Citation Nr: 18160853 Decision Date: 12/28/18 Archive Date: 12/27/18 DOCKET NO. 14-13 557 DATE: December 28, 2018 ORDER Entitlement to service connection for a psychiatric disorder other than posttraumatic stress disorder (PTSD), diagnosed as a panic disorder, is granted. FINDING OF FACT The Veteran currently has an acquired psychiatric disorder, diagnosed as a panic disorder, that is related to his military service. CONCLUSION OF LAW An acquired psychiatric disorder, diagnosed as a panic disorder, was incurred in active service. 38 U.S.C. § 1101, 1110, 1131 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the West Virginia Air National Guard. He had an initial period of active duty for training from January 2001 to August 2001 and a period of active duty from January 2004 to September 2004. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). A claim for service connection for PTSD was separately denied in an October 2015 Board decision. Therefore, that issue is no longer on appeal. The Board requested an advisory medical opinion from the Veterans Health Administration (VHA) in June 2018, which was later provided in August 2018. Law and Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 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. As psychosis is considered to be a chronic disease for VA compensation purposes, if chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331(Fed. Cir. 2013). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including psychosis, are presumed to have been incurred in service if they manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In considering the evidence of record under the laws and regulations as set forth above, the Board finds that service connection for an acquired psychiatric disorder that has been diagnosed as a panic disorder. In an April 2010 statement, the Veteran indicated that he started experiencing symptoms of PTSD and depression following a car accident in June 1995, but stated that he was able to function. He also reported that he began experiencing severe anxiety and depression in service due to his deployment and family issues. The Veteran noted that he subsequently had problems with substance abuse and arrests. A September 2013 VA medical record also noted his report that his symptoms began during his deployment when he experienced emotional stress with his wife. The Veteran has explained that his wife had a narcotics addiction and relapsed just prior to his deployment and that he had to leave her with their new baby, which caused him great stress. The Veteran’s military enlistment examinations do not document any psychiatric abnormalities. In an April 2000 report of medical history, it was noted that he was previously treated for head trauma due to a car wreck in 1996. In October 2004, the Veteran was seen for stress from work and issues at home. He was assessed as having acute life stress. He was later diagnosed in November 2004 with generalized anxiety disorder and partner relational problems. The post-service medical records document various diagnoses, including a panic disorder, generalized anxiety disorder, PTSD, and major depressive disorder. A May 2009 VA medical record documented the Veteran’s report of having panic attacks that began in 2004, and a February 2012 VA medical record noted that his anxiety started in service, which was coincidental to marital stress. An August 2016 VA medical record indicated that the Veteran stated that he began using opiates during his military service. It was also noted that month that the Veteran reported an upsetting experience during his deployment when he looked out of a plane and saw fire. It was again noted that his anxiety coincided with his marital problems in service. The Veteran has reported being involved in a motor vehicle accident when he was 16 years-old. He was the driver and hit a telephone pole; his friend in the passenger seat was badly injured. See August 2016 VA medical record. A February 2016 VA medical record also noted a long history of PTSD related to the car accident. The Veteran was afforded a VA examination in September 2013 during which he reported witnessing another individual get his arm run over by a truck and being afraid for his life during an aircraft malfunction in Kuwait. The examiner indicated that he did not meet the diagnostic criteria for PTSD. Instead, he was diagnosed with a panic disorder without agoraphobia and opioid dependence in early full remission. The examiner opined that the Veteran’s panic disorder was less likely as not related to his military service. He also found that the opioid dependence was not related to his military service because the use of opioid painkillers occurred secondary to an injury outside of service. The Veteran was provided another VA examination in April 2017 at which time he was diagnosed with an unspecified personality disorder with mixed features, major depressive disorder, and opioid use disorder in early full remission. The examiner found that the Veteran’s panic attacks and anxiety were symptoms of his major depressive disorder and did not represent separate conditions. She also determined that, due to a lack of pre-military history, the Veteran was incorrectly diagnosed with generalized anxiety disorder in service and was instead experiencing a recurrence of major depressive disorder, which existed prior to service. Thus, she concluded that an opinion regarding a panic disorder was not relevant or necessary. The April 2017 VA examiner opined that it is less likely than not that the personality disorder was incurred in or caused by his military service because, by definition, a personality disorder is a pattern of behavior that is stable and of long duration, and its onset can be traced back to at least adolescence or early adulthood. She also stated that it is less likely than not that the personality disorder was permanently aggravated by his military service because a personality disorder is pervasive, inflexible, and stable across time and domains. However, there was no discussion of whether there may have been a superimposed disease or injury during service. The April 2017 VA examiner also opined that it is less likely than not that the Veteran’s current major depressive disorder was caused by, incurred in, and/or permanently aggravated by his military service. Rather, she stated that it is more likely than not that the disorder existed prior to his military service. However, the Board notes that legal standard is whether the evidence shows that a disorder clearly and unmistakably existed prior to service. In addition, the April 2017 VA examiner opined that it is less likely than not the Veteran’s opioid use disorder was caused by, incurred in, and/or permanently aggravated by his military service. In so doing, she noted that the Veteran had reported on multiple occasions that the onset of the disorder was a result of an injury that he suffered during a civilian construction job following his final period of activity duty. Thereafter, a VHA psychiatrist provided medical opinion in August 2018. After a thorough review of the records, he explained that it is technically challenging to obtain specific diagnostic clarity from the documentation, given that there is often variable and conflicting reports of symptoms yielding several mood/anxiety diagnoses over many years, including generalized anxiety disorder, panic disorder, substance-induced anxiety disorder, PTSD, major depressive disorder, anxiety disorder not otherwise specified, depressive disorder not otherwise specified, and an unspecified personality disorder. He stated the diagnoses have significant crossover of symptoms, including presentation with generalized anxiety, panic, depression, sleep disruption, difficulty focusing and concentrating, substance use, and mental fatigue. Although the Veteran’s documented report of trauma-related symptoms from an automobile accident prior to service and other psychosocial stressors complicated diagnostic clarity, the VHA psychiatrist found that his panic disorder had its onset during active duty. The VHA psychiatrist excluded consideration of other diagnoses with rationale and found that there was not clear and unmistakable evidence of a panic disorder prior to service. Based on the Veteran’s statements that his panic symptoms started during a deployment that required him to leave his family with reported ongoing psychosocial stressors and the evidence showing that he met criteria for panic disorder, the VHA psychiatrist opined it is at least as likely as not that panic disorder manifested during the Veteran’s service. The Board finds that the August 2018 VHA opinion has significant probative value because the examiner reviewed the claims file and supported the conclusion with a thorough and well-reasoned rationale. Accordingly, the Board concludes that service connection for a panic disorder is granted. In reaching this decision, the Board acknowledges that the Veteran has been diagnosed with various psychiatric disorders. However, the benefit sought on appeal is granted in a manner consistent with the fact that the most probative evidence shows that the proper diagnosis for the Veteran’s current service-connected psychiatric disability is panic disorder. Moreover, the psychiatric symptomatology among his mental disorder diagnoses are substantially similar, and the single evaluation assigned for the psychiatric disability would be assigned under the same rating criteria. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Kuczynski