Citation Nr: 18132300
Decision Date: 09/06/18	Archive Date: 09/06/18

DOCKET NO. 16-08 023
DATE:	September 6, 2018
Entitlement to service connection for an acquired psychiatric disorder, to include depression and a binge eating disorder, is remanded.  
The Veteran served on active duty from September 1980 to September 1985.  
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from August 2011 and November 2013 rating decisions.
In the August 2011 rating decision, the RO denied service connection for a binge eating disorder.  In the November 2013 rating decision, the RO denied service connection for depression.  Thereafter, in an April 2016 supplemental statement of the case, the RO recharacterized the Veteran’s claim more broadly as entitlement to service connection for an acquired psychiatric disorder, to include depression and a binge eating disorder.  See Clemons v. Shinseki, 23 Vet. App. 1, 5-6, 8 (2009).
On review, the Board finds that additional development is necessary prior to final adjudication of the Veteran’s claims.
In a September 2014 private medical evaluation, Dr. H.H. (initials used to protect privacy) opined that the Veteran’s service-connected left elbow degenerative joint disease and fracture of the left fifth metatarsal fracture with heel spur caused and aggravated his depressive disorder.  In so finding, she stated that the Veteran suffered from permanent and debilitating left elbow degenerative joint disease and a fracture of the left metatarsal with heel spur.  However, Dr. H.H. did not reconcile her opinion with the VA medical evidence that addresses the severity of the Veteran’s service-connected disabilities.  For example, a March 2011 VA orthopedic examination noted that the Veteran denied having any overall functional impairment from his service-connected left elbow and foot disabilities.  In addition, a July 2014 VA medical record noted that the Veteran was cleared for work with no physical limitations.  As such, it appears that the opinion was based on an inaccurate or incomplete factual premise.
The Veteran was afforded a VA examination in February 2016.  However, the Board notes that the examiner did not provide an opinion as to whether the Veteran’s acquired psychiatric disorder was aggravated by his service-connected disabilities.  Moreover, she did not address the Veteran’s claimed eating disorder.  Therefore, a remand is necessary to obtain an additional VA medical opinion. 
The matter is REMANDED for the following action:
1.  The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for an acquired psychiatric disorder and an eating disorder.  A specific request should be made for authorization to obtain records dated in approximately 1994 from the private hospital as identified by the Veteran during a February 2016 VA examination.  After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file.
The AOJ should also obtain any outstanding VA medical records, to include any records from the Atlanta VA Medical Center (VAMC) dated from January 2016 to the present. 
2.  After completing the foregoing development, the AOJ should schedule the Veteran for a VA examination to determine the nature and etiology of any acquired psychiatric disorder and eating disorder that may be present.  Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed.  
The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions.  He or she should specifically consider the September 2014 private medical evaluation from Dr. H.H. and the February 2016 VA examination report.  
The examiner should identify all current psychiatric disorders and eating disorders, to include depression and a binge eating disorder.  If any previously diagnosed psychiatric disorders are not found on examination, the examiner should address whether they were misdiagnosed or have resolved.
For each diagnosis identified, the examiner should opine as to whether it is at least as likely as not that the disorder manifested in or is otherwise causally or etiologically related to the Veteran’s military service.
The examiner should also opine as to whether it is at least as likely as not that the disorder was either caused by or aggravated by the Veteran’s service-connected left elbow degenerative joint disease and/or status-post fracture of the left 5th metatarsal with heel spurs.
In rendering these opinions, the examiner should address the Veteran’s contention that he has a current eating disorder as a result of having to eat too quickly during service.  
(The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.)
A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board.
3.  The AOJ should review the examination report to ensure that it is in compliance with this remand.  If the report is deficient in any manner, the AOJ should implement corrective procedures. 
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Wulff, Associate Counsel

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