Citation Nr: 18158911
Decision Date: 12/18/18	Archive Date: 12/18/18

DOCKET NO. 16-62 352
DATE:	December 18, 2018
REMANDED
Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected migraines, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from September 1967 to September 1969.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin.
Service connection for an acquired psychiatric disorder
The Veteran contends that he has an acquired psychiatric disorder that is secondary to his service-connected migraine headaches.  In October 2016, he was afforded a VA examination, following which the examining physician opined that the Veteran did not have any psychiatric diagnoses.  By way of rationale, the examiner stated:
In summary, although the veteran is reporting some occasional anxiety and depression associated with headaches it does not rise to the level of a formal psychiatric disorder under ICD 10 criteria in that it is not causing substantial impairment in psychosocial functioning.  The primary issue has been the veteran’s headaches and some other medical problems.  
Thereafter, the Veteran questioned the veracity of the examiner’s report, noting that he had been asked only three questions, and contested the examiner’s determination that he did not have a mental health diagnosis.  The Veteran noted that in fact he had in fact been diagnosed with a mental health disorder, and, moreover, had been prescribed medication.  On review, the Board agrees that the VA examiner’s findings were inadequate, as the Veteran’s VA problem list includes a diagnosis of depression/anxiety disorder that was not addressed in the examination report.  Additionally, although the Board lacks the medical expertise to opine as to whether the Veteran’s mental health symptoms amount to a diagnosis, it bears noting that the examiner’s stated criteria for a diagnosis—whether the Veteran’s symptoms were productive of “substantial” impairment—appear to be a rather high threshold, and is not consistent with the VA rating criteria pertaining to mental disorders.  See 38 C.F.R. § 4.130.
For the reasons discussed above, the Board finds that an updated VA examination is necessary.  See Barr v. Nicholson, 21 Vet. App. 303 (2007) (when VA undertakes to provide a VA examination or obtain an opinion, it must ensure that the examination or opinion is adequate).  On remand, the examiner must evaluate the entire record and offer an opinion clarifying whether the Veteran’s symptoms rise to the level of a current psychiatric diagnosis, and, if so, whether such is caused or aggravated by his service-connected migraines. 
The matter is REMANDED for the following action:
Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his claimed acquired psychiatric disorder.  The examiner must first review the entire record and clarify whether the Veteran has a current psychiatric diagnosis.  The examiner should specifically discuss the Veteran’s VA treatment notes, to include the notation of depression/anxiety disorder on his VA problem list.  Then, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any such disorder is caused or aggravated by the Veteran’s service-connected migraines.  
Aggravation is defined as worsening beyond the natural progression of the disability.
A complete rationale must be provided for any opinion offered.

 
ROBERT C. SCHARNBERGER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	T. Minot, Associate Counsel