Citation Nr: 23015751 Decision Date: 03/15/23 Archive Date: 03/15/23 DOCKET NO. 16-45 275 DATE: March 15, 2023 REMANDED Entitlement to service connection for depression, to include as secondary to service-connected insomnia, is remanded. Entitlement to service connection for alcoholism, to include as secondary to a service-connected disability, is remanded. INTRODUCTION The Veteran served honorably on active duty in the United States Army during the Gulf War Era, from January 1991 to January 1995. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2015 Rating Decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston Salem, North Carolina. When the Veteran's service connection claims for depression, alcoholism, and obstructive sleep apnea (OSA) came before the Board most recently in February 2022, the claims for depression and alcoholism were denied and the claim for OSA was remanded. While on remand, a September 2022 Rating Decision granted the Veteran service connection for OSA and, as this represents a full grant of the benefit sought, the issue is no longer before the Board on appeal. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Thereafter, he appealed to the United States Court of Appeals for Veterans Claims (Court) which, pursuant to a Joint Motion for Partial Remand (JMPR), entered its November 2022 Order remanding the matters for action consistent with the terms of the JMPR. REASONS FOR REMAND Entitlement to service connection for depression, to include as secondary to service-connected insomnia, is remanded. The Veteran contends his depression manifested during active duty service or, alternatively, is caused or aggravated by his service-connected insomnia. According to the JMPR, the September 2021 VA medical opinion was inadequate in addressing whether the Veteran's service-connected insomnia aggravates his depression. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to obtain an opinion, the opinion must be adequate). As a result, the JMPR determined the Board "should obtain a new medical opinion that addresses whether [the Veteran's] service-connected insomnia aggravated his depression beyond its natural progression." Thus, the matter is remanded to afford the Veteran another VA examination and procure a VA medical opinion adequate for adjudication purposes. Moreover, as the Veteran was subsequently granted service connection for OSA, the opinion must also address whether OSA aggravates his depression. Entitlement to service connection for alcoholism, to include as secondary to a service-connected disability, is remanded. The Veteran seeks service connection for alcoholism which he contends manifested during active duty service and is secondary to depression. According to the JMPR, the Veteran's entitlement to service connection for alcoholism is inextricably intertwined with his claim for entitlement to service connection for depression. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are inextricably intertwined when they are tied together so closely that a final decision on one cannot be made without a final decision on the other). Because a decision on the Veteran's service connection claim for depression would have a significant impact on his claim for alcoholism, the service connection claim for alcoholism must also be remanded. Accordingly, these matters are REMANDED for the following action: Schedule the Veteran for an in-person VA examination(s) with an examiner who has not previously offered an opinion in this matter and possessing the necessary expertise to fully assess and render an opinion as to the nature, severity, and likely etiology of his depression and alcoholism. The examiner MUST obtain a full history from the Veteran as he is competent to attest to factual matters of which he has first-hand knowledge, such as in-service events and observable in-service/post-service symptomology and functional limitations. All pertinent symptomology, including when initially manifesting and any continuity and progression over time, MUST be elicited from the Veteran and reported in detail. Any indicated studies MUST be performed. Based upon review of all pertinent evidence in the claims file (e.g., medical treatment and examination records, lay statements), the Veteran's self-reports during the examination, and the examination results, the examiner MUST offer an opinion as to: (a.) Whether it is AT LEAST AS LIKELY AS NOT (i.e., at least approximately balanced, or nearly equal, if not higher) any acquired psychiatric disorder(s) manifested during active duty service; OR is due to or etiologically associated with an in-service injury, event, or illness; OR is proximately due to OR aggravated beyond its natural progression by a service-connected disability including, but not limited to, OSA and/or insomnia? (b.) Whether it is AT LEAST AS LIKELY AS NOT (i.e., at least approximately balanced, or nearly equal, if not higher) alcoholism manifested during active duty service; OR is due to or etiologically associated with an in-service injury, event, or illness; OR is proximately due to OR aggravated beyond its natural progression by an acquired psychiatric disorder or a service-connected disability? In offering the above opinions the examiner MUST consider, discuss, and reconcile as necessary all pertinent lay and medical evidence of record, such as: service treatment records (STRs) dated July 1991 and September 1992 noting injuries sustained after drinking alcohol; lay statements received January 2015 from the Veteran's mother, Ms. D.F., and sister, Ms. K.F., regarding his depression and onset of alcohol abuse; the Veteran's Notice of Disagreement (NOD) received August 2015 indicating he "did not drink until [he] went to Korea," which worsened due to fear of people behind him stemming from service in Sudan. The examiner is advised the mere absence of evidence does not automatically equate to unfavorable evidence. The Veteran's self-reports as to such considerations as causation, as well as symptomology onset and continuity over time MUST be considered and fully discussed. All opinions expressed MUST be fully-articulated, based upon an accurate medical history, and contain clear conclusions and references to supporting data (i.e., pertinent evidence of record and, as warranted, medical literature) with soundly reasoned medical explanations connecting the two. Danette Mincey Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Worsham 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.