Citation Nr: 21008020 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 14-36 703 DATE: February 11, 2021 REMANDED The issues of entitlement to service connection for psychosis for the purpose of establishing eligibility for treatment pursuant to the provisions of 38 U.S.C. § 1702 and entitlement to service connection for an acquired psychiatric disorder are remanded. REASONS FOR REMAND The Veteran served on active duty from July 1979 to August 1979 and from December 1990 to September 1991. These matters come to the Board of Veteran’s Appeals (Board) on appeal from January 2006, September 2011, and December 2012 rating decisions issued by the Department of Veteran Affairs (VA) Regional Office (RO). In September 2008 and June 2010, the Board remanded the issue of entitlement to service connection for an acquired psychiatric disorder. In July 2018 and October 2020, the Board remanded the issues of entitlement to service connection for psychosis for the purpose of establishing eligibility for treatment pursuant to the provisions of 38 U.S.C. § 1702 and entitlement to service connection for an acquired psychiatric disorder. 1. Entitlement to service connection for psychosis for the purpose of establishing eligibility for treatment pursuant to the provisions of 38 U.S.C. § 1702. 2. Entitlement to service connection for an acquired psychiatric disorder. The June 2010 Board remand found that the May 2009 VA opinion was inadequate to decide the claim as no rationale was provided for the negative opinion rendered and remanded for another VA examination and medical opinion. An addendum opinion was provided in August 2010. In rendering the opinion, the VA examiner provided no rationale, or at best used circular, conclusory logic. Thus, the Board found that this examination also was inadequate, and remanded the claim for an additional opinion addressing the etiology of the Veteran’s acquired psychiatric disorders. Pursuant to the October 2020 remand, the Veteran was afforded another VA mental disorders examination in December 2020. The examiner diagnosed the Veteran with schizoaffective disorder, bipolar type, alcohol use disorder in sustained remission, and cocaine use disorder in sustained remission. She opined that the Veteran’s psychiatric disorders were less likely than not related to service. She determined that the Veteran’s schizoaffective disorder was not due to service because he did not seek formal psychiatric treatment until almost nine years after separation from service, and that a temporal relationship between the neuropsychiatric disorder and the Veteran’s military service therefore could not be established. She also determined that the Veteran’s alcohol and cocaine use disorders were a product of his own willful misconduct and bore no relation to his military service or to any service-connected disabilities. The examiner finally opined that the Veteran’s schizoaffective disorder was not caused by his service-connected disabilities as the Veteran did not seek psychiatric care until nine years after the events that led to his service-connected disabilities. Based on this fact, she reasoned that the Veteran’s schizoaffective disorder was of a different etiology, time frame, pathophysiology, and anatomical system from his service-connected disabilities and therefore were of no relation to each other. Significantly, however, the VA examiner did not reconcile other psychiatric diagnosis of record, did not consider the Veteran’s lay statements of his experiences during his deployment to Saudi Arabia, and did not address whether the Veteran’s service-connected disabilities or the associated signs or symptoms aggravated his psychiatric disorders. Based on the foregoing deficiencies, the Board finds that the VA examiner’s opinions are inadequate, and another opinion that assesses the etiology of his acquired psychiatric disorders is necessary prior to adjudication of the claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination when developing 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). The matters are REMANDED for the following actions: 1. Schedule a VA examination of the claims file to determine the etiology of the Veteran’s mental health disability. The clinician should review the claims file and provide the following opinions: (a.) Identify all currently diagnosed mental health disabilities. In doing so, the examiner should note that the term “current” means occurring at any time during the pendency of the Veteran’s claim; i.e., from January 2005 onward. The psychiatric disorder need not be present at the time of the examination; rather it is sufficient if it previously existed during the pendency of the claim and then resolved prior to the examination. The Board notes in this regard that the record shows past diagnoses of schizoaffective disorder, major depressive disorder, psychosis, and post-traumatic stress disorder. All of these disorders should be considered and discussed, in addition to any other disorders that may be found on review of the claims file. If any specific disorder is ruled out (cannot be validated), a complete explanation must be provided. That explanation should include a discussion of all the pertinent evidence of record, to include lay evidence. So, for example, if the examiner were to find that a psychosis is not a current disability, then the explanation should include a discussion of the medical records, prior VA examinations, as well as the Veteran’s lay statements regarding his condition. If the examiner determines that any prior diagnosis cannot be validated, she or he should explain why. With respect to each diagnosed disorder, the examiner should state whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s psychiatric disability arose during service or is otherwise related to any incident of service, including his deployment to Saudi Arabia for the Liberation of Kuwait campaign? Please explain why or why not. With respect to each diagnosed disorder, is it at least as likely as not (50 percent probability or greater) that the Veteran’s psychiatric disability was caused or aggravated by a service-connected disability or its associated signs and/or symptoms, to include hearing loss, tinnitus, headaches, degenerative joint disease of the left knee, and degenerative joint disease of the right ankle as a result of an injury? Please explain why or why not. The clinician should also offer an opinion as to whether it is possible to distinguish the symptoms and effects of the Veteran’s alcohol and/or cocaine dependence from those attributable to any other psychiatric disorder found. A rationale for any opinions expressed should be set forth. If the examiner cannot provide an above opinion without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Bilstein, 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.