Citation Nr: 21075160 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 14-28 682A DATE: December 17, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include as due to a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1967 to June 1970 and from June 1972 to February 1975. The claim was most recently before the Board in May 2021 and remanded for further development. Entitlement to service connection for an acquired psychiatric disorder, to include as due to a service-connected disability is remanded. The Board is unable to make a fully informed decision because the July 2021 VA opinion did not substantially comply with the Board's May 2021 remand directives to address the Veteran's report to the provider authoring the July 2018 private opinion that he reached a breaking point [mentally] from his service-connected heart disability and pain from his orthopedic disabilities and whether his service-connected disability caused or aggravated any of the Veteran's diagnosed psychiatric disorders. Since, the July 2021 VA examination opinion did not substantially comply with the May 2021 remand directives, an addendum VA examination is warranted. Stegall v. West, 11 Vet. App. 268 (1998). Additionally, prior VA examinations provide an opinion that the Veteran does not meet the full criteria for posttraumatic stress disorder (PTSD) because he does not report having flashbacks or hypervigilance, etc. However, the Veteran submitted a July 2021 statement that he does experience flashbacks and nightmares of combat along with other effects he experiences. On remand, the examiner must discuss the Veteran's full report of symptoms he relates to combat experiences and whether he now meets the full criteria for PTSD. The matter is REMANDED for the following actions: 1. Schedule the Veteran for a VA examination (or tele-health interview, review of the record, etc., if an in-person examination is not feasible) with an appropriate VA examiner, to determine service connection for his acquired psychiatric disorder claim. The claims file and copies of all pertinent records must be made available to the examiner. After reviewing the claims file, the examiner is asked to answer the following: (a) Identify and list any diagnosed psychiatric disorder that Veteran has had throughout the period on appeal. The examiner is asked to review and discuss the Veteran's July 2021 statement of experiencing flashbacks and nightmares. The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. (b) Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed psychiatric disorder was caused by the Veteran's service. (c) Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed psychiatric disorder is proximately due to any of the Veteran's service-connected disabilities? The examiner is asked to review and discuss the July 2018 private opinion where the Veteran reports he reached a breaking point [mentally] from his service-connected heart disability and pain from his orthopedic disabilities. (d) Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed psychiatric disorder is aggravated by any of the Veteran's service-connected disabilities? The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. 2. Confirm that the VA medical opinions provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. Journet Shaw Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Perkins, 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.