Citation Nr: A25020249 Decision Date: 03/05/25 Archive Date: 03/05/25 DOCKET NO. 240703-451193 DATE: March 5, 2025 ORDER Entitlement to service connection for unspecified depressive disorder with alcohol use disorder (claimed as acquired psychiatric condition) is granted. REMANDED Entitlement to service connection for chronic kidney disease is remanded. Entitlement to total disability based on individual unemployability (TDIU) is remanded. FINDING OF FACT The evidence of record persuasively weighs in favor of finding that Veteran's unspecified depressive disorder with alcohol use disorder is the result of his military service. CONCLUSION OF LAW The criteria for service connection for unspecified depressive disorder (claimed as acquired psychiatric condition) have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1967 to August 1969. This matter comes before the Board of Veterans' Appeals (Board) from March 2024 and May 2024 rating decisions issued by a Department of Veterans Affairs (VA) regional office (RO). In the July 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on October 31, 2024. A transcript of the hearing is part of the record. Therefore, the Board may only consider the evidence of record at the time of the March 2024 and May 2024 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. However, because the Board is remanding the claims of service connection for chronic kidney disease and TDIU, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). During the course of this matter, the Veteran's claim has been characterized as service connection for acquired psychiatric disorder, post-traumatic stress disorder (PTSD), unspecified depressive disorder, and alcohol use disorder. When identifying the current disability underlying a service connection claim, the Board is to expand claims to include all potential disabilities, regardless of the nature of the claimed disability, and must address all diagnoses reasonably encompassed by the Veteran's statements. See Clemons v. Shinseki, 23 Vet. App. 1 (2009); Brokowski v. Shinseki, 23 Vet. App. 79 (2009). As such, the Board has recharacterized the Veteran's claim as service connection for unspecified depressive disorder with alcohol use disorder. The Board acknowledges that it has thoroughly reviewed the evidence of record in conjunction with this case. However, the Board has limited its discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Thus, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim on appeal. Entitlement to service connection for unspecified depressive disorder (claimed as acquired psychiatric condition) is granted. The Veteran contends that his acquired psychiatric condition is the result of his military service. October 2023 VA Form 21-526EZ. Service connection may be granted for a disability resulting from injury or disease that was incurred in, or aggravated by, military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after a veteran's discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To substantiate a claim of service connection, there must be evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). There are particular requirements for establishing PTSD in 38 C.F.R. § 3.304 (f), in addition to those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Establishing service connection for PTSD requires: (1) medical evidence diagnosing PTSD in conformance with established criteria; (2) a link, established by medical evidence, between a veteran's present symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. See 38 C.F.R. §§ 3.304 (f), 4.125. The Veteran was afforded a VA PTSD examination in October 2023. The VA examiner found that the Veteran did not meet the DSM 5 diagnostic criteria for PTSD, and instead met the DSM 5 diagnostic criteria for unspecified depressive disorder and alcohol use disorder- mild- in sustained remission. The VA examiner noted that it was possible to differentiate the symptoms attributable to which diagnosis, stating that because the Veteran's alcohol use disorder is in sustained remission, his current symptoms/impairment are solely related to this unspecified depressive disorder diagnosis. The VA examiner found that it was at least as likely as not that the Veteran's unspecified depressive disorder and alcohol use disorder was incurred in or caused by his military service, specifically his military service in Vietnam. The Veteran reported that he was not happy during his military service, though he did not realize it at the time. The Veteran served in Vietnam and did not engage in direct combat or firefights. The Veteran reported that one evening, they were "overrun" when the enemy came onto the base camp and fellow soldiers were injured or killed. He stated that he still thinks about the soldiers that were killed and that it "still doesn't seem like it could happen." The Veteran reported that sometimes if he sees a truck, it will remind him of the truck he drove in Vietnam. The Veteran stated that he noted a change in his mood and isolation after returning from Vietnam. The Veteran reported that he was first diagnosed with depression in the late 1970s after his primary doctor asked him about the last time he "had a good time" and the Veteran was unable to answer. When depressed, the Veteran did not have the motivation to socialize, was fatigued, and had difficulty concentrating. The Veteran stated he feels anxious about two to three times per month, with restlessness and fatigue. He does not like people standing behind him. The Veteran also stated he does not like going out but will sometimes force himself to do so. The Veteran reported that he gets an average of five hours of sleep per night, that he has difficulty staying asleep and often wakes up for unknown reasons. He also has dreams about being redeployed. The Veteran reported that he began drinking alcohol in 1970 after his separation from service and was drinking every day, resulting in being arrested 3 times for DUI and having his driver's license revoked. The Veteran stated he went to treatment and has been sober for 10 years. Based upon the foregoing, the Board finds that the evidence of record persuasively weighs in favor of finding that the Veteran has a current diagnosis of unspecified depressive disorder with alcohol use disorder which was incurred in and the result of the Veteran's military service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Therefore, the Board finds that service connection for unspecified depressive disorder with alcohol use disorder is warranted. 