Citation Nr: 21032507 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 14-38 866 DATE: May 27, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1983 to June 1986, and from December 1986 to May 1992. He died in January 2010. At the time of her claim, the Appellant was the Veteran's surviving spouse. She appealed a November 2010 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) denying entitlement to service connection for the cause of the Veteran's death. In a December 2018 decision, the Board denied the claim. The Appellant appealed that denial to the Court of Appeals for Veterans Claims (Court). In February 2020, the Court granted a Joint Motion for Remand (JMR) filed by representatives for both parties and remanded the claim to the Board for further proceedings consistent with the JMR. The Board remanded the matter in November 2020 for additional development. The case has returned to the Board for further appellate proceedings. The Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board's prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board's November 2020 remand directed that the Appellant be provided an opportunity to identify any pertinent medical records, and thereafter associate those records with the claims file, as well as all outstanding service personnel records, VA medical records, and any records identified by the Appellant. Personnel records were subsequently obtained, and the Appellant was sent a letter requesting she identify any other sources of pertinent records. The Appellant submitted a response in January 2021, identifying the VA Hospital Clinic in Fresno, California for the period from 2009 to 2010. A January 2021 Medical Records Request Reject Notice stated that the request for those records was denied because a death certificate was needed. Review of the claims file suggests no further action was taken on this matter. Accordingly, the AOJ is requested to take steps necessary to obtain any outstanding VA medical records. The Board also directed that the AOJ obtain an opinion from an appropriate clinician regarding the nature and etiology of any diagnosed psychiatric condition and its contribution, if any, to the Veteran's cause of death. The clinician was asked to opine on any diagnosis of PTSD the Veteran may have had at the time of his death, as well as any other acquired psychiatric disorders, and whether any conditions so identified were related to service. If any condition was deemed related to service, the clinician was to opine whether such conditions contributed substantially or materially, combined to cause, or aided or lent assistance to the production of death. A medical opinion was obtained in March 2021. The clinician reviewed the evidence of record, noting the Veteran's January 2010 request for VA mental health counseling and assessment of mood disorder and insomnia. The clinician then opined that the facts contained in the record did not support a full stand-alone diagnosis for PTSD. A revised opinion was requested and subsequently obtained in April 2021. The clinician concurred with the March 2021 opinion, stating that there was no evidence of a comprehensive exam rendering a diagnosis of PTSD and that multiple negative PTSD screens were noted in the record. The clinician further stated that records indicating insomnia, fatigue, and intrusive thoughts did not necessary indicate a DSM 5 diagnosis of PTSD. The March 2021 and April 2021 opinions do not comport with the Board's remand instructions. The clinician was asked to address PTSD as well as any other acquired psychiatric disorders that the Veteran may have been diagnosed with at the time of his death. The clinician failed to address diagnoses other than PTSD. Accordingly, remand is required for a new opinion. This matter is REMANDED for the following actions: 1. Afford the Appellant an opportunity to identify any pertinent medical records relating to the Veteran, including those associated with any periods of employment or incarceration. Thereafter, obtain and associate with the claims file VA treatment records and any pertinent records identified by the Appellant. 2. After the above has been completed together with any additional development warranted by the record, obtain an opinion from an appropriate clinician regarding the nature and etiology of any diagnosed psychiatric condition and its contribution, if any, to the Veteran's death. The opinion should be obtained from a clinician other than the author of the March 2021 and April 2021 opinions. The entire claims file must be provided to, and reviewed by the clinician. The reviewing clinician is asked to opine on the following: a) If a PTSD diagnosis is supported by the record, whether it is at least as likely as not related to an in-service stressor. The clinician should specify: a. What stressor(s) was sufficient to produce PTSD; b. Whether the remaining diagnostic criteria to support the diagnosis of PTSD have been satisfied; and c. Whether there is a link between the Veteran's symptomatology and one or more of the in-service stressors. b) For each diagnosed acquired psychiatric condition other than PTSD, whether it is at least as likely as not that such condition had its onset during, or is otherwise related to, the Veteran's active duty service. c) If and only if a diagnosed psychiatric condition, to include PTSD, is found to be related to the Veteran's active duty service, whether such condition or conditions at least as likely as not contributed substantially or materially, combined to cause, or aided or lent assistance to the production of death. The reviewing clinician is advised that the Appellant is competent to report the Veteran's symptoms and history of which she is personally aware. The term "at least as likely as not" does not mean within the realm of medical possibility. Rather, it means that the weight of the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion as it is to find against the conclusion. Any opinion expressed by the reviewing clinician should be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the reviewing clinician should identify and specifically cite each reference material utilized. If the reviewing clinician is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. 3. Thereafter, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Pelican, Luke H. 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.