text:
Citation Nr: 1632746
Decision Date: 08/18/16    Archive Date: 08/26/16

DOCKET NO.  12-20 751A	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in St. Petersburg, Florida

THE ISSUE

Entitlement to service connection for posttraumatic stress disorder (PTSD).

REPRESENTATION

Appellant represented by:	Joseph R. Moore, Esq.

ATTORNEY FOR THE BOARD

C. Ryan, Associate Counsel

INTRODUCTION

The Veteran served on active duty from January 1968 to December 1969.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida.

The Board notes that in November 2012, the Veteran initially requested a hearing.  At the time, the Veteran's representative, the Florida Department of Veteran Affairs (FDVA) requested that if the Veteran did not receive a hearing, the claims file should be returned to the FDVA so it might prepare an informal hearing presentation.  In December 2015, the Veteran retained a private lawyer, Joseph R. Moore.  In March 2016, Mr. Moore cancelled the Veteran's hearing request.  Because the Veteran is no longer represented by the FDVA, the Board finds it unnecessary to return the claims folder.

In addition, the Board acknowledges the Veteran's representative's request for a stay of proceedings and a copy of the Veteran's claims file.  However, given the disposition below, the Board finds no prejudice will attach by issuing this decision, as it is fully favorable to the Veteran regarding the issue on appeal.

FINDING OF FACT

The Veteran suffers from PTSD that is linked to a confirmed in-service stressor.

CONCLUSION OF LAW

The criteria for service connection for PTSD are met.  38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.303, 3.304 (2015).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran believes he is entitled to service connection for PTSD.  For the following reasons, the Board finds service connection is warranted.

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.  38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009).

Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

In addition to the general requirements for service connection, PTSD claims require: (1) medical evidence diagnosing the condition; (2) a link, established by medical evidence, between 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).  A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which provides that all psychiatric diagnoses must conform to the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders.  38 C.F.R. § 3.304(f).

The evidence necessary to establish the occurrence of a stressor during service to support a diagnosis of PTSD will vary depending upon whether the Veteran
engaged in "combat with the enemy," as established by recognized military combat citations or other official records.  See Cohen v. Brown, 10 Vet. App. 128 (1997).  If VA determines the Veteran engaged in combat with the enemy and the alleged stressor is combat-related, then the Veteran's lay testimony or statement is accepted as conclusive evidence of the stressor's occurrence and no further development or corroborative evidence is required, provided that such testimony is found to be "satisfactory"-i.e., credible, and "consistent with the circumstances, conditions, or hardships of service."  See 38 U.S.C.A. § 1154(b); see also Dizoglio v. Brown, 9 Vet. App. 163, 164 (1996).  If, however, the Veteran's stressor is unrelated to participation in combat, then lay testimony, in and of itself, is insufficient to corroborate the stressor.  The record must contain credible supporting information from an independent source that corroborates his testimony or statements, such as service records.  See Cohen, 10 Vet. App. at 146-47; see also Moreau v. Brown, 9 Vet. App. 389, 394-95 (1996).

Apart from the above provisions, VA revised the regulation governing adjudication of claims for service connection for PTSD, effective July 13, 2010.  See 75 Fed. Reg. 39,843 (since codified at 38 C.F.R. § 3.304(f)(3)).  The revised regulation essentially eases the requirement that there be corroboration of a claimed in-service stressor.  Under this standard, if a stressor claimed by a Veteran is related to the Veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran's symptoms are related to the claimed stressor, provided the stressor is consistent with the places, types, and circumstances of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the stressor.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant.  38 U.S.C.A. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).  To deny a claim on its merits, the evidence must preponderate against the claim.  Alemany v. Brown, 9 Vet. App. 518, 519 (1996).

A review of the facts reveals the following: in October 2002, the Veteran underwent a Compensation and Pension (C&P) examination for PTSD, in which the examiner determined the Veteran suffered from PTSD, as well as a depressive disorder.  The Veteran explained his PTSD worsened in 2000, when he switched from working night shift to day shift, and he was forced to frequently interact with co-workers and family members.  The stress of such interactions increased his temper, and he became verbally abusive toward his family members.  Shortly thereafter, he entered treatment at the VA and enrolled in private mental health services where he was diagnosed with depressive disorder and PTSD.

The Veteran informed the examiner he dreamed often, but only occasionally about Vietnam.  Following his discharge, he often awoke from sleep screaming and in a panicked state, and he still experienced daily, recurrent thoughts of Vietnam.  Moreover, he was forced to actively avoid veteran associations or discussions of combat.  He tended to avoid crowds or groups of people because of feelings of potential danger or threat and heightened anxiety.  He avoided others out of a fear of losing control and angry impulses.  Lastly, he experienced trouble controlling his temper and struggled to interact with others at work and with his family.  Socially, the Veteran maintained one or two friendships.

The examiner determined the Veteran was alert and oriented to all spheres.  His appearance was clean, and he was adequately dressed and groomed.  His speech was coherent and of a normal rate, rhythm, and tone.  He displayed good eye contact and demonstrated appropriate interpersonal interaction.  His thought process was logical and goal directed, and he exhibited no overt or reported signs of psychosis, delusion, or hallucination.

The examiner concluded that the Veteran suffered from both PTSD and a depressive disorder.  The Veteran's experiences in Vietnam served as his traumatic stressor.  The examiner believed the Veteran's PTSD developed following his discharge from the service.

Following the examination, the Veteran was consistently and continuously diagnosed with PTSD, continued to report symptoms of PTSD, and continuously received both in-patient and out-patient PTSD counseling from 2002 until 2009.

In December 2007, the Veteran submitted a statement, concluding that his PTSD caused him to mentally break down at VA hospitals, receive disciplinary charges at work, and forced him to undergo hospitalization for psychiatric care in January 2005.

In December 2009, the Veteran underwent a C&P examination for PTSD.  However, the Veteran did not complete the exam due to his mental angst.  Prior to the examination, the Veteran had asked for and received from his treating psychologist a note stipulating that his wife should be allowed to attend the C&P examination with him.  Upon arriving for the C&P examination, the examiner informed him his wife was not allowed to attend.  This upset the Veteran to such a degree the examiner was forced to end the examination.

In December 2009, the Veteran's daughter submitted a statement in which she concluded her father's PTSD had worsened over the past few months, and she was very worried about his anger.  She stated that she never knew what was going to happen around him, and although he continued to receive treatment at the VA, his condition had worsened, not improved.

