Citation Nr: 23022335 Decision Date: 04/14/23 Archive Date: 04/14/23 DOCKET NO. 19-17 661 DATE: April 14, 2023 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from July 1971 to August 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran previously submitted a claim of entitlement to service connection for psychiatric conditions which was denied in a February 2008 rating decision and the denial was continued in an August 2008 statement of the case (SOC). This decision became final as the Veteran did not appeal the SOC or submit new evidence in connection with the claim within the appeal period. See 38 C.F.R. § 3.156(b). In connection with the Veteran's claim to reopen, he submitted additional lay statements, medical evidence, and was provided with a VA medical examination. Thus, the Board finds that new and material evidence has been received sufficient to reopen his previously denied claim. 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010); Justus v. Principi, 3 Vet. App. 510, 513 (1992). Acquired Psychiatric Condition When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicolson, 21 Vet. App. 303, 312 (2007). To be considered adequate, a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). While there is an April 2019 VA medical opinion regarding the etiology of the Veteran's psychiatric disorders, the Board finds it to be inadequate. In proffering their opinion, the April 2019 examiner did not provide a "reasoned medical explanation" for the proffered opinions. In providing their negative nexus opinion, they did not provide any explanation or rationale to support their findings. The examiner merely noted that symptoms and treatment began "many years post discharge from military." However, the examiner did not address the Veteran's competent lay statements of experiencing symptoms since military service. For example, the Board notes a September 2015 lay statement wherein the Veteran indicated that before experiencing the typhoon in Okinawa his proficiency report rating was 4.1-4.6 out of 5, however, after the typhoon his rating dropped to as low as 2.5. The Veteran attributes this drop in proficiency to psychiatric symptoms he was experiencing at that time. As such, the April 2019 medical opinion for direct service connection is inadequate for adjudication purposes. Finally, the Board notes that the record for review may be incomplete. The Board notes that the most recent VA treatment records uploaded to the Veteran's claim's file are from April 2019. Records of his VA treatment are constructively before VA. As such, remand is necessary to obtain updated medical records. See Lang v. Wilkie, 971 F.3d 1348 (Fed. Cir. 2020); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). In light of the outstanding treatment records, the Board additionally finds it prudent to afford the Veteran an updated VA examination. See Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007) (an adequate VA medical examination must consider the Veteran's pertinent medical history). The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran's issues on appeal. Specifically, the RO should attempt to obtain/locate any outstanding VA or private treatment records. If needed, the RO should contact the Veteran and ask him to better identify and/or submit the records. If any requested records are not available, the record should be annotated to reflect such, and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. After completing the above, schedule the Veteran for a VA examination from an examiner, who has yet to opine on this case, with sufficient expertise to comment on the etiology of the Veteran's claimed acquired psychiatric disabilities. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, for each psychiatric disability diagnosed, the examiner should state an opinion regarding the following: - Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the Veteran's diagnosed acquired psychiatric conditions are etiologically related to his active-duty service. For purposes of these opinions, the examiner should assume that the Veteran is a reliable historian and must not ignore the Veteran's competent reports of in-service injuries, or of symptoms experienced during active service and since. In this regard, the examiner must discuss and consider the Veteran's competent lay statements. The Board directs the examiner's attention to the Veteran's September 2015 lay statement wherein he noted that after experiencing the typhoon in Okinawa his psychiatric symptoms caused a drop in his service proficiency ratings. The examiner must provide a complete rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If an examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiners should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Gresham, Trevor 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.