Citation Nr: 19106943 Decision Date: 01/30/19 Archive Date: 01/29/19 DOCKET NO. 17-28 547A DATE: January 30, 2019 REMANDED The issue of service connection for an unspecified depressive disorder is remanded. The issue of service connection for obstructive sleep apnea, to include as secondary to an unspecified depressive disorder, is remanded. The issue of continued entitlement to service connection for cardiomyopathy with acute renal failure, to include as secondary to an unspecified depressive disorder, is remanded. REASONS FOR REMAND The Veteran had active duty service from October 1979 to March 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from March and September 2014 rating decisions of the VA Regional Office (RO) in Columbia, South Carolina. The issue of entitlement to a total disability rating for individual unemployability (TDIU) has been raised by the record in a January 2017 statement, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over this issue, and it is referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b) (2017). 1. Unspecified depressive disorder 2. Obstructive sleep apnea 3. Cardiomyopathy with acute renal failure The Board has determined that additional development is necessary and the appeal is, therefore, REMANDED as directed below. 1. Reasons for the remand: The Veteran contends that he has a current diagnosis of unspecified depressive disorder that is related to his active duty service. Specifically, the Veteran asserts that his symptoms of unspecified depressive disorder, to include depression, excessive worry, and drug use, began during active duty service and have continued since that time, although he was not diagnosed with unspecified depressive disorder until January 2017, approximately 27 years after his separation from active duty. Development is necessary to determine the etiology of the Veteran’s acquired psychiatric disorder, to include unspecified depressive disorder, if any. The Veteran contends that he has a sleep disorder that is secondary to his unspecified depressive disorder. He also contends that his cardiomyopathy is secondary to his unspecified depressive disorder, as he self-medicated to alleviate his psychiatric symptoms and that this drug use caused his cardiomyopathy. The claims for entitlement to service connection for a sleep disorder and cardiomyopathy are inextricably intertwined with the Veteran’s unspecified depressive disorder claim. Thus, adjudication of these claims is deferred. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). 2. Schedule the Veteran for a VA examination and obtain an opinion regarding the etiology of the Veteran’s acquired psychiatric disorder, if any. All applicable tests should be performed and the findings should be reported in detail. THE VETERAN MAY BE REQUESTED TO PROVIDE THE DATES, LOCATIONS, AND CIRCUMSTANCES OF ANY RELEVANT MEDICAL RECORDS AND/OR TREATMENT TO ENABLE VA TO INVESTIGATE THE CLAIM. All relevant medical records must be made available to the examiner for review of pertinent documents. The opinion should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Indicate all currently-diagnosed acquired psychiatric disorders of the Veteran, if any. (b.) Indicate and provide a thorough explanation of whether the Veteran had symptoms of an acquired psychiatric disorder during active duty service and, if any, whether: (i.) they resolved; OR (ii.) continued since active duty service; AND (iii.) are attributable to a currently-diagnosed acquired psychiatric disorder. ** If the examiner concludes that the Veteran had symptoms of an acquired psychiatric disorder during service but that they resolved and are not related to any currently-diagnosed acquired psychiatric disorder, the examiner must specifically state this conclusion and provide adequate rationale. ** (c.) Indicate and provide a thorough explanation of whether the Veteran’s acquired psychiatric disorder, if any, was caused or aggravated by an in-service event, injury, disorder, or disease, during the Veteran’s period of active duty. Thoroughly explain the etiology of the Veteran’s acquired psychiatric disorder, if any. The examiner’s attention is drawn to the following: * The Veteran was diagnosed with unspecified depressive disorder in January 2017, approximately 27 years after his separation from active duty. * The Veteran was found to be psychiatrically normal at his service entrance examination in August 1979. * The Veteran was found to be psychiatrically normal at his service medical examination in June 1987. * The Veteran was found to be psychiatrically normal at his service medical examination in January 1991, although he reported experiencing depression and excessive worry. * An undated in-service medical record indicated that the Veteran reported personal problems while he was overseas but that they had resolved. * The Veteran was discharged for misconduct due to drug use. * August 2000 VA treatment records show that the Veteran denied psychiatric symptoms within the previous 30 days, although there is an unclear notation of a lifetime of possible depression. * September 2000 VA treatment records show that the Veteran reported that he had been depressed roughly one year in 1997, after his abrupt separation and divorce. He also reported possible depression after the then-recent death of his mother and aunt. * September 2000 VA treatment records show that the Veteran began a VA drug program after he was asked to take a workplace drug test. VA treatment records show that the Veteran reported substance abuse problems, to include crack cocaine and alcohol, with various periods of sobriety and relapse. * September 2000 VA treatment records show that the Veteran reported isolating himself to curb his cravings and that his social isolation was due to drug use. * April 2005 VA treatment records show that the Veteran screened negative for depression and posttraumatic stress disorder. He declined feeling detached from others. * Social Security Administration (SSA) records show that the Veteran applied for SSA benefits in March 2012 for hypertension, acute renal failure, and vascular disease with onset in January 1991. There was no indication or report of symptoms and/or complaints of an acquired psychiatric disorder. A similar application was completed in September 2012, at which time the Veteran reported that he had no new mental limitations. * The Veteran’s first assertion of an acquired psychiatric disorder is in May 2014, when the Veteran submitted a new claim for VA disability compensation and related compensation benefits and service connection for his cardiomyopathy was severed. * In September and October 2016, the Veteran’s sisters reported that after his military service he was withdrawn, anxious, and depressed. One sister reported that his prior employer fired him after the Veteran was drinking alcohol during work. * In January 2017, the Veteran was interviewed by a private psychologist who diagnosed him with unspecified depressive disorder. She reported that the Veteran performed his daily living tasks, to include food shopping, preparing his own meals, attending to his personal hygiene, and managing his finances. She stated that the Veteran had a difficult time maintaining employment and social relationships, and that his physical conditions impacted his mood. The psychologist concluded that the Veteran’s unspecified depressive disorder began in service and continued uninterrupted to the present. She reported that the Veteran “admits self-medicating with drugs in the past and alcohol in the present (drinks one or two half pints daily).” 3. IF IT IS DETERMINED THAT THE VETERAN HAS A MENTAL DISORDER THAT WAS CAUSED OR AGGRAVATED BY SERVICE (AS ABOVE), SCHEDULE A PHYSICAL EXAMINATION TO BE CONDUCTED BY AN APPROPRIATELY-QUALIFIED PHYSICIAN TO DETERMINE IF THE VETERAN HAS EITHER OR BOTH BELOW DISORDERS THAT WERE CAUSED BY THE MENTALL DISORDER: (A) SLEEP APNEA AND; (B) ACTIVE CARDIOMYOPATHY WITH RENAL FAILURE OR RESIDUALS Thorough explanations must be provided for the opinions rendered. If the examiner cannot provide an opinion without resorting to speculation, he or she should expressly indicate this and provide supporting rationale as to why an opinion cannot be made without resorting to speculation. 4. After completion of the above and any other appropriate development deemed necessary, readjudicate the issues on appeal. If the benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). (Continued on the next page)   This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (2012). Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Carolyn Colley, Associate Counsel