In March 2012, the Veteran received another C&P examination for PTSD, in which the examiner determined the Veteran did not suffer from PTSD.  She concluded that the Veteran did not meet PTSD criteria under the DSM-IV Criteria B (re-experiencing), Criteria C (avoidance and numbing), or Criteria D (hyperarousal).  The examiner indicated that under Criteria B (re-experiencing), the Veteran did not suffer from recurrent distressing thoughts of the event, or recurrent distressing dreams of the event.  Under Criteria C (avoidance and numbing), the Veteran did not actively avoid activities, places, or people that arouse recollections of the trauma.  Under Criteria D (hyperarousal), the examiner indicated the Veteran did not suffer from irritability or outbursts of anger.  Moreover, the examiner could not explain why the Veteran had been diagnosed with PTSD by past treatment providers because she could not review how those providers arrived at a diagnosis.  Lastly, she opined that the Veteran merely suffered from isolated symptoms of PTSD which were not sufficient to make a PTSD diagnosis under the DSM-IV.

In June 2012, the Veteran submitted a statement explaining that he had received continuous PTSD diagnoses for the past 10 to 12 years, and he continued to suffer from the disease.

The Board begins by noting that due to the Veteran's combat service in Vietnam, the RO conceded the existence of in-service stressors.  Thus, a discussion concerning stressors is unnecessary.

The Board finds that the evidence supports the Veteran's claim of service connection for PTSD.  First, the record demonstrates the Veteran served in Vietnam, and the RO conceded that the Veteran's in-service stressors occurred.  Second, the Veteran's VA treating physicians believe the Veteran suffers from PTSD.  For more than the past decade, the Veteran has complained of and sought treatment for PTSD, and the providers whom the Veteran saw on a daily basis concluded the Veteran suffered from PTSD.  Last, the October 2002 C&P examiner diagnosed the Veteran with PTSD and concluded that the Veteran's PTSD stemmed from his service in the military.

In March 2012, the Veteran underwent a C&P examination for PTSD, in which the examiner concluded the Veteran did not suffer from PTSD.  In making this finding, the examiner determined the Veteran did not suffer from the following: recurrent distressing thoughts of the event; recurrent distressing dreams of the event; an avoidance of activities, places, or people that arouse recollections of the trauma; or irritability or outbursts of anger.  The record, however, directly contradicts those findings.  In the October 2002 statement, the Veteran informed the examiner he experienced daily, recurrent thoughts of Vietnam, occasional nightmares, and that he actively avoided veterans and activities associated with Vietnam.  Moreover, the Veteran explained to the examiner that he frequently suffered from irritability and anger outbursts with his family and co-workers, and the Veteran continued to assert that in his lay statements.  In December 2009, the Veteran's daughter submitted a letter to the RO in which she stated she was worried about her father's worsening anger, unpredictability, and irritability.  Due to the fact that the March 2012 examiner mischaracterized the Veteran's symptoms and behavior, the Board finds the examination and examiner's conclusion less than probative.  See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (finding that medical opinions based on incomplete or inaccurate factual premises are not probative).

Accordingly, given the Veteran's treating physicians' multiple diagnoses of PTSD, the Board finds the evidence is at least in equipoise as to whether the Veteran has PTSD and its relation to service.

In addition to the general requirements for service connection, PTSD claims require: (1) medical evidence diagnosing the condition; (2) a link, established by medical evidence, between 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).  A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which provides that all psychiatric diagnoses must conform to the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders.  38 C.F.R. § 3.304(f).

In this situation, the evidence establishes the Veteran has (1) medical evidence diagnosing the condition; (2) the October 2002 C&P examiner determined the Veteran's PTSD traumatic stressor concerned his experience in Vietnam with a mortar attack; and (3) the RO has conceded that the Veteran's claimed in-service stressor occurred.  38 C.F.R. § 3.304(f).

The Board finds the evidence concerning service connection to PTSD is at least in equipoise.  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant.  38 U.S.C.A. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).  Accordingly, the criteria for service connection for PTSD have been met.

ORDER

Service connection for PTSD is granted.

_________________________________________________
BRADLEY W. HENNINGS
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

