Citation Nr: 21000260 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 15-45 398 DATE: January 4, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for substance abuse, to include as secondary to an acquired psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1975 to September 1976. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. The Veteran testified at a hearing before the undersigned in July 2018. This matter was remanded by the Board in March 2019 for further development. As discussed below, unfortunately another remand is warranted. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. Additional development is necessary with regard to the Veteran's claim for service connection for an acquired psychiatric disorder, to include PTSD. Although the Board sincerely regrets the delay, it is necessary to ensure that there is a complete record upon which to decide his claim so that he is afforded every possible consideration. The Veteran contends that he developed a psychiatric disorder during active service. See July 2018 Hearing Transcript. Specifically, he testified that he began experiencing symptoms of anxiety during active service. See id. Pursuant to the March 2019 Board remand, the Veteran was afforded a VA Initial PTSD Disability Benefits Questionnaire in March 2020. The Board remand instructed the VA examiner to address the nature and etiology of any of the Veteran’s psychiatric disorders. The Board noted that the Veteran has previously been diagnosed with depressive disorder, insomnia, and mood disorder. The Board also instructed the VA examiner to consider the Veteran’s July 2018 hearing testimony in providing an opinion on the etiology of any psychiatric disorder he may have. The March 2020 VA examiner diagnosed the Veteran with four different drug abuse disorders and stated that they were not related to an in-service stressor related event. The examiner then offered her medical opinion, stating that the Veteran does not meet the criteria for and has never been diagnosed with PTSD by any VA provider. The examiner stated that she reviewed the Veteran’s claim file and cited a number of mental health triage notes, including ones which showed that the Veteran suffers from intermittent depression. Nevertheless, the examiner did not offer an opinion as to whether the Veteran has depressive disorder, insomnia, or mood disorder that is related to his active service, despite the Veteran’s record showing that he has been diagnosed with these disabilities. The Board finds the March 2020 VA Examination inadequate, as it does not discuss the Veteran’s diagnosed psychiatric disorders, including depressive disorder, insomnia, and mood disorder. Additionally, the examiner did not discuss the Veteran’s testimony at his July 2018 Board hearing and in his July 2018 Statement in Support of Claim regarding his symptoms of anxiety during active duty, including experiencing extreme anxiety attacks during active service in Panama. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, a new medical opinion is warranted that addresses whether the Veteran presently has any acquired psychiatric disorder, and whether this condition was incurred in or caused by service. Further, newly obtained VA treatment records reflect that the Veteran was treated at St. Joseph’s Hospital in 1992. These records should be obtained on remand. 2. Entitlement ot service connection for substance abuse, to include as secondary to an acquired psychiatric disorder is remanded. The Veteran has applied for service connection for substance abuse as secondary to an acquired psychiatric disorder. The Board finds that the Veteran's claim for service connection for substance abuse is dependent, in part, on the outcome of the service connection claim for an acquired psychiatric disorder that is being remanded herein as any potential grant of service connection of a remanded issue could form the foundation for service connection on a secondary basis. Therefore, the Veteran's claim for service connection for substance abuse is inextricably intertwined with the issue of service connection for an acquired psychiatric disorder. See 38 C.F.R. § 4.16 (a); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). Accordingly, this issue must be remanded as well. Additionally, if the Veteran’s psychiatric disorder is found to be service connected, an opinion should be obtained as to the relation it has, if any, on his substance abuse disorder. The matters are REMANDED for the following action: 1. Obtain the Veteran’s complete treatment records from St. Joseph’s Hospital, dated in 1992. 2. Obtain the Veteran’s complete VA treatment records, dated from August 2020 forward. 3. Next, obtain an addendum medical opinion by an appropriate clinician to determine the nature and etiology of any current psychiatric disorders the Veteran may have, to include his diagnosed depressive disorder, mood disorder, and insomnia. If the clinician determines that an additional examination of the Veteran is necessary in order to provide the requested opinion(s), then the Veteran should be scheduled for an appropriate examination. The entire claims file and a copy of this REMAND must be reviewed by the examiner in conjunction with the opinion. The examiner should confirm in the examination report that he or she has reviewed the folder in conjunction with the examination. The examiner is asked to provide opinions on the following: (a) The examiner should identify all acquired psychiatric disorders that have been present since December 2013. In doing so, the examiner should consider all disabilities currently present or present at any point pertinent to the current claim, including previously diagnosed depressive disorder, mood disorder, and insomnia. See November 2013Mental Health Note; May 2018 PTSD Disability Benefits Questionnaire (received August 22, 2018). (b) For each identified psychiatric disorder, the examiner should provide an opinion addressing whether it is at least as likely as not (50 percent or greater probability) that the diagnosed psychiatric disorder had its clinical onset during active service or is related to any incident of service, to include the stressors described by the Veteran on his Statement in Support of Claim for Service Connection for PTSD dated July 2, 2018 and during his personal hearing on July 30, 2018. • In providing this opinion, the examiner should consider the Veteran’s service personnel records showing that he requested a discharge from service. It was noted that he had not fully demonstrated the personal characteristics desired and needed in the Air Force and that he showed little enthusiasm or motivation in his performance of his duties and responsibilities related to his frustration over not being able to the educational benefits he had anticipated. • The examiner should also consider the Veteran’s reported symptoms of anxiety, to include extreme anxiety attacks during active service in Panama. See July 2018 Statement in Support of Claim. See also July 2018 Board Hearing. (c) If any acquired psychiatric disorder is found to be related to the Veteran’s active duty service, the examiner should provide an opinion addressing whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s substance abuse disorder is either (i) caused by, or (ii) aggravated (i.e. worsened) by his psychiatric disorder. (Continued on the next page)   A supporting rationale for all opinions expressed must be provided. If the examiner is unable to provide any opinion as requested, the examiner should fully explain the reason why such opinion could not be rendered. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Mohammad 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.