Citation Nr: 21011721 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 20-22 484 DATE: March 2, 2021 REMANDED 1. Entitlement to service connection for an acquired psychiatric disability, other than PTSD, to include adjustment disorder, is remanded. 2. Entitlement to service connection for gastroesophageal reflux disease (GERD) (claimed as acid reflux) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 2005 to October 2005, October 2005 to February 2007, May 2007 to June 2008, and May 2009 to May 2010. These matters come before the Board of Veterans’ Appeals (Board) on appeal from January 2015 and May 2015 rating decisions issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). In pertinent part, the January 2015 rating decision denied the Veteran’s claim seeking entitlement to service connection for PTSD. In February 2015, the Veteran submitted a lay statement containing new and material evidence as to this claim sufficient to toll the finality of the January 2015 rating decision under 38 C.F.R. § 3.156(b). The claim was readjudicated in the May 2015 rating decision, along with an original determination for acid reflux, and a timely VA form 21-0958, Notice of Disagreement, was received in March 2016. For this reason, the Board has determined that both the January 2015 and May 2015 rating decisions are on appeal. This matter was previously remanded by the Board in December 2020 for additional evidentiary development. However, as will be discussed in more detail below, the Board finds that there has not been substantial compliance with its remand directives. Therefore, this matter must be remanded once again. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). This matter has been advanced on the docket pursuant to 38 C.F.R. § 20.900. 1. Entitlement to service connection for an acquired psychiatric disability, other than PTSD, to include adjustment disorder, is remanded. In a December 2020 Board decision, the Veteran’s claim for service connection for PTSD was remanded with a directive to the RO to request a VA examiner opine on whether the May 2014 diagnosis of adjustment disorder under the DSM-5 criteria was accurate, and if so, whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s May 2014 diagnosis of adjustment disorder under the DSM-5 criteria was etiologically related to the Veteran’s active duty service, as opposed to interpersonal relationship problems with his father and spouse? While the Board finds that the RO substantially complied with the previous remand directives by securing the December 2020 addendum opinion, the Board concludes that the December 2020 opinion is inadequate to adjudicate the service connection claim. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). The December 2020 VA examiner provided a negative opinion concerning a nexus between the Veteran’s currently diagnosed adjustment disorder and his service. The rationale stated that the examiner specifically asked the Veteran to discuss only his 2014 emergency room visit and mental health consult. In response, the Veteran reported that in 2014 he was experiencing marital difficulties, and had become separated from his wife a month prior to the mental health consult. The Veteran also reported that around the same time, his estranged father contacted him “out the blue” to inform him of a family death. As a result, the Veteran began to experience feelings of stress and uncertainty, until his estranged father ceased further contact. The Veteran lastly pointed out that his irritable mood and anxiety dissipated after the divorce from his wife was finalized. Based on the above-mentioned statements, the examiner opined that as the Veteran reported resolution of mood symptoms following the resolution of the stressors (marital and father’s new contact), the diagnosis of Adjustment Disorder, NOS, is considered accurate and related to those stressors only as symptoms resolved with the resolution of those stressors. He reasoned that if the stressor causing the adjustment disorder was active service, the symptoms would not have resolved when the marital and father stress resolved. The Board finds this rationale to be incomplete, at best. First, the examiner seems to have narrowly focused his examination and opinion on what the Veteran reported in 2014, and failed to consider or even ask questions concerning the Veteran’s active duty service. Further, the examiner reasoned that because the Veteran’s “mood symptoms” resolved after his marriage ended and his father ceased contact, the adjustment disorder was less likely due to service, and more likely due to those stressors. However, the examiner failed to describe or list the current symptoms associated with the Veteran’s adjustment disorder. Without this information, the Board is left to question whether there are separate symptoms, other than those noted as associated with the Veteran’s mood, that the Veteran suffers from, and if so, whether they too resolved after the resolution of the Veteran’s interpersonal relationship problems? Because of this missing information, and the lack of clarity, the Board finds an addendum opinion is warranted. 2. Entitlement to service connection for gastroesophageal reflux disease (claimed as acid reflux) is remanded. The Veteran seeks entitlement to service connection for acid reflux. He alleged that he suffered from acid reflux while on active duty, or in the alternative, that his acid reflux is secondary to any mental health disabilities he has experienced during the appellate period. See February 2015 lay statement. The Board notes that the December 2020 examiner confirmed a GERD diagnosis, and found that while the Veteran’s GERD is less likely than not related to service, it is more likely than not related to his diagnosed adjustment disorder. However, because GERD is inextricably intertwined with the remanded claim; consideration of this matter must be deferred pending resolution of this claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain a VA addendum medical opinion from the same VA examiner who prepared the December 2020 opinion. If not available, the RO should obtain a medical opinion from another appropriate clinician to determine whether the Veteran’s currently diagnosed adjustment disorder is at least as likely as not (50 percent probability or greater) etiologically related to the Veteran’s active duty service, as opposed to interpersonal relationship problems with his father and spouse? The examiner should question the Veteran about his time in service; specifically inquiring about any in-service stressors which he feels could be etiologically linked to his currently diagnosed Adjustment Disorder. (Continued on the next page)   The examiner should also list all symptoms associated with the Veteran’s adjustment disorder and discuss whether each of those symptoms resolved as a result of the resolution of his interpersonal relationship problems. 2. The RO is requested to ensure that all medical opinions issued by the VA examiners are accompanied by complete rationales based on each examiner’s clinical experience and medical expertise; established medical principles; and/or citations to the electronic claims file, as appropriate. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Russell, Tangela 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.