Citation Nr: 18149788
Decision Date: 11/13/18	Archive Date: 11/13/18

DOCKET NO. 09-32 203A
DATE:	November 13, 2018
REMANDED
Entitlement to service connection for an acquired psychiatric disorder is remanded.
REASONS FOR REMAND
The Veteran served on active duty from June 1977 to June 1993. 
This claim was remanded by the Board of Veterans’ Appeals (Board) in February 2014 and February 2016.  In August 2017, the Board denied the claim.  The appellant appealed.
In May 2018, the United States Court of Appeals for Veterans Claims granted a joint motion for remand. The parties to the joint motion for remand agreed that VA’s duty to assist requires the conduct of a new examination, and that examination was to consider a March 1993 report of medical history in which the Veteran endorsed “depression or excessive worry,” “loss of memory,” and “nervous problems;” as well as an October 1993 medical certificate reflecting a diagnostic impression of anxiety. The parties also agreed that the examiner should address whether the Veteran’s psychiatric disorder was caused or aggravated by his service-connected disabilities. Accordingly, remand is warranted. 
The Board acknowledges the representative’s submission of a September 2018 opinion of Dr. J.S. that the Veteran’s major depressive disorder “developed secondary to his service-connected physical disabilities.” Given the substantial conflicting evidence of record, the Board finds that remand is most appropriate. 
Accordingly, the matter is REMANDED for the following action:
1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed acquired psychiatric disorder. For each and every acquired psychiatric disorder diagnosed at any time by any examiner since February 27, 2006, the examiner must opine whether it is at least as likely as not that the disorder is related to an in-service injury, event, or disease, including claimed in-service head trauma. The examiner must address the March 1993 report of medical history in which the Veteran reported “depression or excessive worry,” “loss of memory,” and “nervous trouble,” and the October 1993 medical certificate reflecting a diagnostic impression of anxiety.
For each acquired psychiatric disorder diagnosed at any time by any examiner since February 27, 2006, the examiner must also opine whether it is at least as likely as not caused by one or more service-connected disabilities, to include posttraumatic headache syndrome, chronic sinusitis, residuals of a left leg laceration with transection of the superficial peritoneal nerve and anterior muscle with left leg radiculopathy, a lumbosacral strain, two deep scars of the left leg, right lower extremity radiculopathy, left knee tender scars, left knee instability, right knee arthritis knee, right little finger fracture residuals, tinnitus, left knee arthritis, a right ear sensorineural hearing loss, and left ear hearing loss. 
If not, the examiner must opine whether any such acquired psychiatric disorder is at least as likely as not aggravated by one or more service-connected disabilities. 
The examiner must specifically address the September 2018 opinion of Dr. J.S. that the Veteran’s major depressive disorder “developed secondary to his service-connected physical disabilities.” If aggravation is found, the examiner must also state, to the extent possible, the baseline level of disability prior to aggravation. 
A complete, well-reasoned rationale must be provided for any opinion offered.  If any requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training.
 
DEREK R. BROWN
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Paul J. Bametzreider, Associate Counsel