Citation Nr: 1305124 Decision Date: 02/12/13 Archive Date: 02/21/13 DOCKET NO. 95-27 478 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUE Entitlement to service connection for a psychiatric disorder. REPRESENTATION Veteran represented by: Daniel G. Krasnegor, Attorney at Law ATTORNEY FOR THE BOARD Debbie A. Breitbeil, Counsel INTRODUCTION The appellant is a Veteran who served on active duty from July 1971 to July 1974. This case is before the Board of Veterans' Appeals (Board) on appeal from a June 1995 decision by a Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts. The case was initially before the Board in June 1998, when the Board denied the Veteran's appeal to reopen a claim of service connection for a psychiatric disorder on the basis that new and material evidence had not been presented. He appealed that decision to the United States Court of Appeals for Veterans Claims (Court). By a November 1998 Order, the Court vacated the June 1998 Board decision, and remanded the matter for readjudication. In an August 1999 decision, the Board again denied the Veteran's appeal in this matter, and he again appealed the Board's decision to the Court. In a March 2001 Order, the Court, in noting the enactment of the Veterans Claims Assistance Act of 2000 (VCAA), vacated the August 1999 Board decision and remanded the matter for readjudication consistent with the VCAA. In August 2001, the Board remanded the case to the RO for additional development, to include furnishing appropriate notice under the VCAA. A May 2003 Board decision again denied the Veteran's appeal, and he again appealed the Board's decision to the Court. In a December 2003 Order, the Court vacated the Board's May 2003 decision, and remanded the matter for action consistent with a December 2003 Joint Motion by the parties, VA Secretary and the Veteran, in essence alleging that VCAA notice had been inadequate. In July 2004, the Board remanded the case to the RO, essentially for compliance with the requests for more complete and accurate notice as identified in the Joint Motion of December 2003. In a June 2005 decision, the Board again denied the Veteran's appeal, and the Veteran again appealed the Board's decision to the Court. In a December 2006 Order, the Court vacated the June 2005 Board decision, and remanded the matter for readjudication consistent with the Order (essentially further notice to the Veteran). VA appealed the Court Order to the United States Court of Appeals for the Federal Circuit (Federal Circuit), which in a December 2007 Order vacated the December 2006 Court Order and remanded the matter to the Court for its consideration of the rule of prejudicial error. In a January 2008 Memorandum Decision, the Court found, in essence, that the Veteran had been prejudiced by inadequate notice, and remanded the matter to the Board for it to address the fact that the Veteran had received "confusing notice." In July 2008 and in August 2009, the Board remanded this matter to the RO for additional development (primarily to provide the Veteran further/accurate notice of the VCAA, and specifically notice of what would constitute new and material evidence sufficient to reopen the claim). In a March 2010 decision, the Board reopened the claim of service connection for a psychiatric disorder, finding that new and material evidence had been presented, and remanded the matter to the RO for further development of the merits of the claim of service connection. In a June 2011 decision, the Board denied the Veteran's claim of service connection for a psychiatric disorder on the merits. The Veteran appealed that decision to the Court. In a May 2012 Memorandum Decision, the Court vacated the Board's June 2011 decision and remanded the matter to the Board for further proceedings consistent with the decision. In November 2012 the undersigned denied the Veteran's attorney's motion seeking recusal by the undersigned. FINDINGS OF FACT 1. An acquired psychiatric disorder is not shown by clear and unmistakable evidence to have pre-existed the Veteran's service. 2. An acquired psychiatric disorder, first diagnosed after service and currently diagnosed as dysthymic disorder and general anxiety disorder, has been related by competent and credible evidence to the Veteran's period of service. CONCLUSION OF LAW Service connection for dysthymic disorder and generalized anxiety disorder is warranted. 38 U.S.C.A. §§ 1110, 1111, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate a claim. As the decision herein is favorable to the Veteran, VCAA compliance need not be addressed. II. Legal Criteria, Factual Background, and Analysis Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in service. This may be accomplished by affirmatively showing inception during service. 