BVA9500836 DOCKET NO. 93-02 066 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to service connection for an acquired psychiatric disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Raymond F. Ferner, Counsel INTRODUCTION This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a March 1992 rating decision of the Department of Veterans Affairs (VA) Regional Office in Muskogee, Oklahoma (RO). The veteran, who had active service from March 1954 to April 1964, appealed that decision to the BVA, and the case was initially received at the Board in January 1993. A BVA decision dated in October 1993, which determined that new and material evidence had been submitted which was sufficient to reopen a previously denied claim for service connection for a psychiatric disorder, remanded this case for further development, and the case was returned to the Board in April 1994. CONTENTIONS OF APPELLANT ON APPEAL The veteran essentially contends that the RO was incorrect in not granting the benefit sought on appeal. The veteran maintains, in substance, that he had the onset of an acquired psychiatric disorder during service. It is asserted that while the veteran was diagnosed as having a personality disorder during service, symptomatology associated with that disorder was actually an early manifestation of the acquired psychiatric disorder diagnosed following service. Reference is made to the evidence of record as supporting these contentions. Therefore, a favorable determination has been requested. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed all of the evidence of record. Based on a review of the evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim for service connection for an acquired psychiatric disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. An acquired psychiatric disorder was not manifested during service. 3. An acquired psychiatric disorder which is related to service has not been shown following service. CONCLUSION OF LAW An acquired psychiatric disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). That is, the Board finds that the veteran has presented a claim which is not implausible when his contentions and the evidence of record are viewed in the light most favorable to that claim. The Board is also satisfied that all relevant facts have been properly and sufficiently developed. The Board would also note that while previous rating decisions had denied service connection for a psychiatric disorder, the Board's prior remand determined that the additional evidence submitted in connection with the reopened claim was new and material and sufficient to reopen the previously denied claim. See 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1993). See also Manio v. Derwinski, 1 Vet.App. 140 (1991). As such, the veteran's claim will be reviewed based on all of the evidence of record. The veteran's service medical records show that while on active duty he was diagnosed as having a personality disorder, rather than an acquired psychiatric disorder. This is significant because a personality disorder is not a disability for which service connection may be granted. See 38 C.F.R. §§ 3.303(c), 4.9, 4.127 (1993). Service medical records disclose that a January 1960 psychological evaluation did not diagnose the veteran as having an acquired psychiatric disorder, and while the veteran was referred for a neuropsychiatric consultation in October 1963 because of "nerves" and depressive symptomatology towards the Air Force and his wife, that consultation apparently resulted in a diagnosis of an inadequate personality disorder. That diagnosis was contained on a March 1964 Medical Board Report and on records of a hospitalization of the veteran performed in conjunction with that Medical Board Report. Following service, a VA examination performed in June 1964 concluded with a diagnosis of an inadequate personality and/or emotional instability. A June 1970 statement from William R. Moore, M.D., indicated that the veteran had been totally incapacitated since early June 1970 with anxiety-depression, and a July 1970 statement from Gordon L. Bates, Ph.D., who had provided treatment of the veteran under the supervision of Dr. Moore, indicated that the veteran was experiencing a severe anxiety reaction with some paranoid trends which appeared to be largely associated with feelings of persecution and maltreatment on his job. Statements dated in July and September 1970 from Moorman P. Prosser, M.D., relate that the veteran suffered from nervousness, and had been completely incapacitated since early June 1970, although Dr. Prosser's September 1970 letter indicates the veteran had been nervous prior to that date. In a November 1974 letter Dr. Prosser relates that the veteran was first seen because of nervousness associated with physical disabilities. Dr. Prosser went on to state that "While the disorder was termed that of an inadequate personality, subsequent observations have demonstrated that we are actually looking at a chronic emotional disorder which has increased through the years and periodically has been almost completely disabling by reason of the paranoid features that appear....His nervousness has been manifested by rather profound anxiety with hyper-irritability, and sometimes hyper-sensitivity to an alarming degree; and periods of hyperkinesis with strong