Citation Nr: 22015707 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 17-53 992 DATE: March 18, 2022 REMANDED Entitlement to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1976 to July 1979, with additional service in the National Guard. The Board most recently remanded the claim in April 2019 for further development. The Veteran's service personnel records show that he served in Panama from June 11, 1988. to July 2, 1988 on temporary duty. A National Guard points history reflects 22 days of active duty points during this period. The Veteran's service personnel records also include a July 1988 Jungle Training Certificate for completing the standard Jungle Operation Training Course at the Jungle Operations Training Center at Fort Sherman, Canal Zone, as a member of the 2nd Battalion 116th Infantry Virginia National Guard. The Veteran contends that he experiences PTSD symptoms due to his service with the National Guard in Panama during the summer of 1988. In April 2019, the Board remanded the Veteran's claim for a VA examination. The Board requested that the examiner determine the nature and etiology of the Veteran's psychiatric disorder. Specifically, the examiner was advised to provide an opinion on etiology regarding any psychiatric disorders, to include PTSD. The examiner was also told to discuss the Veteran's December 2016 stressor statement. In December 2019, the Veteran was afforded a VA examination that diagnosed him with (1) unspecified depressive disorder with anxious distress and (2) cocaine use disorder. The claim must be remanded because the VA examination is inadequate. Specifically, the examiner opined that the Veteran does not have PTSD despite the December 2014 diagnosis. Even if the Veteran could not be diagnosed with PTSD at the time of the VA examination, he has been diagnosed with PTSD during the course of the appeal. Thus, the examiner must provide an opinion as to whether this PTSD diagnosis made during the appeal period is etiologically related to the Veteran's military service. See McLain v. Nicholson, 21 Vet. App. 319 (2007). Furthermore, the December 2019 examiner opined that the Veteran's stressors/traumas did not meet DMS-5 criteria because "some were premilitary and some were postmilitary." However, the Veteran's service personnel record reflects 22 days of active duty points during this period in Panama. Thus, any stressors/trauma during this period should be considered as due to military service. Finally, the December 2019 examiner's negative nexus opinions regarding psychiatric disorders other than PTSD are inadequate for the Board to adjudicate the claim because they are based exclusively on the absence of service treatment records documenting either condition. An opinion based on the absence of treatment records without consideration of a Veteran's competent reports is inadequate. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Remand is needed for a supplemental VA opinion that evaluates not only the medical evidence, but also the Veteran's December 2016 stressor statement. The matters are REMANDED for the following action: 1. Take all appropriate action to corroborate the Veteran's in-service stressors, including his report of incidents with the wildlife while serving in the Panamanian jungles during the summer of 1988. The Veteran served in Panama during the time of tension between the U.S. and Noriega; he heard C-130s flying and weapons firing in the jungle; and psychological techniques were used to intimidate his unit, including orders to jump off a boat and swim in full gear. Review the Veteran's December 2016 stressor statement submission. 2. After completion of the above, schedule the Veteran for a psychiatric examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of any acquired psychiatric disability (including PTSD; unspecified depressive disorder; and cocaine use disorder) found to be present. Copies of all pertinent records must be made available to the examiner for review. (a) Prior to the examination, the AOJ must specify for the examiner the stressor or stressors that it is determined are established by the record, and the examiner must be instructed that only those events may be considered for the purpose of determining whether the Veteran was exposed to one or more stressors in service. (b) The examiner should conduct the examination with consideration of the current diagnostic criteria for PTSD. The examination report should include a detailed account of all pathology present. Any further indicated special studies, including psychological studies, should be accomplished. The examiner should note that the Veteran has been diagnosed during the course of the appeal and should provide an opinion for the period that he does have a diagnosis of PTSD, if not current. (c) If a diagnosis of PTSD is appropriate, currently, or during the course of the appeal, the examiner should specify (1) whether each alleged stressor found to be established by the evidence of record was sufficient to produce PTSD; (2) whether the remaining diagnostic criteria to support the diagnosis of PTSD have been satisfied; and (3) whether there is a link between the current symptomatology and one or more of the in-service stressors found to be established by the record by the AOJ and found to be sufficient to produce PTSD by the examiner. (d) If the examination results in a psychiatric diagnosis other than PTSD, the examiner should offer an opinion as to the etiology of the non-PTSD psychiatric disorder, to include whether it is at least as likely as not that any currently demonstrated psychiatric disorder, other than PTSD, is related to the Veteran's military service, including any verified stressors in service and/or his lay stressors involving a snake wrapping around his leg in service. In rendering the requested opinions, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 3. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. Saudiee Brown Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. E. Bresler 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.