Citation Nr: 21006846 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 20-09 300 DATE: February 5, 2021 REMANDED Entitlement to service connection for a mental disorder, to include major neurocognitive disorder due to Alzheimer’s disease and anxiety disorder, is remanded. Entitlement to special monthly compensation based on aid and attendance/housebound is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1962 to February 1964. The Veteran contends that his mental disorder is secondary to his service-connected disabilities, specifically his service-connected traumatic brain injury (TBI). See September 2017 notice of disagreement (NOD). The record illustrates a current diagnosis of major neurocognitive disorder due to Alzheimer’s disease and anxiety. See July 2016 Mental Disorders Disability Benefits Questionnaire (DBQ), December 2019 VA medical record, and an April 2019 letter by a private examiner. He was provided VA examinations in July 2016 and November 2018, but the examiner failed to provide a medical opinion regarding direct theory of entitlement. As such, the Board must remand for an addendum opinion. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed.Cir.1994). Additionally, the VA examiner provided two opinions regarding secondary theory of entitlement, but these opinions are inadequate. The rationale provide for the July 2016 VA opinion was lacking as it was solely based on major neurocognitive disorder being described as caused by Alzheimer’s disease by private Neurologists. The rationale provided for the March 2019 VA opinion is unclear and confusing. The VA examiner stated that the Veteran’s mental disorder (Alzheimer’s disease) was not caused by his service connected TBI as there is no temporal relationship between cerebral concussion with the loss of consciousness of three days duration in 1963 and Alzheimer’s disease with its onset in 2000. Despite providing this opinion, the examiner stated that it is a well-known scientific fact that head trauma is a predisposing factor for Alzheimer’s disease and that TBI still needs to be considered a risk factor for Alzheimer’s in this Veteran by history. Lastly, both opinions failed to comply with the requirements pursuant to El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). For secondary service connection, the VA opinion must address aggravation and causation separately with rationale specific to those findings. Also, of note, the same examiner performed both VA examinations and authored both VA opinions and the November 2018 VA and March 2019 VA examination reports appear to be incomplete and or contain errors. The November 2018 VA report shows that there is no diagnosis of TBI despite the record not only showing such a diagnosis, but the Veteran is service connected for TBI. The March 2019 VA does not provide responses to several questions in the DBQ and although one copy of the report checks the box to show that it was an in person examination, the other copies clearly state that the Veteran need not report and indicate there was no in person examination. With respect to the Veteran’s special monthly compensation claim, the Board finds that a remand is required prior to adjudication of the claim. This issue is inextricably intertwined with the claim for service connection for mental disorder, which is being remanded. The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran’s claims file any outstanding VA treatment records documenting treatment for a mental disorder. The Veteran should also be afforded the opportunity to identify and/or submit any outstanding private treatment records. 2. The AOJ should schedule the Veteran for a VA examination with an appropriate examiner, preferably with an examiner other than the examiner who performed the July 2016 and November 2018 VA examinations, to determine the nature and etiology of the Veteran’s mental health disorder. The AOJ is advised that the Veteran is terminal, and it is very challenging for him to travel. If possible, a virtual examination should be scheduled. The electronic claims file must be made available to and reviewed by the examiner. The examiner must identify each mental disorder found at any time during the appeal period (from June 2016). If any previously diagnosed mental disorder is not found on examination, the examiner should address the prior diagnoses of record and indicate whether they may have resolved or been misdiagnosed. For all diagnosed mental disorders found during the appeal period, and after a review of the examination findings and the entire evidence of record, the examiner is asked to render opinions on the following: (a.) Whether it is at least as likely as not (i.e., probability of 50 percent) that the Veteran’s mental disorder manifested during active service; or is otherwise related to an event, injury, or disease incurred during active service, to include the July 1963 car accident wherein the Veteran sustained a fracture to his right femur and a concussion. (b.) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran’s mental disorder is proximately due to or caused by his service-connected disabilities, to include his service-connected TBI. (c.) Whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s mental disorder, was aggravated (worsened in severity beyond a natural progression) by his service-connected disabilities, to include his service-connected TBI. The examiner is asked to provide a complete a rationale for all opinions offered. 3. Schedule the Veteran for an appropriate Aid and Attendance examination to determine whether his service-connected disabilities render him in the regular need of aid and attendance of another. The examiner is asked to specifically note the disabilities for which he requires the regular aid and attendance of another. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Talamantes 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.