Citation Nr: 18142136 Decision Date: 10/12/18 Archive Date: 10/12/18 DOCKET NO. 16-23 157 DATE: October 12, 2018 ORDER The claim of entitlement to service connection for anxiety disorder, adjustment disorder (claimed as post-traumatic stress disorder) is granted. FINDING OF FACT Resolving all doubt in his favor, the Veteran’s anxiety disorder, adjustment disorder (claimed as post-traumatic stress disorder) is causally related to active service. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for anxiety disorder, adjustment disorder (claimed as post-traumatic stress disorder) have been met. 38 U.S.C. §§ 1110, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Army from April 2007 to October 2011. According to the evidence of record, the Veteran was awarded several distinguished service medals to include the Iraq Campaign Medal, Army Commendation Medal, Army Achievement Medal, and National Defense Service Medal. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2018). As the Board’s decision to grant service connection for anxiety disorder, adjustment disorder (claimed as post-traumatic stress disorder) herein constitutes a complete grant of the benefits sought on appeal, no further action is required to comply with the VCAA and the implementing regulations. Service connection, generally Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. § 1110, 1131 (West 2014); 38 C.F.R. §§ 3.303 (a), 3.304 (2018). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical ‘nexus’ requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303 (a) (2018). Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a) and (b) (2018). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (West 2014); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue. 1. Entitlement to service connection for anxiety disorder, adjustment disorder (claimed as post-traumatic stress disorder) The Veteran contends that his anxiety disorder, adjustment disorder (claimed as post-traumatic stress disorder (PTSD)) was caused by or otherwise related to active service. On review of the record, the Board concludes that the Veteran’s mental health condition is causally related to active service. 38 U.S.C. §§ 1110, 1131, 5107(b) (West 2014); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a) (2018). Despite multiple search attempts, the Veteran’s service treatment records were unavailable for review. Post-service treatment records indicate that the Veteran has a current adjustment disorder not otherwise specified (NOS), mood disorder, and alcohol dependence disorder. The noted diagnoses were rendered within one year of separation. In January 2012, the Veteran was admitted to the hospital for mental health treatment. During the clinical evaluation, he described increasing anxiety and frustration since discharge from service. The Veteran reported five years of service as an infantryman with tours in Afghanistan and Iraq. This service is not in question. He acknowledged current use of alcohol due to frustration, anxiety and chronic back pain. No family history of chemical dependency was reported. On examination, the Veteran was described as alert, oriented and cooperative with appropriate behavior. His mood was described as frustrated with an appropriate affect. The Veteran reported flashbacks with “voices” episodically; without psychosis or suggestive of a delusional or psychotic disorder. He denied any suicidal ideation, plan or intent and did not evidence aggression or inappropriate anger. The Veteran exhibited a capacity for insight, appropriate communication and intact cognitively. Following the clinical evaluation, the examiner diagnosed with an adjustment disorder NOS, anxiety (considered related to PTSD), episodic back pain, and frustrations with military service and his personal relationships. A mental health note, dated February 2012, indicated that the Veteran was discharged from inpatient treatment following a suicide attempt. His symptoms included angry outbursts, and hostility with mood, judgement, and insight described as fair. The Veteran expressed a willingness to take prescribed medication, Zoloft, to treat his symptoms. The examination report indicated that the Veteran felt overwhelmed by life stressors. He acknowledged thoughts of a friend he lost in combat and resistance to forming or maintaining relationships due to fear of losing them. Military themed nightmares were reported, with a recent decline in frequency. Problems with fatigue and concentration were also noted. Contemplation of suicide was noted in March 2012, the Veteran described thoughts of cutting himself. Anti-depressants were prescribed to treat his symptoms however, non-compliance was acknowledged in November 2012. A private psychiatrist diagnosed the Veteran with PTSD, mood disorder, and alcohol dependence in remission. In April 2012, the Veteran was hospitalized for 7 days related to his mental health condition. His current diagnoses were listed as chronic PTSD, a