Citation Nr: 22065713 Decision Date: 11/23/22 Archive Date: 11/23/22 DOCKET NO. 20-26 141 DATE: November 23, 2022 REMANDED Entitlement to service connection for an acquired psychiatric disability, claimed as posttraumatic stress disorder (PTSD), to include as secondary to service-connected bronchial asthma and/or tinnitus. REASONS FOR REMAND The Veteran served on active duty from September 1967 to July 1970. He testified at a videoconference hearing in August 2021. A transcript is of record. This issue was previously before the Board in June 2022, at which time it was remanded for further development. Entitlement to service connection for an acquired psychiatric disability. The Veteran asserts that his acquired psychiatric disability is due to his observation of extremely wounded Vietnam soldiers at the VA hospital while he was receiving in-patient treatment during active service, as well as the suicide of a friend due to injuries he suffered in Vietnam. In the alterative, the Veteran asserts his acquired psychiatric disability is proximately due to or aggravated by his service-connected bronchial asthma. In its June 2022 decision, the Board noted that while the April 2017 VA examiner provided an opinion regarding direct service connection, she failed to address the issue regarding aggravation. Additionally, the Board recognized that the Veteran had submitted an undated private medical opinion by E.W., indicating a diagnosis of PTSD and providing a positive nexus opinion between a PTSD diagnosis and active service. However, the Board determined that the private opinion was too conclusory in nature to support an award of service connection as an adequate medical rationale or explanation was not provided to support the findings. Therefore, the Board remanded the Veteran's claim in order to afford the Veteran another VA examination so that an adequate opinion could be obtained addressing the Veteran's current acquired psychiatric diagnoses and his secondary service-connection claim. In July 2022, the Veteran was afforded another VA examination, at which time the VA examiner opined that the Veteran's acquired psychiatric disability was less likely than not related to his active-duty service, nor was it caused or aggravated by the Veteran's service-connected bronchial asthma. Regarding direct service connection, the VA examiner addressed the Veteran's contentions that his acquired psychiatric disability was due to his hospitalization for asthma during service, as well as his observation of extremely wounded soldiers while hospitalized and concluded that it was more likely than not that the Veteran's psychiatric disability was due to post-service life stressors. She did not discuss the Veteran's assertion that his acquired psychiatric disability was proximately due to learning of the suicide of a friend that was severely injured in Vietnam, nor did she consider the Veteran's assertions that post-life stressors merely exacerbated a psychiatric disability caused by service. Regarding secondary service connection, the examiner stated that there was no clinical correlation between the Veteran's service-connected asthma or tinnitus and his acquired psychiatric disability as none of the Veteran's medical records mention any correlation. The VA examiner also stated that bronchial asthma does not cause posttraumatic stress disorder (PTSD), when providing an opinion as to the Veteran's acquired psychiatric diagnoses. Unfortunately, the VA examiner failed to address the Veteran's contention that his psychiatric disability was proximately due to the suicide of a friend who was severely injured in Vietnam, as well as the assertion that post-life stressors merely exacerbated a psychiatric disability caused by service. Further, the examiner's opinion regarding secondary service connection was conclusory in nature and did not provide adequate rationale beyond simply stating that the Veteran's post-service medical records mentioned no correlation between the Veteran's acquired psychiatric disability and his service-connected asthma or tinnitus. In an October 2022 statement, the Veteran's representative asserted that the July 2022 VA examination was inadequate as it failed to consider the positive nexus statement and diagnosis of PTSD rendered by E.W., as well as failed to address all of the Veteran's asserted military stressors and reported psychiatric symptoms, such as distressing nightmares about his service. Further, the Veteran's representative asserted that the July 2022 VA examiner failed to address both the physical and psychological effects of the Veteran's tinnitus and asthma on his mental health. Therefore, based on the foregoing, the Board find that remand is warranted so that the Veteran may be afforded another VA examination and so that an addendum opinion can be obtained that adequately addresses the Veteran's contentions. The matters are REMANDED for the following action: 1. Schedule the Veteran for a psychiatric examination with an examiner other than the examiner who performed the July 2022 examination to determine the nature and etiology of any acquired psychiatric disability. The claims folder must be made available to and reviewed by the examiner. The examiner should take a history from the Veteran as to the progression of his claimed disability, and upon review of the file, interview and examination of the Veteran, the examiner should provide responses to the following, as appropriate: (a.) Please identify all acquired psychiatric disabilities that have presented during the pendency of the Veteran's appeal. The examiner is asked to reconcile his/her current findings with those of previous examiners and clinicians, including E.W. (b.) If the examiner determines that the Veteran meets the criteria for a diagnosis of PTSD, he/she must explain how the diagnostic criteria are met and indicate on what stressor the diagnosis is based. (c.) For any acquired psychiatric disorder diagnosed, the examiner must opine whether such at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) had onset in, or is otherwise related to service, to include his in-service respiratory conditions and hospitalizations, his observing wounded patients while hospitalized, and his learning of the suicide of a friend who was severely injured in Vietnam. The examiner should discuss whether post-service stressful events may have aggravated intrusive military memories that were already present. (d.) Notwithstanding the answer to the questions above, the examiner should also opine as to whether any psychiatric disability was caused or aggravated by service-connected bronchial asthma and/or tinnitus. The examiner should set forth all examination findings, along with complete rationale for the conclusions reached, in a printed report. Complete rationale should include an explanation of the evidence used in support of the conclusion, as well as an explanation as to why such evidence supports the conclusion. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bristow Williams, 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.