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Citation Nr: 1701504
Decision Date: 01/23/17    Archive Date: 02/09/17

DOCKET NO.  11-20 562	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Denver, Colorado

THE ISSUES

1. Entitlement to service connection for an acquired psychiatric disability, to include depressive disorder and generalized anxiety disorder, claimed as secondary to service-connected disabilities.

2. Entitlement to service connection for a bilateral knee condition, including as secondary to service-connected disabilities.

REPRESENTATION

Appellant represented by:	Disabled American Veterans

ATTORNEY FOR THE BOARD

M. Thomas, Associate Counsel

INTRODUCTION

The Veteran, who is the appellant in this case, served on active duty from June 1998 to April 1999.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas.  Jurisdiction has since been transferred to the VA RO in Denver, Colorado.

The Veteran initially requested a Travel Board hearing.  However, he withdrew this request in a May 2016 statement.

After reviewing the contentions and evidence of record, the Board finds that the issues on appeal are more accurately stated as listed on the title page of this decision.  In Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) held that the scope of a mental health disability claim includes any mental disorder that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record.  In consideration of Clemons and the other diagnoses of record, the Board has re-characterized the claims as reflected on the title page.

In November 2016, during the pendency of this appeal, the Veteran revoked his Power of Attorney, which had appointed J. Michael Woods, Esquire, as his representative.  The Board finds that the Veteran properly revoked this attorney's representation.  See 38 C.F.R. § 14.631(f)(1).  At the same time, the Veteran appointed Disabled American Veterans as his new representative.

The issue of entitlement to service connection for a bilateral knee condition is addressed in the REMAND portion of the decision below and is REMANDED to the Agency of Original Jurisdiction (AOJ).

FINDING OF FACT

The Veteran's acquired psychiatric disorder, to include depressive disorder and generalized anxiety disorder, is caused by his service-connected disabilities.

CONCLUSION OF LAW

The criteria for service connection an acquired psychiatric disorder, to include depressive disorder and generalized anxiety disorder, have been met. 38 U.S.C.A. §§ 1110, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, (2015).

REASONS AND BASES FOR FINDING AND CONCLUSION

Duties to Notify and Assist

The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on VA to provide claimants with notice and assistance.  38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.326(a).  Given the favorable outcome of this decision, no prejudice to the Veteran could result from this decision.  See Bernard v. Brown, 4 Vet. App. 384, 394 (1993).

Service Connection - Laws and Regulations

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 military 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); 38 C.F.R. § 3.303(a).

Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a).  Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease.  38 C.F.R. § 3.310(b).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant.  Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).  Competency of evidence differs from weight and credibility.  Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted.  Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994).

When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's particular disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to her through her senses.  See Layno, 6 Vet. App. 465, 469.  Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation.  Barr v. Nicholson, 21 Vet. App. 303 (2007).  Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional.  Jandreau, 492 F.3d 1372, 1377.

In the case of conflicting medical opinions, the Board must weigh the credibility and probative value of the medical opinions, and in so doing, the Board may favor one medical opinion over the other.  See Evans v. West, 12 Vet. App. 22, 30 (1998) (citing Owens v. Brown, 7 Vet. App. 429, 433 (1995)); see also Wensch v. Principi, 15 Vet. App. 362, 368 (2001) (it is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons and bases for doing so).  The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.  Guerrieri v. Brown, 4 Vet. App. 467, 470 (1993).  Other factors affecting the probative value of a medical opinion include thoroughness and degree of detail, and a well-reasoned rationale.  See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Bloom v.West, 12 Vet. App. 185, 187 (1999).  The credibility and weight to be attached to these opinions is within the province of the Board.  Id.

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied.  38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102.

Service Connection for an Acquired Psychiatric Condition - Analysis

The Veteran contends that his current acquired psychiatric conditions are related to or caused by his service-connected disabilities.  His medical treatment records list current diagnoses of depressive disorder NOS, generalized anxiety disorder, mood disorder NOS, bipolar disorder, personality disorder and alcohol dependence.

An October 2002 VA treatment record indicates that the Veteran had been diagnosed with depression.

A March 2007 VA treatment record indicates that the Veteran had been diagnosed with anxiety disorder NOS.

The Veteran was afforded a VA examination in August 2009.  The VA examiner diagnosed the Veteran with depression NOS.  The VA examiner stated that the question of whether this diagnosis is related to or caused by the service-connected Hodgkin's disease could not be resolved without resort to mere speculation, noting that the Hodgkin's disease had been in remission for 10 years.

A September 2009 VA treatment record indicates that the Veteran had been diagnosed with a mood disorder NOS and alcohol dependence.

In a February 2010 VA treatment record, the Veteran reported that he began to experience depression and an increase in anxiety and anger after he was diagnosed and treated for Hodgkin's Lymphoma while on active duty.  He was diagnosed with cyclothymic disorder.

An October 2011 VA examiner noted that the Veteran's Hodgkin's disease caused him to have ongoing problems with intermittent fatigue, mood swings impacting his work ability, and interpersonal relationships.

A February 2012 VA treatment record indicates that the Veteran reported having felt depressed for 14 years.  He was diagnosed with depression.

A March 2012 VA treatment record indicates that the Veteran had been diagnosed with a bipolar spectrum disorder.

In November 2012, the Veteran reported that he had been diagnosed with an anxiety disorder and non-combat PTSD starting in March 2007, related to his service-connected Hodgkin's disease.  He stated that he began dealing with his depression by drinking while he was in service.  He also reported being diagnosed with alcohol dependence, which he described as beginning during service as a way to cope with his mental health issues related to his Hodgkin's disease.

In December 2013, a private psychologist diagnosed the Veteran with PTSD and depressive disorder NOS.  He stated that the Veteran's PTSD was caused by his loss of his career as a police officer and loss of his health when he was diagnosed with Hodgkin's disease.  He noted that the Veteran was let go from his job as a police officer due to his service-connected right arm disability.  The psychologist also stated that the Veteran lived in constant threat of his Hodgkin's disease recurring and passing this disease on to his children.  This opinion is probative as it was offered in connection with the psychologist's treatment of the Veteran, indicating a strong familiarity with the Veteran's condition, and provides an adequate rationale for the conclusions.

