Citation Nr: 22017688 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 13-31 650 DATE: March 25, 2022 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include schizoaffective disorder and posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1962 to December 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In September 2014, the Veteran testified before a Veterans Law Judge who has since retired from the Board. A transcript of that hearing is of record. The Veteran was therefore afforded the option for a second Board hearing. In July 2019, the Veteran and his sister-in-law testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is also of record This case has a lengthy procedural history that involves multiple actions by the Board. As the procedural history has been detailed at length in the prior actions in the appeal, it will only be repeated herein as necessary to explain the state of the issue currently before the Board. The appeal was most recently remanded by the Board in September 2021 for further evidentiary development. A review of the record reflects substantial compliance with the Board's Remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). A supplemental statement of the case (SSOC) was issued in February 2022. The Veteran's VA claims file has been returned to the Board for further appellate proceedings. 1. Entitlement to service connection for an acquired psychiatric disability, to include schizoaffective disorder and PTSD, is remanded. The claim on appeal was most recently remanded by the Board in September 2021 in order to obtain a VA addendum opinion as to the question of whether the diagnosed schizoaffective disorder was incurred in or aggravated by the Veteran's active duty service. Pursuant to the Board Remand, a VA examination and medical opinion were obtained in February 2022. However, in the March 2022 Written Brief Presentation, the Veteran's representative raised a theory of secondary service connection due to the Veteran's service-connected disabilities to include coronary artery disease. In support of this contention, the Veteran's representative cited a 2013 study that purportedly determined that, among Vietnam era veterans, PTSD is associated with increased risk of CHD. The Board notes that VA examiners have determined that the Veteran does not have a diagnosis of PTSD and the study does not appear to causally relate schizoaffective disorder to coronary artery disease. Nevertheless, as the Veteran's representative has only recently raised this theory of secondary service connection, the February 2022 VA examiner (as well as the other VA examiners of record: November 2020, November 2019, and November 2014), did not have the opportunity to address the question of whether the diagnosed psychological disability is proximately caused or aggravated by the Veteran's service-connected disabilities. Accordingly, while the Board regrets the additional delay in this case, it must find that the evidence of record is again inadequate to resolve the claim of entitlement to service connection for an acquired psychiatric disability. This matter must be remanded to obtain a VA medical opinion to address outstanding questions of nexus and aggravation. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(4); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination when developing a service connection claim, even if not statutorily obligated to do so, it must provide one that is adequate for purposes of the determination being made). The matters are REMANDED for the following action: Refer the VA claims file to a qualified medical professional to provide an opinion as to the claimed acquired psychiatric disability. The examiner is requested to review the relevant evidence of record. The examiner should then address the following: (a). Is it at least as likely as not that the diagnosed acquired psychiatric disability was caused by the service-connected disabilities to include coronary artery disease, bilateral hearing loss, tinnitus, and scar of the mid-sternum? (b). If not, is it at least as likely as not that the Veteran's acquired psychiatric disability is aggravated (made worse as shown by comparing the current disability to medical evidence created prior to any aggravation) by service-connected disabilities to include coronary artery disease, bilateral hearing loss, tinnitus, and scar of the mid-sternum? In rendering this opinion, the VA examiner must address the contentions raised in the March 2022 Written Brief Presentation to include the 2013 study cited therein. If the Veteran's acquired psychiatric disability is aggravated by a service-connected disability, the examiner should also indicate the extent of such aggravation by identifying the baseline level of disability. This may be ascertained by the medical evidence of record and also by the Veteran's statements as to the nature, severity, and frequency of his observable symptoms over time. Should the examiner decide that a physical examination of the Veteran is required to address these questions, such should be scheduled. K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. K. Buckley, 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.