Citation Nr: 21030748 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-36 091 DATE: May 19, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability is remanded. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1968 to May 1971. This claim comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The claim was most recently before the Board in February 2020 when it was remanded for further development. There has not been substantial compliance with the remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for an acquired psychiatric disability is remanded. The Veteran claims that his acquired psychiatric disorder existed prior to service, and that his psychiatric disorder was aggravated beyond its natural progression by active duty service. Here, the Board lacks the information needed to make a decision in this case. Remand is needed for a clarifying addendum opinion. The March 2020 VA examiner provided an inadequate rationale regarding whether the Veteran's service clearly and unmistakably did not aggravate his pre-existing psychiatric disorder. The examiner failed to consider the Veteran's statements that his service specifically the return from his Atlantic Fleet Force naval deployment in 1969 worsened his psychiatric condition to the point he "self-destructed." The record indicates the Veteran was promoted twice and began to have issues in February 1970 following his Atlantic deployment. The Veteran's service treatment records include a sick call note in September 1970 stating he reported to the clinic because he "felt nervous all the time" due to personal family problems, drinking too much, marital problems, debt issues and civilian legal problems. He also stated that his grandfather had given him pills for his nervousness but that these pills "did not help". The Board further notes that the Veteran was admitted to Bethesda Naval Hospital in February 1971 for a heroin drug addiction which he attributed to his ongoing "emotional conflict". An addendum VA opinion with an adequate rationale is needed to discuss the Veteran's statements regarding whether his active service aggravated his pre-existing psychiatric condition. In addition to the aggravation opinion, the March 2020 VA examiner opined that the Veteran's diagnosed generalized anxiety disorder was not related to service. In support, the examiner wrote that the disability was first diagnosed in 1998 27 years after service. However, the record indicates he was referred by VA to a private provider in March 1983, who diagnosed him with generalized anxiety disorder. On remand, the examiner should specifically discuss the Veteran's March 1983 treatment notes, to include his diagnosis. 2. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran asserts that his bilateral hearing loss is related to service. The Veteran was afforded a VA examination in March 2020. Unfortunately, the examiner indicated pure tone thresholds as "CNT" or could not test. The examiner stated that the Veteran's speech recognition threshold did not equal the pure-tone average, resulting in inconsistent findings. Additionally, speech discrimination scores were also reported as CNT, as a speech discrimination score was not appropriate for the Veteran. The examiner did not opine as to a threshold shift in service, as there was "incomplete or missing entry and/or exit audiograms". The examiner specified that the 1968 entrance examination was available, however, the examiner was unable to find the May 1971 separation examination. The Board finds that another audiological examination is needed to address the questions raised in its February 2020 remand, to include a possible threshold shift as evidenced by the Veteran's May 1971 separation examination. The matters are REMANDED for the following action: 1. Obtain a VA psychiatric addendum opinion. The examiner should review the record, to include this remand. The examiner should provide an opinion, with adequate rationale, as to the following questions: (a) Is there clear and unmistakable (obvious or manifest) evidence that the Veteran had a psychiatric defect, infirmity, or disorder that preexisted his military service? Please identify with specificity any evidence that supports this finding. (b) If there is clear and unmistakable evidence that the Veteran had a preexisting psychiatric defect, infirmity, or disorder at the time of his service entrance, is there evidence that the Veteran's preexisting psychiatric disorder increased in severity (worsened) in service? a. The examiner should discuss the Veteran's lay statements regarding whether his active service worsened his psychiatric condition. Specifically, that his return from a 1969 naval deployment caused him to "deteriorate" to the point he "self-destructed". b. The examiner should discuss the Veteran's statements in the March 1971 psychiatric report, which indicate he started using drugs while in service to cope with psychiatric issues. (c) If the preexisting psychiatric defect, infirmity, or disorder increased in severity in service, is there clear and unmistakable (obvious or manifest) evidence that the increase in severity during service was due to the natural progression of his psychiatric disorder? The examiner should specify any evidence that supports this finding, with an adequate rationale. (d) If the examiner determines that the Veteran has a psychiatric condition that did not preexist service, is it at least as likely as not that the Veteran's current psychiatric disorder had its onset in, or is otherwise etiologically related to his military service? If not, the examiner should also provide an opinion as to whether it is more likely than not, less likely than not, or at least as likely as not, that any current psychiatric disability including depression is proximately due to, or the result of, the service-connected tinnitus, and whether it is at least as likely as not that any current psychiatric disability including depression, is aggravated beyond the natural progression of the disorder by the Veteran's service-connected tinnitus. a. The examiner should discuss the Veteran's March 1983 mental health treatment, to include his diagnosis of generalized anxiety disorder. 2. Obtain a VA audiological addendum opinion. The examiner should opine as to whether it is as likely as not, that his current hearing loss had its clinical onset during service, within one year of service, or is related to any in-service disease, event, or injury. The examiner should comment on the significance, if any, of the in-service threshold shifts shown on the exit examination, the conceded in-service acoustic trauma, and the lay evidence of hearing loss since service. A rationale for any opinion expressed should be provided. The examiner should discuss the Veteran's November 1968 entrance examination and his May 1971 separation examination. The Board notes that the separation examination is in the document labeled "STR Medical". J. Komperda Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. McDonald