In October 2014, a private psychologist evaluated the Veteran and opined that the service-connected right arm brachial plexus nerve injury (right arm disability) and scars caused his current mood disorder.  She also opined that the Veteran's service-connected right arm disability, associated with Hodgkin's disease; scar, right and left anterior chest; and scar, right lateral chest, are more likely than not aggravating his mood disorder.  The private psychologist gave a detailed description of the Veteran's psychiatric symptoms, service-connected disabilities, and psychiatric and medical treatment history.  In support of her opinion, she cited medical literature supporting a causal relationship between medical and psychiatric difficulty.  The Board finds this medical opinion to be highly probative. This opinion included a detailed and accurate description of the Veteran's medical and psychiatric treatment history, citations to medical literature support the relationship between the service-connected disabilities and current acquired psychiatric disability, and an adequate rationale for the conclusion.

After a review of all of the evidence of record, both lay and medical, the Board finds that the preponderance of the evidence is in favor of a finding that the Veteran's current acquired psychiatric disorder, to include depressive disorder and  generalized anxiety disorder, is related to or caused by his service-connected disabilities.  The December 2013 and October 2014 private opinions are the only adequate medical opinions of record, and both conclude that the Veteran's current acquired psychiatric disability is related to his service-connected disabilities.  For these reasons, and resolving all reasonable doubt in the Veteran's favor, the Board finds that the criteria for service connection for an acquired psychiatric disorder, to include depressive disorder and generalized anxiety disorder, claimed as secondary to the service-connected disabilities, have been met.  See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102.

ORDER

Service connection for an acquired psychiatric condition, to include depressive disorder and generalized anxiety disorder, is granted.

REMAND

Once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).

The Veteran was afforded a VA examination in July 2009.  He reported speculation by his physicians that his knee pain was a side effect of chemotherapy treatment for Hodgkin's disease during service.  He reported that the knee pain began six or seven years earlier.  The Veteran contended that his left knee pain was secondary to a right knee condition.  X-rays revealed a "posterior horn, lateral meniscus possible tear" of the right knee.  X-rays did not reveal any left knee abnormalities.  The VA examiner diagnosed the Veteran with a degenerative lateral meniscus of the right knee.  He explicitly stated that degenerative joint disease was not found in the Veteran's bilateral knees.  No nexus opinion was given for the Veteran's lateral meniscus condition.

In December 2009, the Veteran had surgery to repair a lateral meniscal tear and to replace his right knee ACL.

The Veteran was afforded a VA examination in October 2011.  He reported having surgery for an ACL replacement of the right knee in December 2009.  He also had a debridement arthroscopy of the right knee in August 2010.  The Veteran reported having osteoarthritis of both knees with an onset date of 2000.  He did not report any injury.

In December 2016, the Veteran's representative contended that his knees were injured during in-service basic training involving jumping with back packs and crawling on his knees.

Once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).  As the July 2009 VA examination did not address the etiology of the Veteran's lateral meniscus tear or his ACL condition, a new examination is necessary.

Every Veteran is presumed to have been in sound condition at entry into service except as to defects, infirmities, or disorders noted at the time of such entry, or where clear and unmistakable evidence demonstrates that the injury or disease existed before entry and was not aggravated by such service.  38 U.S.C.A. § 1111.  The term "noted," in 38 U.S.C.A. § 1111, refers to "[o]nly such conditions as are recorded in examination reports."  38 C.F.R. § 3.304 (b).  As there were no defects, infirmities, or disorders noted at entry into service, the Veteran's right knee is presumed to have been in sound condition at this time.  However, this presumption can be rebutted by clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior to service and was not aggravated by such service.  38 C.F.R. § 3.304(b).

In August 2007, a VA psychology treatment note indicated that the Veteran reported injuring his right knee at age 14 while wrestling.  He stated that he had a tear in the anterior cruciate ligament (ACL).  The Board finds these statements to be both competent and credible.  Therefore, a new examination to determine whether the Veteran's current bilateral knee conditions are related to service, whether there is clear and unmistakable evidence that the right knee conditions preexisted service, and whether any preexisting right knee disability was aggravated by service. See Gilbert v. Shinseki, 26 Vet. App. 48, 52 (2012) ("before the presumption of soundness is for application, there must be evidence that a disease or injury that was not noted upon entry to service manifested or was incurred in service").

Accordingly, the case is REMANDED for the following action:

1. Obtain the Veteran's updated VA and private treatment records related to his bilateral knee conditions.

2. Schedule the Veteran for a VA examination to determine the nature and etiology of his bilateral knee conditions.  The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the VA examiner.

The VA examiner should provide the following opinions:

(a)  Whether any right or left knee condition is at least as likely as not (50 percent probability or greater) related to or caused by his service, to include the effect of in-service basic training involving jumping with back packs and crawling on his knees.

(b) Whether any right or left knee condition is at least as likely as not (50 percent probability or greater) related to or caused by any treatment for his service-connected Hodgkin's disease.

(c) Whether (i) a right knee disability clearly and unmistakably preexisted service and, if so, (ii) whether such preexisting disorder clearly and unmistakably was not aggravated by service.

The term "at least as likely as not" does not mean within the realm of possibility, but rather that the evidence both for and against a conclusion is so evenly divided that it is as sound to find in favor of a certain conclusion as it is to find against it.

The VA examiner must provide a detailed rationale for all opinions rendered. If the examiner cannot provide the requested information without resort to speculation, it must be so stated with reasons why, and if an additional clinical evaluation is necessary to render the requested information, then that opportunity should be made available.

3. After completion of the above and compliance with the requested actions has been ensured, readjudicate the issue on appeal on the basis of the additional evidence of record.  If the determinations remain adverse to the Veteran, he and his representative should be furnished with a Supplemental Statement of the Case.  An appropriate period of time should then be allowed for a response before the record is returned to the Board for further review.

The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded.  Kutscherousky v. West, 12 Vet. App. 369 (1999).

This claim must be afforded expeditious treatment.  The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner.  See 38 U.S.C.A. §§ 5109B, 7112 (West 2014).

