Citation Nr: 18160353
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 12-06 276
DATE:	December 26, 2018
REMANDED
The issue of entitlement to service connection for a somatoform disorder manifested by complaints of right leg and chronic abdominal pain is remanded.
REASONS FOR REMAND
The Veteran served on active duty from February 2008 to October 2008.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. The RO in Anchorage, Alaska certified the appeal to the Board. The Veteran’s claims file remains in the jurisdiction of the Anchorage RO.
In December 2013, the Board remanded the current issue for further evidentiary development.  The Board subsequently sought a Veterans Health Administration (VHA) expert opinion in April 2017 and received a response in June 2017.
In a March 2018 Brief-Hearing Requested, the Veteran requested a hearing. Then, in September 2018, the Veteran submitted correspondence requesting to cancel the videoconference hearing.  The Veteran filed additional medical evidence “in lieu of presenting before a video conference hearing.”  As such, her hearing request is deemed withdrawn. 38 C.F.R. § 20.704(e).

Service Connection for Somatoform is Remanded
While further delay is regrettable, additional development is necessary prior to adjudication of the Veteran’s service connection claim.
The June 2017 VHA medical specialist was “unable to confirm or deny the presence of a diagnosis of a Somatoform Disorder.”  In support of this determination, the examiner cited to the fact that the Veteran did not attend follow up formal neuropsychological testing after the January 2012 VA examination.  See  February 2012 Report of General Information (stating that a follow up examination could not be scheduled because the Veteran moved to Texas at the time).  Also, the examiner cited to the April 2014 VA examination report which did not document a diagnosis of a psychiatric condition.  The examiner stated that “given the discrepancy in those reports, additional diagnoses of Malingering and Personality Disorder, unspecified, which are pre-existing and/or unrelated to S.F.’s service claim should also be considered.”
Following the issuance of the June 2017 VHA opinion, the Veteran filed private treatment records from the Alaska Neurology Center. August 2018 progress notes documented the Veteran’s complaints of painful legs and the clinician’s statement that “they are likely triggered by nightmares as she notices pain most profoundly after awakening from a nightmare.”   Further, the clinician stated that “primary complaint now being more psychiatric than primary pain lead me to believe I may be of limited aid in the patient’s ongoing treatment.  Nevertheless, will attempt to contact her psychiatrist in an effort to corroborate and coordinate future care.” 
In light of the fact that the June 2017 VHA examiner was unable to verify a diagnosis of somatoform disorder, August 2018 private treatment records documented the Veteran’s continued complaints of leg pain, and the August 2018 clinician’s assessment that the complaints “now being more psychiatric,” the Board finds that the Veteran should be afforded an additional opportunity for a new VA examination to assess the etiology of a psychiatric condition, with complaints of leg pain and chronic stomach pain.  
Additionally, August 2018 progress notes reveal that the Veteran is currently receiving psychiatric treatment.  The most recent psychiatric treatment records associated with the claims file are from October 2015.  On remand, the AOJ must ensure that all available VA treatment records are obtained.  Also, the Veteran should be afforded another opportunity to identify any outstanding private treatment records related to her claim.
The matters are REMANDED for the following action:
1. Ask the Veteran to identify any outstanding private treatment records that she wishes VA to obtain, and advise her that she may submit any additional evidence or information she might have to support her claim, to include lay statements. After obtaining any necessary authorization forms from the Veteran, obtain any pertinent records identified and associate them with the claims file. Any negative responses should be in writing and should be associated with the claims file.
2. Obtain the Veteran’s VA treatment records for the period from October 2015 to the Present.
If any requested records are unavailable, the claims file should be annotated as such and the Veteran and her representative notified of such.
3. Schedule the Veteran for a VA examination to determine the etiology of any psychiatric disorder with complaints of leg pain and chronic stomach pain.  All indicated tests and studies should be conducted and all clinical findings reported in detail.  Refer the Appellant’s claims file to a psychologist or psychiatrist to determine the nature and etiology of any psychiatric disorders.  The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.  Following review of the claims file, the examiner should respond to the following:
(a.) Please identify all current psychiatric diagnoses of record. 
In determining whether the Veteran meets the criteria for a current diagnosis, please consider medical and lay evidence dated both prior to and since the filing of the claim for service connection.  Please note that although the Veteran may not meet the criteria for a diagnosis at the present time, diagnoses made prior to and since the date of claim filing meet the criteria for a “current” diagnosis.  Please also note that the Veteran is competent to report symptoms, treatment, and injuries, and that her reports must be taken into account in formulating the requested opinion.
(b.) The examiner should endeavor to differentiate symptoms and impairments due to any diagnosed psychiatric disorder.  If the examiner cannot differentiate symptoms and impairments, the examiner should state so and provide reasons why such differentiation cannot be made.
(c.) If a diagnosis of personality disorder is validated, please explain what psychological testing was performed to support the diagnosis.  Please also state whether there are any psychiatric disorders superimposed upon the personality disorder.
(d.) For each diagnosed acquired psychiatric disorder, is it at least as likely as not (50 percent probability or more) that the disorder had its onset in service, is related to the Veteran’s reported in-service stressors, or is otherwise related to service? If the criteria for a diagnosis of a psychotic disorder are met, please state, to the best of your ability, whether the prodromal period for such disorder as likely as not had its onset during the Veteran’s period of active service.
While personality disorders are not diseases or injuries for compensation purposes, please note that a disability resulting from a mental disorder that is superimposed upon a personality disorder may be service-connected.
(e.) If the examiner finds that a currently diagnosed psychiatric disability has been permanently worsened beyond normal progression (aggravated) by a service-connected disability, please describe the degree in aggravation beyond the baseline level of the a currently diagnosed psychiatric disability that is attributed to the service-connected disability.
4. As the Veteran has reported that the military sexual trauma occurred in close time proximity to her in-service treatment for right leg pain, in offering each of the opinions requested above, the specialist should specifically address the relationship, if any, between the Veteran’s reported sexual assaults during AIT and her complaints of right leg pain in August 2008. 
5. A complete rationale for the opinion rendered must be provided.  If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so.
 
S. C. KREMBS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	I. Altendorfer, Associate Counsel

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