Citation Nr: 18148110 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 17-51 187 DATE: November 6, 2018 ORDER Entitlement to service connection for residuals of nasal spine fracture and traumatic cartilage laceration is granted. Entitlement to service connection for an acquired psychiatric disorder is denied. REMANDED Entitlement to service connection for the partial loss of the sense of smell and taste is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his residuals of a nasal spine fracture and traumatic cartilage laceration are at least as likely as not related to an injury to his nose that occurred while deployed. 2. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of any acquired psychiatric disability. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of a nasal spine fracture and traumatic cartilage laceration are met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for service connection for an acquired psychiatric disability are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from November 2010 to September 2014. The Board thanks the Veteran for his service. This matter is before the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated August and September 2015 issued by a Department of Veterans Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Service Connection In order to establish service connection for a claimed disorder, the following must be shown: (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, 1167 (Fed. Cir. 2004). 1. Entitlement to service connection for residuals of nasal spine fracture and traumatic cartilage laceration The Veteran contends that he injured his nose when the tailgate of a 7-ton truck fell on his face while deployed in 2012 and that he continues to experience residual effects, including difficulty breathing and sleep impairment. The Veteran’s lay testimony regarding his in-service injury have been entirely consistent throughout the record. He first established care at the VA in March 2015, less than a year after his discharge. At his initial intake evaluation in March 2015, the Veteran reported “[d]uring active duty he had a tailgate from a 7 ton truck hit him in the nose” while deployed aboard a ship. He reported that he did see a doctor at the time, even though the information is not in the service treatment records (STRs) associated with the claims file. The Veteran was consistent in his report of events in all other medical records associated with the file, including in September and October 2016. In support of the Veteran’s assertion, a buddy statement dated January 2017 was submitted from the Veteran’s squad leader at the time the injury occurred in the summer of 2012. The squad leader stated that he personally witnessed the injury, that the Veteran was hit by the tailgate of a 7-ton truck, and that he remembers being concerned at the time that Veteran might have a concussion or other head trauma because of the weight of the tailgate and “how serious the injury appeared.” He further stated that at the time the incident occurred, “[b]lood immediately began to gush from [the Veteran’s] nose and he required medical treatment.” The Board acknowledges that the STRs of record do not include reference to any treatment for the above-described incident during deployment in 2012. The Board notes, however, that the STRs contain very little reference to treatment outside of the extensive records related to vision treatment and hearing conservation. Indeed, the one record noted to have occurred in a “Theater Facility” is related to the Veteran’s refractive error, which is the subject of most other STR entries. The Veteran’s DD 214 implies that his records related to deployment were classified. It is unclear to what extent that may be related to the gap in the Veteran’s deployment medical records. The Board further acknowledges that in a May 2013 post deployment physical, the Veteran answered “No” to the question of whether he was “wounded, injured, assaulted during your deployment?” Given the context of the question (which may imply it is asking only about combat-related injuries), and the fact that the physical occurred nearly a year after the Veteran’s asserted nose injury, the Board finds that the simple checklist answer does not weigh heavily against the probative value of the lay statements described above. The lay statements provided by the Veteran to his medical providers, and by the Veteran’s squad leader describing his first-hand account, are of high probative value because they are entirely consistent in detail and are both provided by individuals with firsthand knowledge of the incident. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Contemporary recorded evidence of the injury in the Veteran’s STRs is not necessary to corroborate the fact that the injury occurred. X-ray findings of the Veteran’s nose in April 2015 found that he had a “depression of the nasal spine” representing a “fracture of indeterminate age.” In a C&P examination from the same month, the examiner found that the Veteran has a nasal spine fracture and “healed traumatic nasal cartilage laceration with resulting mild distortion R distal nasal alae.” No opinion was given as to the etiology of the conditions. However, VA physicians continued to treat his symptoms as related to the described trauma. In September 2016, his physician observed the Veteran had “right nostril leftward deviation” and ordered a CT scan to further evaluate the effects of the described injury. In October 2016, a physician diagnosed the Veteran with “deviated nasal septum rhinitis” based on the results of the CT scan. Based upon the foregoing, and resolving reasonable doubt in the Veteran’s favor, the Board finds his residuals of a nasal spine fracture and traumatic cartilage laceration are at least as likely as not related to an injury to his nose that occurred while deployed. 