label: Sentence

text: Citation

text: Nr

text: Decision

text: Date

text: Archive

text: Date

text: DOCKET

text: NO

text: A

text: DATE

text: On

text: appeal

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text: Department

text: of

text: Veterans

text: Affairs

text: Regional

text: Office

text: in

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text: THE

text: ISSUE

text: Entitlement

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text: service

text: connection

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text: posttraumatic

text: stress

text: disorder

text: PTSD

text: REPRESENTATION

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text: VA

text: and

text: enrolled

text: in

text: private

text: mental

text: health

text: services

text: where

text: he

text: was

text: diagnosed

text: with

text: depressive

text: disorder

text: and

text: PTSD

text: The

text: Veteran

text: informed

text: the

text: examiner

text: he

text: dreamed

text: often

text: but

text: only

text: occasionally

text: about

text: Vietnam

text: Following

text: his

text: discharge

text: he

text: often

text: awoke

text: from

text: sleep

text: screaming

text: and

text: in

text: a

text: panicked

text: state

text: and

text: he

text: still

text: experienced

text: daily

text: recurrent

text: thoughts

text: of

text: Vietnam

text: Moreover

text: he

text: was

text: forced

text: to

text: actively

text: avoid

text: veteran

text: associations

text: or

text: discussions

text: of

text: combat

text: He

text: tended

text: to

text: avoid

text: crowds

text: or

text: groups

text: of

text: people

text: because

text: of

text: feelings

text: of

text: potential

text: danger

text: or

text: threat

text: and

text: heightened

text: anxiety

text: He

text: avoided

text: others

text: out

text: of

text: a

text: fear

text: of

text: losing

text: control

text: and

text: angry

text: impulses

text: Lastly

text: he

text: experienced

text: trouble

text: controlling

text: his

text: temper

text: and

text: struggled

text: to

text: interact

text: with

text: others

text: at

text: work

text: and

text: with

text: his

text: family

text: Socially

text: the

text: Veteran

text: maintained

text: one

text: or

text: two

text: friendships

text: The

text: examiner

text: determined

text: the

text: Veteran

text: was

text: alert

text: and

text: oriented

text: to

text: all

text: spheres

text: His

text: appearance

text: was

text: clean

text: and

text: he

text: was

text: adequately

text: dressed

text: and

text: groomed

text: His

text: speech

text: was

text: coherent

text: and

text: of

text: a

text: normal

text: rate

text: rhythm

text: and

text: tone

text: He

text: displayed

text: good

text: eye

text: contact

text: and

text: demonstrated

text: appropriate

text: interpersonal

text: interaction

text: His

text: thought

text: process

text: was

text: logical

text: and

text: goal

text: directed

text: and

text: he

text: exhibited

text: no

text: overt

text: or

text: reported

text: signs

text: of

text: psychosis

text: delusion

text: or

text: hallucination

text: The

text: examiner

text: concluded

text: that

text: the

text: Veteran

text: suffered

text: from

text: both

text: PTSD

text: and

text: a

text: depressive

text: disorder

text: The

text: Veteran

text: s

text: experiences

text: in

text: Vietnam

text: served

text: as

text: his

text: traumatic

text: stressor

text: The

text: examiner

text: believed

text: the

text: Veteran

text: s

text: PTSD

text: developed

text: following

text: his

text: discharge

text: from

text: the

text: service

text: Following

text: the

text: examination

text: the

text: Veteran

text: was

text: consistently

text: and

text: continuously

text: diagnosed

text: with

text: PTSD

text: continued

text: to

text: report

text: symptoms

text: of

text: PTSD

text: and

text: continuously

text: received

text: both

text: in

text: patient

text: and

text: out

text: patient

text: PTSD

text: counseling

text: from

text: until

text: In

text: December

text: the

text: Veteran

text: submitted

text: a

text: statement

text: concluding

text: that

text: his

text: PTSD

text: caused

text: him

text: to

text: mentally

text: break

text: down

text: at

text: VA

text: hospitals

text: receive

text: disciplinary

text: charges

text: at

text: work

text: and

text: forced

text: him

text: to

text: undergo

text: hospitalization

text: for

text: psychiatric

text: care

text: in

text: January

text: In

text: December

text: the

text: Veteran

text: underwent

text: a

text: C

text: P

text: examination

text: for

text: PTSD

text: However

text: the

text: Veteran

text: did

text: not

text: complete

text: the

text: exam

text: due

text: to

text: his

text: mental

text: angst

text: Prior

text: to

text: the

text: examination

text: the

text: Veteran

text: had

text: asked

text: for

text: and

text: received

text: from

text: his

text: treating

text: psychologist

text: a

text: note

text: stipulating

text: that

text: his

text: wife

text: should

text: be

text: allowed

text: to

text: attend

text: the

text: C

text: P

text: examination

text: with

text: him

text: Upon

text: arriving

text: for

text: the

text: C

text: P

text: examination

text: the

text: examiner

text: informed

text: him

text: his

text: wife

text: was

text: not

text: allowed

text: to

text: attend

text: This

text: upset

text: the

text: Veteran

text: to

text: such

text: a

text: degree

text: the

text: examiner

text: was

text: forced

text: to

text: end

text: the

text: examination

text: In

text: December

text: the

text: Veteran

text: s

text: daughter

text: submitted

text: a

text: statement

text: in

text: which

text: she

text: concluded

text: her

text: father

text: s

text: PTSD

text: had

text: worsened

text: over

text: the

text: past

text: few

text: months

text: and

text: she

text: was

text: very

text: worried

text: about

text: his

text: anger

text: She

text: stated

text: that

text: she

text: never

text: knew

text: what

text: was

text: going

text: to

text: happen

text: around

text: him

text: and

text: although

text: he

text: continued

text: to

text: receive

text: treatment

text: at

text: the

text: VA

text: his

text: condition

text: had

text: worsened

text: not

text: improved

text: In

text: March

text: the

text: Veteran

text: received

text: another

text: C

text: P

text: examination

text: for

text: PTSD

text: in

text: which

text: the

text: examiner

text: determined

text: the

text: Veteran

text: did

text: not

text: suffer

text: from

text: PTSD

text: She

text: concluded

text: that

text: the

text: Veteran

text: did

text: not

text: meet

text: PTSD

text: criteria

text: under

text: the

text: DSM

text: IV

text: Criteria

text: B

text: re

text: experiencing

text: Criteria

text: C

text: avoidance

text: and

text: numbing

text: or

text: Criteria

text: D

text: hyperarousal

text: The

text: examiner

text: indicated

text: that

text: under

text: Criteria

text: B

text: re

text: experiencing

text: the

text: Veteran

text: did

text: not

text: suffer

text: from

text: recurrent

text: distressing

text: thoughts

text: of

text: the

text: event

text: or

text: recurrent

text: distressing

text: dreams

text: of

text: the

text: event

text: Under

text: Criteria

text: C

text: avoidance

text: and

text: numbing

text: the

text: Veteran

text: did

text: not

text: actively

text: avoid

text: activities

text: places

text: or

text: people

text: that

text: arouse

text: recollections

text: of

text: the

text: trauma

text: Under

text: Criteria

text: D

text: hyperarousal

text: the

text: examiner

text: indicated

text: the

text: Veteran

text: did

text: not

text: suffer

text: from

text: irritability

text: or

text: outbursts

text: of

text: anger

text: Moreover

text: the

text: examiner

text: could

text: not

text: explain

text: why

text: the

text: Veteran

text: had

text: been

text: diagnosed

text: with

text: PTSD

text: by

text: past

text: treatment

text: providers

text: because

text: she

text: could

text: not

text: review

text: how

text: those

text: providers

text: arrived

text: at

text: a

text: diagnosis

text: Lastly

text: she

text: opined

text: that

text: the

text: Veteran

text: merely

text: suffered

text: from

text: isolated

text: symptoms

text: of

text: PTSD

text: which

text: were

text: not

text: sufficient

text: to

text: make

text: a

text: PTSD

text: diagnosis

text: under

text: the

text: DSM

text: IV

text: In

text: June

text: the

text: Veteran

text: submitted

text: a

text: statement

text: explaining

text: that

text: he

text: had

text: received

text: continuous

text: PTSD

text: diagnoses

text: for

text: the

text: past

text: to

text: years

text: and

text: he

text: continued

text: to

text: suffer

text: from

text: the

text: disease

text: The

text: Board

text: begins

text: by

text: noting

text: that

text: due

text: to

text: the

text: Veteran

text: s

text: combat

text: service

text: in

text: Vietnam

text: the

text: RO

text: conceded

text: the

text: existence

