Citation Nr: 21030628 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-33 872 DATE: May 19, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depressive disorder, anxiety, adjustment disorder, and cannabis use disorder, is remanded. Entitlement to service connection for an acquired psychiatric disorder for treatment purposes only under 38 U.S.C. § 1702 is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty for training (ACDUTRA) from June 1988 to November 1998, and on active duty in the United States Navy from January 1991 to May 1991, including combat service in the Persian Gulf. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. In May 2019, the Board remanded the appeal for further development. The Board has recharacterized the psychiatric claims as reflected on the title page to include consideration of all psychiatric disorders reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Unfortunately, another remand is required. Pursuant to the Board's May 2019 remand directives, the Veteran was afforded a VA examination in December 2020. The Board asked the examiner, in relevant part, that: (d) If any other acquired psychiatric disorders are diagnosed under the DSM-5, to include depressive disorder and anxiety, the examiner must opine whether each diagnosed disorder had its onset in service or is otherwise related to service, to include as a result of duties of the Veteran's military occupational specialty (MOS) as a hospital corpsman, including a specific incident where he witnessed the aftermath of the right side of a soldier's body being blown off and having to treat and monitor him. In addressing this question, the Board stated that if diagnoses of depressive disorder and anxiety, are not warranted, please reconcile your findings with diagnoses of the same in December 2014, February 2016, and February 2018 VA treatment records and February 2015 VA examination report. Additionally, the Board also asked the examiner to address: (f) Is it at least as likely as not that the Veteran developed an acquired psychiatric disorder within two years of separation from service? The examiner diagnosed the Veteran with adjustment disorder with mixed anxiety and depressed mood but found no diagnoses for PTSD, anxiety, or depressive disorder. However, the examiner failed to reconcile her findings with diagnoses of depressive disorder and anxiety in VA treatment records and the February 2015 VA examination report, as specifically requested by the Board. Additionally, the examiner also failed to provide an opinion on whether the Veteran developed an acquired psychiatric disorder within two years of separation, as specifically requested by the Board. Thus, for these reasons, another VA examination from a different examiner is needed on remand to ensure substantial compliance with the Board's May 2019 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Finally, the Veteran's TDIU claim is inextricably intertwined with the acquired psychiatric disorder claim and is deferred pending action of the acquired psychiatric disorder claim. To this end, the RO should again request that the Veteran complete another VA Form 21-8940 as the current one of record is incomplete. See October 2012 VA Form 21-8940. Any outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Send the Veteran an Application for Increased Compensation Based on Unemployability, VA Form 21-8940and request him to complete the form in its entirety. Notify the Veteran that failure to return a completed form will adversely affect his claim. 2. Obtain any outstanding VA treatment records since service separation in 1991. 3. Then schedule the Veteran for a psychiatric examination with an examiner other than the February 2015 and December 2020 examiners to determine the nature and etiology of any psychiatric disorder, including PTSD, depressive disorder, anxiety, adjustment disorder, and cannabis use disorder. The examiner must address each of the following: (a) Identify any psychiatric disorders diagnosed under the DSM-5. (b) If a diagnosis of PTSD under the DSM-5 is warranted, specify whether that diagnosis is related to the Veteran's fear of hostile military or terrorist activity. (c) If a diagnosis of PTSD under the DSM-5 is warranted and is not due to a fear of hostile military or terrorist activity, specify the claimed in-service stressor(s) upon which that diagnosis is based. (d) If any other acquired psychiatric disorders are diagnosed under the DSM-5, to include depressive disorder, anxiety, and adjustment disorder with mixed anxiety and depressed mood, the examiner must opine whether each diagnosed disorder had its onset in service or is otherwise related to service, to include as a result of duties of the Veteran's MOS as a hospital corpsman, including a specific incident where he witnessed the aftermath of the right side of a soldier's body being blown off and having to treat and monitor him. If diagnoses of depressive disorder, anxiety, and/or adjustment disorder with mixed anxiety and depressed mood are not warranted, please reconcile your findings with diagnoses of the same in December 2014, February 2016, and February 2018 VA treatment records and February 2015 and December 2020 VA examination reports. In addressing this question, please concede that the Veteran was fearful of being attacked by enemy forces in performing the duties associated with his MOS during service, and determine, based on the same, whether a nexus between the Veteran's psychiatric disorder and service is "medically plausible." See Board Hearing Transcript at 5-6. (e) If any psychiatric disorder is related to service, please also opine as to whether it is at least as likely as not that the Veteran's diagnosed cannabis use disorder is (1) proximately due to or (2) has been aggravated (worsened beyond natural progression) by that disorder. The examiner is advised that two separate opinions are required one for proximate causation and aggravation and a comprehensive rationale must be furnished for all opinions expressed. The examiner is also advised that the primary disability need not be service-connected or even diagnosed at the time cannabis use disorder is incurred, and reliance on this fact will render the opinion inadequate. (f) Is it at least as likely as not that the Veteran developed an acquired psychiatric disorder within two years of separation from service? A comprehensive rationale must be furnished for all opinions expressed. If the examiner is unable to provide a medical opinion, then he or she should provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.