Citation Nr: 21023715 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 15-02 718 DATE: April 21, 2021 REMANDED Entitlement to a rating in excess of 20 percent for residuals of recurrent dislocation of the left shoulder is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1973 to May 1975. These matters originally came before the Board of Veterans’ Appeals (Board) on appeal from October 2010 and August 2014 rating decisions issued by a Regional Office (RO). The Board remanded the appeal in March 2016 for further development of the record. In March 2018, the Board denied the Veteran’s claims for an increased rating for a left shoulder disability, service connection for an acquired psychiatric disorder, and entitlement to TDIU. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In an August 2019 memorandum decision, the Court vacated and remanded the March 2018 Board decision for readjudication. The Board remanded this case in February 2020 for additional development. The case has now returned to the Board for further appellate review. 1. Entitlement to a rating in excess of 20 percent for residuals of recurrent dislocation of the left shoulder is remanded. Subsequent the February 2020 Board remand, the Veteran underwent a VA shoulder examination in December 2020. The examiner noted a history of frequent episodes of shoulder dislocation and arm guarding at all movements, which could warrant a separate rating. However, as the VA treatment records and May 2014 and June 2017 VA examinations showed no recurrent shoulder dislocations, it is unclear upon what evidence the February 2020 VA examiner based his findings. The Board finds a VA addendum opinion is necessary to clarify whether the Veteran suffered from frequent episodes of shoulder dislocation and arm guarding of all movements and the basis of such finding. 2. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Veteran asserts he has a psychiatric diagnosis due to active service. Private opinions dated in October 2003, October 2009, and February 2012 show that the Veteran has an acquired psychiatric disorder due to service. The Veteran underwent a VA examination in August 2016 and he reported that he first sought psychiatric treatment around 1976 or 1977 due to memories of harassment from a sergeant. The August 2016 VA examiner noted that the Veteran’s first mental health note is dated in September 2001. After an examination, the August 2016 VA examiner found the Veteran’s diagnosed unspecified depressive disorder is not related to his military service as there is no nexus between service and development of symptoms. The examiner noted that after service, the Veteran was able to study, marry, and work without impairment of social and/or occupational endeavors. In an August 2017 VA addendum, the examiner found the Veteran’s acquired psychiatric disorder is less likely caused by service. The August 2017 VA examiner noted the Veteran is obsessed about a situation that happened at Fort Campbell and reported the repetitive nightmares and memories about what happened, but this is not evidence of an acute psychosis. Since that time, the Veteran provided VA treatment records dated as early as May 1998 in which the Veteran reported problems in service and a diagnosis of anxiety disorder and indicated the Veteran had previous psychiatric treatment. As new evidence has been presented, the Board finds an additional VA opinion as to the nature and etiology of the Veteran’s acquired psychiatric disorder is necessary. 3. Entitlement to a TDIU is remanded. Finally, because a decision on the remanded issue of an increased rating for a left shoulder disability could significantly impact a decision on the issue of entitlement to TDIU, the issues are inextricably intertwined. A remand of the claim for entitlement to TDIU is also required. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, afford the Veteran an appropriate VA examination to determine the current nature and severity of his service-connected residuals of recurrent dislocation of the left shoulder. All indicated tests and studies should be undertaken. The record, including a complete copy of this Remand, must be made available for review in connection with the examination. The need for further in-person examination is left to the discretion of the examiner. The examiner should comment upon the functional impact of the Veteran's left shoulder disability. The examiner should specifically comment on whether the Veteran’s left shoulder disability has manifested by episodes of shoulder dislocation and arm guarding at all movements at any time during the appellate period since July 2013. The examiner should indicate the basis for any such finding. A rationale for all opinions offered should be provided. 3. Following the receipt of outstanding records, obtain an addendum opinion to determine the nature and etiology of the Veteran’s claimed acquired psychiatric disorder. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests and studies should be accomplished. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Identify all psychiatric disorders diagnosed since July 2013. (B) For any acquired psychiatric disorder diagnosed during that time period, is it at least as likely as not related to the Veteran's service? The examiner should specifically address the VA treatment records dated as early as May 1998 in which the Veteran reported problems in service and a diagnosis of anxiety disorder and indicated the Veteran had previous psychiatric treatment. In rendering an opinion, the VA examiner must also consider all lay statements from the Veteran about the onset and symptomatology of his claimed acquired psychiatric disorder. A detailed explanation is requested for all opinions provided. If an opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include 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. See Jones v. Shinseki, 23 Vet. App. 382 (2010). (Continued on the next page)   The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. M. Donahue Boushehri, 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.