Citation Nr: 21007376 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 15-07 842 DATE: February 9, 2021 REMANDED Service connection for a psychiatric disorder. Service connection for alcohol abuse. Service connection for a liver disease. Service connection for a spleen condition. REASONS FOR REMAND The Veteran served on active duty from November 1962 to January 1963. The case is on appeal from an October 2014 rating decision. In March 2018, the Veteran testified at a Travel Board hearing. The case was last before the Board in October 2018. At that time, the Board dismissed the issue of entitlement to a total disability rating for compensation based on individual unemployability (TDIU) and remanded the claims of service connection for a psychiatric disorder, liver disease, spleen disorder, and alcohol abuse for further development. 1. Service connection for a psychiatric disorder. The Board finds there was not substantial compliance with the Board’s October 2018 remand directives where the Board directed the RO to obtain a new VA medical opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board observed that the earlier VA examination did not discuss whether the Veteran’s articulated worry and anxiety during service, and/or behaviors the Veteran exhibited during service, may have been manifestations of his diagnosed depressive disorder or another clinically diagnosed disorder. Upon remand, a new VA examination medical opinion was provided in October 2019. While the VA examiner seems to have acknowledged the Veteran’s articulated symptoms, the examiner provided, “As a result of him not seeking treatment for mental health until 2013, there is no basis for an opinion as to the effect on his mental health of the events surrounding his discharge.” It should be noted that “symptoms, not treatment, are the essence of any evidence of continuity of symptomatology.” Savage v. Gober, 10 Vet. App. 488, 496 (1997). Therefore, the examiner has not evaluated the question properly. Additionally, in the Board’s October 2018 remand directives, the RO was directed to request and associate outstanding active duty mental health clinic records with the file. If no records were found, a formal finding for the record was requested. The Veteran continues to contend that active duty military records addressing mental health treatment are missing from the claims file. Specifically, there are no records of an in-service January 1963 sick call visit. There is also no formal finding of no records being found. As such, there was not substantial compliance with the Board’s remand directives, and remand is warranted. Stegall, 11 Vet. App. at 271. Further, remand is warranted to clarify the October 2019 VA medical opinion. In the October 2019 medical opinion, the examiner opined it is less likely than not that the Veteran’s current psychiatric symptoms are primarily a function of his military service and more likely than not due to nonservice-related biopsychological factors, including family and social stressors. However, the examiner also stated it is more likely than not that the Veteran’s negative experience during service has led to recurring memories which exacerbate his psychiatric symptoms, including problems with sleep and irritability. Therefore, the Board finds a remand is warranted to determine the etiology and clarify whether the Veteran’s psychiatric disorder is related to service. In light of the remand, updated VA treatment records should be obtained. 2. Service connection for alcohol abuse. 3. Service connection for a liver disease. 4. Service connection for a spleen condition. The intertwined issues of service connection for associated alcoholism, liver disease, and spleen disease are also remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Make a request for the Veteran’s active duty Mental Health Clinic records, including records from January 1963, and associate them with the claims file. Document all efforts to obtain these records. If no records are found, make a formal finding for the record. 2. Obtain outstanding VA treatment records dated from June 2020. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) by an appropriate medical professional to determine the nature and etiology of the Veteran’s psychiatric disorder. The examiner must review the file. The examiner should also discuss the Veteran’s in-service and current complaints and symptoms with the Veteran and document the Veteran’s assertions in the examination report. (Continued on the next page)   After clinical assessment , the examiner should opine, for each psychiatric disorder found on examination and in prior medical records (including depressive disorder and anxiety), whether it is at least as likely as not (50 percent or greater probability) that the disorder had its onset during active duty service or, if the disorder began after service, is related to service. A complete rationale should be provided for any opinion reached. Consideration should be given to active duty medical records and the Veteran’s lay statements about his experiencing depression, anxiety, and worry during service. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becton, 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.