Citation Nr: 21042341 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 17-59 328 DATE: July 12, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include bipolar disorder, depressive disorder, and anxiety disorder, is remanded. Entitlement to service connection for a substance abuse disorder secondary to an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 2001 to October 2003. This matter comes before the Board of Veterans' Appeals (Board) from a September 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Veteran testified before the undersigned Veterans Law Judge at a virtual Board hearing. The record contains evidence that the Veteran has faced homelessness in the recent past. If the Veteran is currently facing homelessness, he is invited to work with his Veterans Service Organization to file a motion with supporting evidence to advance his claim on the Board's docket. The Veteran underwent a psychiatric C&P examination in October 2017. Unfortunately, the examination and corresponding medical opinion are inadequate. In this regard, the examiner listed the Veteran's diagnoses as insomnia, unspecified depressive disorder, and marijuana use disorder, in remission. The examiner did not consider and discuss an August 2017 VA mental health note providing diagnoses of bipolar disorder with "psych" features and anxiety not otherwise specified (NOS). In addition, at the May 2021 hearing the Veteran testified that his psychiatric symptoms began during service and have continued to the present, information that the examiner did not discuss in the October 2017 negative medical opinion. The medical opinion also did not include a discussion regarding the Veteran's use of alcohol during service to cope with his psychiatric symptoms, as the reported at the hearing. Thus, remand is necessary to obtain clarification regarding the Veteran's diagnoses and to consider testimony presented at the hearing. Updated VA and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding pertinent private treatment records. 3. Then schedule the Veteran for a psychiatric examination with an appropriate clinician to determine the nature and etiology of his claimed psychiatric disorders. The entire claims file must be available to and reviewed by the examiner, to include a copy of the May 2021 Board Hearing Transcript (Tr.). After a review of the claims file, the examiner is asked to: (a.) Identify any and all of the Veteran's psychiatric disorders present since August 2017, even if resolved. In doing so, the examiner must consider and discuss the August 2017 VA mental health note listing diagnoses of bipolar disorder with "psych" features, anxiety NOS, insomnia, and nondependent cannabis abuse in remission. (b.) For each psychiatric disorder so diagnosed, please opine whether it is at least as likely as not (50 percent or greater probability) that such disorder (excluding substance use/abuse disorders) had its onset during service or is otherwise related to service. (c.) If the criteria for a diagnosis of a psychotic disorder (see 38 C.F.R. § 3.384) are met, please state, to the best of your ability, whether the prodromal period for such disorder as likely as not had its onset during the Veteran's periods of active service. (d.) If a psychotic disorder is diagnosed, please opine as to whether it is at least as likely as not (50 percent probability or greater) that such disorder was present within one year of the Veteran's separation from service (e.g. by October 2003). If so, please indicate the level of severity of the disability at the time of its onset. In doing so, the examiner must consider and discuss the Veteran's May 2021 testimony relating his psychiatric disorders to being on a constant state of "high alert" during service and that he began drinking during service as a form of self-medication to cope with his psychiatric symptoms. Tr. 6-7. The examiner must also consider and discuss the Veteran's report of symptoms experienced during service, to include mood swings, depression, anxiety, insomnia, impulsiveness, low self-esteem, and social isolation. See August 2017 Statement in Support of Claim; Tr. 7. Please also comment on service treatment records indicating that in July 2001 the Veteran reported not using tobacco but then in April 2002 the Veteran reported smoking 1 pack per day. (e.) If and only if the medical opinion in response to (b.) (d.) is positive, please also opine whether it is at least as likely as not (50 percent or greater probability) that any substance use/abuse disorder is: (1.) proximately due to the service-related psychiatric disorder; or (2.) has been aggravated (worsened) by the service-related psychiatric disorder. In so doing, the examiner must consider and discuss the Veteran's testimony that he began drinking during service as a form of self-medication to cope with his psychiatric symptoms, Tr. 6-7, as well as his August 2017 Statement in Support of Claim in which the Veteran states he used marijuana in service "as a way to self-medicate." The examiner must also consider and discuss any information elicited during the psychiatric examination regarding the Veteran's history of self-medicating with alcohol or other substances. The Board recognizes there is evidence of record indicating the Veteran used marijuana before service. Despite his use of marijuana before service, the examiner must attempt to discern whether the Veteran's use of marijuana (or any other substances) during service was a continuation of pre-service behavior, or, a form of self-medication in response to psychiatric symptoms that arose in service. Basing a negative opinion solely on the fact that the Veteran used marijuana before service will render the opinion inadequate and will necessitate another remand for an addendum opinion. Please provide a robust rationale for all opinions. If unable to opine without resorting to speculation, please provide a basis for reaching this conclusion. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. deBruyn, 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.