Citation Nr: 20021136 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 15-14 738A DATE: March 24, 2020 REMANDED Entitlement to an increased rating in excess of 30 percent for impairment of sphincter control, as a residual of prostate cancer, is remanded. Entitlement to an increased rating in excess of 40 percent for voiding dysfunction, as a residual of prostate cancer, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected prostate cancer residual disabilities, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Air Force from August 1964 to August 1968. 1. Entitlement to an increased rating in excess of 30 percent for impairment of sphincter control, as a residual of prostate cancer, is remanded. 2. Entitlement to an increased rating in excess of 40 percent for voiding dysfunction, as a residual of prostate cancer, is remanded. The Board previously remanded the Veteran’s above claims to obtain records related to the Veteran’s June 2017 colonoscopy. Those records have since been associated with the Veteran’s file and revealed a benign hyperplastic polyp. In May 2019, VA received private treatment records that reported the Veteran’s prostate-specific antigen (PSA) lab results and showed possibly distinct PSA scores (0.02 in March 2018; < 0.10 in March 2019 (reference range 0.10 – 3.99)). These records also included notations that the Veteran has a personal history of malignant neoplasm of the prostate, stating “Diagnosed 2019 (active).” In light of the foregoing, the Board has determined it is necessary to remand for an addendum opinion to determine whether the Veteran has experienced a localized recurrence of malignant neoplasms of the prostate or whether the Veteran’s condition remains in remission. On remand, the Veteran should also be afforded an updated examination to assess the severity of his sphincter control disability. 3. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected disabilities, is remanded. In a July 2018 decision, the Board remanded the issue of service connection for an acquired psychiatric disorder for a medical examination to clarify the nature and etiology of the Veteran’s psychiatric disorders. Although the Veteran received a VA contract examination in September 2019, the examiner did not adequately reconcile his conclusion that the Veteran has no current mental health disability with the prior evidence of record. Indeed, the examiner specifically stated that the medical record was silent as to any ongoing mental health diagnosis related to any medical conditions. A review of the Veteran’s claims file reveals however, that he was diagnosed with depression and anxiety in December 2011 and was prescribed medication for his condition. Additionally, a VA examiner diagnosed the Veteran with an Axis I adjustment disorder, with mixed anxiety and depression in February 2012. While it may be that a current mental health disability does not exist, the September 2019 VA examiner’s conclusion does not explain whether the prior diagnoses were indeed misdiagnoses, or whether the Veteran’s disability simply resolved. Accordingly, the Board finds it necessary to remand this issue for a new examination. The matters are REMANDED for the following action: 1. Schedule the Veteran for appropriate VA examinations to assess the severity of his service-connected prostate cancer residuals, to include voiding dysfunction and impaired sphincter control. Specifically, the examiner or examiners must indicate whether the Veteran has experienced localized recurrence of malignant neoplasms of the prostate or whether the Veteran’s condition remains in remission. See a March 29, 2019 treatment report from Dr. J.M.K. noting “Malignant neoplasm of prostate, Diagnosed 2019 (active).” 2. Schedule the Veteran for a VA examination addressing the nature and etiology of any acquired psychiatric disorder. The claims file should be sent to, and reviewed by the VA examiner. The examiner should take a history from the Veteran as to the progression of his symptoms. After review of the record, interview and examination of the Veteran, the examiner should respond to the following: a) Please clarify all current psychiatric disabilities. If no current disability is identified, please reconcile this finding with prior medical assessments showing diagnoses of anxiety, depression and an adjustment disorder, indicating whether the Veteran was previously misdiagnoses, or whether his disabilities have resolved. b) For each current or resolved psychiatric disability identified, is it at least as likely as not (50 percent or greater probability) that such disability had onset in, or is otherwise related to his period of active duty service? c) Notwithstanding the answer to the question above, is it at least as likely as not that any psychiatric disability identified was caused or aggravated beyond its natural progression by the Veteran’s service-connected disabilities, to specifically include residuals of the Veteran’s prostate cancer? The examiner must provide a complete rationale upon which his or her opinion is based. 3. After completing the above, readjudicate the Veteran’s claims based on the entirety of the evidence. If the claims remain denied, in whole or in part, the Veteran and his attorney should be issued a Supplemental Statement of the Case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Hennessy, 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.