Citation Nr: 20052295 Decision Date: 08/06/20 Archive Date: 08/06/20 DOCKET NO. 18-46 745 DATE: August 6, 2020 ORDER New and material evidence having been received, the appeal to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, to include other specified trauma and stressor related disorder, is reopened. New and material evidence having been received, the appeal to reopen a claim of entitlement to service connection for diabetes mellitus (diabetes), to include as secondary to an acquired psychiatric disorder, is reopened. Service connection for a psychiatric disorder, to include other specified trauma and stressor related disorder, is granted. Service connection for diabetes, to include as secondary to an acquired psychiatric disorder (i.e., other specified trauma and stressor related disorder, posttraumatic stress disorder, major depressive disorder and/or generalized anxiety disorder), is denied. FINDINGS OF FACT 1. A July 1978 rating decision that denied service connection for a nervous condition with functional bowel disease was final; no new and material evidence was submitted to reopen the claim. 2. A November 2010 rating decision that denied depression, not otherwise specified (claimed as anxiety/depression feature) was final because the Veteran withdrew an appeal of the claim in August 2012. Evidence received since the November 2010 rating decision is both new and material. 3. A June 2014 rating decision that denied service connection for diabetes was final; evidence received since that time is both new and material. 4. Resolving reasonable doubt in the Veteran’s favor, the Veteran’s other specified trauma and stressor related disorder is attributable to active service. 5. The preponderance of the evidence is against finding that the Veteran’s diabetes manifested in service, is causally or etiologically related to service, or otherwise developed secondary to or been aggravated by a service-connected disability or medication used to treat a service-connected disability. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen the claim for service connection for an acquired psychiatric disorder. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 2. New and material evidence has been received to reopen the claim for service connection for diabetes. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 3. Resolving reasonable doubt in the Veteran’s favor, the criteria for service connection for other specified trauma and stressor related disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. The criteria for service connection for diabetes, to include as secondary to medication used to treat an acquired psychiatric disorder, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the Navy from June 1975 to August 1976, with service aboard the USS Claude Ricketts from November 28, 1975 to August 4, 1976. His military occupation specialty was boiler technician. The Veteran currently has a combined disability rating of 70 percent. In a September 2015 application for compensation, the Veteran originally sought service connection for anxiety and depression. In a September 2018 statement of the case (SOC), the Regional Office (RO) recharacterized the Veteran’s mental health claims as requests for service connection for an acquired psychiatric disorder, including persistent depressive disorder and generalized anxiety disorder. In a statement received in October 2018, the Veteran sought service connection for posttraumatic stress disorder (PTSD). The RO addressed the Veteran’s PTSD claim in a January 2019 supplemental statement of the case (SSOC). Given the various mental health claims, the Board has broadly construed and simply recharacterized the Veteran’s claim as one for entitlement to service connection for an acquired psychiatric disorder, pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009). New and Material Evidence The RO denied service connection for a nervous condition with functional bowel disease in July 1978. The RO also denied depression, not otherwise specified (claimed as anxiety/depression feature) and diabetes mellitus in rating decisions dated in November 2010 and June 2014. These decisions became final in November 2011 and June 2015, respectively. The evidence submitted after the November 2010 and June 2014 rating decisions include unclassified documents regarding a collision between the USS John F. Kennedy and the USS Belknap that occurred at sea on November 22, 1975 in which eight sailors were killed. The USS Claude V. Ricketts was involved in search and rescue operations related to the collision. Records reflect the Veteran served about the USS Claude V. Ricketts from November 28, 1975 until his discharge on August 4, 1976. The Board finds that on its face, this new evidence is material in that it relates to unestablished facts necessary to substantiate the Veteran’s service connection claims. Therefore, the Board finds that these claims should be reopened. Service Connection Service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a disability that is proximately due to a service-connected condition. 38 C.F.R. § 3.310(a). Service connection is also possible when a service-connected disability has aggravated a claimed condition, but compensation is only payable for the degree of additional disability attributable to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). 1. Service connection for an acquired psychiatric disorder, to include other specified trauma and stressor related disorder The Veteran served on the USS Claude Ricketts from November 28, 1975 to August 4, 1976. He contends that he developed a psychiatric disorder as a result of his after-the-fact exposure to a collision involving the USS John F. Kennedy and the USS Belknap on November 22, 1975 in which 8 sailors were killed. The USS Claude Ricketts was involved in search and rescue operations. The Veteran began his duty on the USS Ricketts six days after the collision. Although not on-board or involved in the actual search and rescue operations, the Veteran reports being traumatized after the collision with his own fears of dying aboard ship that were amplified when he was tormented by fellow sailors who told him the sailors who died in the collision worked in the boiler room. He also claims being traumatized when he boarded an airplane flight that contained the bodies of the eight deceased soldiers. Upon review of the evidence, the Board finds that entitlement to service connection for other specified trauma and stressor related disorder is warranted. The Veteran’s entrance examination reflects a normal clinical psychiatric evaluation. Medical records dated in 1975 reflect ailments such as chest colds, slight otitis of the ears, inflammation of the throat, problems with his right eye, symptoms of rubella and treatment for a skin rash. However, records dated in 1976 reflect consistent complaints of gastrointestinal problems that were found to have no medical basis. Although the service records reveal that the Veteran was not actually aboard the USS Claude Ricketts when it was involved in the post-collision search and rescue mission, they reflect the Veteran’s consistent medical complaints that primarily involved gastrointestinal problems of a potential psychiatric basis in July 1976. Normal medical examinations led to impressions of functional bowel disease related to stress and work conditions. The Veteran’s provisional diagnosis was chronic anxiety with depressive features. Psychiatric