Citation Nr: 21063178 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 15-42 828A DATE: October 13, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1978 to June 1995. He died in October 2010. The Appellant is the Veteran's surviving spouse. This case was previously before the Board. In July 2021, the Board remanded the Veteran's claim to the Agency of Original Jurisdiction (AOJ) for further action consistent with the Board's remand directives. The claim is back before the Board for further appellate proceedings. Here, the Veteran died in October 2010. His cause of death was listed as a self-inflicted gunshot wound to the head. See December 2010 Coroner's Report. Classification of death was listed as suicide. Id. The Board remanded the Veteran's claim in July 2021 in order to address the Appellant's contention that the Veteran's suicide was due to a mental health disability, which she attributed to his time in service. See July 2021 Board Remand. Consequently, a VA medical opinion was produced in August 2021. Notably, although the Appellant specifically contends that the Veteran's death was caused by posttraumatic stress disorder (PTSD), on remand any other psychiatric diagnosis must also be considered. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The August 2021 VA medical opinion provided a negative nexus opinion regarding the etiology of the Veteran's claimed mental health disability and his active service. See August 2021 VA medical opinion. However, the VA clinician noted that he did not review the death certificate or the private treatment records from September 2010 wherein the Veteran endorsed suicidal thoughts. Id. A review of the record indicates that the Veteran did seek treatment at Madera Community Hospital in September 2010, just one month prior to his death, where he was noted to have had suicidal thoughts. See September 2010 private treatment notes. The treatment notes indicate that the Veteran was suffering from insomnia and depression. Id. The September 2010 treatment records that were not reviewed by the August 2021 VA clinician are highly relevant, particularly given that the Veteran sought treatment for suicidal ideation just one month prior to his death. The treatment notes also contain an additional mental health diagnosis of depression that was not considered by the August 2021 VA clinician. Moreover, the Coroner's Report is also available within the Veteran's file for reviewhowever, as noted above, the August 2021 VA clinician stated he did not review said document. Thus, the August 2021 VA medical opinion is not based on a complete record. A medical opinion is not adequate to decide a claim if it does not consider all the relevant evidence of record. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). Therefore, the Board finds that remand is warranted to obtain an adequate medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriately qualified clinician to determine the etiology of the Veteran's claimed acquired psychiatric disability, including but not limited to PTSD and depression. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. After the record review, the reviewing clinician is asked to respond to the following: (a.) Is it at least as likely as not that the Veteran had an acquired psychiatric disability, to include PTSD and/or depression, that was causally related to service? The reviewing clinician shall specifically consider the September 2010 private treatment notes from Madera Community Hospital containing a diagnosis of depression and reports of suicidal ideation. (b.) If the clinician finds that the Veteran had an acquired psychiatric disability that was causally related to service, is it at least as likely as not that such a psychiatric disability was a principal or contributory cause of the Veteran's suicide? The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must 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). 2. After the above development has been completed, readjudicate the claim. If any benefit sought remains denied, provide the Appellant and her representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Katie Poe, 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.