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Notwithstanding the above, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). A Veteran is presumed to have been in sound condition when examined, accepted, and enrolled for service except as to defects, infirmities, or disorders noted at the time of examination, acceptance, enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the "correct standard for rebutting the presumption of soundness under section 1111 requires the government to show by clear and unmistakable evidence that (1) the veteran's disability existed prior to service and (2) that the pre-existing disability was not aggravated during service." Wagner v. Principi, 370 F.3d 1089, 1097 (Fed. Cir. 2004). In determining whether a condition preexisted service, the veteran's medical history, accepted medical principles, evidence regarding the basic character, origin and development of the condition, and lay and medical evidence concerning the inception, development and manifestations of the condition must be considered. 38 C.F.R. § 3.304(b); see Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009). VA must give due consideration to all pertinent medical and lay evidence in a case where a veteran is seeking service connection. 38 U.S.C.A. § 1154(a). The Veteran does not argue, and the record does not show, that the claimed disorder was the result of participation in combat with the enemy. Thus, the provisions of 38 U.S.C.A. § 1154(b) do not apply. Competency is a legal concept in determining whether medical or lay evidence may be considered, in other words, whether the evidence is admissible as distinguished from weight and credibility, a factual determination going to the probative value of the evidence, that is, does the evidence tend to prove a fact, once the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer a medical diagnosis, statement, or opinion. 38 C.F.R. § 3.159. The Board, as fact finder, must determine the probative value or weight of the admissible evidence. Washington v. Nicholson, 19 Vet. App. 362, 369 (2005) (citing Elkins v. Gober, 229 F.3d 1369, 1377 (Fed.Cir.2000) ("Fact-finding in veterans cases is to be done by the Board")). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Initially, the Board notes that it has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. The Veteran contends in part that service connection is warranted because he had a psychiatric disability prior to service that worsened during active duty service and continues to the present time. It is noted, however, that there was no psychiatric disorder noted on the Veteran's entrance examination in July 1971. Thus, the presumption of soundness attaches in this case. 38 U.S.C.A. § 1111. The burden then falls on VA to rebut the presumption of soundness by clear and unmistakable evidence that the Veteran's disability was both preexisting and not aggravated by service. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed.Cir.2004). Clear and unmistakable evidence means evidence that cannot be misinterpreted and misunderstood, that is, the evidence is undebatable. Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009) (quoting Vanerson v. West, 12 Vet. App. 254, 258-59 (1999). The Board will first address the evidence as to whether there is clear and unmistakable evidence that a psychiatric disorder preexisted service. The Veteran reports that he had a psychiatric disability that preexisted service. The evidence in support of this contention includes his written statements and reports to certain medical professionals that "he had a difficult childhood and he was particularly prone to becoming anxious and nervous in many situations." See August 2010 VA examination report. The Veteran has also reported that prior to service he was "depressed frequently" and that "his nervousness would be reflected in severe hand tremors." Id. The Veteran reported that his mother died when he was very young, 4 or 5, and that he has believed for years that his father's physical abuse might have caused her death. He reported that the woman his father married shortly after his mother's death was "always yelling at him" and that "he has had nightmares about her for the 20 years after he left home at age 18 to join the service." See February 2007 disability evaluation report prepared by J. C. Beck, M.D., Ph.D. The evidence which is relevant to the preexistence issue also includes written statements from the Veteran's sister, brother, and his father and stepmother. His sister reported that the Veteran was never told what happened to his mother; that he was not comforted for his loss; and that their stepmother "was not nurturing, loving, or nice to us kid's [sic]". She reports that her brothers, including the Veteran, were beaten "for whatever reason it happened to be, at that time" and that the Veteran developed a shaking in his hands which caused him to be made fun of at school. She stated that "the shy and insecure person that he was deep[en]ing into anxiety and depression." The Veteran's brother, who reported that he had not seen the Veteran in well over 20 years, stated, "[m]y brother and I were close throughout our childhood and we shared the same friends. We were in the same High School Fraternity as well. He however experienced debilitating hand tremors and [was] quieter than I, though more athletic. Today I believe his nervousness and quiet temperament was indicative of anxiety and depression, I did not understand or was cognizant of [sic] back in the Sixties." The Veteran's father and stepmother reported that the Veteran "struggled with acute anxiety and chronic depression as well as debilitating hand tremors throughout his childhood" as well as stomach pains. They reported that the Veteran was evaluated by a neurologist at age 12 but they recalled that the findings were inconclusive with no medication prescribed and no follow-up treatment suggested. They reported that since 1975 they have rarely seen the Veteran and that they have not seen him at all for over 20 years. There are also medical reports in the file that are relevant to the question of the preexistence of a psychiatric disorder. In a March 1979 statement, the director of the Veteran's college counseling center indicated that the Veteran had been seen at the counseling center several times in 1977 and 1978. The Director believed the Veteran had "serious psychological problems" that "go back to the loss of his mother in childhood, followed by conflict with his father and stepmother." In a February 2007 private report, J.C. Beck, M.D., Ph.D., Professor of Psychiatry, Harvard Medical School, noted that the records he reviewed consisted of service records, some post-service treatment records, and some letters from his family members. Dr. Beck did not indicate that he reviewed any pre-service records of psychiatric treatment, and the Veteran does not contend that he received any psychiatric treatment prior to service. Dr. Beck concluded that "I cannot determine whether [the Veteran's] symptoms met the criteria for a mental disorder before the service-it was too long ago, and he is not that good of a historian to make the distinctions necessary to decide if symptoms were sufficient to meet a DSM threshold." He added, "I believe he had something before the service." In an August 2010 VA examination report, the examiner concluded that "it is more likely than not that [the Veteran] had anxiety and depressive problems prior to entering the military as a child. The examiner stated that his conclusions were based "primarily on [the Veteran's] reports." He also stated that he agreed with the findings of Dr. Beck. With respect to the lay statements provided by the Veteran, his sister, his brother, and his father and stepmother, it has been held on multiple occasions that lay statements concerning a pre-existing condition, alone, are insufficient to rebut the presumption of soundness. See, e.g., Paulson v. Brown, 7 Vet. App. 466, 470 (1995) (a layperson's account of what a physician may or may not have diagnosed is insufficient to support a conclusion that a disability preexisted service); Crowe v. Brown, 7 Vet. App. 238, 246 (1994) (supporting medical evidence is needed to establish the presence of a pre-existing condition). Moreover, the Veteran and his family members are not competent to establish (i.e., by their own opinions) a diagnosis for psychiatric symptomatology prior to service. A lay claimant is competent to provide testimony concerning factual matters of which he or she has firsthand knowledge (i.e., reporting something seen, sensed or experienced). Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). However, the determination as to whether a psychiatric disorder preexisted the Veteran's service is medical in nature, that is, not capable of lay observation, and competent medical evidence is needed to address that question. See Savage v. Gober, 10 Vet. App. 488, 498 (1997) (on the question of whether the veteran has a chronic condition since service, the evidence must be medical unless it relates to a condition as to which, under case law, lay observation is competent); Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). No factual foundation has been made to establish that the Veteran or his family members are qualified through education, training, or experience to offer a medical diagnosis or establish etiology of the claimed condition. Hence, their statements regarding the presence of an acquired psychiatric disorder prior to the Veteran's period of service are not competent evidence. Moreover, the private and VA medical opinions addressing the existence of a psychiatric disorder prior to service are inconclusive. The college counseling center director's statement relates current psychological problems to childhood trauma and conflict, but the statement provides no diagnosis of a psychiatric disorder prior to service. Dr. Beck stated that although he believed the Veteran had "something" before service, he was unable to determine whether symptoms were sufficient to meet the criteria for diagnosis under the Diagnostic and Statistical Manual of Mental Disorders. He basically concluded that an opinion as to a preexisting psychiatric disorder could not be provided. The VA examiner agreed with Dr. Beck's assessment and that he also believed the Veteran had anxiety and depressive "problems" before service. Such evidence does not rise to the level of being undebatable. In other words, while the Veteran appeared to have psychiatric symptoms or some unspecified type of mental difficulties before service, possibly related to childhood trauma, the evidence does not show that, without question, he had a diagnosed or diagnosable psychiatric disorder in conformity with accepted