BVA1303141: Natural Progress of Disability

 In Reasoning - In-Service Aggravation

Citation Nr: 1303141 Decision Date: 01/30/13 Archive Date: 02/05/13 DOCKET NO. 04-11 707


1. Clear and unmistakable evidence exists that the Veteran manifested a psychiatric disability prior to his service and that the aggravation of that disability during his service was a result of natural progression of the condition. …


1. The criteria for entitlement to service connection for a psychiatric disability have not been met. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1131, 1153, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.307, 3.309, 3.384, 4.125, 4.130, Diagnostic Codes 9201-9211 (2012). …


However, the Board finds that the in-service increase in the Veteran’s preexisting psychiatric disability was due to the natural progress of the disability. The Board finds that it is unclear whether service medical records indicate that the Medical Board determined that the Veteran’s preexisting psychiatric disability was aggravated by service or not aggravated by service since a mark was placed equally between the boxes for each. That finding is inconclusive. That alone is insufficient. The Medical Board’s determination is not accompanied by an explanation. Horn v. Shinseki, 25 Vet. App. 231 (2012),. The rationale for a medical opinion must be articulated. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007). That leaves for consideration the opinion of the examiner who conducted the February 2008 VA mental disorders examination.

That February 2008 examiner opined that what happened to the Veteran during service clearly was the natural progression of his preexisting psychiatric disability. It was noted that there was no evidence that what happened was attributable to his service such that it would not have occurred absent this service. His psychiatric disability, which was characterized as chronic, was deemed to have been prompted by the stresses and strains of adult life prior to service. It further was deemed to have been increased by the stresses and strains of military life in the same way it would have been increased if he had been stressed and strained in some other fashion. Specifically, it was determined that stress other than from service probably would have resulted in a psychotic episode requiring hospitalization like the in-service episode from the stress of service which required hospitalization. The Veteran’s self-reported increasing stress at work and resulting hospitalization prior to his service was highlighted as an example. His response to stress from non-service experiences, namely hospitalizations, further was highlighted.

Factors that may be considered in assessing the probative value of a medical opinion include a physician’s access to the claims file or other pertinent evidence, the thoroughness and detail of the opinion, the accuracy of the factual premise underlying the opinion, the scope of examination, the degree of certainty provided, and the qualifications and expertise of the examiner in addition to the rationale offered. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Prejean v. West, 13 Vet. App. 444 (2000); Black v. Brown, 10 Vet. App. 297 (1997); Ardison v. Brown, 6 Vet. App. 405 (1994); Sklar v. Brown, 5 Vet. App. 140 (1993); Reonal v. Brown, 5 Vet. App. 458 (1993); Guerrieri v. Brown, 4 Vet. App. 467 (1993). The examiner who conducted the February 2008 VA mental disorders examination is a member of the American Board of Professional Psychology. This examiner’s opinion was rendered following review of the claims file and interview of the Veteran. No deficiency is found in either respect. The Board notes that the Veteran’s interview took a “great deal of time.” That is shown by the examiner’s use of that phrase and the fact that the summarization of the interview is around three pages in length. There is no indication of reliance on an inaccurate factual premise in formulating the opinion. A rationale for it was offered by the examiner. It further is sufficiently thorough and detailed.

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