text: of

text: in

text: service

text: stressors

text: Thus

text: a

text: discussion

text: concerning

text: stressors

text: is

text: unnecessary

text: The

text: Board

text: finds

text: that

text: the

text: evidence

text: supports

text: the

text: Veteran

text: s

text: claim

text: of

text: service

text: connection

text: for

text: PTSD

text: First

text: the

text: record

text: demonstrates

text: the

text: Veteran

text: served

text: in

text: Vietnam

text: and

text: the

text: RO

text: conceded

text: that

text: the

text: Veteran

text: s

text: in

text: service

text: stressors

text: occurred

text: Second

text: the

text: Veteran

text: s

text: VA

text: treating

text: physicians

text: believe

text: the

text: Veteran

text: suffers

text: from

text: PTSD

text: For

text: more

text: than

text: the

text: past

text: decade

text: the

text: Veteran

text: has

text: complained

text: of

text: and

text: sought

text: treatment

text: for

text: PTSD

text: and

text: the

text: providers

text: whom

text: the

text: Veteran

text: saw

text: on

text: a

text: daily

text: basis

text: concluded

text: the

text: Veteran

text: suffered

text: from

text: PTSD

text: Last

text: the

text: October

text: C

text: P

text: examiner

text: diagnosed

text: the

text: Veteran

text: with

text: PTSD

text: and

text: concluded

text: that

text: the

text: Veteran

text: s

text: PTSD

text: stemmed

text: from

text: his

text: service

text: in

text: the

text: military

text: In

text: March

text: the

text: Veteran

text: underwent

text: a

text: C

text: P

text: examination

text: for

text: PTSD

text: in

text: which

text: the

text: examiner

text: concluded

text: the

text: Veteran

text: did

text: not

text: suffer

text: from

text: PTSD

text: In

text: making

text: this

text: finding

text: the

text: examiner

text: determined

text: the

text: Veteran

text: did

text: not

text: suffer

text: from

text: the

text: following

text: recurrent

text: distressing

text: thoughts

text: of

text: the

text: event

text: recurrent

text: distressing

text: dreams

text: of

text: the

text: event

text: an

text: avoidance

text: of

text: activities

text: places

text: or

text: people

text: that

text: arouse

text: recollections

text: of

text: the

text: trauma

text: or

text: irritability

text: or

text: outbursts

text: of

text: anger

text: The

text: record

text: however

text: directly

text: contradicts

text: those

text: findings

text: In

text: the

text: October

text: statement

text: the

text: Veteran

text: informed

text: the

text: examiner

text: he

text: experienced

text: daily

text: recurrent

text: thoughts

text: of

text: Vietnam

text: occasional

text: nightmares

text: and

text: that

text: he

text: actively

text: avoided

text: veterans

text: and

text: activities

text: associated

text: with

text: Vietnam

text: Moreover

text: the

text: Veteran

text: explained

text: to

text: the

text: examiner

text: that

text: he

text: frequently

text: suffered

text: from

text: irritability

text: and

text: anger

text: outbursts

text: with

text: his

text: family

text: and

text: co

text: workers

text: and

text: the

text: Veteran

text: continued

text: to

text: assert

text: that

text: in

text: his

text: lay

text: statements

text: In

text: December

text: the

text: Veteran

text: s

text: daughter

text: submitted

text: a

text: letter

text: to

text: the

text: RO

text: in

text: which

text: she

text: stated

text: she

text: was

text: worried

text: about

text: her

text: father

text: s

text: worsening

text: anger

text: unpredictability

text: and

text: irritability

text: Due

text: to

text: the

text: fact

text: that

text: the

text: March

text: examiner

text: mischaracterized

text: the

text: Veteran

text: s

text: symptoms

text: and

text: behavior

text: the

text: Board

text: finds

text: the

text: examination

text: and

text: examiner

text: s

text: conclusion

text: less

text: than

text: probative

text: See

text: Reonal

text: v

text: Brown

text: Vet

text: App

text: finding

text: that

text: medical

text: opinions

text: based

text: on

text: incomplete

text: or

text: inaccurate

text: factual

text: premises

text: are

text: not

text: probative

text: Accordingly

text: given

text: the

text: Veteran

text: s

text: treating

text: physicians

text: multiple

text: diagnoses

text: of

text: PTSD

text: the

text: Board

text: finds

text: the

text: evidence

text: is

text: at

text: least

text: in

text: equipoise

text: as

text: to

text: whether

text: the

text: Veteran

text: has

text: PTSD

text: and

text: its

text: relation

text: to

text: service

text: In

text: addition

text: to

text: the

text: general

text: requirements

text: for

text: service

text: connection

text: PTSD

text: claims

text: require

text: medical

text: evidence

text: diagnosing

text: the

text: condition

text: a

text: link

text: established

text: by

text: medical

text: evidence

text: between

text: current

text: symptoms

text: and

text: an

text: in

text: service

text: stressor

text: and

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: occurred

text: C

text: F

text: R

text: f

text: A

text: diagnosis

text: of

text: PTSD

text: must

text: be

text: established

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: which

text: provides

text: that

text: all

text: psychiatric

text: diagnoses

text: must

text: conform

text: to

text: the

text: American

text: Psychiatric

text: Association

text: s

text: Diagnostic

text: and

text: Statistical

text: Manual

text: for

text: Mental

text: Disorders

text: C

text: F

text: R

text: f

text: In

text: this

text: situation

text: the

text: evidence

text: establishes

text: the

text: Veteran

text: has

text: medical

text: evidence

text: diagnosing

text: the

text: condition

text: the

text: October

text: C

text: P

text: examiner

text: determined

text: the

text: Veteran

text: s

text: PTSD

text: traumatic

text: stressor

text: concerned

text: his

text: experience

text: in

text: Vietnam

text: with

text: a

text: mortar

text: attack

text: and

text: the

text: RO

text: has

text: conceded

text: that

text: the

text: Veteran

text: s

text: claimed

text: in

text: service

text: stressor

text: occurred

text: C

text: F

text: R

text: f

text: The

text: Board

text: finds

text: the

text: evidence

text: concerning

text: service

text: connection

text: to

text: PTSD

text: is

text: at

text: least

text: in

text: equipoise

text: When

text: there

text: is

text: an

text: approximate

text: balance

text: of

text: positive

text: and

text: negative

text: evidence

text: regarding

text: any

text: issue

text: material

text: to

text: the

text: determination

text: of

text: a

text: matter

text: VA

text: shall

text: give

text: the

text: benefit

text: of

text: the

text: doubt

text: to

text: the

text: claimant

text: U

text: S

text: C

text: A

text: see

text: also

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: Accordingly

text: the

text: criteria

text: for

text: service

text: connection

text: for

text: PTSD

text: have

text: been

text: met

text: ORDER

text: Service

text: connection

text: for

text: PTSD

text: is

text: granted

text: BRADLEY

text: W

text: HENNINGS

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs


text:
Citation Nr: 1633713
Decision Date: 08/25/16    Archive Date: 08/31/16

DOCKET NO.  07-19 282	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Waco, Texas

THE ISSUES

1.  Entitlement to service connection for posttraumatic stress disorder (PTSD).

2.  Entitlement to service connection for an acquired psychological disorder other than PTSD, to include major depressive disorder (MDD), dysthymia, and depressive disorder not otherwise specified (NOS).

REPRESENTATION

Veteran represented by:	Robert V. Chisholm, Attorney

WITNESS AT HEARING ON APPEAL

The Veteran

ATTORNEY FOR THE BOARD

Tracie N. Wesner, Associate Counsel

INTRODUCTION

The Veteran served on active duty in the United States Army from May 1974 to May 1975.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2006 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas.   The Veteran presented sworn testimony at a hearing before a Decision Review Officer in October 2007.  A transcript of that hearing is of record.

In September 2010, the Board remanded the claims for further development, including a VA examination.  In a June 2011 decision, the Board denied the claims for service connection of PTSD and a psychiatric disorder other than PTSD.  The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court).  In December 2011, the Court granted a Joint Motion to Vacate and Remand the Board's decision, finding that the Board failed to discuss the application of the presumption of soundness under 38 U.S.C.A. § 1111.

In January 2013, the Board obtained an expert medical opinion from the Veterans Health Administration (VHA) regarding whether the Veteran had any psychiatric disorders that pre-existed service.  In January 2013, the Veteran and his attorney were provided with a copy of the VHA opinion.  In January and in March 2013, the Veteran's attorney submitted additional argument and evidence.

