Citation Nr: 21063491 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 18-12 743 DATE: October 14, 2021 REMANDED Entitlement to service connection for a psychiatric disorder, claimed as anxiety attacks, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1963 to May 1965. He served honorably in the U.S. Navy. The Board thanks the Veteran for his service to our country. The Veteran testified before the undersigned at a Board videoconference hearing in June 2021. A transcript of the hearing is of record. Entitlement to service connection for a psychiatric disorder, claimed as anxiety attacks, is remanded. A remand is warranted as an addendum opinion is necessary. In a November 2014 VA examination report, the examiner concluded that the Veteran presented with a DSM-5 diagnosis of panic attacks beginning in his 20s after service but stated that his in-service substance use is more likely responsible for his complaints of anxiety, worry, insomnia, and hyperventilation. The Board observes that an April 1965 Report of Board of Medical Survey stated that since the latter part of 1964, he had been taking Benzedrine up to 15 per day and up to 8 marijuana cigarettes in an evening. However, in a July 1964 service treatment record, the Veteran complained of occasional "stomach ache" for the past year. The provider deferred rendering an impression but noted possible psychophysical gastrointestinal reaction. Prior to that, in an April 1963 note, he had complained of stomach pain, chest pain, pain on the left side, and nosebleed; the provider noted that he was asymptomatic and that physical examination was essentially negative and rendered an impression of possible gas pain. In a July 1963 service treatment record, the Veteran had reported stomach pains off and on since coming into service and that he had trouble getting to sleep at night; on physical examination, the provider noted infected sclera and pharynx infected severely and rendered an impression of acute pharyngitis. While there is evidence of a possible psychophysical gastrointestinal reaction and trouble sleeping prior to the latter part of 1964, the examiner did not address this in concluding that the Veteran's in service complaints of anxiety, worry, insomnia, and hyperventilation were due to in-service substance use. In a November 2017 VA opinion, the clinician concluded that there is a relative lack of documentation "definitively" linking the Veteran's current psychiatric symptoms to service; this appears to require a higher degree of certainty than the required "at least as likely as not" standard. Furthermore, the April 1965 Report of Board of Medical Survey noted that a Minnesota Multiphasic Personality Inventory showed and confirmed the existence of a schizoid type of character disorder. As noted above, there is evidence of possible psychophysical gastrointestinal reaction; additionally, in a November 1964 service treatment record, the provider rendered an impression of acute maladjustment reaction with hyperventilation syndrome. Additionally, the Veteran has repeatedly relayed and reported anxiety and stress caused by his duties on the flight line, which exposed him to the risk of hitting a propeller or getting sucked into an engine intake; arriving at work one morning and hearing of a servicemember in another unit being killed by a propeller earlier that day; and being bumped or tackled by another service member and nearly hitting a moving propeller. As there is evidence that a disease or injury superimposed on the diagnosed personality disorder may have occurred in service, an addendum opinion is warranted. Finally, the Board observes that in a March 2021 note the Veteran reported that he saw a man killed by propellers of a plane and in June 2021 he reported that he saw a guy "cut in half" by a propeller. The Board finds that these statements of witnessing a man killed by a propeller are not credible as they are inconsistent with his prior statements of hearing of the accident when he arrived for work one morning. The Board additionally observes that memory impairment and cognitive defects were noted at the time of these reports, including in December 2020 and March, April, May, and June 2021 treatment notes. The Board makes no other credibility determinations at this time. The matters are REMANDED for the following action: 1. Please secure for the record copies of complete updated clinical records (any not already of record) of all VA and non-VA treatment the Veteran has received for the disabilities on appeal, to include any psychotherapy or mental health treatment received through VA community care. Please ask the Veteran to provide the releases necessary for VA to secure private treatment records. 2. After the action requested in paragraph 1 is complete, please refer the claim to an appropriate clinician for an addendum opinion as to the nature and etiology of the psychiatric disorder. The Veteran's claims-file must be made available to and reviewed by the clinician. The clinician is requested to respond to the following: (a.) Please identify by diagnosis all psychiatric disorders current during the period on appeal, including panic disorder and depressive disorder. (b.) For each disorder identified, is the Veteran's psychiatric disorder at least as likely as not (a 50 percent or greater probability) related to service, to include STRs showing a possible psychophysical gastrointestinal reaction and trouble sleeping prior to the latter part of 1964 (when he indicated his substance abuse began), in service complaints of anxiety (including due to his duties on the flight line, which exposed him to the