mood disorder NOS, alcohol dependence disorder, and chronic low back pain. Chronic sleep impairment was also acknowledged. A global functioning assessment (GAF) score of 55 was assigned. In April 2014, the Veteran was afforded a VA examination. During the clinical evaluation, the Veteran reported a childhood history of sexual abuse. He acknowledged leaving high school to join the army due to behavioral issues. The Veteran stated that he was “chaptered out” of active duty in part, due to a diagnosis of an anti-social personality disorder. He acknowledged an arrest and imprisonment for 4 months stemming from an altercation with his mother. At the time of the incident, the Veteran was in possession of a gun. In high school, the Veteran acknowledged use of alcohol and marijuana. Post-service alcohol abuse was reported however, symptom remission began in 2012. The Veteran described an in-service stressor of witnessing the death of his best friend, who was struck by an IED (improvised explosive device). After the incident, he was required to clean the remains from the Humvee. On evaluation, the Veteran’s symptoms included anxiety, hypervigilance, avoidance, re-experiencing, chronic sleep impairment, difficulty establishing and maintaining effective work and social relationships. He was diagnosed with an adjustment disorder with anxiety and other specified personality disorder with mixed personality features. His occupational and social impairment was described as mild or transient symptoms which decrease work efficiency and the ability to perform occupational tasks only during periods of significant stress or symptoms well controlled by medication. Following the clinical evaluation, the examiner opined that both the Veteran’s adjustment disorder and personality disorder impact his ability to function individually and collectively. Although the examiner acknowledged the Veteran’s history of multiple mental health conditions; it was concluded that his symptoms did not meet the criteria for PTSD on the date of examination. Given the Veteran’s history, the examiner opined that it was less likely than not that the Veteran’s mental health conditions were causally related to active service. Instead, Veteran’s condition was deemed causally related to a personality disorder which predated service. A negative finding was reached as to aggravation. On review of the record, the Board finds that the Veteran’s mental health conditions were caused by or otherwise related to active service. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible. In this case, the Veteran reported increasing anxiety, frustration, and struggles with alcohol dependence. Although the Board recognizes that service treatment records are unavailable, post-service treatment records show numerous complaints of symptoms related to a mental health condition. From January to April 2012, the Veteran received both in-patient and outpatient treatment for symptoms including depression, anxiety, re-experiencing, hypervigilance, social avoidance, irritability, and alcohol dependence. During a clinical evaluation, he complained of increasing anxiety and frustrating due to military experiences, to include witnessing the death of his close friend and intrusive nightmares. Assigned diagnoses included a mood disorder, PTSD, and alcohol dependence. On examination in March 2014, the Veteran was diagnosed with an adjustment disorder with anxiety and other specified personality disorder with mixed personality features. Although the examiner acknowledged the Veteran’s complaints of symptoms, to include guilt and reexperiencing related to witnessing the death of his friend and fellow serviceman, the examiner nevertheless opined that the Veteran’s condition was unrelated to service. Specifically, the examiner concluded that the Veteran’s symptoms were causally related to a personality disorder that predated service. A negative finding was noted as to aggravation. On review of the record, the Board finds the Veteran’s statements regarding the onset and cause of his symptoms both probative and credible. While a negative VA opinion is acknowledged, the medical evidence fails to show an onset of symptoms or mental health diagnosis that predated service. Without a diagnosed disability upon enlistment or a finding of psychological symptoms, the Board is unable to find that the Veteran did not meet the presumptive of soundness. It also does not suggest alternate causes for the reported symptoms aside from service. Further, even if a mental health condition was presumed from the Veteran’s behavioral problems prior to induction, his post-service complaints of symptoms suggest that the Veteran suffered from symptoms that were at least as likely as not directly related to his experiences in service. Accordingly, the Board finds that service connection for generalized anxiety disorder is warranted. Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Whitaker, Associate Counsel