Citation Nr: 20054983 Decision Date: 08/19/20 Archive Date: 08/19/20 DOCKET NO. 11-07 010 DATE: August 19, 2020 ORDER Entitlement to service connection for a psychiatric disorder with alcohol use disorder is granted. REMANDED Entitlement to service connection for a gastrointestinal disorder, claimed as a stomach disorder, including as secondary to a psychiatric disorder with alcohol use disorder, is remanded. FINDING OF FACT Affording the Veteran the benefit of the doubt, his current psychiatric disorder at least as likely as not manifested during his period of active service and has continued to the present, and his alcohol use disorder is a result of his psychiatric disorder. CONCLUSION OF LAW The criteria for service connection for a psychiatric disorder with alcohol use disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1970 to May 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned in February 2014. In January 2018, the Board denied service connection for a psychiatric disorder and stomach condition, to include as due to a psychiatric disorder. In August 2019, the Court of Appeals for Veterans Claims (Court) issued a memorandum decision remanding the portion of the Board’s January 2018 decision that denied the Veteran the issues on appeal. Thus, the issues of entitlement to service connection for a psychiatric disorder and a stomach condition were returned to the Board for further adjudication. The Veteran submitted evidence since the August 2019 Court remand, for which a waiver of initial RO consideration was provided. Entitlement to service connection for a psychiatric disorder with alcohol use disorder is granted. Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that compensation cannot be awarded pursuant to 38 U.S.C. §§ 1110, 1131 and 38 C.F.R. § 105(a) either for a primary substance abuse disability incurred during service or for any secondary disability that resulted from primary substance abuse during service. Allen v. Principi, 237 F.3d 1368, 1376 (Fed. Cir. 2001). However, service connection may be granted for an alcohol or drug abuse disability acquired secondary to, or as a symptom of, a service-connected disability. The Federal Circuit further stated that such compensation may be awarded only where there is clear medical evidence establishing that alcohol or drug abuse is caused by a veteran’s primary service-connected disability, and where the alcohol or drug abuse disability is not due to willful wrongdoing. Id. at 1381. When there is an approximate balance of positive and negative evidence regarding any material issue, reasonable doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Veteran submitted a psychological evaluation from private physician, E.Z., Psy.D., completed in May 2020, in which Dr. E.Z. opines that the Veteran’s generalized anxiety disorder at least as likely as not emerged during his military service. Dr. E.Z. also opined that it is at least as likely as not that the Veteran began to use alcohol to cope with the emerging and then worsening symptoms of his generalized anxiety disorder, consistent with a December 2010 VA examination reflecting that the Veteran’s substance abuse is related to his generalized anxiety disorder. The Board finds the reports by the Veteran that his psychiatric symptoms and alcohol abuse have continued since leaving service to be competent and credible evidence of continuing symptoms since active service. See Jandreau v. Nicholson, 492 F.3d 1376-77 (Fed. Cir. 2007); 38 C.F.R. §§ 3.303. In addition, there is no evidence of record that the Veteran’s alcohol use disorder is due to the Veteran’s willful wrongdoing. The Board notes a December 2016 VA examination in which the VA examiner opined that it was less likely than not that the Veteran’s psychiatric disorders were related to, or had their onset during, his military service, in part because the Veteran provided varying accounts of the onset, course, and precipitating factors of his mental health conditions, making it difficult to draw conclusions regarding their relationship to his military service without resorting to speculation. However, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s psychiatric disorder was incurred during military service and has continued ever since, and whether his alcohol use disorder is a result of his psychiatric disorder. By resolving any reasonable doubt in favor of the Veteran, the Board finds service connection for a psychiatric disorder with alcohol use disorder is warranted. REASONS FOR REMAND Entitlement to service connection for a gastrointestinal disorder, claimed as a stomach disorder, including as secondary to a psychiatric disorder with alcohol use disorder, is remanded. It does not appear as though the Veteran has been provided a VA examination regarding his service connection claim for a stomach issue. Particularly in light of the Board’s determination that the Veteran is entitled to service connection for a psychiatric disorder with alcohol use disorder, the Board finds that a VA examination is warranted. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Thus, this issue will be remand for a VA examination. This matter is REMANDED for the following action: Obtain an opinion, preferably with a qualified clinician who has not previously examined the Veteran, regarding his claim of service connection for a stomach and/or gastrointestinal disability. If the selected clinician determines that an examination is necessary to respond to this request, such examination should be scheduled. After review of the claims file, and examination of the Veteran if deemed necessary, the examiner should identify all of the Veteran’s stomach and/or gastrointestinal disabilities during the course of the appeal. For each stomach and/or gastrointestinal disability found during the time period on appeal, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s stomach and/or gastrointestinal disability began in or is otherwise caused by the Veteran’s active service. In addition, for each stomach and/or gastrointestinal disability found during the time period on appeal, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s stomach and/or gastrointestinal disability is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran’s service-connected psychiatric disorder with alcohol use disorder. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the Veteran’s stomach and/or gastrointestinal disability prior to aggravation by the service-connected psychiatric disorder with alcohol use disorder. Please note, causation and aggravation are separate concepts and must be addressed independently. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion.  If the examiner rejects the Veteran’s reports, he or she must provide a reason for doing so. All findings must be reported in detail and all opinions must be accompanied by a clear rationale.  If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Elias, 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.