Citation Nr: 21023617 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 18-06 840 DATE: April 21, 2021 REMANDED Compensation pursuant to 38 U.S.C. § 1151 for opioid withdrawal symptoms related to VA medication management decisions. REASONS FOR REMAND The Board denied the Veteran’s appeal in May 2019. He appealed to the Veteran’s Claims Court. In June 2020, the Court Clerk granted a Joint Motion for Remand (JMR), which vacated the May 2019 Board decision and remanded the case back to the Board for action in compliance with the JMR. In October 2020, pursuant to the JMR directives, the Board remanded the Veteran’s claim to obtain an additional medical opinion from a pain management specialist regarding whether the initial medication management plan itself (to prescribe long-term high dose opioids) constituted carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA. In December 2020 an addendum opinion report from a pain medicine specialist was added to the record; however, the opinion report merely stated that the requested opinions could not be provided without resort to speculation because the opinion request did not specify what the claimed disabilities were. In January 2021 another addendum opinion report was obtained from the same pain medicine specialist. The report stated that it was less likely than not that the Veteran’s dementia, body chills, extreme body pain, and insomnia were related to inappropriate pain medicine reduction. The clinician noted that while some of these symptoms (all except dementia) may happen for a short period while tapering opioids, these symptoms will resolve. This reaction was found to be idiosyncratic with an unclear etiology and had no correlation to the withdrawal process. Unfortunately, the pain medicine specialist did not provide the requested opinion regarding whether the initial pain management plan to place the Veteran on long-term high dose opioids constituted carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA. Therefore, the AOJ did not accomplish the objectives set forth in the October 2020 Board remand. Where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Consequently, a remand is required. The matter is REMANDED for the following action: Return the claims file and a copy of this remand to the pain medicine specialist who provided the January 2021 addendum medical opinion, if available. If not available, the requested opinions should be provided by another similarly-qualified clinician. The clinician is asked to review the claims file, to include a copy of this remand, and address the following: a) Is it at least as likely as not (50 percent or greater probability) that the dose and/or duration of opiates prescribed to the Veteran were the result of negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA? It would be of assistance to the Board if the clinician could describe the standard of care for prescribing opioids at the time they were initially prescribed for the Veteran and discuss whether that standard of care was met. A complete rationale for all stated opinions must be provided. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Redman, 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.