Citation Nr: 21076184 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 13-14 333 DATE: December 22, 2021 REMANDED Service connection for an acquired psychiatric disability, to include post-traumatic stress disorder (PTSD) and dementia, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1968 to January 1970, including service in the Republic of Vietnam (Vietnam). This matter comes to the Board of Veterans' Appeals (Board) from a September 2011 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for an acquired psychiatric disorder, to include PTSD and dementia. The claim has been remanded three times, in September 2017, July 2018, and most recently in July 2021. Although regretting the additional delay, the Board finds that remand is again needed before a decision may be rendered on the claim to ensure compliance with the prior remand requests. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran testified at a February 2018 hearing before a Veterans Law Judge (VLJ) who is no longer at the Board. In May 2021, he was informed of his right to an additional hearing before a different VLJ, but he chose not to have another hearing. Service connection for an acquired psychiatric disability, to include PTSD and dementia, is remanded. The Veteran asserts that he has PTSD, or that, in the alternative, his mood and psychiatric symptoms, including diagnosed dementia, are service connected. The facts of this case are complicated and when the matter was last remanded it was, in part, to afford the Veteran a neuropsychological evaluation to clarify the Veteran's various psychiatric conditions throughout the appellate time frame and the likely etiology thereof. As will be outlined below, it is unclear whether any such neuropsychological evaluation was completed, but in any case, the evaluation is not of record and, therefore, the resulting medical opinion did not have the benefit of it and, indeed, indicated that without such an evaluation a complete opinion could not be completed. Thus, corrective action is once again required. The Veteran's service entrance examination in May 1968 indicates his self-reported "nervous trouble" with the examining official noting that the Veteran got "headaches occasionally," and was "nervous + worried situational[ly]," and drinks a "6 pack of beer daily." At his separation examination, the Veteran again reported "nervous trouble." No psychiatric diagnosis was rendered during his military service. Immediately after service, in July 1970, the Veteran was denied service connection for hospital or treatment purposes for headaches and a "nervous condition." The record does not reflect the basis for the Veteran's claims, but merely observes that there was no reference in his service treatment records (STRs) "to any psychiatric condition or headaches." After service, the Veteran's long-standing substance abuse history is well-documented in his record as is a series of strokes suffered between 2002 and 2007 that produced, as a VA examiner later characterized it, "profound short- and long-term memory loss, impairment of higher cognitive functions, and left-sided hemiparesis." Aside from memory loss, records show a diagnosis of dementia, and other times merely a "history" of dementia suggestive of associated with either the strokes and/or the long-standing substance abuse history. Adding to the complexity of this case, the Veteran has provided detailed descriptions of in-service stressful circumstances during his two-year service in Vietnam, including seeing dead bodies and suffering anxiety attacks over the possibility of being attacked. Records are inconclusive over whether the Veteran has PTSD or ever had PTSD indicating at times negative screenings in 2010 and 2011, and a positive PTSD screen in July 2015. Again, the matter has been remanded several times to afford the Veteran an adequate VA examination, but examiners have recommended "full neurophysical and neurological examination" and it does not appear this has ever been accomplished. As such, the October 2021 VA psychologist most recently opined that a positive nexus opinion could not be provided without a neuropsychological examination. The Board finds additional development is required. This appeal stems from a January 2010 claim. Although the evidence shows that at times the Veteran was diagnosed with PTSD and/or dementia and at other times he was not, it is important to note that the current disability requirement for service connection purposes is satisfied if a "claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim." McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Further, none of the VA examiners appear to have considered the full and accurate factual picture of the Veteran's appeal, to include the in-service notations of his nervous trouble, the in-service notation of consuming "six beers of day," the post-service 1970 hospitalization, his significant history of substance abuse history, and the description of his Vietnam service stressors, all of which pre-dated the post-service strokes. Reonal v. Brown, 5 Vet.App. 458, 460-61 (1993) (medical opinion based on inaccurate factual premise may properly be rejected as non-probative). For these reasons, the Board finds the VA examinations of record remain inadequate and there had not been substantial compliance with prior remand directives. Corrective action is required. Accordingly, the matters are REMANDED for the following actions: 1. Schedule the Veteran for a full VA neuro-physical, neurological, and psychiatric examination to determine the nature and etiology of any cognitive and/or psychiatric condition that currently exists or has existed during the pendency of this appeal (i.e., since the filing of his January 2010 claim), to include contended posttraumatic stress disorder (PTSD) and/or dementia, even if not currently present. The examiner(s) are directed to consider the Veteran's description of in-service stressors during his two-year service in Vietnam related to hostile threat and seeing dead bodies as well as in-service service entrance examination notations of "nervous trouble" and "drinking six beers a day" as well as the separation examination notation of "nervous trouble" and the post-service 1970 hospitalization for nervous trouble and substance abuse. The examiner(s) are also directed to consider the Veteran's post-service series of strokes, and the inconsistent notations in the record of whether or not the Veteran has a diagnosis of PTSD and/or dementia. If the Veteran is currently diagnosed with PTSD or is found to have had PTSD during the pendency of this appeal, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to the described Vietnam related hostile threats. If any other acquired psychiatric disorders are diagnosed, to include dementia, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include his complaints of nervousness and excessive drinking. A complete rationale must be provided for any opinion expressed, based on the examiner's clinical and medical expertise, established medical principles, and references to the evidence of record, as appropriate. To the extent the Veteran is opined to have (or had) both service related and non-service related psychiatric disabilities, the examiner is also asked to discern the effects of each disability where possible. 3. After completing the above, and any additionally indicated development, re-adjudicate the claim. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Wilkinson, Edward L. 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.