Citation Nr: 20076575 Decision Date: 12/02/20 Archive Date: 12/02/20 DOCKET NO. 16-46 648 DATE: December 2, 2020 REMANDED Service connection for psychiatric disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1961 to August 1961. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2017 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned Veterans Law Judge (VLJ) in December 2019. This case was previously remanded by the Board in March 2020 for additional development. Service connection for an anxiety disorder, secondary to service-connected tinnitus is remanded. The Veteran contends that he has anxiety as a result of the loud noise exposure he experienced when he was on active duty in the Army in 1961. A VA examination was conducted in January 2017 which provided a DSM-5 diagnosis of agoraphobia. The Veteran noted multiple stressors, including attending law school, graduating, and paying his way through law school. The Veteran noted that he dealt with symptoms of anxiety by participating vocally in the classroom discussion and getting his mind off of his anxiety. The examiner opined that the condition was less likely than not related to service-connected tinnitus or by the firing of weapons without hearing protection. The rationale provided, was that there was no objective medical evidence that supported a link, or nexus, between firing weapons without hearing protection (with resulting tinnitus) and agoraphobia, or other anxiety disorders. In the Veteran’s February 2017 Notice of Disagreement, he argued the examiner failed to adequately research causal relation of loud noise trauma to the finding of an anxiety disorder. Subsequently, the RO considered medical records from Biloxi VAH which noted anxiety systems starting in Veteran’s third year of law school, feelings of being uncomfortable in multiple settings, and the Veteran’s contentions that his symptoms started in 1965 and have been recurrent including passing out “14 or 15 times.” However, because of the VA examiner’s negative nexus opinion, the Veteran’s claim was denied. In the March 2020 Board decision, the claim was remanded to provide a VA examination for the Veteran’s anxiety disorder, and for an opinion on whether it is as least as likely as not that the Veteran has a psychiatric disability that was cased or aggravated by his service-connected tinnitus. The Veteran was provided a VA mental disorders examination in September 2020. The VA examiner opined for a negative nexus opinion as to secondary service connection, stating there does not appear to be a nexus between current anxiety and tinnitus; additionally the VA examiner stated agoraphobia began two years after discharge and there is no evidence in the STRs that the disorder was aggravated beyond its natural progression by tinnitus. See September 2020 C&P Exam. In recent letters to the VA, the Veteran provided lay statements in which he asserts that he did not contend that his anxiety disorder was a result of or caused by tinnitus; rather, he claims that the same injurious events at the Army Reserve summer camp in 1962, the concussive gun powder explosions and the M-1 rifle firing, may have caused the two year delayed anxiety disorder, which also caused his tinnitus. See August 2020 & September 2020 Correspondence. The Veteran also references a psychiatrist he consulted in 1980 regarding mental health treatment, who opined “there was then no cure for what he also diagnosed as agoraphobia.” Id. The Board notes that the January 2017 VA examination for mental disorders does provide a direct service nexus opinion; however, the examiner does not consider the Veteran’s lay statements regarding his delayed onset and psychiatric symptoms. The September 2020 VA examination and medical opinion do not address direct service connection for Veteran’s agoraphobia. In light of the above, the Board finds that another VA examination is necessary prior to the adjudication of the claim as to his claim for service connection for an anxiety disorder. Such examination must be accomplished on remand. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of the Veteran’s psychiatric symptomatology. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 2. Obtain a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) from an appropriate clinician to address the claim for service connection for psychiatric disability. All psychiatric disabilities should be identified. The examiner is to provide an opinion as to whether the Veteran has a current diagnosis of a psychiatric disability and whether it at least as likely as not had its onset during his active duty service. In offering this opinion, the examiner must acknowledge and discuss the Veteran’s report as to the impact of his in-service acoustic trauma on the development of his psychiatric disability. The examiner must also opine as to whether it is at least as likely as not that the Veteran has a psychiatric disability that was caused or aggravated by any service-connected disability, to include the aggregate impact of his service-connected bilateral hearing loss and tinnitus. A complete and thorough rationale must be provided for all opinions. If the examiner cannot provide an opinion without resorting to speculation, then he or she must provide a complete and thorough rationale as to why an opinion cannot be provided. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor 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.