Citation Nr: 21062687 Decision Date: 10/08/21 Archive Date: 10/08/21 DOCKET NO. 19-03 258 DATE: October 8, 2021 REMANDED The claim of entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1995 to April 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In April 2021, the Veteran testified in a hearing before the Board. A transcript of the hearing is included in the record and has been reviewed. A remand is warranted for additional medical inquiry into the claim. The Veteran underwent VA compensation examination into the claim on appeal in March 2018 and again in March 2019. In the first report, the examiner found the Veteran without an acquired psychiatric disorder. In the second report, the examiner found the Veteran with unspecified anxiety disorder which he found likely not related to service. The examiner indicated a review of the VA treatment records which indicate a diagnosis of posttraumatic stress disorder (PTSD). On remand, the RO should obtain an addendum report addressing whether the Veteran has been diagnosed with PTSD. The VA treatment records indicate that a treating psychiatrist may have diagnosed PTSD. It is not clear that is the case, however. Hence the need for another review and report from the VA examiner. The examiner should also comment on the Veteran's claim that he has other acquired psychiatric disorders such as depressive and anxiety disorders as the result of chronic pain associated with service-connected orthopedic disability. The matter is are REMANDED for the following action: Return the case to the VA examiner who authored the March 2018 and March 2019 VA reports, or to a suitable substitute, for issuance of an addendum opinion addressing the claim of entitlement to service connection for an acquired psychiatric disorder. After again reviewing the electronic claims file, the examiner should answer the following questions: (1) Has the Veteran's treating VA psychiatrist (Dr. Patel, MD) diagnosed the Veteran with PTSD in accordance with the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.)? It is unclear in the record whether she has rendered such a diagnosis or is merely repeating a diagnosis provided in the record by social workers and nurses. (2) Is it at least as likely as not (probability of 50 percent or more) that any acquired psychiatric disorder is due to or caused by service-connected foot and/or knee disability? (3) Is it at least as likely as not that that any acquired psychiatric disorder has been aggravated (i.e., permanently or temporarily worsened beyond the natural progress) by service-connected foot and/or knee disability? If aggravation is found, the examiner should address the following medical issues: (1) the baseline manifestations of the disorder found prior to aggravation; and (2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder(s). The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinions, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. Please explain in detail any opinion provided and the supporting rationale. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee 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.