The Board remanded the Veteran's claims for further development in November 2013 and in November 2015.  Additional VA examinations were conducted and opinions rendered in November 2013 and March 2016.  In June 2016, the Veteran's attorney submitted additional argument accompanied by a waiver of the Veteran's right to have this evidence initially considered by the RO.  Accordingly, the Board may consider this evidence in the first instance.  See 38 C.F.R. § 20.1304(c) (2015).

The Board acknowledges the argument of the Veteran's attorney that improper development was completed, citing the Court's decision in Mariano v. Principi, 17 Vet. App. 305 (2003).  However, the Court has since qualified certain "broad, general" language in Mariano by explaining that the VA "has an affirmative duty to gather the evidence necessary to render an informed decision on the claim, even if that means gathering and developing negative evidence, provided [it] does so in an impartial, unbiased, and neutral manner."  Herbert v. McDonald, 791 F.3d 1364, 1367 (Fed. Cir. 2015) (quoting Douglas v. Shinseki, 23 Vet. App. 19, 25-26 (2009)(internal quotation marks omitted)).

FINDINGS OF FACT

1.  It is at least as likely as not that the Veteran has PTSD resulting from the death of his brother, which was an event that occurred during the Veteran's active military service.

2.  Affording the Veteran the benefit of the doubt, the evidence shows that his diagnosed MDD, dysthymia and depressive disorder NOS had their onset during his active military service.

CONCLUSIONS OF LAW

1.  The criteria for entitlement to service connection for PTSD are met.  38 U.S.C.A. §§ 1110, 1111, 1154(a), 5107(b) (West 2014); 38 C.F.R. §§ 3.303, 3.304(f) (2015).

2.  The criteria for entitlement to service connection for MDD, dysthymia and depressive disorder NOS are met. 38 U.S.C.A. §§ 1110, 1111, 1154(a), 5107(b) (West 2014); 38 C.F.R. § 3.303 (2015).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran seeks service connection for an acquired psychiatric disorder, including PTSD, and depression (diagnosed at various times as MDD, dysthymia and depressive disorder NOS).  The Veteran's younger brother died in a car accident while the Veteran was serving on active duty.  He reports that after the death of his brother, he began experiencing nightmares, depression, social isolation and other psychiatric symptoms.  He reports that he turned to God and religion in an attempt to deal with his pain.  His service records show that he applied for and was granted a discharge from the Army as a conscientious objector.  The Veteran reports that his psychiatric symptoms not only persisted, but worsened after his separation from service, leading to multiple suicide attempts starting in 1976.  His medical records show that he has been treated for psychiatric symptoms since 1984, and has been hospitalized on several occasions as a result of suicide attempts.  He asserts that his continuing symptoms are related to the death of his brother during service.

The Board finds that service connection is warranted for an acquired psychiatric disorder, diagnosed as PTSD, MDD, dysthymia and depression NOS.  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.  Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999).

Establishing service connection for PTSD generally requires:  (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor.  38 C.F.R. § 3.304(f) (2015); see also Cohen v. Brown, 10 Vet. App. 128 (1997).

A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which mandates that, for VA purposes, all mental disorder diagnoses must conform to the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM).  See 38 C.F.R. § 3.304(f) (2015).  The Board notes that during the pendency of the Veteran's appeal, the VA amended the applicable regulations to transition to the use of the DSM-5.  See 80 Fed. Reg. 14308 (March 19, 2015).

As an initial matter, the Board notes that the presumption of soundness applies in this matter.  A veteran will be considered to have been in sound condition when examined and accepted for service, except as to disorders noted on entrance into service, or when clear and unmistakable evidence demonstrates that the disability existed prior to service and was not aggravated by service.  38 U.S.C.A. § 1111 (West 2014); 38 C.F.R. § 3.304(b) (2015).  Although there is evidence of record that the Veteran experienced some psychiatric symptoms prior to service, his May 1974 entrance examination revealed no psychiatric disorder.  Additionally, even though an October 2010 VA examiner opined that the Veteran's PTSD and depression had their onset prior to service, the January 2013 VA examiner opined that it was not undebatable that the Veteran's PTSD and depression pre-existed service.  Thus, the Board finds that presumption of soundness applies in this matter and has not been rebutted by clear and unmistakable evidence.  The issue in this case is whether the Veteran's PTSD and/or depression had an onset in service or is due to an event occurring in service.

The Board finds that service connection for PTSD is warranted because the Veteran has been diagnosed with PTSD linked to the death of his brother during service.  There is no dispute that the Veteran's brother died in October 1974, while the Veteran was serving on active duty.  The issue for adjudication is whether he has a diagnosis of PTSD that is linked to his brother's death.  The Board finds that the evidence is at least in equipoise.  The Veteran submitted private medical opinions in September 2012, February 2013 and April 2014 in which clinical psychologist J. Smith opined that the Veteran met the diagnostic criteria for PTSD, and that the diagnosis of PTSD is linked to the death of his brother.  See September 2012, February 2013 and April 2014 Private Medical Opinions of J. Smith, Ph.D.  The Veteran's VA medical records also show a diagnosis of PTSD during the appeal period.  The Board finds this evidence sufficient to establish a PTSD diagnosis in accordance with the applicable regulations.  See Cohen v. Brown, 10 Vet. App. 128, 140 (1997).

The Board notes that the November 2013 and March 2016 VA examiners both opined that the Veteran did not meet the diagnostic criteria for PTSD under either the DSM IV or the DSM 5 because his stressor fails to meet Criterion A necessary for PTSD diagnosis.  The November 2013 VA examiner also opined that the Veteran denied current significant re-experiencing (Criterion B) symptoms and further denied significant avoidance and impairment in functioning symptoms regarding his reported stressor.  However, in his April 2014 addendum opinion, Dr. Smith addressed these criteria, stating that the death of the Veteran's brother did meet Criterion A because the Veteran was confronted with the death of his brother and his response to this news was one of horror and helplessness.  Dr. Smith further noted that the diagnosis of PTSD reflects continuing symptoms of poor sleep, marked and continuing anxiety and depression, continued intrusion of "triggering" experiences and events such as contact with his family or hearing reports on the news of young people dying in a hit and run situation, and avoidance of the area of where his brother died.  The October 2010 VA examiner also noted that the Veteran reported experiencing intrusive thoughts related to his brother on a weekly basis, and avoidance of therapy because the he "doesn't like to bring up the past."  Thus, the Board finds that the evidence of record is at least in equipoise on the issue of whether the Veteran has a diagnosis of PTSD relating to his brother's death.  38 U.S.C.A. § 5107(b).  Consequently, service connection for PTSD is warranted. See 38 C.F.R. §§ 3.303, 3.304(f); see also Cohen v. Brown, 10 Vet. App. 128 (1997).

