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Citation Nr: 1554166
Decision Date: 12/29/15    Archive Date: 01/07/16

DOCKET NO.  10-32 436	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in New Orleans, Louisiana

THE ISSUE

Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), anxiety and depression.

REPRESENTATION

Veteran represented by:	Veterans of Foreign Wars of the United States

WITNESS AT HEARING ON APPEAL

The Veteran

ATTORNEY FOR THE BOARD

Kate Sosna, Associate Counsel

INTRODUCTION

The Veteran served on active duty from June 1974 to July 1976.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

The Board previously remanded this matter for development in February 2014 and October 2014, and it now returns for final appellate review.

In September 2013, the Veteran testified at a Board hearing before a Veterans Law Judge who has since retired from the Board.  A hearing transcript is of record.  In June 2015, the Board sent the Veteran a letter asking if he desired a hearing before another VLJ.  In the same month, the Veteran submitted correspondence indicating he did not desire an additional hearing.

While the information of record generally indicates that Veterans of Foreign Wars of the United States (VFW) represents the Veteran, he appeared at his September 2013 hearing with an agent of The American Legion.  In September 2015, the Board sent the Veteran a letter asking him to clarify who he wished to represent him before the Board.  In response thereto the Veteran submitted a newly executed VA Form 21-22 in favor of VFW.  As such, the Board recognizes the Veteran as currently represented by that entity.

FINDINGS OF FACT

1.  At no time during the pendency of the claim does the Veteran have a current diagnosis of PTSD, and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim.

2.  An acquired psychiatric disorder other than PTSD is not shown to be causally or etiologically related to any disease, injury, or incident during service.

CONCLUSION OF LAW

The criteria for establishing entitlement to service connection for an acquired psychiatric disorder, to include PTSD, have not been met.  38 U.S.C.A. §§ 1110, 1131, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2015).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

I.  Veteran's Claims Assistance Act

The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance.  38 U.S.C.A. §§ 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2015).  Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide.  38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1).

In Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims (Court) held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim.  Those five elements include: 1) Veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability.

In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the Court held that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on the claim for VA benefits.

In the instant case, the Board finds that VA has satisfied its duty to notify under the VCAA.  Specifically, an October 2008 letter, sent prior to the initial unfavorable decision issued in December 2008 advised the Veteran of the evidence and information necessary to substantiate his service connection claim as well as his and VA's respective responsibilities in obtaining such evidence and information.  Additionally, such letter advised him of the information and evidence necessary to establish a disability rating and an effective date in accordance with Dingess/Hartman, supra.

The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claim.  38 U.S.C.A. § 5103A; 38 C.F.R. §§§ 3.159(c), (d).  This "duty to assist" contemplates that VA will help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim.  38 C.F.R. § 3.159(c)(4).

In this regard, the Veteran's service treatment and personnel records as well as post-service VA treatment records have been obtained and considered.  The Veteran has not identified any additional, outstanding records that have not been requested or obtained.

The Veteran was also afforded a VA examination in March 2015 with respect to the issue decided herein.  The Board finds that such VA examination and accompanying opinion is adequate to decide the issue as they are predicated on an interview with the Veteran; a review of the record, to include his service treatment records; and a mental status examination.  The opinion proffered considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed.  Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); 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").  Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination and opinion regarding the issue decided herein has been met.

Additionally, in September 2013, the Veteran was provided an opportunity to set forth his contentions during the hearing before a now-retired Veterans Law Judge.  In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) requires that the Decision Review Officer or Veterans Law Judge who chairs a hearing to fulfill two duties: (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked.

Here, during the September 2013 hearing, the presiding Veterans Law Judge noted the issue on appeal.  Also, information was solicited regarding the Veteran's in-service experiences he alleges resulted in his psychiatric disorder, the type and onset of symptoms, relevant treatment, and her contention that his military service caused his psychiatric disorder.  Therefore, not only was the issue "explained . . . in terms of the scope of the claim for benefits," but "the outstanding issues material to substantiating the claim," were also fully explained.  See Bryant, 23 Vet. App. at 497.  In light of the Veteran's testimony, the presiding Veterans Law Judge remanded the matter in order to obtain updated VA treatment records and afford him a VA examination so as to determine the nature and etiology of his acquired psychiatric disorder.  Under these circumstances, nothing gives rise to the possibility that evidence had been overlooked with regard to the Veteran's claim decided herein.  As such, the Board finds that, consistent with Bryant, the presiding Veterans Law Judge complied with the duties set forth in 38 C.F.R. 3.103(c)(2)  and that the Board may proceed to adjudicate the claim based on the current record.

As noted previously, the Board remanded the case for additional development in February 2014 and October 2014 in order to obtain updated VA treatment records and afford the Veteran a VA examination so as to determine the nature and etiology of his acquired psychiatric disorder.  As a result of such remands, updated VA treatment records were obtained and the Veteran was afforded a VA examination in March 2015.  Therefore, the Board finds that the AOJ has substantially complied with the February 2014 and October 2014 remand directives such that no further action is necessary in this regard.  See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002).

