Citation Nr: 21025557 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 13-08 243 DATE: April 28, 2021 REMANDED Entitlement to service connection for shin splints, to include as secondary to a service-connected knee disability, is remanded. Entitlement to service connection for a psychiatric disorder, other than major depressive disorder, to include adjustment disorder, affective disorder, anxiety, bipolar disorder, panic disorder, and personality disorder is denied. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1978 to April 1994. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from April 2012 and December 2014 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was most recently before the Board in June 2016, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. The Veteran subsequently passed away in July 2016, while his claims were pending appeal. The appellant is his son. In June 2019, the agency of original jurisdiction acknowledged the receipt of the son’s claim and granted the request for substitution. See 38 U.S.C. § 5121A. Although the Board regrets the additional delay, further development is necessary to ensure substantial compliance with the prior remand directives.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).  REASONS FOR REMAND 1. Entitlement to service connection for shin splints, to include as secondary to a service-connected knee disability. When the issue as to entitlement ot service connection for shin splints was remanded in June 2016, the Board requested, in part, that an examiner provide an opinion as to whether it is at least as likely as not that the Veteran’s shin splints were caused or aggravated by the Veteran’s service-connected left knee bursitis. In September 2019 a VA examiner opined that the medical literature does not support a causative relationship between left knee bursitis and shin splints. The examiner stated that knee bursitis can be caused by frequent and sustained pressure, overuse or strenuous activity, and a direct blow to the knee. Although the examiner addressed the causative factors of left knee bursitis, the examiner did not discuss any of the factors related to the development of shin splints and the Veteran is already service connected for left knee bursitis. Further although the examiner provided an opinion regarding the causative relationship between left knee bursitis and shin splints, the examiner did not address the separate, but related, question as to whether the Veteran’s service-connected left knee bursitis aggravated the Veteran’s shin splints. As such further development is necessary. 2. Entitlement to service connection for a psychiatric disorder, other than major depressive disorder, to include adjustment disorder, affective disorder, anxiety, bipolar disorder, panic disorder, and personality disorder. When this issue was remanded in June 2016, the Board requested, in part, that an examiner must address the prior diagnoses of record of any previously diagnosed disorder to include bipolar disorder, anxiety, panic disorder, adjustment disorder, affective disorder, mood disorder, and a personality disorder. In September 2019 a VA examiner noted that the Veteran was diagnosed with panic disorder which is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) under anxiety disorder. The examiner noted the Veteran was diagnosed with panic disorder in 2015. The examiner noted that the Veteran was diagnosed with an adjustment disorder with anxiety in 2005. It is not clear from the examiner’s rationale if the Veteran was diagnosed with anxiety. The June 2016 Board remand separately listed panic disorder, adjustment disorder, and anxiety. As such, the examiner should have separately addressed anxiety disorder. Further the evidence of record also suggests the Veteran was separately diagnosed with anxiety. For example, March 2014 VA treatment records show that the Veteran’s diagnoses, according to DSM-5 criteria, included “adjustment disorder with disturbance of conduct, depression, anxiety – chronic [and] personality disorder.” This suggests the Veteran may have had a separate diagnosis of anxiety and the Board remand separately listed anxiety. Because the opinion did not directly address the questions posed in the prior remand, further development is required. The June 2016 Board remand directed that the examiner must provide an opinion as to whether it is at least as likely as not that each diagnosed disorder was caused or aggravated by the service-connected major depressive disorder. The examiner opined that there was insufficient evidence to determine whether or to what extent the Veteran’s personality traits/disorder “might have aggravated his SC [service connected] condition or any other disorder.” The June 2016 Board remanded requested an opinion as to whether the Veteran’s personality disorder was aggravated by the service-connected major depressive disorder. However, the examiner addressed how the Veteran’s personality disorder might have aggravated the Veteran’s service-connected major depressive disorder. Because the examiner did not address how the Veteran’s service-connected depressive disorder may have aggravated the Veteran’s personality disorder, further development is necessary. The matters are REMANDED for the following action: 1. To the extent possible, make arrangements to provide the record on appeal to the VA examiner who previously offered opinions with respect to the etiology of the Veteran’s shin splints in September 2019. The entire claims file should be made available to, and be reviewed by, the examiner, and it should be confirmed that such records were available for review. An explanation for all opinions expressed must be provided. First, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that shin splints were caused or aggravated by the Veteran’s military service. The examiner must specifically address the Veteran’s report of frequent leg cramps in his January 1994 Report of Medical History. Second, the examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that shin splints were caused, or aggravated, by the Veteran’s service-connected left knee bursitis. If the September 2019 examiner is no longer employed by VA or is otherwise unable to provide the opinion(s) requested, arrange to obtain the requested information from another qualified examiner. The Board notes that the Veteran is deceased and any necessary requests for information may need to be directed to the appellant. 2. To the extent possible, make arrangements to provide the record on appeal to the VA examiner who previously offered opinions with respect to the etiology of the Veteran’s psychiatric disabilities in September 2019. The claims folder should be made available for review by the examiner. Additionally, all relevant medical records should be made available to the examiner for review, either in the virtual claims file, or if unavailable, then via paper copies of the paper claims file. An explanation for all opinions expressed must be provided. All opinions must take into account the Veteran’s own history and contentions. First, the examiner must identify all current psychiatric disorders found, to include any personality disorder, other than major depressive disorder. If any previously diagnosed disorder, to include bipolar disorder, anxiety, panic disorder, adjustment disorder, affective disorder, mood disorder, and a personality disorder, is not found on examination, address the prior diagnoses of record. Second, the examiner must provide an opinion as to whether it is at least as likely as not that each diagnosed disorder had its onset in, or is otherwise etiologically related to military service. Third, the examiner must provide an opinion as to whether it is at least as likely as not that each diagnosed disorder is caused or aggravated by the service-connected major depressive disorder. Fourth, if a personality disorder is diagnosed, the examiner must provide an opinion as to whether it is at least as likely as not that such personality disorder was subject to a superimposed disease or injury in service that resulted in a current psychiatric disability other than major depressive disorder. If the September 2019 examiner is no longer employed by VA or is otherwise unable to provide the opinion(s) requested, arrange to obtain the requested information from another qualified examiner. The Board notes that the Veteran is deceased and any necessary requests for information may need to be directed to the appellant. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative Richard Kettler Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Smith, 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.