Citation Nr: 21015559 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 18-55 665 DATE: March 17, 2021 REMANDED Entitlement to service connection for a psychiatric condition is remanded. Entitlement to service connection for a kidney condition is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1962 to November 1966. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of October 2016 issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. Following the rating decision on appeal, the Veteran timely filed his notice of disagreement (NOD) in September 2017. After continuing the denial of service connection for a psychiatric condition in an additional rating decision of October 2017, the RO issued a statement of the case (SOC) in October 2018. The Veteran’s timely appeal to the Board followed in December 2018. The undersigned Veterans Law Judge (VLJ) conducted a hearing in these matters in November 2020. A transcript of the hearing is of record. 1. Entitlement to service connection for a psychiatric condition. The Veteran underwent a VA examination on this issue in July 2016. The VA examiner diagnosed the Veteran with major depressive disorder, but opined that the Veteran’s stressors and symptoms did not meet the diagnostic criteria for posttraumatic stress disorder (PTSD). See July 2016 VA Examination Report at 2. The VA examiner did not provide an opinion as to whether the Veteran’s diagnosed major depressive disorder psychiatric condition was incurred in or as a result of active-duty service. See id. at 2-12. In denying the Veteran’s claim, the RO relied on the absence of a diagnosis of PTSD, as well as on the absence of stressor statements requested from the Veteran. See October 2016 VA Memorandum; see also October 2016 Rating Decision at 6-7. The RO’s decision addressed entitlement to both PTSD specifically and to a mental health condition more generally. See id. However, because it relied on an inadequate VA examination report, which did not provide an opinion as to the etiology of the Veteran’s diagnosed psychiatric condition (major depressive disorder), remand for such an opinion is necessary. “[Once] the Secretary undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, he must provide an adequate one[.]” Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, the Board notes that the Veteran has subsequently submitted supporting stressor statements, as well as additional lay statements from his spouse. See June 2017 VA Form 21-4138; see also June 2017 VA Form 21-0781; see also June 2017 Lay Statement. 2. Entitlement to service connection for a kidney condition. The Veteran has not undergone a VA examination specifically addressing this condition. “In disability compensation claims, [VA] must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service… and (3) an indication that the disability… may be associated with the veteran’s service… but (4) insufficient competent medical evidence on file… to make a decision on the claim.” McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The third McLendon element “requires only that the evidence ‘indicates’ that there ‘may’ be a nexus between the two.” Id. at 83. “This is a low threshold… [and includes] credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation.” Id. The Board notes that the Veteran has been diagnosed with a kidney condition. See July 2018 Medical Treatment Records at 1 (noting polycystic kidney disease among medical conditions). The Veteran was exposed to herbicide agents during his active-duty service, resulting in the development of multiple service-connected medical conditions. See August 2018 Rating Codesheet at 1-2. One of these conditions is diabetes mellitus. See August 2018 Rating Codesheet at 1; see also November 2020 Transcript at 5. The Board notes that the Centers for Disease Control and Prevention (CDC) have listed diabetes among the risk factors for developing kidney disease. See “Chronic Kidney Disease Basics,” CDC (accessed via https://www.cdc.gov/kidneydisease/basics.html). Each of the first three McLendon factors has therefore been met. In assessing the fourth McLendon factor, the Board notes that in a VA examination of October 2017 addressing the Veteran’s service-connected diabetes, the examiner did not find renal dysfunction or renal disease as associated complications. See October 2017 VA Examination Report at 3. However, these findings are insufficient to support the adjudication of the Veteran’s claim, because the examiner did not provide any reasoning or analysis to explain why this finding was warranted. Specifically, there is medical evidence in the claims file indicating polycystic kidney disease, but the examiner did not comment on why this is unrelated to any renal disease that may be associated with the diabetes. In this regard, “[Most] of the probative value of a medical opinion comes from its reasoning. Neither a VA medical examination report nor a private medical opinion is entitled to any weight… if it contains only data and conclusions.” Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In cases where “the medical evidence of record is insufficient, or, in the opinion of the BVA, of doubtful weight or credibility, the BVA is always free to supplement the record by seeking an advisory opinion, ordering a medical examination or citing recognized medical treatises in its decisions that clearly support its ultimate conclusions.” Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). These matters are therefore REMANDED for the following action: 1. Arrange for a VA mental disorders addendum opinion for the purpose of evaluating the nature and etiology of any diagnosed mental disorder. If the examiner determines that an examination is necessary to provide the requested opinion, such examination shall be procured. The examiner shall review the claims file, including a copy of this remand, and provide opinions as to the following question: Is it at least as likely as not that the Veteran has a psychiatric condition that was incurred in or a result of his active-duty service? In forming the opinion(s), the examiner shall specifically address any relevant information from the Veteran’s June 2017 stressor statements and the supporting lay statement of the Veteran’s spouse; and any relevant information from the Veteran’s service treatment records (STR), including August and December 1964 reports of nervous reaction, syncope, hospitalization, and acute anxiety reactions. 2. Arrange for a VA addendum opinion by an appropriate examiner for the purpose of evaluating the nature and etiology of any diagnosed kidney disease and/or renal dysfunction. If the examiner determines that an examination is necessary to provide the requested opinion, such examination shall be procured. The examiner shall review the claims file, including a copy of this remand, and provide opinions as to the following question(s): a) Is it at least as likely as not that the Veteran has a kidney condition which is proximately due to or a result of his service-connected diabetes mellitus? b) If not, is it at least as likely as not that the Veteran has a kidney condition which was incurred in or a result of his active-duty service, including his exposure to herbicide agents? 3. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, complete explanations stating why this is so shall be provided. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 4. Readjudicate the issues on appeal. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Blore, 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.