Citation Nr: 21026977 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 13-28 665A DATE: May 4, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), an anxiety disorder other than PTSD, a mood disorder due to a general medical condition, and substance-related disorders, to include as secondary to a service-connected disability is remanded. Entitlement to a total rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1974 to June 1976. He also had additional service in the Army Reserves after his discharge from active duty. These matters come to the Board of Veterans' Appeals from a December 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Decision Review Officer hearing held in June 2013 and a Travel Board hearing held in March 2015 with the undersigned Veterans Law Judge. Transcripts of those hearings have been associated with the electronic record. In June 2015, March 2018 and July 2020 the Board remanded the issues on appeal for further development. The Board finds that more development is necessary prior to final adjudication of the claims on appeal. Pursuant to the July 2020 Board remand, the Veteran was afforded an examination in January 2021. The January 2021 VA examiner opined that it was less likely than not that the Veteran had a mental health disorder that was connected to or exacerbated by his military service. The examiner also noted that there was not enough evidence to establish service connection specific to the Veteran's limited knee flexion or in-service events. However, the examiner did not address whether the Veteran's service-connected right knee disability has aggravated his acquired psychiatric disorder disability. The Veteran also underwent a VA examination in February 2021. The examiner opined that the Veteran's depression was less likely than not incurred in or caused by the claimed in-service event, injury or illness. The examiner noted that the Veteran was depressed due to the pain that he was experiencing as the Veteran fell on his back while in service in 1975. The examiner also opined that it was less likely than not that the Veteran's acquired psychiatric disorder was proximately due to or the result of the Veteran's service connected disability as the Veteran's depression as due to pain, which in part, was due to the fall on his back during service. The examiner also opined that it was as likely as not that the Veteran's psychiatric disorder was aggravated beyond its natural progression by the service-connected disability as the Veteran's back pain contributed to the disability. However, the Board notes that while the February 2021 VA examiner found that it was as likely as not that the Veteran's psychiatric disorder was aggravated beyond its natural progression by the service-connected disability, the Veteran is not service connected for a lumbar spine disability. Notably, the Board in a July 2020 decision denied entitlement to service connection for a lumbar spine disability. This denial was based in part on a July 2018 VA examination report in which a VA examiner opined that it was less likely than not that the Veteran's claimed lumbar spine disability was incurred in or the result of the claimed in-service event, injury or illness as a review of the service treatment records was negative for lumbar spine trauma or injury. Instead, the Veteran is currently only service-connected for a right knee disability which was not specifically addressed in the February 2021 VA opinion. As a result, the January 2021 and February 2021 VA examination opinion reports do not comply with the Board's July 2020 instructions as they do not specifically address whether the Veteran's service-connected right knee disability has aggravated his acquired psychiatric disorder disability. The United States Court of Appeals for Veterans Claims has held that a remand confers on the veteran, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). As such the Board finds that the evidence currently of record is insufficient to resolve the claim for an acquired psychiatric disorder disability and that further medical clarification in connection with this claim is warranted to determine whether the Veteran's current acquired psychiatric disorder disability was caused or aggravated by a service-connected right knee disability. Accordingly, the Board finds that he should be scheduled for a VA addendum opinion to determine whether the Veteran has a current psychiatric disability that is related to service to include as being caused or aggravated by a service-connected right knee disability. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c) (4). Finally, the Board notes that further development and adjudication of this claim may provide evidence in support of his claim for TDIU. See Henderson v. West, 12 Vet. App. 11 (1998), citing Harris v. Derwinski, 1 Vet. App. 180 (1991), for the proposition that where a decision on one issue would have a "significant impact" upon another, and that impact in turn could render any review of the decision on the other claim meaningless and a waste of appellate resources, the claims are inextricably intertwined. The Board has therefore concluded that it would be inappropriate at this juncture to enter a final determination on that issue. The matters are REMANDED for the following action: 1. The Veteran should be requested to provide the names, addresses and approximate dates of treatment of all medical care providers, VA and non-VA, who have treated him for the disability on appeal. After the Veteran has signed the appropriate releases, those records should be obtained and associated with the claims folder. 2. Return the claims file to the VA examiner that examined the Veteran in February 2021. If that examiner is not available, return the file to another examiner with the appropriate knowledge and expertise. If the new examiner feels that an actual physical examination is necessary, such examination should be scheduled. The examiner should determine the nature, extent of severity, and etiology of any psychiatric disorder(s) which may have been present at any time during the pendency of this appeal, to include PTSD. The examiner should provide a diagnosis for any psychiatric disorder that existed during the pendency of this claim. Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such psychiatric disorder, to include PTSD if diagnosed, is related to any incident of the Veteran's active duty service, to include a fear of hostile military or terrorist activity. The examiner should also provide an opinion as to whether if it is at least as likely as not (at least a 50 percent probability) that the Veteran has a current acquired psychiatric disability that is caused or aggravated by a service-connected right knee disability. If the examiner finds that the Veteran has an acquired psychiatric disability that has been permanently aggravated/worsened by a service-connected right knee disability, to the extent feasible, the degree of worsening should be identified. Adequate reasons and bases for any opinion rendered must be provided. All studies deemed appropriate in the medical opinion of the examiner should be performed. The claims file should be made available to the examiner, who should review the entire claims folder in conjunction with this examination. All opinions expressed by the examiner must be accompanied by a complete rationale. 3. Ensure that the examination report complies with this remand and answers the questions presented herein. If any report is insufficient, it should be returned to the examiner for necessary corrective action, as appropriate. See Stegall v. West, 11 Vet. App. 268 (1998). 4. After completion of the above and any additional development deemed necessary, the issue on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review, if in order. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James A. DeFrank, 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.