Citation Nr: 21015388 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 15-11 786 DATE: March 17, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 24, 1969,to December 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Board remanded the claim to obtain an addendum opinion on a direct and secondary basis. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and as secondary to a service-connected disability. The Veteran contends that his acquired psychiatric disorder is related to service. Upon remand, a supplemental opinion was obtained in December 2020. Regarding direct service connection, the examiner opined that the condition claimed was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The examiner stated that the Veteran fulfilled DSM-5 diagnostic criteria for the Depressive Disorder established on the previous mental exam done by the undersigned (Unspecified Depressive Disorder) and no other formal mental disorder was found. Therefore, the examiner stated, an opinion cannot be rendered regarding other formal mental disorder such as major depression, generalized anxiety, mild neurocognitive disorder, adjustment disorder with depressed mood, and major depressive affective disorder, without mere speculation, at present. Regarding secondary service connection, the examiner opined that the condition claimed is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition. The examiner explained that the Veteran started psychiatric care in 2012, and there is no documentation on the evaluation of his erectile dysfunction as an identified stressor. Further, the examiner stated that there is no evidence of significant occupational or social impairment. The Board regrets the further delay but finds that a new opinion is needed to afford the Veteran full consideration of his claim. The opinion is inadequate because it continues to rely too heavily on the lack of documentation of treatment or complaints for an acquired psychiatric disorder during service. It is further inadequate because neither direct nor secondary opinion addresses the reports of the Veteran regarding in-service incident. Additionally, the secondary opinion does not contain an adequate rationale. For these reasons, in addition to the examiner’s assertion that it would be speculative to opine on the etiology of other psychiatric disorders noted during the pendency of the appeal, the Board finds that a new opinion from a different examiner is necessary. Accordingly, the matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. After completing directive #1, request a new medical opinion from a clinician different than the one who provided the December 2020 supplemental opinion. The examiner should be provided with a copy of the claims file and following review of such, determine the nature and etiology of the acquired psychiatric disorder(s). a) The examiner is asked to opine on whether it is as least as likely as not (a 50 percent probability or greater) that the following are etiologically related (caused or aggravated), in whole or in part, to the Veteran’s active service: (a) unspecified depressive disorder; (b) major depression; (c) generalized anxiety; (d) mild neurocognitive disorder; (e) adjustment disorder with depressed mood; and (f) major depressive affective disorder. In making this assessment, the examiner should address the Veteran’s lay statement that he has had nightmares and intrusive memories related to encountering human cadavers in a freezer during service in Vietnam. b) The examiner is also asked to opine on whether it is as least as likely as not (a 50 percent probability or greater) that the Veteran’s service-connected erectile dysfunction (a) caused the Veteran’s acquired psychiatric disorder or (b) aggravated (worsened beyond the normal progression of the disability) the Veteran’s acquired psychiatric disorder.   A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.