Citation Nr: 22015154 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 18-35 114 DATE: March 16, 2022 ORDER Entitlement to service connection for an acquired psychiatric disorder, diagnosed as posttraumatic stress disorder (PTSD) and unspecified depressive disorder, is granted. REMANDED Entitlement to service connection for bilateral hand peripheral neuropathy is remanded. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a heart disability, to include ischemic heart disease, cardiomyopathy, congestive heart failure and defibrillator pacemaker, is remanded. Entitlement to service connection for kidney cancer, status post ureteronephrectomy is remanded. Entitlement to an effective date prior to April 16, 2015, for tinnitus is remanded. Entitlement to an initial rating in excess of 10 percent for tinnitus is remanded. FINDING OF FACT The Veteran's PTSD and unspecified depressive disorder are shown to be related to military service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, diagnosed as PTSD and unspecified depressive disorder, are met. 38 U.S.C. §§ 1110, 1131, 1154; 38 C.F.R. §§ 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1973 to November 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board has recharacterized the claim for an acquired psychiatric disorder as reflected on the title page to ensure consideration of all diagnoses of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). The appeal was remanded for further development in July 2019. Service Connection 1. Entitlement to service connection for an acquired psychiatric disorder, diagnosed as PTSD and unspecified depressive disorder, to include as secondary to service-connected disabilities, is granted. The Veteran asserts his psychiatric disorder is due to traumatic events in service, including witnessing a child getting run over and crushed to death by a truck while on orders to retrieve an item for a motor pool and having his legs kicked out from under him, knocking his chin which knocked him on the ground unconscious, bleeding all over, and being trapped under a parachute. See December 2020 VA examination report. Alternatively, the evidence of record raises a possibility that his psychiatric disorder is due to his service-connected disabilities. See October 2016 private opinion. As the discussion below is favorable regarding direct service connection, which is more favorable to the Veteran, no other theory of entitlement will be addressed further. Service connection generally may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Service connection requirements for PTSD are more specific than general service connection requirements. Establishing service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); (2) a link, established by medical evidence, between a Veteran's current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. §§ 3.304(f), 4.125(a); Cohen v. Brown, 10 Vet. App. 128, 139 (1997); 80 Fed. Reg. 53, 14308 (March 19, 2015). The Veteran has current diagnoses of PTSD and unspecified depressive disorder. See October 2020 VA examination report. In this regard, the October 2020 examiner noted that Veteran's PTSD and unspecified depressive disorder cannot be differentiated in terms of symptoms because the symptoms are overlapping and intermingled. To this end, the examiner explained that their components interact, exacerbate, and reinforce each other in complex ways, that there is a clinical association between the Veteran's diagnoses, and that their symptoms are similar and overlapping, such that a person with one of these conditions is more likely to develop symptoms of the other disorder. Lastly, the examiner noted research has found that nearly half of people with PTSD also have depression. Id. Therefore, his diagnoses would be treated as one disorder for rating purposes as the evidence of record does not sufficiently distinguish the symptoms of all diagnoses from each other and many symptoms overlap. Mittleider v. West, 11 Vet. App. 181, 182 (1998). Thus, element one is met for both diagnoses, PTSD and unspecified depressive disorder, as one disability. As to element two, a link between the Veteran's current symptoms and his in-service stressor, the Board notes the Veteran has competently and credibly recalled pertinent stressors, in detail, including witnessing a child getting run over and crushed to death by a truck while on orders to retrieve an item from a motor pool and having his legs kicked out from under him, knocking his chin which knocked him on the ground unconscious, bleeding all over, and being trapped under a parachute. See October 2020 VA examination report. The VA examiner found that these stressor events supported the current diagnosis of PTSD. Additionally, his military personnel records confirm his military occupational specialty (MOS) as a power general equipment operator and note him as receiving a parachute badge. As such, the Board finds that the claimed stressors are consistent with the places, types, and circumstances of the Veteran's service and is adequate to support a diagnosis of PTSD based on the same. Finally, lay statements from the Veteran's mother and best friend recall him being withdrawn, depressed, irritable, and having nightmares immediately following his return from service, which was contrary to his demeanor and behavior prior to enlisting in the Army. See August 2016 Buddy/Lay Statements. Thus, the second element is established for PTSD. As to medical nexus regarding PTSD, the Veteran presented for a VA examination in October 2020. The examiner indicated his above-named stressors met the criteria for a diagnosis of PTSD and opined that the etiology of his PTSD and unspecified depressive disorder stems from traumatic incidents during his military service, which suggests that these conditions were incurred in or caused by these in-service events, rather than proximately related to the Veteran's service-connected conditions. In support of her opinion, the examiner noted that these traumatic events, and the onset of his mental health difficulties, occurred much earlier than the onset of his current medical conditions (tinnitus, scar, leg and ankle injury, degenerative joint disease, sleep apnea) and that both of the Veteran's mental health diagnoses (PTSD and depression) are related to these events, with overlapping symptoms, and the impairment from each individual condition cannot be separated from one another without speculation. Albeit quite brief, the Board finds the examiner's opinion to be probative. Additionally, in two separate private opinions (October 2016 and July 2020), Dr. H. S. stated the Veteran has experienced depression and anxiety symptoms since his military service and that these symptoms are related to his service. Thus, the third element is established for PTSD and unspecified depressive disorder. All the criteria for a grant of service connection are met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304(f). REASONS FOR REMAND 2. Entitlement to service connection for bilateral hand peripheral neuropathy is remanded. 3. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. 4. Entitlement to service connection for bilateral hearing loss is remanded. 5. Entitlement to service connection for a heart disability, to include ischemic heart disease, cardiomyopathy, congestive heart failure and defibrillator pacemaker, is remanded. 6. Entitlement to service connection for kidney cancer, status post ureteronephrectomy is remanded. 7. Entitlement to an effective date prior to April 16, 2015, for tinnitus is remanded. 8. Entitlement to an initial rating in excess of 10 percent for tinnitus is remanded. In a February 2021 letter, the Veteran's attorney indicated he was submitting 15 pages of evidence in support of the Veteran's above-listed claims. However, it appears only two pages were included in the initial transmission and an additional six pages were submitted a couple days later which only referenced one issue, his now service-connected psychiatric disorder. To date, the remaining pages of evidence do not appear to be associated with the claims file. Thus, remand is necessary to obtain the missing pages of evidence as they could be pertinent to any one of the above-listed claims. Any outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. (Continued on the next page) 2. With any necessary assistance from the Veteran, obtain any outstanding private treatment records. 3. Obtain the complete 15 pages of evidence referenced in the Veteran's attorney February 2021 letter and associate them with the claims file. MARGARET M. LUNGER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.