Citation Nr: 18160634
Decision Date: 12/27/18	Archive Date: 12/27/18

DOCKET NO. 11-15 073
DATE:	December 27, 2018
REMANDED
Entitlement to service connection for an acquired psychiatric disorder, to include as due to right humerus fracture residuals, is remanded.
REASONS FOR REMAND
The Veteran served honorably in the U.S. Army on active duty from July 1966 to September 1968.  He also served in the Army National Guard with verified periods of active duty for training (ACDUTRA), including from August 4, 1984 to August 18, 1984.  The Board thanks the Veteran for his service to our country.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from the December 2009 Rating Decision of the St. Petersburg, Florida, Department of Veterans Affairs (VA) Regional Office (RO).  The Board previously remanded this case in August 2014, February 2017, and November 2017 for additional development.  The case has now returned to the Board for further appellate review.
The Veteran seeks service connection for an acquired psychiatric disorder, to include as secondary to service-connected right humerus fracture residuals.  Additionally, the Veteran’s representative contends that service connection is warranted based on continuity of symptomatology under 38 U.S.C. § 3.303(b).
The Board finds that a remand is warranted as an opinion regarding the etiology of the Veteran’s acquired psychiatric disorder is needed.  In a July 2009 examination report the examiner did not identify any mental disorder symptoms and indicated no Axis I diagnosis or condition.  The record shows that the Veteran was diagnosed with adjustment disorder in July 2011; a September 2011 mental health treatment plan note confirms this diagnosis as adjustment disorder with anxious mood.  However, in April 2015 and April 2017 the examiner concluded that the Veteran did not contemporaneously meet the diagnostic criteria for a mental health disorder and therefore did not furnish opinions as to the etiology of the Veteran’s acquired psychiatric disorder.  The Board finds that a new opinion is necessary to determine the nature and etiology of any acquired psychiatric disability present during the appeal period.  See McClain v. Nicholson, 21 Vet. App. 319 (2007).
The matter is REMANDED for the following action:
1. Please obtain any outstanding VA and non-VA treatment records relevant to the claim.
2. The AOJ should refer the case to a VA clinician for an addendum medical opinion.  The claims file must be made available to and reviewed by the clinician.  The clinician is requested to accept as fact for the purposes of the opinion that the Veteran was diagnosed with adjustment disorder on July 20, 2011, the disorder was confirmed as adjustment disorder with anxious mood on September 22, 2011, and the disorder meets the definition of a current disability for VA purposes.  The clinician should identify any other psychiatric disorders that were present at any time following the Veteran’s June 2009 claim but have since resolved, as such meets the definition of a current disability for VA purposes.  Based on review of the record, the clinician should provide an opinion that responds to the following: 
(a.) As to adjustment disorder (diagnosed in 2011) and any other psychiatric disorder(s) diagnosed during the appeal, is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s acquired psychiatric disorder is related to service?
(b.) Is it at least as likely as not (a 50 percent or greater probability) that adjustment disorder (diagnosed in 2011) and any other psychiatric disorder(s) diagnosed during the appeal was caused by his service-connected right humerus fracture residuals?
(c.) Is it at least as likely as not (a 50 percent or greater probability) that adjustment disorder (diagnosed in 2011) and any other psychiatric disorder(s) diagnosed during the appeal was aggravated by (where aggravation is any increase in severity) the service-connected right humerus fracture residuals?
In addressing these questions, the clinician is requested to please assume the following:
•	In August 1984, while on ACDUTRA, the Veteran sought treatment complaining of pain in his right arm.
•	The next day, the Veteran sought treatment complaining of nerves.  The treatment provider opined that he was mentally sound and was not under the influence of alcohol or drugs.  The Veteran was diagnosed with acute stress disorder with typical paranoid reaction due to worry, tensions, low-grade depression, and three days of insomnia.
•	The following day, the treatment provider assessed that the Veteran had reactive depression with psychotic features. 
The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate.  The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms.  If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made.
ONLY IF the clinician determines that an examination is necessary for an etiological opinion, the AOJ should arrange for the Veteran to be scheduled for an appropriate VA examination to determine the nature and 
 
likely etiology of the psychiatric disorder, and the examiner should provide an opinion that responds to the questions listed above.
 
M. C. GRAHAM
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Vashaw, Associate Counsel

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