Citation Nr: 1306258 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 09-18 603 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, to include bipolar disorder or depression. 2. Entitlement to service connection for drug sensitivity as secondary to fibromyalgia or an acquired psychiatric disorder. WITNESSES AT HEARING ON APPEAL Appellant and her spouse ATTORNEY FOR THE BOARD James A. DeFrank, Counsel INTRODUCTION The Veteran served on active duty from January 1987 to September 1988. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2008 rating decision of the Department of Veterans Affairs (VA) regional office (RO) located in Winston-Salem, North Carolina. In August 2010, a Travel Board hearing was held before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. In December 2010, the Board remanded the Veteran's claims for further development. In March 2012, the Board again remanded the issues above for additional development. Such development has been completed and associated with the claims file, and these matters are returned to the Board for further review. The Board notes that, in addition to the paper claims file, there is a Virtual VA electronic claims file associated with the Veteran's claim. A review of the documents in the electronic file reveals that they are either duplicative of the evidence in the paper claims file or are irrelevant to the issue on appeal. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran claims that she has an acquired psychiatric disorder, to include bipolar disorder or depression, that is related to service, to include as due to in-service radiation exposure. By way of background, shortly after service but beyond the one-year presumptive period for service connection, the Board notes that private treatment records dated March 1994 to June 1994, and several reservist treatment records dated from April 1994 to August 1994, reflect that the Veteran was diagnosed with, among other things, depression and anxiety, and that she had reported suicidal thoughts. See, e.g., Private Treatment records, Anchor Family Health Center, March 29, 1994, Rohlf Memorial Clinic, June 1994; Service (reservist) Treatment Records, April 1994, August 1994. Effective August 1994, the Veteran was found to be not qualified for reservist duty due to, among other things, diagnosed major depression, and she was discharged from service in the naval reserves. More recently, a September 2006 VA treatment record reflects a diagnosis of bipolar disorder not otherwise specified. In December 2010, the Board remanded the Veteran's claim so that the Veteran could be afforded a VA examination relating to her claim. Pursuant to the Board's remand directive, the Veteran was provided with a VA examination in May 2011. In short, the examiner recorded diagnoses of major depressive disorder and trichotillamania and opined that the Veteran's mental health conditions preexisted service. No opinion was provided, however, as to whether the Veteran's mental health conditions were aggravated by service beyond the natural progression of the disease. Based thereon, in a March 2012 decision, the Board determined that a remand was necessary to obtain an addendum VA medical opinion for clarification as to aggravation. Per the March 2012 Board remand instructions, a VA examiner conducted a mental disorders examination of the Veteran in April 2012. The examiner noted that the examiner who conducted the May 2011 VA examination was not available. The April 2012 examiner opined that it was less likely than not that the Veteran's personality disorder not otherwise specified (NOS), major depressive disorder and trichotillomania (all of which pre-dated the Veteran's service) were permanently aggravated by or were aggravate by service beyond their natural progression. In coming to this conclusion, the examiner indicated that she reviewed the claims file. However, the examiner also indicated that she did not review either the private medical records or the service treatment records as they were unavailable. In April 2012, the examiner who conducted the May 2011 VA examination provided an addendum opinion. The VA psychologist opined that it was less likely than not that the Veteran's military experiences caused or aggravated beyond their natural course, any of her diagnosable behavioral-emotional conditions. It was also less likely than not that the ionizing radiation caused or aggravated beyond their natural course any of her diagnosable behavioral-emotional conditions. While the examiner noted that he reviewed the Veteran's claims file, the Board notes that this opinion was merely a conclusory opinion which concurred with his previous conclusions in the May 2011 VA opinion and the conclusions of the April 2012 VA examiner. As noted above, private treatment records dated March 1994 to June 1994, and several reservist treatment records dated from April 1994 to August 1994, reflect that the Veteran was diagnosed with, among other things, depression and anxiety, and that she had reported suicidal thoughts. Additionally, as the Veteran's mental health conditions preexisted service, a determinative question is whether the Veteran's mental health conditions were aggravated by service beyond the natural progression of the disease. As a result, the Board finds that a review of the Veteran's service treatment records and his private treatment records are necessary for an adequate VA examination to be conducted. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Therefore, the Board finds that another remand is necessary to provide the Veteran with a new VA opinion relating to her claim. See Stegall v. West, 11 Vet. App. 268 (1998). As a final matter, as the Veteran's claim for service connection for drug sensitivity as secondary to an acquired psychiatric disorder is inextricably intertwined with her claim for an acquired psychiatric disorder being remanded herein, the Board will again defer decision on the matter. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (finding that two or more issues are inextricably intertwined if one claim could have significant impact on the other). Accordingly, the case is REMANDED for the following action: 1. Ask the same examiner who performed the April 2012 opinion (mental disorders) to review the entire claims file, including the Veteran's service treatment records and private treatment records, and provide an opinion clarifying whether each mental health disorder diagnosed on examination (1) was caused by or is otherwise directly related to service, to include in-service radiation exposure, (2) whether, in the alternative, each disorder is found to preexist service, and (3) as to each disorder found to preexist service, whether it was aggravated by service beyond its natural progression. The examiner should provide a complete rationale for any opinions provided. The examiner should also confirm that the complete claims file was reviewing, including service treatment records and post-service private treatment records. 2. Then, perform any additional development necessary, and then readjudicate the Veteran's claims. If her claims remain denied, she should be provided with a Supplemental Statement of the Case (SSOC). After the Veteran has been given the applicable time to submit additional argument, the claim should be returned to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).