Citation Nr: 18153224 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 18-17 823 DATE: November 28, 2018 ORDER Entitlement to service connection for acquired psychiatric disorder, variably diagnosed as PTSD, depressive disorder, and panic disorder is granted. REMANDED Entitlement to service connection for hypertensive vascular disease is remanded. FINDING OF FACT Resolving all doubt in the Veteran’s favor, the Veteran’s acquired psychiatric disorder, variably diagnosed as PTSD, depressive disorder, and panic disorder, is related to and aggravated by service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, diagnosed variably as PTSD, depressive disorder, and panic disorder, have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1979 to September 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The rating decision denied entitlement to service connection for hypertension as well as service connection for PTSD. The Veteran timely appealed. Entitlement to service connection for an acquired psychiatric disorder The Veteran filed his claim for service connection for PTSD in November 2015. This claim will be construed broadly to include any acquired psychiatric disability that may reasonably be encompassed by the description of the claim, reported symptoms, and other information of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). A grant of service connection for an acquired psychiatric disorder incorporates all such psychiatric symptomatology reported by the Veteran. See Clemons, supra; Mittleider v. West, 11 Vet. App. 181, 182 (1998). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 C.F.R. § 3.303(a). Service connection generally requires credible and competent evidence showing: (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. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). When 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(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). In December 2015, the Veteran underwent a private medical assessment and his treating doctor submitted a private benefits questionnaire (DBQ). The Veteran was diagnosed with PTSD, depressive disorder and panic disorder. The Veteran began experiencing symptoms such as periods of depression and anxiety in service, sometimes on daily basis. The in-service events that caused and aggravated these symptoms include 1) being at risk of getting shot in the back by a non-commissioned officer and having to inform that officer that the weapon he was holding to the Veteran’s back was loaded, 2) being wrongfully accused of losing a checked-out pistol that was later recovered elsewhere, and 3) walking up to and witnessing a soldier’s hanging body after she committed suicide on base. After experiencing emotional trauma in service, the Veteran struggled with substance abuse, panic attacks, and depression. The private medical opinion concluded that the symptoms associated with depressive disorder and panic disorder were indistinguishable from symptoms associated with the Veteran’s PTSD. The opinion further concluded that the Veteran likely developed PTSD as a result of childhood abuse, but also specifically indicated that his current symptoms manifested in service or as a result of service, irrespective of any pre-existing PTSD. In other words, the examiner opined that, at the very least, any pre-existing psychiatric disorder was not present at the time of entry into service, and was clearly aggravated beyond natural progression during service. Based on the above, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s acquired psychiatric disorder is related to his military service. Moreover, even though the Veteran’s claimed stressors were not independently corroborated, the examiner specifically indicated that the Veteran’s symptoms of PTSD cannot be distinguished from his symptoms associated with a depressive disorder and panic disorder. Significantly, a corroborated stressor is not required to establish service connection for an acquired psychiatric disorder other than PTSD. As such, the Veteran is entitled to service connection for an acquired psychiatric disorder. The Veteran has a present disability, diagnosed in the December 2015 private medical opinion. The disability was not noted at discharge, and the Veteran experienced trauma in service that triggered his disability. While December 2015 private medical opinion is the only evidence of record illustrating the nexus element of service connection, the opinion clearly establishes that the current symptoms of the Veteran’s depressive disorder and panic disorder cannot be distinguished or disassociated from the Veteran’s PTSD symptoms and that those symptoms are related to and aggravated by his military service. Therefore, service connection for an acquired psychiatric disorder is granted. REASONS FOR REMAND Entitlement to service connection for hypertensive vascular disease is remanded. The Veteran asserts that he developed hypertension while in service. However, the record is unclear as to when hypertension had its onset and what the current diagnosis is. Specifically, the Veteran underwent a pre-entrance physical exam in February 1979 and as a result received notice that he was disqualified from service due to high blood pressure. However, the blood pressure readings associated with his disqualification letter as well as the letter itself, do not necessarily indicate a diagnosis of hypertension. The readings consist of 138/72, 138/72, and 136/74. In addition, the Veteran did enter service in May 1979 despite the disqualification notice. While in service, the Veteran had several high blood pressure readings that still did not result in an actual hypertension diagnosis. In March 1980 his blood pressure was recorded at 140/70. In June 1981, his elevated readings were recorded at 152/86, 140/150 and 138/100. In July 1981, his elevated blood pressure was recorded at 150/92. In August 1981, the Veteran underwent a discharge VA medical exam. Under summary of defects and diagnosis, his exam records indicate that he had “borderline elevated blood pressure.” However, no readings or date of onset were provided. An October 2015 private medical opinion indicates that the Veteran suffered the onset of and was diagnosed with hypertension while in service, and is currently suffering from hypertension. However, the opinion fails to address whether the Veteran’s hypertension pre-existed service, and fails to provide current readings or any supporting rationale behind the conclusions. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for hypertension without establishing when the Veteran’s high blood pressure had its onset and what the current diagnosis is. As such, a VA examination is necessary to review the Veteran’s records with respect to his initial disqualification from service notice, his unexplained allowance to serve despite the disqualification notice, his in-service elevated readings, his discharge borderline high blood pressure diagnosis, and his current diagnosis. The VA examiner should take into consideration those records and opine as to whether high blood pressure had its onset in service irrespective of when hypertension was actually diagnosed. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The matter is REMANDED for the following actions: 1. The RO should request that the Veteran provide the names and addresses of all health care providers who have diagnosis and provided treatment for his hypertension. After acquiring this information and obtaining any necessary authorization, the RO should obtain and associate these records with the claims file. 2. After completing the foregoing development, the RO should schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hypertension that may be present. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment and personnel records and post-service medical records. The examiner must opine: (a.) as to whether the Veteran’s high blood pressure had its onset in-service, irrespective of when hypertension was diagnosed, (b.) whether any diagnosed hypertension is at least as likely as not related to an in-service injury, event, or disease, and (c.) if the examiner finds that the Veteran’s hypertension clearly and unmistakably pre-existed service, whether it was clearly and unmistakably aggravated (a permanent increase in severity) during service. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kuksova, Associate Counsel