Citation Nr: 21031774 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 15-15 248 DATE: May 24, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, other than posttraumatic stress disorder (PTSD), to include major depressive disorder, panic disorder, or alcohol use disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 2, 1981, to April 28, 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2012 rating decision, in which the Regional Office (RO) declined to reopen the Veteran's previously denied claim for service connection for PTSD (also claimed as social adjustment disorder, anxiety, and depression). In March 2018, the Veteran testified at a hearing, and a transcript is of record. In a January 2019 decision, the Board reopened the Veteran's claim. In January 2019, July 2020, and December 2020, the Board remanded this issue, and the case has been returned for appellate consideration. The Veteran is seeking service connection for an acquired psychiatric disorder. In a December 2020 decision, the Board denied service connection for other specified personality disorder, mixed narcissistic and antisocial features and for PTSD. The Veteran's remaining psychiatric disorders include major depressive disorder, panic disorder, and alcohol use disorder. The Veteran was afforded VA examinations in November 2019 and August 2020, and an additional medical opinion from the same clinician was obtained in December 2020. Again, the Board finds that the examining clinician has failed to produce an adequate examination due to lack of a rationale sufficient to fully inform the Board on the merits of the Veteran's claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); El-Amin v. Shinseki, 27 Vet. App. 136, 139 (2013) (citing 38 C.F.R. § 4.2 and emphasizing that examination reports lacking sufficient detail must be returned); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion... that contributes probative value to a medical opinion."); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The clinician opined that the Veteran's major depressive disorder and panic disorder were secondary to his other specified personality disorder, which is not service connected, merely because antisocial personality disorder is known to be "associated" with these conditions. This fails to explain why it is believed to be the case for this Veteran specifically. As to his alcohol use disorder, no rationale was provided to support the negative nexus opinion because "[h]is Alcohol Use Disorder is in remission and not a current DSM 5 diagnosis." This does not explain why it is believed that the Veteran's alcohol use disorder, regardless of being in remission currently, is not related to service. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (explaining that the claimed condition must be present at some time during the pendency of the claim, not necessarily at the time the decision is made). Due to the foregoing incomplete development in this claim, the Board must remand this matter again for a new medical opinion as to the etiology of the Veteran's acquired psychiatric disorders other than PTSD. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. This matter is REMANDED for the following actions: 1. The agency of original jurisdiction should arrange for a new VA medical opinion from an appropriately qualified clinician who previously has not been involved in the Veteran's care or adjudication of this claim to determine the etiology of the Veteran's major depressive disorder, panic disorder, and alcohol use disorder. The clinician asked to offer the opinion should thoroughly review the Veteran's claims file and a complete copy of this Remand in conjunction with offering any opinion and note that this has been done in the examination report. The Board leaves it to the clinician's discretion whether the Veteran should be re-examined. The clinician is advised that the Veteran is competent to attest to observable symptomatology as reported in treatment records and his statements of record during the adjudication of his claim. Likewise, the numerous lay witness statements of record concerning the Veteran's symptoms are competent evidence and must be addressed in any opinion provided. If there is a medical basis to support or doubt the history provided by the Veteran and the lay witnesses, the clinician should provide a fully reasoned explanation. The clinician is advised that the lack of contemporaneous service treatment records documenting evidence of a mental disorder, alone, is an insufficient rationale for a negative opinion. The clinician is further advised that service connection is available for mental disorders superimposed upon a personality disorder. (a) Please indicate whether the Veteran's severe recurrent major depressive disorder, regardless of when symptoms began, is at least as likely as not (50 percent or greater probability) due to or aggravated by an in-service injury, event, or disease, including being found disqualified for his chosen in-service training program due to colorblindness. (b) Please indicate whether the Veteran's panic disorder, regardless of when symptoms began, is at least as likely as not (50 percent or greater probability) due to or aggravated by an in-service injury, event, or disease, including being found disqualified for his chosen in-service training program due to colorblindness. (c) Please indicate whether the Veteran's alcohol use disorder, regardless of when symptoms began, is at least as likely as not (50 percent or greater probability) due to or aggravated by an in-service injury, event, or disease, including being found disqualified for his chosen in-service training program due to colorblindness. The clinician must reconcile any opinion with the evidence of record, citing to the record as appropriate. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. The clinician must address any conflicting medical evidence of record. If the clinician is unable to offer any of the requested opinions, it is essential that the clinician offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is 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. (Continued on the next page.) 2. Readjudicate the claim. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Leanne M. Innet, 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.