Citation Nr: 21009515 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 14-13 231 DATE: February 22, 2021 REMANDED Service connection for a psychiatric condition, excluding posttraumatic stress disorder (PTSD).   REASONS FOR REMAND The Veteran served on active duty from July 1969 to May 1973. The case is on appeal from a July 2011 rating decision. In April 2017, the Veteran testified at a Board hearing. In a January 2018 decision, the Board denied service connection for PTSD and reopened a previously denied claim of service connection psychiatric condition other than PTSD. At that time, the Board remanded the reopened claim for additional development. The Board also remanded the claim for additional development in July 2019 and July 2020. Service connection for a psychiatric condition, excluding PTSD. The Veteran is seeking service connection for a psychiatric disorder. She contends that her current psychiatric conditions are related to experiences she had caring for premature babies, four of whom died, while she was in service. The Veteran also asserts her psychiatric conditions had their onset within one year of service, and she is entitled to presumptive service connection for her psychiatric condition under 3.309(a) as a chronic disease. See November 2010 Statement in Support of Claim. In addition, the Veteran claims that her psychiatric conditions are secondary to her asthma as the side effects caused by her treatment with prednisone worsened her depression. See May 2020 Correspondence. The Veteran’s service personnel records (SPRs) confirm that she had a specialty of medical services specialist and from February 1970 to March 1971, she was assigned to the obstetrics ward of the US Air Force Hospital in Misawa, Japan. In addition, the Veteran’s service treatment records (STRs) show that in May 1971, the Veteran complained of “nervousness,” and it was noted that she did not particularly like Misawa, Japan. At that time, an impression of “mild situational reaction” was noted. In addition, VA treatment records show that the Veteran underwent treatment for “situational stressors” in May 1974, a year after her separation from service. The Veteran’s STRs also show that an exacerbation of asthma was treated with steroids on one occasion in July 1972. The claim was most recently remanded in July 2020 as the Board determined the opinions of record were not adequate to decide the claim. In this regard, the Veteran underwent VA examinations in February 2011, March 2014, and April2018. Addendum opinions were obtained in November and December 2019. The examiners who provided the February 2011 VA examination and March 2014 both noted diagnoses of schizoaffective disorder and major depressive disorder that were less likely than not related to service. However, neither examiner provided a rationale as to why this is so. Regarding the April 2018 opinion, the examiner also provided a negative etiology opinion. She provided a history of the Veteran’s treatment for her psychiatric conditions and stated that it is not clear when the Veteran’s schizoaffective disorder and major depressive disorder were diagnosed, but there is no evidence to suggest that the “situational stressors” in 1971 and 1974 were early manifestations of the later diagnosed major depressive disorder or schizoaffective disorder. The examiner did not provide an adequate rationale for her opinion. The examiner who provided the November 2018 opinion provided a negative etiology opinion based on the occurrence of a steroid induced psychosis during service. However, the Veteran received steroids to treat her asthma on one occasion during service in July 1972, she experienced a steroid induced psychosis related to asthma treatment after service. Thus, November 2018 opinion is not based on an accurate medical history. The December 2019 opinion essentially restated the April 2018 opinion but added that the Veteran’s conditions had their onset during the 1980s. However, the examiner included the comment that he was unable to offer an explanation or opinion for continued mental health treatment beginning in May 1974 without resorting to speculation. Without accounting for this medical history, it is unclear how the examiner reached the conclusion that the Veteran’s conditions had their onset during the 1980’s. Pursuant to the Board’s July 2020 remand, the Veteran underwent an additional examination in October 2020. The examiner reported diagnoses including schizoaffective disorder and major depressive disorder. The examiner provided a negative etiology opinion and explained that the Veteran’s conditions appear to have developed in the 1980’s and do not appear to be a result of her military service. However, the examiner did not explain how she reached this conclusion. Similar to the December 2019 opinion, she did not account the mental health treatment the Veteran received in May 1974. In addition, as noted in the Board’s July 2020 remand, there is not yet an opinion of record that addresses the Veteran’s contention that she has a psychiatric condition that is related to caring for premature babies, four of whom who died under her care, while she was assigned to a hospital obstetrics unit when stationed in Japan. Moreover, the Veteran has also asserted that her depression is secondary to her service-connected asthma in that the side effects of her treatment worsened her depression. An opinion concerning this theory of entitlement has yet to be obtained. Accordingly, a new examination and opinion are warranted on remand. The matters are REMANDED for the following action: 1. Obtain VA treatment records dated since October 2020. 2. Thereafter, schedule the Veteran for an examination (or telehealth interview, records review, etc. if an in-person examination is not feasible) to determine the nature and etiology of the Veteran’s psychiatric conditions. The entire claims file must be reviewed by the examiner. The examiner is to conduct all indicated tests. The examiner should provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that any psychiatric condition had its onset during service or is related to service. The examiner should also provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that any psychosis had its onset within one year of service. The examiner should comment upon the Veteran’s contentions regarding caring for premature babies while she was stationed in Japan and the mental health treatment the Veteran received in beginning in May 1974. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any psychiatric conditions are caused or aggravated by her service-connected asthma. The examiner should consider and specifically address the Veteran’s contentions regarding side effects caused by her treatment with prednisone. “Aggravation” is an increase in severity beyond the natural progress of the disease. The examiner should provide rationale for all opinions expressed, including by citing to the record. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Gray, Associate 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.