38 C.F.R. §§ 3.102, 3.303. REASONS FOR REMAND 1. Entitlement to service connection for chronic kidney disease is remanded. The Veteran contends that his chronic kidney disease is the result of Agent Orange exposure during his military service or his service-connected hypertension. December 2023 VA Form 21-526EZ. Service connection may also be established on a secondary basis for a disability that is due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection for a disability can be granted on a secondary basis if a Veteran has a (1) current disability; (2) a separate disability already subject to service connection; and (3) the first disability is due to or the result of or is aggravated by the service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310. Secondary service connection is warranted for any incremental increase in disability, meaning any additional impairment of earning capacity above the degree of disability existing before the increase, in a nonservice-connected disability resulting from a service-connected disability, regardless of its permanence. See Ward v. Wilkie, 31 Vet. App. 233 (2019). VA's duty to assist includes conducting a thorough and comprehensive medical examination. 38 U.S.C. § 5103A(d)(2). The Board is required to ensure that medical opinions are made on the basis of sufficient facts or data and the application of reliable medical principles. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). A medical opinion is adequate if it is based upon consideration of the Veteran's prior medical history and describes the Veteran's condition in sufficient detail so as to allow the Board to make a fully informed evaluation. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see also Ardison v. Brown, 6 Vet. App. 405, 407 (1994). This requires the opinion to "contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). In the March 2024 rating decision on appeal, the RO conceded that the Veteran has a current diagnosis of chronic kidney disease stage 3, that the primary claimed condition of hypertension is service-connected, that he served in Vietnam and was exposed to herbicide agents during that service, and that he participated in toxic exposure risk activity (TERA) during his military service due to his herbicide exposure and service in Vietnam. See 38 C.F.R. § 3.104(c). The Veteran was afforded a VA kidney conditions examination in March 2024. In rendering a negative nexus opinion as to whether the Veteran's chronic kidney disease is due to or the result of his service-connected hypertension, the VA examiner opined that a review of the Veteran's medical record does not support the contention that the Veteran's chronic kidney disease is due to or the result of his hypertension. The VA examiner then cites medical literature discussing the symptoms and causes of chronic kidney disease, which included that one of the most common primary diseases causing chronic kidney disease is hypertension. The Board finds this opinion to be inadequate for adjudication purposes. The VA examiner rendered a vague, conclusory opinion that does not address the Veteran's particular condition or circumstances and is unsupported by sufficient rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that "a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to the doctor's opinion"); see also McCray v. Wilkie, 31 Vet. App. 243 (2019) (holding that if the findings in an examination report are not supported or if the report does not contain sufficient detail, the report is inadequate for evaluation purposes). Additionally, the VA examiner cited to medical literature which specifically states that hypertension is one of the most common causes of chronic kidney disease yet fails to address why the Veteran's chronic kidney disease is not caused by his service-connected hypertension. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (holding that a medical opinion was inadequate because the examiner did not provide any rationale for his opinion that was specific to the Veteran's particular medical condition and circumstances). Further, the VA examiner failed to proffer an opinion as to whether it is at least as likely as not that the Veteran's chronic kidney disease was aggravated by his service-connected hypertension. See El-Amin v. Shinseki, 26 Vet. App. 136 (2012) (a medical opinion addressing secondary service connection must discuss both causation and aggravation). Therefore, remand is necessary to obtain supplemental VA medical opinions in order to properly adjudicate the Veteran's claim. 2. Entitlement to TDIU is remanded. In December 2023, the Veteran filed a VA Form 21-8940 Application for Increased Compensation Based on Unemployability, stating that he is unable to secure or maintain substantially gainful employment as a result of his service-connected disabilities. This claim was denied in the May 2024 rating decision on appeal. As the Board herein has granted service connection for the Veteran's unspecified depressive disorder with alcohol use disorder and is remanding the Veteran's claim for service connection for chronic kidney disease, the Veteran's entitlement to TDIU is deemed as inextricably intertwined with said claims and is remanded pending the development requested below. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both issues have been considered); Tyrus v. Shinseki, 23 Vet. App. 166, 178 (2009). See also 38 C.F.R. § 20.802(a) (permitting remand for AOJ to satisfy regulatory duty that would have a reasonable possibility of aiding in substantiating the claim). The matters are REMANDED for the following action: 1. Forward the Veteran's claims file to an appropriate medical professional for an addendum opinion to address the nature and etiology of the Veteran's chronic kidney condition. The need for another clinical evaluation is left to the discretion of the medical professional offering the addendum opinion. The entire claims file must be made available to, and be reviewed by, the VA examiner. The medical professional should provide an opinion to the following: (a) Whether the Veteran's chronic kidney condition was incurred in or is otherwise related to the Veteran's active-duty service? (b) Whether the Veteran's chronic kidney condition is caused by any of the Veteran's service-connected conditions? (c) Whether the Veteran's chronic kidney condition is aggravated by any of the Veteran's service-connected conditions? The clinician is reminded that for the examination to be adequate, the medical opinion must provide explanations for both the aggravation and causation prongs of a secondary service connection claim. Atencio v. O'Rourke, 30 Vet. App. 74 (2018). The examiner is asked to explain the reasons behind any opinions expressed and conclusions rendered. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion cannot be provided without resort to speculation, together with a statement as to whether there is additional evidence that might enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). DUSTIN L. WARE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Feely, Lauren E. 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.