HEARING LOSS

JAMES G. REINHART · 2020 · Case ID: 20070582

MIXED

Summary

The veteran, who served from May 1988 to August 1991, appeals the denial of service connection for bilateral hearing loss, tinnitus, and PTSD. The Board found that while the veteran has current diagnoses of bilateral sensorineural hearing loss and tinnitus, the service treatment records did not show onset during service, nor did they manifest within a year of separation. The Board also conceded in-service noise exposure based on the veteran's MOS and statements, but the VA examinations did not establish a nexus to service, with the March 2020 examination concluding the hearing loss and tinnitus were less likely than not caused by service, clearly and convincingly rebutting subjective reports. For PTSD, the Board found that the veteran's claimed stressors were not adequate to support a diagnosis, and the VA treatment records indicated symptoms were more related to personal loss than military service. The December 2011 VA examination was deemed inadequate by the Court due to using an outdated DSM-IV, leading to a remand for a new examination. The March 2020 VA examination found the veteran had a PTSD diagnosis but opined the condition was less likely than not service-related, citing lack of direct involvement in the traumatic incident and general nature of nightmares. The Board denied service connection for hearing loss, tinnitus, and PTSD based on the preponderance of the evidence and lack of nexus. The claim for an acquired psychiatric disorder, other than PTSD (including unspecified mood disorder and depression), was remanded for a new VA opinion addressing the nature and etiology of these conditions.

Rationale

No in-service onset or manifestation; No nexus to service established; VA examinations found less likely than not caused by service

Special Benefit

NO SPECIAL BENEFIT

Docket No.

15-00 877

Full Decision Text

Citation Nr: 20070582
Decision Date: 10/30/20 Archive Date: 10/30/20

DOCKET NO. 15-00 877
DATE: October 30, 2020

ORDER

Service connection for bilateral hearing loss is denied.

Service connection for tinnitus is denied.

Service connection for PTSD is denied.

REMANDED

Service connection for an acquired psychiatric disorder, other than PTSD, to include unspecified mood (affective) disorder and depression, is remanded.

FINDINGS OF FACT

1. The Veteran’s current bilateral sensorineural hearing loss did not have onset during his active service, was not caused by active service, and did not manifest within one year of separation from active service.

2. The Veteran’s current tinnitus did not have onset during his active service, was not caused by active service, and did not manifest within one year of separation from active service.

3. The Veteran’s current PTSD did not manifest during active service and is not etiologically related to active service.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a) (2018).

2. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1101, 1110, 1112 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a) (2018).

3. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1988 to August 1991.

This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In June 2018, the Veteran testified at a Board hearing before the undersigned. A transcript of the hearing is of record.

In a September 2018 decision, the Board denied entitlement to service connection for an acquired psychiatric disorder and tinnitus. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In May 2019 the Court granted a Joint Motion for Partial Remand (JMR) of the Veteran and the Secretary of Veterans Affairs (the Parties) to partially vacate and remand the September 2018 decision. Specifically, claims for service connection for an acquired psychiatric disorder and tinnitus were vacated and remanded. The JMR instructed the Board to remand the psychiatric disorder claim for a new VA examination. Additionally, the Court ordered a remand of the issue of entitlement to service connection for hearing loss for issuance of a Statement of the Case (SOC) on the matter.

In January 2020 the Board issued a remand in accordance with the JMR. The Veteran was afforded a new VA PTSD examination in March 2020. A SOC adjudicating hearing loss was issued in August 2020. The same month, the Veteran filed a VA Form 9 perfecting his appeal of the denial for service connection for bilateral hearing loss. The claims have since been returned to the Board.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

1. Entitlement to service connection for bilateral hearing loss

2. Entitlement to service connection for tinnitus

The Veteran claims to have bilateral hearing loss and tinnitus due to service.

A hearing loss disability is defined for VA compensation purposes with regard to audiological testing involving puretone frequency thresholds and speech discrimination criteria. 38 C.F.R. § 3.385 (2018). For purposes of applying the
2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

1. Entitlement to service connection for bilateral hearing loss

2. Entitlement to service connection for tinnitus

The Veteran claims to have bilateral hearing loss and tinnitus due to service.