paranoid coloring. Interspersed are episodes of depression that follows a rather cyclothymic pattern, and which I think was not really evidencing itself during military service, but was not followed long enough to make a proper diagnosis." A January 1991 letter from Joe G. Savage, M.D., apparently written for a Civil Service personnel matter, offered an opinion that the veteran suffered from a chronic dysthymic disorder with rather marked periods of mood swings and that he was somewhat paranoid, irritable, nervous and unable to work with others for a very long period of time without becoming quite distraught. In a subsequent letter dated in May 1992, Dr. Savage stated that the veteran most likely fit the diagnosis of a manic-depressive illness, and essentially, that the illness was first manifested during service. VA examinations performed in February 1992, and pursuant to the Board's remand in this case in November 1993, both concluded that the veteran had a personality disorder. Although the examiner who performed the February 1992 examination appears to question whether the veteran had a bipolar disorder, he specifically stated that he was "not making a diagnosis" of a bipolar disorder. The examiner concluded that all of the evaluations indicated the presence of a personality disorder "and I really don't feel I've got the data to refute that at this time." Nevertheless, given the opinion of the private physician, the Board requested an additional examination of the veteran. Following the second VA examination, which included a review of the pertinent medical records in the veteran's claims file, the diagnostic impression was of a personality disorder with narcissistic, dependent and paranoid features. The examiner concluded that: "Based on the information in the C-file and from this evaluation, it is my OPINION that this veteran's current psychiatric problems are related to his inadequate personality. The inadequate personality is a lifelong situation and preceded his military service. His inadequate personality which was diagnosed in the service is a sufficient explanation for his rather lifelong psychiatric problems." Based on the medical evidence for consideration by the Board, it is apparent that the bulk of the medical evidence, and indeed the greater weight of the evidence demonstrates that the veteran had a personality disorder during service and that he is not currently shown to have an acquired psychiatric disorder which is in any way related to service. In this regard, the Board would note that the psychiatric symptomatology the veteran manifested prior to 1974 was either diagnosed as a personality disorder or psychiatric symptomatology associated with physical injury sustained in a motor vehicle accident. Private medical records dated in November 1974 beginning with the statement from Dr. Prosser begin to suggest a relationship between post service psychiatric symptomatology and the veteran's period of military service. But it is significant that even Dr. Prosser's November 1974 letter does not appear to question the diagnosis made during service of an inadequate personality and appears to concede that the psychiatric symptomatology manifested following service was not really evidencing itself during military service, but rather that the veteran was not followed long enough during service to make a proper diagnosis. However, the Board would note that the veteran performed over 10 years of military service without any evidence of episodes of depression followed by a rather cyclothymic pattern described by the veteran's private physician. The Board would also note that the statements from Dr. Savage contained differing diagnoses in that in the January 1991 letter he refers to the veteran as having a chronic dysthymic disorder and in the May 1992 letter refers to the veteran as having a bipolar illness. It is noteworthy that Dr. Savage does not appear to have had the benefit of a review of the veteran's service medical records and other information in the veteran's claims file, although the later dated letter from him refers to some service personnel records the veteran had provided for his review. The Board would note that the January 1991 letter incorrectly refers to the veteran as being service connected for obesity and that he had a back disability he suffered during service which was largely ignored, but recorded. A review of pertinent records would disclose that the veteran received treatment and evaluations for his back disability during service, as well as following service, and that the veteran has been awarded compensation for that disability from the VA since 1964. For these reasons, the Board finds that the veteran's service medical records and VA medical records, particularly the most recent VA examination performed in November 1993 had greater probative value then records received from the veteran's private physicians. Those records show that the veteran manifested a personality disorder during and following service, and that any acquired psychiatric disorder shown following service is unrelated to psychiatric symptomatology shown during service. Accordingly, service connection for an acquired psychiatric disorder is not established. ORDER Service connection for an acquired psychiatric disorder is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.