Citation Nr: 21015363 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-11 807 DATE: March 17, 2021 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from July 1943 to March 1946, including in the Asiatic Pacific Theater. The appellant is the Veteran’s surviving spouse. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 administrative decision of the Department of Veteran’s Affairs (VA) Regional Office (RO). The appellant testified in December 2019 at a hearing held before the undersigned Veterans Law Judge (VLJ). The matter was previously before the Board in April 2020 and was remanded for additional development and has now returned for further appellate review. 1. Entitlement to service connection for the cause of the Veteran’s death is remanded. While additional delay is unfortunate, the Board finds that remand is necessary before a final determination can be rendered in this matter. At the December 2019 hearing, the appellant competently and credibly reported that the Veteran was reluctant to discuss his World War II wartime experiences. The appellant indicated, however, that she soon after marrying the Veteran she noticed that he had numerous psychiatric symptoms, such as his sensitivity to sounds, nightmares and violent behavior while he slept, as well as his inability to be in crowds. The appellant also reported that Veteran received treatment for these problems but that those records unfortunately are no longer available. During the hearing, the appellant testified that when the Veteran had nightmares he started “running,” and that it was as a consequence of that behavior, he slipped and fell, causing him to break his hip. The Board finds the Veteran’s account, as a fact witness, both competent and credible and thus must, for the purposes of this appeal, be assumed as true that the Veteran’s hip injury is due to his PTSD, which is a disability of service origin. Pursuant to the April 2020 Board decision, the Veteran’s claims file was reviewed by a VA examiner in June 2020 who opined that there is no evidence in the medical e-file to support the appellant’s contentions that the Veteran’s psychiatric disorder caused him to delay medical treatment for his prostate cancer or that the Veteran experienced a panic induced hip injury that hastened his death. Upon review of the record, the examiner stated that the Veteran’s medical record showed that neither the Veteran, nor the Appellant who attended many of the Veteran’s medical appointments, indicated distress or the presence of mental health symptoms. The examiner went on to state that “[t]here is no suggestion in the e-file that the Veteran had problems with accessing care or was reluctant to access care. There is no suggestion in the records that the Veteran’s hip injury in August 2010 occurred in response to panic or any other mental health issue.” The examiner rationalized that if the Veteran’s psychological function was so severely impaired that he could not make decisions in relation to his health or had panic episodes that contributed to his hip fracture, then some mention would be contained in the records. The examiner concluded that “it is less likely than not that the Veteran’s psychiatric condition had an impact on his ability to make decisions regarding his medical care and that it is also less likely than not that the Veteran’s panic-induced hip injury materially contributed to his death.” The Board observes that the VA examiner’s opinion contains inconsistencies regarding whether the Veteran’s hip injury was the result of an episode of panic related to the Veteran’s psychiatric condition. The Board also notes that the examiner discusses the Veteran’s August 2010 hip injury, but fails to address the hip injury noted in the May 2015 VA treatment records. Accordingly, the Board finds this examination to be inadequate for determining entitlement to service connection for the cause of the Veteran’s death and that remand is warranted to obtain a new medical opinion. The matter is REMANDED for the following action: Make arrangements for the claims file to be reviewed by an appropriate clinician(s) for a medical opinion on the issue of service connection for the cause of the Veteran’s death. Following a review of the record, including the aforementioned May 2015 VA treatment record documenting the Veteran’s diagnosis of PTSD and hip injury, the examiner should provide an opinion as to the following: (a) Whether it is at least as likely as not that the Veteran’s psychiatric condition had an impact on his ability to make decisions regarding his medical care. (b) Assuming as true that it is at least as likely as not that the Veteran’s 2015 hip injury was the result of an episode of panic related to the Veteran’s psychiatric condition, please opine as to whether the Veteran’s hip injury caused, contributed substantially or materially, or hastened the Veteran’s death; If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner should state why this is so. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Gorum, 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.