Citation Nr: 21000698 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 18-37 308 DATE: January 6, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for Alzheimer’s type dementia is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1949 to July 1962. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding has been associated with the record. In a June 2019 decision, the Board denied the Veteran’s claims of entitlement to service connection for Alzheimer’s type dementia and an acquired psychiatric disorder. Thereafter, the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In an April 2020 Joint Motion for Partial Remand (JMPR), the Secretary of VA and the Veteran (the parties) moved the Court to vacate the June 2019 decision as to the aforementioned issues. The Court granted the JMPR in an April 2020 order. In an October 2020 decision, the Board remanded these issues for additional development. Unfortunately, as discussed below, the Board’s directives have not been substantially completed, and a remand is required.  Stegall v. West, 11 Vet. App. 268 (1998).  The Veteran’s appeal has been advanced on the docket. 38 U.S.C. § 7107(a)(2) (2012); 38 C.F.R. § 20.900(c) (2019). 1. Entitlement to service connection for an acquired psychiatric disorder. 2. Entitlement to service connection for Alzheimer’s type dementia. The Veteran is seeking to establish service connection for Alzheimer’s type dementia and an acquired psychiatric disorder. Specifically, he claims that his Alzheimer’s type dementia and acquired psychiatric disorder were incurred in or caused by active duty service, to include exposure to toxic fumes, asbestos, and tobacco smoke while serving aboard submarines in service. As noted above, in an October 2020 decision, the Board remanded this issue for additional development. Specifically, the RO was instructed to obtain a VA medical opinion as to whether the Veteran’s Alzheimer’s type dementia and acquired psychiatric disorder are related to service. In October 2020, pursuant to the remand instructions, a new VA medical opinion was issued. The examiner opined that the Veteran’s Alzheimer’s was less likely than not due to service. He explained that there is no indication that the Veteran had symptoms related to the diagnosis of Alzheimer’s type dementia while in the service, there is no event that occurred in the service that would have resulted in the Alzheimer’s type dementia, and that the diagnosis of Alzheimer’s type dementia was made years after the Veteran’s time in service. Furthermore, there is no clear medical evidence that directly links exposure to toxic fumes, asbestos, and tobacco smoke while serving aboard submarines in service as a direct etiology for the diagnosis of Alzheimer’s type dementia. The examiner also concluded that there is no indication of any other psychiatric disorder in this case. Here the examiner failed to address the Veteran’s diagnosis in his private treatment records of recurrent episodes of major depressive disorder as of June 2017 and the Veteran’s submitted medical studies concerning submarine atmospheres. See April 2019 Correspondence. As such it is inadequate for adjudicative purposes. Accordingly, a remand is warranted to obtain an addendum VA medical opinion regarding the nature and etiology of the Veteran’s Alzheimer’s type dementia and acquired psychiatric disorder. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. The AOJ should obtain all outstanding VA treatment records and any private treatment records identified by the Veteran, to include the Veteran’s military personnel records. All obtained records should be associated with the evidentiary record. 2. After all outstanding treatment records have been associated with the claims file, obtain an addendum opinion from an appropriate clinician, regarding the nature and etiology of the Veteran’s Alzheimer’s type dementia and acquired psychiatric disorder, to include major depressive disorder. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. If an opinion cannot be obtained without an examination, then a VA examination should be afforded to the Veteran. The VA examiner/clinician should address the following: (A) Whether it is as least as likely as not (50 percent probability or greater) that the Veteran’s Alzheimer’s type had its onset in or is otherwise etiologically related to active duty service? Please explain why or why not. In doing so, the examiner should address the Veteran’s submitted statements and any submitted medical literature. See April 2019 Correspondence. In rendering the requested opinion, the examiner should also address the Veteran’s contentions that his claimed disabilities are due to exposure to toxic fumes, asbestos, and tobacco smoke while serving aboard submarines in service. (B) Whether it is as least as likely as not (50 percent probability or greater) that the Veteran’s acquired psychiatric disorder, to include major depressive disorder, had its onset in or is otherwise etiologically related to active duty service? Please explain why or why not. In doing so, the examiner should address the June 2017 private treatment record noting a diagnosis of major depressive disorder and competent lay assertions regarding the Veteran’s symptoms following service, to include statements regarding seclusion tendencies. See April 2019 Board Hearing. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claims should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and return the case to the Board KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kaufer, 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.