Citation Nr: 18160018 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 15-08 877A DATE: December 20, 2018 ORDER Service connection for an acquired psychiatric disability is granted. FINDING OF FACT There is an approximate balance of the evidence regarding whether an acquired psychiatric disorder is related to injury or disease in service. CONCLUSION OF LAW An acquired psychiatric disorder was incurred in service. 38 U.S.C. §§ 1101, 1110 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 2003 to July 2007. This appeal is before the Board of Veterans’ Appeals (Board) from a September 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. In June 2018, the Board remanded the issue on appeal with instructions to obtain all of the Veterans VA treatment records from March 2015 forward, schedule the Veteran for a VA examination regarding the Veteran’s claim, and to readjudicate his claim in light of any new evidence that was collected. A supplemental statement of the case was issued in October 2018. With respect to Veteran’s claim, the Board is satisfied that the instructions in its June 2018 remand have been satisfactorily complied with. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran initially filed a claim of entitlement to service connection for posttraumatic stress disorder (PTSD). However, in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims clarified how the Board should analyze claims for acquired psychiatric disabilities. As emphasized in Clemons, the veteran’s claim “cannot be limited only to that diagnosis, but must rather be considered a claim for any mental disability that may be reasonably encompassed.” Id. Upon review of the evidence, which shows a diagnosis of unspecified trauma and stressor-related disorder and does not show a diagnosis of PTSD, the issue has been recharacterized to comport with the evidence of the record. Service Connection The Veteran claims service connection for an acquired psychiatric disorder, to include unspecified trauma and stressor-related disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). For certain chronic diseases, including psychoses, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a chronic disease is not shown to have manifested to a compensable degree within one year after service, under 38 C.F.R. § 3.303(b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Service treatment records do not reflect any symptoms of or treatment for any psychiatric disability. No psychiatric abnormality was noted at his May 2007 separation examination, and in the accompanying report of medical history the Veteran denied having ever experienced depression, excessive worry, frequent trouble sleeping, or nervous trouble of any sort. VA treatment records reflect that a PTSD screening test and a depression screening test conducted in April 2009 were negative. In this case, as reflected in the Veteran’s August 2013 claim for service connection for PTSD, the Veteran asserts that his military service aboard a navy vessel caused him to develop a psychiatric disorder. In statements submitted with his claim, the Veteran asserts that he has trouble falling asleep and staying asleep, he wakes up in the middle of the night grabbing or punching which makes him afraid to fall back asleep, he suffers from nightmares, and he has trouble staying awake during the day. Additionally, the Veteran reported having a phobia of needles, as well as medical and dental treatment, which he relates back to incidents that occurred in service. VA treatment records are silent regarding any psychiatric disabilities until July 2014 when the Veteran reported that he believed he may be suffering from PTSD due to his military service. While the Veteran’s PTSD screening test was positive, a VA psychologist found that the Veteran presented no clinically significant PTSD symptoms. A February 2015 Mental Health Biopsychosocial Assessment Note reveals that the Veteran reported he was experiencing mild depressive symptoms which the Veteran attributed to non-military service related stressors. The Veteran was diagnosed with an adjustment disorder, with depressed mood. In a February 2015 statement in support of his claim, the Veteran reported that he suffers from claustrophobia from his time in service. In a March 2015 statement in support of his claim, the Veteran reported that during his time in service he had panic attacks. He noted that the panic attacks occurred while travelling in an aircraft to his first duty station. The Veteran also asserted that when he arrived at his duty station, he was blown by an aircraft’s exhaust to the edge of the ship he was stationed on. He noted that this event gave him nightmares, and led to his trouble sleeping. VA treatment records from March 2015 reflect a positive PTSD screening test. A Domiciliary Screening Assessment Consult reveals that the Veteran reported suffering from PTSD, but could not identify any symptoms associated with PTSD. Additionally, the Veteran reported that he had not been diagnosed with PTSD previously. A subsequent March 2015 VA Mental Health Consult revealed that the Veteran reported symptoms consistent with PTSD and Depression; however, the VA clinician noted that the Veteran had trouble identifying symptoms until they were specified by the clinician. An April 2015 PTSD Clinical Team Consult reveals a diagnosis of unspecified trauma and stressor-related disorder, and a rule out diagnosis of adjustment disorder. A February 2016 Mental Health Diagnostic Study Note revealed that the Veteran reported symptoms that met the DSM-IV PTSD Criteria B and Criteria D, but did not meet the requirements of DSM-IV PTSD Criteria C. In October 2016, the Veteran reported to a VA clinic seeking treatment for PTSD. The VA clinician noted that the Veteran did not have a current diagnosis of PTSD, and recommended the Veteran be examined by a VA PTSD specialist. A December 2016 Primary Care Mental Health Integration Assessment revealed that the Veteran was endorsing symptoms of mild anxiety and stress response, along with possible PTSD symptoms. On July 10, 2018, the Veteran reported to a VA Outpatient Clinic for a mental health evaluation. He complained of feelings of depression due to recent life events. The Veteran underwent a VA examination in July 2018. The Veteran reported suffering from impaired sleep, nightmares, feeling tired, feeling disconnected from others, feeling isolated, increased hyper-vigilance, and mild depressive symptoms. The Veteran denied suffering from anxiety or trauma memories during the daytime, panic attacks, current suicidal or homicidal ideation, delusional thinking, hallucinations, or an exaggerated startle response. The Veteran once again asserted that he began suffering from claustrophobia while in-service. Additionally, the Veteran reported the trauma based incident where he was almost blown off the edge of the ship he was stationed on by an aircraft’s exhaust. The examiner opined