Citation Nr: 25005482 Decision Date: 04/23/25 Archive Date: 04/23/25 DOCKET NO. 18-40 125 DATE: April 23, 2025 REMANDED Service connection for an acquired psychiatric disorder. Service connection for a headache disorder. Service connection for hypertension (HTN). Service connection for obstructive sleep apnea (OSA). REASONS FOR REMAND In October 2023, the Board denied the claims on appeal, in part, because the evidence was inconsistent on the issue of whether the Veteran had qualifying service in the Southwest Asia theater of operations. She asserted that she was deployed to Saudi Arabia for two weeks in January 1991 but was returned home due to pregnancy. She appealed the Board's denial to the Veterans Claims Court. In October 2024, the Court Clerk granted a Joint Motion for Partial Remand and returned the case to the Board for further consideration. As to the claim for an acquired psychiatric disorder, a May 2018 private physician diagnosed the Veteran with a major depressive disorder and posttraumatic stress disorder (PTSD), which was found to be at least as likely as not directly associated with experiences and stressors experienced during service. In February 2020, a VA examiner diagnosed the Veteran solely with PTSD and provided a positive nexus opinion which linked PTSD to service; however, there are no verifiable stressors. The VA examiner specifically determined that the Veteran did not have any other diagnosable psychiatric disorders. Given the absence of verifiable stressors to support PTSD at this juncture but evidence of a psychiatric disorder other than PTSD, an addendum opinion is required to clarify the current diagnosis and to determine the etiology of any acquired psychiatric disorder shown other than PTSD. Further, as to the claims for headaches, HTN, and OSA, the Veteran asserts that these disorders are due to participation in a toxic exposure risk activity (TERA) during service in the Persian Gulf War. As such, a TERA examination is required for the examiner to consider the Veteran's total potential exposure through all military deployments, as well as the synergistic, combined effect of all TERAs. Therefore, on remand, an examination with opinions that satisfy the Sergeant First Class Heath Robinson Promise to Address Comprehensive Toxics (PACT) Act of 2022 should be obtained. The matters are REMANDED for the following actions: 1. Identify, obtain, and associate all outstanding military personnel records with the claims file. 2. Conduct all necessary development to confirm all TERAs that the Veteran participated in during service. 3. Schedule the Veteran for an examination to determine the nature and etiology of a psychiatric disorder other than PTSD. Applying general medical knowledge, the examiner's experience, the clinical records, and the Veteran's lay statements, the examiner is asked to address the following: " Does the Veteran have a current psychiatric disorder, other than PTSD? If so, what is the diagnosis? " If a psychiatric disorder other than PTSD is diagnosed, what is the medical probability (that is, the likelihood is at least approximately balanced, or nearly equal, or higher) that the psychiatric disorder was due to or caused by service, to include service in Southwest Asia during the Persian Gulf War? The clinician is asked to address the May 2018 private psychological opinion finding a nexus between the Veteran's psychiatric disorder and service. 4. Schedule the Veteran for a TERA examination in order to address whether the identified disorders, to include headaches, HTN, and OSA, are due to exposure to toxic or environmental hazards during service, to include exposure to burn pits. Applying general medical principles, review of the claims file, the examiner's experience, and the Veteran's lay statements, the examiner is asked to address the following: " What is the medical probability (that is, the likelihood is at least approximately balanced or nearly equal, or higher) that a headache disorder, diagnosed as migraine headaches in 2020, was caused by or etiologically related to in-service exposure to environmental toxins? " What is the medical probability (that is, the likelihood is at least approximately balanced or nearly equal, or higher) that HTN, diagnosed in 2020, was caused by or etiologically related to in-service exposure to environmental toxins? " What is the medical probability (that is, the likelihood is at least approximately balanced or nearly equal, or higher) that OSA, diagnosed in 2016, was caused by or etiologically related to in-service exposure to environmental toxins? The clinician is asked to determine the potential exposure through all military deployments and service and address the synergistic combined effect of all TERAs. It would be helpful to the Board if the examiner could explain why the medical evidence is either consistent with or inconsistent with a finding that headaches, HTN, and/or OSA are related to environmental toxics, including whether the Veteran's reports about the onset of symptoms align with how toxic exposure is known to develop. 5. A rationale for all opinions must be provided. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kokolas, Thomas 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.