Citation Nr: 21042054 Decision Date: 07/11/21 Archive Date: 07/11/21 DOCKET NO. 16-49 451 DATE: July 11, 2021 REMANDED Entitlement to service connection for a left leg condition is remanded. Entitlement to service connection for diabetes mellitus, type II is remanded. Entitlement to service connection for a left eye condition is remanded. Entitlement to service connection for a heart condition is remanded. Entitlement to service connection for a cervical spine condition is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1972 to January 1982 in the United States Air Force. The Board remanded the appeal in August 2019; however, there has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). All of the claims must be remanded again because the medical opinions obtained after the most recent remand are inadequate. 1. Entitlement to service connection for a left leg condition is remanded. The February 2020 VA medical opinion obtained after remand is inadequate. The examiner said there was no diagnosed leg condition related to service because the Veteran had pre-existing left leg symptoms. That opinion is inadequate because there was no left leg defect noted on the Veteran's 1972 enlistment examination. 2. Entitlement to service connection for diabetes mellitus, type II is remanded. The February 2020 VA medical opinion is inadequate because the examiner included insufficient rationale. The examiner referenced a lack of medical literature and research studies to support such a theory of causation, but the examiner's reference to medical literature is unclear, as it is not specified what medical literature or research studies the examiner was referring to. Further remand is necessary. 3. Entitlement to service connection for a left eye condition is remanded. The February 2020 VA medical opinion is inadequate. The examiner said the Veteran's diagnosed left eye conditions are separate conditions not related to his in-service left eye condition, but did include any additional rationale beyond that conclusory statement. 4. Entitlement to service connection for a heart condition is remanded. The February 2020 VA opinion is inadequate. The examiner concluded that the Veteran had pre-existing complaints of chest pain, pressure, and shortness of breath, so no heart condition is etiologically related to his active duty complaints of chest pain. Although the Report of Medical History at enlistment included the Veteran's report of shortness of breath and chest pain after running, clinical examination was normal, and no specific defect was noted on examination. The opinion on remand must provide sufficient information for the Board to consider the presumption of soundness. 5. Entitlement to service connection for a cervical spine condition is remanded. The February 2020 VA opinion is inadequate. The accompanying VA medical opinion stated, in part, that the Veteran's entrance examination noted cervical pain, "which would mean that the Veteran's neck pain started prior to his service." The basis of that opinion is inadequate because no cervical spine defect was noted on enlistment examination; the Veteran is presumed sound. The opinion on remand must consider the appropriate standard for addressing the presumption of soundness. 6. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD. The February 2020 VA opinion is inadequate because that examiner considered that some of the claimed stressors were "confirmed;" however, that determination is not within the examiner's purview. The prior remand directed the AOJ to contact the Veteran for additional stressor information and then take all appropriate action needed to corroborate the stressors. The Veteran responded to that request for information in December 2019 and January 2020; however, the AOJ took no additional steps to corroborate the stressors. The Board specifically directed that, prior to the examination, the AOJ was to tell the VA examiner what stressors were verified and that the opinion may only consider those verified stressors. That was not done prior to the February 2020 examination. The matters are REMANDED for the following action: 1. Take all appropriate action to corroborate the Veteran's in-service stressors, including his report of terrorist attacks on a plane at the Paris airport, being detained following this incident, and witnessing plane crashes in Turkey while pulling security on a US Airforce Base. Review the Veteran's December 2019 and January 2020 submissions. 2. After completion of the above, schedule the Veteran for a psychiatric examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of any acquired psychiatric disability, including PTSD, found to be present. Copies of all pertinent records must be made available to the examiner for review. (a) Prior to the examination, the AOJ must specify for the examiner the stressor or stressors that it is determined are established by the record, and the examiner must be instructed that only those events may be considered for the purpose of determining whether the Veteran was exposed to one or more stressors in service. (b) The examiner should conduct the examination with consideration of the current diagnostic criteria for PTSD. The examination report should include a detailed account of all pathology present. Any further indicated special studies, including psychological studies, should be accomplished. (c) If a diagnosis of PTSD is appropriate, the examiner should specify (1) whether each alleged stressor found to be established by the evidence of record was sufficient to produce PTSD; (2) whether the remaining diagnostic criteria to support the diagnosis of PTSD have been satisfied; and (3) whether there is a link between the current symptomatology and one or more of the in-service stressors found to be established by the record by the AOJ and found to be sufficient to produce PTSD by the examiner. (d) If the examination results in a psychiatric diagnosis other than PTSD, the examiner should offer an opinion as to the etiology of the non-PTSD psychiatric disorder, to include whether it is at least as likely as not that any currently demonstrated psychiatric disorder, other than PTSD, is related to the Veteran's military service, including any verified stressors in service. In rendering the opinions, the examiner must consider and comment reports of the Veteran. A complete rationale should be given for all opinions and conclusions expressed. 3. Forward copies of all pertinent records to appropriate clinicians to obtain the following medical opinions on the likely etiology of the claimed disabilities: (a) For the left leg: (i) did a left leg disability clearly and unmistakably (i.e., it is undebatable) exist prior to his active service that began in 1972? The examiner should consider and discuss as necessary the 1972 enlistment examination and related Report of Medical History. (ii) If the answer to (i) is yes, does the evidence clearly and unmistakably show (i.e., it is undebatable) that the left leg disability was not aggravated by service or that any increase in disability was due to the natural progression of the condition? Please identify such evidence with specificity. (iii) If the answer to either (i) or (ii) is no, is it at least as likely as not that the Veteran's left leg disability had its onset in service, including a fall that the Veteran was treated for during service? (b) For the diabetes mellitus, (i) is at least as likely as not related to active duty service, specifically his diet during active duty. The examiner must cite any medical literature discussed in providing this opinion. (c) For the left eye condition, (i) is at least as likely as not related to in-service left eye injury and blurred vision noted at separation. (d) for the heart condition, (i) did a heart disability clearly and unmistakably (i.e., it is undebatable) exist prior to his active service that began in 1972? The examiner should consider and discuss as necessary the 1972 enlistment examination and related Report of Medical History. (ii) If the answer to (i) is yes, does the evidence clearly and unmistakably show (i.e., it is undebatable) that the heart related disability was not aggravated by service or that any increase in disability was due to the natural progression of the condition? Please identify such evidence with specificity. (iii) If the answer to either (i) or (ii) is no, is it at least as likely as not that a currently diagnosed heart related disability had its onset in service? (e) For the cervical spine: (i) did a cervical spine disability clearly and unmistakably (i.e., it is undebatable) exist prior to his active service that began in 1972? The examiner should consider and discuss as necessary the 1972 enlistment examination and related Report of Medical History. (ii) If the answer to (i) is yes, does the evidence clearly and unmistakably show (i.e., it is undebatable) that the cervical spine disability was not aggravated by service or that any increase in disability was due to the natural progression of the condition? Please identify such evidence with specificity. (iii) If the answer to either (i) or (ii) is no, is it at least as likely as not that the Veteran's cervical spine disability had its onset in service, including a fall that the Veteran was treated for during service, to include an injury during hand to hand combat training, as described in his sworn testimony? A complete rationale should be given for all opinions and conclusions expressed. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.