Thus, the Board finds that VA has fully satisfied the duty to assist.  In the circumstances of this case, additional efforts to assist or notify the Veteran in accordance with the VCAA would serve no useful purpose.  See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements of the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the appellant); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the appellant are to be avoided).  VA has satisfied its duty to inform and assist the Veteran at every stage in this case, at least insofar as any errors committed were not harmful to the essential fairness of the proceeding.  Therefore, he will not be prejudiced as a result of the Board proceeding to the merits of his claim.

II.  Analysis

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C.A. §§ 1110, 1131; 38 C.F.R.            § 3.303(a).  Service connection may also 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).

Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury.
Id.; also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)].

The requirement of a current disability is satisfied when the Veteran has a disability at the time he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim.  McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).  However, when the record contains a recent diagnosis of disability prior to the Veteran's filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.  Romanowsky v. Shinseki, 26 Vet. App. 289 (2013).

Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, including psychoses, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service.  38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309.  According to 38 C.F.R. § 3.384 , the term "psychosis" includes a brief psychotic disorder; delusional disorder; psychotic disorder due to a medical condition; psychotic disorder, not otherwise specified (NOS); schizoaffective disorder; schizophrenia; schizophreniform disorder; shared psychotic disorder; and substance-induced psychotic disorder.

Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service.  See 38 C.F.R. § 3.303(b).  The use of continuity of symptoms to establish service connection is limited to those diseases listed at 38 C.F.R. § 3.309(a).  Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection for PTSD requires medical evidence diagnosing the condition; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred.  38 C.F.R. § 3.304(f).  If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor.  38 C.F.R. § 3.304(f)(2).

Effective July 13, 2010, if a stressor claimed by a Veteran is related to that Veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that a Veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of that Veteran's service, a Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor.  "[F]ear of hostile military or terrorist activity" means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.  38 C.F.R. § 3.304(f)(3).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

At the outset, the Board points out that the preponderance of the probative evidence is against a finding that the Veteran has a current diagnosis of PTSD during the pendency of the claim and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim.  See McClain, supra; Romanowsky, supra.  In this regard, October 2008 VA treatment records document "PTSD-type symptoms" and one clinician indicated the need to "rule out PTSD" as a diagnosis.  Thereafter, PTSD-like symptoms and a history of PTSD were noted during treatment in November 2008.  However, despite these notations, there is no indication in the record that the Veteran has ever been diagnosed with PTSD by a VA or private clinician, nor was he diagnosed with PTSD by the VA psychologist who conducted the March 2015 examination.

Conversely, review of the record reveals that the Veteran has been diagnosed with several acquired psychiatric disorders other than PTSD including:  unspecified depressive disorder, major depression, anxiety disorder not otherwise specified (NOS), personality disorder NOS, and substance abuse disorders, in sustained remission.  Thus, the first requirement for establishing service connection, a current disability, has been met.

The Veteran's service treatment records reveal no treatment for or diagnosis of any psychiatric disorder, and his separation examination revealed no psychiatric abnormalities.  Moreover, there is no evidence the Veteran has ever been diagnosed with a psychosis.  However, in written documents and in his Board hearing testimony, the Veteran contends that his acquired psychiatric disorder is the result of witnessing a shipmate fall overboard while stationed on the USS Constellation CVA 64 in approximately March 1975.  While the AOJ attempted to verify such stressor, it was unsuccessful.  Thus, to establish service connection, there must be probative evidence linking his currently diagnosed psychiatric disorders with any instance of his military service.  Upon review of the evidence, the Board finds the preponderance of the evidence is against the claim.

In this regard, in March 2015 the Veteran was afforded a VA examination in connection with his claim for service connection.  Following an interview with the Veteran, a review of the record, and a mental status examination, the examiner diagnosed an unspecified depressive disorder and substance abuse disorders, in sustained remission.  The examiner noted the Veteran's reports that he received mental health treatment in service, but noted (as does the Board) that there is no indication of such treatment in the Veteran's service treatment records.  The examiner also noted the Veteran's reports of being fearful in service and his unverified stressor of seeing a fellow sailor fall overboard.  Nevertheless, the examiner opined that the Veteran's depressive disorder was not related to his service and that his depressive symptoms are related to a "long history of personality features and/or his substance abuse history."

The Board finds that the opinion of the VA examiner provided after reviewing the claims file and examining the Veteran is highly probative as it reflects consideration of all relevant facts and the examiner provided a detailed rationale for the conclusion reached.  See Nieves-Rodriguez, supra (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl, supra.  There is no competent medical evidence to the contrary.

To the extent the Veteran believes that he suffers from a psychiatric disorder that is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis).  In this regard, the diagnosis and etiology of psychiatric disorders are matters not capable of lay observation, and require medical expertise to determine.  Accordingly, his opinion as to the diagnosis or etiology of the current psychiatric symptomology is not competent medical evidence.  The Board finds the opinion of the VA examiner to be significantly more probative than his lay assertions.

