Citation Nr: 22011845 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 18-55 574 DATE: March 2, 2022 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for bilateral carpal tunnel syndrome (CTS) is remanded. Preliminary Matters The Veteran served on active duty from July 1986 to April 1991 and from November 2002 to May 2003. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is associated with the claims file ad has been reviewed. The issues currently on appeal, to include service connection for a lumbar spine disorder, were previously remanded by the Board in April 2020. In a subsequent December 2020 rating decision, the RO granted service connection for a lumbosacral strain. As such, that issue is no longer before the Board for consideration. REASONS FOR REMAND PTSD Service connection for PSTD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If, as here, a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. "Fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304 (f). The question of whether a veteran was exposed to a stressor in service is a factual one, and VA adjudicators are not bound to accept uncorroborated accounts of stressors or medical opinions based upon such accounts. Wood v. Derwinski, 1 Vet. App. 190 (1991), aff'd on reconsideration, 1 Vet. App. 406 (1991). Hence, whether a stressor was of sufficient gravity to cause or support a diagnosis of PTSD is a question of fact for medical professionals, and whether the evidence establishes the occurrence of stressors is a question of fact for adjudicators. In this case, service personnel records do not show, and the Veteran does not contend, that she engaged in combat with the enemy. On the other hand, the Veteran has reported that she believes her PTSD is due to an incident which occurred in Germany between 1988 and 1991 while processing soldiers at "Tent City" on their way to Iraq during the Persian Gulf War. According to the Veteran, she observed senior non-commissioned officers physically assaulting and dragging soldiers onto airplanes with M-16 assault rifles pointed at close range to their faces and heads because the soldiers did not want to deploy. The Veteran has indicated that she feared having a weapon pointed at her and has indicated that she has flashbacks that haunt her to this day. The Veteran related this stressor experience at a December 2020 VA examination and also reported symptoms of depressed mood and anxiety. The examiner diagnosed the Veteran with generalized anxiety disorder, but declined to diagnose PTSD, finding that the claimed stressor was not adequate to support a diagnosis of PTSD. The examiner did note that the reported stressor was related to the Veteran's fear of hostile military or terrorist activity. The Veteran also submitted a private mental health statement dated in June 2021 from Dr. Kitaeff, a licensed clinical psychologist. At that time, Dr. Kitaeff diagnosed the Veteran with PTSD, which was presumably due to the in-service stressor event discussed in the report. Despite the diagnosis of PTSD from Dr. Kitaeff, a VA psychiatrist or psychologist has not confirmed that the claimed stressor was adequate to support a diagnosis of PTSD. See 38 C.F.R. § 3.304 (f). Thus, the Board finds that a remand is necessary to obtain a clarifying medical opinion. The examiner should review the June 2021 statement from Dr. Kitaeff and render an opinion as to whether the Veteran's claimed stressor is adequate to support a diagnosis of PTSD and whether the Veteran's symptoms are related to the claimed stressor. Bilateral CTS The Veteran was afforded a VA examination in November 2020, at which time, a diagnosis of bilateral CTS was confirmed. During the evaluation, the Veteran reported that her symptoms began in service as a result of performing her duties as a personnel specialist (i.e., typing). The examiner opined that the Veteran's CTS was not related to service. In support of this opinion, the examiner indicated that service records did not show complaints or treatment for any wrist symptoms. Moreover, the examiner indicated that the "onset and causative factor of veteran's carpal tunnel is likely related to non service cause." The Board finds this opinion inadequate. In this regard, the "onset" of the Veteran's symptoms was reported as beginning in 1989. See November 2020 VA examination report. The Veteran specifically indicated that she began having arm pain "while in service" as a result of typing DD forms while serving as a personnel specialist. Moreover, although the examiner related the Veteran's CTS to non-service causes, no further explanation was provided. Although the record shows that the Veteran served in a secretarial capacity after service, an addendum opinion should be obtained to assist in determining whether the Veteran's military duties were, at least in part, the cause of her current CTS disorder. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA psychiatric examination by a VA psychologist or psychiatrist to determine the diagnosis of any psychiatric disorders to include PTSD. The claims file and a copy of this remand must be made available to the reviewing examiner, and the examiner should indicate in the report that the claims file was reviewed. The examiner is then asked to address the following: (a.) Indicate whether the Veteran has a current diagnosis for PTSD in accordance with the DSM-IV or V during the appeal period. **The examiner must review and discuss the June 2021 mental health statement from Dr. Kitaeff (noting a diagnosis of PTSD). (b.) If PTSD is diagnosed, indicate whether it is at least as likely as not (50 percent or greater probability) that the Veteran's stressor is adequate to support that diagnosis; and (c.) whether the stressor reported by the Veteran involved fear of hostile military or terrorist activity; and (d.) whether the Veteran's symptoms are related to the claimed stressor. **In making these determinations, the examiner must review and discuss the June 2021 mental health statement from Dr. Kitaeff. If the examiner is in disagreement with Dr. Kitaeff, fully explain why this is so. (e.) For any other diagnosed psychiatric disorders (other than PTSD), the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's disorders are related to service. (f.) All opinions should be supported by a medical explanation and rationale. 2. Obtain a VA medical opinion regarding the likely etiology of the Veteran's bilateral CTS disorder. The examiner must review all pertinent documents in the record. The examiner should provide the following: (a.) State whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's bilateral CTS is related, at least in part, to her in-service duties. **In making this determination, the examiner should consider the Veteran's military occupational specialty of personnel management (requiring her to perform extensive typing). See DD Form 214. **The examiner should also address the Veteran's statements, noting that her symptoms began in service. (b.) All opinions should be supported by a medical explanation and rationale. 3. Then, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Casadei, 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.