Citation Nr: 24017374 Decision Date: 04/23/24 Archive Date: 04/23/24 DOCKET NO. 22-00 539A DATE: April 23, 2024 REMANDED Entitlement to service connection for an acquired psychiatric disability is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1991 to June 1991 and from February 2003 to October 2003. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision. 1. Entitlement to service connection for an acquired psychiatric disability is remanded. The Veteran asserts that he has a psychiatric disability that is due to his experiences during his active service. He has not been afforded a VA examination for this claim. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2), 38 C.F.R. § 3.159 (c)(4)(i). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. The Veteran has submitted lay statements regarding his experiences during service as well as medical records showing multiple mental health diagnoses. The letter submitted in August 2016 states that the Veteran's listed diagnoses are all due to his active service, but there is no explanation provided. However, this meets the low threshold for requiring a VA examination. Remand is necessary for an examination. 2. Entitlement to service connection for hypertension is remanded. The Veteran contends that his hypertension is related to his active service. In August 2022, during the pendency of this appeal, the Honoring our Promise to Address Comprehensive Toxins (PACT) Act of 2022 (PACT Act) was enacted. The PACT Act creates a presumption of exposure to burn pit and other toxins (BPOT) and additional procedural rights for Veterans with claimed toxic exposure risk activity (TERA). The additional procedural rights for Veterans with claimed TERA include review of the Individual Longitudinal Exposure Record (ILER) for documentation of known TERA. It also provides for TERA examinations that consider the total potential exposure through all applicable deployments and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. On December 22, 2022, pending the promulgation of implementing regulations, VA issued sub-regulatory guidance to claims processors in the form of a Policy Letter. See VBA Letter 20-22-10 at 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78, 543 (Dec. 22, 2022). Although the Board is not bound by this guidance, it finds it instructive in determining whether the Veteran's assertions as to his claimed exposures require consideration under the PACT Act. VBA Letter 20-22-10 indicates that explicit and implicit claims include claims related to "garrison exposures." VHA defines garrison exposure as an environmental exposure that may have been experienced while stationed on a military base. Further, the Policy Letter sets forth that a Veteran may claim any condition due to any environmental exposure that may have been experienced while stationed on a military base. This includes exposures to substances such as fuels. Under the PACT Act, VA is required to provide a disability examination and secure a medical nexus opinion when a Veteran submits a compensation claim, has evidence of a disability, and has participation in a TERA, but the evidence is not sufficient to establish service connection for the disability. 38 U.S.C. § 1168 (a). The Veteran's MOS is listed as light wheeled vehicle mechanic. The Board finds it reasonable to conclude that the Veteran had a garrison exposure during service because he presumably, at the very least, was exposed to fuel and hydraulic fluids while performing his in-service duties. Thus, the Board finds that the Veteran participated in a TERA during active service. As the Veteran has not been provided with a VA medical nexus opinion addressing the contended etiological relationship between his hypertension and his in-service participation in a TERA, the Board finds that VA must provide such an opinion. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his claimed acquired psychiatric disability. The examiner must review the claims file. For each identified acquired psychiatric disability, the examiner is asked to provide a response to the following: Is the disability at least as likely as not related to the Veteran's active service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of the in-service injury and symptoms as well as post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of the current disability, this should be noted. Stated another way, do the Veteran's reports about the symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 2. Prepare an Individual Longitudinal Exposure Record for the Veteran. 3. Schedule the Veteran for a TERA examination to determine the nature and etiology of his claimed hypertension. (a.) Opine whether it is at least as likely as not that the Veteran's hypertension was incurred in or is otherwise related to his active service? In answering this question, as stated, the examiner must consider the total potential exposure through all applicable deployments and the synergistic, combined effect of all his toxic exposure risk activities. Christopher Seppanen Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Creegan 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.