Citation Nr: 21021244 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 18-04 664 DATE: April 12, 2021 ORDER Service connection for right shoulder arthritis is granted. Service connection for left shoulder arthritis is granted. Service connection for a psychiatric disorder, to include depressive disorder, is granted. REMANDED A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Special monthly compensation (SMC) based on the need for regular aid and attendance is remanded. FINDINGS OF FACT 1. The Veteran sustained right and left shoulder injuries during service. 2. The currently diagnosed right and left shoulder disabilities had their onset during service. 3. The Veteran is currently diagnosed with multiple psychiatric disorders, to include depressive disorder. 4. A psychiatric disorder has its onset during service and is etiologically related to service. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for right shoulder arthritis are met. 38 U.S.C. §§ 1110, 1112, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). 2. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for left shoulder arthritis are met. 38 U.S.C. §§ 1110, 1112, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). 3. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for a psychiatric disorder, to include depressive disorder, are met. 38U.S.C. §1110; 38C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1970 to January 1973. In October 2020, in pertinent part, the Board remanded the issues on appeal for additional development, including for VA medical examinations. December 2020 VA examination reports have been associated with the record. As such, an additional remand to comply with the October 2020 remand directives is not required. Stegall v. West, 11 Vet. App. 268 (1998).   1. Service Connection for Right Shoulder Arthritis 2. Service Connection for Left Shoulder Arthritis Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. The Veteran is currently diagnosed with bilateral shoulder arthritis and arthritis is considered a “chronic” disease under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for “chronic” in-service symptoms and “continuous” post-service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Presumptive service connection is also available if arthritis became manifest to a degree of 10 percent or more within one year after the date of separation from such service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). The Veteran essentially contends developing a bilateral shoulder disorder from sustaining in-service injuries, to include injuries sustained during a January 1972 accident when he was blown into a parked aircraft down the flight deck when a launching aircraft exploded. See VA and private treatment records, December 2020 private examination report. Initially, the Board finds that the Veteran is currently diagnosed with arthritis of the right and left shoulder. Specifically, the report from the December 2020 VA examination reflects bilateral shoulder arthritis. The evidence of record is at least in equipoise on the question of whether the January 1972 explosion accident caused the bilateral shoulder disabilities. On the question of direct relationship to service, the record includes a December 2020 private examination report in which the private examiner opines that the bilateral shoulder disabilities are likely related to the January 1972 in-service accident. The December 2020 private examiner reasoned that the service treatment records reflect injures to the shoulders and that the Veteran has consistently attributed the shoulder disabilities to the January 1972 in-service accident. The December 2020 private examiner also reasoned that the same in-service injury caused the already service-connected back disability. Such opinion supports a finding that the shoulder disabilities are related to the January 1972 in service accident. The evidence weighing in favor of the finding of in-service onset also includes the lay statements showing that the Veteran reported sustaining in-service shoulder injuries, and that he sought in-service treatment. The Veteran is competent to report in-service shoulder injuries and treatment. Additional favorable evidence also includes the Veteran’s consistent lay statements demonstrating right and left shoulder disability symptoms since service, to include the December 2020 VA and private examination reports. For these reasons, and resolving reasonable doubt in the Veteran’s favor, the Board finds service connection for right and left shoulder arthritis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Service Connection for Psychiatric Disorder The Veteran contends that a psychiatric disorder is related to service in Vietnam. See VA and private treatment records. The Veteran has also indicated that a psychiatric disorder is related to the January 1972 accident when he was blown into a parked aircraft down the flight deck when a launching aircraft exploded. See Vet Center treatment records, January 2021 VA examination report, July 2018 private examination report. At the outset, the Board notes that the Veteran has been variously diagnosed with multiple physiatric disorders throughout the course of the appeal, to include posttraumatic stress disorder (PTSD) and depressive disorder. Such diagnoses can be found within multiple VA and Vet Center treatment records received throughout the course of this appeal. While the Veteran initially filed a claim for service connection for PTSD, in this case, the Board is unable to differentiate the symptomatology of PTSD from depressive disorder. In such a case of multiple diagnoses, and it is unclear from the record which symptoms are attributable to each distinct disability, the Board is precluded from differentiating between the symptomatology and the disabilities. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam); 38 C.F.R. § 4.130 (providing that all psychiatric disabilities are to be rated under one General Rating Formula). The practical effect of this Board decision is that all psychiatric symptomatology and impairment will be recognized as originating from the now service-connected depressive disorder, so will be considered in assigning the downstream initial rating. As such, the Board finds this to be a full grant of the benefit sought on appeal with respect to this issue. The question in this case is whether the current psychiatric disorder had its onset in service. After a review of all the evidence, the Board resolves reasonable doubt to find that the current psychiatric disorder had its onset in service. A July 2018 private psychological examination report reflects the private examiner indicated that a psychiatric disorder was related to the in-service “traumatic events.” As discussed above, the service treatment records reflect the January 1972 accident when he was blown into a parked aircraft, and the Veteran has consistently attributed a psychiatric disorder to the January 1972 accident. The July 2018 private examiner also reasoned that symptoms of the psychiatric disorder were “congruent with” the Veteran’s “history of traumatic events.” See July 2018 private examination report; see also service treatment records. Such opinion supports a finding that a psychiatric disorder is related to the January 1972 in service accident. As such, the Board finds that a psychiatric disorder began in service. Resolving reasonable doubt in favor of the Veteran, the Board finds that the psychiatric disorder, to include depressive disorder, had its onset in service and is etiologically related to service, and the criteria for service connection for the psychiatric disorder have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 4. TDIU The Board’s instant decision grants service connection for right and left shoulder disabilities, as well as service connection for a psychiatric disorder. In implementing the Board’s grant, the Agency of Original Jurisdiction (AOJ) will assign initial disability ratings for the bilateral shoulder and psychiatric disabilities from the date of claim for service connection; thus, the issue of a TDIU is inextricably intertwined with implementing the grants of service connection and the assignment of initial disability ratings. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). 5. SMC based on Aid and Attendance The issue of entitlement to SMC is also inextricably intertwined with the remanded TDIU issue, and adjudication must be deferred pending completion of the proposed development. Id. Accordingly, entitlement to SMC is remanded to the AOJ for readjudication after all development related to the issue of a TDIU is completed. The matters are REMANDED for the following action: (Continued on the next page)   After implementing the Board’s grant of service connection for right shoulder, left shoulder, and psychiatric disabilities and the assignment of initial disability ratings, readjudicate the issues of TDIU and SMC. L. BARSTOW Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Tenney, 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.