that the Veteran does not meet the criteria for a diagnosis of PTSD; however, the examiner did diagnose the Veteran under the DSM-5 with an unspecified trauma and stressor-related disorder. Further, the examiner opined that it is at least as likely as not that the Veteran’s current symptoms are due to the Veteran’s time in-service, based on the Veteran’s reported symptomatology and his medical records. A July 27, 2018 Mental Health Outpatient Note reveals that the Veteran reported feelings of depression and anxiety. Further, the Veteran asserted that he believed he was experiencing PTSD related to service in Afghanistan. VA treatment records from August 2018 reflect a positive PTSD screening test. A subsequent August 2018 Mental Health Outpatient Note reveals that the Veteran continued to report feelings of depression, anxiety, and symptoms he associated with PTSD related to service in Afghanistan. A September 21, 2018 Mental Health Note reveals the Veteran indicated that he wanted to get it documented that he believes he has PTSD. The Veteran complained of having nightmares once a month, which he ascribed to his in-service traumas. He explained that he had witnessed another military member jump overboard after receiving a letter from their significant other; the Veteran also recounted his experience with being blown over to the side of the ship by an aircraft’s exhaust. The VA clinician indicated that they would have completed a MHIA, but the Veteran seemed to be under the influence at the time of the exam. In a September 22, 2018 statement in support of his claim, the Veteran reported that in addition to almost being blown overboard by jet engine exhaust, the Veteran witnessed a shipmate commit suicide by jumping off the side of the ship he was stationed on. The Veteran asserted that he has been experiencing symptoms of PTSD, including nightmares and claustrophobia, since his time in service. The Veteran returned to the VA on September 24, 2018 seeking mental health services; he reported some depression and anxiety symptoms, poor sleep and nightmares which he asserted were due to the suicide he witnessed in-service and the incident where he was almost blown off ship by jet exhaust. The VA treating psychologist noted that the Veteran expressed a strong interest in service connection for PTSD, and that he wanted his statements to be documented in his medical records. The VA psychologist recommended that the Veteran return to the VA for further assessment and treatment planning; however, subsequent attempts to contact the Veteran were unsuccessful. In an October 2018 statement, a friend of the Veteran reported that she had witnessed a change in the Veteran’s overall demeanor since he entered service. She noted that she had known the Veteran prior to his entrance in the military, and that he was more volatile after his time in service. Additionally, she reported that she had witnessed him having nightmares, yelling in his sleep, and grabbing her while waking up after he separated from service. The Board finds that the record, as it currently stands, contains both evidence for and against the claim. Notably, the fact that the Veteran was diagnosed with unspecified trauma and stressor-related disorder which the VA examiner opined was more likely than not the result of events which he experienced while in-service supports his claim for entitlement to service connection for an acquired psychiatric disorder. The evidence against the claim consists of: the Veteran’s lack of reported symptoms in-service and for six years following his separation from service; the Veteran’s inconsistent reports regarding some of his claimed in-service trauma, specifically, his recollection of service in Afghanistan and his shipmate’s suicide; and the Veteran’s expressed interested in having his statements recorded for the purpose of supporting his service connection claim. The Board is obligated under 38 U.S.C. § 7104(d) to analyze the credibility and probative value of all evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide reasons for its rejection of any material evidence favorable to the veteran. See, e.g., Eddy v. Brown, 9 Vet. App. 52 (1996); Meyer v. Brown, 9 Vet. App. 425 (1996); Gabrielson v. Brown, 7 Vet. App. 36 (1994). The Board is of course cognizant of possible self-interest which any veteran has in promoting a claim for monetary benefits. While the Board must consider all competent lay assertions, in determining the credibility of such assertions, the Board may properly consider the personal interest a claimant has in his or her own case. See Pond v. West, 12 Vet. App. 341, 345 (1999); and see Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (interest may affect the credibility of testimony). There is no question that the Veteran is competent to relate events as he remembers them. His competency is not at issue with regard to recounting the events of service. Rather, it is the credibility of the statements made by the Veteran since July 2018 regarding his time in service that the Board finds lacking. The Veteran first asserts in July 2018 that his current symptoms of PTSD are related to service in Afghanistan. This is the first instance in the record that the Veteran references serving in Afghanistan, and there is no other information regarding stressors related to his claimed service in Afghanistan. The Veteran’s recollections regarding a fellow service-member committing suicide are also not supported by any evidence on record prior to the Veteran’s statements in September 2018. The earliest accounts the Veteran gave of this incident, in September 2018, were provided in the context of his claim for service connection for PTSD; both times the Veteran recalled the claimed event, the medical official treating the Veteran noted that the Veteran was clear that he was interested in having his statements recorded for his service connection claims. Additionally, both treating clinicians from the Veteran’s Setpember VA treatment visits noted that they explained to the Veteran that the purpose of the session was to help him receive the appropriate treatment rather than to advance his service connection claim. Despite the inconsistency with the Veteran’s more recent assertions, the Veteran has remained consistent with his recollections regarding the incident where he was almost blown off ship by aircraft engine exhaust and his claustrophobia, which was the basis of the VA examiner’s diagnosis. Thus, upon review of the entire record, the Board finds that the evidence regarding the issue of whether the Veteran has a diagnosis of unspecified trauma and stressor-related disorder which is related to his active service, is in relative equipoise, i.e., about evenly balanced for and against the claim. In these situations, the Veteran is given the benefit of the doubt. Consequently, the Board will grant this appeal. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Capes, Law Clerk