. § 4.125. When there is an approximate balance of positive and negative evidence regarding any material issue, reasonable doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In this case, resolving reasonable doubt in favor of the Veteran, the Board finds that it is as least as likely as not that the Veteran's current acquired psychiatric disability, diagnosed as social anxiety disorder, is related to service. The Veteran's service treatment records clearly reflect that she began seeking psychiatric treatment during service in approximately 2010. The Veteran's contemporary medical records also reflect that that she was diagnosed with social anxiety disorder by a private medical provider in July 2014. With the first two elements of service-connection fulfilled, the only remaining element for adjudication is nexus. The Veteran contends that she incurred social anxiety disorder in service. The August 2020 VA medical examiner agreed with the Veteran's contention, finding that the Veteran's current diagnosis of social anxiety disorder is at least as likely as not related to service. The examiner opined in relevant part: "The Veteran's Social Anxiety Disorder is at least as likely as not (a 50 percent probability or greater) had its onset in service or is otherwise etiologically related to her active service, to include in-service conceded stressor of intense fear of mortars. Evidence supports that the Veteran's Social Anxiety DO had its onset in service (considering a review of Social Phobia found in the problem list in her STRs and acknowledging her lay testimony that she was treated for social anxiety during military service)." Therefore, the Board accordingly finds that service-connection should be granted for this disability. REASONS FOR REMAND 1. Entitlement to service-connection for left hip condition is remanded. In the October 2018 remand, the Board ordered the RO to obtain a new VA medical opinion as to the etiology of the Veteran's claimed left hip condition. This opinion was to address a number of shortcomings noted in prior medical opinions, including to reconcile the incorrect finding by a prior examiner that the Veteran's present left hip symptoms, as reflected in a May 2014 medical record, do not correlate with the symptoms the Veteran reported experiencing during service in July 2001, after the Veteran's left hip accident. The subsequent July 2019 VA examiner opined that the Veteran's current left leg disability is less likely than not related to service. In accordance with the October 2018 remand, the examiner gave a comprehensive rationale with reasoned consideration of the Veteran's lay statements regarding continued left hip symptoms following service. However, the examiner did not fulfill the remand order to reconcile the finding of similar reported left hip symptoms between the July 2001 injury and the present. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (remand by Board confers upon claimant, as a matter of law, the right to compliance with remand order). This shortcoming is particularly troublesome in light of the Veteran's current diagnoses of coxa profunda, a congenital condition, and femoroacetabular impingement. The examiner is correct that, pursuant to 38 C.F.R. §4.9, VA cannot award service-connection for congenital conditions, meaning an award for coxa profunda alone could not be granted. The examiner further opines that, based on medical literature, coxa profunda itself does not serve as an indicator for acetabular impingement. However, the examiner does not explain why the symptoms repeatedly reflected between the in-service injury and the present cannot be indicative of femoroacetabular impingement themselves. The examiner seems to imply in their opinion that the femoroacetabular impingement could not have been caused by service because of the absence of complaints in service treatment records, but the lack of contemporaneous medical records cannot serve as a bar to compensation. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); see Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). Thus, the Board finds it necessary to obtain an addendum opinion reconciling the reported incurrence and continuation of similar left hip symptoms between the Veteran's in-service injury and the present, in light of the Veteran's current diagnosis of femoroacetabular impingement. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the same VA clinician who authored the July 2019 medical opinion. If this clinician is unavailable, another qualified VA clinician should be selected. If the selected clinician determines that an examination is necessary to respond to this request, such examination should be scheduled. After review of the claims file, and examination of the Veteran if deemed necessary, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current left hip disability, to include femoroacetabular impingement, began in or is otherwise caused by the Veteran's active service. In doing so, the examiner must address the reports of consistent symptomology between the July 2001 in-service left hip accident and the present. This opinion must specifically address the May 2014 VA treatment records noting locking, catching, and instability and July 2001 records noting similar symptomatology. The examiner is advised that the Veteran is competent to report her symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. All findings must be reported in detail and all opinions must be accompanied by a well-reasoned rationale. 2. Then, readjudicate the claim on appeal. Romina A. Casadei Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Narnor, Harriyah 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.