risk of hitting a propeller or getting sucked into an engine intake), worry, insomnia, and hyperventilation? Please consider and address, as appropriate: An April 24, 1963 STR in which the Veteran complained of stomach pain, chest pain, pain on the left side, and nosebleed. The provider noted that he was asymptomatic and physical examination was essentially negative and rendered an impression of possible gas pain. See STR Medical, received 2/21/2014, pg. 48. A July 16, 1963 STR in which the Veteran complained of stomach pains off and on since entrance into service, as well as trouble getting to sleep at night. On physical examination, the provider noted infected sclera and pharynx infected severely and rendered an impression of acute pharyngitis. See STR Medical, received 2/21/2014, pg. 48. A July 27, 1964 STR, in which the Veteran complained of occasional "stomach ache" for the past year. Noting no abnormalities on physical examination, the provider deferred an impression but noted possible psychophysical GI reaction. See STR Medical, received 2/21/2014, pg. 42. A November 9, 1964 STR in which the Veteran developed severe abdominal pains and presented to sick bay. He left before being seen but was brought back because he had "collapsed" outside. On examination, very flushed erythematous face, tachycardia, and pounding heart were noted and he complained of pain "all over," making a sweeping motion of his chest and abdomen. When asked why he had wanted to see a psychiatrist the week before, he relayed becoming mad very easily and wanting to smash everything. See STR Medical, received 2/21/2014, pgs. 40-41. A November 10, 1964 psychiatric consultation report in which the provider noted that the Veteran presented with symptoms of acute anxiety, inability to get along with his peers, blowing up when quite excited, and vague somatic complaints. The provider stated that the major problems, described as "typical," concern separation from home, parents, and finding an identity of his own and rendered an impression of acute maladjustment reaction with hyperventilation syndrome. See STR Medical, received 2/21/2014, pg. 23. A March 2, 1965 STR stating that the Veteran had been examined for special duty as an aircrewman and found not qualified as he was very emotionally insecure with functional and minor complaints and was subject to depression and attacks of anger and anxiety. See STR Medical, received 2/21/2014, pgs. 8, 36. An April 22, 1965 Report of Board of Medical Survey noting that the Veteran had apparently been subject to attacks of anger and anxiety and that he complained of trouble sleeping and nervousness. The Report stated that he indicated that since the latter part of 1964, he had been taking "bennies" up to 15 per day and smoking up to 8 marijuana cigarettes in an evening. The Report stated that on April 11, 1965, he made superficial scratches which led to his transfer to psychiatric service. The Report stated that a Minnesota Multiphasic Personality Inventory showed and confirmed the existence of a schizoid type personality disorder. See STR Medical, received 2/21/2014, pgs. 4-7. The Veteran's statement relaying in-service and post-service events. See VA 21-0781 and VA 21-0781a, both received 7/11/2014. The Veteran's reported fear of ceiling fans See June 24, 2014 private record in Medical Treatment Record Government Facility received 12/5/2017, pgs. 30-31; Buddy /Lay Statement received 7/11/14; and July 16, 2015 VA mental health note. The Veteran's reported fear of flying. See September 11 and 17, 2015 VA mental health notes. The Veteran's reported and witnessed flashbacks related to propellers. See June 11, 2015; August 27, 2015; and January 14, 2016 VA mental health notes. A June 3, 2017 letter from the Veteran's former VA provider. See Medical Treatment Record Government Facility received 6/24/2014, pgs. 2-6. With respect to the April 1965 in-service diagnosis of schizoid personality disorder: (c.) Is it at least as likely as not (a 50 percent or greater probability) that a disease or injury superimposed on the Veteran's personality disorder occurred in service? Please consider and address, as appropriate, the in service treatment records, reports, and diagnoses identified under question (b.) above. In responding to question (c.) above, please consider: (d.) Is there any medical evidence to support that the Veteran had a superimposed disease or injury in service? (e.) Is there any medical reason to accept or reject the proposition that had the any of the claimed events (exposure to stress and anxiety on the flight line, arriving at work to hear of a service member killed by a propeller, and being bumped and nearly hitting a rotating propeller) occurred in service, such event would result in a superimposed disease or injury? The clinician is advised that the Board may not outsource its credibility findings to a medical examiner or clinician. The Board has found that the Veteran's statements of witnessing a man killed by a propeller are not credible but makes no other credibility findings at this time. Accordingly, solely for the purposes of responding to the opinions requested above, with the exception of his statements of witnessing the man killed by the propeller, the clinician is to treat as credible his claimed in-service events. ONLY IF the clinician determines that an examination is necessary for the addendum opinion, the Veteran should be scheduled for an appropriate VA examination to determine the nature and etiology of the disorder. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Vashaw, 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.