Citation Nr: 18101032 Decision Date: 04/26/18 Archive Date: 04/26/18 DOCKET NO. 14-15 448 DATE: April 26, 2018 ISSUES DECIDED: 1 ISSUES REMANDED: 0 ORDER Entitlement to service connection for an acquired psychiatric disorder, variously diagnosed to include a nightmare disorder, is granted. FINDING OF FACT The evidence is in relative equipoise as to whether the Veteran has an acquired psychiatric disorder, diagnosed as a nightmare disorder, attributable to his military service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, diagnosed as a nightmare disorder, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1960 to November 1964. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and nightmare disorder Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if preexisting such service, was aggravated thereby. 38 U.S.C. §§ 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). Generally to establish entitlement to service connection, a veteran must show evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the current disability and an in-service injury or disease. All three elements must be proved. See generally Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Alternatively, under 38 C.F.R. § 3.303 (b), service connection may be established for certain chronic diseases listed under 38 C.F.R. § 3.309 (a) by either (1) the existence of such a chronic disease noted during service, or during an applicable presumption period under 38 C.F.R. § 3.307, and present manifestations of that same chronic disease; or (2) where the condition noted during service is not in fact shown to be chronic or where the diagnosis of chronicity can be legitimately questioned, then a showing of continuity of symptomatology after discharge is required to support the claim of service connection. 38 C.F.R. § 3.303 (b) (2017); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, including psychoses, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.§ 5107 (b); 38 C.F.R. §3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The existence of a present disability is established through the Veteran’s medical treatment records and examination reports produced during the course of his appeal. These records contain a diagnosis of an acquired psychiatric disorder, variously diagnosed as a nightmare disorder and a dream disorder. A review of the clinical evidence indicates that the Veteran was not diagnosed with PTSD. Service treatment records (STRs) revealed no abnormalities that were attributed to PTSD or a nightmare/dream disorder. However, the remaining inquiry is whether the evidence demonstrates the incurrence of an acquired psychiatric disorder, to include a nightmare/dream disorder in service or as a result of service. Upon review of the evidence, the Board concludes that the evidence of record is in relative equipoise as to whether the Veteran has an acquired psychiatric disorder, to include a nightmare/dream disorder as a result of service. The September 1960 induction examination and the November 1964 separation examination indicated that the Veteran was psychiatrically normal. STRs did not show that the Veteran complained of, was treated for, or diagnosed with PTSD or a nightmare/dream disorder in service. A review of the Veteran’s personnel records show that the Veteran completed a 4 week NCO leadership course in 1963. A post-service February 2011 VA treatment note indicated that the Veteran had a negative PTSD screen. In a March 2012 statement, the Veteran’s fellow service member, D.C., asserted that he attended noncommissioned officer (NCO) school with the Veteran in July 1963. D.C. asserted that he and the Veteran were “tortured” at a prisoner of war (POW) training camp at Marine Corp Base Camp Pendleton. D.C. provided a detailed description of the series of events that occurred at the POW camp, including, but not limited to, being fired upon with blank ammunition, being submerged in ice-water, and feeling as though he would drown or suffocate. In a similar statement, the Veteran reported that he was placed in a wooden box and a snake was placed in the box. The Veteran reported that a metal bucket was placed over his head and that an instructor banged on the metal bucket with a hammer. The Veteran reported that he believed he was going to drown while submerged in a 55-gallon drum of ice water. The Veteran asserted that he has dreamed about his experience at the POW camp since separation. In a March 2012 Statement in Support of Claim for PTSD Secondary to Personal Assault, the Veteran reiterated the above series of events in detail. In July 2012, the Veteran was afforded a VA examination. The examiner did not diagnose the Veteran with PTSD, noting that the Veteran’s symptomology did not conform to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. According to the examiner, the Veteran did not appear to meet the criteria for PTSD or any other mental disorder. The examiner opined that the Veteran did not report avoidant symptoms or enough hyper arousal symptoms. Regarding the Veteran’s conduct and proficiency as markers, the examiner opined that they did not appear to be markers and his punishment for singing on the radio in-service was disqualified as a marker because when asked directly if the incident had anything to do with the POW training camp incident, the Veteran strongly denied the same. On VA outpatient treatment in September 2012, the Veteran reported sleep problems and was diagnosed with nightmares and possible PTSD was noted. The Veteran reported that memories of what occurred during POW training would interrupt his sleep at night. An October 2012 VA treatment note indicated that the Veteran was diagnosed with a nightmare disorder but that he did not meet the full criteria for a PTSD diagnosis. The Veteran reported nightmares and interrupted sleep due to thoughts of his he experienced during POW training. The examiner rendered the clinical assessment that the period of time from the purported in-service stressor and the Veteran’s mental health symptoms was too long for the Veteran’s symptomatology to be characterized as an adjustment disorder. The examiner noted that no clear Axis I mental disorder was identified, other than a nightmare disorder. The examiner, however, informed the Veteran that his lack of a clear Axis I diagnosis did not mean that the traumatic event (POW training) had not affected him. In a July 2013 VA medical opinion, the examiner rendered the clinical assessment that the Veteran’s nightmare disorder was “definitely related to his military experiences regardless of whether or not he [met] all the criteria for PTSD.” The examiner referenced the September and October 2012 treatment notes and diagnoses. A November 2014 VA treatment note indicated that the Veteran was diagnosed with a dream disorder. At the November 2017 Board hearing, the Veteran testified that he received POW training in 1963 during NCO school at Camp Pendleton. The Veteran testified that he was submerged in a 55-gallon drum filled with ice water, his legs were numb due to the cold water, a steel bucket was placed on his head and hit with a hammer, he was nailed inside a wooden box and a snake was placed inside the box. The Veteran testified that he began having nightmares in 1963 that worsened in 1977 after he parents died in a car accident. There is unfavorable medical opinion evidence against the claim and favorable medical opinion evidence in favor of the claim. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2017). The Board finds that reasonable doubt should be resolved in favor of the Veteran. In so finding, the Board observes the September 2012, October 2012, and November 2014 VA clinical records that document the Veteran’s nightmare disorder and dream disorder diagnoses. During in-person interviews, the Veteran reported the series of events that occurred during POW training. The September 2012 examiner diagnosed the Veteran with nightmares and appeared to attribute the Veteran’s nightmares and “sleep problems” to his experiences during POW training camp. The October 2012 examiner diagnosed the Veteran with a nightmare disorder and expounded on the fact that what the Veteran experienced during POW training camp had affected the Veteran. The July 2013 VA examiner attributed the Veteran’s nightmare disorder to his service. The July 2013 VA examiner referenced the September 2012 and October 2012 treatment notes and diagnoses in rendering his conclusion that the Veteran’s acquired psychiatric disorder, diagnosed as a nightmare disorder is related to his military service. It light of the foregoing, the Board is satisfied that the criteria for entitlement to service connection for an acquired psychiatric disorder, diagnosed as a nightmare disorder, have been met. 38 U.S.C. 5107(b) (2012); 38 C.F.R. § 3.102 (2017). DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Taylor, Associate Counsel