Citation Nr: 21029120 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 17-27 575 DATE: May 12, 2021 REMANDED The claim for service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from April 1964 to April 1968, to include service in the Republic of Vietnam (RVN). In a January 2018 decision, the Board denied, in part, service connection for an acquired psychiatric disorder. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In a June 2019 Memorandum Decision, the Court vacated the Board's decision, and remanded the case to the Board for compliance with a joint motion for remand (JMR). A review of the JMR shows that it was agreed that a remand was required in order to afford the Veteran a hearing before a Veterans Law Judge (VLJ), and psychiatric examination with an opinion that addresses the etiology of the acquired psychiatric disorder. In accordance with the Court's Memorandum Decision, the Veteran (and predominantly his wife, due to the Veteran's general incapacitation) testified before the undersigned in March 2021. A copy of the proceedings is of record. In addition, the Memorandum Decision indicated that another examination with an opinion that addresses the etiology of the acquired psychiatric disorder was warranted. To this end, the Court concluded that the Board's reasons and bases were inadequate in its denial of the claim in its January 2018 decision. The Court stated that it was unclear as to why the Board had relied on a September 2015 VA examiner's conclusion that as a result of the Veteran's neurocognitive impairment, it would be impossible to fully assess whether he had PTSD symptoms; whether Diagnostic Statistical Manual (DSM)-5 allowed for responses from a guardian to be supplemented or whether the September 2015 examiner had even considered the answers provided by the Veteran's guardian, and, whether the Veteran's use of the medication, Lamictal, prescribed before his 1990 brain injury and subsequent seizures indicated that it might have been prescribed to treat some type of psychosis. The Board notes that VA treatment records, dated in October 2019, contain a diagnosis of PTSD. Thus, the Board finds that in accordance with the Court's Memorandum Decision and recent diagnosis of PTSD, an opinion is necessary to support the diagnosis, including whether it is the result of fear of hostile military or terrorist activity from his active RVN service. Of note, the Veteran was noted to have "shell shock" in 1983, but had a bad fall in 1990 causing significant mental incapacitation. The question that must be answered is whether the Veteran had PTSD as a result of his Vietnam experience prior to his fall in 1990. The matters are REMANDED for the following action: Obtain a medical opinion to address the etiology of the Veteran's psychiatric condition. If a physical examination is necessary to answer the Board's questions, one should be scheduled, but it is noted that the Veteran is largely incapacitated such that he was unable to provide testimony at his Board hearing. The examiner is requested to determine whether the Veteran's diagnosis of PTSD by VA in October 2019 is the result of fear of hostile military or terrorist activity. Why or why not? In providing the requested opinion, the examiner should review the March 2021 Board hearing transcript and the June 17, 2019 Memorandum decision (explaining why the previous examination was inadequate). The examiner should specifically comment on the 1983 diagnosis of "Vietnam Shock Syndrome". The examiner should also state whether the Veteran use of the prescribed medication, Lamictal, prior to his 1990 brain injury and subsequent seizures was an indication of treatment for some type of psychosis or psychiatric disability. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Carole Kammel, 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.