Citation Nr: 18159567 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 16-47 924 DATE: December 20, 2018 REMANDED Entitlement to service connection for a psychiatric disability, to include depression and anxiety and as secondary to service-connected bilateral knee and back disabilities is remanded. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to a psychiatric disability is remanded. Entitlement to service connection for headaches, to include as secondary to a psychiatric disability and OSA is remanded. REASONS FOR REMAND The Veteran had active military service in the United States Marine Corps from June 2001 to June 2005. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision issued by the VA Regional Office (RO) in Roanoke, Virginia. The Board finds that additional development is required before the appeal is decided. The Veteran has contended that he has depression and anxiety that is secondarily-related to his service connected bilateral knee and back disabilities. Service treatment records (STRs) are silent for any in-service complaints of, treatment for, or diagnosis of a psychiatric disability, to include depression and anxiety. Additionally, there are no symptoms of depression, anxiety, or manifestations of any other psychiatric disability noted in the Veteran’s post-service VA and private medical records. In July 2014, the Veteran underwent a private psychological evaluation. He was diagnosed with depressive disorder due to another medical condition with mixed features. He reported symptoms of depression and anxiety and that he was unable to sleep and experienced discomfort due to his bilateral knee and back disabilities. He added that he would fall asleep at work and become upset that people would think less of him or that he was lazy. He commented that he was embarrassed by his lack of energy and that he was unable to do more with his children. The psychologist noted that the Veteran’s depressive disorder was debilitating and had caused a remarkable decline in the Veteran’s quality of life. The psychologist concluded that the Veteran’s bilateral knee and back disabilities had manifested as or caused the Veteran’s depressive disorder. Further, the psychologist opined that the Veteran’s bilateral knee and back disabilities were more likely than not aggravating the Veteran’s depressive disorder. In support of this opinion, the psychologist cited a body of literature that supported a causal relationship between medical conditions and psychiatric disabilities. Additionally, the psychologist noted that a March 2013 VA examination documented that the Veteran’s bilateral knee and back disabilities impacted his ability to work due to pain with walking and/or bending. The Board finds that a VA examination is warranted to determine the nature and etiology of the Veteran’s diagnosed psychiatric disability. In this regard, the private psychologist’s rationale conflates the Veteran’s symptoms, to include problems sleeping, lack of energy, and inability to do more, and did not discuss the causal connection exclusively in the context of the Veteran’s depressive disorder. Moreover, to the extent that the private psychologist opined that the Veteran’s depressive disorder was aggravated by the Veteran’s service-connected bilateral knee and back disabilities, the Board finds that remand is warranted to establish the baseline level of severity. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Additionally, the Board notes that the Veteran underwent a private evaluation by Dr. H. S. for his headache disability in July 2015. The Board finds the rationale provided to be internally inconsistent. Despite the Veteran’s report that his headache disability and OSA began during service, Dr. H. S. did not make a finding of entitlement to service connection on a direct basis. Instead, in July 2015, Dr. H. S. opined that it was as likely as not that the Veteran’s headaches were aggravated by his depressive disorder and OSA. Likewise, in August 2015, Dr. H. S. opined that the Veteran’s depressive disorder aided in the development of and permanently aggravated the Veteran’s OSA. As such, the Board finds that a remand is necessary to establish, at a minimum, the baseline level of severity of the Veteran’s headache disability and OSA. Further, in light of the Veteran’s report that his OSA began and has continued since service, and the post-service diagnosis of OSA; the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of any currently present OSA. McLendon, 20 Vet. App. 81. Finally, current treatment records should be identified and obtained before a decision is made in the appeal. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present psychiatric disability. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present psychiatric disability is etiologically related to the Veteran’s active service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present psychiatric disability was caused or aggravated (chronically worsened) by the Veteran’s service-connected back, and right and left knee disabilities. The rationale for all opinions expressed must be provided. 3. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present obstructive sleep apnea. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present obstructive sleep apnea is etiologically related to the Veteran’s active service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present obstructive sleep apnea was caused or aggravated (chronically worsened) by the Veteran’s psychiatric disability. The rationale for all opinions expressed must be provided. 4. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present headache disability. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present headache disability is etiologically related to the Veteran’s active service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present headache disability was caused or aggravated (chronically worsened) by the Veteran’s psychiatric disability or obstructive sleep apnea. The rationale for all opinions expressed must be provided. 5. Confirm that the VA examination reports and all medical opinions provided comport with this remand, and undertake any other development determined to be warranted. 6. Then, readjudicate the remaining claims on appeal. If the decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD