Citation Nr: 21069496 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 18-28 468A DATE: November 18, 2021 REMANDED 1. Entitlement to service connection for an acquired psychiatric disorder, to include major depression, claimed as secondary to service-connected Bell's Palsy, is remanded. 2. Entitlement to a total disability evaluation based on individual unemployability (TDIU) due to service-connected disabilities remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to December 1970, which included service during the Vietnam Era. These matters come before the Board of Veterans' Appeals (Board) on appeal of a May 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for an acquired psychiatric disorder, to include major depression, claimed as secondary to service-connected Bell's Palsy, is remanded. The Board remanded this matter in October 2020 to obtain any outstanding treatment records and for a VA medical opinion to determine whether any diagnosed acquired psychiatric disorder may be proximately due to or aggravated by a service-connected disability, to include Bell's Palsy. The Veteran underwent an in-person VA examination with a psychologist in December 2020 and was diagnosed with mild major depressive disorder with a history of Bell's Palsy. The examiner opined that it is less likely than not that the Veteran's acquired psychiatric disorder is proximately due to his service-connected Bell's Palsy. The examiner explained that after a review of all available treatment records, there is no indication that the facial changes secondary to Bell's Palsy are the trigger of his depressive episodes nor do they appear to be a factor in sustaining his current psychiatric symptoms at the time of the examination. The examiner also indicated that the Veteran's STRs do not reveal reports of depressed mood or excessive worry due to Bell's Palsy and that his first report of symptoms consistent with depressive episodes was 20 years after his Bell's Palsy diagnosis. Further, the examiner remarked that the Veteran first noted mild depressive symptoms due to work-related stressors in 2000. The examiner opined further that it is less likely that the Veteran's acquired psychiatric disorder was aggravated beyond its natural progression by the service-connected Bell's Palsy. The examiner explained that the evidence does not tend to show that that the residuals of the service-connected Bell's Palsy including facial paralysis of the 7th cranial nerve with weakness and asymmetry are causally related to an acquired psychiatric disorder. The Board finds the December 2020 opinion inadequate as it failed to provide a sufficient rationale for the aggravation opinion. It is important that an examiner adequately address the aggravation element as the evidence appears to suggest that his service-connected Bell's Palsy may have aggravated his psychiatric disorder. In this regard, the evidence reflects that the Veteran last worked for the U.S. Postal Service in April 2000. He has asserted that he was forced to retire from this occupation due to a nervous breakdown in December 2000 because of the impairment caused by his service-connected Bell's Palsy. See August 2002 Correspondence. Specifically, he has communicated that his Bell's Palsy has rendered him unable to be out in public due to embarrassment caused by his neurological symptoms including intermittent facial paralysis. This has also caused extreme depression and he contends that the combined impact of these symptoms has rendered him unable to obtain and maintain substantially gainful employment. Notably, the December 2020 examiner remarked that the Veteran first noted mild depressive symptoms due to work-related stressors in 2000, which is consistent with the Veteran's reports of extreme depression and embarrassment at work due to his service-connected Bell's Palsy and suggests that his Bell's Palsy may have aggravated his depression symptoms. Given that the opinion appears to only address causation and does not provide a sufficient aggravation rationale, an addendum opinion is warranted. 2. Entitlement to TDIU is remanded. The Board finds the issue of entitlement to TDIU is inextricably intertwined with the above service connection claim for an acquired psychiatric disability. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's acquired psychiatric disorder is at least as likely as not aggravated beyond its natural progression by his service-connected Bell's Palsy and explain why. In rendering an opinion, the examiner's attention is drawn to the relevant medical evidence of record, such as the November 2004 VA Examination Report; June 2018 VA Mental Health Note noting an impression of specific mental disorder due to service-connected physical condition, major depression, and dysmorphia; and the March 2020 VA Mental Health Outpatient Treatment Plan noting an impression of mood disorder due to a medical condition. The examiner should also consider the Veteran's relevant lay statements of record, to include the Veteran's reports of depressive symptoms related to embarrassment at work beginning in 2000 caused by neurological impairments from his service-connected Bell's Palsy. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to TDIU. If the benefit sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kyle McKone 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.