Moreover, the Board recognizes that the Veteran reported at his March 2015 examination and elsewhere that he began abusing drugs during service and that the examiner attributed his current depressive symptoms to the Veteran's drug abuse history.  However, both 38 C.F.R. §§ 3.301(a) and 3.301(d) prohibit service connection for diseases incurred during active military service resulting from the abuse of drugs.  As any disease resulting from his abuse of illegal drugs is not considered to be in the line of duty pursuant to 38 C.F.R. § 3.301(d), service connection for a depressive disorder as a result of illegal drug use in service cannot be established.  38 C.F.R. § 3.301(a).

In summary, the Board finds that the preponderance of the probative evidence is against a finding that the Veteran's diagnosed acquired psychiatric disorders arose in service or are etiologically related to service or any incidents therein.  Additionally, there is no evidence that the Veteran was diagnosed with a psychosis within a year of his separation from service.  Accordingly, the claim for service connection for an acquired psychiatric disorder, to include PTSD, is denied.

In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine.  However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal.  See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert, supra.

ORDER

Service connection for an acquired psychiatric disorder, to include PTSD, is denied.

____________________________________________
A. JAEGER
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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text: C

text: A

text: A

text: C

text: F

text: R

text: c

text: d

text: This

text: duty

text: to

text: assist

text: contemplates

text: that

text: VA

text: will

text: help

text: a

text: claimant

text: obtain

text: records

text: relevant

text: to

text: his

text: claim

text: whether

text: or

text: not

text: the

text: records

text: are

text: in

text: Federal

text: custody

text: and

text: that

text: VA

text: will

text: provide

text: a

text: medical

text: examination

text: or

text: obtain

text: an

text: opinion

text: when

text: necessary

text: to

text: make

text: a

text: decision

text: on

text: the

text: claim

text: C

text: F

text: R

text: c

text: In

text: this

text: regard

text: the

text: Veteran

text: s

text: service

text: treatment

text: and

text: personnel

text: records

text: as

text: well

text: as

text: post

text: service

text: VA

text: treatment

text: records

text: have

text: been

text: obtained

text: and

text: considered

text: The

text: Veteran

text: has

text: not

text: identified

text: any

text: additional

text: outstanding

text: records

text: that

text: have

text: not

text: been

text: requested

text: or

text: obtained

text: The

text: Veteran

text: was

text: also

text: afforded

text: a

text: VA

text: examination

text: in

text: March

text: with

text: respect

text: to

text: the

text: issue

text: decided

text: herein

text: The

text: Board

text: finds

text: that

text: such

text: VA

text: examination

text: and

text: accompanying

text: opinion

text: is

text: adequate

text: to

text: decide

text: the

text: issue

text: as

text: they

text: are

text: predicated

text: on

text: an

text: interview

text: with

text: the

text: Veteran

text: a

text: review

text: of

text: the

text: record

text: to

text: include

text: his

text: service

text: treatment

text: records

text: and

text: a

text: mental

text: status

text: examination

text: The

text: opinion

text: proffered

text: considered

text: all

text: of

text: the

text: pertinent

text: evidence

text: of

text: record

text: to

text: include

text: the

text: statements

text: of

text: the

text: Veteran

text: and

text: provided

text: a

text: complete

text: rationale

text: relying

text: on

text: and

text: citing

text: to

text: the

text: records

text: reviewed

text: Moreover

text: the

text: examiner

text: offered

text: clear

text: conclusions

text: with

text: supporting

text: data

text: as

text: well

text: as

text: reasoned

text: medical

text: explanations

text: connecting

text: the

text: two

text: See

text: Nieves

text: Rodriguez

text: v

text: Peake

text: Vet

text: App

text: Stefl

text: v

text: Nicholson

text: Vet

text: App

text: A

text: medical

text: opinion

text: must

text: support

text: its

text: conclusion

text: with

text: an

text: analysis

text: that

text: the

text: Board

text: can

text: consider

text: and

text: weigh

text: against

text: contrary

text: opinions

text: Accordingly

text: the

text: Board

text: finds

text: that

text: VA

text: s

text: duty

text: to

text: assist

text: with

text: respect

text: to

text: obtaining

text: a

text: VA

text: examination

text: and

text: opinion

text: regarding

text: the

text: issue

text: decided

text: herein

text: has

text: been

text: met

text: Additionally

text: in

text: September

text: the

text: Veteran

text: was

text: provided

text: an

text: opportunity

text: to

text: set

text: forth

text: his

text: contentions

text: during

text: the

text: hearing

text: before

text: a

text: now

text: retired

text: Veterans

text: Law

text: Judge

text: In

text: Bryant

text: v

text: Shinseki

text: Vet

text: App

text: the

text: Court

text: held

text: that

text: C

text: F

text: R

text: c

text: requires

text: that

