Citation Nr: 21064857 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 18-40 456 DATE: October 21, 2021 ORDER Service connection for an acquired psychiatric disability, to include unspecified depressive disorder, is granted. Service connection for a bilateral pelvic disability is granted. Service connection for lumbosacral strain disability is granted. REMANDED Service connection for headaches/migraines disability is remanded. FINDINGS OF FACT 1. The Veteran's acquired psychiatric disability, to include unspecified depressive disorder, is related to her active military service. 2. The Veteran's bilateral pelvic disability is related to her in-service fall and injury. 3. The Veteran's lumbosacral strain disability is related to her in-service fall and injury. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disability, to include unspecified depressive disorder, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.125(a). 2. The criteria for service connection for bilateral pelvic disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for lumbosacral strain disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United Stated Army from March 2013 until her discharge in June 2013. Her DD 214 states her character of service was "uncharacterized." As explained later, her discharge was due to an in-service medical condition. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 decision by the Atlanta, Georgia, Regional Office of the United States Department of Veterans Affairs (VA). In March 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. 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). When these elements are satisfied, service connection may be granted on a direct basis. Additional legal theories of service connection will be discussed where appropriate in the analysis portion of this decision. Analysis 1. An acquired psychiatric disability, to include unspecified depressive disorder The Veteran initially filed for, and was denied, service connection for posttraumatic stress disorder. A claim for service connection may be expanded beyond a veteran's lay description of a disability to include any disability "that may reasonably be encompassed by several factors including: the claimant's description of the claim; the symptoms the claimant describes; and the information the claimant submits or that the Secretary obtains in support of the claim." Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). On review of the record, the Board finds it is appropriate to expand the Veteran's claim for service connection to include acquired psychiatric disabilities beyond posttraumatic stress disorder. First element: A current disability In the context of service connection for an acquired psychiatric disability, the "current disability" requirement must be proven with evidence diagnosing the condition in accordance with the Diagnostics and Statistical Manual of Mental Disorder (DSM-5). 38 C.F.R. § 4.125(a). The Veteran submitted a private mental health evaluation from a licensed psychologist dated July 21, 2021. Following review of the Veteran's medical history and military records, in addition to considering the Veteran's lay statements, the psychologist diagnosed the Veteran with unspecified depressive disorder under the DSM-5. The Board finds the psychologist's diagnosis credible, and there is a lack of evidence to contradict the diagnosis. Therefore, the first element is satisfied. Second element: An in-service event, injury, or illness, or aggravation thereof During her March 2021 Board testimony, the Veteran explained that during her active service, her unit had "battle buddies," people they teamed with during training. When she was with her battle buddy, they were cleaning their rifles at a gun range. She turned around for a moment and heard a loud pop behind her. She turned back around and discovered that her battle buddy had shot herself accidently due to an adaptor explosion. Her battle buddy died. Following the incident, her fellow servicemembers began to bully her, making her think it was her fault that her battle buddy had died. She began isolating herself, became depressed, and continued to reexperience the event. To date, she continues to have feelings of guilt. Within two weeks of her discharge from service, she sought treatment for mental health issues and was diagnosed with depression and anxiety. The Board finds the Veteran's statements about witnessing the death of her battle buddy are credible and probative. In addition, her statements about her symptoms in service are corroborated by her VA mental health treatment in July 2013, less than a month following her discharge from service. Therefore, the second element is satisfied. Third element: A causal link The Veteran submitted a private opinion dated July 21, 2021, from the licensed psychologist. The psychologist opined that the Veteran's unspecified depressive disorder was at least as likely as not a direct result of, and attributed to, her witnessing the death of her battle buddy. The psychologist reasoned that the event triggered the Veteran's mental health symptoms in service, which then continued following her discharge. The psychologist relied on the Veteran's statements about the severity and chronicity of her mental health symptoms and her medical history. The psychologist also relied on a lack of any evidence indicating mental health symptoms prior to entering service. The Board finds the psychologist's opinion highly credible and probative. Therefore, the third element is satisfied. Accordingly, service connection for an acquired psychiatric disability, to include unspecified depressive disorder, is granted. 2. Bilateral pelvic disability 3. Lumbosacral strain The Board addresses the Veteran's claims for service connection for a bilateral pelvic disability and lumbosacral strain together as their analyses rely on substantially similar facts. First element: A current disability Bilateral pelvic disability The Veteran's VA medical records do not indicate a particular medical diagnosis associated with her cited bilateral pelvic disability. But they do indicate that she suffered chronic pelvic pain due to a hairline pelvic bone fracture during the claim period. See, e.g., October 2014 VA Womens Health Note. The U.S. Court of Appeals for the Federal Circuit has held that pain alone may constitute a disability, even without an identifiable underlying pathology. