Citation Nr: 21075096 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 18-03 226 DATE: December 17, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1959 to February 1961. In October 2020, the Board, in pertinent part, denied the Veteran's claim for service connection for an acquired psychiatric disorder on a direct and secondary basis. The Veteran appealed the October 2020 Board decision to the United States Court of Appeals for Veterans Claims (CAVC). In a Joint Motion for Partial Remand (JMPR), the CAVC vacated and remanded the portion of the Board's decision that denied entitlement to service connection for an acquired psychiatric disorder. Specifically, the JPMR indicates that the Board relied on inadequate VA medical opinions in denying the Veteran's claim. The JPMR thus instructs that a remand for new medical opinions that adequately addresses whether the Veteran's anxiety disorder is least as likely as not aggravated by his service-connected tinnitus or hearing loss and whether his anxiety disorder was at least as likely as not incurred in or caused by an in-service injury, event or illness. The matter is now again before the Board for action consistent with the terms of the JMPR. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107 (a)(2); 38 C.F.R. § 20.900(c). Entitlement to service connection for an acquired psychiatric disability is remanded. Once VA undertakes the effort to provide an examination in connection with a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one, or at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion will be considered adequate when it is based upon consideration of the Veteran's prior medical history and examinations and provides a sufficiently detailed description of the disability so that the Board's evaluation will be a fully informed one. Id.; Green v. Derwinski, 1 Vet. App. 121, 124 (1991). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, aggravation of a condition by a service-connected disability must be considered independently of direct causation, and medical examinations must provide adequate reasoning and conclusions on both points. Atencio v. O'Rourke, 30 Vet. App. 74, 91 (2018). In a June 2020 VA opinion, the examiner indicated that "there is no documentation in the provided medical record of a mental health/psychiatric conditions diagnosed related to Tinnitus/hearing loss" and that while the Veteran described frustration with not being able to hear and/or understand others, that frustration "does not rise to the level of a clinical mental disorder." However, the CAVC noted that the examiner failed to address whether the Veteran's service-connected tinnitus and/or hearing loss cause an increase in the severity of his anxiety disorder. Additionally, the June 2020 examiner opined that the Veteran's anxiety disorder was less likely than not incurred in or caused by an in-service injury, event or illness, reasoning that "[t]here is no record of such a condition being diagnosed in the military nor is there record of a diagnosis in the record which any past examiners or treatment providers have linked to an in-service injury, event, or illness." However, the CAVC noted that the examiner failed to account for the Veteran's report at the examination that he met with a mental health provider while in the military and spoke, in part, about "not being able to cope with things". For these reasons, new VA opinions are necessary to adjudicate the claim on appeal. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the nature and etiology of the Veteran's acquired psychiatric disorder. The electronic claims file must be made accessible to the examiner for review in conjunction with the examination. (a.) The VA examiner should address whether the Veteran's acquired psychiatric disability is at least as likely as not (50% probability or greater) aggravated (increased in severity beyond the natural progress of the disorder) by his service-connected hearing loss and/or tinnitus. (b.) The examiner should also opine as to whether it is at least as likely as not (i.e., probability of 50 percent or greater) that an acquired psychiatric disorder was related to the Veteran's active service. In rendering this opinion, the examiner should specifically consider the relevant lay report regarding in-service treatment noted during his June 2020 VA examination. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should indicate such and provide a supporting rationale as to why the opinion cannot be made without resorting to speculation. An explanation of all opinions expressed must be provided, with consideration given to all evidence of record. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hite, 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.