______________________________________________
K. PARAKKAL
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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text: particular

text: disability

text: is

text: the

text: type

text: of

text: disability

text: for

text: which

text: lay

text: evidence

text: may

text: be

text: competent

text: Kahana

text: v

text: Shinseki

text: Vet

text: App

text: see

text: also

text: Jandreau

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: A

text: veteran

text: is

text: competent

text: to

text: report

text: symptoms

text: because

text: this

text: requires

text: only

text: personal

text: knowledge

text: not

text: medical

text: expertise

text: as

text: it

text: comes

text: to

text: her

text: through

text: her

text: senses

text: See

text: Layno

text: Vet

text: App

text: Lay

text: testimony

text: is

text: competent

text: to

text: establish

text: the

text: presence

text: of

text: observable

text: symptomatology

text: where

text: the

text: determination

text: is

text: not

text: medical

text: in

text: nature

text: and

text: is

text: capable

text: of

text: lay

text: observation

text: Barr

text: v

text: Nicholson

text: Vet

text: App

text: Lay

text: evidence

text: may

text: establish

text: a

text: diagnosis

text: of

text: a

text: simple

text: medical

text: condition

text: a

text: contemporaneous

text: medical

text: diagnosis

text: or

text: symptoms

text: that

text: later

text: support

text: a

text: diagnosis

text: by

text: a

text: medical

text: professional

text: Jandreau

text: F

text: d

text: In

text: the

text: case

text: of

text: conflicting

text: medical

text: opinions

text: the

text: Board

text: must

text: weigh

text: the

text: credibility

text: and

text: probative

text: value

text: of

text: the

text: medical

text: opinions

text: and

text: in

text: so

text: doing

text: the

text: Board

text: may

text: favor

text: one

text: medical

text: opinion

text: over

text: the

text: other

text: See

text: Evans

text: v

text: West

text: Vet

text: App

text: citing

text: Owens

text: v

text: Brown

text: Vet

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text: Wensch

text: v

text: Principi

text: Vet

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text: it

text: is

text: not

text: error

text: for

text: the

text: Board

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text: the

text: opinion

text: of

text: one

text: competent

text: medical

text: expert

text: over

text: that

text: of

text: another

text: when

text: the

text: Board

text: gives

text: an

text: adequate

text: statement

text: of

text: reasons

text: and

text: bases

text: for

text: doing

text: so

text: The

text: probative

text: value

text: of

text: medical

text: opinion

text: evidence

text: is

text: based

text: on

text: the

text: medical

text: expert

text: s

text: personal

text: examination

text: of

text: the

text: patient

text: the

text: physician

text: s

text: knowledge

text: and

text: skill

text: in

text: analyzing

text: the

text: data

text: and

text: the

text: medical

text: conclusion

text: the

text: physician

text: reaches

text: Guerrieri

text: v

text: Brown

text: Vet

text: App

text: Other

text: factors

text: affecting

text: the

text: probative

text: value

text: of

text: a

text: medical

text: opinion

text: include

text: thoroughness

text: and

text: degree

text: of

text: detail

text: and

text: a

text: well

text: reasoned

text: rationale

text: See

text: Prejean

text: v

text: West

text: Vet

text: App

text: see

text: also

text: Bloom

text: v

text: West

text: Vet

text: App

text: The

text: credibility

text: and

text: weight

text: to

text: be

text: attached

text: to

text: these

text: opinions

text: is

text: within

text: the

text: province

text: of

text: the

text: Board

text: Id

text: When

text: all

text: the

text: evidence

text: is

text: assembled

text: VA

text: is

text: responsible

text: for

text: determining

text: whether

text: the

text: evidence

text: supports

text: the

text: claim

text: or

text: is

text: in

text: relative

text: equipoise

text: with

text: a

text: veteran

text: prevailing

text: in

text: either

text: event

text: or

text: whether

text: a

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: a

text: claim

text: in

text: which

text: case

text: the

text: claim

text: is

text: denied

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: Service

text: Connection

text: for

text: an

text: Acquired

text: Psychiatric

text: Condition

text: Analysis

text: The

text: Veteran

text: contends

text: that

text: his

text: current

text: acquired

text: psychiatric

text: conditions

text: are

text: related

text: to

text: or

text: caused

text: by

text: his

text: service

text: connected

text: disabilities

text: His

text: medical

text: treatment

text: records

text: list

text: current

text: diagnoses

text: of

text: depressive

text: disorder

text: NOS

text: generalized

text: anxiety

text: disorder

text: mood

text: disorder

text: NOS

text: bipolar

text: disorder

text: personality

text: disorder

text: and

text: alcohol

text: dependence

text: An

text: October

text: VA

text: treatment

text: record

text: indicates

text: that

text: the

text: Veteran

text: had

text: been

text: diagnosed

text: with

text: depression

text: A

text: March

text: VA

text: treatment

text: record

text: indicates

text: that

text: the

text: Veteran

text: had

text: been

text: diagnosed

text: with

text: anxiety

text: disorder

text: NOS

text: The

text: Veteran

text: was

text: afforded

text: a

text: VA

text: examination

text: in

text: August

text: The

text: VA

text: examiner

text: diagnosed

text: the

text: Veteran

text: with

text: depression

text: NOS

text: The

text: VA

text: examiner

text: stated

text: that

text: the

text: question

text: of

text: whether

text: this

text: diagnosis

text: is

text: related

text: to

text: or

text: caused

text: by

text: the

text: service

text: connected

text: Hodgkin

text: s

text: disease

text: could

text: not

text: be

text: resolved

text: without

text: resort

text: to

text: mere

text: speculation

text: noting

text: that

text: the

text: Hodgkin

text: s

text: disease

text: had

text: been

text: in

text: remission

text: for

text: years

text: A

text: September

text: VA

text: treatment

text: record

text: indicates

text: that

text: the

text: Veteran

text: had

text: been

text: diagnosed

text: with

text: a

text: mood

text: disorder

text: NOS

text: and

text: alcohol

text: dependence

text: In

text: a

text: February

text: VA

text: treatment

text: record

text: the

text: Veteran

text: reported

text: that

text: he

text: began

text: to

text: experience

text: depression

text: and

text: an

text: increase

text: in

text: anxiety

text: and

text: anger