text: the

text: Decision

text: Review

text: Officer

text: or

text: Veterans

text: Law

text: Judge

text: who

text: chairs

text: a

text: hearing

text: to

text: fulfill

text: two

text: duties

text: the

text: duty

text: to

text: fully

text: explain

text: the

text: issues

text: and

text: the

text: duty

text: to

text: suggest

text: the

text: submission

text: of

text: evidence

text: that

text: may

text: have

text: been

text: overlooked

text: Here

text: during

text: the

text: September

text: hearing

text: the

text: presiding

text: Veterans

text: Law

text: Judge

text: noted

text: the

text: issue

text: on

text: appeal

text: Also

text: information

text: was

text: solicited

text: regarding

text: the

text: Veteran

text: s

text: in

text: service

text: experiences

text: he

text: alleges

text: resulted

text: in

text: his

text: psychiatric

text: disorder

text: the

text: type

text: and

text: onset

text: of

text: symptoms

text: relevant

text: treatment

text: and

text: her

text: contention

text: that

text: his

text: military

text: service

text: caused

text: his

text: psychiatric

text: disorder

text: Therefore

text: not

text: only

text: was

text: the

text: issue

text: explained

text: in

text: terms

text: of

text: the

text: scope

text: of

text: the

text: claim

text: for

text: benefits

text: but

text: the

text: outstanding

text: issues

text: material

text: to

text: substantiating

text: the

text: claim

text: were

text: also

text: fully

text: explained

text: See

text: Bryant

text: Vet

text: App

text: at

text: In

text: light

text: of

text: the

text: Veteran

text: s

text: testimony

text: the

text: presiding

text: Veterans

text: Law

text: Judge

text: remanded

text: the

text: matter

text: in

text: order

text: to

text: obtain

text: updated

text: VA

text: treatment

text: records

text: and

text: afford

text: him

text: a

text: VA

text: examination

text: so

text: as

text: to

text: determine

text: the

text: nature

text: and

text: etiology

text: of

text: his

text: acquired

text: psychiatric

text: disorder

text: Under

text: these

text: circumstances

text: nothing

text: gives

text: rise

text: to

text: the

text: possibility

text: that

text: evidence

text: had

text: been

text: overlooked

text: with

text: regard

text: to

text: the

text: Veteran

text: s

text: claim

text: decided

text: herein

text: As

text: such

text: the

text: Board

text: finds

text: that

text: consistent

text: with

text: Bryant

text: the

text: presiding

text: Veterans

text: Law

text: Judge

text: complied

text: with

text: the

text: duties

text: set

text: forth

text: in

text: C

text: F

text: R

text: c

text: and

text: that

text: the

text: Board

text: may

text: proceed

text: to

text: adjudicate

text: the

text: claim

text: based

text: on

text: the

text: current

text: record

text: As

text: noted

text: previously

text: the

text: Board

text: remanded

text: the

text: case

text: for

text: additional

text: development

text: in

text: February

text: and

text: October

text: in

text: order

text: to

text: obtain

text: updated

text: VA

text: treatment

text: records

text: and

text: afford

text: the

text: Veteran

text: a

text: VA

text: examination

text: so

text: as

text: to

text: determine

text: the

text: nature

text: and

text: etiology

text: of

text: his

text: acquired

text: psychiatric

text: disorder

text: As

text: a

text: result

text: of

text: such

text: remands

text: updated

text: VA

text: treatment

text: records

text: were

text: obtained

text: and

text: the

text: Veteran

text: was

text: afforded

text: a

text: VA

text: examination

text: in

text: March

text: Therefore

text: the

text: Board

text: finds

text: that

text: the

text: AOJ

text: has

text: substantially

text: complied

text: with

text: the

text: February

text: and

text: October

text: remand

text: directives

text: such

text: that

text: no

text: further

text: action

text: is

text: necessary

text: in

text: this

text: regard

text: See

text: D

text: Aries

text: v

text: Peake

text: Vet

text: App

text: Dyment

text: v

text: West

text: Vet

text: App

text: remand

text: not

text: required

text: under

text: Stegall

text: v

text: West

text: Vet

text: App

text: where

text: the

text: Board

text: s

text: remand

text: instructions

text: were

text: substantially

text: complied

text: with

text: aff

text: d

text: Dyment

text: v

text: Principi

text: F

text: d

text: Thus

text: the

text: Board

text: finds

text: that

text: VA

text: has

text: fully

text: satisfied

text: the

text: duty

text: to

text: assist

text: In

text: the

text: circumstances

text: of

text: this

text: case

text: additional

text: efforts

text: to

text: assist

text: or

text: notify

text: the

text: Veteran

text: in

text: accordance

text: with

text: the

text: VCAA

text: would

text: serve

text: no

text: useful

text: purpose

text: See

text: Soyini

text: v

text: Derwinski

text: Vet

text: App

text: strict

text: adherence

text: to

text: requirements

text: of

text: the

text: law

text: does

text: not

text: dictate

text: an

text: unquestioning

text: blind

text: adherence

text: in

text: the

text: face

text: of

text: overwhelming

text: evidence

text: in

text: support

text: of

text: the

text: result

text: in

text: a