medical standards and practices at that time. In short, the Board concludes that the evidence does not clearly and unmistakably demonstrate that a psychiatric disorder preexisted the Veteran's service. As preexistence is not shown by clear and unmistakable evidence, the presumption of soundness on service entry is not rebutted. Accordingly, the theory of entitlement to service connection for a psychiatric disorder on the basis that a preexisting psychiatric disorder was aggravated by service is without foundation in the factual record, and must be rejected. In light of the foregoing finding, the next essential question to address is whether the evidence shows that an acquired psychiatric disorder was due to injury or disease that was incurred in service. This theory of entitlement is one of direct service connection. A review of the service medical records indicates that the Veteran was seen at a military mental health care facility in October 1973, but that a diagnostic impression was deferred at that time. The remainder of the records, including a June 1974 report of examination about the time of his separation from service, is negative for any complaints, diagnosis, or treatment of a psychiatric disorder. In fact, in June 1974 the Veteran specifically denied trouble sleeping, depression or excessive worry, loss of memory, and nervous trouble of any sort. Service personnel records indicate that the Veteran received punishment during service for a period of unauthorized leave of six days in October 1973. The Veteran's DD Form 214 shows that his military occupational specialty was "clerk-typist." On the basis of the service records alone, a psychiatric disorder was not affirmatively shown to have had onset during service, and service connection under 38 U.S.C.A. § 1110 and 38 C.F.R. § 3.303(a) (affirmatively showing inception in service) is not established. Furthermore, medical records do not show that a psychiatric disorder was manifest until a few years after the Veteran's service discharge in July 1974. In an August 1978 letter from an Assistant Director for Medical Services at the University of Maine-Orono, it was noted that the Veteran was seen three times in 1977, with chief complaints related to a varicocele on the left testicle, weight loss of undetermined etiology, and paresthesias involving his right hand and leg. The assistant director reported that the Veteran appeared anxious and tremulous on physical examination. The only reference to the Veteran's service was that he reported to the Assistant Director that he was seen for a varicocele while on active duty. In an October 1993 letter, the Director of the Counseling Center at the University of Maine-Orono wrote that while he remembered the Veteran, he could not provide detailed information regarding medical treatment because records of such treatment had been destroyed. However, in an October 1993 letter from the Director of Psychological Services at the University of Maine-Orono, it was reported that a "skeleton record" was kept that indicated the Veteran was seen at a community mental health center in 1978 and 1979. In a March 1979 letter, the Director of the counseling center at the University of Maine-Orono opined that, while the Veteran had serious psychological problems, he had never shared anything of his military experiences, and thus there was no basis for making a judgment about the effects of his military experiences on his mental health. It was noted, however, that it was possible that his service had aggravated his "basic problems." At the time of a VA examination in October 1979, the examiner diagnosed the Veteran with anxiety neurosis with depressive features in a passive-aggressive individual with paranoid traits (impairment, moderate). The examination report related the Veteran's contention that he had changed as a result of service and due to events in service. The VA examiner expressed no opinion regarding a relationship between the current diagnosis of anxiety neurosis and the Veteran's service. In a private report of February 2007, and in an August 2010 VA examination report, Dr. Beck and a VA examiner are in accord as to the Veteran's current diagnoses of dysthymic disorder and generalized anxiety disorder. As psychiatric symptoms were not shown to be chronic in service, then a showing of continuity of symptomatology after service is required to support the Veteran's claim. 