Citation Nr: 20046543 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 16-60 085 DATE: July 13, 2020 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include post traumatic stress disorder (PTSD) and a non-specified anxiety disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from April 1969 to January 1971 with service in the Republic of Vietnam. Previously, the claim was before the Board in June 2018 and was remanded for additional development, and as discussed below, the Board’s prior remand instructions have not been substantially complied with. As there has not been substantial compliance with the Board’s prior remand instructions, the case is again before the Board, and additional development is warranted. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and a non-specified anxiety disorder The Veteran contends that service connection is warranted for an acquired psychiatric disorder, to include PTSD and an anxiety disorder. The Veteran contends that his current PTSD is due to in-service events in Vietnam, and that it manifested during active duty service and directly thereafter, manifesting as drug use. The Board finds that a remand is warranted for additional development. In June 2018, the Board remanded the case and the regional office (RO) was directed to afford the Veteran a supplemental VA examination. In Stegall v. West, 11 Vet. App. 268, 271 (1998), the United States Court of Appeals for Veterans Claims (Court) held that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the Board’s remand order. Moreover, the Court has held that the Board itself errs when it fails to ensure compliance with the terms of its remand. Id. Although on remand the RO obtained a VA examination and opinion, the RO did not substantially comply with the remand directives because the VA examination failed to fully address issues raised in the June 2018 remand. Specifically, the July 2019 VA examiner summarized the history of combat service in Vietnam, the Veteran’s reported traumatic events, his acknowledged heroin and marijuana use during and after service but that he ceased that abuse in 1976 after undergoing substance abuse treatment. The examiner diagnosed current unspecified anxiety disorder but not PTSD. The examiner noted that the Veteran’s unspecified anxiety disorder is less likely than not incurred in or caused by an in-service injury, event or illness. However, the examiner did not fully address the Veteran’s lay statements of record, specifically that his drug use was not misconduct but rather caused by the traumatic events in service, that the drug use was either a manifestation or cause of the “nervous condition” (diagnosed as personality disorder and drug dependence), and that this was the onset of his current anxiety disorder. VA outpatient mental health records from 2013-16 do show diagnoses and treatment for PTSD arising from the Vietnam events, although with little rationale. As such a remand is warranted for a supplemental VA examination for clarification. The matter is REMANDED for the following action: Schedule the Veteran for a supplemental psychiatric examination and opinion by an appropriate clinical to determine the nature and etiology of any acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and a unspecified anxiety disorder. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor. (a.) Is it at least as likely as not that the Veteran’s unspecified anxiety disorder (a 50 percent probability or greater) is caused by active service to include an in-service injury or disease, including service in Vietnam? (b.) Is it at least as likely as not that the Veteran’s drug use was not misconduct but rather caused by events in Vietnam and represented the onset of or cause of an acquired mental health disorder that continued to the present and is variously diagnosed as anxiety disorder or PTSD? Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Attention is invited to the VA examination in October 2016 noting that the Veteran’s unspecified anxiety disorder is not related to military service, rather attributed to his past substance abuse and medical problems. In addition, attention is invited to the July 2019 VA examination noting noted that the Veteran’s unspecified anxiety disorder is less likely than not incurred in or caused by an in-service injury, event or illness. Further, attention is invited to the Veteran’s lay statements noting that his drug and alcohol use increased in-service and directly after service due to his experiences in Vietnam. The examiner should fully address the Veteran’s lay statements of record specifically as to his drug use during and directly after service that he contends was related to his in-service stressors in Vietnam. The examiner should also address whether the Veteran’s drug use was related to or aggravated by his reported in-service stressor. The Veteran contends a relationship between his service in Vietnam his history of drug and alcohol abuse and his current acquired psychiatric disorder. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kardian, 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.