Citation Nr: 20049983 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 15-37 367 DATE: July 28, 2020 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active military service from January 1974 to May 1976. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran requested a hearing. See October 2015 Form 9. The Veteran was scheduled for a hearing in August 2018. In July 2018, prior to the hearing, the Veteran’s representative withdrew the Veteran’s request for a hearing before the Board. See July 2018 Hearing Related. As such, the Board finds the Veteran’s request for a hearing is deemed withdrawn. By way of background, in January 2019, the Board remanded the issue on appeal as well as the claims for entitlement to service connection for a low back disability, cervical spine disability, and headaches for further development. During the appeal process, in a June 2020 rating decision, the RO granted service connection for a low back disability, cervical spine disability, and headaches. As such, the issues of entitlement to service connection for a low back disability, cervical spine disability and headaches are no longer on appeal. Entitlement to service connection for an acquired psychiatric disability, to include as secondary to service-connected disabilities, is remanded. At the outset, the Board notes that the Veteran has a current diagnosis of cannabis use disorder, alcohol use disorder, cocaine use disorder, and polysubstance induce anxiety disorder. See February 2020 C&P Exam. The Veteran is also service connected for a low back disability, cervical spine disability, and headaches. A review of the service treatment records is silent for any diagnosis of any psychiatric condition during his service. Specifically, the service treatment records show normal psychiatric condition in his January 1974 enlistment examination and March 1976 separation examination. See October 2014 STR – Medical and October 2014 Military Personnel Record. In fact, the Veteran does not allege that his psychiatric disorder manifested in service. Rather, the Veteran claims that his psychiatric disorder is related to his service-connected low back disability, cervical spine disability, and headaches. See October 2015 Form 9. The Veteran was afforded a VA examination in February 2020 wherein the examiner opined that the Veteran’s acquired psychiatric disability is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran’s alcohol use disorder, cannabis and cocaine use disorder, and polysubstance induced anxiety disorder are related conditions, one depending on the others. The examiner stated that evaluating psychiatric complaints in patients with alcohol, cannabis, and cocaine use can sometimes be challenging because the use can coexist with, contribute to, or result from several different psychiatric syndromes, mimic practically any psychiatric syndrome seen in the mental health setting causing signs and symptoms of depression, anxiety, and psychomotor agitation or retardation, perceptual disturbances, cognitive decline, irritability, insomnia, fatigue, and appetite alterations, that at times it makes it difficult to accurately diagnose the nature of the psychiatric syndromes. Thus, until the Veteran is completely alcohol, cocaine and cannabis free, the examiner will consider the primary diagnosis at present. Based on the foregoing, the examiner determined that the Veteran’s mental conditions are not related to military service or any medical conditions. They are the result of the Veteran’s decisions. The examiner also noted that the Veteran is not service connected for any disabilities. The Board finds that since the February 2020 VA examination, the Veteran is service connected to a low back disability, cervical spine disability, and headaches. As such, the Board finds that a remand is warranted to address aggravation. In support of his claim, in October 2018, the Veteran submitted a medical opinion from Dr. M.B. Shoag wherein the physician opined that it is at least as likely as not that the Veteran’s depression is due to his service as it was clearly brought on by the injuries suffered during his time in service. The physician stated that due to the Veteran’s service-connected low back disability and cervical spine disability the Veteran was unable to work which resulted in extreme financial difficulties. Due to these stressors the Veteran resorted to maladaptive coping and turned to non-prescription coping mechanisms in his effort to problem solve. See October 2018 Correspondence. The post-service treatment records show that the Veteran initially sought psychiatric care in April 2009 when he had complaints of sadness and increased anxiety in response to termination of job. See March 2019 CAPRI. In order to relieve his anxiety, the Veteran reported that he went on a binge of cocaine and alcohol use. However, the records show that the Veteran actually stopped working as a painter in December 2009 but was still employed as a maintenance worker from 2007 to 2011. See December 2019 Medical Treatment Records – Furnished by SSA. It is unclear whether the Veteran’s service-connected disabilities were the reason why he was terminated from his painter job in 2009 as the Veteran continued to work in maintenance until 2011. Accordingly, the Board finds that a remand is warranted for further development. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriately qualified examiner to determine the nature and etiology of any psychiatric disability. The claims file, including a copy of this remand, must be made available to be reviewed by the examiner. The examiner must state whether it is at least as likely as not (a fifty percent probability or greater) that the Veteran’s psychiatric disability was (a) caused by or has been (b) aggravated (worsened beyond the natural progress of the disorder) by his service-connected disabilities (chronic headaches, lumbar spine disability, cervical spine disability with bilateral upper extremity radiculopathy. (Continued on the next page)   The examiner should note the October 2018 medical opinion from Dr. Shoag wherein the physician opined that it is at least as likely as not that the Veteran’s depression is due to his service as it was brought on by the injuries suffered during his time in service. The physician stated that due to the Veteran’s service-connected low back disability and cervical spine disability the Veteran was unable to work which resulted in extreme financial difficulties. Due to these stressors the Veteran resorted to maladaptive coping and turned to non-prescription coping mechanisms in his effort to problem solve. A complete rationale for all opinions should be provided. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Noh, 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.