Citation Nr: 21062794 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 17-28 620A DATE: October 12, 2021 REMANDED Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Appellant is a surviving spouse of a deceased veteran (the Veteran) who served honorably in the U.S. Navy from October 1944 to October 1947, and from December 1950 to June 1967, including service during the World War II, Korean War, and Vietnam War eras. Unfortunately, the Veteran passed away in November 2016, prompting the Appellant to file the instant claim for service connection for cause of death in December 2016. The Appellant testified before the undersigned at a hearing held in July 2019; a transcript of that hearing is of record. The Board notes that a May 2021 rating decision, issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ), granted evaluation of chronic pansinusitis to include bronchitis, which is currently 30 percent disabling, effective July 17, 2015. The AOJ stated in the May 2021 rating decision that their decision to grant a 30 percent evaluation of chronic pansinusitis to include bronchitis, represents a full and final determination of that issue on appeal and is therefore considered resolved in full. The Board remanded this appeal in March 2021 for further development, including obtaining a medical addendum opinion regarding the Veteran's cause of death. However, as set forth more fully below, because the April 2021 addendum opinion lacks the necessary adequacy for adjudication, substantial compliance with the Board's March 2021 Remand directives has not yet occurred; accordingly, the Appellant's claim for service connection for cause of death must unfortunately be remanded again for further development. See Stegall v. West, 11Vet. App.268, 271 (1998). 1. Service connection for cause of death. As an initial matter, the Board notes that a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West at 271. This issue was previously remanded in March 2021 for a VA medical opinion regarding service connection for cause of death. The Board provided very detailed reasons for the remand in the March 2021 remand and provided specific directives. Specifically, the Board requested, under remand directive #2, that an addendum medical opinion be given by a mental health specialist. Subsequent VA medical opinions were provided in April 2021. One opinion that directly addressed whether the mental health condition was related to service was provided by a psychiatrist. Another April 2021 opinion that addressed whether the cause of the Veteran's death was related to service or a service-connected disorder was rendered by a family practice doctor. Subsequently, as noted above service-connection for bronchitis was granted and the condition was evaluated with the pansinusitis. In light of this grant, an addendum medical opinion was obtained and signed in July 2021. This addendum concluded that the Veteran's respiratory conditions were less likely than not related to service and it was less likely than not that any respiratory conditions attributed to the Veteran's death. This opinion was completed by a physician who was noted to be "General Practice, Obstetrics and Gynecology." The Board finds the April 2021 and July 2021 VA examiner's opinion is inadequate for adjudication purposes. The Board notes that the March 2021 Board remand required the addendum opinion to be rendered by a mental health specialist. As noted in the opinion, only one of the April 2021 opinions was a psychiatrist and the other was a family practice doctor and the July 2021 VA examiner, was not a mental health specialist but instead was a general practitioner who appears to specialize in obstetrics and gynecology. VA's duty to assist includes providing a qualified medical examiner, and the probative value of the medical examination is based on the physician's skill and knowledge in analyzing the data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301. As the April 2021 and July 2021 medical opinions did not comply with the March 2021 remand directives to provide the Veteran with a medical opinion rendered by a mental health specialist, another remand and a further addendum opinion is necessary. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision"). Although the Board regrets this delay, such a remand is necessary to ensure fair and appropriate adjudication of the Veteran's claim consistent with VA's duties to assist. The matter is REMANDED for the following action: Obtain an addendum opinion from a mental health specialist to determine the nature and etiology of the disability listed as the Veteran's cause of death, to include dementia or Alzheimer's dementia. The examiner must provide a complete written history, including all statements and reports made by the Veteran. The examiner is requested to provide an opinion as to the following: (a.) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's cause of death, dementia, is related to his active military service. (b.) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's cause of death, dementia, is related to his service connected disabilities, including any of the following: (i) his service-connected chronic pansinusitis with bronchitis; (ii) his service-connected bilateral leg disability; (iii) his service-connected hearing loss; or (iv) his service-connected right hand disabilities. (c.) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's psychiatric disorder other than dementia, to include anxiety and depression, was due to or otherwise causally or etiologically related to his military service. (d.) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's psychiatric disorder other than dementia, was a primary or contributory cause of his death. A thorough rationale should be provided for all opinions expressed, including discussion of the facts of this case and any medical studies or literature relied upon. The examiner should fully articulate a sound reasoning for all conclusions made. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. The entire claims file, including a copy of this REMAND, must be reviewed. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Dourmashkin 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.