Citation Nr: 18140991 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 12-31 466 DATE: October 9, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder other than "other trauma and stressor related disorder," to include a panic disorder and agoraphobia is granted secondary to the Veteran’s service-connected other trauma and stressor related disorder, is granted. FINDING OF FACT The Veteran’s currently diagnosed acquired psychiatric disorder other than “other trauma and stressor related disorder,” to include a panic disorder and agoraphobia, is at least likely as not aggravated by his service-connected other trauma and stressor related disorder. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder other than "other trauma and stressor related disorder," to include a panic disorder and agoraphobia, have been met. 38 U.S.C. §§ 1110, 1112, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Navy from January 1968 to November 1971. The Board notes that the issue of entitlement to a TDIU was raised by Veteran in a May 2017 correspondence. That matter is referred to the regional office for appropriate action. 1. Entitlement to service connection for an acquired psychiatric disorder other than “other trauma and stressor related disorder,” to include a panic disorder and agoraphobia, secondary to the Veteran’s service-connected other trauma and stressor related disorder Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. With regard to a present disability, a November 2015 VA examination diagnosed the Veteran with panic disorder and agoraphobia. Thus, the first element of service connection has been satisfied. In regard to an in service diagnosis, injury or event, the Veteran’s service treatment records (STRs) include no complaint, finding, or diagnosis related to a panic disorder or agoraphobia. Upon separation in October 1971, his examination was normal and he did not endorse any relevant symptoms on his report of medical history at discharge. However, the Veteran has alleged his symptoms of a panic disorder and agoraphobia are due to his experiences being confined to the naval vessel on which he served during the military. Considering the circumstances of the Veteran’s service, the Board finds the Veteran experienced the living situation alleged by the Veteran. Thus, affording the Veteran the full benefit of the doubt, the Board finds the second element of service connection has been established. Turning to nexus, in an August 2010 correspondence, the Veteran has stated his fear of enclosed spaces began while serving aboard naval ships. This was reiterated in an August 2010 VA medical center (VAMC) treatment note in which the Veteran reported his panic disorder developed while on active service. Upon VA examination in November 2015, the Veteran reported he experienced anxiety including fears of being trapped in an elevator, fears of being left alone where no one will find him, and hypervigilance, which he the Veteran reported began as a result of ship refueling operations during service. The Veteran reported his fear of being trapped and panic attacks began after military service. The examiner concluded that while the Veteran stated the refueling operations during military service made him anxious due to a fear of falling overboard, the Veteran was not aware of any symptoms associated with military service until approximately 10 years prior to the examination. The examiner further noted the Veteran’s first panic attack was as a result of being trapped in a trailer post-service. The examiner concluded that it was less likely than not that is panic disorder and agoraphobia developed as a direct result of his military service. Upon VA examination in February 2018, the VA examiner concluded the Veteran’s symptoms related to fear of falling overboard and dying during service are accounted for by the other trauma and stressor related disorder, while the etiology of the panic disorder was the experience of being trapped in a trailer post-service. The preponderance of the evidence weighs against a direct causal relationship between the Veteran’s active service and his acquired psychiatric disorder to include a panic disorder and agoraphobia. As discussed above, during November 2015 VA examination, the examiner opined the Veteran’s panic disorder and agoraphobia were less likely than not caused by or etiologically related to his active service, and the February 2018 examiner related the panic disorder to a post-service incident. Although a 2010 VAMC record notes the Veteran’s assertion that panic disorder began in service and the examiner stated that the panic disorder “apparently” began during service, the Board finds that this opinion, reiterating the Veteran’s assertion without providing any supportive rationale, is insufficient to evidence of nexus. In sum, the medical evidence does not support the Veteran’s military service directly caused his panic disorder and agoraphobia. The question remains if there is a medical nexus between the Veteran’s panic disorder and agoraphobia and one of his service connected disabilities including his service-connected other trauma and stressor related disorder. Upon VA examination in April 2017, the VA examiner concluded the Veteran’s panic disorder and agoraphobia was not cause by or aggravated by his service connected other trauma and stressor related disorder. The examiner provided that the Veteran’s panic disorder and agoraphobia did not develop until many years after his military service, but at least several years before his other trauma and stressor related disorder became symptomatic. Further, the examiner noted the only trigger identified for his other trauma and stressor related disorder was going to the beach at night, which significantly differs from the triggers for panic disorder and agoraphobia. The examiner concluded the different triggers and different periods of development of symptoms do not support that the service-connected other trauma and stressor related disorder aggravates the Veteran’s panic disorder and agoraphobia. In May 2017, the Veteran’s wife submitted a statement that the Veteran has shown signs of claustrophobia and panic disorder since being discharged from military service. She stated the Veteran cannot ride elevators, has problems with public restrooms, crowds, and riding in cars. She further stated the Veteran will panic as a result of simple things, such as his zipper being stuck. She stated the Veteran’s symptoms have increased with age. As previously noted, in February a 2018 VA examination, the examiner concluded the Veteran’s symptoms related to fear of falling overboard and dying during service are accounted for by the other trauma and stressor related disorder, while the etiology of the panic disorder was the experience of being trapped in a trailer post-service. The examiner did, however, find it likely that the other trauma and stressor related disorder aggravated the Veteran’s panic disorder and agoraphobia. The examiner reasoned that the fear of future panic attacks results in avoiding anything which might make him anxious, which includes reminders of his military trauma. (Continued on the next page)   In light of the positive February 2018 opinion, the Board finds that the evidence is, at minimum, in equipoise regarding the question of whether the Veteran’s panic disorder and agoraphobia is aggravated by his service-connected other trauma and stressor related disorder. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.310. The benefit of the doubt will be conferred in the Veteran’s favor, and the service-connection claim for an acquired psychiatric disorder to include panic disorder and agoraphobia is thereby granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Laura A. Crawford, Associate Counsel