Citation Nr: 21005918 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 14-11 023A DATE: February 2, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include depression, as secondary to service-connected skin disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from December 1988 to January 1993. 1. Entitlement to service connection for an acquired psychiatric disability, to include depression, as secondary to service-connected skin disability is remanded. The Board finds that, with regards to the Veteran’s claim for service connection for a psychiatric disability, to include depression, the VA examination and opinions acquired since the last Board remand are considered inadequate for adjudication. Specifically, the Board notes that the Veteran was afforded two separate VA examinations and opinions, a single day apart on January 17, and January 18, 2020. In the initial January 17, 2020 VA examination report, the VA examiner found ultimately that the Veteran’s psychiatric condition, which included depression, was aggravated by the Veteran’s skin disability and associated medication; in contrast, the January 18, 2020 VA examination reported, noted no etiological relationship between depression and the Veteran’s service-connected skin disability, or medication taken. The Board finds that, a close review of both opinions, however, reveals that both such opinions to be incomplete and inadequate as neither provide sufficient and/or adequate rationale to their findings regarding establishing an etiological nexus, especially in light of the additional evidence of record, and an opposing opinion. With regards to the first January 17, 2020 opinion, the Board finds that this opinion to the inadequate. Despite that the fact that it was a positive nexus opinion in favor of the Veteran, the examiner explicitly noted in the report that such opinion was based on inaccurate, inconsistent, and potentially outright false facts presented by the Veteran. The Board finds that despite the positive opinion offered by the examiner with regards to secondary aggravation based on medical studies of the correlation between the use of the Veteran’s skin medication and the aggravation of depression, such opinion is not probative that it is not based on a truthful factual basis. The Board likewise find that January 18, 2020 VA examination and opinion to be equally inadequate. To this end, the Board notes that as this examination was conducted a day after the previous examination, such examiner could not have had access to the positive opinion noted in the previous report, and those medical studies cited in the prior examination report. Consequently, by virtue of the proximity of these examinations, the latter opinion is incomplete and inadequate as it did not, and could not reconcile its opposing findings with that of the VA’s previous opinion; and as such, the Board must find such opinion to be inadequate. Finally, with regards to both examinations and opinions, the Board finds that later developed medical evidence regarding the Veteran’s claim for at traumatic brain injury (TBI) disability shows that the Veteran may have suffered from a TBI during his active service. In this regard, the Veteran has not only been assessed several times regarding TBI symptoms in the duration after the last VA examinations, but has also submitted a private medical opinion from a Dr. V. M., finding that these progressive TBI’s during service could be responsible for various neuropsychiatric symptoms and manifestations. The Board finds that as both the January 2020 VA examinations noted no TBI and as such claimed TBI’s could account for various psychiatric symptoms noted in the previous examinations, the Board finds that additional development is required. When medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). Therefore, remand is required for the VA to fulfill its duty to the Veteran. 2. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. With regard to the claim for TDIU, as the claim for service connection for a psychiatric disability is being remanded for additional development, the outcome of that claim could be a direct bearing on the Veteran’s claim for TDIU. Therefore, the Board finds that the claim for service connection is inextricably intertwined with any analysis of the Veteran’s claim for a TDIU. Accordingly, since that claim is being remanded, the Board finds that it would be potentially prejudicial to the Veteran for the Board to consider this derivative claim prior to the determination of that other claim. Bernard v. Brown, 4 Vet. App. 384 (1993); Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Attempt to obtain any outstanding VA treatment records that have not already been associated with the Veteran’s claims file. If no records are available, the claims folder must indicate that fact and the Veteran should be notified. 38 C.F.R. § 3.159 (e). 2. Then, schedule the Veteran for a VA examination with an appropriately qualified medical professional. The examiner must provide an opinion with regard to the etiology of any psychiatric disability, and whether it is at least as likely as not related to the Veteran’s active service or is caused or aggravated by service-connected disabilities, to include medication. The examiner must review the claims file and should note that review in the report. The examiner is asked to provide an opinion and rationale for the following: (a) Is it at least as likely as not (50 percent probability or greater) that any psychiatric disability had its onset in service or is otherwise related to service? The examiner must explicitly speak to the Veteran’s claimed TBI during service, and the private medical opinion that founds that various psychiatric symptoms can be attributed to the residuals of the TBI. (b) Is it at least as likely as not (50 percent probability or greater) that any psychiatric disability was caused by any service-connected disabilities, to especially include the Veteran’s skin condition? (c) Is it at least as likely as not (50 percent probability or greater) that any psychiatric disability has been aggravated (permanently worsened beyond the natural progress of the disorder) by any service-connected disabilities, to especially include the Veteran’s skin disability? The examiner should specifically consider and explicitly speak to and reconcile any opinion with regards to those positive and negative nexus opinions already of record. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Ziheng Zhu, 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.