2. Entitlement to service connection for an acquired psychiatric disorder The Veteran asserts that he experienced sexual assault in the military, and thus has posttraumatic stress disorder (PTSD). 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 or any other acquired psychiatric disorder, 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). At the outset, the Board wants to emphasize that, while it finds the Veteran does not have a diagnosed psychiatric disability, it has sympathy for the Veteran’s experience. The May 2015 VA examiner evaluated the Veteran and determined that he does not experience any subjective symptoms of PTSD or any other acquired psychiatric disability. The examiner reviewed the Veteran’s file and conducted an in-person examination, including discussing the Veteran’s reported in-service sexual assault by a friend while drinking at the friend’s residence. The examiner acknowledged that the Veteran reported that he thinks about the assault and will feel sad or angry depending on his mood. The Veteran also reported that he does not feel depressed or anxious and does not experience nightmares. The examiner found that the Veteran was well adjusted in his family and work life, and that he did not have a diagnosis of any acquired psychiatric disability. Further, STRs and VA treatment records do not reflect psychiatric complaints or treatment, nor do they contain a diagnosis of any psychiatric disorder. The Board acknowledges that there is one piece of potential positive evidence. Though most PTSD and depression screens in the Veteran’s STRs and VA medical record were negative, there was a single positive PTSD screen in September 2016. In that screen, the Veteran reported having nightmares, having to try hard not to think about the past event, and being “constantly on guard, watchful, or easily startled.” He denied feeling “numb or detached from others, activities, or your surroundings.” He did not discuss any symptoms with the physician at his appointment, or disclose what event he was thinking of when completing the screening. The Board notes that the PTSD screening tests administered at a general VA physical are not diagnostic in nature. Diagnosis of PTSD under the DSM-5 requires that the Veteran have experienced a stressor that meets the DSM-5 definition, and experience symptoms from every listed criteria category. The Board notes that, in the May 2015 examination, the examiner found that the Veteran lacked symptoms to meet any of the necessary criteria categories and that his in-service event as described did not meet the definition of a stressor under the DSM-5. Further, the Veteran answered “no” to all questions on a depression screening administered on the same day in September 2016. While the Veteran believes he has PTSD, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. 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 above information, the preponderance of the evidence is against finding the Veteran has a current diagnosis of an acquired psychiatric disability, to include PTSD. Accordingly, the Board finds that the requirements for service connection are not met. REASONS FOR REMAND 3. Entitlement to service connection for the partial loss of the sense of smell and taste is remanded. An April 2015 VA examination found that the Veteran had a partial loss of both smell and taste. The examiner acknowledged that the Veteran reported he began experiencing a loss of smell following the above-described nose injury in service. However, the examiner opined that the partial loss of smell and taste were each less likely than not related to the injury, without providing any rationale. Because the Veteran reported the onset of symptoms occurred at the same time the service-connected nose injury occurred, but no rationale was given for why the conditions are unrelated, the matter must be remanded for an addendum opinion providing a full rationale. The examiner should additionally address whether the conditions are aggravated by the service-connected injury, or whether they had their onset in service. The matter is REMANDED for the following action: 1. Obtain an addendum opinion regarding the Veteran’s loss of smell and taste. The Examiner should opine: (a.) Is it at least as likely as not (50 percent or greater probability) that the currently diagnosed loss of smell and taste had its onset in active service or is otherwise related to the Veteran’s active service? (b.) Is it at least as likely as not (a 50 percent or greater probability) that the currently diagnosed loss of smell and taste was caused or aggravated by (increased in severity due to) the Veteran’s service-connected nose disability (i.e. residuals of an in-service nose fracture and traumatic cartilage laceration)? (c.) If the opinion is that the loss of smell and taste was not caused, but was aggravated by a service-connected disability, specify, to the extent reasonably possible, the degree of disability that resulted from such aggravation (i.e., identify the baseline level of severity of the disorder before the aggravation occurred, and the level of severity of the disorder after aggravation). (d.) A full rationale is to be provided for all stated medical opinions. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Anderson, Associate Counsel