text: particular

text: case

text: such

text: adherence

text: would

text: result

text: in

text: unnecessarily

text: imposing

text: additional

text: burdens

text: on

text: VA

text: with

text: no

text: benefit

text: flowing

text: to

text: the

text: appellant

text: Sabonis

text: v

text: Brown

text: Vet

text: App

text: remands

text: which

text: would

text: only

text: result

text: in

text: unnecessarily

text: imposing

text: additional

text: burdens

text: on

text: VA

text: with

text: no

text: benefit

text: flowing

text: to

text: the

text: appellant

text: are

text: to

text: be

text: avoided

text: VA

text: has

text: satisfied

text: its

text: duty

text: to

text: inform

text: and

text: assist

text: the

text: Veteran

text: at

text: every

text: stage

text: in

text: this

text: case

text: at

text: least

text: insofar

text: as

text: any

text: errors

text: committed

text: were

text: not

text: harmful

text: to

text: the

text: essential

text: fairness

text: of

text: the

text: proceeding

text: Therefore

text: he

text: will

text: not

text: be

text: prejudiced

text: as

text: a

text: result

text: of

text: the

text: Board

text: proceeding

text: to

text: the

text: merits

text: of

text: his

text: claim

text: II

text: Analysis

text: Service

text: connection

text: may

text: be

text: granted

text: for

text: a

text: disability

text: resulting

text: from

text: disease

text: or

text: injury

text: incurred

text: in

text: or

text: aggravated

text: by

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: a

text: Service

text: connection

text: may

text: also

text: be

text: granted

text: for

text: any

text: disease

text: diagnosed

text: after

text: discharge

text: when

text: all

text: of

text: the

text: evidence

text: including

text: that

text: pertinent

text: to

text: service

text: establishes

text: that

text: the

text: disease

text: was

text: incurred

text: in

text: service

text: C

text: F

text: R

text: d

text: Direct

text: service

text: connection

text: may

text: not

text: be

text: granted

text: without

text: evidence

text: of

text: a

text: current

text: disability

text: in

text: service

text: incurrence

text: or

text: aggravation

text: of

text: a

text: disease

text: or

text: injury

text: and

text: a

text: nexus

text: between

text: the

text: claimed

text: in

text: service

text: disease

text: or

text: injury

text: and

text: the

text: present

text: disease

text: or

text: injury

text: Id

text: also

text: Caluza

text: v

text: Brown

text: Vet

text: App

text: aff

text: d

text: F

text: d

text: Fed

text: Cir

text: table

text: The

text: requirement

text: of

text: a

text: current

text: disability

text: is

text: satisfied

text: when

text: the

text: Veteran

text: has

text: a

text: disability

text: at

text: the

text: time

text: he

text: files

text: his

text: service

text: connection

text: claim

text: or

text: during

text: the

text: pendency

text: of

text: that

text: claim

text: even

text: if

text: the

text: disability

text: resolves

text: prior

text: to

text: adjudication

text: of

text: the

text: claim

text: McClain

text: v

text: Nicholson

text: Vet

text: App

text: However

text: when

text: the

text: record

text: contains

text: a

text: recent

text: diagnosis

text: of

text: disability

text: prior

text: to

text: the

text: Veteran

text: s

text: filing

text: of

text: a

text: claim

text: for

text: benefits

text: based

text: on

text: that

text: disability

text: the

text: report

text: of

text: the

text: diagnosis

text: is

text: relevant

text: evidence

text: that

text: the

text: Board

text: must

text: address

text: in

text: determining

text: whether

text: a

text: current

text: disability

text: existed

text: at

text: the

text: time

text: the

text: claim

text: was

text: filed

text: or

text: during

text: its

text: pendency

text: Romanowsky

text: v

text: Shinseki

text: Vet

text: App

text: Where

text: a

text: Veteran

text: served

text: for

text: at

text: least

text: days

text: during

text: a

text: period

text: of

text: war

text: or

text: after

text: December

text: and

text: manifests

text: certain

text: chronic

text: diseases

text: including

text: psychoses

text: to

text: a

text: degree

text: of

text: percent

text: within

text: one

text: year

text: from

text: the

text: date

text: of

text: termination

text: of

text: such

text: service

text: such

text: disease

text: shall

text: be

text: presumed

text: to

text: have

text: been

text: incurred

text: or

text: aggravated

text: in

text: service

text: even

text: though

text: there

text: is

text: no

text: evidence

text: of

text: such

text: disease

text: during

text: the

text: period

text: of

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: According

text: to

text: C

text: F

text: R

text: the

text: term

text: psychosis

text: includes

text: a

text: brief

text: psychotic

text: disorder

text: delusional

text: disorder

text: psychotic

text: disorder

text: due

text: to

text: a

text: medical

text: condition

text: psychotic

text: disorder

text: not

text: otherwise

text: specified

text: NOS

text: schizoaffective

text: disorder

text: schizophrenia

text: schizophreniform

text: disorder

text: shared

text: psychotic

text: disorder

text: and

text: substance