38 C.F.R. § 3.303(b). As previously indicated, the medical records do not document psychiatric symptoms until at least 1977, when it was noted by personnel at a university that the Veteran appeared anxious and tremulous on examination. The Veteran was also noted to have been seen at the university mental health center in 1978 and 1979, although information about the nature of the visits and symptoms is not available. In October 1979, a VA examiner diagnosed anxiety neurosis with depressive features. Then, the records show more recent private and VA medical evaluation reports of diagnoses of dysthymic disorder and generalized anxiety disorder. In other words, there are large gaps in the medical record as to the existence and persistence of psychiatric symptomatology from the time of service. The Veteran has attempted to fill these gaps with his own numerous statements in support of his claim and statements from family members. In his statements, he reiterates a contention that he has a psychiatric disability that initially manifested in service. In some statements, he recounted his life experiences in the years immediately following service. For example, he recalled that he attended university but struggled with chronic depression and acute anxiety such that he nearly committed suicide in 1974 and 1978. He also asserts, among other things, that his criminal record many years after service demonstrates that he had a psychiatric disorder that began in service. Of record are extensive state criminal records and court documents pertaining to the Veteran's convictions for various criminal acts, including armed bank robbery. The records indicate that the Veteran was incarcerated for 15 years beginning about 1992; they do not contain any medical evidence relating to a psychiatric disorder, and are negative for any reference to the Veteran's service. The Veteran has also submitted letters from his father and stepmother, and his brother and sister, who recounted the Veteran's change in behavior subsequent to service. The Veteran's parents stated that the Veteran's letters home during basic training "showed signs of extreme stress and emotional unstableness," and they were concerned that he would "have a nervous breakdown or go AWOL before he completed basic." They reported that the Veteran lived with them for several months after his separation from service, and during that time he had appeared very withdrawn, unsocial, and frequently argumentative. The Veteran's brother and sister reported that the Veteran became withdrawn and reclusive after his separation from service, and that after his separation from service "he wasn't the same person. He was more unsocial, angry, and withdrawn." The Board, as fact finder, must determine the probative value or weight of the statements in deciding whether there is continuity of symptomatology. In past reviews of the case before it, the Board has determined that the statements of the Veteran and his family members were either not credible or of minimal probative value. It is noted that the Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In weighing credibility, VA may consider interest, bias, inconsistent statements, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board in a June 2011 decision, which was vacated by the Court in a May 2012 Memorandum Decision, made various findings regarding credibility of lay evidence. For example, the Board found the Veteran's accounts to be self-serving and his reports of preservice history to be inconsistent (such as the conflicting histories he gave to Dr. Beck in 2007 and to a psychologist at the University of Maine in 1979). Further, other evidence showed the Veteran had problems with truthfulness, such as an April 1993 presentencing report revealing counterfeiting charges filed against him in the 1980s, and a history of breaking into lockers at health clubs where he worked out and stealing identification cards. Given the self-serving and inconsistent statements, as well as a criminal history with respect to fraud, the Board had found the Veteran's assertions in support of his claim to be not credible. The Board had also, in its June 2011 vacated decision, found, that the statements of the Veteran's family members were of minimal probative value. For example, there was a question of their objectivity in the matter due to their having had a personal relationship with the Veteran. Given the time that had passed, their recollections of events that occurred decades ago was called into question, especially as they have had very limited contact with the Veteran since 1975 and no contact in more than 20 years. Also, in the context of the Veteran's long history of violent, threatening, and aggressive behavior towards those who offended him or thwarted his plans, the Board believed that any corroborating statements made by his family members could be seen as a result of coercion. It was pointed out that in 1985 the Veteran was jailed for assaulting and beating a police officer who attempted to stop him from stealing money from a locked car, and that in 1986 he was arrested for threatening to injure a United States Senator, a U.S. District Court Judge, and a state Attorney General. For this, he served three years in a federal correctional facility. Then, in December 1992 he was convicted of two counts of assault with the intent to kill (he shot and wounded three men because he believed one of them had made a homosexual advance). The Court in a May 2012 decision found that the Board's assessment regarding the lack of credibility of the lay statements was inadequate, because it did not identify any evidence that supported the determination. [Notably, the Court's Memorandum Decision is the "law of the case".] Without an opportunity to query the family members about their statements to obtain a more complete picture in which the statements were made, the Board is left to consider those statements on their face. While the Board may judge that it had made a reasonable conclusion about the motivating factors underlying the lay statements, in light of the documented behaviors and criminal history of the Veteran and the non-existent contact with his family members for two decades, the Board now feels constrained to accept the lay statements as credible. For the foregoing reasons, then, while continuity of symptomatology has not been established by the clinical record, it is established by the lay witnesses who essentially corroborate the statements of the Veteran with regard to psychiatric symptoms during and following service. 