Citation Nr: 18146239 Decision Date: 10/31/18 Archive Date: 10/30/18 DOCKET NO. 16-23 345 DATE: October 31, 2018 ORDER The claim of entitlement to service connection for a stomach disability, to include colitis, is denied. The claim of entitlement to service connection, specifically for posttraumatic stress disorder (PTSD), is denied. The claim of entitlement to service connection for an acquired psychiatric disability, to include dysthymic disorder with persistent depressive disorder, is granted. REMANDED The claim of entitlement to service connection for a back disability is remanded. FINDINGS OF FACT 1. The Veteran had active service at the United States Marine Corps Base located at Camp Lejeune, North Carolina, in 1975, and as such, was exposed to contaminated water while serving at that facility. 2. The Veteran’s colitis did not manifest during service and is not causally related to the Veteran’s active service, to include as due to exposure to contaminated water at Camp Lejeune. 3. The Veteran does not have a diagnosis of PTSD. 4. The Veteran’s dysthymic disorder with persistent depressive disorder manifested during service and is aggravated by his service-connected tinnitus and hearing loss. CONCLUSIONS OF LAW 1. The criteria for service connection for a stomach disability, to include colitis, have not been satisfied. 38 U.S.C. §§ 1110, 5107(b) (West 2014); 38 C.F.R. §§ 3.102, 3.303(a), 3.307(7), 3.309(f) (2018). 2. The criteria for service connection for PTSD have not been satisfied. 38 U.S.C. §§ 1110, 5107(b) (West 2014); 38 C.F.R. §§ 3.102, 3.303(a) (2018). 3. The criteria for service connection for dysthymic disorder with persistent depressive disorder have been satisfied. 38 U.S.C. §§ 1110, 5107(b) (West 2014); 38 C.F.R. §§ 3.102, 3.303(a) (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from August 1975 to March 1976 in the United States Marine Corps. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in 38 C.F.R. § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b)). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Additionally, disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Board also notes that secondary service connection on the basis of aggravation is permitted under 38 C.F.R. § 3.310, and compensation is payable for that degree of aggravation of a nonservice-connected disability caused by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310(b). In order to establish entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate each claim and what the evidence in the claims file shows, or fails to show, with respect to each claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a stomach disability, to include colitis, is denied. The Veteran contends that he has a stomach disability, to include colitis, which is causally due to drinking contaminated water at Camp Lejeune. In the early 1980s, it was discovered that two on-base water-supply systems at Camp Lejeune were contaminated with the VOCs trichloroethylene (TCE), a metal degreaser, and perchloroethylene (PCE), a dry-cleaning agent. Benzene, vinyl chloride, and other VOCs also were found to be contaminating the water-supply systems. I VBA Training Letter 11-03 (Revised) (November 29, 2011). Until scientific evidence shows otherwise, it will be assumed by VA that any Veteran who served at Camp Lejeune between 1957 and 1987 potentially was exposed in some manner to the full range of chemicals known to have contaminated the water there during this time period. Id. In order to establish presumptive service connection for a disease associated with exposure to contaminated water at Camp Lejeune, a claimant must show the following: (1) that the Veteran served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) from August 1, 1953 to December 31, 1987; (2) that the Veteran suffered from a disease associated with exposure to contaminants in the water supply at Camp Lejeune enumerated under 38 C.F.R. § 3.309 (f); and (3) that the disease process manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). The Board concludes that, while the Veteran has a current diagnosis of colitis, and evidence shows that exposure to contaminated water is presumed, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of colitis began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Board first notes that the Veteran’s symptoms of colitis are not one of the enumerated diseases in 38 C.F.R. § 3.309(f). The Veteran’s symptoms are not manifestations of kidney cancer, liver cancer, non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes, or bladder cancer. The Board also notes that no medical evidence of records relates the Veteran’s current colitis to his active service, to include exposure to contaminated water. While the Veteran is competent to report having experienced gastrointestinal symptoms in service or intermittently since separation from service, he is not competent to provide a diagnosis in this case or determine that these symptoms were due to the contaminated water at Camp Lejeune. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and the effect of chemical upon the body systems. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Although the Veteran is not entitled to service-connected based on a presumption due to exposure to contaminated drinking water, the Board must also consider whether service-connection is warranted on a direct basis. A July 1975 enlistment report of medical history showed no current or past frequent indigestion or stomach, liver, or intestinal trouble. A July 1975 enlistment report of medical examination showed clinically normal abdomen and viscera. The Veteran’s service treatment records do not indicate any complaints, treatment, or diagnosis for colitis. In November 1975, the Veteran was unable to keep food down due to a psychiatric issue. A March 1976 separation report of medical examination showed clinically normal abdomen and viscera. The Board notes that the Veteran has now written that the responses on his entrance report of medical history were answered falsely. The Board finds that these statements are not credible. The Board notes that the Veteran’s service treatment records show that he sought treatment for a myriad of medical complaints during service. Significantly, during that treatment, when he specifically complained of other problems, he never reported complaints related to his gastrointestinal tract. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (lay statements found in medical records when medical treatment was being rendered may be afforded greater probative value; statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). Additionally, he did not claim that he responded falsely on the separation examination until he filed his current VA disability compensation claim. Such statements made for VA disability compensation purposes are of lesser probative value than his previous more contemporaneous in-service histories and his previous statements made for treatment purposes. See Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration the Veteran’s statements, it may consider whether self-interest may be a factor in making such statements). The Board also notes that the Veteran’s current statements that he provided inaccurate information at separation from service indicates that he is not a reliable historian. These inconsistencies in the record weigh against the Veteran’s credibility as to the assertion of onset of symptoms during service. See Madden v. Gober, 125 F.3d 1477, 1481 (Board entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Caluza v. Brown, 7 Vet. App. 498, 512 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (upholding Board’s finding that a veteran was not credible because lay evidence about a wound in service was internally inconsistent with other lay statements that he had not received any wounds in service). The Board has weighed the Veteran’s statements and finds his current recollections and statements made in connection with a claim for VA compensation benefits to be of lesser probative value than his previous more contemporaneous in-service history and findings at service separation. The Veteran was afforded a VA examination in September 2011. The examiner noted colitis in 2005 that was treated with antibiotics. He found insufficient evidence to warrant the diagnosis of colitis, gastric disease, or residuals thereof. He had an episode of Yersinia colitis, was treated, and seemed to have no residuals. The Veteran was afforded another VA examination in April 2016. The examiner reviewed the claims file and performed an in-person examination. He diagnosed mucous colitis with a date of onset noted as 2005. The examiner found that the Veteran’s claimed stomach condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Veteran’s treatment records show possible stomach ulcers in May 1976 and September 1976. Colitis symptoms are different from possible stomach ulcers. The Board finds that the examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his colitis either began during active service or is related to an in-service injury, event, or disease, including drinking contaminated water at Camp Lejeune, the Board again notes that he is not competent or credible to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the April 2016 VA examiner’s nexus opinion and the onset of symptoms in 2005 almost three decades after separation from service. Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for colitis. As the preponderance of the evidence is against the claim for service connection for colitis, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for PTSD is denied. The Veteran contends that he has PTSD that is causally related to his active service. The Board notes that the Veteran did not serve in any combat setting. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of PTSD and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran’s June 2013 VA treatment records showed a negative PTSD screening test. An April 2014 VA examiner diagnosed dysthymic disorder and persistent depressive disorder, but did not diagnose any PTSD. A May 2017 psychiatric examination noted persistent depressive disorder, but again did not diagnose any PTSD. Further, despite treatment for psychiatric issues, VA treatment records do not contain a diagnosis of PTSD, but rather continuously indicate a chronic depressive disorder. While the Veteran believes he has a current diagnosis of PTSD, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education to provide a psychiatric diagnosis. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for PTSD. As the preponderance of the evidence is against the claim for service connection for PTSD, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to an acquired psychiatric disability, to include dysthymic disorder with persistent depressive disorder is granted. The Veteran contends that he has an acquired psychiatric disability that manifested during service, is causally related to service, or is caused or aggravated by a service-connected disability. The Board concludes that the Veteran has a current diagnosis of dysthymic disorder with persistent depressive disorder that began during active service and was subsequently aggravated by his service-connected tinnitus and hearing loss. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). No psychiatric difficulties, symptoms, or diagnoses were noted upon entry into service. The July 1975 report of medical examination showed a clinically normal psychiatric examination. Service treatment records show psychiatric complaints during service. In November 1975, the Veteran could not sleep or eat due to nervous complaints. The examiner noted a possible personality problem. Another November 1975 service treatment record showed that the Veteran came in for a psychiatric evaluation. The Veteran was complaining of symptoms of anxiety and depression, including bad headaches, which the Veteran feels are related to his inability to adjust to the Marines. Mental status was consistent with immature personality disorder. The examiner noted no evidence of psychosis or other mental illness. The examiner diagnosed immature personality disorder, existed prior to entry (adolescent adjustment reaction). The Veteran was afforded a VA examination in April 2014. The examiner diagnosed dysthymic disorder and persistent depressive disorder. The Veteran attributed his depression to his financial problems and all of his reported medical conditions including his ears, colitis, and left ankle. The Veteran stated that he had no mental health problems prior to military service. he also noted no mental health issues while in the military, adding no depression while in the military. He attributed his depression to health problems post-military. The examiner found that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Veteran’s