Citation Nr: 18160424 Decision Date: 12/26/18 Archive Date: 12/26/18 DOCKET NO. 15-26 722 DATE: December 26, 2018 REMANDED The claim of entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder and posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1986 to March 1990. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The Veteran testified before the undersigned Veterans Law Judge at a Board videoconference hearing in July 2018. A transcript of this proceeding has been associated with the claims file. While the RO separately adjudicated claims for service connection for major depressive disorder and PTSD, a claim for service connection for a psychiatric disability is deemed to encompass all psychiatric diagnoses reasonably presented in the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, the Veteran’s psychiatric disability claim has been properly characterized to include both diagnoses. The Veteran contends that service connection is warranted for an acquired psychiatric disorder. Specifically, during the July 2018 Board hearing, he testified that he first began experiencing psychiatric problems during his service when he was harassed by his commanding officer. According to the Veteran, his commanding officer was jealous of the Veteran because he was established, drove a nice car, and was friendly with a woman that the commanding officer wanted to date. This resulted in unfair treatment of the Veteran, to include making the Veteran run more frequently than his peers. The Veteran testified that he sought a “4187” transfer to Germany to get away from his commanding officer and received psychiatric counseling during his last three months of service due to the in-service harassment by his commanding officer. Alternatively, during the July 2018 Board hearing both the Veteran and his representative indicated that the Veteran’s depression is related to his service-connected lumbar spine and right lower extremity disorders. A review of the Veteran’s service treatment records is negative for a psychiatric disorder. Post-service VA treatment records show that the Veteran was treated for depression as early as June 2013. The Veteran submitted an initial claim for service connection for PTSD in June 2013. In connection with this claim, updated VA treatment records dated through November 2015 were obtained. Significantly, a June 2013 VA treatment record shows a diagnosis of major depressive disorder. These records also imply that the Veteran’s depression may be related to his chronic pain. During the July 2018 Board hearing, the Veteran’s representative requested that updated VA treatment records be obtained as a VA treatment record dated in 2016 contains a positive nexus opinion relating the Veteran’s depression to the stressful in-service experiences with his commanding officer. The Veteran’s representative also noted that VA treatment records dated in 2013 suggest a relationship between the Veteran’s depression and his service-connected lumbar spine due and right lower extremity disorders due to chronic pain. The Veteran has not yet been afforded a VA examination for the purpose of determining whether a current acquired psychiatric disorder may be related to his military service. The medical documentation of psychiatric problems since at least June 2013 along with the Veteran’s allegation of psychiatric problems since in-service harassment by his commanding officer and the allegations that the Veteran’s service-connected lumbar spine and/or right lower extremity disability is related to his diagnosed depression are sufficient to trigger the duty on the part of VA to provide an examination as to the acquired psychiatric disorder claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, the Veteran should be afforded a VA examination so as to determine whether he currently has an acquired psychiatric disorder and, if so, the nature and etiology of such disorder. Also, the Veteran should be provided with an opportunity to identify any VA or non-VA healthcare provider who has treated him for his claimed acquired psychiatric disorder since service and all outstanding VA treatment records dated since November 2015 should be obtained. The matters are REMANDED for the following action: 1. Afford the Veteran an opportunity to identify any healthcare provider who has treated him for his claimed acquired psychiatric disorder. After obtaining any necessary authorization from the Veteran, obtain all identified records, to include updated VA treatment records dated from November 2015 to the present. 2. After obtaining any outstanding records, schedule the Veteran for a VA psychiatric examination by an appropriate medical professional to determine the nature and etiology of his claimed acquired psychiatric disorder. The claims file should be provided. (A) The examiner should identify all of the Veteran’s current acquired psychiatric disorders. (i) If a diagnosis of PTSD is made, then the examiner should specify whether his symptoms are related to the claimed stressor. (ii) If the examination results in a psychiatric diagnosis other than PTSD, then the examiner should opine whether any non-PTSD psychiatric disorder, if diagnosed, is at least as likely as not (i.e., a 50 percent or greater probability): (a) related to active service or any incident of service, to include the Veteran’s claimed in-service harassment by a commanding officer; (b) caused and/or aggravated by the Veteran’s service-connected degenerative joint disease with intervertebral disc syndrome of the lumbar spine, radiculopathy of the right lower extremity, bilateral hearing loss, and/or tinnitus. (B) The examiner should further consider whether the Veteran developed psychoses within one year of his separation from military service. In this regard, the examiner should opine as to whether it is at least as likely as not that the Veteran had psychoses of within one year after March 15, 1990, his date of separation from active service, and, if so, to describe the manifestations. The examiner is asked to address the Veteran’s reported history of psychiatric problems in service, the post-service June 2013 diagnosis of major depressive disorder, and the post-service VA treatment records implying a relationship between the Veteran’s depression and chronic pain. The rationale for any opinion offered should be provided. 3. Readjudicate the claim. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD April Maddox, Counsel
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