Citation Nr: 21039681 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 11-13 052 DATE: July 1, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and major depressive disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1964 to December 1968. This matter comes before the Board of Veterans' Appeals (Board) from an April 2010 rating decision. The Board most recently remanded this issue in April 2021. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and major depressive disorder is remanded. The Veteran contends that his acquired psychiatric disorder is related to service-connected tinnitus. See December 2020 VA examinations. The Veteran was afforded a VA examination in December 2020, wherein he was diagnosed with major depressive disorder, recurrent mild with anxious distress. The Board previously remanded this issue in February 2021 to obtain an addendum VA examiner's opinion to determine whether the Veteran's acquired psychiatric disorder is secondary to his service-connected tinnitus. See February 2021 BVA Decision. A VA addendum opinion was obtained in February 2021, stating that although the Veteran mentioned tinnitus as a cause of his depression during previous examinations, he also indicated that his depression relates to how he was treated in the military and to his chronic arthritic pain. The examiner concluded that there is no consistent evidence that the Veteran's current depression is related to or caused by, or proximately due to his tinnitus. See February 2021 C&P Exam. In April 2021, the Board remanded and indicated that the February 2021 addendum opinion was inadequate because the examiner improperly based his/her conclusion on the Veteran's assertions that his depression may have multiple causes, to include tinnitus. The Board added that the examiner appeared to have dismissed the current diagnosis of depression on the basis that the Veteran previously denied depression. The Board remanded for a new addendum opinion to provide a detailed rationale on whether the depression was caused by or proximately due to the Veteran's service-connected tinnitus. See April 2021 BVA Decision. Importantly, the Board noted that, if necessary, an update examination should be scheduled. Id. Post remand, the May 2021 VA addendum opinion appears to be a renumeration of the February 2021 VA addendum opinion, and it remains inadequate for the same reasons. The examiner improperly based his conclusion on the Veteran's assertions that his depression may have multiple causes, to include tinnitus, chronic arthritis pain and experience of the treatment during his military service. The examiner reasoned that there is no consistent evidence to indicate that the Veteran's current depression is caused by or related to tinnitus and that there is no nexus between his current depression and his service-connected tinnitus. See May 2021 C&P Exam. Pursuant to 38 U.S.C. § 5103A, the VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination. 38 U.S.C. § 5103A; see Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); see also Green v. Derwinski, 1 Vet. App. 121, 124 (1991). An examination is adequate "where it is based upon consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl, 21 Vet. App. at 1236 Vet. App. 405, 407-08; Green, supra. It is a medical examiner's responsibility to provide a well-supported opinion so that the Board may carry out its duty to weigh the evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (concluding that a medical opinion is not entitled to any weight "if it contains only data and conclusions"); Stefl, 21 Vet. App. at 124 (stating that VA medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). An examination report may be inadequate if it fails to discuss something that is necessary. See 38 C.F.R. § 4.2. Here, the April 2021 examiner opined that there is no consistent evidence to indicate that the Veteran's depression is caused by or related to tinnitus, based on a review of the record. Essentially, this opinion is based on a lack of documentation of a nexus relationship, which is insufficient to deny service connection. If the examiner was unable to provide a sufficiently detailed opinion without an examination or additional evidence, an updated examination should have been scheduled, as noted in the April 2021 BVA Decision, and an evaluation should have been performed to obtain evidence. The opinion is inadequate in that it does not include a well-supported opinion with analysis that the Board can consider and weigh against contrary opinions. The Board regrets the further delay but finds that a remand is necessary to afford the Veteran full consideration of his claim. The addendum opinion is inadequate as stated above. A new VA examination is needed to provide a detailed rationale on whether the depression, or any other diagnosed acquired psychiatric disability, is caused by or proximately due to his service-connected tinnitus. Accordingly, the matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, schedule the Veteran for an updated VA examination. Following a review of the record and a copy of this remand, the examiner is asked to opine as to the following regarding the Veteran's diagnosed major depressive disorder, and any other acquired psychiatric disability diagnosed during the appeal period: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's acquired psychiatric disability began during or is otherwise etiologically related to service? b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's acquired psychiatric disability is proximately due to, or the result of, his service-connected tinnitus? c) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's acquired psychiatric disability has been aggravated beyond normal progression by his service-connected tinnitus? ("Aggravation" means to have caused any increase in severity beyond the normal progression, and it need not be permanent in nature.) A complete rationale must be provided for all opinions expressed. The examiner is asked to specifically address the relationship, if any, between the Veteran's current diagnosis of depression and service-connected tinnitus. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. G. Brooks 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.