Citation Nr: 21003378 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 17-23 447 DATE: January 21, 2021 REMANDED Service connection for an acquired psychiatric disorder, however diagnosed, is remanded. Service connection for hairy cell leukemia, to include of due to an undiagnosed illness and as due to various exposures, is remanded. REFERRED In his November 2014 claim, the Veteran raised the issue of service connection for Gulf War Syndrome generally. That issue, as noted at his videoconference hearing, has not been addressed yet. It accordingly is referred to the Agency of Original Jurisdiction (AOJ) for any appropriate action. REASONS FOR REMAND The Veteran served on active duty from March 2000 to February 2005. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2015 rating decision. In June 2020, the Veteran testified regarding it at a videoconference hearing before the undersigned. Acquired Psychiatric Disorder The Veteran contends he has an acquired psychiatric disorder due to his service. That he experienced a stressful event or fear of hostile military or terrorist activity has been conceded by the AOJ, based on his deployments to Iraq, Kuwait, and Afghanistan. His service treatment records further document that he admitted to depression in September 2004. It additionally is undisputed that the Veteran currently has an acquired psychiatric disorder. PTSD and various forms of depression indeed have been diagnosed in VA and private treatment records as well as upon VA medical examinations. Arrangements must be made for another examination to resolve the dispute as to which diagnosis is most appropriate. It must include another nexus opinion, since none of those rendered so far is adequate. Specifically, the January 2015 opinion against service connection lacks a supporting explanation and was rendered without the benefit of the Veteran’s subsequent recounts of his service. The September 2016 opinion, the only one for service connection, was rendered without an assessment of him and also lacks a supporting explanation. After assessing him, this opinion was amended in November 2016 to being against service connection. The sole supporting explanation that there is no documentation of depression during service is not true, however. To ensure the new VA medical examination and opinion are as fully informed as possible, attempts must be made beforehand to obtain outstanding relevant records. In this regard, the most recent VA treatment records available are dated in February 2017. They reflect that the Veteran received psychiatric medication from an outside provider. Hairy Cell Leukemia Residuals The Veteran contends he has hairy cell leukemia due to his service. In doing so, he referenced an undiagnosed illness, identified fatigue as a relevant symptom and noted he often had it during service, and recounted various exposures then. They include working with and sometimes being drenched in chemicals, solvents, or gas/fuels, working on vehicles that had been near a sulfur fire, sleeping close to burn pits, helping with burn pits by igniting them and picking up feces and refuse to go into them, and detonating a cache of explosives. Though no details were provided, the Veteran also mentioned depleted uranium, vaccinations, and sarin gas. His DD-214 shows that he work involved construction equipment repair. Service treatment records further show that he had to have a cast on his right fifth metacarpal replaced in September 2004 because it smelled of fuel. As such, it is undisputed that the Veteran had some exposures as he contends. He has mentioned submitting photographs as further proof, but thus far he has not done so. A reminder will be sent to him. Service treatment records additionally reflect that he complained of fatigue from July to September 2004. That the Veteran had hairy cell leukemia finally is undisputed. Private treatment records indeed reveal that he has been in remission ever since undergoing treatment for this leukemia in 2008. While a January 2015 VA medical examination determined that it does not qualify as an undiagnosed illness, no nexus opinion was rendered. Arrangements therefore must be made for one. To ensure it is as fully informed as possible, attempts must be made beforehand to obtain the Veteran’s updated VA treatment records and any outstanding private treatment records identified by him or his representative as relevant. This matter is REMANDED for the following action: 1. Remind the Veteran to submit photographs or any other evidence he has that tends to show he was exposed to various substances, burn pits, etc. during service. 2. Follow established procedure for obtaining the Veteran’s VA treatment records dated from February 2017 to present, his outstanding private treatment records related to his psychiatric medication if identified by him or his representative, and any other outstanding private treatment records identified as relevant to his psychiatric state or hairy cell leukemia residuals. 3. After completing paragraphs 1 and 2, arrange for a qualified VA clinician to examine the Veteran regarding his acquired psychiatric disorder. This clinician specifically shall review the claims file, interview and assess the Veteran in person, via teleconference, or otherwise to account for the ongoing coronavirus pandemic, and diagnose each such disorder present. The clinician then shall opine as to whether each diagnosis made is at least as likely as not (a 50 percent or greater probability) related to the Veteran’s experiences during service while deployed in Iraq, Kuwait, and/or Afghanistan, his depression during service, or his service otherwise. A detailed explanation is required to support each opinion. This means that relevant medical principles and/or literature should be discussed as it relates specifically to the Veteran. In this regard, comment must be made on his reports concerning the onset and course of his relevant symptoms. 4. Also after completing paragraph 1 and 2, arrange for a qualified VA clinician to opine as to whether the Veteran’s hairy cell leukemia is at least as likely as not (a 50 percent or greater probability) related to his fatigue during service, his various exposures during service, or his service otherwise. These exposures include, but are not limited to, working with and sometimes being drenched in chemicals, solvents, or gas/fuels, working on vehicles that had been near a sulfur fire, sleeping close to burn pits, helping with burn pits by igniting them and picking up feces and refuse to go into them, detonating a cache of explosives, depleted uranium, vaccinations, and sarin gas. A detailed explanation is required to support the opinion. This means that relevant medical principles and/or literature should be discussed as it relates specifically to the Veteran. In this regard, comment must be made on his reports concerning the onset and course of his relevant symptoms. 5. Then readjudicate this matter. If either issue remains denied, follow established procedure for returning it to the Board. Thomas H. O’Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becker 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.