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). The veteran's pain, however, must amount to a functional impairment to constitute a disability. Id. at 1367. "Functional impairment," the Federal Circuit noted, is defined as the inability of the body or a constituent part of it " 'to function under the ordinary conditions of daily life including employment.' " Id. at 1363 (quoting 38 C.F.R. § 4.10). In other words, pain alone can qualify as a disability where it diminishes the body's ability to function, even where it is not diagnosed as connected to a current underlying condition. Id. In this instance, the Board finds the Veteran's chronic bilateral pelvic pain, which has been continuously documented throughout her VA medical records, resulted in decreased functionality, and it interfered with her gait and general tolerance for walking. Lumbosacral strain The Veteran received a VA-contracted examination in January 2019 at which time the examiner diagnosed her with lumbosacral strain, which was related to her pelvic pain. The Board finds the Veteran has a bilateral pelvic disability and lumbosacral strain, each of which satisfy the first element of direct service connection. Second element: An in-service event, injury, or illness, or aggravation thereof The Veteran testified at her March 2021 Board hearing that during physical training she was participating in a run (while carrying a ruck sack) when a fellow soldier stumbled and fell. She tried to help that soldier up, but she fell from an extreme pain in lower back and pelvic area at the same time. When she fell, she hit her back. She received a medical scan and was told that she had two stress fractures on both sides of her pelvis. She also experienced intense lower back pain. The Veteran's in-service medical records document her injury and a diagnosis of pelvic stress fracture in 2013. Notably, her DD 214 indicates her reason for separation was "condition, not a disability," and separation authority was "AR 635-200, PARA 5-17." Army Regulation 635-200, paragraph 5-17 (2013), provides for the separation of personnel due to other designated physical or mental conditions that potentially interfere with performance of duty. During VA medical treatment, she consistently reported the same event during evaluations. She reported a bone scan in service that showed a fractured pelvis. She also report being placed on crutches. The Board finds the evidence is highly credible and probative, thus establishing that the Veteran suffered an in-service injury to her pelvis and low back due to the in-service fall she sustained. Therefore, the second element is satisfied as to both claims for service connection. Third element: A causal link Although no medical opinion properly addresses the etiology of the Veteran's bilateral pelvic disability or lumbosacral strain, the Board finds such an opinion is unnecessary in this case. The evidence overwhelmingly establishes that the Veteran suffered a pelvic and low back injury in service. She sought treatment for her injuries in service and continued to seek treatment for her injuries immediately following her separation from service. She has credibly described the symptoms she has experienced since service in relation to her pelvis and low back injuries, to include pain and functional limitation. The Board finds her statements highly probative. The Board concludes that the Veteran's current pelvic and low back disabilities are reasonably related to her in-service injuries due to the chronicity of symptoms that she has experienced since her service. There is a lack of evidence that any other intervening cause could have reasonably led to her current disabilities. See Savage v. Gober, 10 Vet. App. 488, 497 (1997) (holding that lay evidence of continuing symptoms of a disability following service can be sufficient to demonstrate a medical nexus between a current disability and an in-service event or injury, even where there is no medical opinion establishing that nexus). Therefore, the third element is satisfied for each service connection claim. Accordingly, service connection for a bilateral pelvic disability and lumbosacral strain is warranted. REASONS FOR REMAND 1. Service connection for headaches/migraines is remanded. During her Board testimony, the Veteran asserted that she suffers from headaches/migraines secondary to her psychiatric disorder. As the Board has granted service connection for an acquired psychiatric disorder in this decision, remand is required to afford the Veteran a VA examination and to obtain a medical opinion addressing the etiology of her cited headaches/migraines. Accordingly, the matter is REMANDED for the following actions: 1. Obtain any of the Veteran's outstanding VA medical records and associate them with the claims file. 2. After any additional records are associated with the claims file, obtain a VA examination from an appropriately qualified clinician who is asked to provide an opinion addressing the onset and etiology of the Veteran's claimed headaches/migraines. The entire claims file must be made available to and be reviewed by the examiner, including a copy of this REMAND order. The examiner is asked to provide an opinion regarding: (a.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran's headaches/migraines, if any, had their onset in or is otherwise etiologically related to an in-service event, injury, or disease, to include when the Veteran hit her head against a wall in service lacerating it open. (b.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran's headaches/migraines were caused by (proximately due to or as the result of) her service-connected acquired psychiatric disability. (c.) Whether it is at least as likely as not (a 50 percent probability or more) that the Veteran's headaches/migraines were aggravated by her service-connected psychiatric disability. The examiner is advised "aggravation" means any increase in the severity of the underlying disability beyond its natural progression. In rending his or her opinion, the examiner should consider and, if deemed relevant, address the following, in addition to any other relevant evidence: (a.) Three articles submitted by the Veteran on March 26, 2021, which are: 1. A portion of an article from the International Classification of Headache Disorders 3rd Edition, entitled, "Headache attributed to psychiatric disorder." 2. The Link Between Mental Illness and Your Headaches, www.verywellhleath.com 3. The Associations Between Preexisting Mental Disorders and Subsequent Onset of Chronic Headaches: A Worldwide Epidemiologic Perspective, American Pain Society, 16 Journal of Pain 1, 4252 (2015). The examiner is reminded to consider the Veteran's lay statements regarding the nature and onset of her headaches/migraines, including any evidence concerning continuity of symptomatology, as she is legally permitted to report her symptoms, past medical history, and experiences. The examiner must not opine on the credibility of the Veteran. The examiner may, however, discuss whether there is any medical reason to accept or reject the Veteran's assertion of a headaches/migraines in service or the assertion that the Veteran's service-connected psychiatric disability led to her headaches/migraines. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board. Please do not simply list the facts on which you relied. The examiner is informed that reliance on a lack of treatment and/or gap between discharge from military service and diagnosis of a disability, without explaining why such evidence is significant, is an insufficient rationale. The examiner is informed that the absence of contemporaneous service treatment records or medical records in general, standing alone, without explaining why such evidence is significant, is an insufficient rationale. If the examiner relies on medical treatises, the examiner should identify the treatises. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). 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.