Citation Nr: 21076936 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 15-00 072A DATE: December 28, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include as secondary to service-connected disabilities is remanded. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1978 to August 1981. This matter comes to the Board of Veterans' Appeals (Board) on appeal from April 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was last before the Board in June 2021, and was remanded for further development. A September 2021 rating decision granted service connection for deep vein thrombosis of the left lower extremity. This is a full grant of the benefit sought and, therefore, this issue is no longer before the Board. REASONS FOR REMAND Entitlement to service connection for an acquired psychiatric disability, to include as secondary to service-connected disabilities is remanded. Unfortunately, another remand is necessary for this issue. As noted in the prior remand, the Veteran has argued that his physical disabilities either caused or aggravated his acquired psychiatric disability. The Veteran was afforded a VA examination in April 2019 to assess the nature and etiology of his claimed acquired psychiatric disability. The examiner pertinently opined that while the Veteran's depression and anxiety are less likely than not related to service, it is more likely that his physical health contributed to the development of his depression and anxiety, and have exacerbated them beyond normal progression. However, the examiner also noted that the veteran is service connected for left foot callous. There is no causal relationship between anxiety, depression and left foot callous. A June 2021 Board decision remanded the claim for further development, including an opinion as to whether the Veteran's psychiatric disability was caused or aggravated by his service-connected bilateral knee disabilities which were service connected during the pendency of the claim. An addendum opinion was obtained in June 2021, wherein the examiner opined that it is less likely than not that the Veteran's knee disabilities caused or aggravated the acquired psychiatric disability. The examiner noted that VAMC treatment notes indicated that even with pain issues, depression was stabilized per 2015 VAMC notes, and the Veteran denied depression despite being in pain and discomfort due to physical health condition. The examiner also noted that VAMC notes indicated that prior to 2015, around 2013, there was documented depression and pain/physical health contributed to issues of depression, but were not the main cause; he was depressed about DUI, financial issues, and psychosocial problems. The April 2019 and June 2021 opinions are in conflict. On the one hand, the April 2019 examiner opined that the Veteran's physical health contributed to the development of his depression and anxiety and have exacerbated them beyond their normal progression, but did not specify which physical health conditions he was referencing. On the other hand, the 2021 examiner indicated that there is no aggravation, as the Veteran's depression was stabilized. Further, the examiner noted that pain/physical health contributed to issues of depression, but were not the main cause. However, secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. Thus, a remand is necessary to obtain an addendum that addresses these issues. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding, pertinent VA and private treatment records. 2. Obtain an addendum opinion from an appropriate clinician who has not previously provided an opinion regarding the etiology of the Veteran's diagnosed acquired psychiatric conditions. If the clinician finds it necessary to conduct a new examination, schedule such an examination for the Veteran. The clinician is asked to review the claims file to become familiar with the pertinent medical history. The clinician is asked to provide an opinion whether it is at least as likely as not (i.e. a 50 percent probability or greater) that the Veteran's acquired psychiatric disorder(s) was (1) proximately due to or (2) aggravated by any service-connected disability, to include his foot, bilateral knee, or deep vein thrombosis of the left lower extremity disabilities. Please review and reconcile the April 2019 and June 2021 conflicting medical opinions. The examiner is advised that the term "aggravation" is defined for legal purposes as a chronic worsening of the underlying condition beyond its natural progression. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (i.e., a baseline) before the onset of the aggravation. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and 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), the record (additional facts are required), or the examiner (does not have the knowledge or training). A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Comninos, Georgio 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.