Citation Nr: 21028485 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 15-39 712 DATE: May 11, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include chronic depression and generalized anxiety, to include as secondary to a left knee condition, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1989 to June 1993 . This matter comes before the Board of Veterans' Appeals (Board) on appeal of October 2013 and November 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. In February 2019, the Veteran testified at videoconference hearings at the RO before the undersigned Veterans Law Judge sitting in Washington, DC. Transcripts of the testimony are associated with the claims file. This claim was previously before the Board in May 2019, at which time it was remanded for further development. Entitlement to service connection for an acquired psychiatric disorder, to include chronic depression and generalized anxiety, to include as secondary to a left knee condition Pursuant to the May 2019 Board remand, the Veteran received a VA examination in November 2019 and the examiner noted a diagnosis of persistent depressive disorder. Based on the results of the examination, the examiner concluded that the condition was less likely than not related to service, as there was no report of mental health issues during service and no consistent report of ongoing mental health problems since service. It was also less likely than not caused or aggravated by the service-connected left knee condition, as it was a separate entity entirely from the service-connected condition and unrelated to it. Furthermore, he reported that his depression had improved over the years. At the outset, the Board notes that a medical opinion based solely on the absence of documentation in the record is inadequate and a medical opinion is also inadequate if it does not take into account the Veteran's reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). However, the Board also notes that the opinion for secondary service connection is inadequate, as the examiner did not provide a rationale for his conclusion that the diagnosed acquired psychiatric disorder was less likely than not related to the service-connected left knee condition. "[M]ost of the probative value of a medical opinion comes from its reasoning" and the Board "must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Therefore, this claim must be remanded for a new examination. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination with an examiner other than the November 2019 examiner to determine the nature and etiology of any currently diagnosed acquired psychiatric disorder. The claims file must be made available to the examiner, and the examiner must specify in the examination report that these records have been reviewed. The examiner is asked to opine as to whether it is as least as likely as not (50 percent probability or more) that the Veteran's acquired psychiatric disorder had its onset in service or is otherwise the result of an incident in service. The examiner is also asked to opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's acquired psychiatric disorder was caused or aggravated by his service-connected left knee disorder. Aggravation is defined for these purposes as a worsening of the underlying condition versus a temporary flare-up of symptoms. If the examiner finds that the Veteran's acquired psychiatric disorder has been permanently aggravated/worsened by his service-connected left knee condition, the degree of worsening should be identified. The examiner should consider all evidence, including lay statements, medical records, and other medical opinions of record. Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Daniels, 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.