Citation Nr: 21069533 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 17-33 595 DATE: November 18, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1983 to May 1986 and from March 2003 to May 2004, with additional service in the Reserves. The Veteran's claim was last before the Board of Veterans Appeals (Board) in January 2021 wherein the Board denied the Veteran's claim. The Veteran appealed that denial to the United States Court of Appeals for Veteran's Claims (Court). Thereafter, through a July 2021 Joint Motion for Remand (JMR), the Veteran's claim was remanded to the Board for additional action consistent with the JMR. The Board notes that the July 2021 JMR finds the May 2019 and October 2020 VA examinations to "not contain adequate rationale" explaining "specifically, neither examination addresses the possible connection between [the Veteran's] psychiatric disorder and his service." There is no further detail to explain why the examinations were inadequate. Entitlement to service connection for an acquired psychiatric disability is remanded. The Veteran contends that he has an acquired psychiatric disability that is etiologically related to service. To begin, it is unclear to the Board what, if any, acquired psychiatric disability the Veteran has met the diagnostic criteria for since his application for service connection in September 2012. A May 2012 private opinion does not adequately explain his potential diagnoses or diagnostic criteria. A November 2012 VA examination finds only that the Veteran does not have diagnoses of a sleep disorder and/or posttraumatic stress disorder (PTSD). Finally, May 2019 and October 2020 VA examinations find that the Veteran does not meet the full diagnostic criteria for depression or anxiety but may meet the criteria for such disorders in an "unspecified" manner. Thus, a remand is required to ascertain what, if any, diagnoses the Veteran has had since September 2012. Further, there are many vague references to the Veteran's asserted in-service event. In reviewing the record, the Veteran described his military stressors at the November 2012 VA examination: "'in Iraq, everything that happened to others happened to me'; tension of uncertainty of what would happen next, a lot of pressure from officers, escort missions on several occasions, taken off the military occupational specialty (MOS) often: MOS supply, then laundry, then bathrooms. No physical trauma, only tensions especially during night duty." Thus, the difficulty the Veteran experienced was the uncertainty of his time in Iraq and difficulty adjusting. Finally, regarding the May 2019 and October 2020 VA examinations, the VA clinicians appear only to consider the Veteran's life stressors during the period on appeal and their respective impact on the Veteran's mental functioning. However, the clinicians do not consider the impact of the Veteran's military service in the development of these stressors. Specifically, the examiners point to the Veteran's loss of his job and financial insecurity as causes of his recent distress but do not discuss the Veteran's history of symptoms that led up to him quitting his job that resulted in the stress. Therefore, a remand to consider the development of the Veteran's acquired psychiatric disability is required. The matters are REMANDED for the following action: 1. Obtain an examination from a qualified clinician to consider the Veteran's claim for service connection for an acquired psychiatric disability. Prior to answering the below questions, the clinician should review the Veteran's medical record, to include the May 2012 private opinion. See VBMS, document labeled Third Party Correspondence, receipt date September 9, 2012. The Veteran's in service event/stress are described as follows: "in Iraq, everything that happened to others happened to me"; tension of uncertainty of what would happen next, a lot of pressure from officers, escort missions on several occasions, taken off the military occupational specialty (MOS) often; MOS supply, then laundry, then bathrooms. No physical trauma, only tensions especially during night duty." Thus, his difficulty during service was the uncertainty of his time in Iraq and difficulty adjusting. The clinician should clarify from the Veteran if there are any additional events, incidences, or difficulties that the Veteran experienced during service. The clinician should then answer the questions below: a. What, if any, psychiatric diagnoses has the Veteran had since September 2012 through to the present? The clinician must address what, if any, diagnoses were present at the time of the Veteran's application based on the evidence of record. b. Given the Veteran's history of symptoms and his difficulties in the military, is it at least as likely as not that the Veteran's acquired psychiatric disability is etiologically related to service? Note that the records from the Veteran's second period of service are unavailable for review. If the clinician finds that the Veteran's acquired psychiatric disability to be related to life events after September 2012 rather than his military service, the clinician must address any evidence that relates to the likely etiology of any diagnoses present as of September 2012. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. M. Hitchcock 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.