Citation NR: 9732624	
Decision Date: 09/25/97		Archive Date: 10/01/97
DOCKET NO.  94-38 906	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Pittsburgh, 
Pennsylvania


THE ISSUE

Entitlement to service connection for an acquired psychiatric 
disorder, to include a post-traumatic stress disorder.


REPRESENTATION

Appellant represented by:	Paralyzed Veterans of America, 
Inc.


WITNESS AT HEARING ON APPEAL

Appellant




ATTORNEY FOR THE BOARD

T. Hal Smith, Counsel 



INTRODUCTION

The veteran served on active duty from December 1963 to 
January 1965.  

This matter is currently before the Board of Veterans’ 
Appeals (Board) on appeal from rating decisions from the 
Department of Veterans Affairs (VA) Regional Office (RO) in 
Pittsburgh, Pennsylvania.  

By a rating decision dated in November 1966, service 
connection was denied for anxiety reaction.  The issue 
developed and certified on appeal was listed as entitlement 
to service connection for post-traumatic stress disorder 
(PTSD).  At a hearing before the undersigned Member of the 
Board in August 1997, the veteran's representative requested 
that the issue be recharacterized as entitlement to service 
connection for an acquired psychiatric disorder, to include 
PTSD.  In compliance with the representative request, and in 
view of the clinical data of record, the Board has restated 
the issue as requested.  Additionally, the Board will 
consider this issue on a de novo basis inasmuch as the Board 
finds that the findings and opinions of a VA psychiatric 
examiner in November 1992 and December 1994 clearly 
constitute new and material evidence.

At the August 1997 personal hearing in Washington, D.C., the 
issue of clear and unmistakable error was raised as to the 
denial of service connection for a psychiatric disorder in 
November 1966.  As this issue has not been developed for 
appellate review, it is referred to the RO for such further 
action as is deemed appropriate.  While it can be argued that 
this issue is inextricably intertwined with the issue cur-
rently before the Board, in view of the favorable decision by 
the Board, any decision by the RO as to whether or not there 
was clear and unmistakable error in the November 1966 
decision would not render the Board's decision meaningless.  
Likewise, the Board's favorable decision on the issue 
currently before it will not prejudice the veteran's claim of 
clear and unmistakable error in the November 1996 decision.


CONTENTIONS OF APPELLANT ON APPEAL

Essentially, it is argued that the veteran should be granted 
service connection for an acquired psychiatric disorder, to 
include PTSD.  It is maintained that his experiences during 
service resulted in his currently diagnosed dysthymic 
disorder with PTSD features.


DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A. 
§ 7104 (West 1991 & Supp. 1997), has reviewed and considered 
all of the evidence and material of record in the veteran's 
claims file.  Based on its review of the relevant evidence in 
this matter, and for the following reasons and bases, it is 
the decision of the Board that, with resolution of reasonable 
doubt in the veteran’s favor, the evidence supports the claim 
for service connection for a dysthymic disorder with elements 
of PTSD.


FINDINGS OF FACT

1.  The RO has obtained all relevant evidence necessary for 
an equitable disposition of the veteran’s appeal.  

2.  The service medical records show that the veteran was 
hospitalized and then released from military service because 
of psychiatric symptoms, including anxiety, depression, and 
suicidal ideas.

3.  A VA psychiatrist, who reviewed the service medical 
records and examined the veteran, stated that the veteran had 
a dysthymic disorder (depression) with elements of PTSD which 
was attributable to his military experiences.


CONCLUSION OF LAW

A dysthymic disorder with elements of PTSD was incurred in 
military service.  38 U.S.C.A. §§ 1110, 1131, 5107 (West 
1991); 38 C.F.R. § 3.304 (1996).  


REASONS AND BASES FOR FINDINGS AND CONCLUSION

The veteran’s claim is well-grounded within the meaning of 
38 U.S.C.A. § 5107(a) (West 1991); that is, he has presented 
a claim which is plausible.  Further, the Board is satisfied 
that all relevant facts have been properly developed.  There 
is no indication that there are additional records which have 
not been obtained which would be pertinent to the veteran’s 
claim.  Thus, no further assistance is required to comply 
with the duty to assist as mandated by 38 U.S.C.A. § 5107(a).  
Godwin v. Derwinski, 1 Vet.App. 419 (1991); White v. 
Derwinski, 1 Vet.App. 519 (1991).  

