Citation Nr: 21041530 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 18-39 117 DATE: July 9, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1969 to February 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision. In March 2019, the Board reopened and remanded claims for service connection for an acquired psychiatric disorder and peripheral neuropathy of the bilateral lower extremities. In April 2021, the Board remanded the case for further development. The case has since been returned to the Board for appellate review. 1. Entitlement to service connection for an acquired psychiatric disorder The Veteran was afforded a VA psychiatric examination in May 2021 during which the examiner diagnosed him with major depressive disorder. Unfortunately, the Board finds that the May 2021 VA medical opinion does not substantially comply with the Board's prior remand instructions. Stegall v. West, 11 Vet. App. 268 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). In April 2021, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain a medical opinion regarding the Veteran's acquired psychiatric disorders, to include generalized anxiety disorder (GAD), depressive disorder, major depressive disorder, depression with psychotic features, unspecified depressive disorder, and posttraumatic stress disorder (PTSD). However, the May 2021 examiner did not address the diagnoses of acquired psychiatric disorders other than major depressive disorder, as directed by the Board. Stegall, 11 Vet. App. at 271. In addition, in rendering his opinion, the May 2021 examiner stated that the Veteran quit drinking in 2004 after decades of suffering from alcoholism and that he "later developed a depressive disorder since 2007." However, the examiner did not address the June 1999 diagnoses of anxiety and depression, as directed by the Board. Stegall, 11 Vet. App. at 271. Moreover, the examiner did not reconcile his opinion with the medical evidence of record that appears to document relevant symptoms and diagnoses of psychiatric disorders prior to 2007. See, e.g., VA medical records dated in March 1991 (noting that the Veteran reported having a history of a sleep disorder); June 1998 (noting a diagnostic impression of anxiety); and November 1999 (noting a diagnosis of major depression with psychotic features). In light of the above, and although the Board sincerely regrets the delay, a remand is necessary to obtain an additional opinion regarding the etiology of the Veteran's acquired psychiatric disorder. The Board also noted that the Veteran reported receiving treatment for a nervous condition during his service in the Republic of Vietnam. See April 2001 statement in support of claim. The service treatment records currently associated with the claims file do not document treatment for a nervous condition. As mental health treatment records are often kept separately from service treatment records, a remand is necessary to request any such records. 38 C.F.R. § 3.159(c). 2. Entitlement to service connection for peripheral neuropathy, to include as due to exposure to herbicide agents, is remanded. In a May 2021 VA medical opinion, the examiner opined that the Veteran's peripheral neuropathy was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner stated that the Veteran's peripheral neuropathy onset "in 206." The examiner also stated that there was no evidence of any peripheral neuropathy in service or within a year after service, so "as to have a nexus with herbicide exposure." However, the examiner once again did not provide any rationale for his conclusion regarding the date of onset for the Veteran's peripheral neuropathy. Moreover, the examiner's opinion does not adequately address whether the Veteran's peripheral neuropathy is directly related to his in-service herbicide exposure. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). In light of the above, and although the Board sincerely regrets the delay, a remand is necessary to obtain an additional opinion regarding the etiology of the Veteran's bilateral lower extremity peripheral neuropathy. See Stegall, 11 Vet. App. at 271; see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide a medical examination or opinion, it must ensure that the examination or opinion is adequate). Lastly, in April 2021, the Board directed the AOJ to update the electronic file with any new VA treatment records and private treatment records. However, there is no indication that the AOJ made efforts to obtain any outstanding private treatment records. Therefore, a remand is necessary. Stegall, 11 Vet. App. at 271. The matters are REMANDED for the following action: 1. Ask the Veteran to identify and provide complete authorization to obtain any outstanding, relevant private medical records regarding his acquired psychiatric disorder and peripheral neuropathy. After securing the necessary authorization, these records should be requested. All attempts and responses should be documented in the claims file. 2. Contact the appropriate location to request any records of mental health treatment and evaluations that the Veteran received during his period of service from February 1969 to February 1971. The Board notes that mental health treatment records are often kept separately from other service treatment records. 3. Obtain a VA medical opinion from an appropriate clinician regarding the etiology of any current acquired psychiatric disorders. An additional examination should only be performed if deemed necessary by the individual providing the opinion. (a) The examiner should identify any acquired psychiatric disorders during the appeal period or in close proximity thereto, to include generalized anxiety disorder (GAD), major depressive disorder, depression with psychotic features, unspecified depressive disorder, and PTSD. If any previously diagnosed psychiatric disorders are not found, the examiner should address whether they were misdiagnosed or have resolved. (b) For each diagnosis identified other than PTSD, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the disorder had its onset in service or is otherwise causally or etiologically related to the Veteran's active service. (c) With respect to any identified PTSD, the AOJ should provide the examiner with a summary of any verified in-service stressors, and the examiner must be instructed that only these events and any stressors related to fear of hostile military or terrorist activity may be considered for the purpose of determining whether exposure to an in-service stressor has resulted in PTSD. The examiner should determine whether the diagnostic criteria to support the diagnosis of PTSD have been satisfied. If the PTSD diagnosis is deemed appropriate, the examiner should then comment upon the link between the current symptomatology and any verified in-service stressor. In rendering this opinion, the examiner should consider and address: (1) a March 1991 VA medical record in which the Veteran reported having a history of a sleep disorder; (2) a June 1998 VA medical record that noted a diagnostic impression of anxiety; (3) a June 1999 VA medical record that noted diagnoses of anxiety and depression; (4) a September 1999 VA medical record, in which the Veteran reported that he began drinking during his active service and the military "taught him to drink;" (5) a November 1999 VA medical record that noted a diagnosis of major depression with psychotic features; (6) a September 2000 VA medical record that noted the Veteran "seems to be having military hallucinations;" (7) the Veteran's April 2001 claim for service connection for a nervous condition due to his service in the Republic of Vietnam; and (8) a March 2007 VA medical record noting that the Veteran developed psychiatric symptoms since coming back from the Republic of Vietnam. All opinions must be supported by detailed rationale. 4. Obtain a VA medical opinion from an appropriate clinician regarding the etiology of the Veteran's peripheral neuropathy of the bilateral lower extremities. The entire claims file must be made available to the examiner. (a) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's peripheral neuropathy had its onset in service or is otherwise causally or etiologically related to his active service, including exposure to herbicide agents (notwithstanding the fact that it may not be a presumed association). In providing this opinion, the examiner should consider the Veteran's lay statements, including a May 1999 VA medical record in which he complained of left leg numbness. (Continued on the next page) All opinions must be supported by detailed rationale. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Wulff, 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.