Citation Nr: 23044827 Decision Date: 08/11/23 Archive Date: 08/11/23 DOCKET NO. 17-02 428 DATE: August 11, 2023 ORDER Service connection for delusional disorder is granted. FINDING OF FACT The evidence is approximately balanced as to whether the Veteran's delusional disorder is related to the Veteran's service. CONCLUSION OF LAW The criteria for service connection for delusional disorder are 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 had active service from October 1987 to August 1990 and from January 1991 to May 1991. This matter comes before the Board of Veteran's Appeals (Board) on appeal from a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2021 and March 2023, the Board remanded the appeal for additional development. The Veteran has originally filed a service connection claim for posttraumatic stress disorder (PTSD). Given evidence indicating other acquired psychiatric disabilities, the Board has broadened the claim to include all acquired psychiatric disorders including delusion disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 C.F.R. § 1110; 38 C.F.R. § 3.303 Service connection for delusional disorder is granted. The Veteran contends that he has PTSD due to in-service military sexual trauma (MST). See January 2015 claim. Specifically, he contends that he was sexually assaulted in Saudi Arabia and was subjected to five needles in the neck for DNA and blood extraction, resulting in memory loss. See January 2015 Statement in Support; June 2015 Notice of Disagreement. Additionally, the Veteran contends that his psychological condition is related to his combat experience. See August 2015 Notice of Disagreement. Given that the Veteran had documented combat experience in Saudi Arabia the Board finds that his report of an in-service traumatic event is consistent with the circumstances of his service. See 38 U.S.C. § 1154(b); Records of Assignment. The Veteran is currently diagnosed with a delusional disorder, see, e.g., February 5, 2019 VA Mental Health Note. Accordingly, the remaining issue is whether the current diagnosis is related to the Veteran's service. To this end, a May 2023 VA examiner provided a positive nexus opinion for the Veteran's delusional disorder based on his exposure to combat that resulted in "severe stress" as he was "in harm's way due to the ongoing military operations." As support, the examiner cited a strong evidentiary link between trauma and delusions/psychosis, postulating that the reported military sexual assault was an indicator for the Veteran's delusions and paranoid thoughts. As further evidence for nexus, the examiner reviewed the Veteran's clinical records and pointed out that the Veteran had multiple psychiatric hospitalizations and endorsed "problems in occupational functioning" soon after service. The May 2023 VA examiner's medical findings were based on his full consideration of all pertinent medical records and was supported with complete rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board assigns significant probative weight to the May 2023 medical opinion. Of note, a March 2017 private mental status examination report, Dr. J.A. linked the Veterans' psychiatric symptoms to his service, but the opinion was speculative at best and provides an inadequate basis on which to support the Veteran's claim. See Bostain v. West,11 Vet. App. 124, 127-28 (1998), quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993). For that reason, that opinion is assigned little probative value. (Continued on the next page) ? Of note, a May 2015 VA examiner found he could not render a nexus opinion as there was no mental health diagnosis. However, given various diagnoses of delusional disorder documented in the clinical records, that opinion was based on inaccurate factual premises and is assigned no probative weight for that reason. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based on an inaccurate factual premise has no probative value). Accordingly, as the May 2023 serves as the most probative opinion evidence of record and relates the Veteran's delusional disorder to his service, the Board resolves all doubt in the Veteran's favor and finds that service connection is warranted. S. Kim Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Griggs 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.