Citation Nr: 21007746 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 19-11 655 DATE: February 10, 2021 ORDER Entitlement to service connection for adjustment disorder, secondary to service-connected disabilities, is granted. REMANDED Entitlement to service connection for colitis is remanded. FINDING OF FACT The medical evidence is in relative equipoise as to whether the Veteran’s adjustment disorder is secondary due to his service-connected disabilities. CONCLUSION OF LAW The criteria for entitlement to service connection for adjustment disorder, secondary to service-connected disabilities have been met. 38 U.S.C. §§ 1110, 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 States Navy from February1988 to February 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In addition to the issues listed on the first page of this decision, the Veteran also filed a timely appeal as to the issue of entitlement to service connection for irritable bowel syndrome (IBS). However, the claim has since been granted, by way of a March 2020 rating decision that awarded service connection for IBS, with a 30 percent evaluation effective March 20, 2017. Thus, to this extent, the claim for service connection for IBS has been granted in full and is no longer on appeal. In October 2020, the Veteran filed a request for Higher Level Review by the Agency of Original Jurisdiction (the RO) with regards to the effective date assigned for his now service-connected IBS. That issue will be addressed by the AOJ and is not currently on appeal. 1. Entitlement to service connection for adjustment disorder, secondary to service-connected disabilities, is granted. Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). This permits service connection not only for a disability caused by a service-connected disability, but also for the degree of disability resulting from aggravation of a disability by a service-connected disability. See 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Board has reviewed all of the evidence of record and finds that entitlement to service connection for an adjustment disorder, due to service-connected disabilities is warranted. The medical evidence reflects a current psychiatric diagnosis, adjustment disorder with anxiety and obsessive-compulsive personality disorder. See March 2015 VA Mental Disorder Examination report. Review of the Veteran’s service treatment records are negative for diagnoses or pertinent symptomatology indicating a psychiatric disorder during active duty service. Post-service medical evidence, however, indicates that the Veteran’s adjustment disorder is due to or aggravated by his service-connected tinnitus, inguinal hernia, and hernia scar disabilities. A March 2015 VA examination reveals that the examiner diagnosed the Veteran with adjustment disorder with anxiety and obsessive-compulsive personality disorder. The examiner opined that the Veteran’s anxiety is at least likely as not proximately due to or the result of claimed disabilities. The examiner rationalized that in the absence of documented evidence that the Veteran experienced a mental disorder prior to military service, and in the presence of reported symptoms of anxiety related to claimed disabilities, it appears at least likely as not that the Veteran’s anxiety was caused by or a result of claimed disabilities. The examiner noted right temporal lobe epilepsy as the medical diagnosis relevant to the understanding or management of the mental health disorder and noted that the Veteran’s anxiety increased after the seizures started. The examiner indicated that it is possible to differentiate the symptoms attributable to each diagnosis and found that the symptoms of anxiety are mostly relate to his adjustment disorder while noting that the Veteran’s personality traits are exacerbated when he has anxiety. In an April 2015 addendum opinion, the same VA examiner opined that the Veteran’s anxiety disorder is not due to his service-connected tinnitus, bilateral inguinal hernia, and scars. The examiner rationalized that the Veteran reported difficulty with anxiety that pre-dated his seizures, and it was initially related to adjusting to civilian life, marital stress, and generalized declining health (but not specifically scars, tinnitus, or inguinal hernias) and financial strain. The examiner again remarked that the Veteran’s anxiety increased after the seizures started and his current anxiety appears to be due to the nonservice-connected seizure disorder and its impact on his life. However, also in April 2015, a separate VA examiner opined that the claimed condition is at least as likely as not proximately due to or the result of the Veteran’s service-connected conditions. The examiner rationalized that there are multiple factors increasing the risk of anxiety disorder in the Veteran, such as bilateral inguinal hernia, with residual scars and tinnitus, and that it is not possible to determine the precise percentage each risk factor plays in the overall condition of anxiety disorder. Here, although there are three medical opinions of record, the Board finds that there are essentially two competing medical opinions, with one being favorable and the other being unfavorable as at the time of the March 2015 examination, the Veteran was not yet service-connected for any disability. While the opinions do not eliminate all doubt with regards to the nature and etiology of the Veteran’s adjustment disorder, the April 2015 favorable opinion places the evidence in equipoise as to whether the Veteran’s adjustment disorder is secondary to his service-connected disabilities. Instead, the evidence is in a state of relative equipoise and, therefore, requires the Board to resolve all doubt in favor of the Veteran. Accordingly, entitlement to service connection for adjustment disorder, secondary to service-connected disabilities, is granted. 38U.S.C. §5107(b). As the evidence does not indicate that service connection is warranted on a direct basis, the Board need not discuss any other theories of entitlement. REASONS FOR REMAND 1. Entitlement to service connection for colitis is remanded. While the record demonstrates that the Veteran had a diagnosis of acute colitis at some point, the record is unclear as to whether the Veteran has had a current diagnosis of colitis, or residuals of the disorder, during the period on appeal. Further, the record is void of an opinion determining the nature and etiology of such condition. A March 2015 examiner diagnosed the Veteran with acute colitis, resolved. The examiner further found that the Veteran had colitis in 2000 and 2013 and both resolved with no functional limitation. However, in a June 2015 favorable opinion letter, the Veteran’s nurse indicated that the Veteran’s current colitis condition was present during service. However, the letter is unaccompanied by any rationale. Moreover, a November 2017 VA medical center (VAMC) treatment record reflects that acute colitis is included on the problems list. Yet, in January 2020, a VA examiner confirmed a diagnosis of irritable bowel syndrome but did not diagnose a colitis condition. Thus, the record is unclear of whether the Veteran has had colitis at any time during the period on appeal, which is since November 13, 2014. Thus, remand is necessary for an examination. The matter is REMANDED for the following action: 1. Schedule a VA examination with an appropriate clinician to determine the nature and etiology of the Veteran’s claimed colitis disability for the period on appeal. The claims file and a copy of this remand must be made available for review, and the examination report must reflect that review of the claims file occurred. An in-person examination may be scheduled if the examiner deems it necessary or may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic. (a) The examiner is asked to determine whether the Veteran has had a colitis disability, or residuals thereof, at any time since on or after November 13, 2014. (b) For the Veteran’s claimed colitis disability, the examiner is asked to opine whether it is at least as likely as not that the Veteran’s colitis is related to an in-service injury, event, or disease. The examiner should consider and directly discuss the Veteran’s lay statements and medical evidence, including in service treatment records and post service medical treatment records. A complete rationale for the opinion must be provided. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Q. Alli, 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.