Citation Nr: 21026262 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 17-62 027 DATE: April 30, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disability to include bipolar disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1969 to March 1972. This matter initially came before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision issued by the Agency of Original Jurisdiction (AOJ). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in March 2019. The transcript is of record. The appeal was remanded in April 2019 for further development to include obtaining an adequate medical opinion as to the nature and etiology of the Veteran’s psychiatric disorders. New VA examinations and medical opinions were associated with the file in May 2019 and September 2020. The Board finds the medical opinions are inadequate. Thus, the Board determines that there has not been substantial compliance with the April 2019 remand directives, and further remand is required. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for an acquired psychiatric disability to include bipolar disorder is remanded. In the April 2019 remand, the Board requested a VA examiner identify any additional psychiatric disabilities outside of posttraumatic stress disorder (PTSD). The May 2019 examiner noted that since the Veteran began seeking mental health services, he has been diagnosed with major depressive disorder, alcohol-related mood disorder, panic disorder, PTSD, and alcohol dependence. However, the examiner diagnosed the Veteran with only PTSD and alcohol use disorder. In a September 2020 addendum, the examiner noted that the Veteran had also recently been diagnosed with a neurocognitive disorder. The examiner did not opine as to direct service connection for any of the identified conditions. As to secondary service connection, the examiner addressed only the alcohol use and neurocognitive disorders neglecting to explain why the Veteran was no longer diagnosed with major depressive disorder or panic disorder. The examiner did not provide an opinion as she concluded she could not make any assertions about a causal relationship between the Veteran’s PTSD and neurocognitive or alcohol use disorders without resorting to speculation. The Board notes, the examiner found the Veteran’s problematic alcohol use began in service. She documented the Veteran’s reports that he did not use alcohol whatsoever prior to service and that his use of substances escalated dramatically after being assaulted by other service members. Importantly, the examiner did not cite the medical literature which supports her assertion that continued substance abuse is not a form of self-medication nor did she acknowledge the medical literature that contradicts this theory. Therefore, further remand is required to ensure compliance with the April 2019 remand directives. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for his disabilities. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records. 2. Schedule the Veteran for an appropriate VA examination with an appropriate VA examiner, other than the May 2019 examiner, to determine the etiology of the Veteran’s psychiatric disorders. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. All studies, tests, and evaluations should be performed as deemed necessary by the examiner, and the results of any testing must be included in the examination report. After considering the pertinent information in the record in its entirety, the VA examiner should identify any additional psychiatric disabilities outside of PTSD. The examiner must address all prior diagnoses to include major depressive disorder, bipolar disorder, panic disorder, alcohol use disorder, and neurocognitive disorder. If the examiner finds that the Veteran does not have a current diagnosis for any of these conditions the examiner must provide an opinion as to whether the prior diagnoses were in error, and if so why, or if the condition has resolved, and if so why. The examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that any other acquired psychiatric disability identified, including major depressive disorder, bipolar disorder and neurocognitive disorder, if still present, were incurred in or aggravated by his active duty OR whether it is at least as likely as not caused by or aggravated by his PTSD. As to the Veteran’s diagnosed alcohol use disorder, the examiner is asked to opine as to whether it is at least as likely as not caused or aggravated by his PTSD. In providing an opinion, the examiner should comment on the September 2, 2009 VA treatment note wherein the Veteran’s treating psychiatrist wrote: “This veteran appears to self-medicate his symptoms of trauma and mood disturbance with alcohol.” All opinions must be accompanied by a clear rationale. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 3. Ensure that the examination report complies with this remand and the questions presented in this request. If the report is insufficient, it must be returned to the examiner for necessary corrective action, as appropriate 4. After completing the requested actions and any additional notification and/or development deemed warranted, readjudicate the issues on appeal. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Sherman 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.