Citation Nr: 18144304 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 12-35 572 DATE: October 24, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1970 to August 1974. The Veteran seeks service connection for an acquired psychiatric disorder, to include PTSD. When this matter initially came before the Board in February 2015, the Board remanded the issue for further development, to include obtaining a new VA examination. The development has been completed and the matter returned to the Board for adjudication. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. Regrettably, the Board finds that additional development is warranted before a decision may be rendered on the Veteran’s claim for service connection for an acquired psychiatric disorder, to include PTSD. In the February 2015 remand, the Board noted that a previous VA examiner’s opinion was not adequate because the examiner, on the one hand, noted that the Veteran had difficulty sleeping due in part to ruminating over war experiences, but then the examiner opined that the Veteran’s insomnia was not related to his service without providing any further rationale regarding the ruminations. In addition, the Board noted that while the February 2015 examiner noted the Veteran had no continuum of treatment for insomnia since service, continuity of symptomatology is not required for an award of service connection, albeit a lack of complaint or treatment for many years after service may certainly be a factor to consider. Another VA examination of the Veteran was conducted in March 2015. The Board notes that this VA examiner’s opinion is also inadequate. The examiner diagnosed the Veteran with persistent depressive disorder and opined that the condition was less likely than not incurred in or caused by an in-service injury, event or illness. However, the rationale is inadequate. For example, the March 2015 examiner stated that even considering the Veteran’s service personnel records and other documents present in the claims file, he could not determine “whether or not there was a psychiatric disorder present” during service. In addition, the examiner stated that the Veteran has consistently reported alcohol and drug use in service, which he noted can cause anxiety, depression, and sleep disturbances. The examiner opined that it was equally likely that the Veteran’s substance use during service could have caused or worsened his mood and sleep symptoms. Finally, the examiner opined that the Veteran has reported various post-service stressors such as work, pastoring a church, and family “that could have equally caused onset” of his psychiatric symptoms. The Board finds that the March 2015 VA examiner’s opinion is inadequate. In so finding, the Board notes that the March 2015 opinion, like the January 2012 opinion, relies in part on a finding that the Veteran did not have a psychiatric treatment in service. As noted in the February 2015 remand, continuity of symptomatology is not required for an award of service connection. Further, despite finding that it was “less than at least as likely as not” that the Veteran’s current psychiatric diagnosis is due to service, the examiner also stated that his in-service alcohol or drug use could have worsened his symptoms. The Board views this statement as a suggestion that the Veteran’s anxiety, depression, and sleep disturbance symptoms may have been present while he was on active duty. Because the March 2015 VA examination is inadequate, further opinion is required. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matter is REMANDED for the following action: 1. Obtain an addendum medical opinion, or a VA examination if necessary, from an appropriate medical professional to determine the etiology of the Veteran’s diagnosed persistent depressive disorder, or any other psychiatric disorder found to be present. The examiner must thoroughly review the claims file and offer a well-reasoned opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed persistent depressive disorder had its onset in service or is otherwise related to service. In rendering these conclusions, the examiner must review the Veteran’s entire claims file and discuss the following: • the Veteran’s service in actual combat conditions from June 1968 to November 1968; • the Veteran’s ruminations of war and diagnosis of primary insomnia as reported in the January 2012 VA examination; • the Veteran’s medical records from the Vet Center which reflect a diagnosis of PTSD; • the Veteran’s diagnosis of persistent depressive disorder as reported in the March 2015 VA examination; • the effect, if any, of the Veteran’s alcohol and substance abuse while in service; and, • the Veteran’s contentions, along with the lay statement from his spouse, regarding his mental health symptoms. A complete rationale must be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, he or she should provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jiggetts, Associate Counsel