Emotional Instability Reaction Term

[Josephine]

Emotional Instability Reaction _ code 460 - may not always be a " Personality Disorder"?

[

Citation Nr: 0302710

Decision Date: 02/12/03 Archive Date: 02/19/03

DOCKET NO. 99-19 695 ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in No. Little

Rock, Arkansas

THE ISSUE

Entitlement to service connection for an anxiety disorder.

REPRESENTATION

Appellant represented by: The American Legion

WITNESSES AT HEARING ON APPEAL

Appellant and spouse

ATTORNEY FOR THE BOARD

J. D. Deane, Associate Counsel

INTRODUCTION

The veteran served on active duty from August 1958 to March

1959.

This case comes before the Board of Veterans' Appeals (Board) from a July 1999 rating decision of the North Little Rock, Arkansas, Regional Office (RO) of the Department of Veterans

Affairs (VA).

The Board remanded the veteran's claim in July 2001 for action consistent with the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000) (codified as amended at 38 U.S.C.A. § 5100 et seq. (West Supp. 2001)). In August 2002, the Board further developed

the claim, ordering a VA examination to evaluate the veteran's disability.

The veteran had a personal hearing before the undersigned

Member of the Board in May 2001.

FINDINGS OF FACT

1. All evidence requisite for equitable disposition of the veteran's claim for service connection has been obtained and examined, and all due process concerns as to the development

of the claim have been addressed.

2. The veteran has a current anxiety disorder, which was diagnosed as an emotional instability reaction during his military service.

CONCLUSION OF LAW

An anxiety disorder was incurred in active service. 38 U.S.C.A. §§ 1101, 1110 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303 (2002).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Service connection is granted for a disability resulting from an injury suffered or disease contracted while in active duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. See 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 2002); 38 C.F.R. § 3.303

(2002). In general, establishing service connection for a disability requires the existence of a current disability and a relationship or connection between that disability and a disease or injury incurred in service. See 38 U.S.C.A. § 1110 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303, 3.304

(2002); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992).

I. Entitlement to Service Connection for Anxiety Disorder

The veteran contends that he currently suffers from an anxiety disorder as a result of his active service, and that service connection for his psychiatric disability is appropriate. After a review of the evidence, the Board finds that the record supports his contention, and that service connection for an anxiety disorder is warranted.

Most of the veteran's service medical records are unavailable. The National Personnel Records Center reported that they did not have such records for the veteran, and that they had probably been accidentally destroyed in a 1973 fire at that facility. However, a January 1959 treatment record

states that the veteran complained of chronic anxiety reaction. Another report from January 1959 noted that the veteran was admitted to the hospital in a lethargic state after ingesting an overdose of pills. The February 1959 Medical Evaluation Board report lists a diagnosis of emotional instability reaction including symptoms of lability of emotions, suicidal gesture, lowered tolerance to frustration, difficulty in accepting authority, and somatizations when under stress.

The veteran has also submitted VA outpatient treatment records, statements from his wife, and his own statements to support his claim. VA outpatient records from 1997 to 1999 show treatment for a major depressive order, insomnia, and a history of substance abuse. In the May 2001 hearing

transcript, the veteran as well as his spouse described his symptoms during and after separation from service.

A December 2002 VA examination report lists a diagnosis of anxiety disorder. The examiner noted in his report that the veteran complained of chronic sleep impairment and anxiety during the examination. The examiner also stated that the veteran was casually groomed and cooperative with an anxious mood as well as exhibited limited insight and adequate judgment. No gross memory impairment, hallucinations or delusions were noted in the December 2002 examination report.

The examiner stated that the veteran had received a diagnosis of emotional instability reaction during service, a term that was no longer part of the diagnostic nomenclature. It was noted that the symptoms reported in service appeared to be the same as symptoms described by the veteran in the

examination report. The examiner opined that there appeared to be a nexus between the emotional instability diagnosed in service and the veteran's present symptomatology.

In brief, the record shows that the veteran's current anxiety disorder is related to his period of active service. The opinion contained in the December 2002 VA examination report establishes a link between the veteran's current anxiety disorder and the symptoms diagnosed as an emotional

instability reaction during his active military service. Service medical records reflect that the veteran suffered from an emotional instability reaction while in service. In the December 2002 VA examination report, the examiner specifically stated that the veteran's current disability is

attributable to his period of active military service. The Board finds that the veteran's claim for service connection of an anxiety order must be granted.