text: after

text: he

text: was

text: diagnosed

text: and

text: treated

text: for

text: Hodgkin

text: s

text: Lymphoma

text: while

text: on

text: active

text: duty

text: He

text: was

text: diagnosed

text: with

text: cyclothymic

text: disorder

text: An

text: October

text: VA

text: examiner

text: noted

text: that

text: the

text: Veteran

text: s

text: Hodgkin

text: s

text: disease

text: caused

text: him

text: to

text: have

text: ongoing

text: problems

text: with

text: intermittent

text: fatigue

text: mood

text: swings

text: impacting

text: his

text: work

text: ability

text: and

text: interpersonal

text: relationships

text: A

text: February

text: VA

text: treatment

text: record

text: indicates

text: that

text: the

text: Veteran

text: reported

text: having

text: felt

text: depressed

text: for

text: years

text: He

text: was

text: diagnosed

text: with

text: depression

text: A

text: March

text: VA

text: treatment

text: record

text: indicates

text: that

text: the

text: Veteran

text: had

text: been

text: diagnosed

text: with

text: a

text: bipolar

text: spectrum

text: disorder

text: In

text: November

text: the

text: Veteran

text: reported

text: that

text: he

text: had

text: been

text: diagnosed

text: with

text: an

text: anxiety

text: disorder

text: and

text: non

text: combat

text: PTSD

text: starting

text: in

text: March

text: related

text: to

text: his

text: service

text: connected

text: Hodgkin

text: s

text: disease

text: He

text: stated

text: that

text: he

text: began

text: dealing

text: with

text: his

text: depression

text: by

text: drinking

text: while

text: he

text: was

text: in

text: service

text: He

text: also

text: reported

text: being

text: diagnosed

text: with

text: alcohol

text: dependence

text: which

text: he

text: described

text: as

text: beginning

text: during

text: service

text: as

text: a

text: way

text: to

text: cope

text: with

text: his

text: mental

text: health

text: issues

text: related

text: to

text: his

text: Hodgkin

text: s

text: disease

text: In

text: December

text: a

text: private

text: psychologist

text: diagnosed

text: the

text: Veteran

text: with

text: PTSD

text: and

text: depressive

text: disorder

text: NOS

text: He

text: stated

text: that

text: the

text: Veteran

text: s

text: PTSD

text: was

text: caused

text: by

text: his

text: loss

text: of

text: his

text: career

text: as

text: a

text: police

text: officer

text: and

text: loss

text: of

text: his

text: health

text: when

text: he

text: was

text: diagnosed

text: with

text: Hodgkin

text: s

text: disease

text: He

text: noted

text: that

text: the

text: Veteran

text: was

text: let

text: go

text: from

text: his

text: job

text: as

text: a

text: police

text: officer

text: due

text: to

text: his

text: service

text: connected

text: right

text: arm

text: disability

text: The

text: psychologist

text: also

text: stated

text: that

text: the

text: Veteran

text: lived

text: in

text: constant

text: threat

text: of

text: his

text: Hodgkin

text: s

text: disease

text: recurring

text: and

text: passing

text: this

text: disease

text: on

text: to

text: his

text: children

text: This

text: opinion

text: is

text: probative

text: as

text: it

text: was

text: offered

text: in

text: connection

text: with

text: the

text: psychologist

text: s

text: treatment

text: of

text: the

text: Veteran

text: indicating

text: a

text: strong

text: familiarity

text: with

text: the

text: Veteran

text: s

text: condition

text: and

text: provides

text: an

text: adequate

text: rationale

text: for

text: the

text: conclusions

text: In

text: October

text: a

text: private

text: psychologist

text: evaluated

text: the

text: Veteran

text: and

text: opined

text: that

text: the

text: service

text: connected

text: right

text: arm

text: brachial

text: plexus

text: nerve

text: injury

text: right

text: arm

text: disability

text: and

text: scars

text: caused

text: his

text: current

text: mood

text: disorder

text: She

text: also

text: opined

text: that

text: the

text: Veteran

text: s

text: service

text: connected

text: right

text: arm

text: disability

text: associated

text: with

text: Hodgkin

text: s

text: disease

text: scar

text: right

text: and

text: left

text: anterior

text: chest

text: and

text: scar

text: right

text: lateral

text: chest

text: are

text: more

text: likely

text: than

text: not

text: aggravating

text: his

text: mood

text: disorder

text: The

text: private

text: psychologist

text: gave

text: a

text: detailed

text: description

text: of

text: the

text: Veteran

text: s

text: psychiatric

text: symptoms

text: service

text: connected

text: disabilities

text: and

text: psychiatric

text: and

text: medical

text: treatment

text: history

text: In

text: support

text: of

text: her

text: opinion

text: she

text: cited

text: medical

text: literature

text: supporting

text: a

text: causal

text: relationship

text: between

text: medical

text: and

text: psychiatric

text: difficulty

text: The

text: Board

text: finds

text: this

text: medical

text: opinion

text: to

text: be

text: highly

text: probative

text: This

text: opinion

text: included

text: a

text: detailed

text: and

text: accurate

text: description

text: of

text: the

text: Veteran

text: s

text: medical

text: and

text: psychiatric

text: treatment

text: history

text: citations

text: to

text: medical

text: literature

text: support

text: the

text: relationship

text: between

text: the

text: service

text: connected

text: disabilities

text: and

text: current

text: acquired

text: psychiatric

text: disability

text: and

text: an

text: adequate

text: rationale

text: for

text: the

text: conclusion

text: After

text: a

text: review

text: of

text: all

text: of

text: the

text: evidence

text: of

text: record

text: both

text: lay

text: and

text: medical

text: the

text: Board

text: finds

text: that

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: in

text: favor

text: of

text: a

text: finding

text: that

text: the

text: Veteran

text: s

text: current

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: depressive

text: disorder

text: and

text: generalized

text: anxiety

text: disorder

text: is

text: related

text: to

text: or

text: caused

text: by

text: his

text: service

text: connected

text: disabilities

text: The

text: December

text: and

text: October

text: private

text: opinions

text: are

text: the

text: only

text: adequate

text: medical

text: opinions

text: of

text: record

text: and

text: both

text: conclude

text: that

text: the

text: Veteran

text: s

text: current

text: acquired

text: psychiatric

text: disability

text: is

text: related

text: to

text: his

text: service

text: connected

text: disabilities

text: For

text: these

text: reasons

