Citation Nr: 21040822 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 14-41 847 DATE: July 7, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a disability claimed as a rib dislocation, to include thoracic outlet syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 2000 through September 2006. The Veteran testified at a hearing before the undersigned in December 2020. A transcript of the hearing is associated with the claims file. The Veteran's claims were remanded by the Board of Veterans' Appeals (Board) in April 2021. Unfortunately, the Board finds that additional development must be conducted prior to adjudication of the Veteran's claims. 1. Entitlement to service connection for an acquired psychiatric disorder The Veteran's claim for service connection for an acquired psychiatric disorder was remanded for a VA examination to determine whether the Veteran has any psychiatric disorder diagnosed during the period on appeal since June 2011 (or approximately thereto) which was incurred in, or otherwise due to, the Veteran's period of active service. The examiner was asked to specifically discuss a diagnosis of an adjustment disorder provided by a VA psychologist in May 2015. Unfortunately, the Board finds that the medical opinion provided by the VA examiner is inadequate to resolve the issue on appeal. The 2021 examiner opined that "the totality of the evidence does not point to a mental health disorder diagnosis of anxiety, depression, sleep, psychosis, PTSD, adjustment disorder, etc. What is presented as evidence of treatment was actually diagnostic evaluations in 2015 within the context of appealing mental health VA claims." The examiner does not explain why a "diagnostic evaluation" provided by a licensed VA psychologist based upon a 65-minute interview of the Veteran that reports a diagnosis of an adjustment disorder pursuant to the DSM-5 does not demonstrate a diagnosis of an acquired psychiatric disorder during the appeal period. The Board finds that without a rationale for this assertion, the opinion is incomplete. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As such, the Board finds that a new medical opinion should be obtained that discusses whether any acquired psychiatric disorder present during the period on appeal, since June 2011 (or approximately thereto), is at least as likely as not due to the Veteran's period of active service. 2. Entitlement to service connection for a disability claimed as a rib dislocation, to include thoracic outlet syndrome The Board also remanded the Veteran's claim for service connection for a disability claimed as a rib dislocation for a determination if the Veteran had a disability during the appeal period, and if so, whether such a disability at least as likely as not was due to any incident of his period of service, or any service-connected disability. In May 2021, a VA examiner provided a diagnosis of thoracic outlet syndrome and opined that the condition was less likely than not due to the Veteran's period of active service. The examiner supported this opinion by stating, "there is no evidence in the Veteran's claims file that the Veteran's rib condition or thoracic outlet syndrome began during his time in service. This condition was first noted in 2008 as reported both by the veteran and in the claims file. A nexus has not been established." Review of the Veteran's claims file, however, indicates that when the Veteran was seen at a VA facility on July 29, 2008 for an initial evaluation and treatment secondary to pain, numbness, weakness and tingling in his left upper extremity (diagnosed as thoracic outlet syndrome) that the Veteran reported that "it started in 2002 and really did not begin noticing the radicular symptoms until after he fell and reinjured his left shoulder which resulted in another surgery on 2005." Additionally, the Board notes that this treatment was received within two years of the Veteran's separation from active service and that the Veteran denied trauma to the area since his in-service bicycle accident in his November 2014 VA Form 9. As the examiner failed to address this evidence relating the Veteran's thoracic outlet syndrome to events during the Veteran's period of service in 2002 and 2005, particularly his in-service bicycle accident and subsequent surgery, the Board finds the May 2021 medical opinion to be inadequate and a new medical opinion must be obtained. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any psychiatric disorder present during the appeal period. The evidence of record should be made available to the examiner for review. All indicated diagnostic testing should be conducted. The VA examiner should identify all acquired psychiatric diagnoses provided during the appeal period and provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any psychiatric disorder diagnosed during the appeal period had its onset in service or is otherwise is related to service. In rendering the requested opinions, the Board directs the VA examiner's attention to, but to not limit his or her review to, the following evidence: (i) VA treatment records from Cheyenne VA dated May 2015, showing a diagnosis of adjustment disorder with anxiety; the notation from the May 2015 psychologist that Veteran's primary issue seems related to medical discharge from the military after this accident, and the active problems list reporting Depression. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any provided opinions. A clear explanation for all opinions would be helpful. If the examiner is unable to provide an opinion he or she should explain why. 2. Schedule a VA examination with an appropriate clinician to determine the nature and etiology of his disability diagnosed as thoracic outlet syndrome, or any rib disability present since the Veteran filed his claim in February 2012. The claims file must be provided to the examiner for review. All indicated tests and studies should be performed. The examiner is asked to opine whether it is as least as likely as not (50 percent probability or more) that the Veteran's thoracic outlet syndrome (or any rib disability present since the Veteran filed his claim in February 2012) had its onset during service is otherwise causally or etiologically related to service, to include his in-service bicycle injury in 2006. The examiner is asked to discuss the diagnosis of thoracic outlet syndrome at a Cheyenne VA medical facility on July 29, 2008 and the Veteran's reports of symptoms since 2002 and 2005 at that time. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinion. Any opinions expressed must be accompanied by a complete rationale. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.M. Johnson, 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.