Citation Nr: 21004943 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-60 890 DATE: January 28, 2021 ORDER Entitlement to service connection for a headache disorder is granted. Entitlement to service connection for mantel cell leukemia is granted. Entitlement to service connection for an acquired psychiatric disorder, other than posttraumatic stress disorder (PTSD), and including major depressive disorder, is granted. Entitlement to service connection for PTSD is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in the Veteran’s favor, the evidence of record shows a headache disorder is due to the Veteran’s service 2. Resolving all reasonable doubt in the Veteran’s favor, the evidence of record shows mantel cell leukemia is due to the Veteran’s service. 3. Resolving all reasonable doubt in the Veteran’s favor, the evidence of record shows depressive disorder is caused by his service-connected mantel cell leukemia. 4. The Veteran does not have a current diagnosis of PTSD in accordance with the DSM-5. CONCLUSIONS OF LAW 1. The criteria for service connection for headache disorder are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for mantel cell leukemia are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for an acquired psychiatric disorder are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 4. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 4.125. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1986 to June 1991. In August 2019, the Veteran presented testimony before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the claims file. The Board has advanced this case on the docket, on account of a December 2020 statement indicating that the Veteran has a terminal illness. Service Connection In order to establish entitlement to service connection for a disability, a veteran must show: (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, 1166-67 (Fed. Cir. 2004). With regard to secondary service connection, a disability can be service-connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(a). Moreover, secondary service connection may also be established by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(b), effective October 10, 2006. See 71 Fed. Reg. 52,744-52,747 (September 7, 2006); Wallin v. West, 11 Vet. App. 509, 512 (1998). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b). When a reasonable doubt arises regarding service origin, such doubt will be resolved in the favor of the claimant. Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. 1. Headache disorder The Veteran is seeking entitlement to service connection for a headache disorder that he believes is due to service, to include exposure to chemicals and other environmental toxins. The Board concludes that the Veteran has a headache disability that is attributable to his service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). As an initial matter, the February 2016 VA examiner diagnosed the Veteran with mixed headaches. Thus, the question becomes whether the current disability is related to service. On this question there is probative evidence in favor of and against the claim. The evidence against the claim includes the fact the Veteran’s service treatment records are completely silent regarding any complaints, treatment, or a diagnosis of headaches during service. While the Veteran’s VA treatment records note “recurrent headaches,” there are no indications of treatment for headaches prior to October 2014. A February 2016 VA examiner provided the opinion that the Veteran’s headaches are less likely than not incurred in or caused by his service. As rationale, the examiner stated that headaches are not specifically noted as likely due to Gulf War exposures per the guidelines. The Board finds that this opinion is of low probative value, as the examiner did not specifically address whether the Veteran’s headaches are caused by or related to active duty service. Furthermore, the examiner was unaware of the lay statements from the Veteran regarding his recurrent symptoms from discharge to the present. The evidence in favor of the claim includes the Veteran and his wife’s testimony in August 2019 that his chronic headaches began during active duty service and have continued on a consistent basis to the present. The Veteran is competent to report the onset and persistent nature of his headaches. See Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Charles v. Principi, 16 Vet. App. 370, 374-75 (2002). Furthermore, there is nothing in the claims file to indicate that his statements that he experienced recurrent headaches since service are not credible. In fact, the lay statements from his wife support his claim that his headaches began during service and continued from service to the present. Thus, the Board finds that the lay statements as to experiencing headaches in service with recurrent symptoms since service are credible. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the current headache disorder is related to active service, and there is no reason to accord more weight to negative evidence of record. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a headache disorder is warranted. The appeal is granted. 