Citation Nr: 21022194 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 09-28 816 DATE: April 15, 2021 REMANDED Entitlement to service connection for transient ischemic attacks (TIAs) with seizures, to include as due to exposure to mustard gas and sarin gas, is remanded. Entitlement to service connection for diarrhea, to include as due to exposure to mustard gas and sarin gas, is remanded. Entitlement to service connection for involuntary movements, to include as due to exposure to mustard gas and sarin gas, is remanded. Entitlement to service connection for migraine headaches, to include as due to exposure to mustard gas and sarin gas, is remanded. Entitlement to service connection for depression and mental confusion with anger outbursts, to include as due to exposure to mustard gas and sarin gas, is remanded. Entitlement to service connection for blurred vision, to include as due to exposure to mustard gas and sarin gas, is remanded. Entitlement to a total disability rating for compensation purposes based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1958 to September 1961. He died in 2013. The appellant is the Veteran’s surviving spouse who has been properly substituted as the claimant. These matters come before the Board of Veterans’ Appeals (Board) on appeal of a decision issued by the Department of Veterans Affairs (VA). In June 2019, the Board denied the claims listed on the title page of this decision. The appellant appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In August 2020, the Court granted a Joint Motion for Remand in which the parties agreed that the Board erred by failing to provide an adequate statement of reasons and bases for its determinations. Specifically, the parties noted that the Board had requested an opinion from a neuropsychiatrist, or a neurologist and a psychiatrist, in its 2013 remand directives, but the March 2015 VA examination was completed by a neurologist and a psychologist. The parties also agreed that the Board failed to discuss whether a January 2019 VA medical opinion, provided by an “environmental medicine specialist”, complied with the prior remand directives. Consistent with the parties’ agreement in the Joint Motion for Remand, the Board finds that these matters must be remanded for a VA medical opinion completed by a neuropsychiatrist, or a neurologist and a psychiatrist. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The claim of entitlement to a TDIU is inextricably intertwined with the claims of service connection and will be addressed after further development. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain a medical opinion from either: (1) a neuropsychiatrist, or (2) a neurologist and a psychiatrist as to the nature and etiology of the deceased Veteran’s claimed neurological and psychiatric issues. Please note that an opinion by a psychologist is not sufficient and will require further remand. The clinician is asked to review the claims file and to opine on the following: (a) Is it at least as likely as not that the Veteran’s TIAs with seizures had onset during or are etiologically related to military service, to include conceded exposure to sarin/nerve and mustard gas during training at Fort McClellan, Alabama? (b) Is it at least as likely as not that the Veteran’s diarrhea had onset during or is etiologically related to military service, to include conceded exposure to sarin/nerve and mustard gas during training at Fort McClellan, Alabama? (c) Is it at least as likely as not that the Veteran’s involuntary movements had onset during or are etiologically related to military service, to include conceded exposure to sarin/nerve and mustard gas during training at Fort McClellan, Alabama? (d) Is it at least as likely as not that the Veteran’s migraine headaches had onset during or are etiologically related to military service, to include conceded exposure to sarin/nerve and mustard gas during training at Fort McClellan, Alabama? (e) Is it at least as likely as not that the Veteran’s depression and mental confusion with anger outbursts had onset during or is etiologically related to military service, to include conceded exposure to sarin/nerve and mustard gas during training at Fort McClellan, Alabama? (f) Is it at least as likely as not that the Veteran’s blurred vision had onset during or is etiologically related to military service, to include conceded exposure to sarin/nerve and mustard gas during training at Fort McClellan, Alabama? The clinicians are advised that the Veteran is conceded to have been exposed to a “three-drop” mustard gas test which involves placing three drops of the agent on the forearm. The clinicians are also advised that the Board has conceded that the Veteran was exposed to sarin in a training course, but no quantum of exposure is available. A complete rationale should be provided for all opinions. The clinicians are asked to consider scientific and medical evidence submitted by the appellant, and to cite to relevant scientific treatises and medical literature in their opinions where appropriate. The clinicians are asked to consider and discuss relevant lay and medical evidence, to specifically include: • The VA medical opinion by the environmental medicine specialist in 2019 • Lay contentions raised by the Veteran and the appellant, including that he was exposed to sarin and mustard gas, which led to his disorders • Private medical opinions by Dr. K.M. and J.C. Ph.D. • Prior VA examination reports and medical opinions The clinicians are reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.