II. VCAA

A change in the law, on November 9, 2000, redefined the obligations of VA with respect to the duty to assist and included an enhanced duty to notify the claimant of the information and evidence necessary to substantiate a claim for VA benefits. See Veterans Claims Assistance Act of 2000

(VCAA), 38 U.S.C.A. §§ 5100 et. seq. (West Supp. 2002). Implementing regulations for VCAA have been published. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2002).

Except for amendments not applicable, the provisions of the regulations merely implement the VCAA and do not provide any rights other than those provided by the VCAA.

As noted above, the Board remanded this appeal to the RO in July 2001 for action consistent with the VCAA. As this decision of the Board is a complete grant of the benefit sought on appeal - i.e., service connection for an anxiety disorder - the Board concludes that sufficient evidence to

decide the claim has been obtained and that any defect in the notice and development requirements of the VCAA that may exist in this instance would not be prejudicial to the

veteran.

ORDER

Service connection for an anxiety disorder is granted.

MARY GALLAGHER

Member, Board of Veterans' Appeals

IMPORTANT NOTICE: We have attached a VA Form 4597 that tells

you what steps you can take if you disagree with our

decision. We are in the process of updating the form to

reflect changes in the law effective on December 27, 2001.

See the Veterans Education and Benefits Expansion Act of

2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the

meanwhile, please note these important

Josephine

[Pete53]

My experience when the VA changes a Code it is usually not to help Veterans but to cover their ass. One thing the VA does worry about is how they look to Professionals so they always try to look like they are in mainstream. Not that they are cheating Vets out of earned benefits.

[Josephine]

Pete,

I have that " emotional Instability Reaction" stuck to me like glue, because of that darn code of 460.

I do remember my form - 9 states " Emotional Instability Reaction " can be a " Psychiatric disorder.

This case leads me to believe that I may be correct?

Comments Please?

Josephine

[free_spirit_etc]

Yes. The case shows that it doesn't always mean personality disorder. I also notice the BVA judge was a female.

I would think that the change in the diagnostic nomenclature might work to your advantage in this one.

It would be interesting to find why they stopped using that as a diagnosis - and what diagnosis branched off of that. I imagine the DSM changed it.

I was also interested in your letters from your minister. They talked about how active you were in the church, etc. BEFORE you went into the service.

Were you also active in school organizations? Service groups?

I know usually the big deal is proving something occured in the service - and the nexus.

However, I think the broader picture you could create of how "normal" you were BEFORE the service - the odder the "personality disorder" diagnosis would look.

So - if you have to appeal - even a couple of statements from someone in the past may help. They wouldn't even have to be someone who knew you after and noticed the marked change in you. In fact someone who says things about you before the service but says they did not see you much after - and can't remark on it much - still add credibility to your other statements from those who DID see the change. and the statements should be pretty credible, as they are not testifying to things they don't have knowledge of.

For example - a statement I wrote for my husband's claim - there were places where I stated - I cannot discuss that period, as I did not know him at that time, but I can discuss what I DO know.

Sometimes such statements can be more supportive tha ones that have something to say about everything. They can back the other statements.

I wouldn't overwhelm them with 100 statements. But you could ask 100 people - so you will get 7 - 2 of which will be good to use.

Anyway - just MY idea. If I were looking at the case...And one doctor said it was personality disorder and the other doctor said it was anxiety - and both connected it to my service. And then I saw a few statements about how you were involved in this, that, and the other right before you went into the service - the personality disorder theory would start looking more questionable to me.

Then I would start looking more closely at the personality disorder C&P. What tests did they do to determine that? Where did they get their information about the incidents they describe? If they state the patient reported them, why didn't she ever report the same things to someone else? Or why did no one else mention them in their reports.

How do they know she is a "cutter" Did they take pictures of, or describe any scars?

