Citation Nr: 20002525 Decision Date: 01/10/20 Archive Date: 01/10/20 DOCKET NO. 16-08 504 DATE: January 10, 2020 REMANDED 1. Entitlement to service connection for panic disorder, to include as due to Gulf War syndrome and/or undiagnosed illness, is remanded. 2. Entitlement to service connection for insomnia, to include as due to Gulf War syndrome and/or undiagnosed illness, or as secondary to panic disorder, is remanded. 3. Entitlement to service connection for fatigue, to include as due to Gulf War syndrome and/or undiagnosed illness, or as secondary to panic disorder, is remanded. REASONS FOR REMAND The Veteran had active service in the Army from September 1990 to December 1992. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously considered the case in September 2018, when it denied entitlement to service connection including for fatigue, insomnia, and panic disorder. The Veteran perfected an appeal to the Court of Appeals for Veterans Claims (Court). In July 2019, the Court granted a Joint Motion for Remand (JMR), which vacated the September 2018 Board decision as to the issues on appeal, and remanded for action consistent with the JMR. 1. Entitlement to service connection for panic disorder, to include as due to Gulf War syndrome and/or undiagnosed illness, is remanded. 2. Entitlement to service connection for insomnia, to include as due to Gulf War syndrome and/or undiagnosed illness, or as secondary to panic disorder, is remanded. 3. Entitlement to service connection for fatigue, to include as due to Gulf War syndrome and/or undiagnosed illness, or as secondary to panic disorder, is remanded. The parties to the JMR agreed that the March 2014 VA psychiatric examination was inadequate. While the March 2014 VA psychiatric examiner stated that panic disorder was less likely than not associated with service because his “[s]ymptoms began in 2009 and his military service ended in 1992,” the March 2014 VA psychiatric examiner did not address the Veteran’s documented treatment for insomnia during service, nor the March 2014 Gulf War examiner’s opinion that panic disorder can cause insomnia. See December 1992 service treatment records. Accordingly, the Board finds that remand is required for an additional VA addendum opinion addressing this in-service treatment and whether his insomnia was a manifestation of his current panic disorder. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see Stegall v. West, 11 Vet. App. 268, 271 (1998). The parties to the JMR also agreed that the issues of entitlement to service connection for insomnia and fatigue are inextricably intertwined with the issue of entitlement to service connection for panic disorder. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined). Therefore, the Board finds that the claims for service connection for insomnia and fatigue must be deferred pending completion of the action requested below. Finally, the Board notes that private medical records from one provider have not yet been associated with the record, because the provider determined that the Veteran’s authorization for release was not entirely HIPAA compliant. See September 2014 correspondence. On remand, the RO should again attempt to locate these private medical records and associate them with the record. The matters are REMANDED for the following action: 1. With the Veteran’s assistance and authorization, attempt to obtain the outstanding private medical treatment records as referenced in a September 4, 2014 correspondence response referencing invalid authorization per HIPAA, and associate them with the claims file. 2. Forward the record and a copy of this remand to a suitably qualified VA examiner for completion of an addendum opinion. If the examiner determines that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. Following review of the record, the examiner should express an opinion as to: Whether it is at least as likely as not (50% or greater probability) that the Veteran has panic disorder related to active service, to include as manifested by insomnia during service in December 1992, to include as due to Gulf War syndrome and/or undiagnosed illness. Rationale must be provided for the opinion proffered. In providing this opinion, the VA examiner must address the Veteran’s documented in-service treatment for insomnia in December 1992. The examiner should also reconcile his/her opinion with the March 2014 VA Gulf War examiner’s statement that panic disorder can cause insomnia. 3. After completion of the above, review the expanded record, including the evidence entered since the most recent supplemental statement of the case, and readjudicate the issues on appeal. If any benefit sought remains denied, furnish the Veteran and his representative with a supplemental statement of the case. The appropriate period should be allowed for response before the appeal is returned to the Board. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Frasch, 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.