Citation Nr: 21026765 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 16-52 255 DATE: May 3, 2021 REMANDED Service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression. REASONS FOR REMAND The Veteran served on active duty from August 1979 to June 1986. The case is on appeal from an April 2015 rating decision. In a December 2018 decision, the Board denied service connection for PTSD and depression, as well as a cervical spine disorder and DVT of the lower extremities. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In December 2019, the Court issued a Memorandum Decision in which it vacated the Board's decision and remanded the matters for readjudication. The claims most recently came before the Board in June 2020 and were remanded for further development. Thereafter, in a November 2020 rating decision, the issues of service connection for deep vein thrombosis (DVT) of the bilateral lower extremities and a cervical spine disorder were granted. As those benefits sought on appeal were granted in full, the two issues are no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). Service connection for a psychiatric disorder. The Veteran contends that his psychiatric disorder, including PTSD and depression, is related to service. Alternatively, he asserts his psychiatric disorder is causally related to his service-connected DVT of the lower extremities. Along with the Veteran's September 2013 claim, he submitted a September 2013 medical opinion in which he was diagnosed with chronic PTSD and chronic major depression. The VA examiner opined that the Veteran's stressor included injuring his leg during service as a paratrooper and subsequently, developing DVT, which he was told was life threatening. The examiner indicated nightmares once per month, flashbacks, and constant anxiety, as well as symptoms of hypervigilance and memory trouble. He stated the Veteran feels depressed approximately 70 percent of the time with little interest in things. The examiner noted "Because of this service connected PTSD," the Veteran is moderately compromised in his ability to sustain social and work relationships. The physician submitted an additional medical opinion dated August 2013 in which he indicated the Veteran has military stressors, including injuring his leg as a paratrooper, DVT in both legs, and that he witnessed injuries and deaths in service, some of whom were close friends. The examiner reported diagnoses of PTSD and major depression. The Veteran was afforded a February 2021 VA examination in which the examiner found the Veteran does not meet the diagnostic criteria for PTSD under DSM-5 criteria. The examiner indicated the Veteran is diagnosed with unspecified depressive disorder and reported stressor involved a jump accident in service in which a couple of soldiers died from the incident. The examiner found the stressor not adequate to support a diagnosis of PTSD. With regard to his diagnosed depression, the examiner opined the Veteran's medical records do not support that the disorder is related to service, and such was not noted during his separation examination in May 1986. The examiner indicated the Veteran underwent a mental health assessment and had no mental health diagnosis or symptoms upon separation. The examiner indicated the Veteran's service treatment records are absent for mental health complaints, diagnosis or treatment. The examiner stated further the Veteran's post-service medical records are silent for evidence of chronicity or continuity of mental health care from when he separated from service until 2013. The examiner reported the Veteran's depression symptoms are unspecified and possibly have organic cause, as he is diagnosed with severe obstructive sleep apnea and had a motorcycle accident in 2017 which caused diffuse axonal injury. With regard to secondary service connection, the February 2021 examiner indicated the Veteran's depression is not related to his service-connected DVT. The examiner stated there is lacking medical evidence linking his depression to DVT and as noted, the evidence suggests his depression is due to other reasons, namely untreated sleep apnea and traumatic brain injury. The Board finds an additional VA psychiatric examination is warranted as there is a conflict in the medical evidence as to the diagnosis, and the February 2021 VA examiner did not address the secondary aggravation theory of entitlement. The examiner's opinion that depression is due to other reasons does not rule out that it may also have been due to or aggravated by the service-connected disability. ElAmin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). An additional opinion is needed to determine if the Veteran's psychiatric disorder is related to service or his service-connected DVT. The matters are REMANDED for the following action: Obtain an opinion from an appropriate clinician regarding the Veteran's psychiatric condition. An in-person examination of the Veteran should be arranged if determined necessary by the appointed examiner. (a) The examiner should identify all current psychiatric disorders, including whether the Veteran meets the criteria for a diagnosis of PTSD. If a diagnosis of PTSD is not established based on DSM criteria, the examiner should discuss the diagnoses of PTSD found throughout the record, including in private medical opinions dated August and September 2013. If PTSD is diagnosed, the underlying stressor(s) should be identified. (b) The examiner should opine whether it is at least as likely as not that any diagnosed psychiatric disorder had its onset during, or is otherwise related to, service, including jump accidents the Veteran experienced in service. (c) If not directly related to service, the examiner should opine as to whether it is at least as likely as not that the psychiatric disorder was caused or aggravated by his service-connected DVT of the lower extremities. Corey Bosely Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Isaacs, 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.