Citation Nr: 21077546 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 12-11 146 DATE: December 30, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1963 to October 1965. This appeal was previously remanded by the Board in February 2018, February 2021, and August 2021. Subsequent to the most recent remand, by an October 2021 rating decision, the RO granted service connection for vision problems. This is considered a full grant of the benefits sought on appeal. The Board acknowledges that the Veteran's representative submitted argument regarding the assigned rating; however, the Veteran never appealed the initial rating assigned in the October 2021 rating decision, and as such, this issue is not in appellate status. On review, an additional remand is necessary prior to analyzing the merits of this claim. Of record are August 2009, December 2011, October 2015, March 2021, and September 2021 examinations. With the exception of the December 2011 examination, all other examiners concluded that the Veteran does not have a current diagnosis of a mental disorder. However, neither examiner reconciled numerous mental health diagnoses throughout the years. For example, in September 2003, a psychiatric evaluation showed diagnoses of schizophrenia paranoid type, obsessive compulsive disorder, and rule out major depressive disorder with psychotic symptoms. October 2003 Social Security Administration (SSA) determination showed an affective disorder secondary to physical impairments and functional limitations. The 2011 examiner diagnosed major depressive disorder. Throughout the pendency of the claim, mental health treatment records showed symptoms of depression, anxiety, mania, cognitive deficits, mood changes, sleep disorders, psychosis/schizophrenia and panic attacks with agoraphobia, anhedonia, and dysphoria. On remand, an adequate addendum medical opinion that will include a comprehensive review of the claims file is necessary. The matter is REMANDED for the following action: 1. Ensure all outstanding VA treatment records are associated with the claims file. 2. Thereafter, obtain an addendum medical opinion from an appropriate VA examiner to help determine the likely etiology of any currently diagnosed acquired psychiatric disorder. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After a review of the record, the examiner is asked to respond to the following: (a) Under the criteria of the DSM-IV and/or DSM-V, does the Veteran have a current diagnosis or had one during the appeal period of a psychiatric disorder, to include but not limited to schizophrenia paranoid type, obsessive compulsive disorder, and rule out major depressive disorder with psychotic symptoms, major depressive disorder, affective disorder secondary to physical impairments and functional limitations, and major depressive disorder. **If the examiner concludes that no psychiatric disorder is shown, he or she must reconcile prior diagnoses of shown in the record and explain how they have resolved or no longer show any pathology. ** (b) For any currently diagnosed acquired psychiatric disorder or any diagnosed acquired psychiatric disorder during the appeal period, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) related to the Veteran's active-duty service. (c) For any currently diagnosed acquired psychiatric disorder or any diagnosed acquired psychiatric disorder during the appeal period, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) was caused OR aggravated by a service-connected disability. Aggravation under 38 C.F.R. § 3.310 (b) does not require that there be "permanent" worsening of the nonservice connected disability. (Continued on the next page) A complete rationale should be provided for all opinions on direct, causation, AND aggravation. 3. Thereafter, readjudicate the remanded claim. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Yaffe, 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.