Citation Nr: 21027571 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 14-13 348 DATE: May 6, 2021 REMANDED Entitlement to service connection for acquired psychiatric disorder (other than major depressive disorder with unspecified anxiety disorder), to include other specified schizophrenia spectrum and psychotic disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1980 to November 1980, and from February 1982 to February 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision. In June 2015, this matter was remanded by the Board for a videoconference hearing before a Veterans Law Judge. In December 2015, the Veteran testified at a videoconference Board hearing. The Veteran Law Judge who conducted the hearing is no longer employed by the Board. The Veteran was offered the opportunity for another hearing but did not respond. In March 2016, the Board remanded the claim for additional development. In September 2016, a rating decision awarded service connection for major depressive disorder with unspecified anxiety disorder. As the Veteran was diagnosed with additional acquired psychiatric disabilities, specifically other specified schizophrenia spectrum and psychotic disorder, the Veteran's claim for service connection for such psychiatric disabilities remained on appeal. In September 2018, the Board remanded the matter for additional development. Unfortunately, another remand is warranted. 1. Entitlement to service connection for acquired psychiatric disorder (other than major depressive disorder with unspecified anxiety disorder), to include other specified schizophrenia spectrum and psychotic disorder, is remanded. In March 2016, the Board remanded this matter to obtain VA psychiatric examination with medical opinion regarding whether the Veteran's psychiatric disorders were related to service or secondary to his service-connected hearing loss or hydradenitis suppurativa disabilities. The Veteran underwent VA psychiatric examination in June 2016. The VA examiner diagnosed the Veteran with major depressive disorder and unspecified anxiety disorder and opined that these disabilities were secondary to the Veteran's service-connected hearing loss or hydradenitis suppurativa disabilities. In September 2016, the Veteran was awarded service connection for these conditions. The June 2016 VA examiner also diagnosed the Veteran with other specified schizophrenia spectrum and other psychotic disorder under DSM 5 criteria. The VA examiner noted the Veteran's persistent auditory hallucinations and paranoid ideation as the basis for these diagnoses. The VA examiner opined that it is less likely than not that these disorders are related to the Veteran's service-connected medical conditions. The VA examiner noted that the Veteran reported auditory hallucinations in which he hears others speaking or whispering but he cannot make out what they say began sometime after service. He also reported that his paranoid ideation where he reports times when he feels that he is being followed began after service when he began interacting with the civilian population again. The VA examiner noted that the Veteran did not report a causal relationship between these disorders and his service-connected hearing loss or hydradenitis suppurativa disabilities. However, the June 2016 VA examiner did not opine as to whether these psychiatric disorders were related to service, as directed in the Board's March 2016 remand. Accordingly, in September 2018, the Board remanded this matter to obtain additional VA examination and medical opinion regarding whether these disorders were related to service and whether the Veteran's psychosis began within a year of service. See Stegall v. West, 11 Vet. App. 268 (1998). Following the Board's September 2018 remand, the Regional Office attempted to schedule a VA psychiatric examination. The record shows that the examination was cancelled at the Veteran's request. However, it does not appear that the Regional Office attempted to obtain a VA medical opinion regarding whether the Veteran's other specified schizophrenia spectrum and other psychotic disorder are related to service based on the evidence in the claims file. In addition, in the April 2021 brief, the Veteran's representative cites to a study finding that hydradenitis suppurativa is associated with schizophrenia. In light of the above, and to give the Veteran the benefit of the doubt, remand is warranted to obtain additional VA medical opinion regarding whether the Veteran's other specified schizophrenia spectrum and other psychotic disorder disabilities are related to service, manifested within a year of service, or are secondary to his service-connected hydradenitis suppurativa. While this matter is on remand, outstanding VA treatment records should be obtained, including VA treatment records from February 2020 to the present. The matters are REMANDED for the following action: 1. Obtain any additional VA treatment records, to include VA treatment records from February 2020 to the present. 2. After obtaining outstanding records to the extent possible, ask the appropriate examiner to review the Veteran's file. The necessity of an in-person examination is left to the discretion of the examiner. The examiner should identify all acquired psychiatric disorders (except major depressive disorder with unspecified anxiety disorder) that the Veteran has experienced during the claims period (since June 2012), even if resolved. The examiner should specifically address the other specified schizophrenia spectrum and psychotic disorder disability identified by the June 2016 VA examiner. For each disability, the examiner should opine regarding whether it is at least as likely as not (a 50 percent or greater probability) that the disability: (a) had an onset in service; (b) is the result of a disease or injury in service; or (c) is caused or aggravated by the Veteran's service-connected hydradenitis suppurativa disability. For any psychosis, the examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the disability manifested to a compensable degree within one year of separation from service (i.e., by February 1987). Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected condition. The examiner should consider all medical and lay evidence of record. The examiner should specifically address the Veteran's report that his paranoid ideation (where he reports times when he feels that he is being followed) began after service when he began interacting with the civilian population again, and the study regarding a link between hydradenitis suppurativa and schizophrenia cited by the Veteran's representative in the April 2021 brief. The examiner is asked to explain the reasons behind any opinions expressed. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Purcell 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.