Citation Nr: 21001401 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 18-46 304 DATE: January 8, 2021 REMANDED Entitlement to service connection for a psychiatric disorder, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Army from November 1950 to September 1953. He was awarded the Combat Infantryman Badge. This matter comes before the Board of Veterans’ Appeal (Board) on appeal from an April 2018 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). This matter was previously remanded for further development in June 2019. In June 2019, the Board reopened the previously denied claim for service connection for an acquired psychiatric disability. In addition, the RO was asked to obtain all outstanding private treatment records from VAMC San Juan PR from April 2018 to the present. All available records have since been associated with the claims file. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter returns to the Board for appellate consideration. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900. Entitlement to service connection for a psychiatric disorder, to include as secondary to service-connected disabilities, is remanded. The Veteran contends that his psychiatric disorder is related to service, to include as secondary to his service-connected disabilities. In the June 2019 remand, the Board found that the April 2018 VA opinion was inadequate because it did not address whether the Veteran’s psychiatric disability is chronically aggravated by the service-connected chronic sinusitis or tinnitus, as claimed by the Veteran. The RO was asked to obtain an addendum opinion and address whether the Veteran’s currently diagnosed psychiatric disability is proximately due and/or aggravated by his service-connected chronic sinusitis, hearing loss, and/or tinnitus. An August 2019 VA opinion was obtained. The examiner opined the Veteran’s psychiatric condition is less likely than not proximately due to or the result of his service-connected conditions. The examiner indicated there is scientific data linking chronic rhinosinusitis to dementia (referencing a January-February 2015 study). The examiner stated, with regard to an association between dementia and hearing loss/tinnitus, that the conditions aggravate dementia because the brain circuit required to recall and learn through the ear’s Heschl gyrus is disturbed, and thus unable to retrieve data to be recalled and learned through the fronto-temporal brain circuitry. The examiner concluded the theory of aggravation of dementia beyond its natural progression by the service-connected sinusitis could not be asserted based on available clinical data, and that VA records are silent for chronic maxillary sinusitis and only demonstrate rhinitis in 2012. A July 2020 addendum opinion was obtained due to conflicting information. The examiner indicated that there is no evidence in neuropsychiatry literature of a direct physiological consequence between the Veteran’s service-connected severe impaired hearing/sinusitis/tinnitus and his neurocognitive mental disorder. The examiner explained that dementia is defined as Alzheimer’s (senile plaque in temporal lobe), pick diseases (frontal dementia atrophy), lewy bodies subcortical dementia (lewy body pathology), vascular dementia (cerebrovascular disease, brain ischemia), and “CJ dementia” as secondary to abnormal brain reaction to a prion (antigenic viral protein). The examiner concluded that common dementias listed above had specific pathology and no evidence in neurology/psychiatry literature to make a direct correlation to the service-connected severe impaired hearing/sinusitis/tinnitus. The examiner also concluded that the Veteran’s major neurocognitive disorder is not related to chronic sinusitis nor aggravated beyond its normal progression by his service-connected impaired hearing/sinusitis/tinnitus. The Board finds the most recent July 2020 addendum opinion is inadequate. The examiner failed to provide a rationale in support of the aggravation opinion. Stegall v. West, 11 Vet. App. 268, 271 (1998). Given the deficiency in the VA opinion, the Board must remand for another addendum opinion. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from the July 2020 VA examiner or another qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must provide opinions as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s currently diagnosed psychiatric disability is aggravated by his service-connected chronic sinusitis, hearing loss, and/or tinnitus. Aggravation does not require that there be “permanent” worsening of the nonservice connected disability. The examiner must provide all findings, along with a complete rationale for his or her opinion(s), in the examination report. 2. Readjudicate the claim. If the benefit sought on appeal remains denied, provide an additional supplemental statement of the case to the Veteran, and return the appeal to the Board for appellate review, after the Veteran and his representative have had an adequate opportunity to respond. L. CHU Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. Asfaw, 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.