Citation Nr: 1018079 Decision Date: 05/14/10 Archive Date: 05/26/10 DOCKET NO. 05-31 298 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include anxiety disorder REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD S. Lipstein, Associate Counsel INTRODUCTION The Veteran had two distinct periods of active military service. He had active duty service from September 1954 to September 1956, and he had active duty service from May 1958 to June 1976. This matter came before the Board of Veterans' Appeals (Board) on appeal from a July 2004 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. This matter was remanded in June 2008 and September 2009. A review of the record shows that the RO has complied with all remand instructions to the extent possible. Stegall v. West, 11 Vet. App. 268 (1998). In November 2007, a hearing was held before Mark W. Greenstreet, the Veterans Law Judge designated by the Chairman to conduct that hearing, pursuant to 38 U.S.C.A. § 7107(b)(c) (West 2002). A copy of the transcript of that hearing is of record. FINDING OF FACT An acquired psychiatric disorder, anxiety disorder, began during service. CONCLUSION OF LAW An acquired psychiatric disorder, anxiety disorder, was incurred in active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 4.125(a) (2009). REASONS AND BASES FOR FINDING AND CONCLUSION Criteria & Analysis Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as psychoses, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service Reports of Medical Examinations dated in September 1956, February 1958, January 1961, March 1964, March 1967, April 1973, and for separation purposes in May 1976, reflect that the Veteran's 'psychiatric' condition was clinically evaluated as normal. Reports of Medical History dated in January 1961 and March 1967 reflect that the Veteran checked the 'no' boxes for depression or excessive worry, frequent trouble sleeping, and nervous trouble of any sort. The Board notes that the Veteran's service personnel records reflect that the Veteran is a recipient of several service medals, including an Award of the Army Commendation Medal for meritorious achievement while participating in ground operations against a hostile enemy force in the Republic of Vietnam, an Award of the Air Medal for meritorious achievement while participating in aerial flight in the Republic of Vietnam, and three Award of the Bronze Star Medal for meritorious achievement not involving participation in aerial flight, in connection with ground operations against a hostile enemy force in the Republic of Vietnam. VA outpatient treatment records dated in October 2003 reflect that the Veteran was assessed with depression. The Veteran underwent a VA examination in February 2007. He reported insomnia, low energy, and feelings of guilt about "The things that I did in my past." He stated that he had intrusive thoughts about his service time. He reported cognitive problems related to his time in the service and that he could not remember names. He stated that he drank about 6 to 8 shots of whiskey per day. He reported that these symptoms occurred daily and were of moderate severity. Following mental status examination, the examiner diagnosed adjustment disorder with depressed mood, as well as alcohol dependence, phase of life problem, and nicotine dependence in full sustained remission. The examiner opined that it is more likely than not that the Veteran's mood symptoms are a combination of his increased substance use and attempts to deal with worsening vision. The Veteran underwent another VA examination in April 2009. He reported feeling depressed, anhedonia, increased irritability, past passive suicidal ideations, and low energy. Following mental status examination, the examiner diagnosed anxiety disorder, not otherwise specified; alcohol dependence, in partial remission; and substance-induced mood disorder. The examiner noted that alcohol use is likely a means for coping with PTSD-related symptoms. The examiner opined that the anxiety disorder is due to or a result of military service. The examiner noted that the Veteran reported a chronic history of alcohol abuse since his return from Vietnam. The examiner opined that the Veteran's depressive symptoms are more likely than not associated with the chronic use of alcohol. In addition, the examiner noted that the alcohol use is more likely than not a means of coping with his combat-related experiences and subsequent symptoms of anxiety. The Veteran underwent another VA examination in October 2009. The examiner noted that the Veteran's claims file records showed multiple awards for "meritorious achievement while participating in ground operations against a hostile enemy force in the Republic of Vietnam" as well as "participating in sustained aerial flight in support of ground forces." He was noted to have participated in 25 aerial missions over hostile territory in support of operations against communist aggression. His DD Form 214 showed that the Veteran was awarded several other awards. The examiner noted that the Veteran reported a chronic history of alcohol abuse since his return from Vietnam. The examiner opined that the Veteran's depressive symptoms reported are more likely than not associated with the chronic use of alcohol, and that the alcohol use was more likely than not a means of coping with his combat related experiences and subsequent symptoms of anxiety. Based on all of the above, the examiner opined that the Veteran's anxiety disorder is most likely caused by or a result of military service. The Board finds that there is evidence of an acquired psychiatric disorder, i.e., anxiety disorder. There is also evidence linking the Veteran's anxiety disorder to the Veteran's military service. The Veteran is entitled to have the benefit of the doubt resolved in his favor, and the Board concludes that there is sufficient evidence linking the Veteran's current anxiety disorder to his military service. See 38 U.S.C.A. § 5107(b). Therefore, as the medical evidence demonstrates that an anxiety disorder was caused by the Veteran's military service, entitlement to service connection for that acquired psychiatric disorder is granted. Per DSM-IV, both generalized anxiety disorder and post-traumatic stress disorder are classified under the general diagnostic classification of "anxiety disorders". As they are both subtypes of the same diagnostic entity, there is no need to parse the components of each for rating purposes. There is no need to undertake any review of compliance with the Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations in this case since there is no detriment to the Veteran as a result of any VCAA deficiency in view of the fact that the full benefits sought by the Veteran are being granted by this decision of the Board. See generally 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.156(a), 3.159 and 3.326(a). ORDER Service connection for an anxiety disorder is granted. ____________________________________________ MARK W. GREENSTREET Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs