Citation Nr: 18159374 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 09-27 451 DATE: December 19, 2018 REMANDED Service connection for an acquired psychiatric disorder, to include PTSD and/or a depressive disorder as secondary to a service-connected skin disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1965 to September 1967, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal an October 2008 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2012, the Veteran testified at a videoconference hearing before a Veterans Law Judge (VLJ) who is no longer employed by the Board. The Veteran was provided an opportunity for another hearing before a different VLJ, which was declined in December 2017. In October 2012, the Board remanded the claim on appeal for additional development. In a January 2018 decision and remand, the Board remanded the claim on appeal for additional development, and granted service connection for a skin disability, to include squamous cell carcinoma with residuals. In May 2018, the Veteran appealed the January 2018 Board decision and remand to the United States Court of Appeals for Veterans Claims (Court). In July 2018, the Court dismissed the Veteran’s appeal. See July 2018 Court Decision. The Board observes that the issue of a total disability rating due to individual unemployability (TDIU) has been raised by the record. See February 2011 Medical Opinion. The issue of entitlement to a TDIU is referred to the agency of original jurisdiction for appropriate action. See 38 C.F.R. § 19.9. Through his fiduciary, the Veteran has submitted additional statements concerning his need for the regular aid and attendance for another person. See, e.g., December 2017 Correspondence; May 2018 Correspondence. A statement of the case (SOC) was issued concerning this issue, but the Veteran did not timely perfect his appeal. See October 2015 SOC. If the Veteran believes that he requires the regular aid and attendance of another person due to his service-connected disabilities, he is encouraged to file a claim on the appropriate VA-promulgated form. 1. Service connection for an acquired psychiatric disorder, to include PTSD and/or depression as secondary to a service-connected skin disability, is remanded. Remand is necessary, as the September 2018 medical opinion obtained pursuant to the January 2018 remand directives is inadequate, as the examiner’s opinion that “[t]here is not overwhelming evidence of record indicating that the [V]eteran has a current, chronic, disabling mental disorder associated with his service” does not address the appropriate legal standard. Thus, an addendum opinion is necessary to address this deficiency. Moreover, the Board observes that the issue of secondary service connection has been raised, as the examiner noted that the Veteran’s significant medical problems contribute to his mental health concerns. Accordingly, an opinion should be secured addressing whether the Veteran has an acquired psychiatric disorder that has been caused or aggravated by a service-connected disability. Any outstanding treatment records should also be secured. The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then refer the claims file to an appropriate clinician for an addendum opinion as to the nature and etiology of any acquired psychiatric disorder. 4. Based on a review of the claims file, the examiner is asked to respond to the following: (a) Diagnose any acquired psychiatric disorders, to include depression, present since April 2008, and address any conflicting diagnoses of record. (b) For each acquired psychiatric disorder so identified, state whether it is at least as likely as not (a 50 percent or greater probability) that such disorder: (i) had its onset during active service, or is otherwise etiologically related to the Veteran’s active duty service, to include service in Vietnam; (ii) is proximately related to the Veteran’s service-connected disabilities, to include his skin disability (squamous cell carcinoma and actinic keratosis); or (iii) has been aggravated (worsened beyond natural progression) by the Veteran’s service-connected disabilities, to include his skin disability (squamous cell carcinoma and actinic keratosis). Please provide a separate answer for each sub-part of question 1(b) for each acquired psychiatric disorder diagnosed in response to question 1(a). A complete rationale must be provided for all opinions. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion than an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.M. Badaczewski, Associate Counsel