A hearing loss disability is defined for VA compensation purposes with regard to audiological testing involving puretone frequency thresholds and speech discrimination criteria. 38 C.F.R. § 3.385 (2018). For purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. Id.

The question for the Board is whether the Veteran has a chronic disability that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service.

On March 2020 VA examination, a diagnosis of bilateral sensorineural hearing loss was provided. Auditory thresholds for at least three applicable frequencies were 26 dB or greater. The Veteran is competent to provide lay evidence of tinnitus as this condition is observable by his own senses. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). Thus, these diagnoses satisfy the first element of a service connection claim.

The Board concludes that, while the Veteran has bilateral sensorineural hearing loss and tinnitus, which are chronic diseases (organic diseases of the nervous system), they were not chronic in service or manifested to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Notably, the record does not include evidence of hearing loss or tinnitus during active service or within one year of the separation from active duty service. As such, service connection on a presumptive basis is not warranted. See 38 C.F.R. § 3.307 (a)(3).

Service connection may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s bilateral hearing loss and tinnitus and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d).

The Veteran’s DD Form 214 lists a military occupational specialty (MOS) of armor crewman. Service treatment records include an August 1989 reference audiogram indicating that the Veteran was routinely exposed to hazardous noise. In an April 2011 statement in support of claim, the Veteran reported that his MOS was a M1AL tanker and that he was exposed to noise and had problems with hearing and ringing in his ears since service. In a June 2011 statement, the Veteran reported that his hearing loss was due to loud noise from the firing of the main gun. The Veteran is competent to report his in-service noise exposure and his reports are consistent with the circumstance of his service. 38 U.S.C. § 1154 (a) (2012). Therefore, in-service noise exposure is conceded. The remaining question is whether his bilateral hearing loss and tinnitus disabilities are related to noise exposure during service.

In a December 2011 VA Disability Benefits Questionnaire (DBQ) for hearing loss and tinnitus, the examiner stated that the 1991 audiological examination revealed normal hearing bilaterally. The examiner indicated that the Veteran has a diagnosis of clinical hearing loss, and his tinnitus is at least as likely as not a symptom associated with the hearing loss, as tinnitus is known to be a symptom associated with hearing loss. However, he explained that the Veteran’s hearing loss is less likely as not caused by or a result of military service and that tinnitus is as likely as not a symptom of the current hearing loss. He stated that “having determined that it is less likely as not that the current hearing loss was caused by or the result of
1 VA Disability Benefits Questionnaire (DBQ) for hearing loss and tinnitus, the examiner stated that the 1991 audiological examination revealed normal hearing bilaterally. The examiner indicated that the Veteran has a diagnosis of clinical hearing loss, and his tinnitus is at least as likely as not a symptom associated with the hearing loss, as tinnitus is known to be a symptom associated with hearing loss. However, he explained that the Veteran’s hearing loss is less likely as not caused by or a result of military service and that tinnitus is as likely as not a symptom of the current hearing loss. He stated that “having determined that it is less likely as not that the current hearing loss was caused by or the result of military service, it follows that the tinnitus is not caused by noise exposure in service.” The examiner stated that “this does not rule out tinnitus as symptom of other conditions associated with military service” and that “of there are other conditions with known associated to tinnitus, these would need to be considered, especially if they have nexus to military service.” The examiner stated that “the Veteran’s testimony about the time course of tinnitus (longstanding) is deemed important, however, the Veteran is not competent to give the etiology.” He stated that there is no compelling scientific evidence to support the onset of tinnitus in the absence of hearing loss and that “there are such cases, but studies have speculated on the possible causes but none have offered a firm etiology.” He stated that he “would be speculating that tinnitus could be caused by tanks and not cause measurable hearing loss or threshold changes.”

During the June 2018 Board hearing, the Veteran testified that he was a tanker and was exposed to a lot of loud noises during service. He stated that they fired a main gun and that over a period of time it took effect. He stated that they also had their own individual weapons training, so he had a lot of loud noise exposure, and over that period of time it caught up with him. He reported experiencing ringing today, especially on his left side.