text: and

text: resolving

text: all

text: reasonable

text: doubt

text: in

text: the

text: Veteran

text: s

text: favor

text: the

text: Board

text: finds

text: that

text: the

text: criteria

text: for

text: service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: depressive

text: disorder

text: and

text: generalized

text: anxiety

text: disorder

text: claimed

text: as

text: secondary

text: to

text: the

text: service

text: connected

text: disabilities

text: have

text: been

text: met

text: See

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: ORDER

text: Service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: condition

text: to

text: include

text: depressive

text: disorder

text: and

text: generalized

text: anxiety

text: disorder

text: is

text: granted

text: REMAND

text: Once

text: VA

text: undertakes

text: the

text: effort

text: to

text: provide

text: an

text: examination

text: when

text: developing

text: a

text: service

text: connection

text: claim

text: even

text: if

text: not

text: statutorily

text: obligated

text: to

text: do

text: so

text: it

text: must

text: provide

text: an

text: adequate

text: one

text: See

text: Barr

text: v

text: Nicholson

text: Vet

text: App

text: The

text: Veteran

text: was

text: afforded

text: a

text: VA

text: examination

text: in

text: July

text: He

text: reported

text: speculation

text: by

text: his

text: physicians

text: that

text: his

text: knee

text: pain

text: was

text: a

text: side

text: effect

text: of

text: chemotherapy

text: treatment

text: for

text: Hodgkin

text: s

text: disease

text: during

text: service

text: He

text: reported

text: that

text: the

text: knee

text: pain

text: began

text: six

text: or

text: seven

text: years

text: earlier

text: The

text: Veteran

text: contended

text: that

text: his

text: left

text: knee

text: pain

text: was

text: secondary

text: to

text: a

text: right

text: knee

text: condition

text: X

text: rays

text: revealed

text: a

text: posterior

text: horn

text: lateral

text: meniscus

text: possible

text: tear

text: of

text: the

text: right

text: knee

text: X

text: rays

text: did

text: not

text: reveal

text: any

text: left

text: knee

text: abnormalities

text: The

text: VA

text: examiner

text: diagnosed

text: the

text: Veteran

text: with

text: a

text: degenerative

text: lateral

text: meniscus

text: of

text: the

text: right

text: knee

text: He

text: explicitly

text: stated

text: that

text: degenerative

text: joint

text: disease

text: was

text: not

text: found

text: in

text: the

text: Veteran

text: s

text: bilateral

text: knees

text: No

text: nexus

text: opinion

text: was

text: given

text: for

text: the

text: Veteran

text: s

text: lateral

text: meniscus

text: condition

text: In

text: December

text: the

text: Veteran

text: had

text: surgery

text: to

text: repair

text: a

text: lateral

text: meniscal

text: tear

text: and

text: to

text: replace

text: his

text: right

text: knee

text: ACL

text: The

text: Veteran

text: was

text: afforded

text: a

text: VA

text: examination

text: in

text: October

text: He

text: reported

text: having

text: surgery

text: for

text: an

text: ACL

text: replacement

text: of

text: the

text: right

text: knee

text: in

text: December

text: He

text: also

text: had

text: a

text: debridement

text: arthroscopy

text: of

text: the

text: right

text: knee

text: in

text: August

text: The

text: Veteran

text: reported

text: having

text: osteoarthritis

text: of

text: both

text: knees

text: with

text: an

text: onset

text: date

text: of

text: He

text: did

text: not

text: report

text: any

text: injury

text: In

text: December

text: the

text: Veteran

text: s

text: representative

text: contended

text: that

text: his

text: knees

text: were

text: injured

text: during

text: in

text: service

text: basic

text: training

text: involving

text: jumping

text: with

text: back

text: packs

text: and

text: crawling

text: on

text: his

text: knees

text: Once

text: VA

text: undertakes

text: the

text: effort

text: to

text: provide

text: an

text: examination

text: when

text: developing

text: a

text: service

text: connection

text: claim

text: even

text: if

text: not

text: statutorily

text: obligated

text: to

text: do

text: so

text: it

text: must

text: provide

text: an

text: adequate

text: one

text: See

text: Barr

text: v

text: Nicholson

text: Vet

text: App

text: As

text: the

text: July

text: VA

text: examination

text: did

text: not

text: address

text: the

text: etiology

text: of

text: the

text: Veteran

text: s

text: lateral

text: meniscus

text: tear

text: or

text: his

text: ACL

text: condition

text: a

text: new

text: examination

text: is

text: necessary

text: Every

text: Veteran

text: is

text: presumed

text: to

text: have

text: been

text: in

text: sound

text: condition

text: at

text: entry

text: into

text: service

text: except

text: as

text: to

text: defects

text: infirmities

text: or

text: disorders

text: noted

text: at

text: the

text: time

text: of

text: such

text: entry

text: or

text: where

text: clear

text: and

text: unmistakable

text: evidence

text: demonstrates

text: that

text: the

text: injury

text: or

text: disease

text: existed

text: before

text: entry

text: and

text: was

text: not

text: aggravated

text: by

text: such

text: service

text: U

text: S

text: C

text: A

text: The

text: term

text: noted

text: in

text: U

text: S

text: C

text: A

text: refers

text: to

text: o

text: nly

text: such

text: conditions

text: as

text: are

text: recorded

text: in

text: examination

text: reports

text: C

text: F

text: R

text: b

text: As

text: there

text: were

text: no

text: defects

text: infirmities

text: or

text: disorders

text: noted

text: at

text: entry

text: into

text: service

text: the

text: Veteran

text: s

text: right

text: knee

text: is

text: presumed

text: to

text: have

text: been

text: in

text: sound

text: condition

text: at

text: this

text: time

text: However

text: this

text: presumption

text: can

text: be

text: rebutted

text: by

text: clear

text: and

text: unmistakable

text: obvious

text: or

text: manifest

text: evidence

text: demonstrates

text: that

text: an

text: injury

text: or

text: disease

text: existed

text: prior

text: to

text: service

text: and

text: was

text: not

text: aggravated

text: by

text: such

text: service

text: C

text: F

text: R

text: b

text: In

text: August

text: a

text: VA

text: psychology

text: treatment

text: note

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text:
Citation Nr: 1710389
Decision Date: 03/28/17    Archive Date: 04/11/17

DOCKET NO.  12-12 279	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in St Paul Minnesota

THE ISSUE

Entitlement to service connection for a psychiatric disorder.

