Citation Nr: 21039660 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 15-40 639 DATE: July 1, 2021 REMANDED Entitlement to service connection for acquired psychiatric disorder, to include as secondary to service-connected traumatic brain injury (TBI), is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2008 to May 2009, with additional service in the Army National Guard. This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in March 2021, at which time the issue currently on appeal was remanded for additional development. The case has now been returned to the Board for further appellate action. Entitlement to service connection for acquired psychiatric disorder The Veteran contends that her acquired psychiatric condition is directly related to her service. Alternatively, she has asserted that her acquired psychiatric condition is related to her service-connected TBI. The March 2021 Board decision remanded the appeal for a VA examination to determine the nature and etiology of all of the Veteran's current psychiatric disabilities. See BVA Decision (March 2021). The examiner was asked to opine whether any diagnosed psychiatric disability had its clinical onset in service or is otherwise related to active duty or is caused or aggravated beyond its normal progression by her service-connected TBI. Id. Should posttraumatic stress disorder (PTSD) be diagnosed, the examiner was asked to note the specific in-service stressor(s) leading to the diagnosis. Id. Should any previously diagnosed psychiatric disability not be found, the examiner was asked to discuss why the diagnosis is not appropriate. Although a March 2021 medical opinion was obtained, it is inadequate because it does not provide the requested opinion. Rather, the March 2021 VA medical opinion found that psychiatric conditions which met the DSM-5 criteria consisted of unspecified depressive disorder and panic disorder. See C&P Exam (March 2021). The opinion concluded that neither unspecified depressive disorder nor panic disorder had its clinical onset in service or were otherwise related to service as the Veteran was not diagnosed with, treated for, or complained of symptoms of a depressive disorder or panic disorder during military service. The March 2021 opinion also concluded that unspecified depressive disorder and panic disorder were not caused or aggravated beyond their natural progression by any service-connected disability, as the Veteran's symptoms were better explained as emotional reactions to various life stressors. Id. The opinion provides no meaningful discussion of the Veteran's theory of entitlement or medical principles as they pertain to whether her psychiatric conditions are caused or aggravated by her service connected TBI. In fact, the opinion found the determination that the Veteran has a TBI to be in error which is outside of the scope of the examination. Further, aggravation is not the same as causation, and the examiner's rationale does not address aggravation and causation as independent concepts. See Atencio v. O'Rourke, 30 Vet. App. 74 (2018) (questions of causation and aggravation are independent concepts that require separate findings and rationales). Therefore, the March 2021 VA medical opinion is inadequate for adjudicative purposes. Therefore, the Board finds that remand is required to obtain an adequate medical opinion related to the etiology of the Veteran's acquired psychiatric disorder. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician on the etiology of any diagnosed psychiatric disability. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms of psychiatric disability, including the nature, onset, progression and severity of any symptoms consistent with diagnosed psychiatric disability. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician should opine on: Whether the Veteran's acquired psychiatric disability is at least as likely as not (a) related to service, (b) proximately due to service-connected TBI, or (c) aggravated beyond the natural progression by service-connected TBI. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): Because causation and aggravation are independent concepts, an adequate medical opinion must have separate findings and rationales. 2. Ensure that the VA medical opinion obtained includes a complete rationale for the conclusions reached and is within the scope of the requested opinion. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include 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. Christopher J. O'Donnell Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Edwards, Capresha 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.