The Veteran was afforded another VA hearing loss and tinnitus examination in March 2020. the Veteran reported that he could not recall when tinnitus started, but that it was constant. The examiner opined that the Veteran’s bilateral hearing loss and tinnitus are not at least as likely as not (50 percent probability or greater) caused by or a result of military service. The examiner acknowledged review of the claims file, reports of hazardous noise exposure, and conceded that the Veteran was exposed to loud noise during service. However, hearing tests conducted in August 1989 and at separation in July 1991 do not show significant threshold shifts beyond normal measurements during service. As such, the examiner concluded that the Veteran did not have a hearing injury during service and the evidence “clearly and convincingly rebuts” subjective reports of hearing loss and tinnitus during service. The examiner referenced medical literature in explaining that delayed onset of hearing loss due to noise exposure is unlikely to occur. In the absence of an objectively verifiable hearing injury while in service, the association between hearing loss and tinnitus and noise exposure cannot be assumed to exist.

The VA examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran has not provided any competent medical evidence to rebut the opinion against the claim or otherwise diminish its probative weight. While the Veteran believes that his bilateral hearing loss and tinnitus are related to active service, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, including the March 2020 VA examiner’s opinions.

The Board concludes that the weight of evidence is against claims for service connection for bilateral hearing loss and tinnitus and the claims are denied. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (2018).

3. Entitlement to service connection for PTSD

The Veteran contends that he has PTSD related to service.

3. Entitlement to service connection for PTSD

The Veteran contends that he has PTSD related to service.

In addition to the general service connection requirements stated above, to be entitled to service connection for PTSD, as opposed to another mental health disorder, the record must include: (1) medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128, 138 (1997).

If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(2).

If a stressor claimed by a veteran is related to the veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of posttraumatic stress disorder and that the veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, “fear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or psycho- physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3).

However, the United States Court of Appeals for the Federal Circuit, affirmed that when a reported stressor is not related to either combat or the fear of hostile military or terrorist activity, then a Veteran’s statements and testimony alone are not considered to be sufficient to establish the occurrence of a claimed in-service stressor. Hall v. Shinseki, 717 F.3d 1369 (2013).

In this case, the evidence does not show that the Veteran engaged in combat, or that he was exposed to hostile military or terrorist activity; therefore, the presumptions afforded to veterans who allege fear of hostile military or terrorist activity are inapplicable in this case. Thus, any alleged in-service stressors must be independently verified, i.e., corroborated by objective, credible supporting evidence.

STRs do not indicate any complaints, treatment, symptoms or diagnosis of PTSD or any other psychiatric disorder.

VA treatment records received in June 2011, include a November 24, 2010 record, indicating that the Veteran complained of depression, PTSD, anxiety, and sleep and memory problems.

Private medical records received in November 2010 include a psychosocial assessment dated October 4, 2006, indicating that the Veteran never had any past inpatient or outpatient psychiatric/psychological treatment. The record indicates an Axis I diagnosis of major depressive disorder, recurrent, cocaine dependence, rule out bipolar disorder.

In a November 2010 statement in support of claim for PTSD, the Veteran indicated that a friend of his in service was “killed down range during training (gun range) in Korea.” The Veteran stated that during company movement he was driving his tank at night and it flipped over in a creek and he almost drowned and “had to escape through driver’s hatch.”

In an April 2011 statement in support of claim, the Veteran stated that he had a fear of hostile military due to being the driver of a tank while in service. He stated that he was in the first Gulf War and they were constantly training and on alert, maneuvering during night and daytime, and training on the gun range. He stated that while in Korea, after his friend died in a training exercise, they were all in fear of performing training. He stated that he was stationed at Camp Casey, and that it was very close to the DMZ so they were always in fear of attack.

In a December 2011 DBQ PTSD Examination, the report indicates that the Veteran does not have a diagnosis of PTSD. The report indicates an Axis I diagnosis of mood disorder due to polysubstance abuse, an Axis II diagnosis of polysubstance abuse, and Axis I diagnosis of adult antisocial behavior. The examiner stated that the Veteran meets the criteria for adult antisocial behavior. The examiner stated that the Veteran has a continuing history of polysubstance abuse which would be more likely than not to cause mood disorder symptoms. The examiner opined that the Veteran’s claimed condition, PTSD, was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that the Veteran is not a reliable historian as noted above by the many inconsistencies in his record and statements made today and to others previously. The examiner’s rationale was that the Veteran’s claimed stressors are consistent with the places, types, and circumstances of the Veteran’s service and that the PTSD symptoms he endorses could be related to the Veteran’s fear of hostile military or terrorist activity while in Korea but that the claimed stressors are not adequate to support a diagnosis of PTSD.