text: induced

text: psychotic

text: disorder

text: Alternatively

text: when

text: a

text: disease

text: at

text: C

text: F

text: R

text: a

text: is

text: not

text: shown

text: to

text: be

text: chronic

text: during

text: service

text: or

text: the

text: one

text: year

text: presumptive

text: period

text: service

text: connection

text: may

text: also

text: be

text: established

text: by

text: showing

text: continuity

text: of

text: symptomatology

text: after

text: service

text: See

text: C

text: F

text: R

text: b

text: The

text: use

text: of

text: continuity

text: of

text: symptoms

text: to

text: establish

text: service

text: connection

text: is

text: limited

text: to

text: those

text: diseases

text: listed

text: at

text: C

text: F

text: R

text: a

text: Walker

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: Service

text: connection

text: for

text: PTSD

text: requires

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: If

text: the

text: evidence

text: establishes

text: that

text: the

text: Veteran

text: engaged

text: in

text: combat

text: with

text: the

text: enemy

text: and

text: the

text: claimed

text: stressor

text: is

text: related

text: to

text: that

text: combat

text: in

text: the

text: absence

text: of

text: clear

text: and

text: convincing

text: evidence

text: to

text: the

text: contrary

text: and

text: provided

text: that

text: the

text: claimed

text: stressor

text: is

text: consistent

text: with

text: the

text: circumstances

text: conditions

text: or

text: hardships

text: of

text: the

text: Veteran

text: s

text: service

text: the

text: Veteran

text: s

text: lay

text: testimony

text: alone

text: may

text: establish

text: the

text: occurrence

text: of

text: the

text: claimed

text: in

text: service

text: stressor

text: C

text: F

text: R

text: f

text: Effective

text: July

text: if

text: a

text: stressor

text: claimed

text: by

text: a

text: Veteran

text: is

text: related

text: to

text: that

text: Veteran

text: s

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: and

text: a

text: VA

text: psychiatrist

text: or

text: psychologist

text: or

text: a

text: psychiatrist

text: or

text: psychologist

text: with

text: whom

text: VA

text: has

text: contracted

text: confirms

text: that

text: the

text: claimed

text: stressor

text: is

text: adequate

text: to

text: support

text: a

text: diagnosis

text: of

text: PTSD

text: and

text: that

text: a

text: Veteran

text: s

text: symptoms

text: are

text: related

text: to

text: the

text: claimed

text: stressor

text: in

text: the

text: absence

text: of

text: clear

text: and

text: convincing

text: evidence

text: to

text: the

text: contrary

text: and

text: provided

text: the

text: claimed

text: stressor

text: is

text: consistent

text: with

text: the

text: places

text: types

text: and

text: circumstances

text: of

text: that

text: Veteran

text: s

text: service

text: a

text: Veteran

text: s

text: lay

text: testimony

text: alone

text: may

text: establish

text: the

text: occurrence

text: of

text: the

text: claimed

text: in

text: service

text: stressor

text: F

text: ear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: means

text: that

text: a

text: Veteran

text: experienced

text: witnessed

text: or

text: was

text: confronted

text: with

text: an

text: event

text: or

text: circumstance

text: that

text: involved

text: actual

text: or

text: threatened

text: death

text: or

text: serious

text: injury

text: or

text: a

text: threat

text: to

text: the

text: physical

text: integrity

text: of

text: the

text: Veteran

text: or

text: others

text: such

text: as

text: from

text: an

text: actual

text: or

text: potential

text: improvised

text: explosive

text: device

text: vehicle

text: imbedded

text: explosive

text: device

text: incoming

text: artillery

text: rocket

text: or

text: mortar

text: fire

text: grenade

text: small

text: arms

text: fire

text: including

text: suspected

text: sniper

text: fire

text: or

text: attack

text: upon

text: friendly

text: military

text: aircraft

text: and

text: the

text: Veteran

text: s

text: response

text: to

text: the

text: event

text: or

text: circumstance

text: involved

text: a

text: psychological

text: or

text: psycho

text: physiological

text: state

text: of

text: fear

text: helplessness

text: or

text: horror

text: C

text: F

text: R

text: f

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: the

text: Secretary

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: C

text: F

text: R

text: see

text: also

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: At

text: the

text: outset

text: the

text: Board

text: points

text: out

text: that

text: the

text: preponderance

text: of

text: the

text: probative

text: evidence

text: is

text: against

text: a

text: finding

text: that

text: the

text: Veteran

text: has

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: during

text: the

text: pendency

text: of

text: the

text: claim

text: and

text: the

text: record

text: does

text: not

text: contain

text: a

text: recent

text: diagnosis

text: of

text: disability

text: prior

text: to

text: the

text: Veteran

text: s

text: filing

text: of

text: a

text: claim

text: See

text: McClain

text: supra

text: Romanowsky

