Citation Nr: 21021836 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 10-06 500 DATE: April 14, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1975 to July 1975. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2014 and April 2018, the Veteran testified at hearings before the Board regarding the issue above. A transcript of each hearing has been included in the claims file and has been reviewed. The Board remanded this claim for development on multiple occasions. Most recently, in October 2020, the Board remanded the claim for additional development, which has not been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran contends that his current acquired psychiatric disorder is the result of abuse by a drill sergeant in service. The Board notes that this claim was remanded in October 2020 for additional development. Specifically, the Board requested another VA medical opinion on the etiology of the Veteran’s psychiatric disorder. The examiner was directed to address and consider the Veteran’s in-service and post-service psychiatric problems. See October 2020 Board Decision. In November 2020, an addendum opinion was completed. The examiner gave a negative opinion that the Veteran’s psychiatric disorder was due to military service. See November 2020 VA Examination Addendum. The examiner noted that the enlistment examination notes depression, excessive worry, frequent trouble sleeping, and nervousness. Id. While in service, the Veteran reported missing his parents, being intimidated by the harsh treatment of drill sergeants, and being discouraged that he was unable to pursue his preferred position. Id. Service records note that the Veteran threatened to overdose if he was not granted discharge. Id. The examiner opined that the “stress inherent in any boot camp experience may have caused a temporary exacerbation of the Veteran’s psychological conditions.” Id. Further, the examiner determined that the Veteran’s experiences in childhood likely had a far greater impact on his psychological development than a “single incident at the age of 20 that had no accompanying physical injury.” Id. Significantly, the Board remand, in part, instructed the examiner to accept the presumption that the Veteran entered military service without a mental health disorder. The examination opinion does not appear to follow this directive as it addresses the Veteran's pre-military mental health. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). The VA also has a duty to assist veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist includes providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159 (c)(4). Once VA undertakes the effort to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A remand is necessary for an addendum opinion to discuss the nature and etiology of the Veteran’s acquired psychiatric disorder. The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. Neither the Veteran’s credibility nor any lack thereof should be presumed in this remand.  2. Return the case to the VA examiner who provided the November 2020 VA opinion, or to a suitable substitute, for issuance of an addendum medical opinion. After reviewing the claims file, please answer the following question: Is it at least as likely as not(i.e., probability of 50 percent or greater) that either the schizoaffective disorder or the general anxiety disorder (diagnoses noted in the January 2016 and July 2020 VA reports) had its onset during service, or is related to an event or injury during service? In answering this question, address the Veteran’s claim that abuse by a drill instructor led to his current psychiatric problems. See April 2018 Board Hearing Transcript; see also June 2018 Buddy/Lay Statement. The question must be addressed accepting the presumption that the Veteran entered service without a mental health disorder. Please explain in detail any opinion provided and the supporting rationale. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If the physician rejects the Veteran’s reports of symptomatology, he or she must provide a reason for doing so. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V. Schmidt 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.