Citation Nr: 18160698
Decision Date: 12/27/18	Archive Date: 12/27/18

DOCKET NO. 15-09 037
DATE:	December 27, 2018
REMANDED
Entitlement to service connection for a psychiatric disability, to include posttraumatic stress disorder (PTSD), depression, sleeplessness, and an inability to concentrate is remanded.
Entitlement to service connection for sexual disorder is remanded.
REASONS FOR REMAND
The Veteran was a member of the West Virginia Air National Guard from November 1995 to October 1998.  He had a period of active duty for training from June 1996 to October 1996.
This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina, which, inter alia, denied service connection for a psychiatric disability, to include PTSD, depression, sleeplessness, and an inability to concentrate, as well as sexual disorder.
As a preliminary matter, the Board notes that the Veteran requested a Board videoconference hearing in his VA Form 9. In a March 2018 Report of General Information, the RO documented contacting the Veteran to schedule an in-person hearing. The Veteran stated that he wanted to waive his hearing. Accordingly, the Board deems the hearing request withdrawn.  38 C.F.R. § 20.704(e) (2017).
1. Entitlement to service connection for a psychiatric disability to include PTSD, depression, sleeplessness, and inability to concentrate is remanded.
The Veteran contends that he has a psychiatric disability which is directly related to his active service and/or secondary to his service-connected bronchial asthma. See Veteran’s January 2013 statement in support of claim; Veteran’s January 2013 statement in support of claim for PTSD; May 2014 notice of disagreement (NOD); and March 2015 VA Form 9.
Specifically, the Veteran claims that during his period of active service, he was hospitalized, quarantined, and made to undergo a battery of tests, including blood tests, to determine if he had been exposed to hepatitis from contaminated water. He states that this traumatic experience scared him during service and continues to haunt him. He also contends that during service, he was frightened of grenade and other weapons “going off around him,” during a period of training. 
The Board notes that although service military and personnel records show that the Veteran participated in ground combat skills training in 1996, they contain no indication whatsoever that he was hospitalized or quarantined for evaluation after exposure to contaminated water.  Rather, his service treatment records reflect that he underwent routine laboratory testing, such as for cholesterol and sickle cell.  Although these lab reports are included in the service treatment records, there is no indication that he was tested for hepatitis or otherwise quarantined or hospitalized following exposure to contaminated water.  Thus, the Board finds his statements to be lacking in credibility.  Cf. Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (holding that silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder (citing Fed. R. Evid. 803(7))); see AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present).
Moreover, the service treatment records are entirely negative for any indication of a psychiatric disability during his period of active service.  Indeed, in March 1998, the Veteran completed a report of medical history on which he denied having or ever having had depression or excessive worry, frequent trouble sleeping, and nervous trouble of any sort.   
Nonetheless, the Veteran has alleged that he has a psychiatric disability secondary to his service-connected asthma.  Service connection is in effect for asthma, rated as 60 percent disabling.  In addition, the post-service record on appeal contains VA clinical records documenting that the Veteran has exhibited depression, difficulties with sleep, and anxiety. See VAMC records 2009-10; VAMC records 2013-14.
The Veteran has not had a VA examination in connection with his claim.  Given the evidence of record, an examination is necessary.  McClendon v. Nicholson, 20 Vet. App. 79, 81-6 (2006).
2. Entitlement to service connection for sexual disorder is remanded.
The Veteran seeks service connection for sexual disorder.
The Veteran contends that his sexual disorder is related to his psychiatric disorder. VAMC records note a diagnosis of erectile dysfunction. See VAMC 2013 records.
As resolution of the claim of entitlement to service connection for a psychiatric disorder may have an impact on the Veteran’s claim of entitlement to service connection for sexual disorder, the issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any appellate review meaningless and a waste of judicial resources, the two claims are inextricably intertwined).
Accordingly, the matters are REMANDED for the following action:
1. Afford the Veteran an examination to determine the nature and etiology of any current psychiatric disability. Access to the Veteran’s electronic VA claims file should be made available to the examiner for review in connection with the examination. 
After reviewing the record and examining the Veteran, the examiner should delineate all current mental disorders exhibited by the Veteran, if any. Diagnoses should be rendered in accordance with DSM-5. 
(a) If PTSD is diagnosed, the examiner should identify the stressor upon which the diagnosis is based.
(b) For any other mental disability that is diagnosed, the examiner should provide an opinion, with supporting rationale, as to whether it is at least as likely as not that such disability is causally related to the Veteran’s active service or any incident therein.
If not, is it at least as likely as not that such disability is causally related to service-connected bronchial asthma?
If neither, it is at least as likely as not that such disability was aggravated by service-connected bronchial asthma? If aggravation is found, the examiner must attempt to establish a baseline level of severity for the psychiatric disorder, prior to aggravation.
The examiner is asked to address the relevant evidence of record, including the Veteran’s service treatment records (STRs), VAMC records, the Veteran’s lay statements in a January 2013 statement in support of claim for PTSD and a January 2013 statement in support of claim, May 2014 notice of disagreement, and March 2015 VA Form 9.
A complete explanation must be provided for any opinion offered. In providing the requested opinion, the examiner should reference any relevant evidence of record.
2. If the Veteran is diagnosed with a psychiatric disorder and service connection is granted, order an addendum opinion to determine if the Veteran’s sexual disorder is at least as likely as not causally related to or aggravated by his service-connected psychiatric disorder.
 
K. Conner
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Ruddy, Associate Counsel
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