Citation Nr: 21077488 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 19-08 898 DATE: December 29, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder (GAD), panic disorder and depressive disorder, is granted. FINDING OF FACT The diagnosed psychiatric disorder has been shown to be etiologically related to the Veteran's active service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 2008 to December 2012. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2017 rating decision by a Department of Veterans Affairs Regional Office (RO). In April 2020, the Veteran testified at a hearing before the undersigned. A copy of the transcript has been associated with the claims file. This matter was remanded in April 2020 to obtain a VA examination. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Acquired Psychiatric Disorder The Veteran seeks entitlement to service connection for an acquired psychiatric disorder. Specifically, he asserts that his current psychiatric disorder is etiologically related to in-service stressors, including losing a fellow Marine and friend to an IED attack, and due to his military occupational specialty (MOS) as Military Police (MP). See February 2019 letter and April 2020 Board Hearing Transcript. Initially, the Board notes that the Veteran's DD 214 shows his MOS was MP, and his reported in-service stressor of a friend killed by an IED attack during his period of active duty service has been confirmed. Accordingly, his reported in-service stressors are conceded. See April 2021 Records Research Response. During the period on appeal, the evidence of record includes VA medical records showing treatment and diagnoses for psychiatric disorders. In this regard, he was seen in November 2018 for medication management related to diagnoses for anxiety and depression. Current diagnoses for GAD, panic disorder and depressive disorder were provided. The Veteran reported flare-ups of anger that were unchanged since he started treatment. He did report improvement in his mood, including depression, motivation and interest level. See VA Medical Records Received May 2021. In an April 2020 letter, the Veteran's VA treating psychiatrist noted she had seen the Veteran on four occasions and that he had been diagnosed with GAD. In addition, she noted the Veteran reported that his GAD emerged after his history of military service. Additionally, the Veteran submitted an April 2020 letter from a friend and fellow service member who stated that service related constant stress and uncertainty due to staying up long hours caused long lasting effects. In this regard, the friend stated that during service, the Veteran developed difficulty sleeping, and that he began to show signs of anxiety and depression. The fellow service member also stated that he was a medical professional, and that it was his opinion that the Veteran's symptoms were directly caused by the constant hassle, aggravation and uncertainty of his pre-deployment garrison life. A VA examination report was obtained in July 2020. The examiner indicated that the claims file was reviewed, including treatment records. In this regard, the examiner noted that psychiatric treatment records noted diagnoses for GAD, panic disorder and depressive disorder. The examiner opined that it was at least as likely as not that the Veteran's diagnosed psychiatric disorders were etiologically related to service. In support of this opinion, the examiner cited VA treatment records showing difficulty readjusting to civilian life. Specifically, the examiner noted that the Veteran felt proud to serve and felt a sense of purpose while in the Marines, but since he was not allowed to continue in-service occupation in the military police, he had lost focus and confidence. Additionally, since separation from service, the examiner noted symptoms of feeling inadequate, out of control, and fearful of making mistakes. The examiner further noted irritability, anxiety around people, wanting to be left alone, and difficulty working in the civilian world, and that VA treatment records supported this finding. Lastly, the examiner noted the Veteran lost a friend during service who was killed in an IED attack. In this regard, the examiner stated that while the Marines gave the Veteran a sense of purpose and confidence which gave him resilience to deal with that stressor during service, that he lost that resilience after his discharge from service. Following further development, another VA examination report was obtained in May 2021. A diagnosis for unspecified personality disorder was provided. The Veteran reported serving in the Marines as an MP, and that he wanted to reenlist, but that there were not any slots open for MPs at that time. He also reported having diagnoses for depression and anxiety. The following symptoms were noted: chronic sleep impairment; difficulty in establishing and maintaining effective work and social relationships; and inability to establish and maintain effective relationships. In addition, the Veteran was symptomatic of narcissistic personality traits, reduced frustration tolerance and increased irritability. The examiner opined that it was "less likely than not (less than 50 percent probability)" that the Veteran's psychiatric disorder was etiologically related to service. In support of this opinion, the examiner cited the Veteran's reports of having difficulty tolerating people and that he was disinterested in associating with anyone he considered beneath his status as a Marine. The examiner further cited the Veteran's belief that he was better than everyone as a result of being held to a higher standard as a Marine. In addition, the examiner stated that the Veteran did not currently present with anxiety and depression, but, instead, with a personality disorder with narcissistic traits. Given the nature of personality disorders and their development over time, the examiner deemed it "less likely than not that the claimant's issues are service connected but rather that he sought being in the Marines as a means of expressing his sense of self-importance." VA medical records and the July 2020 VA examination clearly show the Veteran has been diagnosed with a psychiatric disorder. Additionally, as noted above, his reported in-service stressors have been conceded. Accordingly, the remaining question on appeal is whether his acquired psychiatric disorder is otherwise related to service. After a review of the evidence of record, the Board finds that entitlement to service connection for an acquired psychiatric disorder has been established. The Board recognizes that there are conflicting nexus opinions of record. The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The credibility and weight to be attached to these opinions is within the province of the Board. Id. With regard to the April 2020 letter from the Veteran's friend, although the letter noted the friend was a medical professional, the letter is devoid of any information as to what type of medical profession he belonged to. The letter was equally absent any information regarding relevant medical training, certifications or titles. Accordingly, the Board finds the April 2020 letter inadequate insofar as it relates to a nexus opinion. Turning to the VA examination reports of record, the Board finds the July 2020 VA nexus opinion to be of more probative value than the May 2021 nexus opinion. First, the May 2021 VA examiner did not consider or address any treatment record noting diagnoses other than unspecified personality disorder. In fact, the absence of any mention of prior treatment records, including those of the Veteran's treating psychiatrist, casts into doubt whether any such records were reviewed or considered. Second, the Board finds the rationale for the May 20201 nexus opinion speculative in nature. In this regard, the examiner based the negative nexus opinion, in large part, on a general statement about "the nature of personality disorders." Absent is any analysis as to the nature of the Veteran diagnosed personality disorder. Instead, the July 2020 VA examiner considered the Veteran's treatment records as well as previously provided psychiatric diagnoses. Based on a review of those records, the Veteran's in-service records and his lay statements, the examiner opined that it was "at least as likely as not" that his diagnosed GAD, panic disorder and depressive disorder were etiologically related to service. At the very least, the evidence is at least in relative equipoise with regard to a causal connection between the Veteran's diagnosed acquired psychiatric disorder and his service. Therefore, the claim is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Lamb, 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.