Citation Nr: 21027270 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 10-05 020 DATE: May 5, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a heart disorder is remanded. Entitlement to service connection for a lower intestinal disorder is remanded. Entitlement to a total disability rating for compensation based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1979 to July 1982 in the United States Army with additional service in the National Guard. The appeal was most recently before the Board in May 2020; there has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. The claim must be remanded again for an adequate medical opinion that addresses whether the Veteran had a psychiatric disorder at any time during the period on appeal and if so, whether that is related to active duty service. Followoing an October 2020 VA examination, the examiner said that the Veteran did not report "significant or distressing mental health symptoms at the time of this evaluation...[t]here is insufficient evidence in the medical record to document that a psychiatric disability had its onset during service." However, the examination expressly notes documented psychiatric disabilites that have been included in the Veteran's treatment records throughout the period on appeal. The Board also notes that in March 2021 the Veteran was hospitalzed at a VA inpatient pscyhiatric factility. Any addendum opinions provided in response to this remand should specifically address these records. 2. Entitlement to service connection for a left ankle disorder is remanded. 3. Entitlement to service connection for a heart disorder is remanded. 4. Entitlement to service connection for an intestinal disorder is remanded. The Veteran, and others, indicated in multiple statements that he was hospitalized during service in Germany. These records may include evidence of the Veteran's lower intestine removal, left ankle injury, and heart condition which he contends occurred during service. It is unclear whether any attempt has been made to locate in-service hospital records. A remand is required to allow VA to request these potentially relevant records. An additional opinion is needed to address the likely etiology of the a left ankle condition. No VA examiner has adequately addressed the Veteran's actual left ankle diagnosis or opined whether the Veteran's left ankle pain symptoms represent a disability that is at least as likely as not related to active duty service. Based on the December 2020 VA examination the examiner opined that there is "no left ankle arthritis pathlogy to render a diagnosis...[t]herefore, no opinion rendered." Review of the examination indicates that the Veteran has a diagnosis of left ankle lateral collateral ligament sprain. There is also documented left ankle pain, which the Board notes may represent a disability. See Saunders v. Wilkie, 886 F.3d. 1356 (Fed. Cir. 2018). Therefore, the Board finds the opinion merely relying on a lack of arthritis pathology is inadequate. The heart condition must be remanded for an adequate medical opinion. An October 2020 VA examination diagnosed stable angina, which was addressed. However, subsequent VA treatment records, including March 2021 hospitalization records, indicate a hypertension diagnosis. As this diagnosis was not noted during the VA examiantion or accompanying opinion further remand is necessary. 5. Entitlement to a TDIU is remanded. Finally, because a decision on the remanded issues of entitlement to service connection could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim for entitlement to a TDIU is required. The matters are REMANDED for the following action: 1. Take all appropriate action to obtain records of any inpatient treatment at Landstuhl Hospital (Landstuhl Regional Medical Center) between 1979 and 1982. Document all requests for information as well as all responses in the claims file. 2. After completion of the above, obtain an addendum opinion from an appropriate clinician regarding whether the Veteran had any psychiatric condition that existed at any time during the period on appeal that is at least as likely as not related to an in-service event, to include those identified on the December 2020 VA examination. The examiner must specifically discuss the Veteran's March 2021 VA psychiatric in-patient records. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left ankle disability. Copies of all pertinent records must be made available to the examiner for review. Based on an examination, review of the record, and any tests or studies deemed necessary the examiner should provide opinions as to the following: (a) Identify all diagnosed left ankle disabilities since June 2011. The examiner should comment on the left lateral ligament strain on December 2020 VA examination. (b) For each diagnosed left ankle disability, is it at least as likely as not related to an in-service injury, event, or disease? (c) If no specific left ankle disability is diagnosed, the examiner must consider whether any pain results in functional impairment of earning capacity. For any identified functional impairment of the left ankle, the examiner must opinion whether it is at least as likely as not related to an in-service injury event, or disease. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hypertension is at least as likely as not related to active duty service or in-service event/injury. Copies of all pertinent records must be made available to the examiner for review. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to a TDIU. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.