Citation Nr: 21023131 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-33 857 DATE: April 20, 2021 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1965 to June 1968 and from May 1967 to June 1971. He passed away in June 1998 and the Appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Appellant testified before the undersigned Veterans Law Judge (VLJ) at a hearing in March 2020. A copy of the transcript has been reviewed and associated with the claims file. This matter was before the Board in June and November 2020 and on each occasion was remanded for additional evidentiary development. Entitlement to service connection for the cause of the Veteran’s death is remanded. The Veteran passed away in June 1998. The cause of death was listed on his death certificate as cardiopulmonary arrest due to multiple medical problems, including alcoholism. The Veteran was service connected for a Syme amputation of the left foot and shell fragment wounds at the time of his death. The Appellant asserts that the Veteran suffered from a psychiatric disability related to service, which led to his alcoholism. His service-treatment records reveal that he served in the infantry in Vietnam and was blown out of the back of a jeep by a rocket-propelled grenade. His post-service treatment records reveal that he was assessed with adjustment disorder with anxious mood, situational anxiety, and unspecified depressive disorder prior to his passing. Pursuant to the remand instructions, a medical opinion was issued in December 2020. The examiner concluded that the Veteran did not have a diagnosis of posttraumatic stress disorder (PTSD) prior to his death and that his diagnosis of adjustment disorder with anxiety was not related to service but related to the psychological stress experienced in the context of his marriage and home life. The examiner also indicated that pain in his leg was also cited as a contributing factor to his psychiatric disability. After a review of the evidence, the Board finds that an addendum medical opinion is warranted on remand. In this regard, the examiner failed to acknowledge or discuss the Veteran’s service in the infantry in Vietnam and the July 1970 injury in Vietnam where he was blown out of the back of a jeep by a rocket-propelled grenade and his left foot was subsequently run over by a five-ton truck per the remand instructions. Moreover, the examiner referenced that his pain in his leg may be a contributing factor to his psychiatric disability. Lastly, the examiner failed to acknowledge or discuss the Veteran’s diagnosis of depression. Accordingly, the Board finds that a remand is warranted for an addendum opinion to be issued to determine whether the Veteran’s psychiatric disability was related to service and/or secondary to his service-connected Syme amputation of the left foot and/or shell fragment wounds, which in turn caused his alcoholism that led to his death. The matter is REMANDED for the following action: Forward the claims file, including a copy of this remand, to the December 2020 mental health examiner to determine whether the Veteran’s psychiatric disability was related service and/or secondary to a service-connected disability and, if so, if it caused and/or contributed to his alcoholism. If the December 2020 examiner is not available, forward the claims file to an appropriate mental health examiner for the addendum opinion. The claims file should be reviewed by the examiner and such review should be noted in the examination report. The examiner should discuss each psychiatric disability identified in the record and/or raised by the Appellant, including posttraumatic stress disorder (PTSD), adjustment disorder with anxious mood, situational anxiety, and unspecified depressive disorder. If the examiner finds that the Veteran did not have any of the listed diagnoses raised by the record prior to his passing, the examiner should explain why. If PTSD is found by the examiner, he or she should identify the stressor(s) the diagnosis is based upon. For each diagnosed psychiatric disability, the examiner should respond to the following: A. Is it at least as likely as not (probability of at least 50 percent) that any psychiatric disability prior to the Veteran’s death was related to his period(s) of active service? B. If not directly related, is it at least as likely as not (probability of at least 50 percent) that any psychiatric disability was caused by his service-connected Syme amputation of the left foot and/or shell fragment wounds, including any related pain? If not, is it at least as likely as not (probability of at least 50 percent) that any diagnosed psychiatric disability was aggravated (any incremental increase in disability) as a result of his service-connected Syme amputation of the left foot and/or shell fragment wounds, including any related pain? If aggravation is found, is there evidence created prior to the aggravation or between the aggravation and psychiatric disability that shows a baseline of his psychiatric disability prior to aggravation? If so, please identify. C. If a psychiatric disability is found to be related to service and/or secondary to a service-connected disability, is it at least as likely as not (probability of at least 50 percent) that the psychiatric disability contributed substantially or materially to his death, including via his alcoholism? The examiner should also remark as to whether it is at least as likely as not that alcoholism is related to the diagnosed psychiatric disorder. The examiner must provide a comprehensive rationale for each opinion provided. The examiner should discuss the Veteran’s diagnosed psychiatric disabilities prior to his death, his service-treatment records indicating that he served in the infantry in Vietnam and was blown out of the back of a jeep by a rocket-propelled grenade, the Appellant’s hearing testimony, statements submitted by the Appellant and children, and December 2020 statement by B.C. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. (Hurley) Merrick 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.