Citation Nr: 1305836 Decision Date: 02/20/13 Archive Date: 02/27/13 DOCKET NO. 10-41 776 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUE Entitlement to service connection for a psychiatric disability, to include posttraumatic stress disorder (PTSD). REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD R. Anderson, Associate Counsel INTRODUCTION The appellant is a Veteran who served on active duty from July 1965 to July 1967. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision of the St. Paul, Minnesota, Department of Veterans Affairs (VA) Regional Office (RO). Notably, when the Veteran filed his claim seeking the benefits at issue, he characterized the disability specifically as the psychiatric entity of PTSD. When the RO adjudicated the matter (apparently in keeping with the holding by the United States Court of Appeals for Veterans Claims (Court) in Clemons v. Shinseki, 23 Vet. App. 1 (2009) that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record) as encompassing both PTSD and the diagnosis of an anxiety disorder which was shown by the record. In keeping with Clemons, the Board has likely characterized the issue to reflect that it is one of service connection for a psychiatric disability, however diagnosed. FINDING OF FACT The Veteran has a diagnosis of anxiety disorder which, by competent medical evidence has been etiologically related to his active duty service. CONCLUSION OF LAW Service connection for anxiety disorder is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The VCAA applies to the instant claim. However, inasmuch as the benefit sought is being granted, there is no reason to belabor the impact of the VCAA on this matter, as any notice error or duty to assist omission is harmless. . Factual Background The Veteran served in Vietnam from January 1966 to January 1967 as an Ammunition Records Clerk. The Veteran's service treatment records (STRs) are silent for any complaints, findings, treatment, or diagnosis related to a psychiatric disability. In a statement dated in April 2009, the Veteran described an alleged traumatic event he experienced while in Vietnam. He stated that in August or September 1966 he killed two persons (a woman and child) who had a grenade (and in his belief posed a threat to him).. In another statement dated in April 2009, the Veteran provided additional accounts of alleged stressor events; he related that he would transport ammunition to the field and bring back wounded soldiers. He recalled picking up a soldier on a stretcher whose right arm had become detached, remaining on the ground. He reported that he picked up the arm, and that such incident continues to bother him. The RO has made a finding that the Veteran's accounts are unaccompanied by sufficient detailed information to allow for corroboration (deaths of civilians are generally not verifiable; the Veteran did not provide identification for the soldier who allegedly lost his arm). The RO arranged for a VA psychiatric evaluation of the Veteran in May 2009. The examiner elicited the Veteran's history, conducted a psychiatric evaluation, and concluded that the veteran did not meet the criteria for a diagnosis of PTSD, but did have a diagnosis of anxiety disorder, NOS (not otherwise specified) which more likely than not was caused by his military service. The Veteran has also submitted the report of a private psychologist who in July 2010 evaluated him from a County Veterans Service Officer. This provider also found that the Veteran did not meet all the criteria for a diagnosis of PTSD, but did have a diagnosis of an anxiety disorder which more likely than not was "a result of his stressful and traumatic experiences while serving in Vietnam". The RO has denied service connection for a psychiatric disability based essentially on a finding that the Veteran had not shown treatment for a psychiatric disability in service or continuity of such treatment postservice. Legal Criteria and Analysis The Board notes that it has reviewed all of the evidence in the Veteran's claims file and in Virtual VA (VA's electronic data storage system), 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) (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. Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially 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). In order to prevail on the issue of service connection, there must be medical evidence of a current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). 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. When all of the evidence is assembled, VA must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is to be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The record does not show that the Veteran served in combat (he did not receive any awards or decorations that denote combat); he has not provided any credible supporting evidence of an alleged stressor event in service; and he does not have a diagnosis of PTSD in accordance with DSM-IV, either VA or private. He does however, have a diagnosis of an anxiety disorder which both a VA psychologist and a private provider have related to the stresses of his military service. While the RO has denied his claim based on the record not showing psychiatric complaints or treatment in service, or any continuity of such complaints/treatment postservice, the Board observes that showing a disability was manifested in service and that there was postservice continuity of complaints/symptoms/treatment since is but one method of substantiating a claim. Another method for substantiating a service connection claim is by showing a current diagnosis of the claimed disability and relating it to service by competent evidence. See 38 C.F.R. § 3.303(d). In the matter of a medical nexus, the RO may not reject the opinion of its designated expert provider and (as appears to be the case here) substitute its own medical judgment. Furthermore, in advising the Veteran that the law requires a diagnosis in service and continuity postservice to substantiate the claim of service connection for an anxiety disorder, the RO simply misstates the law. The Board finds no reason in this case to reject out-of-hand the medical opinion offered by the VA's own designated expert (which is consistent entirely with the opinion by the Veteran's private provider). All the competent (medical) evidence in the matter (both VA and private) shows that the Veteran has a diagnosis of an anxiety disorder; and both the VA and the private psychologists have related the disability to the stress of service. The factual and legal requirements for substantiating the Veteran's claim are met. Service connection for an anxiety disorder is warranted.. ORDER Service connection for an anxiety disorder is granted. ____________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs