Citation Nr: 22008086 Decision Date: 02/11/22 Archive Date: 02/11/22 DOCKET NO. 16-35 046 DATE: February 11, 2022 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder, is remanded. REASONS FOR REMAND Service connection for generalized anxiety disorder The Veteran served on active duty in the United States Navy from September 1991 to November 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in May 2021 when it was remanded for additional development. The Veteran's claim of service connection for an acquired psychiatric disorder has been recharacterized to include all psychiatric disorders in accordance with Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran asserts that service connection is warranted for his psychiatric disorder since it is related to service. See July 2016 VA Form 9. In support of this claim, the Board notes that Veteran's record has credible evidence of a diagnosed psychiatric condition, to include generalized anxiety disorder and depressive disorder, with treatment. See June 2014, and February and July 2019 VA medical treatment records. Additionally, his service treatment record show anxiety problems in service. See April 1998 report. In May 2021, the Board remanded this issue to obtain a new VA examination and medical opinion that provides a reasoned rationale, based upon the entire record, in support of its conclusion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (probative value of a medical opinion is derived from it being factually accurate, fully articulated, and soundly reasoned). Subsequently, in September 2021, the Veteran was provided a VA examination and the examiner stated that the Veteran did not suffer from a diagnosed psychiatric condition and continued to provide a negative nexus opinion. The rationale was that the Veteran's reports were inconsistent with his reported symptoms during his evaluation. The examiner reasoned that many people feel their anxiety is more intense at a certain time than others. Additionally, most people experience anxiety during different times of life, or during certain activities. Having anxiety at times and having a diagnosis of GAD are two completely different things. The examiner opined that even the Veteran's self-described symptoms do not meet the criteria for the diagnosis. However, the Board finds the September 2021 VA examination to be inadequate as the record shows a diagnosis for a psychiatric disorder with treatment, and the examiner does not note or discuss the diagnosis, treatment, complaints and symptomatology on record. See June 2014, and February and July 2019 VA medical treatment records. Indeed, although the Board has found the February 2014 VA examination and March 2014 opinion to be inadequate based on the lack of reasoning for its conclusions, the examination did confirm a diagnosis for a psychiatric disorder. See February 2014 and September 2021 VA medical examinations. Further, the September 2021 VA examination did not provide supporting rationale regarding the Veteran's psychiatric disorder onset and relation to service. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-304 (2008); see also El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013). Therefore, the Board finds this examination to be of limited, if any, probative value regarding this issue as it appears to be based on an inaccurate, and at the very least incomplete, factual premise. See Reonal v. Brown, 5 Vet. App. 548 (1993). Consequently, on remand the Veteran should be provided a VA medical examination to determine the onset, nature and etiology of his psychiatric disorder. Lastly, the Board invites the Veteran to submit any medical evidence of treatment he has received regarding his psychiatric disorder. Thus, any outstanding treatment records should also be secured on remand. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Notify the Veteran that he may submit additional lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service psychiatric disorder. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 4. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of his psychiatric disorder. The examiner is asked to address the following: (a) Provide a diagnosis for any psychiatric disorder found. If no psychiatric disorder is found, provide a complete rationale for this reasoning and discuss the previous psychiatric diagnoses and treatment in the record, specifically addressing the February 2014 VA examination diagnosis of generalized anxiety disorder. (b) Is it at least as likely as not that the Veteran's psychiatric disorder is related to or had its onset during service? (c) Is it at least as likely as not that the Veteran's psychiatric disorder is caused by his service-connected disabilities? (d) Is it at least as likely as not that the Veteran's psychiatric disorder was aggravated by his service-connected disabilities? A complete rationale should be given for all opinions and conclusions expressed. Please note that separate opinions addressing proximate cause and aggravation are needed. In offering this opinion, the examiner must acknowledge and discuss the Veteran's competent lay statements of his disability and any lay evidence regarding the onset of his disability. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. Jarrette A. Marley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alvarado- 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.