Citation Nr: 20054980 Decision Date: 08/19/20 Archive Date: 08/19/20 DOCKET NO. 17-36 266 DATE: August 19, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder is granted. FINDING OF FACT The Veteran’s acquired psychiatric disorder is related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty service from August 1972 to June 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (c). 38 U.S.C. § 7107 (a)(2). In the May 2019 Board remand, the RO was requested to identify all psychiatric diagnoses applicable to the Veteran and provide medical opinions for each identified diagnosis. In April 2020, all psychiatric diagnoses were identified, and adequate medical opinions were provided with sufficient rationales. Therefore, there has been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). In February 2020, the Veteran revoked the power of his attorney and filed a VA Form 21-22a in favor of Gabriela Vargas, who represents him under 38 C.F.R. § 14.630. Entitlement to service connection for an acquired psychiatric disorder is granted. The Veteran contends his acquired psychiatric disorder is related to service. In particular, in the June 2017 Form 9, he stated that when he entered the military in 1972, he was constantly depressed and did not know his symptoms were indicative of a disability at the time. Also, he stated he did not report his depression symptoms to his unit out of fear of repercussions. Additionally, he stated he used alcohol to relieve himself from constant depression. 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 service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in-service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disability, there must be (1) a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303 (2018); see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A veteran is entitled to the benefit of the doubt, standard of proof for benefit claim decisions. 38 U.S.C. § 5107(b). The benefit of the doubt is applicable when there is an approximate balance of positive and negative evidence. 38 C.F.R. § 3.102. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In the March 1973 military personnel record, the Veteran wrote “I feel that if I stay in the army I’ll have a nervous breakdown. I also feel that I’m going crazy or something because how I’ve changed.” Additionally, in the March 1973 Report of Medical History, the Veteran checked “yes” for frequent trouble sleeping, depression, excessive worry, and nervous trouble of any sort. In the August 2017 prison medical record, the Veteran was diagnosed with major depressive disorder (MDD). In the April 2020 VA Posttraumatic Stress Disorder (PTSD) Disability Benefits Questionnaire (DBQ), the VA examiner identified that the Veteran has the following psychiatric disorders: alcohol use disorder (AUD), stimulant use disorder (SUD), MDD, and unspecific anxiety disorder. It was noted that the does not have a PTSD diagnosis that conforms to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. First, the VA examiner opined that it is less likely than not that the Veteran’s AUD began during active service or is related to an incident of service. The VA examiner reasoned that the Veteran reported that he started drinking alcohol during childhood. Further, the VA examiner stated that that the Veteran demonstrated alcohol abuse behaviors prior to service as evidenced by DUIs prior to service. For example, the VA examiner referenced that a judge gave the Veteran the choice of joining service or going to jail, which prompted him to join the service in the first place. Second, the VA examiner opined that it is less likely than not that the Veteran’s SUD began during active service or is related to an incident of service. The VA examiner reasoned that there is no evidence of stimulant abuse in service. Also, the VA reasoned that the Veteran reported he used drugs during his youth, and he started using stimulants when he was 22 years old—four years after service. Third, the VA examiner opined that it is less likely than not that the Veteran’s MDD and unspecified anxiety disorder began during active service or is related to an incident of service. The VA examiner noted that the Veteran’s entrance examination did not note any psychiatric symptoms and he was considered “of sound mind” upon entering service and that he endorsed symptoms of depression upon his exit examination. However, the VA examiner reasoned that there is much more evidence that his emotional disturbance pre-dated his military service, and no change in behavior can be established. For example, the VA examiner referenced that the Veteran’s service treatment record (STR), mental hygiene note, indicated a personality disorder which by definition develops during one’s childhood and are long lasting. Further, the Veteran’s STR mental hygiene report noted he had a self-inflicted wound, which is common for people with personality disorders. Instead, the VA examiner concluded that the Veteran’s depression and unspecified anxiety disorder is most likely due to his alcohol abuse (as has been suggested by providers in his treatment records) or his childhood trauma and resultant personality disorder. In the March 2019 private medical opinion, Dr. P.J. opined that the Veteran has been struggling with MDD continuously since service based upon review of his in-service and post-service treatment records and military personnel records. First, Dr. P.J. reasoned that the Veteran’s enlistment examination does not indicate any psychological problems at the time of induction. Second, Dr. P.J. reasoned that there is clear evidence of early symptoms of MDD in February 1973, six months into his period of service. For example, Dr. P.J. concluded that the Veteran’s sudden decline in performance and behavior are the result of his anhedonia and depression. Also, Dr. P.J. referenced that the Veteran’s exit examination noted that he reported difficulty sleeping, depression or excessive worry and nervous trouble. Collectively, Dr. P.J. concluded these are obvious symptoms of MDD that increased in number and intensity after his discharge. Based upon review of the evidence, the Board finds the evidence is in relative equipoise as to whether Veteran’s acquired psychiatric disorder is related to service. The March 2019 private medical opinion medical opinion is probative because it is based upon complete review of the Veteran’s medical record—inservice and post-service—and on an audio/visual examination of the Veteran. Additionally, Dr. P.J. provided a sufficient rationale based on her clinical experience. The Board notes that a veteran is presumed 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 examination, acceptance, 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, 1132; 38 C.F.R. § 3.304. Thus, less probative weight is given to the April 2020 VA medical opinions because the VA examiner primarily reasoned that the Veteran was not in a psychiatrically sound condition before entering service, which is not reflected his entrance examination. Therefore, after resolving all doubt in favor of the Veteran, the Board finds that service connection for an acquired psychiatric disorder is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Willoughby, Associate Counsel 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.