text: supra

text: In

text: this

text: regard

text: October

text: VA

text: treatment

text: records

text: document

text: PTSD

text: type

text: symptoms

text: and

text: one

text: clinician

text: indicated

text: the

text: need

text: to

text: rule

text: out

text: PTSD

text: as

text: a

text: diagnosis

text: Thereafter

text: PTSD

text: like

text: symptoms

text: and

text: a

text: history

text: of

text: PTSD

text: were

text: noted

text: during

text: treatment

text: in

text: November

text: However

text: despite

text: these

text: notations

text: there

text: is

text: no

text: indication

text: in

text: the

text: record

text: that

text: the

text: Veteran

text: has

text: ever

text: been

text: diagnosed

text: with

text: PTSD

text: by

text: a

text: VA

text: or

text: private

text: clinician

text: nor

text: was

text: he

text: diagnosed

text: with

text: PTSD

text: by

text: the

text: VA

text: psychologist

text: who

text: conducted

text: the

text: March

text: examination

text: Conversely

text: review

text: of

text: the

text: record

text: reveals

text: that

text: the

text: Veteran

text: has

text: been

text: diagnosed

text: with

text: several

text: acquired

text: psychiatric

text: disorders

text: other

text: than

text: PTSD

text: including

text: unspecified

text: depressive

text: disorder

text: major

text: depression

text: anxiety

text: disorder

text: not

text: otherwise

text: specified

text: NOS

text: personality

text: disorder

text: NOS

text: and

text: substance

text: abuse

text: disorders

text: in

text: sustained

text: remission

text: Thus

text: the

text: first

text: requirement

text: for

text: establishing

text: service

text: connection

text: a

text: current

text: disability

text: has

text: been

text: met

text: The

text: Veteran

text: s

text: service

text: treatment

text: records

text: reveal

text: no

text: treatment

text: for

text: or

text: diagnosis

text: of

text: any

text: psychiatric

text: disorder

text: and

text: his

text: separation

text: examination

text: revealed

text: no

text: psychiatric

text: abnormalities

text: Moreover

text: there

text: is

text: no

text: evidence

text: the

text: Veteran

text: has

text: ever

text: been

text: diagnosed

text: with

text: a

text: psychosis

text: However

text: in

text: written

text: documents

text: and

text: in

text: his

text: Board

text: hearing

text: testimony

text: the

text: Veteran

text: contends

text: that

text: his

text: acquired

text: psychiatric

text: disorder

text: is

text: the

text: result

text: of

text: witnessing

text: a

text: shipmate

text: fall

text: overboard

text: while

text: stationed

text: on

text: the

text: USS

text: Constellation

text: CVA

text: in

text: approximately

text: March

text: While

text: the

text: AOJ

text: attempted

text: to

text: verify

text: such

text: stressor

text: it

text: was

text: unsuccessful

text: Thus

text: to

text: establish

text: service

text: connection

text: there

text: must

text: be

text: probative

text: evidence

text: linking

text: his

text: currently

text: diagnosed

text: psychiatric

text: disorders

text: with

text: any

text: instance

text: of

text: his

text: military

text: service

text: Upon

text: review

text: of

text: the

text: evidence

text: the

text: Board

text: finds

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: claim

text: In

text: this

text: regard

text: in

text: March

text: the

text: Veteran

text: was

text: afforded

text: a

text: VA

text: examination

text: in

text: connection

text: with

text: his

text: claim

text: for

text: service

text: connection

text: Following

text: an

text: interview

text: with

text: the

text: Veteran

text: a

text: review

text: of

text: the

text: record

text: and

text: a

text: mental

text: status

text: examination

text: the

text: examiner

text: diagnosed

text: an

text: unspecified

text: depressive

text: disorder

text: and

text: substance

text: abuse

text: disorders

text: in

text: sustained

text: remission

text: The

text: examiner

text: noted

text: the

text: Veteran

text: s

text: reports

text: that

text: he

text: received

text: mental

text: health

text: treatment

text: in

text: service

text: but

text: noted

text: as

text: does

text: the

text: Board

text: that

text: there

text: is

text: no

text: indication

text: of

text: such

text: treatment

text: in

text: the

text: Veteran

text: s

text: service

text: treatment

text: records

text: The

text: examiner

text: also

text: noted

text: the

text: Veteran

text: s

text: reports

text: of

text: being

text: fearful

text: in

text: service

text: and

text: his

text: unverified

text: stressor

text: of

text: seeing

text: a

text: fellow

text: sailor

text: fall

text: overboard

text: Nevertheless

text: the

text: examiner

text: opined

text: that

text: the

text: Veteran

text: s

text: depressive

text: disorder

text: was

text: not

text: related

text: to

text: his

text: service

text: and

text: that

text: his

text: depressive

text: symptoms

text: are

text: related

text: to

text: a

text: long

text: history

text: of

text: personality

text: features

text: and

text: or

text: his

text: substance

text: abuse

text: history

text: The

text: Board

text: finds

text: that

text: the

text: opinion

text: of

text: the

