Citation Nr: 21071988 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 17-47 016 DATE: December 2, 2021 ORDER Entitlement to service connection for unspecified anxiety disorder is granted. FINDING OF FACT When resolving the benefit of the doubt in favor of the Veteran, his acquired psychiatric disability, diagnosed as unspecified anxiety disorder, began during active service. CONCLUSION OF LAW The criteria for service connection for unspecified anxiety disorder are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 2013 to June 2015. The character of service on the Veteran's DD 214 was listed as under other than honorable conditions. However, in an April 2016 determination, the agency of original jurisdiction (AOJ) found that the Veteran's period of active service was considered honorable and thus, entitlement to VA benefits was established. The Board previously remanded this issue for further development in March 2019. The Board also remanded the issue of entitlement to service connection for a low back disability. In an October 2021 rating decision, service connection for lumbar strain was granted; representing a full grant of the benefit sought on appeal. Entitlement to service connection for an acquired psychiatric disability The Veteran contends that his acquired psychiatric disability began in service. He has further reported that his symptoms have continued since that time. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Initially, the Board notes that the Veteran filed a claim for posttraumatic stress disorder (PTSD). However, after examining the Veteran and reviewing the claims file, two VA examiners found that the Veteran did not meet the criteria for PTSD. Rather, the appropriate diagnosis was unspecified anxiety disorder. Likewise, VA clinical records also do not show a diagnosis of PTSD. Further, while the Veteran is competent to describe his symptoms, he is not competent to render a diagnosis for such symptoms as specialized medical knowledge is necessary. In turn, based on the probative medical evidence of record, the Board finds that the Veteran does not meet the criteria for a diagnosis of PTSD. Importantly, the medical evidence of record shows that the Veteran has a current diagnosis of unspecified anxiety disorder. The Board now turns to whether such disability is related to service. Based on the evidence of record and when resolving the benefit of the doubt in favor of the Veteran, the Board concludes that the Veteran's acquired psychiatric disability, diagnosed as unspecified anxiety disorder, began during active service. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In this regard, service treatment records showed that in October 2014, the Veteran was screened for acute stress reaction upon return from Afghanistan, but there were no symptoms at that time. However, a February 2015 clinical record showed that the Veteran was experiencing some situational stressors, which had increased his level of anxiety and distress. Subsequently, that same month, it was noted that the Veteran had made suicidal statements and had moderate anxiety. He was then hospitalized for suicidal comments. Thereafter, in March 2015, the Veteran was seen in the emergency room for altered mental state, suicidal attempt and drug overdose. In May 2015, the Veteran requested a discharge in lieu of a Court Martial trial. He was discharged in June 2015 without a separation examination. Within three months of his discharge from active duty, in September 2015, the Veteran filed his current claim for service connection. In an October 2016 statement, the Veteran reported trouble sleeping that started in service. He also stated he had attempted suicide while in service. Subsequently, in April 2017, the Veteran sought initial treatment at the VA for anxiety and depression. Again, at that time, he reported that his symptoms began while in the Army. As the Veteran's statements are supported by the evidence of record and have been consistent throughout the course of the appeal, the Board finds his statements concerning the onset of his symptoms in service as well as pertinent symptomatology since service to be credible. The Veteran was afforded a VA examination in July 2016. The examiner diagnosed unspecified anxiety disorder and opined that the Veteran's psychiatric illness was not caused by the claimed stressor of fear. The only rationale provided was that there was no evidence that "fear" causes any psychiatric illness. Given that this opinion was not supported by an analysis or reasoned explanation, the Board previously found that it was inadequate and remanded for another VA examination. On remand, the Veteran was afforded another VA examination in September 2020. The examiner again diagnosed unspecified anxiety disorder. It appears that the examiner offered two opinions. In both statements, the examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. In one opinion, the examiner rationalized there is no evidence that the Veteran's diagnosis is consistent with symptoms while on active duty and there is no evidence of continuous symptoms since that time. The examiner noted that the Veteran has history of significant trauma prior to his enlistment in the Army. In another opinion, the same examiner rationalized that the Veteran has a diagnosis of unspecified anxiety disorder, which is not considered related to military service. He does not have a diagnosis of PTSD. While he deployed to Afghanistan from June to October 2014, at the time of his evaluation on July 5, 2016, he reported that he "didn't see any action". Prior to the Army, he experienced physical and emotional abuse in childhood and spent four years in juvenile detention for sexual battery. There is no evidence that current symptoms are related to symptoms reported in the Army; there is no evidence of continuous symptoms since that time. In a July 2021 addendum opinion, the examiner stated that the Veteran's report of symptoms of insomnia are considered subsumed within the diagnosis of unspecified anxiety disorder. Although the VA examiner indicated that the Veteran suffered from childhood trauma, the Board observes that a Veteran is presumed to have been sound upon entry into the military, except as to conditions noted at the time of the acceptance, examination, or enrollment. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). In this case, the Veteran is presumed sound because there was no notation of a psychiatric disorder on acceptance, examination, or enrollment in December 2012. Clear and unmistakable evidence that the disability existed prior to service and was not aggravated by service will rebut the presumption of soundness. 38 U.S.C. § 1111; VAOPGCPREC 3-2003. Here, based on a review of the overall record, there is not clear and unmistakable evidence that the Veteran's current psychiatric disorder preexisted service. In this regard, service treatment records are silent with respect to any preexisting psychiatric disability. Further, although the VA examiner indicated that the Veteran suffered from childhood trauma, the examiner did not find that there was clear and unmistakable evidence that his current psychiatric disorder preexisted service. In sum, the evidence does not rise to the clear and unmistakable standard. Thus, the question turns on whether the Veteran's psychiatric disorder manifested while in service. After considering the evidence of record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's unspecified anxiety disorder arose in service. On one hand, service treatment records clearly document psychiatric treatment, including findings of anxiety as well as a suicide attempt. Again, the Veteran has credibly reported as to the onset and pertinent symptomatology of his symptoms. Although the September 2020 VA examiner found that the Veteran's disability was not related to service, this opinion in part was based on a lack of continuity, which is contradicted by the remaining evidence of record. Moreover, the examiner did not discuss the in-service incidents. Importantly, in the addendum opinion, the VA examiner stated that the Veteran's insomnia was considered subsumed within his unspecified anxiety disorder. Again, the Veteran has credibly reported the onset of his sleep symptoms while in service. In turn, as the VA examiner considered insomnia as part of the Veteran's anxiety disorder, it would appear that his disorder had its onset in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that the Veteran's psychiatric symptoms began during active service and have continued to the present; and, thus, service connection for unspecified anxiety disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.N. Moats 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.