Citation Nr: 25005679 Decision Date: 04/25/25 Archive Date: 04/25/25 DOCKET NO. 18-14 402 DATE: April 25, 2025 REMANDED Service connection for any acquired psychiatric condition, to include posttraumatic stress disorder (PTSD), is remanded. Service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1967 to October 1968 with additional service in Reserve. These matters come to the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2022, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A transcript of the proceeding has been associated with the claims file. Following the hearing, the Board remanded these claims in June 2022 for additional development. The Board again remanded these claims in June 2024 and February 2025 to ensure substantial compliance with the Board's previous remand directives regarding service connection for an acquired psychiatric condition. Unfortunately, remand is again necessary for the reasons that follow. See Stegall v. West, 11Vet. App. 268, 271 (1998). 1. Service connection for any acquired psychiatric condition, to include PTSD, is remanded. The Veteran contends he has an acquired psychiatric condition, to include PTSD, that is related to service. The record throughout the course of this claim since 2016, contains multiple VA examinations and many treatment records all referencing various diagnoses including, but not limited to, PTSD, cannabis use disorder, alcohol use disorder, cannabis induced psychotic disorder, delusional disorder, unspecified depressive disorder and unspecified trauma and stressor-related disorder. The remaining issue is whether the Veteran has any acquired psychiatric disability that is related to service or had one during the course of this claim since 2016. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board previously remanded this claim, including most recently in February 2025, for a VA examiner to reconcile whether the Veteran had any acquired psychiatric condition. In response, the Veteran was afforded another VA examination in February 2025. While the February 2025 VA examiner found that he did not have a current diagnosis of PTSD, but rather only met the diagnostic criteria for cannabis use disorder and cannabis induced psychotic disorder, the examiner did not resolve the question of whether the Veteran had any other psychiatric conditions throughout the course of this claim since 2016. To this point, the examiner rendered a negative nexus opinion based, in-part, on the rationale that there was no clinical evidence of depression or bipolar disorder, and delusional disorder was an identified diagnosis because cannabis use was not disclosed at that time. This opinion, however, is inconsistent with the medical evidence of record; therefore, another VA opinion is needed to resolve this claim. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). That is, treatment records in 2017 reference diagnoses of unspecified depressive disorder and unspecified trauma and stressor-related disorder with notations to "rule out" bipolar disorder, cannabis use order, and alcohol use disorder suggesting that the provider at that time was aware of the Veteran's cannabis use. During this 2017 appointment, the Veteran also conveyed the contended stressors identified during the course of this claim. Thus, further clarification is needed as to whether the Veteran had any acquired psychiatric conditions, even if resolved, during the course of this claim since 2016, that are related to service. The examiner must address the 2017 records reflecting unspecified depressive disorder and unspecified trauma and stressor-related disorder. Accordingly, this claim is remanded for additional development. 2. Service connection for OSA is remanded. As previously mentioned by the Board, the Veteran contends he has OSA that is related to service, or in the alternative, is secondary to a psychiatric condition. Accordingly, service connection for OSA must also be remanded as inextricably intertwined with the pending service connection claim for a psychiatric condition being remanded herein for additional development. See Harris v. Derwinski, 1Vet. App.180 (1991). The matters are REMANDED for the following action: 1. Return the entire claims file and this remand to the February 2025 VA examiner, if available, or to another appropriate examiner for review. The examiner is directed to render an addendum opinion, including rationale, addressing the following: (a.) Clarify whether the Veteran had at any time during the pendency of this claim since 2016 any acquired psychiatric condition(s), to include PTSD, even if resolved. NOTE: The examiner is specifically directed to address and consider the 2017 references to unspecified depressive disorder and unspecified trauma and stressor-related disorder. (b.) If so, whether each disability found is "at least as likely as not" (likelihood is at least approximately balanced or nearly equal, if not higher) related to service, to include the contended stressors identified. NOTE: The examiner is specifically directed to address and consider the 2017 treatment record discussing the contended stressors in association with unspecified depressive disorder and unspecified trauma and stressor-related disorder. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports should be acknowledged and considered in formulating any opinion. If medical literature is relied upon, the examiner should identify and specifically cite each reference material used. The examiner should specifically discuss any contradictory evidence in the claims file and reconcile that evidence with their findings. All opinions should be accompanied by supporting rationale explaining how the examiner arrived at the conclusions expressed. (Continued on the next page) ? If the examiner determines that s/he cannot provide an opinion without resorting to speculation, s/he should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, s/he should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. 2. After the above development, and any other development deemed necessary, readjudicate the claims, including those inextricably intertwined. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.C. Allen, 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.