Citation Nr: 21061900 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 15-17 703 DATE: October 5, 2021 ORDER Service connection for an acquired psychiatric disability, to include depression, anxiety, and bipolar disorder, is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his psychiatric disability, to include depression, anxiety, and bipolar disorder, is at least as likely as not related to his active military service. CONCLUSION OF LAW The criteria for service connection for a psychiatric disability, to include depression, anxiety, and bipolar disorder, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from August 1995 until his discharge under honorable conditions in January 1999. This appeal has been advanced on the Board of Veterans' Appeals' (Board) docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). This case comes before the Board on appeal from a September 2014 decision by a Regional Office of the United States Department of Veterans Affairs (VA), which denied service connection for a psychiatric disability, to include depression, anxiety, and bipolar disorder. In April 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). In November 2018, the Board remanded the case to the VA Regional Office for further development. Specifically, the Board directed the VA Regional Office to obtain the Veteran's complete service personnel records and to obtain a VA medical examination and opinion addressing the etiology of his psychiatric disability. The VA Regional Office did obtain a VA medical examination and opinion, but it did not make any attempts to obtain outstanding service personnel records. Normally, failure to make reasonable attempts to obtain such records would constitute a failure to comply with VA's duty to assist. In this instance, however, the Board finds the error harmless because it is granting service connection for the Veteran's claimed disability. See Seri v. Nicholson, 21 Vet. App. 441, 447 (2007) (the grant of a claim of service connection constitutes an award of full benefits sought on an appeal). Evidentiary Standards In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 12829 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claims. Service Connection VA provides compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to be entitled to service connection there must be competent, credible evidence of (1) a current disability, (2) an in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). For psychiatric disorders, a current diagnosis under the Diagnostics and Statistical Manual of Mental Disorders (DSM-5) is required. Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). When these elements are satisfied, service connection may be granted on a direct basis. Analysis First element: A current disability Recently, the Veteran received a VA examination in August 2019 to assess his psychiatric disability. A VA psychiatrist diagnosed the Veteran with bipolar disorder, alcohol use disorder, and gambling disorder by history. The examiner stated that these diagnoses can coexist together, and it is impossible to separate them. The Veteran previously submitted a private medical opinion from a clinical psychologist who, in April 2018, diagnosed him with bipolar disorder, severe major depression disorder, and generalized anxiety disorder. Each of the medical professionals utilized the DSM-5. The Board finds no reason to doubt the medical professionals' respective findings. Therefore, the first element is satisfied. Second element: An in-service event, injury, or illness, or aggravation thereof The Veteran did not identify a particular event during his military service that he believed was related to his psychiatric disability. Instead, during his April 2018 Board hearing, he testified that he had no psychiatric issues prior to his active service. April 2018 Board Hearing, at 4. During his service, he began to experience depression and related issues due to his fellow service members harassing him because of his nationality and lack of English language skills. Id. at 45. His depression, in turn, led to alcohol dependence and a gambling addiction during active service, which continues currently. Id. at 56. In addition, he informed his private clinical psychologist that his general anxiety and stress associated with his service, to include service in Korea, increased his psychiatric issues during his service. The Board finds the Veteran's statements about his symptoms and the circumstances surrounding his symptoms credible. His statements are corroborated, to a reasonable extent, by the lay statements submitted by his friends and family who knew him prior to entrance into the Army. His friends and family members indicated that each of them routinely interacted with the Veteran prior to his entrance into the military. On the Veteran's return from the miliary, each individual similarly stated that they noticed a change in his disposition. For example, he was less social, more disrespectful, highly irritable, and had taken to gambling. Overall, his personality had changed. Based on the Veteran's statements and those of his friends and family, the Board finds the evidence is sufficient to establish an in-service onset of symptomatology associated with his psychiatric disability. Therefore, the second element is satisfied. Third element: A causal link Within the record, the Board finds two medical opinions addressing the etiology of the Veteran's psychiatric disability. First, the Veteran submitted an April 2018 opinion from a private clinical psychologist. The psychologist utilized a Suicide Risk Assessment Checklist, Beck Depression Inventory, Beck Anxiety Inventory, Hypomania/Mania Symptoms Checklist, and used the DMS-5 standards. The psychologist indicated review of the Veteran's VA case file and his personal statement. After discussing the Veteran's background, his mental status, and his test results, the psychologist concluded that it was more likely than not that the Veteran's psychiatric disability was due to his military service. The psychologist rationale, however, was only that his symptoms were not present prior to his active military service. Thus, the Board is left to conclude that the only reasonable inference is that his symptoms began in service. In addition, later within the opinion, the psychologist stated that it was "as likely as not" that his psychiatric disability was due to his military service, which is contrast to the earlier statement that it was "more likely than not" due to his military service. At the least, the Board concludes the opinion states a positive nexus, regardless of the degree of certainty. Second, the Veteran received an August 2019 VA examination, and the VA psychiatrist who examined him opined that his neuropsychiatry condition "most likely tha[n] not was present before his military service time and continue[d] during hi[s] service until [the] present time." The examiner relied on the Veteran's statements that his father had a gambling disorder. The examiner also stated the Veteran's alcohol use disorder pre-existed service, but the examiner cited no evidence in support of that conclusion. Finally, the examiner relied on the absence of treatment or diagnosis for fifteen year following the Veteran's separation from service. The Board does not afford this opinion any probative weight because the rationale is insufficient. The examiner only cited facts without explaining why those facts were important to his conclusion, such as how he was able to link the Veteran's gambling disorder with his father's gambling disorder, how he determined the Veteran's alcohol disorder pre-existed service, and why the lack of treatment for fifteen years following service was important. In addition, the examiner did not address any of the Veteran's lay statements about the onset of depression or anxiety even though they were endorsed during the examination. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("It is the fully articulated, sound reasoning for the conclusion . . . that contributes probative value to a medical opinion."). Overall, the Board finds neither opinion is wholly adequate. Nevertheless, the April 2018 private clinical psychologist's opinion, while not a model of clarity, has minimal probative value in the Board's eyes because it links the Veteran's psychiatric disability to his military service with some factual support. Consequently, resolving reasonable doubt in the Veteran's favor, the Board finds there is sufficient support to conclude that a medical nexus has been established linking the Veteran's psychiatric disability with his active military service, even if it is the bare minimum of evidence necessary to do so. Therefore, the third element is satisfied. Accordingly, service connection for a psychiatric disability, to include depression, anxiety, and bipolar disorder, is warranted. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. F. Sawka, 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.