Citation Nr: 21029363 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 14-15 262 DATE: May 13, 2021 REMANDED Service connection for acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1967 to September 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision by the Department of Veterans Affairs (VA). This issue was remanded by the Board in March 2018 and April 2019 and then denied by the Board in a September 2019 Board decision. The Veteran appealed that decision to the Court of Appeals for Veterans Claims (Court), which vacated the decision pursuant to a December 2020 Joint Motion for Remand (JMR). In the December 2020 JMR, the Court found that the Board erred in failing to provide an adequate statement or reasons or bases when denying service connection for acquired psychiatric disorder. Specifically, the Board found that a May 2019 VA examiner's opinion was inadequate without addressing whether any additional development, to include a clarifying medical opinion, was necessary to ensure compliance with its own remand directives. Further, the Board failed to reconcile its finding that the May 2019 VA examiner's opinion conflicted with a May 2012 treatment record with the April 2019 Board remand order directive. The May 2019 VA examiner found that the Veteran's acquired psychiatric disorder was at least as likely as not related to his service. The examiner stated that the Veteran had diagnosed conditions of persistent depressive disorder with anxious distress and alcohol use disorder. There is no evidence of a diagnosed psychiatric condition prior to entry into military service. The Veteran reported stressful experiences in service, such as a near plane crash, and being stationed in an area where there were likely psychosocial stressors, such as proximity to active fighting. The Veteran reported that he noticed he was "tense" and noted depressive symptoms while in service, and reported that he used alcohol and drugs to cope with his depressive symptoms. The September 2019 Board decision found that the May 2019 VA examiner's opinion was based on the Veteran's reported history and not the objective evidence of record. The April 2019 Board remand order for a VA examination stated that the examiner must consider the May 2012 VA treatment visit at which the Veteran reported his depression symptoms began in service and the clinician gave an impression of depressive disorder. The September 2019 Board decision stated that in May 2012, the Veteran reported his psychiatric symptomology started after his military service. A review of the record shows that the Veteran reported in May 2012 "that his depression seems to have started after his military service." The Board finds this statement to be ambiguous regarding whether the Veteran's psychiatric symptoms started as a result of his military service or if the onset of his symptoms began after his separation from service. As such, the Board finds that a clarifying VA examination and opinion is required to determine the etiology of the Veteran's acquired psychiatric disorder based on the objective medical evidence of record as a whole. The Board encourages the Veteran to clarify when his symptoms onset, during this examination and/or through the submission of additional evidence. The matters are REMANDED for the following action: 1. The AOJ should obtain update VA and non-VA treatment records. 2. Arrange for a VA examination of the Veteran to determine the nature and likely cause of any acquired psychiatric disability, to include persistent depressive disorder with anxious distress and alcohol use disorder. The examiner should review the claims file (including this remand) and note such review was conducted. Based on review of the record and examination of the Veteran, the examiner should provide an opinion with detailed rationale that responds to the following: (i) Please identify, by diagnosis, all acquired psychiatric disabilities present during the appeal period, pursuant to the DSM-5 criteria. (ii) For each psychiatric disability diagnosed, is it at least as likely as not (50 percent or greater probability) that such disability was either incurred in or otherwise related to the Veteran's military service? Please explain why. The examiner must consider the May 2012 VA treatment visit at which the clinical psychologist noted the Veteran "states that his depression seems to have started after his military service." The examiner should seek clarification from the Veteran regarding this statement and the onset of his psychiatric symptoms related to his military service. The examiner should also consider the statements made by the Veteran to the May 2019 examiner regarding his in-service psychiatric stressors, and the onset of his depressive symptoms when he was stationed in Germany. Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Kerner, 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.