The Board also finds that the evidence of record is at least in equipoise as to whether the Veteran's depression is related to the death of his younger brother.  The Veteran reported experiencing psychiatric symptoms, including depression, social isolation and nightmares, in service and since his discharge from service.  He stated that he experienced a "radical change," and tried turning to religion.  See October 2007 Hearing Tr. at 2.  The Veteran also reported attempting suicide within one year after his separation from service, and attempting suicide multiple times before seeking treatment in 1984.  The Veteran is competent to offer testimony regarding the symptoms he experienced.  See Layno v. Brown, 6 Vet. App. 465 (1994).

The Board observes that there is evidence of record that contradicts the Veteran's assertion that his symptoms started in service and have been recurrent since that time.  Most notably, he was examined multiple times in service and found to have no psychiatric disorder.  See February 1975 Report of Mental Status Evaluation; see also May 1975 Mental Hygiene Consultation Report.  However, the Veteran reported that his psychiatric examination was very brief.  Additionally, Dr. Smith opined that the examination "appeared to be simply designed to meet an administrative requirement and did not constitute a full psychiatric examination" because the examination report showed no evidence that the examiner explored the Veteran's reaction to his brother's death.  See April 2014 Addendum Private Medical Opinion of J. Smith.  Thus, the Board does not find the lack of a psychiatric diagnosis on examination during service to be determinative.

After weighing the evidence and affording the Veteran the benefit of all reasonable doubt, the Board finds his reports regarding the onset and continuation of his depressive symptoms to be credible.  As noted by the March 2016, the Veteran's reports of ongoing psychiatric symptoms have been consistent.  In August 1989, when discussing the history of his depression, he stated that his brother's death had been very traumatic for him.  See August 1989 VA Medical Record.  At a February 2006 group therapy session, he talked about how his brother's death was "still bothering him."  See February 2006 VA Medical Record.  During an April 2006 examination performed in connection with his Social Security disability claim, he stated that he thought his psychological symptoms were due, at least in part, to the death of his brother.  See April 2006 Psychological Examination Report.  The Board notes that he reported having "problems" beginning in 1984, but that during the same time frame he also reported first seeking treatment in 1984 and first experiencing an impact in his ability to work in 1984.  Thus, it appears that he did not mean that his symptoms started at that time, but that he became significantly impaired in 1984.  At his October 2007 hearing, he again reported having an onset of depressive symptoms in service.  See October 2007 Hearing Tr. at 2-4.  During the October 2010 VA examination, he reported "increased" depression after the loss of his brother.  He also reported that he attempted suicide in the early 1970s after service, and that his suicide attempts have been primarily by overdose, carbon monoxide poisoning and a few times by placing a gun to his head without pulling the trigger.  This report is consistent with his statements made during his interview with Dr. Smith (as reported in the September 2012 independent evaluation report), the statements captured in his February 2013 affidavit, and the statements made during the November 2013 and March 2016 VA examinations.  In light of the consistencies in the Veteran's reports concerning the onset and continuity of his symptoms, the Board finds his testimony credible.

Because the Board finds the Veteran's reports of his recurrent psychiatric symptoms to be credible, it affords more probative value to the opinions of the Dr. Smith, and less probative value to the opinions of the VA examiners.  The November 2013 and March 2016 VA examiners opined that the Veteran's depression was not related to his brother's death because there were no contemporaneous medical records confirming his reports of depressive symptoms prior to 1984.  The November 2013 VA examiner also reasoned that there were no mention of mental health issues in the letters the Veteran submitted from friends and family in support of his discharge from service.  In general, a VA examiner may not rely on the absence of evidence as negative evidence, particularly where there is no indication that the fact should have been recorded.  See, e.g., Fountain v. McDonald, 27 Vet. App. 258, 272-75 (2015); Buczynski v. Shinseki, 24 Vet. App. 221, 223-24 (2011).  In this case, as noted by Dr. Smith, "absence of a formal record of care in no way proves that symptoms were not present, nor does it suggest that care was not needed- only that formal care had not as yet been sought."  April 2014 Private Addendum Opinion of J. Smith.  Additionally, there is no reason for the Board to determine that there would be reports of psychiatric symptoms contained in the letters provided by the Veteran's friends and family in support of his request for discharge from service based on his religious beliefs.  The evidence of record shows that the purpose of those letters was to corroborate the Veteran's assertion that his change in religious viewed prevented him from serving on active duty; consequently, it is not expected that any discussion of depressive symptoms would be included in such letters.  For these reasons, the Board affords the November 2013 and March 2016 VA examiners' negative nexus opinions little probative value.

As all three elements necessary to establish service connection have been met, service connection for depression (diagnosed as MDD, dysthymia and depressive disorder NOS) is warranted.

ORDER

Service connection for PTSD is granted.

Service connection for major depressive disorder, dysthymia and depressive disorder NOS is granted.

