Citation Nr: 21076215 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 16-46 031 DATE: December 22, 2021 REMANDED Entitlement to service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty for training from April 1981 to August 1981 and on active duty from November 1990 to July 1991. The Veteran passed away in September 2010. The Appellant is his surviving spouse. The issue was remanded by the Board of Veterans' Appeals (Board) in September 2020 and June 2021 for further development. Upon review of the record, the Board finds that the claim must be remanded for a new medical opinion. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Appellant that it is necessary for a full and fair adjudication of her claim. A medical opinion provided by a VA examiner in August 2021. The VA examiner concluded that she was unable to opine as to the relationship between the Veteran's death and his service, whether it was at least as likely as not related to posttraumatic stress disorder (PSTD), or if the PTSD was a primary or contributory cause of death without resorting to guessing. As rationale for why she was unable to provide an opinion, she only wrote that it was because the causes of ischemic heart disease were mostly unknown and that many factors had been implicated, as seen in a peer-review article. Unfortunately, the Board finds that the August 2021 opinion does not substantially comply with the Board's June 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). In particular, the August 2021 examiner failed to note and address the June 2011 and May 2015 articles submitted by the Appellant, and the opinion did not provide sufficient explanation regarding why a medical opinion could not be provided without resorting to guessing. The Appellant has also contended that the Veteran's PTSD caused him to smoke, and that this led to his heart disease and death. This should also be addressed by an examiner. Accordingly, a remand is necessary to obtain another medical opinion. The matters are REMANDED for the following action: Obtain a VA opinion that addresses the etiology of the Veteran's cause of death. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran's documented medical history. The examiner should offer comments, an opinion, and a supporting rationale that address the following: (a.) Is it at least as likely as not that the Veteran's cause of death, ischemic heart disease, was caused by or was otherwise etiologically related to his service? (b.) Is it at least as likely as not that the Veteran's cause of death, ischemic heart disease, was either caused or aggravated by his service-connected PTSD? Please discuss the June 2011 and May 2015 articles submitted by the Appellant which link PTSD to heart disease. (c.) Is it at least as likely as not that the Veteran's service-connected PTSD was a primary or contributory cause of his death? Please address the Appellant's contentions that the Veteran's PTSD caused him to smoke, and that this contributed to his death. The examiner must provide the rationale for all proffered opinions. 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 must 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. Mary E. Rude Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. L. Park, 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.