Citation Nr: 21010900 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 16-33 521 DATE: February 26, 2021 ORDER Service connection for an acquired psychiatric disorder, variously diagnosed as posttraumatic stress disorder (PTSD), other trauma and stressor related disorder, unspecified depressive disorder, and major depressive disorder is granted. FINDING OF FACT The most probative medical evidence establishes the Veteran’s acquired psychiatric disorder is attributable to military service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.125. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1971 to March 1973. This matter comes before the Board of Veterans’ Appeal (Board) from a September 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran and his son provided testimony at a June 2019 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. This case has a long procedural history. Most recently, in October 2019, the Board reopened the Veteran’s acquired psychiatric disorder claim and remanded it for further development. The development requested having been completed, the case is now appropriate for appellate review. Decisions of the Board shall be based on the entire record and consideration of all evidence, lay and medical, that is material. 38 U.S.C. § 7104(a); 38 U.S.C. § 5107(b); 38 C.F.R. § 3.303(a). In evaluating the evidence in any given appeal, it is the responsibility of the Board to make appropriate determinations of (a) competence; (b) credibility; and (c) weight. Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Medical opinions are deemed competent since they are from medical professionals. 38 C.F.R. § 3.159(a)(1). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all the evidence is assembled, the VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Service connection for an acquired psychiatric disorder Generally, to establish service connection on a direct basis, a Veteran must show a current disability; an in-service incurrence of a disease or injury; and a causal relationship between the present disability and the disease or injury incurred during service, the so-called “nexus” requirement. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Disorders diagnosed after discharge may still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection for PTSD has unique requirements. Specifically, it requires medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a), which – here – means that PTSD should be diagnosed under the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), credible evidence that an in-service stressor actually occurred, and medical evidence of a nexus between the Veteran’s current symptoms and the claimed stressor. 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128 (1997). The Veteran contends his acquired psychiatric disorder is attributable to service; specifically, when he was detained and interrogated by Japanese police for hours and feared for his life in 1972. He also contends his anxiety and PTSD are related to him witnessing a person being killed during a riot while in Japan. See February 2015 VA treatment record. Here, the June 2016 VA examination diagnosed the Veteran as having PTSD and major depression. The August 2020 VA examination diagnosed the Veteran as having other trauma and stressor related disorder as well as unspecified depressive disorder. The Veteran has received various psychiatric diagnoses in-service and post-service. According to the Veteran’s September 1972 service treatment records (STRs), the Veteran was provisionally diagnosed as having possible separation anxiety. Post-service treatment records show the Veteran being diagnosed with various mental health conditions including major depression, mood disorder, depression, anxiety, mood disorder “consistent with either PTSD or MDD”, and PTSD. See August 1998, June 2003, September 2003, April 2007, February 2010, November 2010, May 2014, August 2014, November 2014, October 2015, February 2016, and August 2016 VA treatment records. Thus, the Veteran has a current disability and meets the first element. The issue before the Board is whether the Veteran’s current disability is causally related to military service. In the Veteran’s October 1972 STRs, the Veteran had a psychiatric consultation in which the Veteran reported he had thoughts of suicide at one time and the medical clinician observed the Veteran to be mildly depressed. Post-service treatment records demonstrate the Veteran has experienced ongoing psychiatric symptoms such as mood swings, sleep disturbances, irritability, suicidal thoughts, fear of self-harm, auditory/visual hallucinations, depressed mood, nightmares, frequent angry outbursts, increased vigilance, anxiety, and chronic depression. See January 1998, August 1998, June 2003, September 2003, August 2004, September 2017, July 2018, and December 2018 VA treatment records. According to the February 2002 VA treatment records, the Veteran was hospitalized for suicidal ideation when he was diagnosed as having major depressive disorder. In the June 2003 VA treatment records, the Veteran states he has been depressed “for years” and shows the Veteran made a suicide attempt. In the January 2008 VA treatment records, the Veteran’s medical history shows the