REPRESENTATION

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

ATTORNEY FOR THE BOARD

M. Taylor, Counsel

INTRODUCTION

The Veteran served on active duty from August 1970 to August 1974.

This matter comes before the Board of Veterans' Appeals (Board) from a March 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In October 2014, the Board remanded the case for further development.

Per the authority granted in 38 U.S.C.A. § 7109 and 38 C.F.R. § 20.901, the Board requested that a medical expert from the Veterans Health Administration (VHA) render an opinion regarding the potential relationship between a psychiatric disorder and service.  The VHA opinion and associated addendum were obtained in October 2016 and February 2017, respectively.

FINDINGS OF FACT

1.  The Veteran does meet the criteria for a diagnosis of posttraumatic stress disorder (PTSD).

2.  The Veteran's chronic adjustment disorder with depressed and anxious features is related to service.

CONCLUSIONS OF LAW

1.  The criteria for service connection for PTSD are not met.  38 U.S.C.A. §§ 1110, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2016).

2.  The criteria for service connection for chronic adjustment disorder with depressed and anxious features have been met.  38 U.S.C.A. §§ 1110, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2016).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

I.  Laws and Regulations

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303.  "To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement."  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Establishment of service connection for PTSD in particular 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).

A diagnosis of PTSD must be in conformance with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria.  Effective March 19, 2015, VA replaced outdated references with references to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

II.  Analysis

The Veteran seeks service connection for a psychiatric disorder.  He maintains that his variously diagnosed psychiatric disorder stems from the trauma of potentially being deployed to a combat zone in Vietnam while stationed in Japan during service in 1974.

Initially, the Board notes that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record.  Clemons v. Shinseki, 23 Vet. App. 1 (2009).  The Veteran specifically identified PTSD as the claimed disability in his December 2010 claim.  However, as noted in the Board's October 2014 remand, other potential psychiatric disorders reflected in the record result in a claim with a broader scope than solely PTSD.

The Veteran's DD FORM 214 reflects his military occupational specialty (MOS) is listed as "DSTE" (Digital Subscriber Terminal Equipment) maintenance repairman.  Although there is no indicia of service in Vietnam, five months and 19 days of foreign service is noted, and service treatment records document service in Japan.

Further, the June 1970 service entrance examination report shows that psychiatric evaluation was normal, and on the accompanying medical history, he denied having or having had depression or excessive worry and nervous trouble of any sort.  A January 1973 service treatment records reflects a diagnosis of chest wall syndrome secondary to anxiety.  In addition, the August 1974 separation examination report, which was accomplished at Yokota Air Base in Japan, reflects two episodes of chest pain diagnosed as chest wall syndrome secondary to anxiety, one of which was noted to have occurred in 1974.

Additionally, and although a December 2010 VA treatment record reflects an impression of PTSD based on the Veteran's detailed, self-report of numerous traumas experienced during alleged service in Vietnam, the July 2012 VA examiner clarified that the Veteran did not serve in Vietnam, noting the Veteran's admission that he never had orders to rebuild a damaged communication center in Vietnam.  "Instead, he states that his memories and nightmares are of the time he was stationed in Japan 'just sitting and waiting and anticipating you might get orders.'  It was noted that the Veteran recalled that he was fearful that he might be sent to Vietnam.

Moreover, both the July 2012 and February 2011 VA examiners specifically determined that the Veteran does not meet the criteria for a diagnosis of PTSD based upon clinical testing.  Although the Veteran's VA psychiatrist noted in April 2016 that the Veteran's psychiatric symptoms were related to his fear of deployment to high threat zones during service, with a corresponding daily fear of death, culminating in his current symptoms, which were noted to be very similar to those experienced in individuals with PTSD, the diagnosis entered was chronic adjustment disorder with depressed and anxious features, not PTSD.

The Board notes that although the Veteran is competent to report his symptoms, medical expertise is necessary to provide a diagnosis of any certain psychiatric disorder.  See, e.g., Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) ("PTSD is not the type of medical condition that lay evidence . . . is competent and sufficient to identify.").  Here, the probative evidence establishes that the Veteran neither served in Vietnam nor met the criteria for a diagnosis of PTSD at any time during the appeal period.  Thus, the Board finds that service connection for PTSD is not warranted.

With respect to diagnoses other than PTSD, and although a December 2011 letter from the Veteran's VA psychiatrist notes depressive disorder, not otherwise specified (NOS), the July 2012 VA examiner determined that the Veteran does not have a psychiatric disorder.  In addition, the February 2015 VA examination report reflecting a diagnosis of unspecified anxiety disorder notes that the conflict in the evidence made it difficult to determine whether the Veteran's psychiatric symptoms were related to service.  The examiner added that although the Veteran may believe that his symptoms are due to his experiences during service in Japan, he likely engages in significant misattribution.

On the other hand, in addition to chronic adjustment disorder with depressed and anxious features diagnosed by the Veteran's VA psychiatrist in April 2016 and noted to be related to service, the February 2017 VHA addendum opinion states that it is at least as likely as not that the Veteran's recurrent manifestations of anxiety have been exacerbated by service, at least in part.  To the extent that the February 2017 VHA addendum opinion raises the possibility of a psychiatric disability existing prior to service entrance, in the absence of clear and unmistakable evidence showing that a psychiatric disorder existed prior to service entrance and was not aggravated by such service, the presumption of soundness at service entrance is not rebutted.  See 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304(b); see also Gilbert v. Shinseki, 26 Vet. App. 48 (2012).

The evidence is in at least equipoise with respect to service connection for chronic adjustment disorder with depressed and anxious features and, when resolving all reasonable doubt in the Veteran's favor, the Board finds that the Veteran has chronic adjustment disorder with depressed and anxious features related to service.  See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102.  As such, service connection for a psychiatric disorder, best characterized as chronic adjustment disorder with depressed and anxious features, is warranted.

