Citation Nr: 21042692 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-05 464A DATE: July 13, 2021 REMANDED Entitlement to service connection for weakness, to include as secondary to service-connected PTSD is remanded. Entitlement to service connection for a respiratory condition, to include as secondary to service-connected PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1982 to January 1994. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, the Board remanded this case for further development. Thereafter, a July 2020 rating decision granted the Veteran's claims for service connection for fatigue and headaches. Thus, only the Veteran's claims for weakness and a respiratory condition are on appeal. 1. Entitlement to service connection for weakness, to include as secondary to service-connected PTSD is remanded. 2. Entitlement to service connection for a respiratory condition, to include as secondary to service-connected PTSD is remanded. While the Board sincerely regrets further delay, a fully-informed decision on the issue of entitlement to service connection can not be made because there has not been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). In December 2018, the Board remanded this case to obtain VA examinations to address whether the Veteran's weakness and respiratory condition were related to his service or caused or aggravated by his service-connected PTSD, to include any medications for it. The Veteran was afforded a VA examination for his weakness and respiratory condition in March 2020. The examiner opined the Veteran's weakness and respiratory condition were not related to his service-connected PTSD. The only rationale provided was a list of physical symptoms caused by PTSD. The examiner noted weakness and respiratory conditions were not on this list, and are not known to be caused by PTSD. The examiner focused on PTSD factors without describing the etiology specifically for the Veteran's weakness and respiratory condition. Additionally, the examiner failed to discuss direct service connection, aggravation, and the relationship to any medications used to treat PTSD. Therefore, the Board finds this opinion inadequate. Thus, a remand is necessary to obtain an addendum opinion to determine whether the Veteran's weakness and respiratory condition are related to service or caused or aggravated by his PTSD, to include medications for it. The matters are REMANDED for the following action: 1. Obtain all VA treatment records not currently associated with the claims file. 2. Obtain an addendum opinion by an examiner with appropriate expertise for the Veteran's weakness and respiratory condition. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's weakness and respiratory condition: A) had its clinical onset during active service or is related to any in-service disease, event, or injury. B) is proximately due to his service-connected PTSD and any medication for it. C) has been aggravated (worsened beyond natural progression) by his service-connected PTSD and any medication for it. In addressing the questions (b) and (c), please note that there is no temporal requirement that the primary condition (service-connected disability) be service-connected, or even diagnosed, at the time the secondary conditions (weakness and a respiratory condition) were incurred, and reliance on this fact will render any opinion inadequate. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. Specifically, the examiner should address the factors that affect the Veteran rather than list them. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Papacalos, 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.