Citation Nr: 21028873 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 16-35 158 DATE: May 12, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include schizophrenia, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1989 to July 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. The Board remanded the claim in November 2018 for further development of the record. 1. Entitlement to service connection for an acquired psychiatric disorder, to include schizophrenia, is remanded. This matter was previously before the Board in November 2018, at which time the Board remanded the claim for the purpose of affording the Veteran a VA examination with accompanying etiology opinion. The Veteran was scheduled for an examination on September 12, 2019, but as stated in the August 2020 supplemental statement of the case (SSOC), he failed to appear for the examination. However, VA treatment records reflect that the Veteran was hospitalized for a lengthy period of time after suffering a major stroke in early 2019. These records also show that the Veteran sustained significant residual impairments in communication and physical limitations and that he was transferred to a nursing home/rehabilitation facility in May 2019. In an October 2020 communication, the Veteran's attorney confirmed that the Veteran has resided in a rehabilitation/nursing home facility since his stroke and that he is unable to communicate meaningfully and/or travel to VA examinations. The attorney requested that the Board remand the matter back to the AOJ for a VA opinion (without examination) given the Veteran's limited ability to currently participate and assist in his appeal. In light of the foregoing, the Board finds good cause for the Veteran's failure to appear at the September 2019 examination. Further, given the Veteran's noted impairments and inability to travel, on remand, his file should be forwarded to an appropriate VA clinician and the clinician should attempt to provide an etiological opinion based upon the record. The matters are REMANDED for the following action: 1. Obtain all outstanding records of VA treatment. 2. Forward the claims file to an appropriate clinician and attempt to obtain an etiological opinion based upon the record. The entire claims file must be reviewed. The clinician should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that schizophrenia, and/or any other acquired psychiatric disorder shown by the record, (i) had its onset during service, (ii) had its onset within the initial year after separation from service as a psychosis*, or (iii) is otherwise related to service, to include his reported exposure to situational stressors while serving in Saudi Arabia from September 1990 to March 1991. *In addressing the above, the examiner is on notice that psychoses, such as schizophrenia, are considered by VA to be "chronic" diseases, and thus, service connection may be presumed if such a disease initially manifested to a degree of 10 percent within the Veteran's initial; post-service year. The clinician is advised of, and invited to comment on the following: (a) the December 2010 VA examination report in which the VA examiner diagnosed a psychotic disorder "which was likely further exacerbated by increased environmental stressors inherent to military service within an active combat zone." (b) the Veteran's statements as to the onset of psychiatric symptoms as early as 1993 and 1994. (c) October 2010 lay statements from the Veteran's mother regarding his mental health immediately following service. (d) VA psychiatry notes dated in 2010 and 2011 in which the Veteran's mother and cousin reported changes in the Veteran's behavior after his discharge from service ("disorganized behaviors beginning, including isolation and acting as though he were in the field, after his military experience and continuing since that time"). A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide any requested opinion without resorting to mere speculation, this should be so stated along with supporting rationale. 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 the particular question. 3. Readjudicate the issue on appeal. If the benefit is not granted to the fullest extent, the Veteran and his private attorney must be provided a copy of this readjudication and be afforded the applicable opportunity to respond. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Hoeft 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.