Citation Nr: 18144345 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 18-33 441 DATE: October 24, 2018 ISSUE Entitlement to service connection for depression, claimed as secondary to the service-connected bilateral hearing loss (BHL). REMANDED Entitlement to service connection for depression, claimed as secondary to the service-connected BHL is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1956 to January 1960. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2018 rating decision by the Department of Veterans Affairs (VA) Veterans Benefits Administration Regional Office (RO). Jurisdiction was subsequently transferred to the RO in Portland, Oregon. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900 (c) (2017). 38 U.S.C. § 7107 (a) (2) (West 2014). The Board finds that additional evidentiary development is required before the claim for service connection is decided. The Veteran was afforded a VA-contracted examination in January 2018 in which the examiner diagnosed persistent depressive disorder and commented that it appeared to be secondary to chronic pain and related sleep problems. The examiner noted that the claims file was not reviewed, although pertinent records were discussed at the conclusion of the examination report. The examiner also noted that the Veteran completed a traumatic brain injury questionnaire as a favor to the examiner. The Board finds that clarification is required in this case as to the etiology of the Veteran’s depression. To this point, the January 2018 examiner’s opinion appears to be speculative at best. Bloom v. West, 12 Vet. App. 185, 187 (1999) (stating that medical opinions that are equivocal in nature, such as those expressed in speculative language (e.g., “could have caused”, etc.), do not provide the degree of certainty required for medical nexus evidence); Black v. Brown, 5 Vet. App. 177, 180 (1993); Reonal v. Brown, 5 Vet. App. 458, 460 (1993). The Board finds that the pertinent questions to be addressed on remand are whether it is at least as likely as not (50 percent or better probability) that any depression diagnosed during the pendency of this claim had its onset in service, is otherwise related to service, or was caused or aggravated (permanently worsened) by the Veteran’s service-connected BHL. Moreover, the Veteran asserted in his March 2018 notice of disagreement that the January 2018 examination was inadequate for multiple reasons to include length of the examination with use of the time for an unrelated questionnaire, condition of the office, notation that the claims file was not reviewed, and that the assertation that depression was due to chronic pain appeared to be a guess. Accordingly, the Board finds that the Veteran should be afforded a VA examination on remand by a psychologist or psychiatrist who has not previously examined him. The matter is REMANDED for the following action: 1. Afford the Veteran a VA examination by a psychologist or psychiatrist who has not previously examined him. Access to the Veteran’s electronic claims file, including a copy of this remand, must be made available to and reviewed by the examiner. Based on review of the files, the examiner should state a medical opinion as to whether it is at least as likely as not (50 percent or better probability) that any depression diagnosed during the pendency of this claim had its onset in service, is otherwise related to service, or was caused or aggravated (permanently worsened) by the Veteran’s service-connected BHL. The examiner must explain the rationale for all opinions, citing to supporting factual data and/or medical literature, as deemed appropriate. If the examiner is unable to offer any requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the current limits of medical knowledge. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. 2. Thereafter, and after undertaking any additional development deemed necessary, readjudicate the issue on appeal. If the benefit sought on appeal remains denied, in whole or in part, provide the Veteran and his representative with a supplemental statement of the case and afford them a reasonable opportunity to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R.M.K., Counsel