Citation Nr: 18150364 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 14-24 793 DATE: November 15, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, other than posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for polysubstance dependence, to include as secondary to the Veteran’s PTSD, is remanded. REASONS FOR REMAND The Veteran had active military service from February 1988 to July 1991. This matter comes before the Board of Veterans’ Appeals (Board) from the March 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. The Veteran appeared at an October 2015 hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017). 1. Entitlement to service connection for an acquired psychiatric disorder, other than posttraumatic stress disorder (PTSD). The Veteran contends that he has an acquired psychiatric disability, other than PTSD, that is etiologically related to his active service. The VA treatment records reflect diagnoses for depression, anxiety, and polysubstance abuse. A February 2013 VA examiner provided diagnoses for adjustment disorder with mixed anxiety and depressed mood; polysubstance dependence in early sustained remission, and antisocial personality disorder. In remarks, the examiner noted that the Veteran has a longstanding history of legal problems, interpersonal violence, and substance abuse that preceded his military career and has persisted since that time. He opined, “All diagnosed disorders are less likely as not caused by or a result of military experiences.” In its December 2016 Remand, the Board found that the February 2013 VA examiner’s opinion to be inadequate for decision-making purposes, and that a remand was necessary to obtain an adequate VA opinion as to the Veteran’s acquired psychiatric disabilities other than PTSD and polysubstance dependence. See Barr, 21 Vet. App. at 312. Specifically, the February 2013 VA examiner did not provide adequate rationale for the negative nexus opinion. To the extent that the VA examiner referred to the Veteran’s pre-service psychiatric symptoms as rationale for the opinion, the Board notes that the Veteran’s January 1988 medical examination for entrance to active service reflects a normal psychiatric evaluation and does not otherwise note a psychiatric condition. Furthermore, the Veteran’s statements as to pre-service legal problems, interpersonal violence, and substance abuse do not constitute clear and unmistakable evidence that he had a psychiatric disability at the time of his entrance into service. Therefore, the Veteran is considered to have been sound as to psychiatric conditions upon entrance into service. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Accordingly, the VA examiner’s reference to the Veteran’s pre-service history does not constitute adequate rationale for the opinion that all disorders diagnosed at the February 2013 VA examination are less likely as not caused by or a result of military experiences. Additionally, the Board noted that, in the Veteran’s private evaluation in July 2016, the physician did not provide opinions as to the likely etiologies of the Veteran’s polysubstance abuse and acquired psychiatric disabilities other than PTSD. Therefore, there were no adequate medical opinions of record as to the etiologies of the Veteran’s acquired psychiatric disabilities other than PTSD and this matter was remanded in September 2016. Pursuant to the Board’s September 2016 remand, the Veteran underwent a VA examination in March 2017. The examiner stated that the Veteran is currently diagnosed with cannabis use disorder, cocaine use disorder, and antisocial personality disorder. The VA examiner stated that he disagreed with the Veteran’s July 2016 private psychological examination and all of the diagnoses within it. Specifically, the examiner noted that the Veteran does not meet the full criteria for PTSD, depression, anxiety, or any other mental health disorder. However, although the March 2017 VA examiner found that the Veteran does not meet the diagnostic criteria of the diagnoses discussed in the Veteran’s private July 2016 evaluation, the VA examiner did not discuss or acknowledge that the Veteran has previously been diagnosed with acquired psychiatric disorders by the VA. For example, a VA record dated in January 2013 indicates that the Veteran had been diagnosed with anxiety and depression. Therefore, an addendum opinion is warranted to determine whether or not any diagnosed acquired psychiatric disorders during the appeal period are related to the Veteran’s military service as no adequate opinion regarding their etiology is of record. 2. Entitlement to service connection for polysubstance dependence, to include as secondary to the Veteran’s PTSD. As to the claim for entitlement to service connection for polysubstance abuse, service connection may not be granted for substance abuse on the basis of service incurrence or aggravation. 38 U.S.C. §§ 105, 1110, 1131; 38 C.F.R. § 3.301(a); VAOPGCPREC 2-98. However, secondary service connection is available for polysubstance abuse if such abuse is found to be secondary to a service connected disability. As such, in the Board’s September 2016 remand, the VA examiner was instructed to provide an opinion as to whether the Veteran’s polysubstance abuse is secondary to any acquired psychiatric disability other than PTSD. As discussed above, at the Veteran’s March 2017 VA examination, the examiner found that the Veteran does not meet the diagnostic criteria for any acquired psychiatric disorder. Therefore, the examiner did not provide an opinion regarding the Veteran’s polysubstance abuse. However, the Board finds that an opinion is required to determine whether the Veteran’s polysubstance abuse is secondary to the Veteran’s service connected PTSD. Additionally, as the resolution of the claim for service connection for an acquired psychiatric disorder, other than PTSD, might be determinative of the Veteran’s claim for service connection for a polysubstance disorder, the issues are inextricably intertwined, and the polysubstance abuse issue must also be remanded. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Therefore, a remand is necessary to obtain an addendum opinion regarding the etiology of the Veteran’s polysubstance abuse. Since the claims file is being remanded, it should be updated to include any outstanding VA treatment records. See 38 C.F.R. § 3.159(c)(2); see also Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate those documents with the Veteran’s claims file. 2. Schedule the Veteran for an examination to provide an opinion as to the nature and etiology of the Veteran’s polysubstance abuse, to include as secondary to the Veteran’s service connected PTSD, that has been present during the period on appeal. Additionally, the examiner is instructed to diagnose any other acquired psychiatric disorders that have been present during the period on appeal (December 2012 to present). After reviewing the record, to include the Veteran’s lay testimony, the examiner is asked to address the following: a) Is it at least as likely as not (a 50 percent probability or greater), that any diagnosed acquired psychiatric disorder, other than PTSD, was caused by service, or is otherwise related to the Veteran’s military service? If the examiner finds that the Veteran has never met the criteria for any psychiatric diagnosis other than PTSD, the examiner must discuss the previous diagnoses rendered by VA and explain why he disagrees with such diagnoses. b) Is it at least as likely as not (a 50 percent or higher probability) that the Veteran’s polysubstance abuse was caused by his service connected PTSD or any other diagnosed acquired psychiatric disorder? c) Is it at least as likely as not (a 50 percent or higher probability) that the Veteran’s polysubstance abuse was aggravated by his service connected PTSD or any other diagnosed acquired psychiatric disorder? All opinions provided must be thoroughly explained and an adequate rationale for any conclusions reached must be provided. If any requested opinion cannot be provided without resort to speculation, the medical professional should state and explain why an opinion cannot be provided without resort to speculation. 3. Following completion of the above, and a review of any additional evidence received, the RO should also undertake any other development it deems to be necessary, to include, if warranted, an addendum medical opinion which considers any newly received evidence. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mountford, Associate Counsel