Citation Nr: 18158669 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 13-33 857 DATE: December 18, 2018 ORDER Service connection for an acquired psychiatric disorder, to include major depressive disorder and polysubstance abuse disorder, is granted. VETERAN’S CONTENTIONS The Veteran is seeking service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, major depressive disorder, and polysubstance abuse disorder. The Veteran contends that her current psychiatric disabilities were caused by a military sexual trauma (MST) she experienced during her active duty service. FINDING OF FACT The Veteran’s major depressive disorder and polysubstance abuse disorder are caused by her in-service military sexual trauma. See 1996 Service Treatment Record; Veteran’s Statements dated June 2010; October 2018 VHA Expert Opinion; but see VA Examinations dated September 2011, December 2011, September 2017. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include major depressive disorder and polysubstance abuse disorder, are met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Coast Guard from June 1995 to February 1999. This case is before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In August 2015, the Board remanded the case to seek records related to the Veteran’s claimed MST and for a new VA examination. A VA examination and opinion was obtained in September 2017. In January 2018, after seeking the Veteran’s records at the National Personnel Records Center, the Coast Guard Personnel Service Center, and the Coast Guard Investigative Service, the RO made a formal finding of the unavailability of the Veteran’s service personnel records. There is no evidence that additional examinations are in order or that any relevant records have yet to be requested. Thus, there has been substantial compliance with the Board’s prior remand instructions, and an additional remand is not necessary. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998) where Board’s remand instructions were substantially complied with), aff’d, Dyment v. Principi, 287 F.3d 1377 (2002). Service Connection for an Acquired Psychiatric Disorder 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). Here, the Veteran has current diagnoses of major depressive disorder and benzodiazepine and alcohol use (polysubstance) disorder, in partial remission. See VA Examinations dated September 2011, September 2017; October 2018 VHA Expert Opinion. In addition, the Veteran has reported that she was sexually assaulted by a superior officer during her active duty service, which she contends caused her to gain weight leading to her honorable discharge, and also caused her current psychiatric disabilities. See Veteran’s Statements dated June 2010. Hence, the first and second elements of service connection are satisfied. The remaining element is a nexus between the Veteran’s current diagnoses and her in-service trauma. The Veteran has been afforded two VA examinations and opinions throughout the claim period, in September 2011 and September 2017. In addition, in December 2011 VA obtained an addendum to the September 2011 opinion, and the Board obtained a Veterans Health Administration (VHA) expert opinion in October 2018. The September 2011 examiner was asked to opine as to whether the Veteran’s treatment and personnel records supported her report of MST. The examiner responded that he could not render the opinion without resorting to speculation. In the December 2012 addendum, the examiner opined that it was less likely than not that the Veteran’s current psychiatric diagnoses were related to her in-service diagnosis of depression. The examiner reasoned that the in-service depression diagnosis had been revised to a diagnosis of personality disorder. Because her in-service diagnosis was in fact personality-based, the examiner concluded that her current depressive disorder was not related to her in-service diagnosis. In an August 2015 remand, the Board found the September 2015 VA examination to be inadequate, on the grounds that it failed to provide a rationale which accounted for the Veteran’s then-current psychiatric diagnosis. The December 2012 addendum opinion was not of record at the time of the remand. The September 2017 VA examiner opined that the Veteran’s depression pre-dated her active duty service, and that it was less likely than not that the Veteran experienced MST in service. The examiner noted that the Veteran’s service treatment records (STRs) indicated that she had seen a psychiatrist at the age of nine for depression. In addition, the Veteran reported at the examination that she was unsure whether she was raped during her reported MST. The examiner concluded: “In light of the Veteran’s self-report of uncertainty as to being raped and in the absence of a formal complaint, it is less likely than not that an MST occurred.” The Veteran is competent to report events that she herself experienced. In addition, her reports of her in-service MST and its effects have been consistent across the claim period, and are consonant with her STRs and service personnel records, which reflect in-service psychological treatment and discharge for weight gain. The Board finds the Veteran to be credible, and accordingly credits her report of in-service MST. Taking as true the Veteran’s reports of an in-service MST, the October 2018 VHA expert opined that it was at least as likely as not that the Veteran’s current major depressive disorder and history of polysubstance abuse were related to her in-service MST. The expert reasoned that the effects of the Veteran’s MST—difficulty getting along with others and performing to standard, insubordination, and excessive weight gain leading to discharge—triggered “a progressive mood disorder resulting in a Major Depression Diagnosis.” The examiner also noted that the Veteran was referred to substance abuse evaluation because of her reported MST. Partly in light of the finding that the Veteran did experience an MST in service, the Board finds that the September 2017 VA examination and opinion is inadequate. Although the examiner opined that the Veteran’s depressive disorder pre-existed her service, he failed to opine as to whether there was clear and unmistakable evidence that the disorder pre-existed service, as required by VA regulations. 38 C.F.R. § 3.304(b). Second, the examiner failed to opine as to whether the Veteran’s substance use disorders were related to or caused by her service. Third, the examiner’s conclusion that it is less likely than not that the Veteran experienced MST in service is directly contrary to the facts as found by the Board. Further, although the Board does not find that the December 2011 addendum opinion is inadequate, that opinion does not address the question of whether the Veteran’s current psychiatric diagnoses are related to her in-service MST. Consequently, the October 2018 VHA expert opinion is the only probative medical opinion of record. The expert’s opinion is competent, credible, and entitled to significant weight. Therefore, the Board finds that the Veteran’s current psychiatric disorder, to include major depressive disorder and polysubstance abuse, was caused by her in-service MST. Accordingly, service connection for an acquired psychiatric disorder, to include major depressive disorder and polysubstance abuse, is warranted. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Timmerman, Associate Counsel