2. Mantel cell leukemia The Veteran is seeking entitlement to service connection for mantel cell leukemia that he believes is due to his exposure to chemicals and environmental toxins during his deployment to the Southwest Asia Theater of Operations in support of Operation Desert Shield. See August 2019 Board Hearing Transcript. The Board concludes that the record reflects the Veteran has been diagnosed with mantel cell leukemia, which is directly attributable to his military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); See April 2017 Statement from Dr. A.C. In support of his claim, the Veteran submitted a statement from his treating oncologist, Dr. A.C., dated in April 2017. Dr. A.C. concluded that the Veteran was, in fact, exposed to known carcinogens during his military service. Specifically, Dr. A.C. stated that known contaminations at El Toro, at which the Veteran was stationed and which is confirmed by the DD Form 214, include trichloroethylene (TCE) and benzene, both of which are known carcinogens according to the World Health Organization and the Agency for Toxic Substances and Disease Registry, a division of the Federal Department of Health and Human Services. In support of this finding, Dr. A.C. submitted medical treatise information. Consequently, Dr. A.C. concluded that it is very likely the Veteran was exposed to these carcinogens during service. Therefore, it is more likely than not the Veteran’s mantel cell leukemia is directly linked to his service. There are no conflicting opinions of record. Consequently, the Board finds service connection is warranted. The appeal is granted. 3. PTSD and acquired psychiatric disorder The Veteran is seeking entitlement to service connection for an acquired psychiatric disorder that he asserts is due to service. Additionally, he has provided testimony that he believes his depression is due to or aggravated by the now service-connected mantel cell leukemia. See August 2019 Board Hearing Testimony. The Board concludes that the Veteran has a current diagnosis of major depressive disorder. 38 U.S.C. §§ 1110, 1131, 5107(b); see November 2014 VA PTSD DBQ. The Board notes that the record also purports to show a diagnosis of PTSD according to a February 2016 PTSD screen contained in the VA treatment records. Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) a link, established by medical evidence, between the current symptoms and the claimed in-service stressor. 38 C.F.R. § 3.304(f); see also Cohen v. Brown, 10 Vet. App. 128 (1997). The Board has carefully reviewed the evidence but finds that service connection for PTSD is not warranted. In this regard, the Board points out that a key element in establishing service connection is to show that a veteran currently has a diagnosis of the disability for which service connection is sought. See 38 C.F.R. § 3.304. Here, the evidence of record does not show that the Veteran has met the requirements for a diagnosis of PTSD. Specifically, while the Board notes there are references to PTSD in the VA treatment records, there is no indication that the diagnosis was made in accordance with the DSM-5 or the criteria as indicated in 38 C.F.R. § 3.304. Moreover, the November 2015 VA PTSD DBQ failed to provide a diagnosis of PTSD in accordance with the DSM-5. The examiner provided a detailed rationale, summarizing that the DSM-5 criteria had not been met and that there was another mental disorder diagnosis. The Board considers this to be the most probative evidence of record, and the Veteran himself lacks the training and credentials to competently provide a diagnosis of PTSD. As such, the Board concludes that the reliable and/or probative evidence of record, on balance, does not show that the Veteran has a PTSD diagnosis. In the absence of a diagnosis of PTSD, there is no basis to grant the claim for service connection for PTSD. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Turning to the remaining diagnosis of major depressive disorder, the Veteran’s service treatment and service personnel records are silent as to any complaints or treatment for a psychiatric disorder during service. Further, the VA treatment records do not include any etiological opinions regarding the diagnosed depressive disorder. A direct service connection grant is thus not warranted in this case. However, regarding entitlement to service on a secondary basis to the now service-connected mantel cell leukemia, the Board finds service connection is warranted. Specifically, the November 2015 VA examiner determined it is more likely than not that the Veteran's depressive disorder is secondary to his lymphoma. There are no other etiological opinions of record to rebut the findings of the November 2015 VA PTSD DBQ. A claim will be denied only if the preponderance of the evidence is against the claim. If the evidence for and against a claim is in equipoise, the claim will be granted. See 38 U.S.C. § 5107. Thus, entitlement to service connection for major depressive disorder on a secondary basis is granted. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Berry, 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.