current diagnosis met the DSM criteria, but there is no evidence that it is related to his military service. The Veteran attributed his depression to post-military health and financial problems. The Veteran submitted a disability benefits questionnaire in May 2017. The examiner diagnosed persistent depressive disorder, early onset. The examiner reviewed the claims file and VA treatment records and performed a mental status examination. The Veteran denied a personal mental health history prior to the military. The examiner noted that the Veteran endorsed that his persistent depressive disorder symptoms were a result of his military service and have been exacerbated since military separation. The examiner noted that there is a body of literature detailing the emergence of mental health symptoms within active duty servicemen. Military service impacts depression, anxiety, and quality of life satisfaction. Additionally, other researchers revealed that guilt is a salient feature in mental health diagnoses of active duty military personnel. Active duty military personnel become disillusioned with their personal and professional identities and as a result of the chronic guilt and shame associated with their service identities have more mental health events than civilians. The examiner also cited literature detailing the connection between medical issues, like the issues that the Veteran struggled with and psychiatric disorders. In fact, he described a causal relationship between medical and psychiatric difficulty. The examiner noted a body of literature detailing the association between tinnitus and comorbid psychological disorders including a high prevalence of anxiety and depression in tinnitus sufferers. The consequences of tinnitus include emotional effects, reduced involvement in work-related activities, interpersonal problems, and decreased opportunities to engage in previously enjoyable activities. Numerous research studies document that hearing loss has a significant biopsychosocial impact on quality of life, including enjoyment. Additionally, psychologically, people with hearing loss are more inclined to experience depression, anxiety, anger, frustration, social isolation, and loneliness. The examiner noted that due to the complex overlap of endorsed symptoms, it is inconceivable to differentiate specific causation for disability. Therefore, it should be noted that the disease pattern cannot be attributed to one particular medical condition; rather, all conditions may indeed contribute to the overall decompensation and disability of the Veteran. It is the belief of the examiner, based on interview and review of the claims file, that the Veteran suffered from persistent depressive disorder that more likely than not began in military service and continued uninterrupted to the present and was aggravated by his tinnitus and bilateral hearing loss. The record also contains medical literature noting the connection between those with tinnitus and hearing loss and symptoms of depression and anxiety. In sum, the Veteran was found to be sound upon entry into service. He reported psychiatric complaints four months after entry into service. The record contains medical literature and studies connecting tinnitus to anxiety and depression. The April 2014 VA examiner found that the Veteran’s psychiatric complaints were causally related to his medical issues to include his ears, for which he is service-connected. The May 2017 examiner found that the Veteran’s psychiatric complaints began during service and are exacerbated by his tinnitus and hearing loss. Given the evidence cited above, the Board finds that entitlement to service connection for dysthymic disorder with persistent depressive disorder is warranted. To that extent, the appeal is granted. REMANDED ISSUE Entitlement to service connection for a back disability is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a back disability because the current nexus opinions are inadequate. In October 2012, a chiropractor reviewed the events of the Veteran’s military past. The examiner opined and was more likely than not that the Veteran’s injuries of the vertebrae and lower discs in the back were a direct and indirect result of the stress put upon his malformed Pars defect of L5-S1 most probably due to the training at Camp Lejeune as well as in 1976 at Infantry Training School at Camp Lejeune. The examiner, however, did not indicate that he reviewed or was aware of the Veteran’s normal findings related to his back as indicated in the service treatment records. The Veteran was afforded a VA examination in April 2016. The examiner reviewed the claims file and performed an in-person examination. The examiner found that the Veteran’s claimed back condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. He cited that the Veteran’s service treatment records were silent for a back condition. He stated that it would be mere speculation to opine that carrying infantry equipment during eight months of service caused chronic back pain with laminectomy 20 years later. The examiner, however, did not address the claimed Pars defect or the assertions of the October 2012 chiropractor. An addendum opinion is necessary to address the conflicting opinions provided by the October 2012 private examiner and the April 2016 VA examiner, to include the negative findings in the service treatment records and the Pars defect. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current back disability at least as likely as not manifested during active service or is causally related to activities during service to include physical training. A complete rationale must be provided for all opinions offered. If any opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence would potentially allow for a more definitive opinion. If an additional examination is required for the examiner to sufficiently address the above questions, then a new examination should be afforded. 2. After undertaking the development above and any additional development deemed necessary, the Veteran’s claim should be readjudicated. If the benefits sought on appeal remain denied, the appellant and his representative should be furnished a supplemental statement of the case and be given an appropriate period to respond thereto before the case is returned to the Board, if in order. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Patricia Veresink