The Board acknowledges that in an August 2012 statement, the Veteran stated that the December 2011 VA examiner for PTSD stated that the second stressor met the PTSD criteria and was related to the fear of hostile military. The Veteran stated that the examiner then stated that it was less likely than not incurred or caused by service and that the claimed stressors were not adequate to support a diagnosis of PTSD. The Veteran contends that this is a contradiction that should have been clarified with the examiner. The Board finds, however, that the VA examiner indicated that, despite the reported stressor, the Veteran does not meet the full criteria for a diagnosis of PTSD. He explained that while the reported stressors are consistent with the Veteran’s service and could be related to the Veteran’s fear of hostile military or terrorist activity, they were not adequate to support the diagnosis of PTSD. Thus, no clarification from the VA examiner is needed.

VA treatment records received in September 2013 indicate a diagnostic impression of Axis I PTSD, depression NOS, and alcohol dependence vs abuse. In a July 10, 2013 addendum, the examiner stated that “it is most appropriate that this [V]eteran return to his MH team to address PTSD symptoms, as symptoms are not military related and more the result of the death and loss of his daughter as well as other family members.”

In the June 2018 Board hearing, the Veteran testified regarding his PTSD claim. He stated that he had one incident where he was taking a 19 kilo tanker and they were on an exercise mission and he was the tank driver. He reported an accident in a local creek bed, stating that the tank tipped over enough that the water was high enough that if he had not escaped through the driver’s hatch, there was a good chance he could have drowned. He stated that during one of the gunner exercises, a couple of his friends were killed downrange. He stated that he can no longer remember their names and that he did not see them get killed, but he knows it happened during training. He was stationed at Camp Casey, and that the incident occurred in 1990.

As stated above, in a September 2018 decision, the Board denied the claim for service connection for PTSD. The Veteran appealed the claim to the Court. In May 2019 the Court granted a JMR that vacated and remanded the denial.

The basis for the Court’s remand, as set out in the May 2019 JMR, was that the December 2011VA examination relied upon by the Board in its decision was inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2017). Significantly, the examiner relied on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Because the Veteran’s certification of appeal was dated in May 2015, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) applies. As such, the Board did not ensure that the duty to assist was satisfied.

Accordingly, it was determined that it was an error for the Board to rely on the December 2011 examination report in reaching its decision. The Court vacated the Board decision and remanded the matter for a new medical examination and readjudication. In a January 20120 the Board remanded the claim for a new VA examination and opinion.

The Veteran was afforded a VA PTSD examination in May 2020. The examiner marked “yes” that the Veteran had a PTSD diagnosis that conforms to the DSM-V criteria. For stressor, the Veteran stated that he “witnessed the death of a friend in a friendly fire incident while stationed in Korea.” The examiner opined that the Veteran’s current PTSD is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner stated that the Veteran was not directly involved in the traumatic incident. Although he suffered numerous injuries from his MOS during service, his overall military experience was generally positive. The examiner explained that the Veteran’s nightmares are more of a general nature and seldom related to military themes.

The competent medical evidence of record does not establish that the Veteran’s PTSD is etiologically related to service by medical opinion or by reference in any treatment records, by any practitioner during the appeal period. Instead, the competent evidence of records shows the Veteran’s PTSD is unrelated to military service. See Gilbert v. Shinseki, 26 Vet. App. 48, 54 (2012).

When addressing a claim on the merits, the Board has an obligation to evaluate the credibility of evidence and to assign probative weight to competent evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (recognizing the Board’s “authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence”).

As to some of the factors that go into making credibility determinations both the Court of Appeals for Veterans Claims (Veterans Court) and the Court of Appeals for the Federal Circuit (Federal Circuit) have provided guidance. See Buchanan v. Nicholson, 451 F3.d 1331, 1336-37 (Fed. Cir. 2006) (stating that “the Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc”.); see also Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (stating that “[t]he credibility of a witness can be impeached by a showing of interest, bias, inconsistent statements, or, to a certain extent, bad character.”).

