Citation Nr: 23045686 Decision Date: 08/17/23 Archive Date: 08/17/23 DOCKET NO. 18-13 799 DATE: August 17, 2023 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1982 to August 1987. He testified at a hearing before the undersigned in March 2021; a transcript of the hearing is associated with the record. The Board previously remanded the claims in January 2023 and May 2023. Unfortunately, there has not been substantial compliance with the previous remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. In the May 2023, the Board remanded the claim because the February 2023 and March 2023 VA examination opinions were inadequate. The Board explained that opinions were inadequate because the examiner references "coping mechanisms" during service and the possibility that his depression could be related to the general discharge he received. Further, none of the opinions considered the Veteran's testimony that he began experiencing anxiety after the inservice motor vehicle accident and used alcohol as a coping mechanism to help him with his anxiety. In May 2023, a VA examiner reviewed the claims file and offered a negative opinion. The examiner opined that although the Veteran's alcohol use began in the military there was no evidence of a diagnosed substance abuse condition in service. However, this is factually inaccurate. In this regard, the Board notes that the July 2022 VA examiner found that the Veteran's alcohol use disorder was at least as likely as not related to service based upon the Veteran's noted alcohol use during his active service. The May 2023 examiner further opined that the Veteran's depressive disorder was more likely related to his substance abuse disorder. The examiner explained that according to the American Psychological Association, chronic substance abuse can result in depressive symptoms. Further, the examiner concluded that the Veteran did not participate in mental health treatment while in military service until incarcerated per his letter his Commander. There was no discussion of mental health symptoms related to a motor vehicle accident in Germany in his records. The Board finds the May 2023 opinion is not fully responsive to the prior remand directives. Stegall, 11 Vet. App. at 271. Specifically, the Board asked the VA examiner to comment on the February 2023 examiner's reference to "coping mechanisms" for anxiety during service and the possibility that the diagnosed depression "could be" related to the Veteran's general discharge. The reference to the motor vehicle accident abuse is not fully responsive because it considers only one aspect of the Veteran's theory of service connection. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the likely etiology of the diagnosed acquired psychological disorder is at least as likely as not related to service. Copies of all pertinent records must be made available to the examiner for review. After reviewing the records, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any currently diagnosed depressive disorder was incurred in or is otherwise related to service? The examiner MUST discuss the Veteran's testimony (i) that he began experiencing anxiety during service while stationed in Germany, (ii) he attempted to hide his anxiety and feelings as the military taught him, and (iii) he began using alcohol as a coping mechanism. (b) The examiner should comment on the February 2023 examiner's reference to "coping mechanisms" during service and the possibility that the diagnosed depression "could be" related to the Veteran's general discharge. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lauritzen, Dane (he/they) 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.