Citation Nr: 18131289
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 15-38 094
DATE:	August 31, 2018
ORDER
Service connection for an acquired psychiatric disorder, diagnosed as unspecified depressive disorder, is granted.
Service connection for residuals of a traumatic brain injury (TBI), to include headaches and mild cognitive impairment with memory loss, is granted.
FINDINGS OF FACT
1. Unspecified depressive disorder was incurred in service.
2. Residuals of a TBI, to include headaches and mild cognitive impairment with memory loss, were incurred in service.
CONCLUSIONS OF LAW
1. The criteria for service connection for unspecified depressive disorder are met.  38 U.S.C. §§ 1110, 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017).
2. The criteria for service connection for residuals of a TBI, to include headaches and mild cognitive impairment with memory loss, are met.  38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from May 1988 to May 1997, commendations include the Southwest Asia Service Medal.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from June 2013 and April 2014 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Newark, New Jersey.
In February 2018, the Board granted service connection for sleep apnea and remanded the issues of entitlement to service connection for residuals of a TBI and a psychiatric disorder.
In June 2018, the Board requested a medical expert opinion from the Veterans Health Administration, which was provided in August 2018.  
This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2017).  38 U.S.C. § 7107(a)(2) (2012).

Service Connection
The Veteran seeks service connection for an acquired psychiatric disorder and residuals of a TBI.  He reports memory loss, headaches, difficulty concentrating, and depression since an in-service motor vehicle accident.  See, e.g., Claim (August 2, 2013).  Prior to service, the Veteran was an average student and did not experience any disciplinary problems.  See, e.g., VA examination (May 2013).
Service treatment records confirm that the Veteran suffered loss of consciousness and mild concussive symptoms following a motor vehicle accident.  See, e.g., Private treatment records (November 26, 1996).  Several days after the accident, clinicians noted that the Veteran reported symptoms suggestive of depression.  See, e.g., STR (December 18, 1996).  Upon separation from service in May 1997, the Veteran reported frequent, severe headaches and a head injury.
In November 1999, the Veteran reported flashbacks of the Gulf War and his shipmate being attacked.  See Statement (November 18, 1999).  In 1999, he began to experience legal trouble; in 2000, he quit working; in 2001, he began to use drugs; and in 2003, he began receiving mental health treatment.  See VA examination (May 2013); see also VA treatment record (August 7, 2012) (diagnosing PTSD and polysubstance abuse).
In August 2012 and May 2013, VA examiners ruled out a diagnosis of PTSD and diagnosed polysubstance abuse, in remission.  The May 2013 VA examiner opined that the Veteran’s past psychiatric symptoms were likely due to his drug use and legal problems and that his symptoms have remitted since stabilization of his housing and abstention from drugs.
In May 2013, a VA clinician diagnosed depressive disorder.
In September 2013, a VA neurological examiner opined that while the Veteran suffered a mild TBI in service, he likely made a complete recovery.  The examiner further opined that the Veteran’s reported TBI residuals are likely the result of psychosocial and other disturbances unrelated to the head trauma.
The Board finds that the May 2013 and September 2013 opinions that the Veteran’s post-service drug and legal problems caused his psychiatric and TBI symptoms appears to have been predicated on the inaccurate factual premise that these symptoms manifested after the Veteran’s drug and legal problems.  In this regard, the evidence indicates that the Veteran’s symptoms of memory loss, headaches, difficulty concentrating, and depression began after his 1996 motor vehicle accident and prior to his drug and legal problems.
In March 2018, a VA neurologist opined that the Veteran’s current symptoms of memory loss, headaches, difficulty concentrating, and depression are less likely than not related to his in-service TBI.  The examiner explained that the Veteran’s in-service head injury resulted in a mild concussion, an injury that did not require hospital admission.  The examiner further explained that a complete clinical recovery from such trauma would be expected and such recovery likely occurred in this case.  The examiner concluded that this minor traumatic event is not a plausible explanation for the Veteran’s subsequent psychosocial problems or for the symptoms he continues to experience.
The Board finds that while the March 2018 neurologist addressed whether the Veteran’s current TBI residuals (memory loss, headaches, difficulty concentrating) are related to his in-service TBI, he did not address the Veteran’s credible report he has had such symptoms since service.  In other words, while the examiner opined that the current disabilities are not related to the in-service TBI, he did not address whether the current symptoms/disorders had their onset in service or are otherwise related to service.  An opinion to this effect is significant in light of the documented reports of depression and headaches in service.
In June 2018, the Board requested a medical expert opinion from the Veterans Health Administration.  In response to the Board’s request, in August 2018, the Chief of Mental Health Services of a VA Medical Center found that evidence sufficiently establishes that the Veteran suffers from unspecified depressive disorder and mild cognitive impairment with memory loss.  The expert opined that it is at least as likely as not that the unspecified depressive disorder and mild cognitive impairment with memory loss the had their onset in service.  The expert explained that service treatment records show that the Veteran initially complained of memory loss, headaches, difficulty concentrating, and depression in service, and that there is no evidence of cognitive impairment prior to his service.
The Board affords significant probative value to the expert’s opinion as it is based upon all evidence of record, to include the Veteran's statements, prior medical history, and examinations.  Additionally, the expert provided clear conclusions with supporting data, as well as a reasoned medical explanation connecting the two. 
After resolving any doubt in the Veteran’s favor, the Board finds that the Veteran’s competent, credible report of memory loss, headaches, difficulty concentrating, and depression since his documented in-service TBI, coupled with the August 2018 expert medical opinion, the evidence establishes that his current unspecified depressive disorder and residuals of a TBI, to include headaches and mild cognitive impairment with memory loss, were incurred in service.  Accordingly, service connection is warranted.
 
STEVEN D. REISS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Joshua Castillo, Counsel 
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