Citation Nr: 21070431 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 17-05 397 DATE: November 24, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2001 to October 2002. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding will be associated with the record. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Board finds that further development of the record is necessary to comply with VA's duty to assist the Veteran in the development of facts pertinent to his claim of service connection. The Veteran was afforded a VA examination for mental disorders in December 2012. The VA examiner indicated she had reviewed the Veteran's file and noted that he had been discharged from service due to a personality disorder. He had been admitted to the emergency room following a suicidal gesture where he ingested an excessive amount of medication. Treatment records indicated that the Veteran had endured abuse as a child from his biological parents and was removed from the home. He was adopted around age four or five and saw a counselor during his adoption. The Veteran was deemed a special needs child but was diagnosed with attention deficit disorder (ADD) and not a mood disorder. Treatment records reflected that the Veteran, as an adult, reported he was unsure when he began hearing voices, but it was likely during his adolescent years. He also reported worsening depressive symptoms at 13 years old. On examination, the Veteran noted that his hallucinations, depressed mood, and anxiety started "all of a sudden" in basic training but became more intense while he was stationed in Korea. He noted he had attempted suicide in service and was "chaptered out." The Veteran reported he had no mental health treatment for years following service because he had no medical insurance. He noted he had tried to seek medical help for suicidal ideations but was denied treatment because he had no insurance. The Veteran stated he began receiving mental health treatment in 2009 while he was in prison. The Veteran reported current symptoms of depression, anxiety, irritability, panic attacks, chronic sleep impairment, concentration, and attention. He endorsed frequent auditory hallucinations. The VA examiner noted diagnoses of a mood disorder not otherwise specified (NOS) with psychotic features, panic disorder without agoraphobia, and polysubstance abuse in sustained full remission. The examiner indicated it was not possible to differentiate which symptoms were attributable to each diagnosis. The examiner opined that the Veteran's mood disorder NOS and panic disorder without agoraphobia were less likely than not continuing manifestations of the adjustment disorder with mixed anxiety and depressed mood noted during service in September 2002. The examiner explained that adjustment disorders typically resolve within six months and the Veteran had not been seen for mental health complaints until 2007, seven years following his separation from service. Therefore, the examiner found that the evidence did not support finding that the Veteran's symptoms were continuous from the time of discharge until present. The Board finds that the December 2012 VA examiner's opinion is inadequate for adjudication purposes. The examiner based his negative nexus opinion on the Veteran's absence of mental health treatment following his separation from service; however, the Veteran had reported during the examination that he had been unable to receive treatment because he lacked medical insurance. Additionally, the evidence of record suggests that the Veteran may have suffered from a psychiatric disorder prior to entering service. Treatment records reflect that the Veteran had been hearing auditory hallucinations beginning in adolescence. During treatment in May 2012, the Veteran reported he had attempted suicide by overdosing on pills due to a "derogatory command hallucination" while serving in the Army in Korea. VA has yet to obtain a medical opinion addressing whether the Veteran had a preexisting psychiatric disorder that was aggravated by service. Given the foregoing, remand for a VA examination is warranted. The Board also finds that remand is necessary due to treatment records that have not been associated with the claims file. While the Veteran reported receiving mental health treatment in prison from May 2009 to May 2012, these treatment records have not been obtained and associated with the record. Additionally, a January 2013 letter from the Social Security Administration (SSA) indicates that the Veteran was awarded disability benefits related to his psychiatric disorder. The records associated with his application have not been associated with the claims file but are likely relevant to the adjudication of the Veteran's claim. Therefore, appropriate steps should be taken to obtain any relevant SSA records and treatment records during the Veteran's incarceration. The matter is REMANDED for the following action: 1. Obtain all prison medical treatment records from the correctional facility in which the Veteran was incarcerated from 2009 to 2011. Add all such records to the claims file, and appropriately document if such records are unavailable. 2. Contact the SSA and obtain any records pertaining to the Veteran's claim for disability benefits. Add all such records to the claims file, and appropriately document if such records are unavailable. 3. After the preceding development is completed to the extent possible, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed psychiatric disorder. The electronic claims folder, including a copy of this remand, should be made available to the examiner, and the examiner must review the entire claims file in conjunction with the examination. The examiner should respond to the following: (a) Provide a diagnosis for each psychiatric disorder found. b) Does the evidence of record clearly and unmistakably (i.e., it is undebatable) show that the Veteran's current acquired psychiatric disorder preexisted service? Please provide an opinion for each diagnosis. c) If so, is there clear and unmistakable evidence that the Veteran's preexisting acquired psychiatric disorder was not aggravated by service (beyond the natural progress of the disease)? Please provide an opinion for each diagnosis. d) If there is not clear and unmistakable evidence that the Veteran had an acquired psychiatric disorder that preexisted service, then the Veteran must be considered to have been sound at entry. Based upon that premise, it is as least as likely as not (a probability of 50 percent or greater) that the Veteran's acquired psychiatric disorder had its onset in service or is otherwise related to service? Please provide an opinion for each diagnosis. The examiner must include a complete rationale to support any opinion provided. If an opinion cannot be provided without resorting to mere speculation, the examiner 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). 4. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claim should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Silverblatt, 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.