Citation Nr: 21031044 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 16-44 972 DATE: May 20, 2021 REMANDED The claim of entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1952 to May 1956. The U.S. Department of Veterans Affairs (VA) has determined that only the period of service between January 7, 1952 and January 6, 1954 is considered other than dishonorable. 38 C.F.R. § 3.12. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a September 2014 rating decision by a VA Regional Office (RO). The Veteran died in September 2016. The appellant is his surviving spouse and has been substituted into the claim on appeal. In April 2019, the appellant testified in a hearing before the Board. A transcript of the hearing has been included in the electronic claims file and has been reviewed. The claim on appeal has been remanded for medical inquiry three times, in June 2020, December 2020, and February 2021. In response, VA medical opinions have been included in the claims file. Another remand is warranted for issuance of an addendum medical opinion. A VA opinion was completed for the Veteran's acquired psychiatric condition in April 2021. See April 2021 VA Opinion. The examiner checked the box that noted the Veteran's condition clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. However, the examiner separately opined that there was not clear and unmistakable evidence that the Veteran entered service with an acquired psychiatric disorder. In rendering this decision, the examiner acknowledged that the Veteran reported a history of child abuse and feeling depressed for as long as he could remember. However, as there was no evidence of a diagnosis or treatment for depression prior to service, the examiner determined that the Veteran's depression did not onset prior to service. Next, the examiner found the Veteran's psychiatric disability was unrelated to service because the Veteran's service treatment records (STRs) were silent for any symptoms and he was not diagnosed with depression until nearly 40 years after his last period of honorable military service. The VA has a duty to assist veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist including providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159(c)(4). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds the April 2021 opinion is of significantly reduced probative value. The examiner opined that the Veteran did not meet the criteria for major depressive disorder because the Veteran's treatment records did not include reports of symptoms of depression. Notably, the Veteran testified that he started using alcohol to self-medicate for his depression after his father's death in July 1951. See 1993 Hearing Testimony. He further testified that he "never really stopped drinking" and that he "could not control it." Additionally, his military personnel records show that within his first year of service he was disciplined. See Military Personnel Records. The examiner failed to address the Veteran's substance abuse issues and in-service discipline history in rendering his or her opinion regarding the Veteran's acquired psychiatric disorder. An adequate rationale must be provided for any medical opinion rendered; a conclusory, contradictory or incomplete analysis is not adequate. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Since there exists insufficient competent medical evidence to decide the Veteran's acquired psychiatric disorder claim, the Board will remand this matter for a clarifying VA medical opinion that addresses all the evidence of record. The matter is REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Return the case to the VA examiner who issued the April 2021 opinion, or to a suitable substitute, for issuance of an addendum opinion. After reviewing the claims file, the examiner should address the following question(s). (1). Is it clear and unmistakable (i.e., undebatable) that the Veteran entered service in January 1952 with an acquired psychiatric disorder? 3. (2). If so, is it also clear and unmistakable that the acquired psychiatric disorder WAS NOT aggravated (i.e., permanently worsened) by service? In other words, is it clear and unmistakable that any increase in severity of a pre-service psychiatric disorder during service between January 7, 1952 and January 6, 1954 was due to the natural progress of the disorder? The examiner must comment on the Veteran's substance abuse history and November 1952 disciplinary action. (3). If you find under #1 that it is not clear and unmistakable that a psychiatric disorder existed prior to service: Is it at least as likely as not (i.e., probability of 50 percent or more) that a psychiatric disorder had its onset during service between January 7, 1952 and January 6, 1954, or is related to a disease, event, or injury during this period of service? The examiner must comment on the Veteran's substance abuse history and November 1952 disciplinary action. If #3 is answered, it must be presumed that the Veteran did not have a psychiatric disorder prior to service entrance. Please explain in detail any opinion provided and the supporting rationale. In rendering the requested opinion, the examiner should note that laypersons are competent to attest to matters of first-hand knowledge, including observable symptomatology. The examiner should address the appellant's testimony that she observed what could possibly be mental disorder symptoms because the Veteran didn't seem as friendly as he did before he went into the service. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.