Citation Nr: 25004084 Decision Date: 03/26/25 Archive Date: 03/26/25 DOCKET NO. 17-05 496 DATE: March 26, 2025 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include unspecified anxiety disorder (but excluding specific phobia of water), is granted. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, his acquired psychiatric disorder is etiologically related to his active military service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include unspecified anxiety disorder (but excluding specific phobia of water), are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1965 to July 1969. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in October 2009 by a Department of Veterans Affairs (VA) Regional Office. This matter has a lengthy procedural history, including appeals to the United States Court of Appeals for Veterans Claims (CAVC), that is incorporated herein by reference. Addressing the most relevant procedural history, in May 2024 the Board remanded the issue of entitlement to service connection for an acquired psychiatric disorder, other than specific phobia of water, claimed as posttraumatic stress disorder (PTSD), for additional development. The case has now returned to the Board for further appellate review. As additional development has been conducted, to include providing the Veteran with applicable forms to request medical records and associating the Veteran's VA treatment records with the claims file, the Board finds that there has been substantial compliance with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for an acquired psychiatric disorder, other than specific phobia of water, to include unspecified anxiety disorder. The Veteran contends his acquired psychiatric disorder had its onset in or is otherwise directly related to his military service. Specifically, the Veteran contends, while in service, he was aboard the USS Shangri-LA when the ship collided with another vessel, throwing the Veteran from his bed, which has caused his current disorder. The Veteran also asserts, while in service, he was walking on deck and witnessed an accident in which another sailor was injured or killed which has led to his acquired psychiatric disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, to establish service connection, there must be competent, credible evidence of 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A diagnosis of PTSD must be in conformance with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV) criteria. Effective March 19, 2015, VA replaced outdated references with references to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM V). However, the DSM IV criteria may be used at any time during the appeal, including after August 4, 2014, if application of the DSM IV after August 4, 2014, would be more favorable to the Veteran. The Board may not use the DSM IV alone as a basis for rejecting favorable medical evidence regarding the adequacy of the Veteran's symptomatology in terms of establishing a PTSD diagnosis. See Cohen v. Brown, 10 Vet. App. 128, 139-42 (1997). 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 the issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). There is no dispute that the Veteran has had an acquired psychiatric disorder during the period on appeal. VA treatment records indicate the Veteran receives prescription medications for anxiety and depression. Further, a June 2022 private medical opinion indicated that, based upon a review of the Veteran's claim file, the Veteran's symptoms are best accounted for by a diagnosis of unspecified anxiety disorder. To the extent that the Veteran has contended that he has PTSD, the Board finds the most competent and probative evidence of record weighs against such a finding. With regards to PTSD, the Veteran has been afforded numerous VA examinations addressing such issue. Notably, none of the VA examiners, nor the private examiner, provided a diagnosis of PTSD. To the extent that the Veteran's VA treatment records note a diagnosis of PTSD, the reports overall show that the assessments/diagnoses were noted based on various reasons, to include a history of PTSD, suggestions of PTSD, indications that the notation was not sufficient for diagnostic purposes, or on tests other than the DSM criteria. Further, VA examiners have clarified the symptoms the Veteran attributes to PTSD are actually attributable to his already service-connected specific phobia of water. Finally, as noted by the January 2020 VA examiner, "There are inconsistencies in diagnoses but one must recognize that clinicians generally accept self-reported symptoms at face value. For example, if Veteran ... reports to a provider that he has PTSD and reports a few symp[toms consistent with that diagnosis, he will likely have the diagnosis listed in notes. Then other treatment providers will reference what is documented and often refer to the diagnoses as 'history of' in their own documentation." While the Veteran may believe that he has PTSD, he is not competent to provide such diagnoses as diagnosing a mental health disorder is a medically complex issue, and the Veteran does not possess the required training. Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) (holding that "PTSD is not the type of medical condition that lay evidence... is competent and sufficient to identify"); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Nonetheless, the evidence of record shows that the Veteran has a diagnosis of unspecified anxiety disorder; thus, the first element of service connection has been established. Turning to the second element of service connection, an in-service event, the Veteran's service treatment records (STRs) are silent for any treatment, diagnoses, or complaints related to a psychiatric condition. However, the Veteran reports witnessing two traumatic events while in service including a ship collision and the death of a fellow sailor. A Defense Personnel Records Retrieval System (DPRIS) report indicates that on August 27, 1965 the USS Shangri-LA and USS Newman K. Perry collided, resulting in the death of one sailor. An October 2009 deferred rating decision conceded this ships accident occurred. Further, the Veteran's service records indicate he was aboard the USS Shangri-LA from July 1965 through July 1966. Resolving all doubt in favor of the Veteran, the Board finds an in-service occurrence. Turning to the third element of service connection, the Board notes the Veteran was not provided a VA opinion regarding the etiology of his unspecified anxiety disorder. March 2019 and January 2020 VA examiners indicated the Veteran's symptomology was due to a longstanding personality disorder. However, the Veteran also provided the June 2022 private medical opinion of Doctor of Psychology, Dr. J.P., which indicated such diagnosis and conclusion was, "inaccurate and inappropriate." Dr. J.P. further explained the DSM-V noted "the clinician must be cautious in diagnosing personality disorders" and that any personality disorder would have been noted on the Veteran's entrance examination. Further, as noted above, Dr. J.P. indicated the Veteran's correct diagnosis was that of unspecified anxiety disorder and such was at least as likely as not the direct result of his service, to include the aforementioned ship collision. Here, the Board affords great probative value to the aforementioned private clinician's opinion as such was based on the evidence of record and the Veteran's reported history of his symptomatology and includes a complete rationale, relying on and citing to specific medical and lay evidence in support thereof. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion...must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Board affords the March 2019 and January 2020 VA opinions little probative weight as the opinions are inconsistent with the other evidence of record, to include other VA examinations, the private medical opinion, and VA treatment records. Id. (Continued on the next page) ? Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's acquired psychiatric disorder, to include unspecified anxiety disorder, is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Hager, William J. 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.