Citation Nr: 18148338 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 16-27 841 DATE: November 7, 2018 ORDER Entitlement to service connection for unspecified anxiety disorder, claimed as PTSD, is granted. REMANDED Entitlement to service connection for a heart disability is remanded. FINDING OF FACT The Veteran’s unspecified anxiety disorder is the result of in-service events. CONCLUSION OF LAW The criteria for entitlement to service-connection for unspecified anxiety disorder have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Navy from July 1958 to July 1961. This matter initially came to the Board of Veterans’ Appeals (Board) on appeal from ratings decision issued in December 2013 and July 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2018, the Board remanded the service connection claim for PTSD. A VA examination was conducted in March 2018. Service Connection Generally, to prove service-connection, a veteran must show: (1) a present disability; (2) an 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. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service-connection may also be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Unspecified Anxiety Disorder The Veteran contends that he has an acquired psychiatric disorder related to his military service. He originally claimed PTSD, but the Board has expanded the issues to include any acquired psychiatric disorder. The Veteran reported a particular incident as a stressor resulting in PTSD. In October 1959, the Veteran was aboard the USS Toledo as it traveled up the Saigon River. The ship stayed in Vietnam for approximately one week. The Veteran believes that the ship, which housed nuclear warheads, should have fired its missiles while in Vietnam. He has claimed feelings of guilt over the numerous American casualties during the Vietnam War believing that if his ship had fired missiles, the war would have been prevented. The Veteran’s account of events in Vietnam is deemed credible and the Veteran is competent to state where the ship he was aboard was located. Ship logs in the record confirm its presence in Vietnam in October 1959. In addition, there is a lay statement from another person aboard the ship. It also confirms the ship was in Vietnam and that the Veteran was aboard the ship. There are records of ongoing psychiatric issues post-service. During a 1963 drill pay examination, the Veteran reported symptoms of “depression or excessive worry” and “nervous trouble.” In 1979, a private physician diagnosed him with anxiety and depression. In 2005, a private counselor diagnosed the Veteran with PTSD, specifically citing his service in Vietnam and an assault claimed to have taken place in service. A VA examination for PTSD was conducted in July 2015. The examiner concluded that this stressor did not meet the DSM-5 criteria for PTSD as the Veteran was not responsible for firing the missiles and he did not witness death or other traumatic events. The examiner also noted that the Veteran did not show any psychiatric complaints until many years after he left the military. The Board found that although the examination adequately evaluated this particular stressor, there were other potential stressors in the record that were not evaluated. As such, the claim was remanded in January 2018 for an evaluation of all the stressors. The March 2018 examiner concluded that the Veteran’s psychiatric symptoms did not meet criteria for PTSD, but they met the criteria for unspecified anxiety disorder. The examiner found that the anxiety disorder was “at least as likely as not incurred in, caused by, or otherwise related to the veteran’s active duty service.” The rationale provided, in part, that “his symptoms are related to his Navy service” and that “he felt that his ship’s visit to Vietnam could have acted to prevent the Vietnam War, but due to their inaction, he experienced overwhelming feelings of guilt about the deaths of so many servicemen during the war. Despite being told by repeated providers that it was not his fault, he felt his ship should have acted, and would have prevented the war.” The Board finds that the Veteran’s statements as to the in-service events are credible, and although the Veteran does not meet the criteria for a diagnosis of PTSD, he has a current diagnosis of anxiety disorder. The first two elements of service connection are met. There are both positive and negative opinions of record. These opinions were provided by competent and credible examiners, and included a detailed discussion of the pertinent evidence of record. As there is positive and negative evidence of whether the Veteran’s anxiety disorder is due to service, the evidence of nexus is in relative equipoise. The Board finds all reasonable doubt in the Veteran’s favor. Service-connection for unspecified anxiety disorder is granted. REASONS FOR REMAND Heart disability The Veteran contends that his currently diagnosed heart disability is secondary to his service-connected emphysema with COPD. In January 2018, this issue was remanded for an opinion regarding whether the heart condition was caused by or aggravated by the service-connected emphysema. In March 2018, a VA examination was conducted. After a review of the file, the Board finds that another remand is necessary as there has not been substantial compliance with the January 2018 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). First, the examiner stated that the heart disability was less likely than not proximately due to or the result of the Veteran’s service-connected lung disabilities. The rationale provided was that service treatment records (STRs) did not contain any heart disability that is connected to emphysema with COPD and that supraventricular arrhythmia (SVT) is not related to emphysema with COPD. The examiner further stated that there is “no medical correlation with the Veteran’s diagnoses of SVT and noted bradycardia and his claimed condition of emphysema and COPD.” The second part of the opinion states “the Veteran does not have any documented evidence of heart disease in service that would be due to or aggravated by emphysema with [COPD], therefore the Veteran’s SVT was not aggravated by his emphysema with [COPD]. Neither part of the opinion adequately responds to the directives of the remand regarding the Veteran’s current heart disability, and instead focuses on the nonexistence of a heart condition in service. Such an opinion is inadequate. Furthermore, a VA examination for secondary service connection must address both causation and aggravation. As such, a new examination is necessary. The matter is REMANDED for the following action: 1. Forward the Veteran’s claims file to an appropriate examiner to provide a supplemental opinion regarding whether the Veteran’s claimed heart disability is secondary to his service-connected emphysema with COPD. The examiner is asked to respond to the following: a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s heart disability was caused by his service-connected emphysema with COPD? b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s heart disability was aggravated by (worsened beyond its natural progression) due to his service-connected emphysema with COPD? If aggravation is found, the examiner should also state the baseline level of disability prior to aggravation. The examiner is asked to provide a complete rationale for any opinion or conclusion expressed. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals J. Jack, Law Clerk Department of Veterans Affairs