38 C.F.R. § 3.303(b). Further, such psychiatric symptomatology observed by the Veteran and his family members around the time of service or in the years following service has been relied upon by Dr. Beck in February 2007 and by a VA examiner in August 2010 in expressing opinions favorable to the claim that the Veteran's currently diagnosed dysthymic disorder and generalized anxiety disorder are traceable to his period of service. 38 C.F.R. § 3.303(d). As noted, there is no diagnosis of an acquired psychiatric disorder until five years after service. The lay statements of the Veteran's family members serve to document psychiatric symptomatology during and immediately after service, and corroborate the Veteran's allegations of symptoms traceable to service. The medical opinions obtained by the Veteran and by VA are competent evidence that links the current psychiatric diagnoses to disease in service. The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the analytical findings, and the probative weight of a medical opinion may be reduced if the physician fails to explain the basis for an opinion. Sklar v. Brown, 5 Vet. App. 140 (1993). Among the factors for assessing the probative value of a medical opinion are the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). In a previous review of the record, and in a decision vacated by the Court, the Board found the medical opinions addressing etiology of the Veteran's current psychiatric disorder to carry no probative weight because they were based on the Veteran's and other lay accounts of the Veteran's mental health history that the Board had deemed to be not credible. However, as a result of the credibility findings discussed above, there is a basis to find that the medical opinions are probative and entitled to significant weight, particularly as they are based on facts found in the record, predicated on a comprehensive review of the file or most pertinent records in the file, supported by rationale, and uncontradicted by any other medical opinion. Dr. Beck in 2007 noted that he reviewed service records, some post-service treatment records, and some letters from his family members. He believed the Veteran was not a "sufficiently good historian" in order for him to answer the question as to whether the Veteran's current disability was at least as likely as not "present while the veteran was on active duty." Thus, it would seem that because the Veteran was found to be an unreliable historian, Dr. Beck was unable to opine as to whether a chronic acquired psychiatric disability was manifested while the Veteran was on active duty. However, another interpretation is that this appears to be in the context of an inquiry related to furnishing specific symptoms experienced by the Veteran prior to service in an attempt to discern whether a diagnosable mental disorder existed prior to service or whether it actually had onset during service. Dr. Beck subsequently finds that the Veteran's anxiety and depression were aggravated by events in service. Further, in a concluding paragraph, Dr. Beck commented that he believed the Veteran was truthful about his reports of mental difficulties and the distress he suffered, and he believed that the symptoms related to the Veteran's diagnoses were evident during service as a result of his military experience. The VA examiner in 2010 completely agreed with Dr. Beck's assessment of the Veteran's diagnoses. He also concurred with Dr. Beck's finding that the Veteran's anxiety and depression were present during service and that such symptoms have had a "significant impact on his life since getting out of the military" both in a school and employment context. He even attributed the Veteran's criminal history in part to his mental difficulties. He concluded by vouching for the excellent professional reputation of Dr. Beck. In view of the foregoing, there is satisfactory proof that the Veteran has current acquired psychiatric disorders, diagnosed as dysthymic disorder and generalized anxiety disorder, which are related to his period of service. While historically this case has presented questions regarding the credibility of lay evidence, those problems have been resolved in the Veteran's favor. As a result, the favorable medical opinions are entitled to full probative weight and the Veteran's claim for service connection is granted on a direct basis under 38 C.F.R. § 3.303. ORDER Service connection for dysthymic disorder and generalized anxiety disorder is granted. ____________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs