Citation Nr: 18143493 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 16-30 023 DATE: October 19, 2018 REMANDED Service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) and unspecified depressive disorder is remanded. Service connection for sarcoidosis is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1986 to September 2006. The Board notes that the Veteran had been represented in this appeal by the North Carolina Division of Veterans Affairs (NCDVA). In correspondence dated and received in January 2016, the Veteran revoked NCDVA as his representative and requested to proceed pro se. 1. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) and unspecified depressive disorder is remanded. The Veteran contends that his unspecified depressive disorder and PTSD is due to his service during Desert Storm and while serving in response to Hurricane Katrina. The Veteran also contends that his mental health conditions are due to his multiple service-connected conditions. In September 2015, private physician H.J. diagnosed the Veteran with PTSD and opined that that the Veteran’s PTSD is as likely as not related to his hostile military service. An April 2015 VA examiner opined that the Veteran’s symptoms did not meet the criteria for a diagnosis of PTSD. However, the Veteran was diagnosed with unspecified depressive disorder. The examiner noted that the Veteran acknowledged that he had mental health difficulties due to his divorce, life losses, distant relationships with his children, his business failure, health problems, and military trauma. The VA examiner attributed a small percentage of the Veteran’s mental distress to military trauma and pain from service-connected disabilities. The Veteran served in Desert Storm after the enemy combatants had been pacified and volunteered to serve in the aftermath of Hurricane Katrina. The VA examiner found that the stressors did not meet the criteria adequate to support a diagnosis of PTSD. In a July 2015 addendum opinion, the VA examiner opined that the Veteran’s unspecified depressive disorder is less likely as not related to his service-connected disabilities as the cause of his unspecified depressive disorder was his failed marriage, alienation from children, and his failed business. As the VA examiner found that the Veteran’s unspecified depressive disorder was due in part to pain from his service-connected disabilities, yet did not address his finding in his addendum opinion, the Board finds that a remand is necessary to obtain an addendum opinion to ascertain the nature and etiology of this disability, notably whether the Veteran’s unspecified depressive disorder is due to the pain from his service-connected disabilities. 2. Entitlement to service connection for sarcoidosis is remanded. The Veteran contends that his sarcoidosis was misdiagnosed as psoriasis or pseudofolliculitis barbae (PFB) during his active duty service. The Veteran’s service treatment records (STRs) include a May 2000 periodic examination report that noted folliculitis of the scalp/acne keloidalis nuchae, controlled with medication including Eryigel, Retin A and Kenalog cream. May 2000 examination revealed bumps on the back of the neck and the top of the head. He was noted to have been seen approximately three months earlier and given erythromycin which he stated helped. The diagnosis was acne keloidalis nuchae, improved. In an October 2006 rating decision, service connection was established for acne keloid nuchae of the scalp. Post-service medical records dated two months after discharge in November 2006, show complaints including that of psoriasis. In the associated report of medical history, it was noted that psoriasis had been diagnosed several years earlier and that compliance with treatment had been good. His primary complaints included joint stiffness and facial rash. Fairly mild symptoms included myalgias. The pattern of joint symptomatology had been episodic with symptom-free periods in between. This evidence strongly suggests that psoriasis was diagnosed while the Veteran was on active duty. A private practitioner, S.D., opined in September 2015 that the Veteran’s lung sarcoidosis is at least as likely as not related to an in-service diagnosis of PFB and in December 2014, he opined that the Veteran’s lung sarcoidosis is at least as likely as not related to his service-connected psoriasis condition; however, neither statement provides a rationale or explanation for the opinion. The Board cannot make a fully-informed decision on the issue of service connection for sarcoidosis because no VA examiner has opined whether sarcoidosis is related to the Veteran’s active duty service or was misdiagnosed as psoriasis or other skin condition during his active duty service. The matter is REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine the etiology of any psychiatric disorder, including PTSD and depression. The record and a copy of this remand must be reviewed by the examiner. All necessary tests should be conducted and all clinical findings reported in detail. The examiner is requested to provide an opinion as to the diagnosis of all psychiatric disorders found to be present, including, if appropriate, PTSD and depression. The examiner is asked to determine whether the Veteran has PTSD and/or depression. The examiner should provide an opinion as to whether it is more likely than not, less likely than not, or at least as likely as not, that any current psychiatric disorder, including PTSD and depression, had its clinical onset during active duty, if a psychosis was manifest within one year of service, or if a current psychiatric disability is related to any in-service disease, injury, or event, to include proximately due to or alternatively, aggravated by, the pain from his multiple service-connected conditions. Also, if the examiner finds that the Veteran meets the diagnostic criteria for diagnosis of PTSD, the examiner should indicate whether the claimed stressors identified by the Veteran are adequate to support a diagnosis of PTSD and whether the Veteran’s symptoms are related to the claimed stressors. The examiner must provide a comprehensive report including complete rationales for all conclusions reached. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any sarcoidosis. The examiner must opine whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. Also, the examiner must opine whether sarcoidosis was misdiagnosed as psoriasis or other skin condition including follicular disease such as scalp/acne keloidalis nuchae during the Veteran’s active duty service. As noted above, a November 2006 outpatient treatment record suggests by way of history that the Veteran had been seen for psoriasis previously while he was on active duty. The examiner must provide a comprehensive report including complete rationales for all conclusions reached. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Costello, Associate Counsel