Citation Nr: 21020720 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 09-06 871 DATE: April 8, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder, is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1972 to April 1973. The Board in June 2018 denied the issues on appeal. The Veteran appealed to the United States Court of Appeals for Veterans Claims (the Court). The claims were remanded to the Board in January 2019 pursuant to a Joint Motion for Remand. Issues 1-2: Entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder, and TDIU are remanded. On the most recent VA examination in December 2020, the diagnosis was unspecified depressive disorder per the DSM-5 criteria. The examiner noted that the Veteran sought psychiatric treatment in 1997, however there was no evidence of such treatment. The examiner opined that the claimed disorder was less likely than not incurred in or caused by service based on the rationale that the Veteran first sought psychiatric treatment in 2003, almost 30 years after service and his mental disorder found in 2003 is not related to service. The examiner also opined that the claimed psychiatric disorder is less likely than not proximately due to or the result of the Veteran’s service-connected premature ventricular contractions (PVC) with heart failure and ventricular hypertrophy based on the rationale that medical literature does not show an etiological relationship and thus the Veteran’s depressive disorder was not due to nor the result of nor aggravated by his service-connected heart disorder. The examiner noted that these two conditions were in different time frames, had different etiologies and anatomical systems and were unrelated. The examiner also opined that the claimed condition, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service event, injury or illness based on the rationale that as for aggravation the Veteran sought psychiatric treatment in 2003, almost thirty years after service, a temporal relationship between the neuropsychiatric disorder and service-connected heart disorder was not established as the latter for thirty years preceded the Veteran’s neuropsychiatric disorder and thus the neuropsychiatric disorder could not be aggravated by the service-connected heart disorder. The December 2020 VA examiner, a psychiatrist, also noted that as for the September 1977 examination with a finding of cardiac neurosis, it was rendered by an internist or cardiologist and not in the line of a psychiatrist’s expertise. The December 2020 examiner also pointed out that this is an old nomenclature without a current validation. The December 2020 VA opinion is inadequate for the following reasons. The December 2020 examiner determined that the Veteran first sought psychiatric treatment almost 30 years after service, however, as noted by the Veteran’s attorney, the Veteran was treated for a psychiatric condition in the earlier 1990s. See, e.g., June 2019 Appellate Brief. Notably, medical records dated in April 1994 show a diagnosis of slight chronic major depression and in September 1996 show a diagnosis of a mood disorder. Further, the December 2020 VA opinion also is inadequate to the extent that the December 2020 VA examiner opined that the Veteran’s psychiatric disorder preexisted service, which is factually inaccurate. Lastly, on VA examination in December 2020, the diagnosis was unspecified depressive disorder per the DSM-5 criteria. However, effective August 4, 2014, VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to Diagnostic and Statistical Manual, 4th Edition (DSM-IV) and replacing those references with references to the recently updated DSM-V. See 38 C.F.R. § 3.304 (f)(2); Molitor v. Shulkin, 28 Vet. App. 397, 410-11 (2017). As the Veteran’s claim was before the Board on August 4, 2014, the DSM-IV criteria is applicable in the instant case. See July 2014 Board docketing letter.   As for entitlement to TDIU, as noted in the November 2020 remand the Board finds that the Veteran’s claim for TDIU is intertwined with the issue of entitlement to service connection for a psychiatric disorder. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Contact the Veteran and ask him to provide written authorization for VA to obtain any outstanding private treatment records. With any necessary assistance from the Veteran, obtain any outstanding VA medical records. All attempts associated therewith should be memorialized in the Veteran’s claims file. 2. Afterwards schedule the Veteran for an examination by an appropriate examiner. After reviewing the claims folder, conducting all necessary tests, and examining the Veteran the examiner is asked to do the following: a.) Identify/diagnose all current psychiatric disorders per the DSM-IV criteria and for each diagnosed psychiatric disorder opine whether it is at least as likely as not (50 percent or better probability) that it is related to an in-service injury, event, or disease. b.) Provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any acquired psychiatric disorder was (a) caused or (b) aggravated by the Veteran’s service-connected premature ventricular contractions (PVC) with heart failure and ventricular hypertrophy. In rendering the above opinions, the examiner is hereby advised that the September 1977 examination includes a finding of cardiac neurosis and a December 2008 opinion shows that the Veteran’s depression was secondary to his service-connected heart disorder. The examiner also is advised that the Veteran was treated for a psychiatric condition in the earlier 1990s. See, e.g., June 2019 Appellate Brief. Notably, medical records dated in April 1994 show a diagnosis of slight chronic major depression and in September 1996 a diagnosis of a mood disorder. For all opinions rendered, the examiner should explain the rationale. If the examiner is unable to provide an opinion, he or she should explain why. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mac, 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.