Citation Nr: 18149473
Decision Date: 11/09/18	Archive Date: 11/09/18

DOCKET NO. 16-37 111
DATE:	November 9, 2018
REMANDED
Entitlement to service connection for an acquired psychiatric condition, to include as secondary to service-connected tinnitus and bilateral hearing loss, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from June 1978 to June 1981.
Entitlement to service connection for an acquired psychiatric condition, to include as secondary to service-connected tinnitus and bilateral hearing loss, is remanded.
The Veteran asserts that his current acquired psychiatric condition is the result of military sexual trauma (MST), or alternatively, the result of aggravation from his service-connected tinnitus and bilateral hearing loss.  The Veteran’s treatment records indicate that he carries a diagnosis of bipolar I disorder, post-traumatic stress disorder (PTSD), attention-deficit hyperactivity disorder (ADHD), and borderline personality disorder (BPD).  The April 2016 VA examiner opined that the Veteran’s acquired psychiatric condition was less likely than not the result of an in-service MST and offered a detailed rationale for this finding.  Nevertheless, the VA examiner did not offer an opinion as to whether the Veteran has a psychiatric disorder secondary to his service-connected hearing loss and tinnitus.
However, in support of his claim, the Veteran submitted an August 2016 private opinion, which found that the Veteran’s bipolar disorder was aggravated by his service connected tinnitus and hearing loss.  Unfortunately, the Board finds that the August 2016 private opinion did not consider all the relevant evidence of record and offer sufficient rationale for the opinion.  Thus, the opinion is inadequate to support the award of service connection.  Initially, the examiner did not quantify the degree of additional disability resulting from aggravation.  See 38 C.F.R. § 3.310(b).  Moreover, the Board notes that the opinion is written for purposes to establish a causal basis for a total disability rating based on individual unemployability (TDIU).  On several occasions the clinician notes TDIU criteria rather than aggravation criteria and even includes research addressing the employment impact of Veteran’s with psychiatric conditions.  Moreover, the examiner indicated that the Veteran’s hearing loss and tinnitus were debilitating; however, this finding appears to be contradicted by the noncompensable disability rating currently assigned for his hearing loss and the May 2012 VA audiological examination, which indicated that the Veteran’s tinnitus did not impact the Veteran’s daily life, including his ability to work.  Moreover, the publications submitted to support the private examiner’s opinion mainly discuss an association between chronic pain and psychiatric disorders as opposed to a relationship between hearing loss/tinnitus and depression. 
In light of the above, the Board finds that a VA examination with opinion is necessary to address whether the Veteran has a current psychiatric disorder that is proximately due to or has been aggravated (worsened beyond natural progression) by the Veteran’s service-connected hearing loss and tinnitus.  
The matter is REMANDED for the following action:
1.  Obtain the Veteran’s VA treatment records for the period from July 2016 to the present. 
2.  Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any acquired psychiatric disorder.  The examiner must opine whether it is at least as likely as not that a diagnosed acquired psychiatric disorder is (1) proximately due to service-connected hearing loss and tinnitus, or (2) aggravated beyond its natural progression by hearing loss and tinnitus.
The examiner must offer and detailed rationale for any opinion proffered and specifically address the August 2016 private opinion with supporting publications.   

 
J.N. MOATS
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. I. Sims, Associate Counsel