Citation Nr: 18129131
Decision Date: 08/23/18	Archive Date: 08/23/18

DOCKET NO. 15-27 360A
DATE:	August 23, 2018
REMANDED
Entitlement to service connection for a psychiatric disability is remanded.
REASONS FOR REMAND
The appellant served on active duty from April 1972 to July 1972.
1. Entitlement to service connection a psychiatric disability is remanded.
The Board notes that every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111. This is known as the presumption of soundness.
Here, the appellant self-reported frequent trouble with sleep and depression with excess worrying that was assessed as situational depression by medical personnel during his pre-induction examination in 1972.  As such, the Board concludes that a pre-existing psychiatric disability was noted at service entry and the presumption of soundness does not apply. 
A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence in the record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. § 3.306 (b).  Temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted to symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991).
Here, while the appellant was provided a VA examination concerning the etiology of his psychiatric disability in May 2013, the examiner did not opine as to whether the preexisting psychiatric disability clearly and unmistakability was not aggravated by service. The Board notes that the Veteran attempted suicide by drinking Windex cleaner in May 1972, and therefore an additional VA examination is warranted to consider if this incident was an aggravation of his preexisting psychiatric disability. 
The matter is REMANDED for the following action:
Provide the appellant with a VA examination in order to answer the following questions:
Was the appellant’s pre-existing psychiatric disability clearly and unmistakably not aggravated by his military service (meaning that any increase in severity during service should be considered the natural progression of the disease). Why or why not? In providing this opinion, the examiner must comment upon the May 1972 suicide attempt by the appellant. 
Temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted to symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991).
 
MATTHEW W. BLACKWELDER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Dworkin, Associate Counsel