Citation Nr: 21012656 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 11-23 159 DATE: March 4, 2021 REMANDED Entitlement to service connection for a chronic disability, to include a polysubstance abuse, and as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Army from December 1973 to December 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded for further adjudication in July 2014, June 2015, and May 2019. The matter returns to the Board for appellate consideration. Entitlement to service connection for a chronic disability, to include a polysubstance abuse, and as secondary to service-connected disabilities, is remanded. The Veteran contends that his polysubstance abuse is secondarily related to his service-connected unspecified depressive disorder. Although the Board regrets the delay, another remand is required before the Board can render an appellate decision. Pursuant to the May 2019 Board remand directives, a January 2020 VA examination was obtained. The examination demonstrated a diagnosis for substance induced depressive disorder (SIDD). The examiner opined that the Veteran’s substance abuse, to include any residuals as noted in VA treatment records, was not proximately due to the service-connected depressive disorder as the former condition is the precipitant to the latter, citing to per Kuria et.al (2012) evidencing a strong correlation between alcohol use and depression. The examiner noted the Veteran’s cannabis and alcohol use disorder are in remission. The Veteran and his representative have asserted that the February 2020 examiner not only failed to consider other theories of entitlement but rendered a diagnosis of SIDD, although previous VA examinations demonstrated a diagnosis for unspecified depressive disorder and sustained remission of alcohol and drug abuse. See February 2021 Appellate Brief. Furthermore, the Veteran asserted the February 2020 examiner failed to discuss a June 2011 VA treatment record noting the Veteran reduced his alcohol use or an August 2012 VA treatment record demonstrating complaints for nightmares nine months following his last use of marijuana and alcohol. The Board finds the February 2020 opinion is inadequate. First, the examiner failed to consider the theory of aggravation when discussing whether the Veteran’s polysubstance use was secondarily related to his service-connected disorder. As stated above, VA treatment records noted complaints for nightmares nine months following his last substance use. The examiner did not discuss specific residuals of the polysubstance abuse, including nightmares, when discussing the theory of causation. On remand, an addendum opinion should be obtained to ascertain the nature and etiology of the claimed condition as it relates to the service-connected unspecified depressive disorder. The matter is REMANDED for the following action: Obtain an addendum opinion from the February 2020 examiner, or another qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must determine whether it is at least as likely as not (50 percent probability or more) the Veteran’s polysubstance abuse was aggravated beyond its natural progression by the service-connected unspecified depressive disorder? “Permanent worsening” of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation. Ward v. Wilkie, 31 Vet. App. 233 (2019). The examiner should discuss residuals noted in VA treatment records, to include nightmares nine months following the last use of cannabis and alcohol. The examiner should also explain the basis for rendering a diagnosis of SIDD as opposed to the previous service-connected diagnosis for unspecified depressive disorder. The examiner is asked to reconcile any conflicting medical evidence or opinions of record. The examiner must provide all findings, along with a complete rationale for his or her opinion(s), in the examination report. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. Asfaw, 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.