Factual Background

Service medical records reflect that when the veteran was 
examined for the United States Naval Reserves in August 1962, 
no psychiatric abnormality was noted.  He apparently had a 
period of active duty for training in July and August 1963.  
In December 1963 he was examined for extended active duty.  
No psychiatric abnormality was found on clinical evaluation 
and no pertinent history was noted.  He was hospitalized in 
August 1964 for a spontaneous left hemopneumothorax.  He was 
returned to duty in October 1964 but was readmitted several 
days later for complaints of malaise, lassitude, a 
nonproductive cough and a sore throat.  Pleurisy was 
diagnosed and he was returned to duty later that month.  In 
December 1964 the veteran was seen for "neurasthenic type 
complaints."  Depressive reaction was diagnosed and he was 
admitted to a Naval hospital.  No clinical records for this 
period of hospitalization are currently of records.  A Report 
of Board of Medical Survey completed in January 1965 reflects 
that upon admission to the psychiatric service the veteran 
reported that during the several weeks prior to admission he 
was increasingly anxious and depressed and he admitted to 
having had suicidal thoughts aboard ship.  It was reported 
that after he had returned to shipboard duty after hospi-
talization for a left spontaneous hemopneumothorax, his 
military adjustment deteriorated and he felt that a 
Boatswain's mate was "turning everyone against him" and that 
"all his pep had been flushed away."  The veteran indicated 
that he was a "weakling" and that he would "break into 
pieces" if he were returned to his ship.  After a period of 
observation and evaluation, a conference of staff 
psychiatrists concluded that he was suffering from a paranoid 
personality that precluded his rendering further useful 
service to the Navy.  The following diagnosis was given:  
paranoid personality, moderate, manifested by life-long 
resentment of authority and unsystematized persecutory ideas, 
marginal school and vocational adjustment, anxiety, 
depression, and suicidal ideas.  He was discharged from the 
hospital and from Naval service in late January 1965.

The veteran initially applied for compensation for residuals 
of hemopneumothorax and for "nerves" in August 1966.

The veteran was accorded a VA psychiatric examination in 
September 1966.  The veteran reported that he had been 
hospitalized during service for a “collapsed lung.”  The 
veteran related that when he was discharged from the hospital 
he was sent back on full duty to his ship even though he 
still felt weak.  He ultimately came close to a nervous 
breakdown, and he was hospitalized for general nervousness.  
He received a medical discharge and returned to his parents' 
home where he took a period of rest.  He had two jobs of 
short duration in 1965.  At the time of this examination, he 
was an encyclopedia salesman.  He lived with his sister and 
spent most of his time at home.  His hobby was playing in a 
band.  He complained that he always felt tired and had no 
ambition.  He could not stand noises.  Upon neurological 
examination he was described as pale of complexion, with 
somewhat haggard features.  Mental status examination 
reflected that he was friendly and cooperative, but very 
bashful and unsure of himself.  He did not smile and was 
difficult to interview because he looked rather tired and 
exhausted and had difficulty concentrating.  His stream of 
speech was fairly spontaneous and well connected, although he 
was very reserved.  He impressed the examiner as a person who 
was very undecided and did not know what he was going to do 
next.  He was, however, reported to be of fair intelligence, 
and he denied hallucinations, delusions, or suicidal ideas.  
The examiner concluded that without the veteran’s service 
records, this case was “not easy to size up.”  He impressed 
the examiner as a somewhat peculiar type of personality, not 
a very virile type of person, who had a history of having 
hemopneumothorax during service and being very nervous ever 
since.  The diagnosis was anxiety reaction, chronic, 
manifested by fatigue and difficulty in concentrating.  

In November 1966 the RO returned the examination report to 
the examiner together with the service medical records for 
the veteran.  The RO requested the psychiatrist to review the 
service records in conjunction with the VA examination and 
indicate whether or not any change in diagnosis was 
warranted.

In a statement dated in November 1966, the VA psychiatric 
examiner reported that after reviewing the service records, 
it was evident that the veteran was a paranoid personality 
but that personality disturbances usually show only minimal 
subjective anxiety.  The psychiatrist stated that it was his 
belief that the veteran, "independently from his abnormal 
personality, suffered from an emotional illness during 
military service manifested by anxiety, depression and 
suicidal ideas," and that it was very likely that these 
symptoms were caused or aggravated by the physical illness 
from which he suffered during service.  The psychiatrist 
submitted the following diagnoses:  (a)  Anxiety reaction, 
chronic, manifested by fatigue and difficulty in 
concentrating; and (b) Paranoid Personality.

When examined by VA in November 1992, the examiner noted that 
he had reviewed the veteran’s service medical records.  It 
seemed obvious to the examiner that the inservice medical 
board had tried to label the veteran a paranoid type per-
sonality disorder when there was “absolutely no evidence of 
any pre-existing psychopathology of significance.”  At the 
time of this examination, the appellant suffered from severe 
anxiety, psychomotor agitation, and nightmares associated 
with his military service.  He had moderately severe 
depression and poor sleep.  His appetite and weight were 
stable, but energy was practically nonexistent.  He did not 
have suicidal thoughts.  Activities of daily living were 
mainly limited to trying to compose music and to write.  He 
was not active in any clubs or organizations.  On mental 
status examination, he was alert and articulate with 
appropriate behavior.  He showed no signs of paranoia 
whatsoever.  He did show signs of severe anxiety and 
depression.  He was oriented times three, and recent and 
remote memory were intact.  There was a good fund of general 
information.  There were no hallucinations, delusions, or any 
signs of thought disorder or paranoia.  Thinking was ab-
stract, and judgment was intact.  The examiner diagnosed 
dysthymic disorder of severe proportion and offered his 
opinion that the dysthymic disorder was directly attributable 
to the veteran's experiences while on Naval duty.

