Citation Nr: 21005827 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 13-26 803 DATE: February 2, 2021 REMANDED Entitlement to compensation under 38 U.S.C. § 1151 for residuals of electroconvulsive therapy (ECT) performed at the VA Medical Center (VAMC) in Gainesville, Florida, is remanded REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1966 to April 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in September 2019 it was remanded for additional development. Specifically, the RO was instructed to undertake the appropriate development to obtain consent records for the Veteran’s ECT treatment or provide a negative response should they be unable to locate the records. In November 2019, the RO indicated that further attempts to try to locate the Veteran’s informed consent form would be futile. As such, the Board finds that the AOJ substantially complied with the directives in the September 2019 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Remand The Veteran underwent ECT treatment in January 2009 and it was noted in his treatment records that he signed “appropriate consent authorizations” for this treatment. In January 2017, the Veteran submitted the authorization for ECT treatment that he signed which indicated that common side-effects for the treatment included headaches, nausea, and short term memory loss; while uncommon side effects included chipped teeth, infection, and an irregular heartbeat. The medical records show that the Veteran’s ECT treatment was stopped early due to concerns regarding the side effects he was experiencing, specifically around his memory. The Board notes that his contemporary records show that the Veteran was experiencing memory loss greater than is usually seen with ECT. Additionally, his treating physician noted that it was unusual for ECT to cause such severe memory impairment, but not impossible, and that the Veteran’s ECT treatment may be doing more harm than good. The medical evidence in the Veteran’s record conflicts regarding his amnesia following his ECT. There are psychiatric assessments in the file which indicate that the Veteran began experiencing global amnesia following his ECT treatments and there are assessments that attribute his memory difficulties to other sources, such as the Veteran’s depression, emotional/personality factors, or the result of psychogenic amnesia related to his depression (possibly aggravated by the ECT). Given the evidence in the record, the Board finds that a medical opinion is necessary prior to final adjudication. A VA examiner from outside the Gainesville VAMC must take into account the Veteran’s competent lay statements, the medical evidence in the record, the Veteran’s signed consent, and the contemporary medical treatment records and opine whether the Veteran experienced a severe memory loss disability which was caused, aggravated, or otherwise etiologically related to his ECT therapy. Further, the examiner must opine whether the Veteran was provided proper informed consent regarding his ECT treatment given. The matters are REMANDED for the following action: Obtain an opinion from a VA medical professional with knowledge of ECT and does not work at the Gainsville VAMC. The claims file should be reviewed by the examiner. The examiner should address the following questions: (a) Whether the Veteran’s has an additional disability of memory/cognitive impairment following the ETC procedures. In doing so, please discuss the conflicting psychiatric assessments in the file which indicate that the Veteran began experiencing global amnesia following his ECT treatments and additional assessments which attribute his memory difficulties to other sources, such as the Veteran’s depression, emotional/personality factors, or the result of psychogenic amnesia related to his depression. (b) For all ETC procedures, discuss whether VA failed to exercise the degree of care that would be expected of a reasonable health care provider. In doing so, please note the medical articles referenced by the Veteran; and (c) Whether any memory/cognitive impairment is/was the result of an event not reasonably foreseeable. In this regard, please discuss the Veteran’s essential contention that, although short-term memory loss after the ECT procedures was discussed, his long-term memory loss was not an anticipated effect of the treatment. All opinions provided must be thoroughly explained, and an adequate rationale for any conclusions reached should be provided. The Board specifically draws the examiners attention to the following evidence which must be commented on within the opinion: (1) the Veteran’s competent lay statements, (2) the consent document submitted by the Veteran in January 2017, (3) The treatment records contemporary to the Veteran’s ECT treatment which indicated he was experiencing severe memory impairment which was “unusual but not impossible”, (4) The treatment records detailing the ECT treatment being stopped early due to concerns regarding the Veteran’s memory, and (5) The May 2010 examination that discusses psychogenetic amnesia and whether it implies that this could have been caused by the Veteran’s ECT treatment. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Gresham 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.