Citation Nr: 21073780 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 19-00 895 DATE: December 10, 2021 ORDER New and material evidence having been presented, reopening the claim of entitlement to service connection for a psychiatric disability is granted. Entitlement to service connection for a psychiatric disability is granted. Entitlement to service connection for hypertension is granted. FINDINGS OF FACT 1. In an unappealed November 2007 rating decision, entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) was denied. 2. The evidence associated with the record subsequent to the November 2007 rating decision is not cumulative or redundant of the evidence previously of record, and relates to an unestablished fact necessary to substantiate the claim. 3. The Veteran has a psychiatric disability that is etiologically related to his active service. 4. The Veteran's hypertension is due to in-service exposure to herbicide agents. CONCLUSIONS OF LAW 1. New and material evidence has been received sufficient to reopen a claim of entitlement to service connection for a psychiatric disability. 38 U.S.C. § 5108; (2018); 38 C.F.R. § 3.156 (2020). 2. The criteria for service connection for a psychiatric disability have been met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). 3. The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military from September 1968 to September 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Claim to Reopen Psychiatric Disability In a November 2007 rating decision, entitlement to service connection for a psychiatric disorder, to include PTSD, was denied based on a finding that the Veteran did not have a current diagnosis of a disability. The Veteran did not appeal that decision. The evidence that has been added to the record since the November 2007 rating decision includes VA outpatient treatment reports which reveal various psychiatric diagnoses including PTSD, schizophrenia, and depression; a VA examination showing a diagnosis of schizophrenia; and a medical opinion from the Veteran's treating clinician at VA which reveals diagnoses of PTSD, schizophrenia, and depression which began during Vietnam and have persisted since that time. The Board finds that the additional evidence added to the record is new and material. In this regard, the Veteran has submitted evidence that tends to indicate that he has a psychiatric disability that is related to his active service. As such, the Board finds that reopening the claim of entitlement to service connection for a psychiatric disability is warranted. Service Connection Psychiatric Disability The Veteran contends that he has a psychiatric disability as a result of his active service. Specifically, the Veteran contends that symptoms of his psychiatric disorder are a result of traumatic events which he experienced while serving in Vietnam. Service treatment records (STRs) are silent for complaints of, or treatment for mental health symptoms. However, the Veteran is competent to report when he first experienced mental health symptomatology and that the symptoms have continued since service. Heuer v. Brown, 7 Vet. App. 379 (1995); Falzone v. Brown, 8 Vet. App. 398 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). Moreover, the Board finds the Veteran credible in that respect. In May 2016, the Veteran's treating clinician submitted a statement. She indicated that the Veteran has been treated for various psychiatric disorders including PTSD, major depression, and schizophrenia since March 1997. She noted that she is a mental health nurse practitioner and treated the Veteran with medication and psychotherapy. She reported that the Veteran has been treated for insomnia, nightmares with war-related content, hyperarousal, irritability, depressed mood, decline in concentration, and anxiety. She stated that in spite of years of therapeutic and psychopharmacological interventions, the Veteran continues to experience frequent trauma related to nightmares which prevent him from experiencing healthy sleep and intrusive thoughts that trigger bouts of anxiety. She reported that the Veteran has experienced psychiatric symptoms continuously since service in Vietnam and did not experience them prior to Vietnam. In November 2018, the Veteran was afforded a VA examination. At that time, the examiner diagnosed schizophrenia, but indicated that the Veteran did not meet the criteria for a diagnosis of PTSD. However, the examiner failed to provide any opinion as to the etiology of schizophrenia. The Board finds that the November 2018 VA medical opinion is inadequate for adjudication purposes. In this regard, the examiner failed to provide an etiology opinion for the diagnosed psychiatric disorder. As the opinion is not adequate, it cannot be used as the basis of a denial of entitlement to service connection. The Board finds that the May 2016 medical opinion is adequate because the examiner thoroughly discussed the relevant evidence, considered the contentions of the Veteran, and provided a thorough supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As such, the May 2016 medical opinion of record is the most probative evidence of record. Here, as noted above, the Veteran is competent to identify when he first experienced symptoms of insomnia, nightmares with war-related content, hyperarousal, irritability, depressed mood, decline in concentration, and anxiety; and that those symptoms have continued since service. Furthermore, his statements have been found credible. The Veteran has a diagnosis of PTSD, major depression, and schizophrenia that his VA Medical Center treatment provider has linked to his active service. Further, the Board has found the VA medical opinion of record to be inadequate and so, of little probative value. Accordingly, the Board finds that the evidence for and against the claim of entitlement to service connection for a psychiatric disability is at least in equipoise. Therefore, reasonable doubt must be resolved in favor of the Veteran and entitlement to service connection for a psychiatric disability is warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service Connection Hypertension The Veteran contends that he has hypertension as a result of exposure to herbicides while serving in Vietnam. A review of the Veteran's service personnel records reveals that the Veteran served in the Republic of Vietnam from February 1969 to February 1970 and is therefore presumed to have been exposed to herbicides. Post-service VA outpatient treatment reports reveal a diagnosis of hypertension. Although hypertension is not presumptively related to herbicide exposure, 38 C.F.R. § 3.309(e), in 2018, the National Academy of Sciences (NAS) determined that there is "sufficient" epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide exposure. The Veteran also submitted an article from Science Daily which indicates that a report from the Institute of Medicine finds suggestive, but limited evidence that exposure to Agent Orange and herbicides used during the Vietnam War is associated with an increased chance of developing high blood pressure in some Veterans. In this case, the Veteran is presumed to have been exposed to herbicides while serving in the Republic of Vietnam, and he has a current diagnosis of hypertension. There is no competent VA medical opinion of record against the claim. Rather, there is sufficient evidence to conclude that there is a positive association between hypertension and herbicide exposure. (Continued on the next page) Accordingly, the Board finds that the evidence for and against the claim of entitlement to service connection for hypertension is at least in equipoise. Therefore, reasonable doubt must be resolved in favor of the Veteran and entitlement to service connection for hypertension is warranted. 38 U.S.C. § 5107(b) (2018); See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Cryan, 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.