Citation Nr: 21069404 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 16-07 245 DATE: November 18, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include depression disorder, is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1978 to March 1986. 1. Entitlement to service connection for an acquired psychiatric disability, to include depression disorder is remanded. The Board notes that the Veteran's claim for service connection for a psychiatric disability was previously remanded by the Board in November 2020 for further development, to include affording the Veteran another VA examination. To this end, the Veteran was afforded VA examination in June 2021 to assess the nature and etiology of any diagnosed psychiatric disability. The Board finds, however, that a close review of the June 2021 VA examination and opinion reveals that the examiner failed to consider the Veteran's previously diagnosed psychiatric conditions of adjustment disorder and depressive disorder, and as such the opinion is considered inadequate. The Board notes that the VA's statutory duty to assist the Veteran includes the duty to conduct a thorough and contemporaneous examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet. App. 121 (1991); Snuffer v. Gober, 10 Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). When the medical evidence is inadequate, as it is here, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). Therefore, remand is required for the VA to fulfills its duty to the Veteran. Here, the June 2021 VA examiner's nexus opinion was ostensibly based on the fact that the examiner found no diagnosable psychiatric disability at the time of the actual examination. As such, the examiner found that no condition could have been caused or related to the Veteran's service or other service-connected disabilities. A close review of the evidence of record, however, reveals VA examinations in January 2015 and March 2019, diagnosing the Veteran's psychiatric disabilities as adjustment disorder and depressive disorder, respectively. As both such diagnoses were contemporaneous to this claim, the Board finds that most current VA examiner's findings to be inadequate. As such, the Board notes that remand is required for the VA to fulfill its duty to the Veteran and obtain an addendum opinion with regards to his psychiatric diagnoses. 2. Entitlement to service connection for a cervical spine disability is remanded. The Board likewise finds that the June 2021 VA examination and opinion regarding the Veteran's neck disability is also inadequate, as such findings fail to provide adequate rational. Here, in the examiner's opinion and analysis for secondary aggravation, the examiner explicitly noted rationale as to why various other disabilities were not related to the Veteran's neck disability, to include a nerve disability and psychiatric disability, but failed to provide any rationale pertaining to the crux of the case, which is whether such neck disability was aggravated by the Veteran's service-connected back disability. Here, the VA examiner simply concludes that such neck disability was not aggravated by the Veteran's back, without providing any rationale. The Board finds that such opinion to be inadequate, and a remand is again required to obtain a sufficient nexus opinion. 3. Entitlement to service connection for headaches is remanded. 4. Entitlement to service connection for erectile dysfunction is remanded. Finally, because a decision on the above remanded issues for service connection for a psychiatric disability could significantly impact a decision on the issue of service connection for ED and headaches, the issues are inextricably intertwined, and remand of this claim is also required. Harris v. Derwinski,1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a "significant impact" upon another, and that impact in turn could render any appellate review meaningless and a waste of judicial resources, the two claims are inextricably intertwined). Here, the most recent June 2021 VA examinations seem to insinuate some connection between psychiatric disabilities such as depression and the development of ED and headaches. As such, the Board finds that such conditions must also be remanded as further development is concluded on the Veteran's claim for a psychiatric disability. The matters are REMANDED for the following action: 1. Obtain all VA medical records of treatment to include any hospitalizations. 2. Then, schedule the Veteran for a VA examination with a medical doctor who has not previously examined the Veteran. The examiner must provide an opinion with regard to the etiology of any psychiatric disability, to include previously diagnosed adjustment disorder and/or depressive disorder, and whether it is at least as likely as not related to the Veteran's active service. The examiner must review the claims file and should note that review in the report. The examiner is asked to provide an opinion and rationale for the following: (a) Whether any psychiatric disability that is found is at least as likely as not (50 percent or greater probability) etiologically related to service or any in-service injury, disease, or event; and (b) Whether any psychiatric condition found and/or existed during the claims period, was caused and/or aggravated by the Veteran's other service-connected disabilities. The examiner must explicitly reconcile any opinion already of record. 3. Then, schedule the Veteran for a VA examination with a medical doctor who has not previously examined the Veteran. The examiner must provide an opinion with regard to the etiology of the Veterans claimed neck disability, and whether it is at least as likely as not related to the Veteran's active service, and/or other service-connected disabilities. The examiner must review the claims file and should note that review in the report. The examiner is asked to provide an opinion and rationale for the following: (a) Whether any neck disability that is found is at least as likely as not (50 percent or greater probability) etiologically related to service or any in-service injury, disease, or event; and (b) Whether any neck disability was caused and/or aggravated by the Veteran's other service-connected disabilities, to explicitly include the Veteran's back disability. The examiner must provide a clear rationale and explicitly reconcile any opinion already of record. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ziheng Zhu, 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.