Veteran was diagnosed as having major depressive disorder in July 2005. In addition, the Veteran was hospitalized for depression from August 2009 to September 2009. See October 2009 VA Hospitalization Report. The November 2014 VA treatment records show the Veteran was hospitalized for psychiatric treatment and that the Veteran has a history of PTSD, depressive disorder, anxiety disorder and three suicide attempts. In the July 2017 VA treatment records, the Veteran reported he was interrogated by the Vietnamese while stationed there in 1971-1973. Since that time, he has struggled with severe PTSD, depression and anxiety. The October 2015 VA treatment records show the Veteran being diagnosed as having PTSD and the treating psychologist found the Veteran’s PTSD was related to trauma of being interrogated while living in Japan. The Veteran underwent VA examinations in June 2016 and August 2020. The June 2016 examiner diagnosed the Veteran with major depressive disorder co-occurring with a PTSD diagnosis. The examiner reported the Veteran was initially diagnosed with PTSD in October 2015 and major depressive disorder in 1998. The examiner found the Veteran’s in-service stressor as being the Veteran’s detention and interrogation by Japanese police for hours when he was 18 years old and stated the Veteran’s symptoms were related to the in-service stressor. However, the examiner did not provide a separate nexus opinion with a reasoned rationale. At the August 2020 VA examination, the Veteran described the 1972 stressor incident in Okinawa, Japan in which he was arrested and interrogated for hours by Japanese police and that he feared for his life. The Veteran stated it is hard to forget the stressor incident. The examiner diagnosed the Veteran as having other trauma and stressor related disorder as well as unspecified depressive disorder (claimed conditions) stating the symptoms of the diagnoses overlap. The examiner reported that it “[a]ppears the veteran had developed some difficult times from his stressor from Okinawa caused by his interrogation by Japanese police after his arrest.” The examiner concluded that while the Veteran does not meet the full criteria for PTSD, he “has met the criteria for Other Trauma and Stressor related disorder from his report of what happened with respect to being interrogated by Japanese police.” The examiner opined that the Veteran’s claimed conditions were at least as likely as not incurred in or caused by an in-service injury, event or illness. The examiner found the in-service event to be the “interrogation by police in 1972, fear of not coming out alive.” The examiner supported her positive nexus opinion by stating the: Vet had no mental health treatment in the service and now meets criteria for the disorders listed above which incurred or was caused by his events in Okinawa described above. Veteran was seen by psychiatrist with having difficulties after the Japanese police interrogation event in Oct 1972. The psychiatrist noted that the veteran was having problems and indicated the veteran should be discharged as being inappropriate for military. The veteran’s diagnoses of Other trauma and stressor related disorder and Unspecified Depressive disorder are at least likely as not (50% or greater) caused by the events listed and stressor from military service in Okinawa. Considering the examiner conducted an in-person examination, reviewed the claims file, elicited information from the Veteran, and provided a reasoned rationale, the Board finds the examiner’s nexus opinion highly probative. At the June 2019 Board hearing, the Veteran testified that sometime in 1972 while in Okinawa, Japan, he was interrogated by Japanese police for hours and that he was 18 years old and scared to death believing he was not going to see his family again. See Hearing Transcript at 8. He also stated that he keeps reliving those events. The Veteran explained that he was an outstanding marine prior to the 1972 incident, but that the incident changed him. Id. at 9. (Continued on the next page)   The Veteran is competent to report his readily observable symptoms, his firsthand experiences, and report past recollections. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran’s statements about the 1972 incident in Japan are credible because his statements have been internally consistent and the Veteran’s military service record supports the fact that the Veteran had difficulty in military service after the 1972 incident. Additionally, the evidence of record shows that the Veteran’s statements are consistent to those he reported to his medical providers. Statements made for the purpose of medical diagnosis or treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive a proper diagnosis or treatment. White v. Illinois, 502 U.S. 346 (1992). Accordingly, the Board finds the Veteran’s statements probative. Upon review of the record in its entirety, the Board finds the most probative medical evidence establishes that the Veteran’s acquired psychiatric disorder is attributable to military service. Accordingly, the Board finds that service connection for acquired psychiatric disorder is warranted. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Agarwal, 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.