CAVC Case 18-0323: PTSD

The Board determined that a VA examination to evaluate the etiology of the right ankle disability and an addendum medical opinion as to whether there is clear and unmistakable evidence that [a preexisting]right shoulder disability was not aggravated during service were necessary.

Further, the Board concluded that the available VA PTSD examinations were inadequate and thus a new VA examination was warranted.

since January 2012,to include depression and generalized anxiety disorder ; discuss whether a prior depression diagnosis was proper and currently asymptomatic,or a misdiagnosis ;and for each diagnosed disability,even if currently asymptomatic,provide a nexus opinion,and in doing so, reference the [appellant's]statements as to onset [and]the April 1992 [r]eport of [m]edical [h]istory on which the [appellant]reported frequent trouble sleeping.

The examiner opined that the current right ankle condition is caused by tendonitis,which is more likely than not related to aging and occupational stressors.

The examiner provided the following rationale:There is no evidence of a chronic right ankle condition in service or shortly following service;the right ankle condition is less likely than not related to his in-service plantar fasciitis because plantar fasciitis typically does not involve [the]ankle and there is no evidence relating the conditions;the right ankle condition is less likely than not related to his service-connected right knee disability because there is no evidence that the knee injury directly affects the ankle; and in-service environmental hazards and chronic multisystem illnesses did not cause the current condition because it is an [i]solated single joint problem that is typical of strains/tendonitis over the lateral ankle region.

He maintained that this does not change the conclusion or rationale in his July 2015 opinion,and explained that the appellant's current shoulder disabilities are from the rotator cuff region of the shoulder and NOT the clavicle and that they are more likely than not related to aging and occupational stresses[,]which is proven by diagnosis in recent years[,]as opposed to shortly following [discharge from service].

ANALYSIS With regard to his right shoulder,the appellant argues that the Board erred when it found the presumption of soundness had been rebutted.

The Secretary concedes that the Board failed to provide an adequate statement of reasons or bases for relying on the 2016 VA PTSD examination to deny the PTSD claim,but argues that the Court should affirm the remaining portions of the Board's decision.