ORDER

Service connection for PTSD is denied.

Service connection for chronic adjustment disorder with depressed and anxious features is granted.

____________________________________________
RYAN T. KESSEL
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: DATE

text: On

text: appeal

text: from

text: the

text: Department

text: of

text: Veterans

text: Affairs

text: Regional

text: Office

text: in

text: St

text: Paul

text: Minnesota

text: THE

text: ISSUE

text: Entitlement

text: to

text: service

text: connection

text: for

text: a

text: psychiatric

text: disorder

text: REPRESENTATION

text: Veteran

text: represented

text: by

text: Veterans

text: of

text: Foreign

text: Wars

text: of

text: the

text: United

text: States

text: ATTORNEY

text: FOR

text: THE

text: BOARD

text: M

text: Taylor

text: Counsel

text: INTRODUCTION

text: The

text: Veteran

text: served

text: on

text: active

text: duty

text: from

text: August

text: to

text: August

text: This

text: matter

text: comes

text: before

text: the

text: Board

text: of

text: Veterans

text: Appeals

text: Board

text: from

text: a

text: March

text: rating

text: decision

text: of

text: the

text: Department

text: of

text: Veterans

text: Affairs

text: VA

text: Regional

text: Office

text: RO

text: In

text: October

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text: Board

text: remanded

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text: case

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text: render

text: an

text: opinion

text: regarding

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text: potential

text: relationship

text: between

text: a

text: psychiatric

text: disorder

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text: service

text: The

text: VHA

text: opinion

text: and

text: associated

text: addendum

text: were

text: obtained

text: in

text: October

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text: respectively

text: FINDINGS

text: OF

text: FACT

text: The

text: Veteran

text: does

text: meet

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text: criteria

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text: diagnosis

text: of

text: posttraumatic

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text: PTSD

text: The

text: Veteran

text: s

text: chronic

text: adjustment

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text: with

text: depressed

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text: anxious

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text: is

text: related

text: to

text: service

text: CONCLUSIONS

text: OF

text: LAW

text: The

text: criteria

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text: PTSD

text: are

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text: REASONS

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text: Board

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text: discussion

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text: contentions

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text: case

text: as

text: raised

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text: the

text: Veteran

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text: Edition

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text: Analysis

text: The

text: Veteran

text: seeks

text: service

text: connection

text: for

text: a

text: psychiatric

text: disorder

text: He

text: maintains

text: that

text: his

text: variously

text: diagnosed

text: psychiatric

text: disorder

text: stems

text: from

text: the

text: trauma

text: of

text: potentially

text: being

text: deployed

text: to

text: a

text: combat

text: zone

text: in

text: Vietnam

text: while

text: stationed

text: in

text: Japan

text: during

text: service

text: in

text: Initially

text: the

text: Board

text: notes

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text: scope

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text: Veteran

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text: a

text: claim

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text: a

text: broader

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text: solely

text: PTSD

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text: Veteran

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text: DD

text: FORM

text: reflects

text: his

text: military

text: occupational

text: specialty

text: MOS

text: is

text: listed

text: as

text: DSTE

text: Digital

text: Subscriber

text: Terminal

text: Equipment

text: maintenance

text: repairman

text: Although

text: there

text: is

text: no

text: indicia

text: of

text: service

text: in

text: Vietnam

text: five

text: months

text: and

text: days

text: of

text: foreign

text: service

text: is

text: noted

text: and

text: service

text: treatment

text: records

text: document

text: service

text: in

text: Japan

text: Further

text: the

text: June

text: service

text: entrance

text: examination

text: report

text: shows

text: that

text: psychiatric

text: evaluation

text: was

text: normal

text: and

text: on

text: the

text: accompanying

text: medical

text: history

text: he

text: denied

text: having

text: or

text: having

text: had

text: depression

text: or

text: excessive

text: worry

text: and

text: nervous

text: trouble

text: of

text: any

text: sort

text: A

text: January

text: service

text: treatment

text: records

text: reflects

text: a

text: diagnosis

text: of

text: chest

text: wall

text: syndrome

text: secondary

text: to

text: anxiety

text: In

text: addition

text: the

text: August

text: separation

text: examination

text: report

text: which

text: was

text: accomplished

text: at

text: Yokota

text: Air

text: Base

text: in

text: Japan

text: reflects

text: two

text: episodes

text: of

text: chest

text: pain

text: diagnosed

text: as

text: chest

text: wall

text: syndrome

text: secondary

text: to

text: anxiety

text: one

text: of

text: which

text: was

text: noted

text: to

text: have

text: occurred

text: in

text: Additionally

text: and

text: although

text: a

text: December

text: VA

text: treatment

text: record

text: reflects

text: an

text: impression

text: of

text: PTSD

text: based

text: on

text: the

text: Veteran

text: s

text: detailed

text: self

text: report

text: of

text: numerous

text: traumas

text: experienced

text: during

text: alleged

text: service

text: in

text: Vietnam

text: the

text: July

text: VA

text: examiner

text: clarified

text: that

text: the

text: Veteran

text: did

text: not

text: serve

text: in

text: Vietnam

text: noting

text: the

text: Veteran

text: s

text: admission

text: that

text: he

text: never

text: had

text: orders

text: to

text: rebuild

text: a

text: damaged

text: communication

text: center

text: in

text: Vietnam

text: Instead

text: he

text: states

text: that

text: his

text: memories

text: and

text: nightmares

text: are

text: of

text: the

text: time

text: he

text: was

text: stationed

text: in

text: Japan

text: just

text: sitting