So a couple of statements might be helpful. At least the probably wouldn't hurt. Again, if they can describe how you changed - that is nice. But even a statement along the lines of I was surprised to hear that Josephine had so many problems after the service - because I knew her right before that and she was ______. If they don't know for sure how you were after - and state that they don't know - that can be okay - and even add credibility to their statements.

They won't replace a strong medical opinion - But they can help support a positive opinion and help debunk a negative one. At least where the anxiety vs. personality disroder comes into play.

I would think a rational person would start thinking - hmmm - she was normal going in - and was emotionally unstable going out - I wonder what happened in between.

Free

Pete,

I have that " emotional Instability Reaction" stuck to me like glue, because of that darn code of 460.

I do remember my form - 9 states " Emotional Instability Reaction " can be a " Psychiatric disorder.

This case leads me to believe that I may be correct?

Comments Please?

Josephine

[Pete53]

The VARO in Waco Texas diagnosed me with Personality Disorder. I eventually studied and learned all I could about it. A personality disorder is a diagnosis that is very specific. Examples would be someone who fits the DSMV Code and fits it like a glove.

Someone who did not have discipline problems, who held jobs, did not start fires, did not get into brawls, did not get caught cheating in School or finished scholl would be people wrongfuly tagged with a personality disorder.

In my opinion the only way to beat the VA at this game is to challenge the and ask what is the full diagnostic code for the personality disorder and than attack it with a vengeance.

And you can still have a personality disorder and qualify for VA compensation under anxiety disorder or major depression as they are on a different Axis and the VA knows that.

[free_spirit_etc]

Yep. I am with you on that. I am pretty familiar with BPD - and it doesn't seem to fit what I know about Josephine at all.

The black and white thinking - where someone is either all good or all bad, and the one who was all good says ONE thing - and gets "split" to all bad. You are their best frined one minute and their worst enemy the next.I don't see that in Josephine.

She sees the shades of gray, and she doesn't flip back and forth all the time.

Most people with BP think THEY are completely normal - there is nothing in the world wrong with THEM - it is everyone else who has a problem.

I don't see her doing the infamous distortion campaigns -- always causing dramas and trying to turn people against each other.

I have had enough dealings with BP that my radar usually detects BPD -- and I don't see any of the patterns that most BPs have.

It looks like:

1. Instead of saying - "Yes. We caused you so much stress we have damaged you. We will let you go home and take care of you."

They said - We are letting you out because their is something wrong with YOU that you can't handle stress.

2. She got treatment for years with no indication of personality disorders.

3. She got a C&P that could have granted her SC.

4. The RO sent her for a second C&P with someone who would take the emotional instability discharge code and connect it with it's present day "sister' diagnosis - BPD.

I still think her case has a strong chance of success. But it might take a strong medical opinion that links the whole picture together - and shows how the second C&P was not adequate - and that her manifestations are more characteritic of anxiety, PTSD, etc. - and they have been consistent since AFTER the service - and that therefore, since she hasn't had any evidence of a personality disorder since the service (aside from the inadequate C&P) it is likely that she actual was suffering from anxiety when she was discharged - rather than emotional instability.

Free

The VARO in Waco Texas diagnosed me with Personality Disorder. I eventually studied and learned all I could about it. A personality disorder is a diagnosis that is very specific. Examples would be someone who fits the DSMV Code and fits it like a glove.

Someone who did not have discipline problems, who held jobs, did not start fires, did not get into brawls, did not get caught cheating in School or finished scholl would be people wrongfuly tagged with a personality disorder.

In my opinion the only way to beat the VA at this game is to challenge the and ask what is the full diagnostic code for the personality disorder and than attack it with a vengeance.

And you can still have a personality disorder and qualify for VA compensation under anxiety disorder or major depression as they are on a different Axis and the VA knows that.

[free_spirit_etc]

Another good point. In fact I don't think many people with any kind of psychiatric diagnosis only have ONE diagnosis. So another ding on the second C&P -

She's been treated for anxiety and depression for YEARS. She has a VA exam that says she suffers from them. And then suddenly - they don't exist - it is ALL personality disorder based (something that magically only appeared at discharge and a SECOND C&P - after the first C&P was favorable).

Free

And you can still have a personality disorder and qualify for VA compensation under anxiety disorder or major depression as they are on a different Axis and the VA knows that.