Citation Nr: 18149359 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-18 395 DATE: November 9, 2018 REMANDED Entitlement to a rating in excess of 10 percent for anxiety disorder is remanded. Entitlement to service connection for depression, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1986 to October 1986 in the Navy and from September 1997 to February 1998 and June 2000 to July 2002 in the Air Force. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to a rating for anxiety disorder in excess of 10 percent is remanded and entitlement to service connection for depression is remanded. A. VA Records In conjunction with the Veteran’s April 2016 substantive appeal (VA Form 9), the Veteran’s attorney submitted partial Orlando VA Medical Center records. Complete copies of the Veteran’s VA treatment records may be relevant to the Veteran’s claims to the extent they reflect further treatment for his service-connected anxiety disorder and they have not been associated with the claims file. Therefore, all pertinent VA treatment records from Orlando and any other VA facility should be obtained and properly associated with the claims file. See 38 U.S.C. § 5103A(c); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (finding that VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). B. VA Examinations Regarding the Veteran’s increased rating claim, the Veteran was last afforded a VA examination in December 2013. The examiner noted that symptoms of anxiousness, worry, and agitation were associated with the Veteran’s service connected anxiety disorder. Since then there appears to be a worsening of the Veteran’s symptoms. For example, in the April 2016 Form 9, the Veteran’s attorney noted the Veteran complained of feeling overwhelmed most of the time and that his anxiety contributes to stress at work. As such, the Board finds that a new VA examination is needed. As to the Veteran’s service connection claim, once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In the present case, in February 2014, an examiner provided an opinion regarding a possible nexus between the Veteran’s service-connected disabilities and his depression. The examiner opined that the Veteran’s depression was not related to or caused by the Veteran’s service-connected anxiety or seizure disorder. The examiner added that the Veteran’s depressive symptoms reflected current stressful circumstances that include career uncertainty, financial difficulty, and limited social interaction. The Board finds this opinion to be inadequate. The examiner did not use the as likely as not standard. Additionally, the examiner failed to address whether the Veteran’s service-connected disabilities aggravated his depression. Lastly, the Veteran’s attorney has alleged a possible nexus between the Veteran’s service and his depression and the examiner failed to address direct service connection. As such, a new examination and opinions—based on full review of the record and supported by stated rationale—are needed to fairly resolve the Veteran’s claims. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file any VA treatment records from the VA Medical Center in Orlando, Florida and any updated VA treatment records from December 2015 to the present. 2. Contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence in support of his claims, to include any records of treatment with Dr. D.E. from April 2013 to the present. Based on the response received, attempt to procure copies of all records which have not previously been obtained from identified treatment sources. 3. After completing the development requested in items 1 and 2, schedule the Veteran for an examination by an appropriate clinician to determine the nature, extent, and etiology of depression and the current severity of his service-connected anxiety disorder. For the service-connected anxiety disorder, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the disability under the rating criteria. Regarding the claim seeking service connection for depression, the examiner is asked to provide an opinion on the following questions: (a.) Identify all current chronic psychiatric disability(ies), other than the already service-connected anxiety disorder, that have existed since May 2013. (b.) Is it at least as likely as not that any psychiatric disability(ies) diagnosed in conjunction with (a.) was caused by the Veteran’s service? (c.) Is it at least as likely as not that any psychiatric disability(ies) diagnosed in conjunction with (a.) was caused by the Veteran’s service-connected anxiety disorder or seizure disorder? (d.) Is it at least as likely as not that any psychiatric disability(ies) diagnosed in conjunction with (a.) was aggravated (that is, any increase in severity beyond the natural progression of the condition) by the Veteran’s service-connected anxiety disorder or seizure disorder? A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Patel, Associate Counsel