Citation Nr: 18155221 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 15-05 211 DATE: December 3, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder other than posttraumatic stress disorder is remanded. Entitlement to service connection for headaches, to include secondary to service-connected tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty for training from June 7, 1990 to August 10, 1990, and from June 13, 1991 to November 18, 1991. The claimant’s current service connected disorders all arise from his second term of active duty for training, hence, he is a Veteran for that period alone. Acquired psychiatric disorder other than posttraumatic stress disorder In February 2017, a VA examiner opined in favor of service-connection for posttraumatic stress disorder and an anxiety disorder. An addendum opinion was sought on the basis that the Veteran’s statements regarding his in-service stressors were found to lack credibility. In May 2017, the examiner declined to provide an opinion either as to the Veteran’s current psychiatric diagnoses or as to the etiology of any acquired psychiatric disorder. While the Board observes that the record reveals discrepancies between his reports and the objective evidence of record, the service treatment records do contain notes of “anxiety,” as well as multiple psychiatric diagnoses. The Board finds that remand is necessary to obtain another medical opinion to resolve the conflicting evidence of record. Headaches An October 2015 opinion of a private physician indicates that the Veteran’s headaches may be related to his service-connected tinnitus. In February 2017 a VA examiner opined against an in-service etiology of the Veteran’s headaches, but did not explicitly address whether headaches were caused or aggravated by service-connected tinnitus. Remand is necessary to obtain a medical opinion regarding whether the Veteran’s headaches were caused or aggravated by his tinnitus. Accordingly, the matters are REMANDED for the following action: 1. Obtain a joint prepared medical opinion from a clinical psychiatrist and a clinical psychologist addressing the nature and etiology of any diagnosed acquired psychiatric disorder other than posttraumatic stress disorder. These reviewers must be provided access to the appellant’s VBMS and Virtual VA/Legacy files. For each acquired psychiatric disorder other than posttraumatic stress disorder diagnosed at any time since July 5, 2013, the psychiatrist and psychologist must opine whether there is clear and unmistakable evidence that an acquired psychiatric disorder pre-existed the appellant’s active service between June 1991 and November 1991. If so, the psychiatrist and psychologist must opine whether there is clear and unmistakable evidence, i.e., evidence to which reasonable people cannot disagree, that the preexisting psychiatric disorder was not aggravated, i.e., permanently worsened beyond the natural progress of the disease, during service. If there is not clear and unmistakable evidence that any diagnosed acquired psychiatric disorder other than posttraumatic stress disorder preexisted service, the psychiatrist and psychologist must opine whether it was at least as likely as not incurred in or otherwise related to the Veteran’s active-duty service. The psychiatrist and psychologist must discuss the September 2015 opinion of private psychologist H.H. that the Veteran had a diagnosis of unspecified depressive disorder which was more likely than not incurred in service. The reviewers must also discuss the July 1991 service treatment record noting that the Veteran felt tense and nervous, and providing an impression of anxiety, as well as a second July 1991 service treatment record noting “recurring visits to sick call regarding dizziness, weakness, anxiety, [and] hyperventilation.” The psychiatrist and psychologist are advised that at the February 2017 VA examination the Veteran reported that he had a normal childhood and a normal relationship with his father and stepmother. By contrast, August 2006 VA treatment records note that the Veteran reported physical abuse by his stepmother. The service treatment records reflect that the Veteran was in counseling from the age of 13 to 18, and he has reported that this was family counseling related to the combining of his father than stepmother’s families. Further, while the February 2017 VA examination report notes the appellant’s statement that he was assaulted on four occasions by other soldiers during his active-duty service because he had to assign them additional duties, there is no objective evidence to support that the Veteran was assaulted in active service, nor does the record support that he was in a position of authority such that he would have assigned duties to his fellow soldiers. VA treatment records reflect that the Veteran reported that he was in the Army from 1995 to 2007 and that he served as a captain in Iraq from 2003 to 2006. The objective evidence shows that the Veteran left active duty in November 1991 and has had no further active or inactive military service. Indeed, the Veteran himself has acknowledged that these reports are inaccurate and has attempted to correct his medical records. He has suggested that the statements were invented by his treating providers. See July 2017 statement in support of claim. If the reviewers find that the Veteran’s lay statements of history of the disorder are not credible, they must explain why this is so. If any additional examinations are needed they must be conducted. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the reviewers 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 reviewers, i.e., additional facts are required, or the reviewers do not have the needed knowledge or training. 2. Obtain a medical opinion from an appropriate medical professional addressing whether the Veteran’s headaches are at least as likely as not proximately due to tinnitus. If not, the reviewer must address whether it is at least as likely as not that headaches are aggravated beyond their natural progression by tinnitus. The reviewer must discuss the October 2015 opinion of Dr. H.S. that the Veteran’s headaches were related to his tinnitus. If, and only if, the Veteran’s acquired psychiatric disorder is found to be service-connected, the reviewer must also opine whether headaches are at least as likely as not proximately due to a service-connected acquired psychiatric disorder. If not, the reviewer must address whether it is at least as likely as not that headaches are aggravated beyond their natural progression by any service-connected acquired psychiatric disorder. The examiner must discuss the October 2015 opinion of Dr. H.S. that headaches were related to “stress.” If aggravation is found in connection with either opinion requested above, the reviewer must also state, to the extent possible, the baseline level of disability prior to aggravation. If the reviewer finds that the Veteran’s lay statements of history of the disorder are not credible, he/she must explain why this is so. If any additional examinations are needed they must be conducted. A complete, well-reasoned rationale must be provided for any opinion offered. If the 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