Upon psychiatric examination at a private facility in 
November 1994, the veteran was described as angry and bitter 
but well oriented.  He felt worthless.  He reported 
disturbing nightmares and startle responses.  He had no 
suicidal plans.  His past medical history included numerous 
extremely traumatic experiences and a severe head injury.  
The veteran related that he did not see combat during service 
but that he was sexually abused during service.  The 
examiner’s diagnoses included PTSD with depression; probably 
personality disorder, mixed with passive aggressive and 
dependent features; and history of severe head trauma and 
brain injury with secondary traumatic epilepsy.

Upon VA psychiatric examination in December 1994, the 
examiner reported that the claims folder was reviewed and the 
veteran interviewed.  The examiner also noted that he had 
previously examined the veteran in November 1992.  The 
examiner added that while he still believed the major factors 
in the veteran’s situation were depression and organic 
personality disorder, if one believed the veteran's 
allegation that he was raped while in service, the elements 
of PTSD were also present.  The examiner provided details as 
told to him by the veteran as to the inservice rape.  The 
examiner noted that the veteran felt enormously angry and 
ashamed as he recounted this incident in detail.  Current 
symptoms included sleep disturbance, irritability, 
hypervigilance, and startle response.  Mental status 
examination showed that the veteran was alert and articulate.  
His behavior was appropriate, though angry.  Memory was 
somewhat blunted.  He had a slow and somewhat constricted 
fund of general information.  There were no hallucinations or 
delusions.  Diagnostically, the examiner opined that the 
appellant did not have a personality disorder.  The psychi-
atrist felt that the veteran had a dysthymic disorder 
(depression) which was an outgrowth in part from what 
happened to him during service.  The veteran also had an 
organic brain syndrome which was mainly caused by a post 
service injury in 1989.  It was also the examiner’s opinion 
that the veteran did have some elements of PTSD from the 
sexual assault sustained in service.

At a personal hearing in August 1997, the veteran testified 
in support of his claim.  He provided details concerning his 
military experiences and reiterated that his psychiatric 
disorder was due to, and began during, his military service.

Analysis

Service connection connotes many factors, but basically it 
means that the facts, as shown by evidence, establish that a 
particular injury or disease resulting in disability was 
incurred coincident with service in the Armed Forces, or if 
preexisting such service, was aggravated therein.  38 
U.S.C.A. §§ 1110, 1131.  Such a determination requires a 
finding of a current disability which is related to an injury 
or disease incurred in service.  Watson v. Brown, 4 Vet.App. 
309, 310 (1993); Rabideau v. Derwinski, 2 Vet.App. 141, 143 
(1992).

Additionally, the regulations provide that service connection 
may be granted for any disease diagnosed after discharge, 
when all of the evidence, including that pertinent to 
service, establishes that the disease was incurred in 
service.  38 C.F.R. § 3.303(d).

A longitudinal review of the claims folder reflects evidence 
of psychiatric symptoms dating back to military service.  The 
service medical records reflect that the veteran complained 
of depression and admitted that he had suicidal thoughts.  A 
diagnosis of depressive reaction was initially given.  A 
subsequent diagnosis of a personality disorder noted that 
manifestations included anxiety, depression and suicidal 
ideas.  VA examination in 1966 noted that the veteran had 
been very nervous since his hospitalization during service 
for a spontaneous hemopneumothorax.  VA examination in 1992 
noted that the veteran suffered from severe anxiety and 
depression.  The VA psychiatric examiner who reviewed the 
service medical records and examined the veteran in 1992 and 
again in 1994 concluded that the veteran suffers from a 
dysthymic disorder (depression) with features of PTSD.  The 
VA psychiatrist, after review of the service medical records, 
has clearly and unequivocally stated that the veteran's 
current dysthymic disorder with features of PTSD is related 
to his military service.

After careful weighing of all the evidence, both negative and 
positive, the Board finds that the evidence supports a grant 
of service connection for dysthymic disorder with elements of 
PTSD.

ORDER

Service connection for dysthymic disorder with elements of 
PTSD is granted. 


		
	GARY L. GICK
	Member, Board of Veterans' Appeals

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West 
1991 &  Supp. 1997), a decision of the Board of Veterans' 
Appeals granting less than the complete benefit, or benefits, 
sought on appeal is appealable to the United States Court of 
Veterans Appeals within 120 days from the date of mailing of 
notice of the decision, provided that a Notice of 
Disagreement concerning an issue which was before the Board 
was filed with the agency of original jurisdiction on or 
after November 18, 1988.  Veterans' Judicial Review Act, 
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988).  The 
date which appears on the face of this decision constitutes 
the date of mailing and the copy of this decision which you 
have received is your notice of the action taken on your 
appeal by the Board of Veterans' Appeals.
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