Citation Nr: 21027678 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 15-28 642 DATE: May 6, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include PTSD, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1987 to October 1988. In October 2018, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. The transcript has been associated with the claims file. This issue was previously before the Board in June 2019, at which time it was remanded for further development. Unfortunately, another remand is required. Entitlement to service connection for an acquired psychiatric disability, to include PTSD, is remanded. In its prior remand, the Board directed the AOJ to schedule the Veteran for a VA psychiatric examination in the June 2019 Board decision. The Veteran underwent VA examination in March 2020 at which time he was diagnosed with schizoaffective disorder, bi-polar type. The examiner opined that it was highly unlikely that the Veteran's acquired psychiatric disability had onset in service and that it was reasonable to assume that there were multiple ongoing non-military stressors for the Veteran that far preceded his military enlistment. The examiner noted that the available records suggested that a probable psychotic manifestation occurred soon after enlistment but that it was most tenable that the Veteran entered the military with, at least, early signs of the acquired psychiatric disability. On this basis, the examiner opined that it was less likely than not that the Veteran's acquired psychiatric disability had onset in or was otherwise related to his period of active service. Due to the fact that the Veteran's September 1986 Report of Medical Examination for enlistment purposes does not note any acquired psychiatric disabilities, the Veteran must be presumed sound at entry. 38 U.S.C. § 1111; 38 C.F.R. § 3.304. As the Veteran must be presumed sound in this case, the burden then shifts to the government to rebut the presumption of soundness. The presumption of soundness may be rebutted only by clear and unmistakable evidence that the Veteran's disability both (1) pre-existed his service and (2) was not aggravated by his service. Clear and unmistakable evidence means that the evidence "cannot be misinterpreted and misunderstood, i.e., it is undebatable." Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009) (quoting Yanerson v. West, 12 Vet. App. 254, 258-59 (1999)). The clear-and-unmistakable-evidence standard is an "onerous" one. Laposky v. Brown, 4 Vet. App. 331, 334 (1993) (citing Akins v. Derwinski, 1 Vet. App. 228, 232 (1991)). Given the discussion of the March 2020 examiner, an addendum opinion must be obtained to address the history of the Veteran's condition, utilizing the correct standards. The Board acknowledges that, in June 2020 correspondence, the Veteran asserted numerous shortcomings with the March 2020 examination and examiner, including factual errors within the examination report. He has offered to appear for another examination due to these assertions. As a remand is required due to the reasons set forth above, the Veteran will be given the opportunity to attend a VA examination with a different examiner in order to determine the nature and etiology of his acquired psychiatric disability. The matters are REMANDED for the following action: 1. Schedule the Veteran for a psychiatric examination with an examiner other than the examiner who performed the March 2020 VA examination. The record should be sent to, and reviewed by the examiner; and the examiner should take a history from the Veteran as to the progression of the claimed disability. Upon review of the record, interview and examination of the Veteran, the examiner should respond to each of the following: (a.) Please clarify the Veteran's current mental health disabilities. If PTSD is diagnosed, the examiner should specifically indicate the stressor or stressors upon which the diagnosis is based. If the examiner's opinion as to diagnosis differs from those diagnoses set forth in the claims file, the examiner should attempt to reconcile these differences. (b.) Is it clear and unmistakable (i.e. undebatable) that any current acquired psychiatric disability had onset prior to the Veteran's entry into active duty service? (c.) For any disability where the answer to (b) is "yes," then is it also clear and unmistakable (i.e. undebatable) that such disability was NOT aggravated beyond its natural progression during the Veteran's period of active duty service? (d.) For any disability where the answer to either (b) or (c) is "no," assume as true that the Veteran entered service without that disability. With that assumption in mind, is it at least as likely as not (50 percent or greater probability) that such disability had onset in, or is otherwise related to the Veteran's period of service? (e.) Please clarify if it is at least as likely as not that the Veteran has a psychosis that first manifested within one year of his October 1988 discharge. In answering the above questions, the examiner should consider and discuss the Veteran's assertions that his disability is due to verbal harassment endured during his period of active duty. The examiner should consider service treatment records that document work- and family-related stress during his period of active duty. If, from a medical perspective, there is reason to call into question the Veteran's report of having been harassed in service as he so describes, this should be made clear with an explanation as to why this is the case. All medical opinions should be supported with a medical explanation or rationale. (Continued on Next Page) 2. Then, readjudicate the issue on appeal. If the benefit sought remains denied, send the Veteran and his representative a supplemental statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bristow Williams, 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.