Citation Nr: 21022961 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 18-39 117 DATE: April 19, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for peripheral neuropathy, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran had active service from February 1969 to February 1971. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision issued by the Department of Veterans Affairs (VA) regional office (RO) in San Juan, Puerto Rico. The Board issued a prior remand on these claims in March 2019. 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. In the prior Board remand, the Board found that the August 2016 VA examiner’s opinion was not adequate for rating purposes, finding that it did not consist of a thorough review of the claims file and discussion of the relevant evidence. The Board noted instead that the examiner “concluded that there was no relationship between the Veteran’s acquired psychiatric disability and his active service without providing any further rationale than he did not have any manifestations or treatment of an acquired psychiatric disability during service and he had not sought psychiatric treatment until well over a year after his separation from active service.” Therefore, the claim was remanded to provide the Veteran with another VA examination to address the nature and etiology of his acquired psychiatric condition(s). The Veteran was given another VA examination in November 2019. Here, he was diagnosed with major depressive disorder (MDD), but it was opined that his MDD was less likely than not incurred in or caused by his active service. Specifically, the examiner noted that there were no complaints of a mental condition prior to service, during service, nor after service until around 2000. The examiner attributed these problems to alcohol abuse/dependency. No other rationale was given for the negative nexus opinion. However, the Board notes that the record contains several psychiatric diagnoses, including anxiety, generalized anxiety disorder (GAD), depressive disorder, MDD, depression with psychotic features, unspecified depressive disorder, and posttraumatic stress disorder (PTSD). The examiner did not address any of these conditions in his opinion. Moreover, the examiner did not address the prior evidence of record, including the Veteran’s June 1999 diagnoses of anxiety and depression; his September 1999 lay statements that he began to drink during his active service and the military “taught him to drink”; his September 2000 treatment records noting that he “seems to be having military hallucinations”; his April 2001 request for service connection for a nervous condition as due to his service in Vietnam; and his March 2007 treatment records noting that he developed his psychiatric symptoms since coming back from Vietnam. Accordingly, the Board finds that another remand is warranted to obtain an addendum opinion that addresses all the relevant evidence. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding remand by the Board confers on the claimant the right to compliance with the remand requests). 2. Entitlement to service connection for peripheral neuropathy, to include as due to herbicide exposure, is remanded. This claim was previously remanded to provide the Veteran with another VA examination and to obtain an opinion regarding the etiology of such. The Veteran was given another VA examination in November 2019, wherein he was diagnosed with idiopathic peripheral neuropathy of the lower extremities. However, the examiner opined that this condition was less likely than not incurred in or caused by the Veteran’s active service. As rationale, the examiner provided “Idiopathic peripheral neuropathy at lower extremities diagnosed after 37 years after his last active service is not related to agent orange exposure.” No additional explanation for the conclusion reached was given. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). As no clear rationale was provided for the opinion reached, the Board finds that another remand is warranted to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Update the electronic file with any new VA treatment records and private treatment records. 2. Obtain an addendum opinion regarding the Veteran’s acquired psychiatric disorder(s), to include GAD, depressive disorder, MDD, depression with psychotic features, unspecified depressive disorder, and PTSD. The electronic claims file must be reviewed by the examiner, and a note that it was reviewed should be included in the report. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s psychiatric condition(s) are related to his active service. In formulating an opinion, the examiner should specifically consider and address: (1) the Veteran’s June 1999 diagnoses of anxiety and depression; (2) his September 1999 lay statements that he began to drink during his active service and the military “taught him to drink”; (3) his September 2000 treatment records noting that he “seems to be having military hallucinations”; (4) his April 2001 request for service connection for a nervous condition due to his service in Vietnam; and (5) his March 2007 treatment records noting that he developed his psychiatric symptoms since coming back from Vietnam. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Obtain an addendum opinion regarding the Veteran’s idiopathic peripheral neuropathy of the bilateral lower extremities. The electronic claims file must be reviewed by the examiner, and a note that it was reviewed should be included in the report. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s idiopathic peripheral neuropathy of the bilateral lower extremities is related to his active service, to include his presumed herbicide exposure. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Ruiz, 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.