text: and

text: waiting

text: and

text: anticipating

text: you

text: might

text: get

text: orders

text: It

text: was

text: noted

text: that

text: the

text: Veteran

text: recalled

text: that

text: he

text: was

text: fearful

text: that

text: he

text: might

text: be

text: sent

text: to

text: Vietnam

text: Moreover

text: both

text: the

text: July

text: and

text: February

text: VA

text: examiners

text: specifically

text: determined

text: that

text: the

text: Veteran

text: does

text: not

text: meet

text: the

text: criteria

text: for

text: a

text: diagnosis

text: of

text: PTSD

text: based

text: upon

text: clinical

text: testing

text: Although

text: the

text: Veteran

text: s

text: VA

text: psychiatrist

text: noted

text: in

text: April

text: that

text: the

text: Veteran

text: s

text: psychiatric

text: symptoms

text: were

text: related

text: to

text: his

text: fear

text: of

text: deployment

text: to

text: high

text: threat

text: zones

text: during

text: service

text: with

text: a

text: corresponding

text: daily

text: fear

text: of

text: death

text: culminating

text: in

text: his

text: current

text: symptoms

text: which

text: were

text: noted

text: to

text: be

text: very

text: similar

text: to

text: those

text: experienced

text: in

text: individuals

text: with

text: PTSD

text: the

text: diagnosis

text: entered

text: was

text: chronic

text: adjustment

text: disorder

text: with

text: depressed

text: and

text: anxious

text: features

text: not

text: PTSD

text: The

text: Board

text: notes

text: that

text: although

text: the

text: Veteran

text: is

text: competent

text: to

text: report

text: his

text: symptoms

text: medical

text: expertise

text: is

text: necessary

text: to

text: provide

text: a

text: diagnosis

text: of

text: any

text: certain

text: psychiatric

text: disorder

text: See

text: e

text: g

text: Young

text: v

text: McDonald

text: F

text: d

text: Fed

text: Cir

text: PTSD

text: is

text: not

text: the

text: type

text: of

text: medical

text: condition

text: that

text: lay

text: evidence

text: is

text: competent

text: and

text: sufficient

text: to

text: identify

text: Here

text: the

text: probative

text: evidence

text: establishes

text: that

text: the

text: Veteran

text: neither

text: served

text: in

text: Vietnam

text: nor

text: met

text: the

text: criteria

text: for

text: a

text: diagnosis

text: of

text: PTSD

text: at

text: any

text: time

text: during

text: the

text: appeal

text: period

text: Thus

text: the

text: Board

text: finds

text: that

text: service

text: connection

text: for

text: PTSD

text: is

text: not

text: warranted

text: With

text: respect

text: to

text: diagnoses

text: other

text: than

text: PTSD

text: and

text: although

text: a

text: December

text: letter

text: from

text: the

text: Veteran

text: s

text: VA

text: psychiatrist

text: notes

text: depressive

text: disorder

text: not

text: otherwise

text: specified

text: NOS

text: the

text: July

text: VA

text: examiner

text: determined

text: that

text: the

text: Veteran

text: does

text: not

text: have

text: a

text: psychiatric

text: disorder

text: In

text: addition

text: the

text: February

text: VA

text: examination

text: report

text: reflecting

text: a

text: diagnosis

text: of

text: unspecified

text: anxiety

text: disorder

text: notes

text: that

text: the

text: conflict

text: in

text: the

text: evidence

text: made

text: it

text: difficult

text: to

text: determine

text: whether

text: the

text: Veteran

text: s

text: psychiatric

text: symptoms

text: were

text: related

text: to

text: service

text: The

text: examiner

text: added

text: that

text: although

text: the

text: Veteran

text: may

text: believe

text: that

text: his

text: symptoms

text: are

text: due

text: to

text: his

text: experiences

text: during

text: service

text: in

text: Japan

text: he

text: likely

text: engages

text: in

text: significant

text: misattribution

text: On

text: the

text: other

text: hand

text: in

text: addition

text: to

text: chronic

text: adjustment

text: disorder

text: with

text: depressed

text: and

text: anxious

text: features

text: diagnosed

text: by

text: the

text: Veteran

text: s

text: VA

text: psychiatrist

text: in

text: April

text: and

text: noted

text: to

text: be

text: related

text: to

text: service

text: the

text: February

text: VHA

text: addendum

text: opinion

text: states

text: that

text: it

text: is

text: at

text: least

text: as

text: likely

text: as

text: not

text: that

text: the

text: Veteran

text: s

text: recurrent

text: manifestations

text: of

text: anxiety

text: have

text: been

text: exacerbated

text: by

text: service

text: at

text: least

text: in

text: part

text: To

text: the

text: extent

text: that

text: the

text: February

text: VHA

text: addendum

text: opinion

text: raises

text: the

text: possibility

text: of

text: a

text: psychiatric

text: disability

text: existing

text: prior

text: to

text: service

text: entrance

text: in

text: the

text: absence

text: of

text: clear

text: and

text: unmistakable

text: evidence

text: showing

text: that

text: a

text: psychiatric

text: disorder

text: existed

text: prior

text: to

text: service

text: entrance

text: and

text: was

text: not

text: aggravated

text: by

text: such

text: service

text: the

text: presumption

text: of

text: soundness

text: at

text: service

text: entrance

text: is

text: not

text: rebutted

text: See

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: b

text: see

text: also

text: Gilbert

text: v

text: Shinseki

text: Vet

text: App

text: The

text: evidence

text: is

text: in

text: at

text: least

text: equipoise

text: with

text: respect

text: to

text: service

text: connection

text: for

text: chronic

text: adjustment

text: disorder

text: with

text: depressed

text: and

text: anxious

text: features

text: and

text: when

text: resolving

text: all

text: reasonable

text: doubt

text: in

text: the

text: Veteran

text: s

text: favor

text: the

text: Board

text: finds

text: that

text: the

text: Veteran

text: has

text: chronic

text: adjustment

text: disorder

text: with

text: depressed

text: and

text: anxious

text: features

text: related

text: to

text: service

text: See

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: As

text: such

text: service

text: connection

text: for

text: a

text: psychiatric

text: disorder

text: best

text: characterized

text: as

text: chronic

text: adjustment

text: disorder

text: with

text: depressed

text: and

text: anxious

text: features

text: is

text: warranted

text: ORDER

text: Service

text: connection

text: for

text: PTSD

text: is

text: denied

text: Service

text: connection

text: for

text: chronic

text: adjustment

text: disorder

text: with

text: depressed

text: and

text: anxious

text: features

text: is

text: granted

text: RYAN

text: T

text: KESSEL

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs

source: bva