Citation Nr: 18141772 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 01-04 508 DATE: October 11, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service connection lumbar strain and/or right and left knee chondromalacia, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1991 to February 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. In January 2016, the Board remanded the instant appeal for additional development, namely obtaining various treatment records and obtaining an etiology opinion addressing all acquired psychiatric disorders diagnosed since May 2003. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives and, as such, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran contends that his psychiatric disorders are secondary to his service connected knee and back conditions. Alternatively, he contends that his acquired psychiatric disorder stems from being discharged from service for an injury when he intended to make it his career. An August 2016 VA examination report diagnosed the Veteran with antisocial personality disorder and alcohol use disorder in sustained remission. The VA examiner found that the Veteran did not have more than one mental disorder diagnosed. However, this opinion did not address the numerous diagnoses of acquired psychiatric disorders that are reflected in the clinical records. For example, a diagnosis of intermittent explosive disorder was made in a June 2003 VA treatment note, depressive disorder was diagnosed in a July 2005 VA treatment note and diagnoses of delusional disorder and major depressive disorder were made in a December 2003 Social Security Administration evaluation. Further, a December 2011 private treatment note indicates that the Veteran suffers from paranoid schizophrenia and major depression. As such, the Veteran has current diagnoses of acquired psychiatric disorders other than a personality disorder for purposes of obtaining an etiology opinion. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the current disability requirement is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim). On remand, such an addendum opinion should be obtained to determine the nature and etiology of his current acquired psychiatric disorders. Moreover, the VA examiner opined in an August 2016 VA addendum opinion that personality disorders emerge during childhood and/or adolescence in extant research on those conditions and they are not caused by service. The examiner further opined that there was no empirical evidence in extant research that service caused alcohol use disorders nor that general medical conditions cause alcohol use disorders, which are believed to have a strong genetic basis. The examiner therefore opined that it was less than at least as likely as not that the unspecified personality disorder and alcohol use disorder was caused by, aggravated by, even in part, or related to service. However, this examiner does not address the Veteran’s service-connected knee and/or back disabilities, which are the basis of his claim. Moreover, this examiner does not address the December 2011 opinion of clinical psychologist that the Veteran’s personality disorder was exacerbated by his service. Consequently, an addendum opinion is necessary to determine the etiology of the current acquired psychiatric disorders. The Veteran should also be asked to furnish, or to furnish an authorization to enable VA to obtain, any additional private treatment records from providers who treated him for his claimed acquired psychiatric disorder. Additionally, given the time that will pass during the processing of this remand, updated VA treatment records should be associated with the record. The matter is REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained. These VA treatment records include updated VA treatment records dated from June 2018 to the present. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford her an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.15 (e). 2. Return the record to the VA examiner who provided the August 2016 opinion regarding the Veteran’s acquired psychiatric disorders. The record and a copy of this Remand must be made available to the examiner. The examiner shall note in the examination report that the record and the Remand have been reviewed. If the August 2016 VA examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Upon a review of the record, the examiner should respond to the following: a) Identify all psychiatric diagnoses found to be present since May 2003. If the examiner determines that the Veteran does not suffer from a current acquired psychiatric disorder other than antisocial personality disorder and/or alcohol use disorder, the examiner should reconcile this opinion with the diagnoses present in the record. In doing so, the examiner should address whether any current psychiatric disorder is a manifestation of the Veteran’s service connected knee or back disorders. b) Based on a review of the relevant evidence contained therein, the examiner should specifically offer an opinion to the following: i) Is it at least as likely as not (at least a 50 percent probability) the Veteran’s acquired psychiatric disorder(s) was proximately due to his service-connected left and right knee chondromalacia? ii) Is it at least as likely as not (at least a 50 percent probability) the Veteran’s acquired psychiatric disorder(s) was proximately due to his service-connected lumbar strain? iii) Is it at least as likely as not (at least 50 percent probability) that the Veteran’s acquired psychiatric disorder(s) is aggravated by his service-connected left and right knee chondromalacia? iv) Is it at least as likely as not (at least 50 percent probability) that the Veteran’s acquired psychiatric disorder(s) is aggravated by his service-connected lumbar strain? v) Is it at least as likely as not (at least 50 percent probability) that the Veteran’s acquired psychiatric disorder(s) is otherwise related to or had its onset in service? vi) For the Veteran’s diagnosed unspecified personality disorder, the examiner must state whether there was an additional disability due to disease or injury superimposed upon such personality disorder during the Veteran’s military service. If so, please identify the additional disability. The examiner should specifically consider the December 2011 opinion that the Veteran’s antisocial personality disorder was aggravated by his service. The examiner’s report must include a complete rationale for all opinions expressed. KRISTY L. ZADORA Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD O. Owolabi, Law Clerk