Citation Nr: 18131299
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 14-29 350
DATE:	August 31, 2018
ORDER
Service connection for a psychiatric disability, to include adjustment disorder with disturbance of mood and conduct is granted.
REMANDED
Entitlement to service connection for hepatitis C is remanded.
Entitlement to service connection for hypertension, to include as secondary to service-connected adjustment disorder with disturbance of mood and conduct is remanded.
FINDINGS OF FACT
1. The Veteran’s adjustment disorder with disturbance of mood and conduct had its onset in service.
CONCLUSIONS OF LAW
1. The criteria for service connection for a psychiatric disability, to include adjustment disorder with mood disturbance and conduct, have been met.  38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty in the United States Air Force from April 1971 to October 1972.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) Roanoke, Virginia.  The Veteran presented sworn testimony at a hearing before the undersigned in January 2018.
The Board expanded the Veteran’s claim of service connection for PTSD to encompass all acquired psychiatric disorders.  Clemons v. Shinseki, 23 Vet. App. 1 (2009) (when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled).
Entitlement to service connection for an acquired psychiatric disability, to include adjustment disorder with disturbance of mood and conduct.
The Board finds that service connection for an acquired psychiatric disability, to include adjustment disorder with disturbance of mood and conduct is warranted.  Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability).  See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a).  
In this case, the evidence shows that the Veteran was diagnosed with adjustment disorder with disturbance of mood and conduct by his April 2018 private examiner.  See April 2018 Private Examination Report.  At the January 2018 Board Hearing, the Veteran competently and credibly testified that, during service, he was physically assaulted by a person that he testified against in court, endured repeated taunts and racial slurs for his fellow officers, and was mocked by his commanding officers and fellow officers for his intellectual disabilities.  See January 2018 Hearing Transcript at 10, 11; see also April 2018 Private Examination Report at 4.  The Veteran has a full-scale IQ of 59, and adaptive functioning consistent with such a score, placing him firmly in the mildly intellectual disabled category.  See April 2018 Private Examination Report at 3.  In April 2018, his private examiner opined that it is at least as likely as not the Veteran’s adjustment order with disturbance of mood began during the course of his military service.  This opinion is based on a review of the Veteran’s relevant medical history, and the Board finds the opinion highly probative.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).  Thus, all three elements necessary to establish service connection have been met.  
The Board notes, the Veteran has a history of multiple diagnoses; however, the April 2018 private examiner determined, that the Veteran’s previously diagnosed bipolar disorder is not evidenced when his sobriety is maintained and his polysubstance dependence is in remission.  See April 2018 Private Examination Report at 6.  Additionally, at his January 2018 Board hearing, the Veteran testified that a grant of service connection for any psychiatric disability, regardless of diagnosis, would constitute a full grant of the Veteran’s expanded psychiatric disability claim.
REASONS FOR REMAND
1. Entitlement to service connection for hepatitis C is remanded.
At the January 2018 Board hearing, the Veteran testified that he may have contracted hepatitis during an in-service air gun inoculation.  Additionally, he testified that when he filled out his 2011 risk factor for hepatitis C questionnaire, he answered “no” to virtually all of the questions, except for “have you used intranasal cocaine?”  The Veteran should be afforded a VA examination to determine whether service connection is warranted on this basis.  McLendon v. Nicholson, 20 Vet. App. 79 (2006).
2.  Entitlement to service connection for hypertension, to include as secondary to service-connected adjustment disorder with disturbance of mood and conduct.
At the January 2018 Board hearing, the Veteran testified that he believed he developed hypertension, secondary to his service-connected adjustment disorder with disturbance of mood and conduct.   He reported that he is constantly in a state of anxiety, has a lot of trouble dealing with day-to-day life, that this is linked to his service-connected adjustment disorder, and as a result, he developed hypertension.  Accordingly, the Veteran should be afforded a VA examination to determine whether his hypertension had its onset in service or is otherwise related to service, or whether it is secondary to his service-connected adjustment disorder with disturbance of mood.    
The matter is REMANDED for the following action:
1. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service hepatitis C or hypertension symptomatology.  The Veteran should be provided an appropriate amount of time to submit this lay evidence.
2. Schedule the Veteran for appropriate VA examinations to determine the nature and etiology of his symptoms of hepatitis C and hypertension, to include as secondary to his service-connected adjustment disorder.  The examiner is asked to review the pertinent evidence, including the Veteran’s lay assertions regarding his symptomatology, and undertake any indicated studies.  Then, based on the results of the examination, the examiner is asked to address each of the following questions:
Hepatitis C:
a)	Is it at least as likely as not that the Veteran’s hepatitis C had its onset during service or is otherwise related to service?  The examiner should specifically consider and discuss the Veteran’s contention that he contracted hepatitis C from air gun inoculation in-service.
b)	 Is it at least as likely as not that the Veteran’s hepatitis C was caused by an in-service air gun inoculation?  
c)	Is it at least as likely that the Veteran’s hepatitis C was caused by his psychiatric disability?
d)	Is it at least as likely as not that the Veteran’s hepatitis C was aggravated (made permanently worse or increased in severity) by an in-service air gun inoculation?  If yes, was that increase in severity due to the natural progress of the disease?
The examiner should provide a complete rationale or explanation for all opinions reached.
Hypertension:
a)	Is it at least as likely as not that the Veteran’s hypertension had its onset in service or manifested within one year of separation from service?    
b)	Is it at least as likely as not that the Veteran’s hypertension is otherwise related to service?  
c)	Is it at least as likely as not that the Veteran’s hypertension is caused by his service-connected adjustment disorder with disturbance of mood and conduct?    
d)	Is it at least as likely as not that the Veteran’s hypertension is aggravated (made permanently worse or increased in severity) by his service-connected adjustment disorder with disturbance of mood and conduct?   If yes, was that increase in severity due to the natural progress of the disease? 
The examiner should provide a complete rationale or explanation for all opinions reached.
 
STEVEN D. REISS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Jacquelynn M. Jordan, Associate Counsel 

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

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