Citation Nr: 21000692 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 15-36 890 DATE: January 6, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran had active service in the Marine Corps from January 1971 to December 1974. The appeal originates from an October 2013 decision of a Department of Veterans Affairs (VA) Regional Office. The Veteran appeared for a hearing before the undersigned in April 2017. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Veteran asserts that he has an acquired psychiatric disorder, including PTSD, related to service. The matter was remanded in September 2018 to obtain private treatment records and an etiology opinion concerning his psychiatric diagnoses. He did not provide authorization to obtain his private treatment records. He was afforded a VA examination in May 2020 at which time he was diagnosed with adjustment disorder with mixed anxiety and depressed mood, and depressive disorder. A diagnosis of PTSD was not made. The examiner opined that adjustment disorder is “related to military service” but appears to have offered no rationale other than indicating that the Veteran did not have a mental disorder prior to service. The examiner identified “exposure to combat” as an in-service element. No explanation was provided for this finding, which is problematic because personnel records do not show that the Veteran received any combat citation or that he even had any foreign or sea service. The finding is even at odds with the Veteran’s report at a September 2013 examination that he did not have combat exposure. With respect to depressive disorder, the examiner found that it was proximately caused by multiple nonservice-connected disabilities as well as service-connected tinnitus. No explanation for the link to tinnitus was provided other than quoting medical literature expressing uncertainty as to the relationship between depression and tinnitus. The examiner found that depressive disorder was aggravated by a service-connected condition but could not establish a baseline level of severity. The rationale for the finding of aggravation does not specify tinnitus and seems to address a causative relationship rather than aggravation. Regarding a personality disorder and alcohol use disorder, the DBQ and separate opinions appear to conclude that the Veteran was misdiagnosed at the September 2013 examination and did not have such disorders. Confusingly, the examiner still opined on secondary service connection for these diagnoses. For the preceding reasons, the Board finds that a new etiology opinion would be of assistance in adjudicating the claim. The matter is REMANDED for the following action: Provide the Veteran’s file to an examiner with the appropriate knowledge and expertise to opine on a mental disorder. The examiner is asked to address the following:   1. Specify whether the Veteran has had diagnoses of a personality disorder and alcohol use disorder. The examiner must address the findings in the September 2013 and May 2020 examinations. 2. Is it at least as likely as not that an acquired psychiatric disorder, to include adjustment disorder and depressive disorder, had its onset in or is otherwise etiologically related to active service? 3. Is it at least as likely as not that an acquired psychiatric disorder, to include adjustment disorder and depressive disorder, was proximately caused by a service-connected disability? 4. Is it at least as likely as not that an acquired psychiatric disorder, to include adjustment disorder and depressive disorder, underwent any incremental increase in disability, regardless of its permanence, due to a service-connected disability? The term “incremental increase in disability” means additional impairment of earning capacity.  Objective measurement, or numerical quantification, is not required to ascertain an increase in disability.  Moreover, any “incremental increase in disability” need not be permanent.  5. If the examiner determines that the Veteran has had a personality disorder, is it at least as likely as not that the disorder was superimposed upon by a service-connected mental disorder? 6. If the examiner determines that the Veteran has had an alcohol use disorder, is it at least as likely as not that the disorder was proximately caused or underwent any incremental increase in disability, regardless of its permanence, due to a service-connected mental disorder?  MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Alhinnawi 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.