05-26 178, 05-26 178

Veteran served on active duty (1976–1979) and in Army National Guard/Reserves; claims psychiatric disorder related to service and to residuals of a service-connected bilateral mammectomy.
Initial RO denial (Jan 2004); Board denied in Nov 2007; Veteran appealed to CAVC and parties jointly remanded for further development; multiple remands followed (Board Oct 2009, Dec 2011, May 2016).
Board ordered a VA psychiatric examination that included claims-file review and explicit consideration of the Veteran’s lay statements (e.g., “makes him less of a man,” multiple suicide attempts) and required reasoned opinions.
A February 2013 C&P and a June 2016 C&P were obtained but found inadequate: the examiner failed to address the Veteran’s specific lay assertions and did not give a clear rationale for absence of a psychiatric diagnosis or nexus opinion.
Board found lack of substantial compliance with remand directives and ordered another VA psychiatric exam or, if unavailable, an attempted opinion without exam; directed readjudication afterward and issuance of a supplemental statement of the case if benefits remain denied.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the Veteran has a diagnosed psychiatric disorder and whether it is service-connected, including secondary to bilateral mammectomy residuals	Veteran asserts he is depressed, feels “less than a man,” had failed relationships, and attempted suicide due to mammectomy scars; requests nexus opinion and diagnosis	VA/RO asserts prior examinations/evidence do not establish a psychiatric diagnosis or nexus; submitted C&P exams concluding records do not support claim	Board remanded for a new, compliant VA psychiatric examination or opinon that (1) determines diagnosis with clear rationale and (2) addresses nexus to service/service-connected mammectomy and the Veteran’s lay statements; prior exams inadequate and must be redone

Stegall v. West, 11 Vet. App. 268 (1998) (Board/RO must substantially comply with remand instructions)
D'Aries v. Peake, 22 Vet. App. 97 (2008) (requirement of substantial compliance with Court or Board remand)
Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA examinations must be adequate for rating purposes)
Kutscherousky v. West, 12 Vet. App. 369 (1999) (appellant may submit additional evidence/argument after remand)