Citation Nr: 21032763 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 10-15 311 DATE: May 27, 2021 ORDER Service connection for an acquired psychiatric disorder characterized as a bipolar disorder and a major depressive disorder, as secondary to the service-connected asthma, is granted. FINDING OF FACT The preponderance of the medical evidence establishes a nexus between the Veteran's diagnosed psychiatric disorder and his service-connected asthma. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder characterized as a bipolar disorder and a major depressive disorder, as secondary to the service-connected asthma, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303(a), 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1985 to August 1990. This appeal arose from a February 2009 rating decision. In December 2014 and July 2017, the Board remanded the claim for further evidentiary development. In November 2019, the Board denied service connection for an acquired psychiatric disorder. The Veteran appealed the November 2019 Board decision to the Court of Appeals for Veterans Claims (CAVC or Court), which vacated the decision and remanded it back to the Board for further development in November 2020, pursuant to a Joint Motion for Remand (JMR). Specifically, the JMR directed that the Board remand the claim to obtain another opinion regarding the nature and etiology of the Veteran's psychiatric disorder. In other words, the JMR agreed that the Board should have considered evidence of record reflecting the possibility that the Veteran's service-connected asthma (including medication used in treatment therefor) may have caused, or aggravated, his acquired psychiatric disorder. The JMR agreed that a remand for additional evidentiary development pertaining to the issue of entitlement to service connection for an acquired psychiatric disorder on a secondary basis is warranted. In this regard, the Board notes, however, that the above development is unnecessary because the decision rendered herein results in a favorable outcome for the Veteran in light of evidence submitted since the JMR and a thorough reexamination and reconsideration of the evidence on the record. See McBurney v. Shinseki, 23 Vet. App. 136, 150 (2009) (stating that Board has a duty on remand to ensure compliance with the favorable terms stated in the joint motion for remand or explain why the terms will not be fulfilled.); Forcier v. Nicholson, 19 Vet. App. 414, 426 (2006); & Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, the Veteran will not be prejudiced by the adjudication of this matter. Service connection for a psychiatric disorder, as secondary to asthma The Veteran seeks service connection for an acquired psychiatric disorder. He contends that his psychiatric disorder is related to his service-connected asthma. In this regard, the Board notes that service connection may be established on a secondary basis for a disability which is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § § 3.303, 3.310. To prevail on the theory of secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Current evidence of the record establishes that the Veteran has been diagnosed with a major depressive disorder and a bipolar disorder. Previously, VA physicians have opined that the Veteran's psychiatric disorder was caused, or aggravated, by his service-connected asthma. See August 2016 Medical Advisory Opinion (Correspondence); September 2017 Addendum Opinion (VA Examination Report). As explained in the November 2020 JMR, those opinions were deemed inadequate in deciding the nature and etiology of the Veteran's psychiatric disorder. In February 2021, however, the Veteran submitted a private medical opinion from Dr. E.G., who opined, with a reasonable degree of certainty, that the Veteran's asthma (including medicine taken therefor) aggravated his psychiatric disorder. The physician stated that the Veteran's psychiatric disorder was worsened by the treatment of his asthma, noting that the Veteran had become more socially isolated. The physician explained that asthma is a psychosomatic disorder and may have been the earliest manifestation of his bipolar disorder. The physician continued that anxiety and depression are more likely than not related to the severity of the Veteran's asthma. The physician continued that Albuterol, one of the medications the Veteran uses to treat his asthma, is known to cause anxiety, tremors, insomnia, and that these symptoms more likely than not affect his mania. The physician stated that it was unknown if the Veteran took an oral steroid for asthma control, but that steroids and withdrawal from steroids can also cause psychiatric symptoms. The physician reviewed the Veteran's medication list and noted that most of those medications affect the central nervous system by being long acting beta 2 agonists, or corticosteroids, which cause anxiety, tremor, nervousness, and depressed mood. See February 2021 Private Medical Treatment Record. Treatment records document the Veteran's complaints of insomnia and sleep impairments. In a June 2010 VA Psychiatry Note, it was noted that it was difficult to determine if the change of asthma medication may have caused exacerbation of the Veteran's mood disorder but that it was certainly possible. See February 2015 VA Medical Treatment Records (CAPRI). Additionally, the Veteran, through his representative, submitted information and references to medical literature regarding the association of asthma and mental conditions. See June 2017 Informal Hearing Presentation (Correspondence). After a thorough consideration of the evidence of the record, the Board finds that the evidence supports a nexus between the Veteran's psychiatric condition and his service-connected asthma. The Board is aware that Dr. E.G. is not a licensed mental health professional. However, the Veteran's mental condition has already been diagnosed by licensed mental health professionals. The issue in dispute is not if the Veteran has a current diagnosis of a mental disorder, but if his current mental condition is due to, or aggravated by, his asthma. Dr. E.G. is a registered respiratory therapist and cardiopulmonary technologistand therefore possesses the knowledge, experience, and expertise in respiratory conditions and their treatment. This physician reviewed and discussed the particulars of the Veteran's case and provided a thorough rationale explaining the conclusion. Furthermore, the information provided in the Veteran's medical records are supportive of the medical principles proffered by Dr. E.G in the opinion. Accordingly, the Board determines that the criteria for service connection have been met on a secondary basis and that entitlement to service for an acquired psychiatric disorder characterized as a bipolar disorder and a major depressive disorder is warranted. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Middleton, 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.