____________________________________________
STEVEN D. REISS
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

text: Citation

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text: to

text: the

text: death

text: of

text: his

text: brother

text: during

text: service

text: There

text: is

text: no

text: dispute

text: that

text: the

text: Veteran

text: s

text: brother

text: died

text: in

text: October

text: while

text: the

text: Veteran

text: was

text: serving

text: on

text: active

text: duty

text: The

text: issue

text: for

text: adjudication

text: is

text: whether

text: he

text: has

text: a

text: diagnosis

text: of

text: PTSD

text: that

text: is

text: linked

text: to

text: his

text: brother

text: s

text: death

text: The

text: Board

text: finds

text: that

text: the

text: evidence

text: is

text: at

text: least

text: in

text: equipoise

text: The

text: Veteran

text: submitted

text: private

text: medical

text: opinions

text: in

text: September

text: February

text: and

text: April

text: in

text: which

text: clinical

text: psychologist

text: J

text: Smith

text: opined

text: that

text: the

text: Veteran

text: met

text: the

text: diagnostic

text: criteria

text: for

text: PTSD

text: and

text: that

text: the

text: diagnosis

text: of

text: PTSD

text: is

text: linked

text: to

text: the

text: death

text: of

text: his

text: brother

text: See

text: September

text: February

text: and

text: April

text: Private

text: Medical

text: Opinions

text: of

text: J

text: Smith

text: Ph

text: D

text: The

text: Veteran

text: s

text: VA

text: medical

text: records

text: also

text: show

text: a

text: diagnosis

text: of

text: PTSD

text: during

text: the

text: appeal

text: period

text: The

text: Board

text: finds

text: this

text: evidence

text: sufficient

text: to

text: establish

text: a

text: PTSD

text: diagnosis

text: in

text: accordance

text: with

text: the

text: applicable

text: regulations

text: See

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: The

text: Board

text: notes

text: that

text: the

text: November

text: and

text: March

text: VA

text: examiners

text: both

text: opined

text: that

text: the

text: Veteran

text: did

text: not

text: meet

text: the

text: diagnostic

text: criteria

text: for

text: PTSD

text: under

text: either

text: the

text: DSM

text: IV

text: or

text: the

text: DSM

text: because

text: his

text: stressor

text: fails

text: to

text: meet

text: Criterion

text: A

text: necessary

text: for

text: PTSD

text: diagnosis

text: The

text: November

text: VA

text: examiner

text: also

text: opined

text: that

text: the

text: Veteran

text: denied

text: current

text: significant

text: re

text: experiencing

text: Criterion

text: B

text: symptoms

text: and

text: further

text: denied

text: significant

text: avoidance

text: and

text: impairment

text: in

text: functioning

text: symptoms

text: regarding

text: his

text: reported

text: stressor

text: However

text: in

text: his

text: April

text: addendum

text: opinion

text: Dr

text: Smith

text: addressed

text: these

text: criteria

text: stating

text: that

text: the

text: death

text: of

text: the

text: Veteran

text: s

text: brother

text: did

text: meet

text: Criterion

text: A

text: because

text: the

text: Veteran

text: was

text: confronted

text: with

text: the

text: death

text: of

text: his

text: brother

text: and

text: his

text: response

text: to

text: this

text: news

text: was

text: one

text: of

text: horror

text: and

text: helplessness

text: Dr

text: Smith

text: further

text: noted

text: that

text: the

text: diagnosis

text: of

text: PTSD

text: reflects

text: continuing

text: symptoms

text: of

text: poor

text: sleep

text: marked

text: and

text: continuing

text: anxiety

text: and

text: depression

text: continued

text: intrusion

text: of

text: triggering

text: experiences

text: and

text: events

text: such

text: as

text: contact

text: with

text: his

text: family

text: or

text: hearing

text: reports

text: on

text: the

text: news

text: of

text: young

text: people

text: dying

text: in

text: a

text: hit

text: and

text: run

text: situation

text: and

text: avoidance

text: of

text: the

text: area

text: of

text: where

text: his

text: brother

text: died

text: The

text: October

text: VA

text: examiner

text: also

text: noted

text: that

text: the

text: Veteran

text: reported

text: experiencing

text: intrusive

text: thoughts

text: related

text: to

text: his

text: brother

text: on

text: a

text: weekly

text: basis

text: and

text: avoidance

text: of

text: therapy

text: because

text: the

text: he

text: doesn

text: t

text: like

text: to

text: bring

text: up

text: the

text: past

text: Thus

text: the

text: Board

text: finds

text: that

text: the

text: evidence

text: of

text: record

text: is

text: at

text: least

text: in

text: equipoise

text: on

text: the

text: issue

text: of

text: whether

text: the

text: Veteran

text: has

text: a

text: diagnosis

text: of

text: PTSD

text: relating

text: to

text: his

text: brother

text: s

text: death

text: U

text: S

text: C

text: A

text: b

text: Consequently

text: service

text: connection

text: for

text: PTSD

text: is

text: warranted

text: See

text: C

text: F

text: R

text: f

text: see

text: also

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: The

text: Board

text: also

text: finds

text: that

text: the

text: evidence

text: of

text: record

text: is

text: at

text: least

text: in

text: equipoise

text: as

text: to

text: whether

text: the

text: Veteran

text: s

text: depression

text: is

text: related

text: to

text: the

text: death

text: of

text: his

text: younger

text: brother

text: The

text: Veteran

text: reported

text: experiencing

text: psychiatric

text: symptoms

text: including

text: depression

text: social

text: isolation

text: and

text: nightmares

text: in

text: service

text: and

text: since

text: his

text: discharge

text: from

text: service

text: He

text: stated

text: that

text: he

text: experienced

text: a

text: radical

text: change

text: and

text: tried

text: turning

text: to

text: religion

text: See

text: October

text: Hearing

text: Tr

text: at

text: The

text: Veteran

text: also

text: reported

text: attempting

text: suicide

text: within

text: one

text: year

text: after

text: his

text: separation

text: from

text: service

text: and

text: attempting

text: suicide

text: multiple

text: times

text: before

text: seeking

text: treatment

text: in

text: The

text: Veteran

text: is

text: competent

text: to

text: offer

text: testimony

text: regarding

text: the

text: symptoms

text: he

text: experienced

text: See

text: Layno

text: v

text: Brown

text: Vet

text: App

text: The

text: Board

text: observes

text: that

text: there

text: is

text: evidence

text: of

text: record

text: that

text: contradicts

text: the

text: Veteran

text: s

text: assertion

text: that

text: his

text: symptoms

text: started

text: in

text: service

text: and

text: have

text: been

text: recurrent

text: since

text: that

text: time

text: Most

text: notably

text: he

text: was

text: examined

text: multiple

text: times

text: in

text: service

text: and

text: found

text: to

text: have

text: no

text: psychiatric

text: disorder

text: See

text: February

text: Report

text: of

text: Mental

text: Status

text: Evaluation

text: see

text: also

text: May

text: Mental

text: Hygiene

text: Consultation

text: Report

text: However

text: the

text: Veteran

text: reported

text: that

text: his

text: psychiatric

text: examination

text: was

text: very

text: brief

text: Additionally

text: Dr

text: Smith

text: opined

text: that

text: the

text: examination

text: appeared

text: to

text: be

text: simply

text: designed

text: to

text: meet

text: an

text: administrative

text: requirement

text: and

text: did

text: not

text: constitute

text: a

text: full

text: psychiatric

text: examination

text: because

text: the

text: examination

text: report

text: showed

text: no

text: evidence

text: that

text: the

text: examiner

text: explored

text: the

text: Veteran

text: s

text: reaction

text: to

text: his

text: brother

text: s

text: death

text: See

text: April

text: Addendum

text: Private

text: Medical

text: Opinion

text: of

text: J

text: Smith

text: Thus

text: the

text: Board

text: does

text: not

text: find

text: the

text: lack

text: of

text: a

text: psychiatric

text: diagnosis

text: on

text: examination

text: during

text: service

text: to

text: be

text: determinative

text: After

text: weighing

text: the

