Citation Nr: 21062617 Decision Date: 10/08/21 Archive Date: 10/08/21 DOCKET NO. 17-57 819 DATE: October 8, 2021 REMANDED Entitlement to an initial disability rating in excess of 50 percent for posttraumatic stress disorder (PTSD) with major depression, opiate dependency in remission prior to June 4, 2021 is remanded. Entitlement to a disability rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with major depression, opiate dependency in remission from June 4, 2021 is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from June 1969 to March 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2015 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this matter for additional development in April 2021. The claim was remanded to obtain an addendum opinion regarding whether the Veteran experienced occupational and social impairment with deficiencies in most areas or total social and occupational impairments. In June 2021, a negative VA medical opinion was issued. The examiner opined that the Veteran does not experience occupational and social impairment with deficiencies in most areas or total occupational and social impairment. In rendering her opinion, the examiner noted the Veteran experienced traumatic events in service which causes her to have distressing dreams, intrusive memories, flashbacks, and exposure to cues that symbolize or resemble an aspect of the traumatic events have been an issue. The examiner further stated that the Veteran's PTSD does not lead to total social and occupational impairment, noting that the Veteran is able to work to some degree as a nurse. The Veteran indicated that she is looking forward to working through her issues so that she will be able to eventually reinstate her nurse practitioner's license again. She also indicated she is grateful for the relationship with her daughter. The Veteran shared that while she and her daughter have had issues, at the time of the examination she was able to continue with some intermittent contact with her daughter and her grandchild, who live next door to her. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. The VA also has a duty to assist veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist including providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159(c)(4). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds the opinion is insufficient for adjudication as it is unclear whether the examiner answered the questions presented to her and does not provide an adequate rationale. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As the examiner failed to appropriately address and consider the Veteran's statements, including that her mental health condition causes her to miss work and has led to her getting written up, a remand is necessary to obtain an addendum medical opinion. See February 2021 Hearing Transcript. Regrettably, for the above reasons the Board also finds that there has not been substantial compliance with its previous remand directives. As such, this matter must be remanded for an addendum VA medical opinion that complies with the Board's remand directives and considers all the evidence of record The matter is REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Undertake appropriate development to obtain any outstanding records pertinent to the claim. Include in the claims file any outstanding VA treatment records. All records/responses received must be associated with the claims file. See 38 C.F.R. § 3.159. 3. Schedule an examination to determine the nature and severity of PTSD with major depression. After reviewing the claims folder, interviewing the Veteran, and examining her, the examiner should address the following questions. (a). Does the Veteran experience occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships? (b). If so, does PTSD also cause total social and occupational impairment? Please explain in detail any opinion provided and the supporting rationale. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which she has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran and any other lay witnesses, the examiner should indicate this in the examination report and provide a rationale for that determination. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.