consultation notes diagnosed that the Veteran’s bowel disease was attributed to an immature personality manifested by nervousness, insomnia, poor appetite, a sense of being mistreated and a sense of being stressed. He was noted as not getting along with his peers or soldiers; and drinking to excess three-to-four times a week resulting in blackouts and alcohol induced gastritis. However, the examiner found no evidence of disciplinary action. The examiner further reported that the Veteran had no insight into his emotions and that his mental status was immature and tense, without evidence of a thought disorder. The final diagnosis was immature personality with functional bowel disease. It was recommended that the Veteran be administratively separated. During an interview for administrative discharge, the Veteran agreed with the previous evaluation, which was personality inadequate to deal with stress of his duty and features of persecution complex. It was noted that separation from the Navy was probably the best for both parties. Per a July 1976 notation on his performance record, the Veteran was not recommended for reenlistment. In a July 1978 rating decision related to claims for hiatal hernia and an ulcer, the Veteran was again noted as having suffered from insomnia, poor appetite and “said to have been mistreated” while in service. Post-service medical records reveal various psychiatric diagnoses that included rule out substance induced mood disorder, rule out bipolar disorder, adjustment disorder, anxiety state, sleep disturbances/insomnia, major depressive disorder, generalized anxiety disorder, anxiety/insomnia, PTSD with depression and anger, and chronic PTSD. The Board’s review of the evidence revealed no diagnosis of a personality disorder. Several VA examination reports are contained in the claims file. Two reports, dated in July 2018 and August 2018, are against the Veteran’s claim. These examinations were specifically related to mental disorders other than PTSD. The reports reflect diagnoses of persistent depressive disorder and generalized anxiety. The July 2018 examiner opined that the Veteran’s disorders were less likely than not incurred in or caused by mental complaints during service. In doing so, he stated that the Veteran likely exhibited pervasive personality characteristics throughout his life that impaired social functioning. He stated that the Veteran reported a history of tumultuous personal relationships throughout his life but did not describe any traumatic events during his service with the U.S. Navy likely to produce the characterological symptoms he described. An August 2018 medical opinion also found it less likely than not that the Veteran’s mental health treatment in service was related to the mental health treatment he received while in service. The examiner essentially based her opinion on there being a lack of continuity of reported symptoms/treatment between the Veteran’s post-service mental health problems being a continuation of the distress he experienced in the military. The claims file also contains a July 2018 letter from S.O., a board-certified family nurse practitioner that stated that the Veteran had an approximate 15-year history of PTSD and described symptoms related to this disorder. Additional evidence in support of the Veteran’s claim consists of a letter from D.S., a board-certified psychiatric health nurse practitioner, who stated that the Veteran was being treated for PTSD. The Veteran was also evaluated in January 2019. However, this evaluation was specifically related to PTSD. The psychologist examining the Veteran did not specifically diagnose him with PTSD, but he did diagnose the Veteran with a similar disorder, specifically “other specified trauma/stressor related disorder,” in addition to major depressive disorder. He found that the Veteran had symptoms of PTSD but did not meet the requisite criteria for that diagnosis, due to the nature of the identified stressor. In this regard, the Veteran reported that while in the Navy aboard ship, he thought this ship was going to blow up at any time. He stated that he took Valium and Maalox for his symptoms (documented in the service records) because the other soldiers had him “so confused.” He stated that he was in the same work area as where the eight sailors had died, presumably meaning his work in the boiler room; resulting in his development of ulcers in service. The examiner found that while this stressor was insufficient to meet “Criterion A” for a diagnosis of PTSD, it was sufficient for a diagnosis of other specified trauma/stressor related disorder. He opined that it was at least as likely as not that this disorder was caused by or the result of the Veteran’s military experiences. After reviewing the evidence, the Board finds that doubt should be resolved in the Veteran’s favor and service connection for other specified trauma and stressor related disorder should be granted. There are competent and credible positive and negative opinions of record, and they are at least in relative equipoise. For these reasons, the appeal is granted. 2. Service connection for diabetes mellitus The Veteran’s theory of entitlement to service connection is that he developed diabetes secondary to medication he has been prescribed in relation to his (now) service-connected psychiatric disorder. Post-service medical records document the Veteran being diagnosed with obesity and impaired fasting glucose intolerance in February 2005. The most pertinent evidence regarding this issue is a July 2018 medical opinion in which a medical doctor opined that the Veteran’s post-service diabetes is less likely than not proximately due to or the result of his mental health disorders, to include weight gained as a result of medications taken for his disorders. The examiner reported that diabetes is not simply caused by weight gain alone. Rather, it is a multifactorial disease. He stated that there is no direct correlation between psychotropic medications and diabetes. Therefore, he believed the Veteran’s diabetes was not the result of his underlying psychiatric disorders. The Board finds the July 2018 medical opinion to be credible, persuasive and uncontroverted. Although the Veteran may believe that his diabetes is related to medication used to treat his stressor related disorder, as a lay person untrained in the field of mental health medicine he is not competent to offer a medical opinion which requires specialized knowledge and training. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). For the purposes of completion, the Board finds for the record that to the extent that service connection on a direct basis must be addressed, the Veteran has not alleged that his diabetes manifested in service or he experienced symptomatology that can be associated with this disability in service. Further, service treatment records do not reflect a diagnosis of diabetes or symptomatology that can be associated with this disability. Additionally, post-service medical records reflect that the Veteran was first diagnosed with diabetes in 2005. Based upon the foregoing, the Board finds that service connection for diabetes on a direct basis must also be denied. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s diabetes claim, that doctrine is not applicable. The appeal for service connection for diabetes is denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Talpins, Patricia 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.