Citation Nr: 21008830 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 17-00 390 DATE: February 18, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected left knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2000 to January 2001 in the Army and September 2006 to May 2007 in the Air Force. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In January 2020 the Board remanded the claim for additional development and it now returns for further appellate review. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected left knee disability. In January 2020, the Board, as relevant, remanded the Veteran’s claim for service connection for an acquired psychiatric disorder in order to obtain an addendum opinion addressing whether his currently diagnosed major depressive disorder was aggravated by the post-service worsening of his service-connected left knee disability, which has limited his activities and results in falls. In offering such opinion, the examiner was requested to consider the Veteran’s treating VA psychologist’s report in August 2014 that the Veteran’s service-connected left knee disability continued to be a significant factor in his ongoing depression. In March 2020, following an interview with the Veteran, a review of the record, and an examination, a VA examiner noted that, prior to the Veteran’s in-service knee injury, he had a baseline of a low level of functioning as evidenced by academic problems, counseling and medication for issues related to attention and depression, an inability to complete Army boot camp, and an unstable work history. The examiner further found that the severity of the Veteran’s major depressive disorder was not greater than the baseline as evidenced by his contemporaneous symptoms and resulting functional limitations detailed at the time of the May 2014 VA examination. Ultimately, he found that the Veteran had a history of unstable performance throughout his life. He was diagnosed with ADHD and associated depression in high school, was unsuccessful in traditional school and Army boot camp. The Veteran also spent five years in “dead end jobs” prior to entering the Air Force, where he was discharged for medical reasons. He then again bounced around in more “dead end jobs” for five years. However, the examiner indicated that, as the Veteran did not seek mental health treatment until approximately four years after leaving military service, such suggested that he was not experiencing significant mental health problems at the time of his discharge and ultimately left his most recent job in August 2019 due to his knee disability. However, the March 2020 VA examiner did not adequately address whether the Veteran’s major depressive disorder was aggravated by the post-service worsening of his service-connected left knee disability, which has limited his activities and results in falls. In this regard, he focused on the Veteran’s functional ability throughout his life time, rather than the severity of his major depressive disorder, and, relied, in part, on his lack of treatment following his discharge from the Army in 2005 despite his reports that his left knee disability impacted his ability to run, walk, and exercise, which worsened his depression. Finally, while noted within the inquiry in the opinion, the examiner did not appear to consider the Veteran’s treating VA psychologist’s report in August 2014 that the Veteran’s service-connected left knee disability continued to be a significant factor in his ongoing depression. Consequently, the Board finds that a remand is necessary in order to an addendum opinion addressing such matter. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Return the record, to include a copy of this Remand, to the VA examiner who offered the March 2020 opinion as to the etiology of the Veteran’s major depressive disorder. If he is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. Following a full review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s currently diagnosed major depressive disorder is aggravated by the post-service worsening of his service-connected left knee disability, which has limited his activities and results in falls. For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline. In offering the foregoing opinion, the examiner is requested to focus on the severity of the Veteran’s major depressive disorder rather than his overall functional ability. He or she should also consider the Veteran’s reports that his left knee disability impacted his ability to run, walk, and exercise, which worsened his depression, and his treating VA psychologist’s report in August 2014 that the Veteran’s service-connected left knee disability continued to be a significant factor in his ongoing depression. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Waite 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.