Citation Nr: 21063187 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 13-08 866 DATE: October 13, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1974 to March 1976, and January 1991 to July 1991, to include service in Southwest Asia. The Veteran has additional periods of service with the Army National Guard. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) San Juan, Puerto Rico. Jurisdiction of this appeal is currently with the RO in Des Moines, Iowa. This case was most recently before the Board in October 2020, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. Service Connection Acquired Psychiatric Disorder The Veteran seeks service connection for an acquired psychiatric disorder. Specifically, his representative asserts that the Veteran's diagnosed depression is the direct result of his experiences in Southwest Asia and that his acquired psychiatric disorder had its onset during active service and has continued since. See Appellate Brief, January 29, 2021. The Veteran also asserts he has an acquired psychiatric disorder as a result of witnessing and being exposed to dead bodies in 1991. See VA Form 21-526EZ, Fully Developed Claim, February 26, 2019. Moreover, the Veteran's representative seems to assert that his acquired psychiatric disorder is due to combat exposure, and aggravation from other service-connected disabilities. See Appellate Brief, August 8, 2017. As noted above, the claim for entitlement to service connection for an acquired psychiatric disorder was most recently before the Board in October 2020, when it was remanded to the AOJ for further development. Specifically, the October 2020 Board remand directed the AOJ to afford the Veteran an additional VA examination for his claim. In this regard, the October 2020 Board remand noted that the June 2019 VA examination and opinion did not adequately take into consideration August 1997 VA treatment records showing treatment for anxiety and insomnia. Additionally, continuing treatment records and a July 2017 psychiatric evaluation were associated with the record that raised a secondary theory of entitlement. Therefore, the October 2020 Board remand directed the AOJ to obtain an addendum opinion with respect to the nature and etiology of the Veteran's claimed acquired psychiatric disorder. Specifically, the examiner was directed to address the August 1997 VA treatment records showing complaints and diagnoses of anxiety and insomnia, and to opine as to whether his acquired psychiatric disorder were proximately due to or aggravated beyond its natural progression by his service-connected disabilities. A fully articulated medical rationale for all opinions was requested. The directed VA addendum opinion was obtained in November 2020. At that time, the examiner opined that the Veteran's acquired psychiatric disorder was not related to, nor secondary to his military service and that no nexus was found. Additionally, the examiner opined that the Veteran's acquired psychiatric disorder was not proximately due to his service-connected disabilities nor aggravated beyond its natural progression by his service-connected disabilities. The Board finds the November 2020 VA opinion incomplete to decide the claims. The examiner failed to provide any rationale for his opinion but rather provided a summary of the service and post-service treatment records. Given this deficiency, the Board is unable to find that substantial compliance with the prior remand has been achieved. See D'Aries, 22 Vet. App. at 105; see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). As such, remand is again required to afford the Veteran an additional VA examination that complies with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. at 268, 271 (1998). The matter is REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any currently present acquired psychiatric disorder. Any and all indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The need for further in-person examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: (A) Is at least as likely as not (50 percent or greater probability) that the Veteran's acquired psychiatric disorder had its onset during any period of service, or is otherwise related to such period of service? The examiner should specifically consider the Veteran's reports of seeing dead bodies during service, and fear of terrorist activity while stationed in Southwest Asia. (C) Is it at least as likely as not (50 percent or greater probability) that the Veteran's acquired psychiatric disorder was caused or aggravated by service-connected disabilities? The examiner must address the Veteran's VA treatment records showing complaints and diagnoses of anxiety and insomnia in August 1997, continuing treatment records, and a July 2017 psychiatric evaluation showing that his acquired psychiatric disorder may be secondary to medical disorders. A RATIONALE SHOULD BE PROVIDED FOR ALL OPINIONS OFFERED. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.