Citation Nr: 21066235 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 12-17 995A DATE: October 29, 2021 REMANDED Entitlement to Dependency and Indemnity Compensation (DIC) based on service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1968 to July 1970 and from October 1970 to May 1971. The Veteran died in June 2002. The appellant is the Veteran's surviving spouse. The Board remanded the case in April 2021 for additional development. Unfortunately, for the reasons discussed below, that development was not satisfactorily completed and further development is required. 1. Entitlement to DIC based on service connection for the Veteran's cause of death is remanded. In April 2021, the Board remanded the matter for a VA addendum opinion to determine whether the Veteran's excessive smoking and alcohol consumption associated with his service-connected posttraumatic stress disorder (PTSD) substantially or materially contributed to the Veteran's cause of death. Unfortunately, the Board finds that the opinion rendered in July 2021 is inadequate to adjudicate the matter, as the VA examiner failed to recognize that the Board had conceded aggravation of the Veteran's smoking and drinking by his PTSD. See Stegall v. West, 11 Vet. App. 268 (1998) (finding that a remand by the Board confers on the appellant the right to compliance with its remand orders). Further, the Board notes that a January 2021 private medical opinion provided by Dr. T. H. is also inadequate to serve as the basis for a grant of service connection for the Veteran's cause of death. Dr. T. H., a clinical psychologist, determined that the Veteran' smoking and alcohol abuse began after his time in the military and that the Veteran drank and smoked excessively as a means to cope with his PTSD. Based on the March 2009 VA examination and general oncology literature, Dr. T. H. opined that the Veteran's service-connected PTSD caused his excessive alcohol and tobacco use, which more likely than not caused his fatal mouth cancer. The Board finds Dr. T. H.'s rationale is conclusive and without reference to any evidence that supports his opinion. Dr. T. H. determined that the Veteran's excessive smoking and drinking began after service but made no mention of the Veteran's substantial smoking and drinking history prior to service. While the appellant has stated that the Veteran was not a smoker or a heavy drinker before service, even so far as asserting that the Veteran began smoking in service due to C-ration cigarettes supplied to soldiers, the Board finds that her statements are contradicted by the evidence of record. Specifically, in September 1979, the Veteran reported he smoked one pack of cigarettes a day for the past 20 years and drank two to three quarts a day for the past 15 years. This indicates that the Veteran began smoking in 1959, nine years before entering service, and drinking in 1964, four years before entering service. Similarly, an April 2002 treatment record reflected that the Veteran reported a smoking habit prior to entering service, noting he smoked one and a half packs a day for 35 years. As there is no opinion of record adequate to decide the claim, the Board finds that remand is again necessary to determine if the excessive smoking and/or alcohol consumption associated with the Veteran's service-connected PTSD substantially or materially contributed to the Veteran's fatal metastatic squamous cell carcinoma in the mouth. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician. The claims file and a copy of this remand must be made available to the examiner. The examiner should address the following: a) The examiner should note that aggravation by the Veteran's smoking and drinking by his service-connected PTSD has been conceded. b) Whether it is as least as likely as not that the excessive smoking and/or alcohol consumption associated with the Veteran's service-connected PTSD substantially or materially contributed to the Veteran's metastatic squamous cell carcinoma in the mouth. (Continued on the next page) 2. 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 appellant's claim should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, furnish the Veteran and her attorney 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 L. Silverblatt, 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.