Citation Nr: 20002214 Decision Date: 01/09/20 Archive Date: 01/09/20 DOCKET NO. 84-16 821 DATE: January 9, 2020 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from November 1972 to July 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 1984 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburg, Pennsylvania. This matter was previously before the Board in June 2015, and November 2016 at which time the Board reopened the Veteran’s claim and remanded the matter for further development, and subsequently, in October 2017 when the Board denied the Veteran’s claim. The Veteran thereafter appealed the Board’s denial to the United States Court of Appeals for Veterans Claims (Court). Consequently, the Board's decision was vacated and remanded pursuant to a May 2019 Memorandum Decision. The Court determined that the Board’s October 2017 decision denying the Veteran’s service connection claim for acquired psychiatric disorder is not supported with an adequate statement of reasons or bases, specifically with regards to the reason the January 2017 medical evidence was given more weight over the other psychiatric evaluations of record, and with respect to the adequacy of the examination, which did not explain why one particular diagnosis was found to be more appropriate than other diagnoses that were of record at that time. 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Veteran submitted VA and private treatment records that reflect diagnoses of somatoform psychiatric disorders, including an Axis II paranoid personality disorder, which was the basis for the Board reopening the Veteran’s claim in November 2016, at which time the matter was remanded for a VA examination. During the January 2017 VA examination, the examiner confirmed the Veteran’s paranoid personality disorder diagnosis but concluded that his disorder was not caused or exacerbated by his military service. The examiner also opined that the Veteran did not meet the diagnostic criteria for any other mental disorder, also finding that there was no evidence to suggest that the Veteran's personality disorder, “which clearly and unmistakably existed prior to service, was exacerbated beyond its natural progression by any in-service event or injury”. However, the examiner failed to provide factual data and medical literature to support his negative nexus opinion, including his finding of no aggravation, especially since the Veteran’s service treatment record (STR) does not include an entrance examination with a noted preexisting personality disorder condition. Therefore, notwithstanding the Board’s prior denial of the Veteran’s claim, the Board finds that it must remand this issue for a new VA examination, by an examiner other than the January 11, 2017, VA examiner, in order to obtain a more complete evaluation and etiology of the Veteran’s psychiatric symptoms, especially in light of the Veteran’s in-service July 1973 diagnoses of “transient situational disorder” and “underlying immature personality disorder" and a corresponding recommendation for discharge, and the lack of a clear explanation as to why other diagnoses were not found to be viable diagnoses. The matter is REMANDED for the following action: 1. Enlist the Veteran’s assistance to obtain all outstanding psychiatric treatment records, especially the 1975 hospitalization admission record from VAMC Pittsburg (Highland Drive location) that is referenced in several of the Veteran’s treatment records. 2. Schedule the Veteran for an appropriate examination by a VA psychiatrist or psychologist other than the January 11, 2017, VA examiner, to determine the nature and etiology of any acquired psychiatric disabilities under the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria. The complete electronic file, including a copy of this REMAND, should be provided to the examiner prior to conducting the examination, and the examiner should indicate that the Veteran's records have been reviewed. The examiner should then: (a) Provide a specific diagnosis of any other current psychiatric disability that meet the DSM-5 criteria. (b) As to each diagnosed acquired psychiatric disorder, the examiner should opine whether is it at least as likely as not (50 percent or greater probability) that the psychiatric disorder was caused by the Veteran’s period of service from November 1972 to July 1973. For purposes of this analysis, the examiner is also asked to discuss the in-service notation of personality disorder and complaints of depression, nervousness, and other mental health symptoms. If the Veteran does have a personality disorder, the examiner should address whether it increased in severity while he was on active duty by a “superimposed” disease or injury, and whether it resulted in additional disability. The examiner must explain the rationale for all opinions given, citing to supporting factual data and medical literature, as deemed appropriate. In rendering the requested opinions, the examiner should also specifically consider and discuss the Veteran's contentions, lay statements of record, and medical records regarding the conditions and experiences in service and their effect on the Veteran. If the examiner cannot provide an opinion without resorting to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. 3. After all of the above development has been completed, the Agency of Jurisdiction (AOJ) should readjudicate this issue on appeal. If the benefit sought is not granted, the AOJ should send the Veteran and his representative a Supplemental Statement of the Case, provide an opportunity to respond, and then, if necessary, return the case to the Board for further appellate review. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.B. King, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.