Citation Nr: 21073011 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 15-36 149 DATE: December 7, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include bipolar disorder and post-traumatic stress disorder (PTSD), is remanded. INTRODUCTION The Veteran served on active duty in the United States Navy from March 1981 to March 1986. This case comes before the Board of Veterans' Appeals (Board) on appeal of a May 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this case in March 2019, April 2021, and July 2021 for further development. The case has since been returned for additional appellate review. REASONS FOR REMAND Although untenable, the Board finds further development is yet again required before the Veteran's claim is decided. 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, 11 Vet. App. 268, 271 (1998). The Veteran's claim was remanded in April 2021 and July 2021 to obtain an adequate VA opinion; however, to date substantial compliance with the Board's prior instructions has not been achieved. As such, a remand is again required. Inadequate examination When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In its July 2021decision, the Board determined the Veteran was in sound condition upon entry into active service and requested an addendum medical opinion addressing the nature and etiology of the Veteran's acquired psychiatric disorder, to include bipolar disorder and PTSD. The RO obtained an addendum medical opinion in August 2021. The VA examiner opined the Veteran's acquired psychiatric disorder, to include bipolar disorder and PTSD, was less likely than not incurred in service because the examiner could not locate any record of mental health complaints during the Veteran's military service. The Board finds the August 2021 medical opinion inadequate because the examiner failed to address and discuss the Veteran's lay statements regarding the onset of his symptoms. Examiners are not free to ignore a veteran's statements related to lay observable symptoms. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Additionally, a lack of contemporaneous treatment in the service treatment records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Of note, the Veteran asserts his bipolar disorder went undiagnosed while serving on active duty. To support his assertion, the Veteran explained that during his active service he experienced several personality conflicts with his commanding officers. He also stated that his doctors told him that he had been bipolar for years, but the round the clock watches and level of stress in service masked his condition. See VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD, received November 5, 2010. Additionally, in the medical notes from his February 1988 hospital admission, the Veteran reported having behavioral problems for the past year. The Board notes the Veteran separated from service in March 1986. Based on his statements and reports in the medical evidence that his symptoms started a year prior to his February 1988 hospital admission, a medical opinion is needed to assess whether the Veteran's acquired psychiatric disorder manifested to a degree of 10 percent disabling within one year from the date of his separation from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Verification of in-service stressors The Board also finds additional development is needed to verify the Veteran's claimed in-service stressors. The Veteran claims he served one tour in the Persian Gulf War while aboard the USS Robison. See VA Form 21-4138, Statement in Support of Claim, dated July 18, 2010. In a June 2014 statement, the Veteran explained he is unable to provide proof that he served in the Persian Gulf War because the CIA did not want this mission publicized. Additionally, the Veteran has submitted several statements regarding his in-service stressors. In his November 2010 and April 2014 statements, the Veteran stated part of his PTSD symptoms are due to being awoken many times by gunfire. In his November 2010 statement, he also reported that he experienced unwanted sexual advances while aboard the USS Robison causing him to experience sleep disturbances. VA treatment notes from 2015 reference PTSD due to military sexual trauma (MST). In the September 2014 Statement of the Case, the RO explained the stressors in support of a PTSD diagnosis "are not confirmed, not substantiated, not supported, not verified and not established." However, the record does not contain evidence that the RO attempted to verify the reported in-service stressors. Based on the foregoing, the Board finds a remand is necessary before a decision can be made in this case. Accordingly, this matter is REMANDED for the following actions: 1. First, undertake the appropriate development to verify the Veteran's service in the Persian Gulf War and his reported in-service stressor of experiencing unwanted sexual advances and/or harassment aboard the USS Robison. All attempts to verify the reported stressors must be documented in the claims file. 2. Next, the Veteran should be afforded an examination by a VA psychiatrist to determine the nature and etiology of his acquired psychiatric disorder, to include bipolar disorder and PTSD. All pertinent evidence of record must be made available to and reviewed by the examiner, including a copy of this remand. Any indicated studies should be performed. Based on the review of the Veteran's pertinent history and the examination results, the examiner should identify all acquired psychiatric disorders that have been present during the period of this claim. A diagnosis of PTSD should be confirmed or ruled out. If the examiner determines PTSD has not been present during the period of the claim, he or she should explain why a diagnosis of PTSD is not warranted. The examiner must discuss the VA treatment records diagnosing the Veteran with PTSD. If PTSD is diagnosed, the examiner should identify the elements supporting the diagnosis. With respect to each acquired psychiatric disorder, other than PTSD, to specifically include bipolar disorder, the examiner should state an opinion as to whether it is at least as likely as not (i.e., at least 50 percent probable) that such disorder originated in service or is otherwise etiologically related to service, to include whether the Veteran's acquired psychiatric disorder manifested to a degree of 10 percent disabling within a year of his March 18, 1986 separation from active service. In providing such opinions, the examiner must consider and expressly discuss the Veteran's statements. Specifically, the examiner is asked to include a discussion of Veteran's statements concerning his personality conflicts during service and his behavioral issues directly following service. A complete rationale must be provided for all opinions expressed. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Nestander, Jessica S. 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.