Citation Nr: 18152758 Decision Date: 11/26/18 Archive Date: 11/26/18 DOCKET NO. 14-42 728 DATE: November 26, 2018 REMANDED The issue of entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1966 to May 1970. He passed away in May 2013; the Appellant is his surviving spouse. This matter comes to the Board of Veterans’ Appeals (Board) from a December 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin that denied the benefit sought on appeal. In May 2018, the Board remanded the claims for further development of the evidence. Service connection for the cause of the Veteran’s death is remanded. Following the Board’s May 2018 remand, an August 2018 VA examiner issued a medical opinion as to whether it is at least as likely as not that the Veteran’s service-connected posttraumatic stress disorder (PTSD) was the principal cause of death. The examiner was further asked to discuss the Appellant’s contentions that the Veteran’s PTSD caused or aggravated his alcohol abuse, which contributed to the motor vehicle accident that resulted in his death. The Board requested the examiner to offer a “[c]omplete, clearly-stated rationale for all conclusions reached . . . .” In response, the examiner offered the following opinion: It is less likely than not that the Veterans condition of PTSD was the principal cause of his death and it is less likely than not that PTSD aggravation contributed to his death. As stated in the previous opinion provided by James Hastings, PhD, the veteran’s symptoms of PTSD were relatively mild and he reported stable PTSD symptoms shortly before his death. It is less likely than not that the veteran’s alcohol abuse was aggravated by his condition of PTSD. The August 2018 VA examiner did not adequately address whether the Veteran’s PTSD symptoms aggravated, as in worsened beyond normal progression, the Veteran’s alcohol abuse. Instead, the examiner merely noted the severity of the Veteran’s PTSD symptoms prior to his death and baldly concluded that PTSD did not aggravate the Veteran’s alcohol abuse. As the examiner’s medical opinion is incomplete and not supported with a rationale, the Board finds that an addendum opinion should be obtained on remand. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see Stegall v. West, 11 Vet. App. 268 (1998) (holding that the Board errs as a matter of law when it fails to ensure remand compliance). The matter is REMANDED for the following action: 1. If there is outstanding evidence, the Appellant should be invited to submit such evidence, including medical literature or nexus opinions. The Appellant should be provided an appropriate amount of time to submit this evidence. 2. Obtain an opinion from a qualified clinician addressing whether it is at least as likely as not (50 percent probability or more) that the Veteran’s PTSD aggravated, as in worsened beyond normal progression, the Veteran’s alcohol abuse. In addressing the relationship of the Veteran’s medical disorders, PTSD and alcohol abuse, please discuss whether the Veteran abused alcohol to alleviate his PTSD symptoms or cope with the psychiatric trauma that he experienced in the military. In answering each of these questions, the examiner should specifically consider and comment on the following: (a.) The Appellant’s June 2018 correspondence, referring to the Veteran’s alcohol and drug abuse as “self-medication.” (b.) The Appellant’s December 2014 substantive appeal, averring that the Veteran’s alcohol use and PTSD symptoms increased when he stopped using prescription pain medication. (c.) The Appellant’s March 2004 notice of disagreement, stating that the Veteran began “self-medicating in late 2006 until his death in May 2013 . . . my husband spiral[ed] out of control in his attempts to control his PTSD related depression and paranoia through self-medication.” (d.) November 2004 VA treatment record documenting a diagnosis of PTSD and alcohol abuse. (e.) November 2007 VA treatment record documenting the Veteran’s statement that “he did drink a lot of beer when I got out the service.” (f.) September 2012 VA treatment record documenting a diagnosis of PTSD and alcohol abuse. 3. If the examiner determines that there is a positive relationship between the alcohol abuse and PTSD, is it at least as likely as not (50 percent probability or more) that the Veteran’s death was then related to his service-connected psychiatric disability. (Continued on the next page) S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. Altendorfer, Associate Counsel