text: evidence

text: and

text: affording

text: the

text: Veteran

text: the

text: benefit

text: of

text: all

text: reasonable

text: doubt

text: the

text: Board

text: finds

text: his

text: reports

text: regarding

text: the

text: onset

text: and

text: continuation

text: of

text: his

text: depressive

text: symptoms

text: to

text: be

text: credible

text: As

text: noted

text: by

text: the

text: March

text: the

text: Veteran

text: s

text: reports

text: of

text: ongoing

text: psychiatric

text: symptoms

text: have

text: been

text: consistent

text: In

text: August

text: when

text: discussing

text: the

text: history

text: of

text: his

text: depression

text: he

text: stated

text: that

text: his

text: brother

text: s

text: death

text: had

text: been

text: very

text: traumatic

text: for

text: him

text: See

text: August

text: VA

text: Medical

text: Record

text: At

text: a

text: February

text: group

text: therapy

text: session

text: he

text: talked

text: about

text: how

text: his

text: brother

text: s

text: death

text: was

text: still

text: bothering

text: him

text: See

text: February

text: VA

text: Medical

text: Record

text: During

text: an

text: April

text: examination

text: performed

text: in

text: connection

text: with

text: his

text: Social

text: Security

text: disability

text: claim

text: he

text: stated

text: that

text: he

text: thought

text: his

text: psychological

text: symptoms

text: were

text: due

text: at

text: least

text: in

text: part

text: to

text: the

text: death

text: of

text: his

text: brother

text: See

text: April

text: Psychological

text: Examination

text: Report

text: The

text: Board

text: notes

text: that

text: he

text: reported

text: having

text: problems

text: beginning

text: in

text: but

text: that

text: during

text: the

text: same

text: time

text: frame

text: he

text: also

text: reported

text: first

text: seeking

text: treatment

text: in

text: and

text: first

text: experiencing

text: an

text: impact

text: in

text: his

text: ability

text: to

text: work

text: in

text: Thus

text: it

text: appears

text: that

text: he

text: did

text: not

text: mean

text: that

text: his

text: symptoms

text: started

text: at

text: that

text: time

text: but

text: that

text: he

text: became

text: significantly

text: impaired

text: in

text: At

text: his

text: October

text: hearing

text: he

text: again

text: reported

text: having

text: an

text: onset

text: of

text: depressive

text: symptoms

text: in

text: service

text: See

text: October

text: Hearing

text: Tr

text: at

text: During

text: the

text: October

text: VA

text: examination

text: he

text: reported

text: increased

text: depression

text: after

text: the

text: loss

text: of

text: his

text: brother

text: He

text: also

text: reported

text: that

text: he

text: attempted

text: suicide

text: in

text: the

text: early

text: s

text: after

text: service

text: and

text: that

text: his

text: suicide

text: attempts

text: have

text: been

text: primarily

text: by

text: overdose

text: carbon

text: monoxide

text: poisoning

text: and

text: a

text: few

text: times

text: by

text: placing

text: a

text: gun

text: to

text: his

text: head

text: without

text: pulling

text: the

text: trigger

text: This

text: report

text: is

text: consistent

text: with

text: his

text: statements

text: made

text: during

text: his

text: interview

text: with

text: Dr

text: Smith

text: as

text: reported

text: in

text: the

text: September

text: independent

text: evaluation

text: report

text: the

text: statements

text: captured

text: in

text: his

text: February

text: affidavit

text: and

text: the

text: statements

text: made

text: during

text: the

text: November

text: and

text: March

text: VA

text: examinations

text: In

text: light

text: of

text: the

text: consistencies

text: in

text: the

text: Veteran

text: s

text: reports

text: concerning

text: the

text: onset

text: and

text: continuity

text: of

text: his

text: symptoms

text: the

text: Board

text: finds

text: his

text: testimony

text: credible

text: Because

text: the

text: Board

text: finds

text: the

text: Veteran

text: s

text: reports

text: of

text: his

text: recurrent

text: psychiatric

text: symptoms

text: to

text: be

text: credible

text: it

text: affords

text: more

text: probative

text: value

text: to

text: the

text: opinions

text: of

text: the

text: Dr

text: Smith

text: and

text: less

text: probative

text: value

text: to

text: the

text: opinions

text: of

text: the

text: VA

text: examiners

text: The

text: November

text: and

text: March

text: VA

text: examiners

text: opined

text: that

text: the

text: Veteran

text: s

text: depression

text: was

text: not

text: related

text: to

text: his

text: brother

text: s

text: death

text: because

text: there

text: were

text: no

text: contemporaneous

text: medical

text: records

text: confirming

text: his

text: reports

text: of

text: depressive

text: symptoms

text: prior

text: to

text: The

text: November

text: VA

text: examiner

text: also

text: reasoned

text: that

text: there

text: were

text: no

text: mention

text: of

text: mental

text: health

text: issues

text: in

text: the

text: letters

text: the

text: Veteran

text: submitted

text: from

text: friends

text: and

text: family

text: in

text: support

text: of

text: his

text: discharge

text: from

text: service

text: In

text: general

text: a

text: VA

text: examiner

text: may

text: not

text: rely

text: on

text: the

text: absence

text: of

text: evidence

text: as

text: negative

text: evidence

text: particularly

text: where

text: there

text: is

text: no

text: indication

text: that

text: the

text: fact

text: should

text: have

text: been

text: recorded

text: See

text: e

text: g

text: Fountain

text: v

text: McDonald

text: Vet

text: App

text: Buczynski

text: v

text: Shinseki

text: Vet

text: App

text: In

text: this

text: case

text: as

text: noted

text: by

text: Dr

text: Smith

text: absence

text: of

text: a

text: formal

text: record

text: of

text: care

text: in

text: no

text: way

text: proves

text: that

text: symptoms

text: were

text: not

text: present

text: nor

text: does

text: it

text: suggest

text: that

text: care

text: was

text: not

text: needed

text: only

text: that

text: formal

text: care

text: had

text: not

text: as

text: yet

text: been

text: sought

text: April

text: Private

text: Addendum

text: Opinion

text: of

text: J

text: Smith

text: Additionally

text: there

text: is

text: no

text: reason

text: for

text: the

text: Board

text: to

text: determine

text: that

text: there

text: would

text: be

text: reports

text: of

text: psychiatric

text: symptoms

text: contained

text: in

text: the

text: letters

text: provided

text: by

text: the

text: Veteran

text: s

text: friends

text: and

text: family

text: in

text: support

text: of

text: his

text: request

text: for

text: discharge

text: from

text: service

text: based

text: on

text: his

text: religious

text: beliefs

text: The

text: evidence

text: of

text: record

text: shows

text: that

text: the

text: purpose

text: of

text: those

text: letters

text: was

text: to

text: corroborate

text: the

text: Veteran

text: s

text: assertion

text: that

text: his

text: change

text: in

text: religious

text: viewed

text: prevented

text: him

text: from

text: serving

text: on

text: active

text: duty

text: consequently

text: it

text: is

text: not

text: expected

text: that

text: any

text: discussion

text: of

text: depressive

text: symptoms

text: would

text: be

text: included

text: in

text: such

text: letters

text: For

text: these

text: reasons

text: the

text: Board

text: affords

text: the

text: November

text: and

text: March

text: VA

text: examiners

text: negative

text: nexus

text: opinions

text: little

text: probative

text: value

text: As

text: all

text: three

text: elements

text: necessary

text: to

text: establish

text: service

text: connection

text: have

text: been

text: met

text: service

text: connection

text: for

text: depression

text: diagnosed

text: as

text: MDD

text: dysthymia

text: and

text: depressive

text: disorder

text: NOS

text: is

text: warranted

text: ORDER

text: Service

text: connection

text: for

text: PTSD

text: is

text: granted

text: Service

text: connection

text: for

text: major

text: depressive

text: disorder

text: dysthymia

text: and

text: depressive

text: disorder

text: NOS

text: is

text: granted

text: STEVEN

text: D

text: REISS

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs