Citation Nr: 21029946 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 15-35 330 DATE: May 17, 2021 REMANDED Entitlement to service connection for residuals of a cerebrovascular accident (CVA), claimed as secondary to service-connected Post-Traumatic Stress Disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran was a member of the United States Army National Guard. He had a period of active duty training from October 1979 to February 1980. He served for periods of active duty from November 1990 to September 1991 and January 2003 to November 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision by the Regional Office (RO) of the United States Department of Veterans Affairs (VA). The Board notes that the Veteran requested a hearing before a Veterans Law Judge in connection with his appeal. However, he was a "no show" for the scheduled hearing and has not provided any good cause for his failure to appear or requested rescheduling. The hearing request is considered withdrawn. 38 C.F.R. § 20.704. This matter was previously before the Board in February 2019 and September 2020, at which time it was remanded for further development. Most recently, the Board remanded the issue for an addendum opinion and for additional attempts to obtain private treatment records. Addendum opinions were obtained in March 2021 and the Veteran was provided a subsequent development letter requesting any treatment records from relevant private providers, including those identified in the September 2020 remand instructions. The matter is again before the Board. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 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. The Board finds that the Agency of Original Jurisdiction (AOJ) did not substantially comply with the September 2020 remand directives. As such, another remand is warranted. With regard to private medical records, the September 2020 remand directed that the Veteran be asked to supply releases for any private care providers, including Dr. Laubenthal, DCH Regional Medical Center, and Pickens Family Practice Center. Two attempts were required. The initial contact with the Veteran, a September 2020 letter, simply cut and pasted the Board direc5ive into a boilerplate paragraph, resulting in a confusing mishmash. Worse, the Veteran's response supplied an unnecessary release for a VA facility, and VA compounded the confusion by attempting to develop for the VA records as private records, even after being informed the wrong development process was being used. The Veteran was not again contacted about his private treatment records. The efforts are inadequate, and remand is again required for private records. Additionally, the February 2020 remand instructed that a new opinion was necessary to address whether the Veteran's CVA was at least as likely as not directly caused by service or whether it was secondary to or aggravated by the Veteran's service-connected PTSD, to include medications taken for that condition. In the March 2021 addendum opinions, the examiner stated that none of the Veteran's medications were known to be risk factors for stroke, but such fails to address whether PTSD could have caused or aggravated a CVA by some other mechanism. The examiner noted strokes are due to interruption of blood flow or the bursting of a blood vessel, but did not discuss how such might be impacted by PTSD. Accordingly, the opinions are inadequate, as they are incomplete. The matters are REMANDED for the following action: 1. Contact the Veteran and request properly executed, releases for any private care providers who have treated him for his stroke or associated residuals. Releases for Dr. Laubenthal, DCH Regional Medical Center, Dr. E. Ray Stewart, and Pickens Family Practice Center must be specifically, and clearly, requested. Upon receipt of such, VA must take appropriate action to contact the identified providers and request complete treatment records. The Veteran should be informed that in the alternative he may obtain and submit the records himself. 2. Obtain an addendum opinion from a suitably qualified clinician other than the doctor who opined in March 2021; the claims file must be reviewed in conjunction with such. The need for an additional in-person examination is left to the discretion of the medical professional offering the addendum opinion. The clinician must opine as to whether it is at least as likely as not (50 percent probability or higher) that the Veteran's CVA was caused or aggravated by the Veteran's service-connected PTSD, including but not limited to any medications taken to treat the PTSD. A full and complete rationale is required for all opinions expressed. 3. Upon completion of the above, and any additional development deemed appropriate, readjudicate the remanded issue. If the benefit sought remains denied, the Veteran should be provided with a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.P. Faris 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.