text: VA

text: examiner

text: provided

text: after

text: reviewing

text: the

text: claims

text: file

text: and

text: examining

text: the

text: Veteran

text: is

text: highly

text: probative

text: as

text: it

text: reflects

text: consideration

text: of

text: all

text: relevant

text: facts

text: and

text: the

text: examiner

text: provided

text: a

text: detailed

text: rationale

text: for

text: the

text: conclusion

text: reached

text: See

text: Nieves

text: Rodriguez

text: supra

text: holding

text: that

text: it

text: is

text: the

text: factually

text: accurate

text: fully

text: articulated

text: sound

text: reasoning

text: for

text: the

text: conclusion

text: that

text: contributes

text: to

text: the

text: probative

text: value

text: of

text: a

text: medical

text: opinion

text: Stefl

text: supra

text: There

text: is

text: no

text: competent

text: medical

text: evidence

text: to

text: the

text: contrary

text: To

text: the

text: extent

text: the

text: Veteran

text: believes

text: that

text: he

text: suffers

text: from

text: a

text: psychiatric

text: disorder

text: that

text: is

text: related

text: to

text: service

text: as

text: a

text: lay

text: person

text: he

text: has

text: not

text: shown

text: that

text: he

text: has

text: specialized

text: training

text: sufficient

text: to

text: render

text: such

text: an

text: opinion

text: See

text: Jandreau

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: noting

text: general

text: competence

text: to

text: testify

text: as

text: to

text: symptoms

text: but

text: not

text: to

text: provide

text: medical

text: diagnosis

text: In

text: this

text: regard

text: the

text: diagnosis

text: and

text: etiology

text: of

text: psychiatric

text: disorders

text: are

text: matters

text: not

text: capable

text: of

text: lay

text: observation

text: and

text: require

text: medical

text: expertise

text: to

text: determine

text: Accordingly

text: his

text: opinion

text: as

text: to

text: the

text: diagnosis

text: or

text: etiology

text: of

text: the

text: current

text: psychiatric

text: symptomology

text: is

text: not

text: competent

text: medical

text: evidence

text: The

text: Board

text: finds

text: the

text: opinion

text: of

text: the

text: VA

text: examiner

text: to

text: be

text: significantly

text: more

text: probative

text: than

text: his

text: lay

text: assertions

text: Moreover

text: the

text: Board

text: recognizes

text: that

text: the

text: Veteran

text: reported

text: at

text: his

text: March

text: examination

text: and

text: elsewhere

text: that

text: he

text: began

text: abusing

text: drugs

text: during

text: service

text: and

text: that

text: the

text: examiner

text: attributed

text: his

text: current

text: depressive

text: symptoms

text: to

text: the

text: Veteran

text: s

text: drug

text: abuse

text: history

text: However

text: both

text: C

text: F

text: R

text: a

text: and

text: d

text: prohibit

text: service

text: connection

text: for

text: diseases

text: incurred

text: during

text: active

text: military

text: service

text: resulting

text: from

text: the

text: abuse

text: of

text: drugs

text: As

text: any

text: disease

text: resulting

text: from

text: his

text: abuse

text: of

text: illegal

text: drugs

text: is

text: not

text: considered

text: to

text: be

text: in

text: the

text: line

text: of

text: duty

text: pursuant

text: to

text: C

text: F

text: R

text: d

text: service

text: connection

text: for

text: a

text: depressive

text: disorder

text: as

text: a

text: result

text: of

text: illegal

text: drug

text: use

text: in

text: service

text: cannot

text: be

text: established

text: C

text: F

text: R

text: a

text: In

text: summary

text: the

text: Board

text: finds

text: that

text: the

text: preponderance

text: of

text: the

text: probative

text: evidence

text: is

text: against

text: a

text: finding

text: that

text: the

text: Veteran

text: s

text: diagnosed

text: acquired

text: psychiatric

text: disorders

text: arose

text: in

text: service

text: or

text: are

text: etiologically

text: related

text: to

text: service

text: or

text: any

text: incidents

text: therein

text: Additionally

text: there

text: is

text: no

text: evidence

text: that

text: the

text: Veteran

text: was

text: diagnosed

text: with

text: a

text: psychosis

text: within

text: a

text: year

text: of

text: his

text: separation

text: from

text: service

text: Accordingly

text: the

text: claim

text: for

text: service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: PTSD

text: is

text: denied

text: In

text: reaching

text: the

text: above

text: conclusion

text: the

text: Board

text: has

text: considered

text: the

text: applicability

text: of

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: However

text: as

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: Veteran

text: s

text: claim

text: that

text: doctrine

text: is

text: not

text: applicable

text: in

text: the

text: instant

text: appeal

text: See

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Gilbert

text: supra

text: ORDER

text: Service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: PTSD

text: is

text: denied

text: A

text: JAEGER

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs