Citation Nr: 21041177 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 20-22 764 DATE: July 8, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder to include major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from March 1958 to April 1960. The Veteran had additional service in the U.S. Army Reserves from April 1960 to March 1964, and in the national guard from January 1951 to December 1952. However, dates of active and inactive duty are not verified. This claim was remanded in July 2020 to obtain additional service records from national guard and reserve service, and to obtain additional VA and private treatment records. While this development was accomplished, after review of the evidence, the Board finds that it must again remand the claim. In short, the Board finds the evidence presented meets the threshold level in 38 C.F.R. § 3.159(c)(4) triggering the requirement for VA examination. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). First, the medical evidence shows the Veteran was diagnosed and treated for a psychiatric disorder during the period of time on appeal. The Veteran's claim for entitlement to service connection for PTSD, among other illnesses, was received by the agency of original jurisdiction (AOJ) in April 2017. Medical evidence received prior to and after the July 2020 remand shows the Veteran was diagnosed with depression and MDD during the pendency of this appeal. Entries in prison treatment records show the Veteran diagnosed with depression and MDD in 2017 and treated including with psychotropic medications, counseling, and classes. In 2019, the Veteran was diagnosed with recurrent MDD in partial and full remission. Second, service personnel and treatment records are generally consistent, in terms of military occupational specialty and assignments, with the Veteran's lay statements. These records show the Veteran's military occupational specialty during active service was as a dental technician. He was stationed at Fort Riley, Kansas, from November 1959 to April 1960, when he was discharged due to family hardship, which resulted from his father's illness and his brother's criminal activities. The Veteran's hardship package details the difficulties he and his family faced at that time. The Veteran has attributed his acquired psychiatric disorder to events that occurred while he was assigned as a dental technician at the Army medical hospital associated with Fort Riley, Kansas. In an August 2017 statement, he explained he volunteered to take on additional duties in the main hospital, leading to his working in other parts of the hospital, including the morgue. He identified three events he found stressful and disturbing: (a) his presence in the morgue and exposure to dead bodies; (b) visiting with a sick one-year old child over a period of a month, who died and whose body he encountered in the morgue; and (c) delivering the clothes of a deceased woman to her husband, a soldier he knew. Third, the Veteran attests that he has experienced intrusive thoughts, flashbacks, and memories of these events and to experience other symptoms such as avoidance, arousal and difficulty with relationships, work and other major areas of his life that have continued from his active service to present time. The Board thus finds that VA examination is required to determine the etiology of the Veteran's diagnosed acquired psychiatric disorder. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The matter is thus REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his claimed psychiatric disorder to include MDD and PTSD. The AOJ should document all attempts to schedule the Veteran for his examination in the claims file and include negative responses. Confer with the correctional facility to determine whether the Veteran should be transported to a VA facility for examination, whether the correctional facility has medical personnel that can conduct an examination according to VA examination worksheets, or whether they will allow a VA or fee-basis examiner into the correctional facility to conduct the examination. Due to any remaining COVID-19 precautions, the examination may be conducted via telehealth or similar service. 2. All indicated tests and studied should be conducted and any and all psychiatric pathology should be diagnosed. The VA examiner must review the entire claims file in conjunction with the examination, to include any and all service treatment records, service personnel records, post-service medical treatment records including treatment records from correctional facilities, and the Veteran's lay statements. For each acquired psychiatric disorder diagnosed, the VA examiner is asked to provide an opinion (with rationale) to help answer the following question: Is any diagnosed psychiatric disorder, including MDD and PTSD, at least as likely as not related to active service or any incident therein? Please discuss the assertion that the Veteran experiences intrusive memories, flashbacks, and other symptoms arising from stressful experiences during active service including a) Circumstances encountered while voluntarily working additional hours in other parts of the main hospital he would not normally work in as a dental technician, such as i) exposure to dead bodies in the main hospital morgue; ii) attachment to a one-year old child who died; iii) returning the clothes of a deceased person to her spouse; and/or b) Circumstances of family illness and stress that led to his hardship discharge in 1960 prior to his term of enlistment expiring. The examiner's attention is directed to service personnel records showing the Veteran's assignment to Dental Det USAG Ft Riley, Kansas from November 1959 to April 1960, and his military occupational specialty as a dental laboratory technician effective from October 1958; the statements of witnesses in support of his hardship discharge; and the Veteran's contemporaneous and post-service lay statements. A complete rationale should accompany the examiner's opinion and should be based on examination findings, history records, and medical principles. 3. If an in-person or telehealth examination cannot be obtained, send the claims file to a VA examiner for the requested medical opinions as indicated above. 4. If a diagnosis of PTSD is made, the AOJ must take all appropriate action to verify the Veteran's stressors. Please note 5. After completing the above, and any other development that may be indicated, the Veteran's claim should be readjudicated based on the entirety of the evidence. If the claims remain denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bakke, Lila J. 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.