Citation Nr: 21028764 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 15-05 712 DATE: May 12, 2021 REMANDED The claim of entitlement to service-connection for an acquired psychiatric disorder, to include major depressive disorder, and to include as secondary to service-connected arthritis of the left knee, status post torn lateral meniscus (left knee disability), is remanded. The claim of entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had honorable active duty service in the United States Army from September 1978 to September 1981. These matters are before the Board of Veterans' Appeals (Board) on appeal from a February 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018 and October 2020, the Board remanded these matters to the RO for additional development, including to obtain an adequate VA medical opinion regarding the claimed psychiatric condition. Specifically, the Board's remand directives have sought to address whether it is at least as likely as not that the Veteran's psychological disorder was caused or aggravated by the Veteran's service-connected left knee disability. The Board previously found the VA examination opinions of May 2012, October 2014, and November 2019 to be inadequate for rating purposes as they generally failed to address the aggravation element of the secondary service connection question. The Board also found inadequate a June 2013 medical opinion by a private psychologist with the initials A.F. Regrettably, there has not been substantial compliance with the Board's prior remand directives as to the psychiatric disability claim, as the VA examination opinion of January 2021 merely adopted the reasoning of the prior inadequate VA medical opinions and again failed to provide a satisfactory assessment as to aggravation. See Stegall v. West, 11 Vet. App. 268 (1998). When a VA opinion is obtained, the VA must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As the matter of entitlement to TDIU is inextricably intertwined with the psychiatric disability claim, remand of both matters is required. 1. The claim of entitlement to service-connection for an acquired psychiatric disorder, to include major depressive disorder, and to include as secondary to service-connected arthritis of the left knee, status post torn lateral meniscus (left knee disability), is remanded. The Veteran contends that his depressive disorder is related to his left knee condition. As outlined above, remand is needed for an addendum medical opinion to address whether the Veteran's service-connected knee disability caused "any" increase in the Veteran's psychiatric disability. See Ward v. Wilkie, 31 Vet. App. 233, 240 (2019) (noting that similar cases have "required medical determinations for ascertaining the incremental increase in disability that may not be subject to numerical quantification, but must be evaluated by a qualified medical professional based on the totality of symptoms."). 2. The claim of entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. Entitlement to a TDIU is inextricably intertwined with the decision to remand the Veteran's claim of service connection for an acquired psychiatric disorder, to include major depressive disorder, as it affects the Veteran's ability to obtain gainful employment. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (noting that two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from a qualified clinician as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's psychological disorder (to include recurrent major depressive disorder) was caused or aggravated by his service-connected left knee disability. The addendum opinion must address: (a.) Whether it is at least as likely as not that the Veteran's psychiatric condition was either 1) caused by, or 2) aggravated by, the service-connected knee disability. An opinion should be provided for each 1) and 2). The term "aggravated" in this context refers to a any incremental increase in disability (beyond its natural progression and regardless of its permanence) in the non-service-connected psychiatric disability resulting from the service-connected left knee condition. In other words, the addendum opinion must address whether the Veteran's knee disability caused "any" increase in his psychiatric disability, not merely whether the knee condition was a primary cause of his depressive condition. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The clinician must consider the full evidence of record in providing this opinion, including the Veteran's August 1981 separation examination that noted the Veteran was "prone to depression." 2. Following completion of the above, the Agency of Original Jurisdiction (AOJ) should review the record, ensure adequacy of the updated medical opinion, and readjudicate the claims on appeal. If the claim remains denied, the AOJ should issue an appropriate supplemental Statement of the Case, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, 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.