Citation Nr: 21027267 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 14-28 682A DATE: May 5, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), and persistent depressive disorder with anxious distress, to include as secondary to service connected disabilities, is remanded. REASONS FOR REMAND The Veteran served in active duty in the United States Army from June 1967 to June 1970 and from June 1972 to February 1975. This matter comes before the Board of Veterans' Appeal from a December 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2018 and again in October 2020, the Board remanded this matter to the RO for further development. In March 2021, the RO issued a Supplemental Statement of the Case again denying service connection for his acquired psychiatric disorder. The matter now returns to the Board. In light of the various psychiatric impressions in the record, the Board has recharacterized the claim as entitlement to service connection for an acquired psychiatric disorder, to include PTSD and persistent depressive disorder with anxious distress. See Clemons v. Shinseki, 23 Vet. App. 1, (2009) (finding that a service connection claim for a diagnosed psychiatric disability encompasses all psychiatric disabilities shown by the record, however diagnosed). 1. Service connection for an acquired psychiatric disorder remanded. The Veteran contends that he has PTSD due to traumatic experiences during the Vietnam War. See December 2010 Statement in Support of Claim for PTSD. In its October 2020 remand, the Board determined that there was no medical opinion of record that adequately addressed all of the available evidence and that it was unclear what the Veteran's proper diagnosis was. Therefore, the Board remanded the instant matter to obtain an addendum opinion to determine the proper diagnosis for any acquired psychiatric disorder and for an etiology opinion as to secondary service connection. Such an opinion was obtained in March 2021. The examiner determined that the Veteran did not meet the diagnostic criteria for PTSD as he did not endorse the prototypical symptoms of PTSD such as flashbacks, hypervigilance and an exaggerated startle response. The examiner determined that the Veteran did meet the diagnostic criteria for persistent depressive disorder with anxious stress and opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness and was not due to aggravated by a service connected condition. The examiner reasoned that there is no evidence via record review or self-report that it is due to or related to his service in Vietnam, that the Veteran has never sought nor received any mental health treatment and there is no evidence via the clinical record of any complaints of or treatment for anxiety, depression or any other mental health condition or those mental health conditions being due to service in Vietnam or a service connected disability. However, this examiner did not consider the Veteran's reports regarding the onset of his acquired psychiatric disorder and instead relied solely upon the absence of clinical evidence. See, e.g., Dalton v. Nicholson, 21 Vet. App. 23(2007) (an examination was inadequate where the examiner did not comment on a Veteran's reports of in-service injury and instead relied on the absence of evidence in a Veteran's service treatment records to provide a negative opinion). The Veteran has stated in a December 2010 submission that he did not discuss his anxiety and psychiatric symptoms in the past due to a fear of being stigmatized. Moreover, this opinion did not contain an adequate rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). On remand, an adequate etiology opinion should be obtained. Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an addendum etiology opinion by an appropriate clinician to determine the nature and etiology of the Veteran's claimed acquired psychiatric disorder. The examiner should review the entire claims file and note such review in the opinion. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Is it at least as likely as not (50 probability or greater) that the Veteran's current acquired psychiatric disorder had its onset during service or is otherwise related to service? (B) Is it at least as likely as not (50 probability or greater) that the Veteran's current acquired psychiatric disorder is caused or aggravated by a service connected disability? The examiner should specifically address the July 2018 opinion from Dr. J.L. that the Veteran reached the breaking point in 2008 and 2009 due to having a heart attack, needing a stent and debilitating cardiovascular and orthopedic pain. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Adeyemi, 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.