Citation Nr: 21025478 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-19 395 DATE: April 28, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and mixed anxiety disorder and depressed mood disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1979 to September 1983. The Veteran testified at a July 2018 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. This issue was remanded by the Board in an April 2019 decision for further development. It has since returned for appellate review. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and mixed anxiety disorder and depressed mood disorder, is remanded. A remand is required to obtain an adequate opinion. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21, Vet. App. 303, 312 (2007). A medical opinion must support its conclusions with analysis. Stelf v. Nicholson, 21 Vet. App. 120, 124 (2007). Here, on the June 2020 VA medical opinion, the examiner opined that the Veteran’s mixed anxiety and depressed mood disorder are less likely than not caused by service. The examiner noted that on the June 1979 medical examination, the Veteran endorsed depression or excessive worry, frequent trouble sleeping, nervous trouble, and a head injury. The examiner stated that the Veteran was in a motor vehicle accident that resulted in 151 stitches and a loss of consciousness. The examiner also noted that the Veteran was a victim of assault in June 1980. At treatment for the June 1980 assault, the medical provider indicated the Veteran consumed a case a beer a week. As a result, the examiner concluded that the Veteran’s alcohol overuse started prior to the June 1980 assault, and not as a result of the assault. Also, the June 2020 VA medical opinion stated that on the August 1983 separation examination the Veteran endorsed symptoms of depression or excessive worry and that he was never treated for a mental disorder. The examiner stated that this suggests that the depression and anxiety symptoms were pre-existing, but not exacerbated by the assaults enough for treatment. Further, the June 2020 VA examiner indicated the Veteran has a heavy polysubstance abuse, to include alcohol, cocaine, heroin, and marijuana. The examiner noted the Veteran last used cocaine in 2007 and alcohol in 2009, but his mental health diagnoses appear secondary to heavy substance use. The examiner stated that although the Veteran’s problem list documents diagnoses of chronic PTSD and bipolar disorder in 2016 and depressive disorders in 2003, the 2015 initial PTSD evaluation noted the Veteran had trauma symptoms, but not PTSD. Therefore, the examiner concluded, the Veteran appears to have bipolar disorder that is unrelated to the assaults during military service. The examiner opined that it is more likely as not that the Veteran’s bipolar disorder is related to heavy substance use over many years, homelessness, and other traumas. The June 2020 VA examiner’s opinion is inadequate as it does not make a finding regarding whether the Veteran’s acquired psychiatric disorder clearly and unmistakably preexisted service and, if so, whether the acquired psychiatric disorders were clearly and unmistakably not aggravated by service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); 38 C.F.R. § 3.304(b). Given the inadequacy of the VA opinion, an addendum opinion is necessary to determine whether the Veteran clearly and unmistakably had a pre-existing acquired psychiatric disorder and, if so, whether that acquired psychiatric disorder was clearly and unmistakably not aggravated by service, to include a June 1980 assault. The matters are REMANDED for the following action: Schedule the Veteran for a new VA examination by an appropriate clinician to determine the nature and etiology of the Veteran’s acquired psychiatric disorder, to include mixed anxiety and depressed mood disorder. The examiner must specifically address each of the following: • Identify and diagnose any acquired psychiatric disorder that presently exists and that has existed during the appeal period. • For each such disorder, state whether there is clear and unmistakable (undebatable) evidence that an acquired psychiatric disorder preexisted the Veteran’s active service. Any such disorder should be clearly identified. • For any acquired psychiatric disorder found to have preexisted service, state whether there is clear and unmistakable evidence that the disorder was not aggravated by the Veteran’s service beyond its natural progression, to include by the June 1980 assault. • For any acquired psychiatric disorder not found to have preexisted the Veteran’s active service, state whether it is at least as likely as not that the disorder(s) had its onset in service or is otherwise etiologically related to the Veteran’s active service, to include an in-service injury, event, or disease, to include the June 1980 assault. All opinions offered must be accompanied by a clear rationale consistent with the evidence of record. If the examiner finds it impossible to provide any part of the requested opinions without resort to pure speculation, he or she should so indicate and provide a rationale as to why such a finding is made. Caroline B. Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Thompson, 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.