Citation Nr: 20052910 Decision Date: 08/10/20 Archive Date: 08/10/20 DOCKET NO. 15-10 328A DATE: August 10, 2020 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran had active service from September 1970 to March 1972. He was awarded a Combat Infantryman Badge and an Air Medal among his awards and decorations. The Veteran died in January 2013. The Appellant is his surviving spouse. In March 2018, the Appellant testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file. The Board of Veterans’ Appeals (Board) previously remanded the issue for further development in August 2018. The case has now been returned to the Board for appellate review. Unfortunately, another remand is required because the VA medical opinion obtained pursuant to the August 2018 Board remand is inadequate for rating purposes.   Entitlement to service connection for the cause of the Veteran's death is remanded. The Appellant asserts that the Veteran’s death, listed on the death certificate as septic shock, with pneumococcal pneumonia, alcohol-related cirrhosis, and alcohol abuse listed as underlying causes of death, is related to his period of active service. Specifically, she contends that his longstanding drug and alcohol abuse represented signs and symptoms of posttraumatic stress disorder (PTSD) due to his experiences in Vietnam. Alternatively, she contends that the Veteran’s diagnosed diabetes mellitus, while not listed on the death certificate, also substantially contributed to the Veteran’s death. The Board notes that at the time of the Veteran’s death, he was not service connected for any disability; nor did he have any claims pending at that time. At the March 2018 Board hearing, the Appellant asserted that the Veteran sought treatment for PTSD on multiple occasions at Vet Centers located in Santa Barbara and Ventura, California, but was turned away. She also contends he was treated for depression and anxiety by private physicians dating back as early as 1980. In its August 2018 remand, the Board sought missing medical records and medical opinions regarding the Veteran’s PTSD and diabetes mellitus as related to the cause of his death. In October 2019, a VA medical examiner opined that it is less likely than not that PTSD was related to the Veteran’s military service because he was not formally diagnosed with PTSD. The examiner stated that a “review of the medical file produced no records of any past mental health disorders or treatment by the VA.” He also noted that opining that PTSD caused or contributed to his death would be speculative because there is no record in his medical file of a diagnosis of PTSD. However, a review of the record indicates that the Veteran was seen at the Ventura Vet Center in 1988 and again in 1997 for counseling related to drug and alcohol abuse and other psychological symptoms. In October 1988, the Veteran reported that he was exposed to extensive combat and other stressors and began using heroin while serving in Vietnam. The counselor’s assessment listed addiction, PTSD and possible depression. Ongoing post-service treatment records from the Veteran’s private physician indicate continuous drug and alcohol abuse. As the October 2019 VA examiner failed to address the medical records in the Veteran’s claims file demonstrating at least some treatment and indication of PTSD symptoms or the Appellant’s lay statements regarding observable symptomatology, the Board finds the opinion to be inadequate for rating purposes. An addendum opinion addressing these deficiencies is warranted. The matter is REMANDED for the following action: 1. Arrange for the production of opinions by a VA examiner with an appropriate specialty for producing findings for psychiatric disorders. The complete electronic claims file must be made available to the examiner. The examiner should detail all findings. The examiner is requested to opine, if possible, whether the Veteran had findings sufficient to support a diagnosis of PTSD or any other acquired psychiatric disorder at any time prior to his death. If any acquired psychiatric disorder is found, to include PTSD, the examiner should opine whether it was at least as likely as not (a 50 percent or greater probability) related to the Veteran’s active service. If a psychiatric diagnosis is made and found to be etiologically related to the Veteran’s military service, the examiner should opine whether that disorder contributed substantially or materially to the Veteran's death in any way, to include longstanding drug and alcohol abuse as a symptom or consequence of the disorder. The examiner must provide a complete rationale for any opinions expressed, based on the examiner's clinical experience, medical expertise, and established medical principles. If an opinion cannot be made without resort to speculation, the examiner 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. The examiner should comment on the findings and opinions of other examiners, which appear in the record. In addition, the examiner should acknowledge, address, consider, and discuss all lay evidence in the record, including the Appellant's March 2018 Board hearing testimony, her lay statements, as well as the Veteran's reports to treatment providers, as they appear throughout the record. Findings should be reconciled with other records on file to the extent possible. 2. After the development requested has been completed, the Agency of Original Jurisdiction (AOJ) should review any report to ensure that it is in complete compliance   with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Sneeringer, Associate 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.