In this case, there is a lack of evidence supporting the adequacy of the Veteran’s claimed stressors. The December 2011 VA examiner indicated that the Veteran reported stressors in service but found that the stressors were not adequate to support a diagnosis of PTSD. The VA treatment records indicated a diagnostic impression of Axis I PTSD, depression, and alcohol dependence vs abuse, but noted that the Veteran’s symptoms are not military related and are more the result of the death and loss of his daughter as well as other family members. At the most recent March 2020 VA examination, the Veteran reported that his PTSD was related to witnessing the death of a friend while stationed in Korea.

The STRs show that he had no onset of symptoms during service and there is no indication of psychosis manifesting within one year of separation from service.

The Board acknowledges the Veteran’s statements. While the Veteran is competent to report a change in his behavior during and after service
were not adequate to support a diagnosis of PTSD. The VA treatment records indicated a diagnostic impression of Axis I PTSD, depression, and alcohol dependence vs abuse, but noted that the Veteran’s symptoms are not military related and are more the result of the death and loss of his daughter as well as other family members. At the most recent March 2020 VA examination, the Veteran reported that his PTSD was related to witnessing the death of a friend while stationed in Korea.

The STRs show that he had no onset of symptoms during service and there is no indication of psychosis manifesting within one year of separation from service.

The Board acknowledges the Veteran’s statements. While the Veteran is competent to report a change in his behavior during and after service, he is not competent to determine whether these behavioral changes are related to his current PTSD. Whether the Veteran’s currently diagnosed PTSD is related to his service is a complex medical question and is not within the realm of knowledge of a lay person. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). There is no indication that the Veteran has medical expertise. Consequently, the Board gives more probative weight to the competent medical evidence of record.

Accordingly, the preponderance of the evidence is against granting service connection for PTSD. There is no reasonable doubt to be resolved and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for an acquired psychiatric disorder, other than PTSD, to include unspecified mood (affective) disorder and depression, is remanded.

In the February 2011 rating decision, the RO characterized the issue on appeal as entitlement to service connection for PTSD. A claim for service connection for a psychiatric disability is deemed to encompass all psychiatric diagnoses reasonably presented in the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Pursuant to this decision, the claim for service connection for PTSD is denied. However, the claims file contains diagnoses other than PTSD. Pursuant to Clemons, the claim for entitlement to service connection for an acquired psychiatric disorder, other than PTSD, is also before the Board.

VA treatment records list a diagnosis of depression since March 2019. On February 2020 examination, diagnoses of PTSD and unspecified mood (affective) disorder were provided. As discussed above, the examiner provided a negative medical nexus opinion on the relationship between the Veteran’s current PTSD and service. No further medical opinion was provided.

As the examiner did not provide a medical opinion on all current psychiatric disorders, to include unspecified mood (affective) disorder and depression, the claim is remanded for a new medical opinion.

The matters are REMANDED for the following action:

1. Obtain a VA opinion on the nature and etiology of the Veteran’s acquired psychiatric disorders other than PTSD. If a physical examination is deemed necessary, one should be scheduled.

The claims file and this remand must be reviewed by the examiner; consideration of such should be reflected in the completed examination report.

For any acquired psychiatric disorder diagnosed, including unspecified mood (affective) disorder and depression, the examiner must opine whether each diagnosed disorder (other than PTSD) is at least as likely as not (50 percent probability or more) related to an in-service injury, event, or disease.

In answering the above, the examiner should consider and comment upon the February 2020 VA PTSD examination.

The examiner must provide a rationale for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what if any additional evidence would be necessary before an opinion could be rendered.

2. Readjudicate the claim remaining on appeal. If any benefit sought is not granted in full, furnish to the Veteran and his representative a supplemental statement of the case (SSOC) and afford an appropriate period of time for response. Thereafter, the case should be returned to the Board, if in order.

JAMES G. REINHART

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board Amanda Baker, 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.

if in order.

JAMES G. REINHART

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board Amanda Baker, Counsel

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