Citation Nr: 18153107 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 12-35 243 DATE: November 27, 2018 REMANDED ISSUES Entitlement to service connection for acquired psychiatric disorder, to include posttraumatic stress disorder, anxiety, and depression. Entitlement to service connection for a bilateral hand disorder. Entitlement to service connection for a right shoulder disorder. REASONS FOR REMAND The Veteran served on active duty from October 1987 to February 1988 and from October 1990 to June 1991 and March 2003 to June 2003. The Veteran also has additional service in the Army Reserves. The Board regrets further delay, but additional development is necessary before adjudicating the claims. Acquired Psychiatric Disorder In July 2017, the Board remanded the claim for service connection for acquired psychiatric disorder. Upon remand, the examiner was asked to provide a nexus opinion discussing the Veteran’s treatment records (STR) that document reports of anxiety in June 2006 and 2002, as well as the Veteran’s testimony of being placed on suicide watch in service. Pursuant to the Board’s remand, an addendum opinion was obtained in September 2017, but the examiner’s opinion did not comply with the Board’s directives as it did not discuss the aforementioned evidence. Therefore, because the Board’s prior remand directives have not been complained with a remand is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions). Bilateral Hand Disability The claim for entitlement to service connection for bilateral had disability was remanded in June 2017 to obtain an examination. Accordingly, the Veteran underwent a VA examination in August 2017, where it shows a diagnosis of degenerative arthritis. However, the negative nexus opinion provided did not adequately address the Veteran’s arthritis diagnosis. Therefore, a remand is necessary to obtain an opinion that address the Veteran’s arthritis. Right Shoulder Disability In the June 2017 remand, the Board directed for an addendum opinion regarding the claim for right shoulder disability. In September 2017, a nexus opinion was obtained, where the examiner concluded that the Veteran’s right shoulder disability is less likely than not etiologically related to her military service. The examiner’s opinion, however, does not adequately address a July 11, 2007 report of shoulder pain while the Veteran was in ACDUTRA. For this reason, a remand is necessary to obtain another opinion. The matters are REMANDED for the following action: 1. Update VA medical records. 2. After completion of directive #1, schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of any acquired psychiatric disorder. The examiner should review the claims file in its entirety and provide an opinion answering the following question: Following the completion of the examination, the examiner must provide an opinion answering the following question: Is the Veteran’s acquired psychiatric disorder at least as likely as not (50 percent or greater probability) attributable to service? The examiner is asked to consider the Veteran’s period of active service, as well as period of ACDUTRA. The examiner is asked to provide an opinion regarding all acquired psychiatric disorder diagnosed. The examiner should discuss an episode of anxiety the Veteran had in June 2006 and her report of anxiety attack in 2002 documented in her service treatment record. The examiner should also consider and comment on the Veteran’s testimony regarding being placed on suicide watch while she was stationed in Saudi Arabia. A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case. 3. After completion of directive #1, forward the claims file to an appropriate VA examiner for an opinion as to the etiology of the Veteran’s bilateral hand disability. If the examiner determines that he/she needs to examine the Veteran in order to answer the below question, such an examination should be scheduled. After reviewing the claims file in its entirety, the examiner should answer the following question: Is the Veteran’s bilateral hand disability at least as likely as not (a 50 percent or greater probability) related to her military service? The examiner is asked to consider the Veteran’s period of active service, as well as period of ACDUTRA and INACDUTRA. The examiner should consider and comment on whether the Veteran’s current condition is related to her complaint of bilateral hand pain and numbness during her period of ACDUTRA in 2007, as well as the diagnosis of bilateral carpal tunnel syndrome in June 2007. The examiner should also consider and comment on the Veteran’s report of arthritis, rheumatism, or bursitis in October 1997 and November 2002, as documented in her service treatment records. A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case. 4. After completion of directive #1, forward the claims file to an appropriate VA examiner for an opinion as to the etiology of the Veteran’s right shoulder disability. If the examiner determines that he/she needs to examine the Veteran in order to answer the below question, such an examination should be scheduled. After reviewing the claims file in its entirety, the examiner should answer the following question: Is the Veteran’s right shoulder disability at least as likely as not (a 50 percent or greater probability) related to her military service? The examiner is asked to consider the Veteran’s period of active service, as well as period of ACDUTRA and INACDUTRA. The examiner’s opinion should comment on whether the Veteran’s report of right shoulder pain during the period of ACDUTRA in July 11, 2007 is related to her military service. The examiner should also address the impact, if any, the Veteran’s physically demanding job in the military had on her current condition.   A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.SOLOMON