Citation Nr: 18151430 Decision Date: 11/20/18 Archive Date: 11/19/18 DOCKET NO. 16-24 284 DATE: November 20, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder to include depression is remanded. Entitlement to service connection for sleep apnea is remanded. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a heart disability is remanded. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for diabetes mellitus is remanded. Entitlement to 10 percent evaluation based on multiple, noncompensable, service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1979 to September 1983. 1. Psychiatric Disability Essentially, the Veteran maintains that he has psychiatric disabilities, including depression, that were incurred in or aggravated by his military service. The Veteran underwent a VA psychiatric examination in March 2014. The examiner diagnosed attention deficit hyperactivity disorder (ADHD) and dysthymic disorder and opined that these disabilities existed prior to service and were not aggravated therein. In a May 2013 statement, the Veteran reported that his military performance evaluations contain evidence of his depression in service. These records are not contained in the military personnel records in the claims file, and an attempt should be made to obtain them on remand. Additionally, since the 2014 VA examination, VA outpatient treatment records show additional psychiatric diagnoses, including anxiety. Moreover, in a July 2014 statement, the Veteran’s sister reported observing increased anxiety and depression in the Veteran since his time in the military. In a July 2014 opinion, Dr. S opined that the Veteran’s psychiatric disabilities were exacerbated during his service. Accordingly, on remand, another VA medical opinion should be obtained that considers this additional evidence. Sleep Apnea, Heart Disability, Diabetes Mellitus, 10 Percent Evaluation Based on Multiple, Noncompensable, Service-Connected Disabilities The additional service connection claim and the claims to reopen include secondary service connection arguments (see argument and evidence submitted by the Veteran’s attorney in August 2016). Therefore, these claims, along with the claim for a 10 percent evaluation based on multiple, noncompensable, service-connected disabilities, will be remanded as intertwined with the claim for service connection for a psychiatric disability. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Undertake all appropriate development to obtain the Veteran’s complete service personnel file, to specifically include any performance evaluation reports and any indication of any promotion or demotion. If any such records are determined to be unavailable, a formal finding must be made for the record. 2. Thereafter, the Veteran should be afforded a VA examination to determine the nature and etiology of all psychiatric disorders that may be present. The entire claims file should be made available to and be reviewed by the examiner, and it should be confirmed that such records were available for review. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. First, the examiner must identify all current psychiatric disorders. Second, for each psychiatric disability identified: (a) Did the psychiatric disability clearly and unmistakably pre-exist the Veteran’s entry to military service in September 1979? If the examiner finds that a psychiatric disability pre-existed service, he/she should identify the disability and the evidence supporting pre-existence. (b) If a pre-existing psychiatric disability is found, is there clear and unmistakable (undebatable) evidence that such pre-existing psychiatric disability did not undergo an increase in the underlying pathology, i.e., was not aggravated beyond its natural progression, during service? The examiner should point to the specific clear and unmistakable evidence relied upon for the finding that the disability was not permanently aggravated by service. (c) If no pre-existing psychiatric disability is found, is it at least as likely as not (50 percent or greater probability) that any current psychiatric disability is of service onset, is otherwise related to the Veteran’s military service? A rationale for all opinions expressed should be provided, with consideration given to the medical opinions of record and the statement from the Veteran’s sister. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). (Continued on Next Page) 3. Undertake any additional development indicated by the results of the development requested above (to include the scheduling of any VA examinations, if necessary). A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.R.Fletcher, Counsel