Citation Nr: 21029627 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 18-34 575 DATE: May 14, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder to include major depressive disorder, anxiety, and adjustment disorder is granted. REMANDED Entitlement to service connection for migraine headaches is reopened and remanded. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, her acquired psychiatric disability is at least as likely as not related to her military service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from August 2005 to August 2009. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2016 and January 2017 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). In July 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Entitlement to service connection for an acquired physiatric disability. The Veteran contends that her current psychiatric disability was caused by her military service. During the July 2020 Board hearing, the Veteran testified that she had difficulty handling everyone her plate while in service. She was easily agitated and experienced sadness and depression. At her previous base, she had an equal opportunity case that she was convinced was sealed. However, the information got out at her new base and other people learned about it. From that point, she felt that she had a target on her back for being a woman who had an equal opportunity case. She experienced a lot of stress and anxiety from that experienced. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service treatment records (STR) show the Veteran was treated for a psychiatric disability while in service. See July 2009 STR (adjustment disorder with depressed mood). Post-service treatment records show the Veteran has a current diagnosis of a psychiatric disability. See e.g., April 2014 Seymour John Record (anxiety); August 2016 Private treatment record (single episode depression; anxiety). The Veteran was afforded a VA examination October 2016. The examiner confirmed the diagnosis of unspecified depressive disorder. The examiner wrote that the medical notes for veteran during her service dated 2007 indicating that veteran was treated for adjustment disorder with depressed mood which was deemed due to difficulties with adjustment to family dynamics associated with her husband's deployment. The last note dated December 12, 2007 suggests that this is resolved and no further treatment was necessary. The examiner opined that there was no objective evidence for an Adjustment Disorder diagnosis at that time. An addendum opinion was obtained in December 2016. The examiner found that the Veteran was treated for adjustment disorder with depressed mood during her military service which resolved based on information provided. She was not treated again for four years following military service and her treatment for depression now not clearly related. The Veteran submitted a private medical opinion dated September 2017. The examiner opined that the Veteran's psychiatric disability was at least as likely than not (50 percent probability) incurred in or caused by an inservice injury, illness, or event. The examiner indicated that the Veteran's records were reviewed. The examiner wrote that the Veteran's chronic adjustment disorder with anxiety and depressed mood clearly began whilst in the military and her current symptoms are a continuation an natural progression of her service incurred condition and where, for the first time, she was confronted with service connected stress she could not handle alone, and which required treatment on base. The Board finds that all the medical opinions are equally probative as they clearly stated an opinion, which was supported by a thorough and cogent rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). The Board finds that the evidence is at least in relative equipoise to warrant entitlement to service connection for the Veteran's psychiatric disability. Thus, the entitlement to service connection for an acquired psychiatric disability is granted. REASONS FOR REMAND Entitlement to service connection for migraine headaches. The Veteran contends that her current disability of migraine headaches was caused by her military service. STRs show the Veteran had a history migraine headache while in service. See e.g., June 2006 STR (migraine headaches); July 2009 STR (migraine headaches). The Veteran was afforded a VA examination in August 2011. The examiner opined that the Veteran's headaches were less likely as not caused by or a result of military service. The examiner explained that he was unable to find evidence of headaches in the Veteran's STR. During the July 2020 Board hearing, the Veteran testified that she was treated for headaches in service and the examiner missed the notations in the STR. The Board finds that her testimony is sufficient to reopen the claim of service connection for headaches. The Board also finds the August 2011 opinion is based, at least in part, on an inaccurate factual premise, and accordingly, is of diminished probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion based on an inaccurate factual premise has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely."). The examiner based his medical opinion on the no notations of headaches while in service; however, the evidence in the STR was present at the time the medical opinion was rendered. Therefore, a new VA examination is warranted to consider this evidence. The matters are REMANDED for the following action: 1. Obtain any outstanding medical treatments related to the claim on appeal and associate them with the claims file, to include reports of an MRI of the head which the Veteran testified was performed during service at an off base facility. 2. Afford the Veteran a new VA examination to determine the nature and etiology of her migraine headaches. A copy of the claims file, including a copy of this remand, must be provided to the examiner for review. The examiner is asked to review the claims file in its entirety and indicated in the record that he or she has done so. The examiner is asked to render an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's migraine headaches was caused by her military service. The Board draws the examiner's attention to the history of migraine headaches listed in the June 2006 and July 2009 STR. The examiner is asked to acknowledge and comment on these records. A complete rationale should be provided for any opinions reached. If the examiner cannot provide some or all of such opinions, the examiner must make clear that he or she has considered all relevant, procurable data, but that any member of the medical community at large could not provide such an opinion without resorting to speculation. 3. Thereafter, readjudicate the claim on appeal. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Harris, Attorney Advisor 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.