Citation Nr: 20021623 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 17-40 181 DATE: March 26, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depressive disorder, and substance use disorder, hereafter referred to as an “acquired psychiatric disorder,” is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his acquired psychiatric disorder was at least as likely as not aggravated by in-service trauma. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from August 1973 to October 1976. This case is on appeal before the Board of Veterans’ Appeals (Board) from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Veteran initially filed a claim for service connection for 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 PTSD and other acquired psychiatric disabilities. As emphasized in Clemons, a 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. Accordingly, the Board has re-characterized the issue as shown on the title page. In October 2017, the Veteran appeared and provided testimony before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is associated with the claims file. This matter was previously before the Board in March 2019, at which time it rendered a decision remanding the issue of entitlement to service connection for an acquired psychiatric disorder. Specifically, the RO was ordered to conduct a new VA examination to clarify the Veteran’s mental health diagnosis and determine whether this condition was incurred in or aggravated by service. The required development has now been completed. Stegall v. West, 11 Vet. App. 268 (1998). As such, the matter now returns to the Board for final adjudication. As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. §§ 3.159, 3.326(a). The Board herein grants in full the benefit sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be discussed. The Veteran seeks service connection for an acquired psychiatric disorder, which he traces to an in-service traumatic event. The relevant facts and regulations have already been summarized in the March 2019 Board remand. That material is hereby incorporated by reference into this decision. In compliance with the March 2019 Board remand order, the Veteran was afforded a VA psychiatric examination in July 2019. The examination report reflects an in-person evaluation as well as review of the claims file. It documents symptoms of depressed mood, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining effective relationships, difficultly adapting to stressful circumstances, and inability to establish and maintain effective relationships. The examiner also noted that the Veteran presented to the appointment with appropriate dress and behaviors. His speech was verbose and his thoughts were logical yet tangential. Based on these symptoms, the examiner opined that the Veteran’s acquired psychiatric disorder was less likely than not related to service. While he was not found to meet the criteria for a diagnosis of PTSD under the DSM-5, the examiner affirmed the Veteran’s earlier diagnoses of major depressive disorder and alcohol use disorder. The examiner went on to say that the Veteran entered the military with a history of depression. Although he experienced a traumatic event, some symptoms of PTSD and depression overlap. Therefore, it was difficult to state whether the Veteran’s symptoms were strictly PTSD-related and not attributable to his preexisting depression. Nonetheless, the examiner pointed out that the progression of depression and alcohol use can be a signal of how the traumatic event exacerbated the Veteran’s preexisting mental health condition. She also indicated that his alcohol use could have been a way to cope with his in-service trauma. After careful consideration of the claims file, the Board determines that the evidence of record is in relative equipoise as to whether the Veteran’s acquired psychiatric disorder was aggravated by events in service. Here, the evidence of record confirms that the Veteran suffers from major depressive disorder and alcohol use disorder. Although his symptomology was not sufficient to satisfy the requirements for a DSM-5 diagnosis of PTSD, the existence of the diagnosed conditions establishes the presence of a current acquired psychiatric disorder. The evidence associated with the claims file also indicates that the Veteran was near a shipboard explosion during his period of active duty. He traces his current mental health condition to this incident and its aftermath. Therefore, in order to attain service connection for an acquired psychiatric disorder, the evidence of record must establish a connection between the Veteran’s psychological impairment and his in-service trauma. The medical opinion evidence associated with the claims file is unanimous in the conclusion that the Veteran’s major depressive disorder and alcohol use disorder preexisted service. While both the October 2014 and July 2019 VA examiners found that the Veteran’s acquired psychiatric disorder preceded his in-service trauma and thus could not have been caused by it, the July 2019 VA examiner went on to state that the progression of depression and alcohol use could signal an escalation of the Veteran’s preexisting mental health condition due to events in service. She also indicated that his alcohol use could have been a way to cope with in-service trauma. Therefore, despite finding that the weight of the evidence is against the Veteran’s acquired psychiatric disorder having been caused by his in-service trauma, the Board nonetheless concludes that it is in relative equipoise as to whether his psychiatric impairment was aggravated by in-service events. Hickson v. West, 12 Vet. App. 247, 253 (1999). Since there is relatively equal evidence both against and in favor of the Veteran’s claim, the benefit of the doubt rule applies. Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Accordingly, his appeal for service connection for an acquired psychiatric disorder is granted. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals MJS, Attorney for the Board Department of Veterans Affairs The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.