Citation Nr: 20038043 Decision Date: 06/03/20 Archive Date: 06/03/20 DOCKET NO. 15-23 615 DATE: June 3, 2020 ORDER Service connection for anxiety and depressive disorders is granted. FINDING OF FACT Affording the Veteran the benefit of the doubt, his anxiety and depressive disorders began in his active service. CONCLUSION OF LAW The criteria for service connection for anxiety and depressive disorders have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from July 1969 to June 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In March 2018, the Board issued a decision, which dismissed the appeal of service connection for an acquired psychiatric disability, to include depression with anxiety. Subsequently, in April 2018, the Board vacated that dismissal and issued a remand the issue for an addendum medical opinion to assist in determining the etiology of the diagnosed acquired psychiatric disorder. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (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 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. In the current appeal, the Veteran seeks service connection for an acquired psychiatric disorder. As an initial matter, the Veteran was diagnosed with anxiety disorder and depressive disorder in October 2010. As such, the current disability prong for service connection has been met. The Veteran contends that his anxiety and depressive disorders were caused by his stressful experiences during active service during the Vietnam War. Specifically, he contends that, as a Survivor Assistance Officer, he was tasked with informing families of deaths and stayed with the families throughout the funeral and survivor benefit process period. The Veteran reported that this duty was extremely stressful. The DD Form 214 reveals that the Veteran’s military occupational specialty (MOS) during active service was that of a military police officer. Regardless of the listed MOS, the Board finds that the Veteran’s contention that he was a Survivor Assistance Officer during the Vietnam era, who notified families of a death of military personnel, is credible and consistent with the places, types, and circumstances of his service. 38 U.S.C. § 1154(a). As such, there is clearly evidence of an in-service event in addition to a current disability. The remaining question is whether the Veteran’s current anxiety and depressive disorders onset in service or are otherwise related thereto. Post-service medical records indicate that the Veteran was provided a VA examination to evaluate his anxiety and depressive disorders in March 2012. The VA examiner opined that the diagnoses of anxiety and depressive disorders are less likely as not caused by, or a result of, the Veteran’s military duties as a Casualty Assistance Officer. The examiner’s rationale stated, “[r]egarding his military experiences [the Veteran] reports symptoms related to funerals. Specifically, he states he cannot attend funerals, he avoids funerals on tv, and he avoids listening to taps. He becomes tearful during these events.” Additionally, the examiner reported that “[t]he other reported symptoms such as feelings of doom, hopelessness, inadequacy, regret, loss of interest, reduced libido, and irritability cannot be directly connected to [the Veteran’s] military experiences, but more so to his social and financial stressors.” See March 2012 VA examination and opinion. No further rationale was provided. In April 2018, the Board remanded the appeal for service connection for an acquired psychiatric disability, to include depression with anxiety, for an addendum medical opinion to assist in determining the etiology of this diagnosed disability. In an April 2020 VA addendum medical opinion, the examiner discussed the March 2012 VA examination and then mentioned reports from the October 2010 VA examination and various VA treatment records from over the years. However, the examiner’s rationale was as follows: “based on the available objective documents indicated above, it is less likely that that the Veteran’s diagnoses of anxiety disorder and depressive disorder are related to his work as a survivor assistance officer during the Vietnam War during service.” See April 2020 VA addendum medical opinion. The probative value attributed to a VA or private medical opinion issued with regard to a service connection claim depends on factors such as thoroughness, degree of detail, and whether there was a complete review of the veteran’s claims file. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The Board must consider whether the examining medical provider had a sufficiently clear and well-reasoned rationale, and a basis in supporting objective clinical data. Bloom v. West, 12 Vet. App. 185, 187 (1999); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that do not indicate whether the physicians actually examined the veteran, do not provide the extent of the examination, and do not provide supporting clinical data) & Miller v. West, 11 Vet. App. 345, 348 (1998) (holding that a bare conclusion, even when reached by a health care professional, is not probative without an accurate factual predicate in the record). The Board is free to assess medical evidence and is not obligated to accept a physician’s opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). In this case, the Board declines to accept the March 2012 VA examination and opinion and April 2020 VA addendum medical opinion. While the Board acknowledges that the both opinions reflect, in pertinent part, that the Veteran’s anxiety disorder and depressive disorder are less likely than not service connected, the Board notes that these opinions are problematic because they do not provide an adequate rationale in support of the examiner’s opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 123-25 (2007) (an adequate medical opinion addresses the appropriate theories of entitlement and provides a supporting rationale for any medical opinion); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008 (noting a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). Additionally, the April 2020 VA addendum medical opinion also does not provide a sufficient and adequate rationale as instructed by the April 2018 Board decision. Significantly, both medical opinions failed to account adequately for the Veteran’s competent and credible lay statements such as the Veteran’s assertion that the task of notifying a Veteran’s death to their families was “extremely stressful for [the Veteran] with much dread and extremely high anticipatory anxiety.” See June 2017 VA treatment report. Thus, the March 2012 VA examination and opinion and the April 2020 VA addendum medical opinion do not form a sufficient foundation upon which to base a denial of entitlement to service connection, and the Board affords these medical opinions less probative weight. Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2009). In a July 2013 VA treatment examination and opinion, the Veteran’s treating VA physician of geriatric neuropsychiatry opined that it is more likely than not that there is a direct relationship between the Veteran’s current (psychiatric) disability and service-related events of performing duties as a Survivor Assistance Office. The physician’s rationale stated that “[the Veteran] has suffered from stressful events in service causing his anxiety. He currently suffers from this disability.” Additionally, the physician stated that, “[the Veteran] was charged with personally notifying families of the death of their loved ones - [the Veteran] describes this task as extremely stressful for him.” See July 2013 VA treatment report In a January 2017 VA treatment examination and opinion, the examiner reported that the Veteran has an anxiety disorder with panic attacks, as well as accompanying dysphoria at times bordering on full major depression. The examiner stated that the Veteran has suffered from stressful events in service causing his anxiety. Further, the examiner opined that there is a direct relationship between his current disability and service-related events. The examiner noted that the Veteran’s anxiety and panic symptoms continue to have a significant negative impact on the Veteran’s ability to cope with everyday life events. Significantly, the examiner stated, “[i]n my opinion, [the Veteran] absolutely qualifies for service-connected disability compensation for this condition.” Notably, the examiner reported that the Veteran will require medication for the rest of his life for his anxiety disorder. The Board notes that the July 2013 and January 2017 VA treatment medical examiner’s opinions were both adequately supported by a comprehensive review of the Veteran’s medical records. They are thus highly probative of a positive medical nexus between the Veteran’s current anxiety and depressive disorders and his active duty because they contain a clear conclusion with supporting data and a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Both examinations and opinions adequately accounted for the Veteran’s competent and credible lay statements. Thus, the third element of service connection can be satisfied through a positive medical nexus opinion linking the Veteran’s current anxiety and depressive disorders to his active service. In sum, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s current anxiety and depressive disorders began in service. The evidence shows that there is a current anxiety disorder and depressive disorder. Additionally, service treatment records, as well as post-service medical records, reflect an in service event and a positive medical nexus opined in both the July 2013 and January 2017 VA treatment examinations and opinions. Although the March 2012 VA examination and opinion and April 2020 VA addendum medical opinion reported that the Veteran’s current anxiety disorder and depressive disorder are less likely than not began during service, those examiners failed to account adequately for the Veteran’s competent and credible lay statements and did not give an adequate explanations. Resolving all doubt in Veteran’s favor, the Board concludes that service connection for anxiety and depressive disorder is warranted. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Dourmashkin, Law Clerk 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.