Citation Nr: 21024333 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 18-24 996 DATE: April 22, 2021 REMANDED Entitlement to service connection for a psychiatric disorder, diagnosed as anxiety disorder, including secondary to a bilateral knee disability, is remanded. REASONS FOR REMAND The Veteran had active service from June 1997 to May 2000. This appeal arises before the Board of Veterans’ Appeals (Board) from a rating decision from a Department of Veteran Affairs (VA) Regional Office (RO). The Veteran’s claim was previously before the Board in July 2019. At that time, the Veteran’s claim was denied. The Veteran appealed this denial to the Court of Appeals for Veterans Claims (Court), which vacated the Board’s July 2019 denial and remanded the appeal for further consideration in a May 2020 Order granting a Joint Motion for Partial Remand (JMR). As stated in the JMR, in the Board’s prior decision, the Board failed to address whether an examination was necessary to address secondary service connection for an acquired psychiatric disorder due to the Veteran’s knee disabilities. In September 2020, the Board remanded this matter for an addendum VA medical opinion to address whether the Veteran’s service-connected knee disability has aggravated his anxiety disorder. The examiner was asked to review the entire record before providing their opinion. The January 2021 VA addendum medical opinion provides a negative nexus opinion with respect to aggravation of a psychiatric disorder by a service-connected knee disability. The examiner relied heavily on the October 2020 VA psychological examination during which the Veteran reported current knee pain rated as a 10/10 in severity. The examiner stated that the Veteran appeared to have “over-reported” his knee pain symptoms because his physical presentation during the examination was incongruous with the reported magnitude of knee pain. The examiner also stated that VAMC mental health treatment notes from December 2019 to February 2020 make no mention of knee pain being associated with his psychiatric disorder. Critically, however, the examiner failed to address or consider pertinent VAMC mental health treatment notes from February 2018 documenting that the Veteran was prescribed Cymbalta medication to “address depression with anxiety in the context of chronic pain.” The Court specifically pointed to this evidence in its May 2020 JMR as being potentially illustrative of an association between chronic knee pain and a psychiatric disorder. Considering the above, the Board finds that the January 2021 VA addendum medical opinion is inadequate, and the matter must again be remanded for further development. The matters are REMANDED for the following action: 1. Associated any additional VA treatment records with the claims file. 2. Obtain a VA addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s currently diagnosed anxiety disorder. An examination may be scheduled only if the clinician deems it necessary. The examiner must opine to the following: (a.) Whether it is at least as likely as not (a 50% or better probability) that the Veteran’s anxiety disorder is proximately due to or caused by his service-connected knee disability. (b.) Whether it is at least as likely as not (a 50% or better probability) that the Veteran’s anxiety disorder is aggravated by his service-connected knee disability. In offering an opinion on aggravation the examiner MUST specifically address VAMC mental health treatment notes from February 2018 documenting that the Veteran was prescribed Cymbalta medication to “address depression with anxiety in the context of chronic pain.” (Continued on the next page)   *The examiner must also remain mindful that a recent precedent case clarified that secondary service connection does not require “permanent” worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental, so even if not above and beyond the condition’s natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The Veteran is considered credible for the purposes of the examination/opinion requested herein only. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kyle McKone 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.