BVA9508314 DOCKET NO. 93-14 134 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include a personality disorder, post traumatic stress disorder (PTSD) and a somatoform disorder. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD Christopher P. Kissel, Associate Counsel INTRODUCTION The appellant served on active duty from April 1944 to May 1946, from November 1950 to September 1952, and from January 1959 to August 1961. This case comes before the Board of Veterans' Appeals (the Board) on appeal from December 1992, rating decision of the Des Moines, Iowa, Department of Veterans Affairs Regional Office (VARO). CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in substance, that he suffers from a psychiatric disorder which is related to his military service experience. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file(s). Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that a preponderance of the evidence supports the appellant's claim seeking entitlement to service connection for an acquired psychiatric disorder, specifically, an adjustment disorder with anxious features and a somatoform disorder. FINDINGS OF FACT 1. Service medical records reflect a period of hospitalization in April 1961, for evaluation of the appellant's complaints of nervousness for the past few months; a diagnosis of anxiety reaction manifested by anxiety, hypochondriacal complaints, restlessness and a state of tension was established at that time. 2. During a period of VA hospitalization in April 1992, it was indicated that there existed an "anxiety component" to the appellant's multiple physical complaints and illnesses. 3. On VAX in November 1992, the examining VA psychiatrist found no clinical evidence to support a diagnosis of PTSD; however, an adjustment disorder with anxious features was diagnosed based on the appellant's symptoms and the results of mental status examination. 4. Psychological testing completed in conjunction with the November 1992, VAX resulted in a diagnosis of somatoform disorder. CONCLUSION OF LAW The evidence of record establishes that an acquired psychiatric disorder, presently diagnosed as an adjustment disorder with anxious features and a somatoform disorder, was incurred in service. 38 U.S.C.A. §§ 1131, 5107(b) (West 1991); 38 C.F.R. §§ 3.303(b), (d) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v. Derwinski, 1 Vet.App. 78 (1990). Furthermore, the undersigned believes that this case has been adequately developed for appellate purposes by VARO and that a disposition on the merits is now in order. The appellant is seeking service connection for an acquired psychiatric disorder which he believes was incurred during military service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Under pertinent law and VA regulations, service connection may be granted if symptomatology attributable to an acquired psychiatric disorder appeared during service or, in the case of psychosis, the disability is manifested to a compensable degree within one year thereafter. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1994). Service medical records for the appellant's first (1944-46) and second (1950-52) periods of service are negative for any specific complaints, findings, or diagnoses of a psychiatric disorder. Further, with respect to his first and second periods of service, there is no record of in-service physical limitations, treatment/medication regimen, or period of hospitalization of any psychiatric disorders. However, during his third and final period of military service (1956-61), the appellant was treated on multiple occasions for complaints of abdominal pains for which no clear-cut etiology was established. In April 1961, he was hospitalized for evaluation of his complaints of nervousness for the past few months and diagnosed with an anxiety reaction manifested by anxiety, hypochondriacal complaints, restlessness and a state of tension. Subsequently, in June 1961, he was hospitalized for an amnesia episode for which a final diagnosis of emotional instability reaction was established. He was recommended for separation from military service on the basis of unsuitability due to the aforementioned diagnosis. A Board of Medical Survey concluded in July 1961, that "... this patient suffers from a personality disorder of emotionally unstable type which renders him unsuitable for further service in the U. S. Navy." Medical records which are dated in the post service periods reflect treatment primarily for multiple physical conditions, including diabetes mellitus and atherosclerotic heart disease. While there is no evidence showing any actual inpatient or outpatient treatment for complaints of psychiatric illness or anxiety in the years soon after the appellant's third and final period of service, the record reflects that the appellant was hospitalized in February 1948, at a VA medical facility and diagnosed with a "psychogenic reaction" of the gastrointestinal (GI) tract, manifested by vomiting. He related at that time a history of episodic GI upset with vomiting since 1945. Similar to that which was indicated above relative to his abdominal pain complaints treated in service in 1959, clinical findings during his hospitalization in 1948 failed to reveal any intrinsic pathology for his GI upset complaints. More recently, during a period of VA hospitalization in April 1992, it was indicated that there existed an "anxiety component" to the appellant's multiple physical complaints and illnesses. Clonopin was prescribed at that time for treatment purposes with effective results. A diagnosis of "anxiety with adjustment disorder" was established upon hospital discharge. In connection with his claim for service connection, the appellant was examined on VA compensation examination (VAX) in November 1992. A special PTSD evaluation was conducted in conjunction with the VAX and it was indicated that the appellant failed to meet the criteria for a diagnosis of PTSD, based on his reported combat experiences in World War II, the relevant medical history and the results of mental status examination. However, the examining VA psychiatrist diagnosed his condition as an "adjustment disorder with anxious features," stating "[t]he patient gives a history of anxiety occurring for some time now which may, in fact, have occurred at some point in time while in the service." Psychological testing on VAX in November 1992, also found no basis for a diagnosis of PTSD; however, it was indicated that his complaints and results of testing suggested the presence of "... a conversion reaction or some other type of somatoform disorder." Following his review of the psychological testing results, the examining VA psychiatrist reported no change in his diagnosis of adjustment disorder with anxious features. Initially, the Board notes that personality disorders are not considered to be diseases within the meaning of applicable legislation providing VA disability compensation benefits. 38 C.F.R. § 3.303(c) (1994). Moreover, a confirmed diagnosis of PTSD has not been established. Therefore, service connection for a personality disorder or PTSD is not warranted. In the opinion of the Board, the medical evidence of record establishes that an acquired psychiatric disorder, presently diagnosed as an adjustment disorder with anxiety features and a somatoform disorder, had its onset in service. The diagnosis established on VAX in November 1992, as formulated by the above- cited opinions of a VA psychiatrist and a VA clinical psychologist, provides reasonable inference placing the onset of this disease in service. Although these medical examiners did not have the benefit of review of the appellant's claims file, his reported medical history provided on VAX in 1992 is essentially corroborated by that which is demonstrated by the evidence of record. As indicated above, he was diagnosed in service in April 1961, with an anxiety reaction manifested by hypochondriacal complaints. His post service medical history and current psychiatric diagnoses are essentially similar in nature (anxiety complaints related to multiple physical problems and fears). Accordingly, the undersigned considers that the posture of the evidence is currently at least in equipoise, supporting a grant of service connection. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. §§ 3.303(b), (d) (1994). ORDER Service connection for a personality disorder or PTSD is not warranted. Service connection for an adjustment disorder with anxious features and a somatoform disorder is granted, subject to VA regulations pertaining to the payment of monetary benefits. C. P. RUSSELL 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.