Q T C Doctor

[Lflint33]

Hello everyone I would like to say I received my doctor report from my 11-29-07 exam and I would like to let everyone know the doctor lied on me through out the entire report. He had to be talking about someone else because I did nothing he stated in his report. This is a few things he said I was calling the V A names using foul language he said I said I had a problem with my doctor at the V A and he said I was calling him names.He said I showed up early and was demanding to be seen he also said I wanted him to exam me for my back and not the depression he said I wanted to structure the interview he said I was very un-cooperative and hostile he said I hates talking about the miltary he said I occasional have difficulty performing activities of daily living. He used my old G A F of 51 dated 2004 and it was 2003 and it was used on my last rating decision of 2004 also he used a 61 GAF he gave me in June 2004 which was used on my last rating decision. From my last rating decision my doctor at the V A has given my a GAF of 50 13 times. Could this fool use my scores from my last rating decision. I have already asked for a hearing I also plan to try and have this doctor removed from doing C% P exams His name is Dr. Reynaldo Abejuela out of Riverside Ca.

[stillhere]

Hello everyone I would like to say I received my doctor report from my 11-29-07 exam and I would like to let everyone know the doctor lied on me through out the entire report. He had to be talking about someone else because I did nothing he stated in his report. This is a few things he said I was calling the V A names using foul language he said I said I had a problem with my doctor at the V A and he said I was calling him names.He said I showed up early and was demanding to be seen he also said I wanted him to exam me for my back and not the depression he said I wanted to structure the interview he said I was very un-cooperative and hostile he said I hates talking about the miltary he said I occasional have difficulty performing activities of daily living. He used my old G A F of 51 dated 2004 and it was 2003 and it was used on my last rating decision of 2004 also he used a 61 GAF he gave me in June 2004 which was used on my last rating decision. From my last rating decision my doctor at the V A has given my a GAF of 50 13 times. Could this fool use my scores from my last rating decision. I have already asked for a hearing I also plan to try and have this doctor removed from doing C% P exams His name is Dr. Reynaldo Abejuela out of Riverside Ca.

Not sure what to do in a case like this but I am sure someone will come along and help. I did want to let you know that I too have a problem with the exam that the doctor for QTC said they preformed. I recently got a copy of my C file and in it the doctor went on to say about the precentages of ankle movement and such. She never once touched me! Just sat in a chair and talked to me. Fraud!

Good luck with your claim! Stillhere

[Berta]

"Dr. Abejuela, who has been working as a nurse's aide to support his family, said he had been unable to enter a hospital residency training program because of the medical association's new policies. He said he had high grades on qualifying tests, and had sent letters to 380 hospitals seeking admission to graduate training programs, but was granted only one interview."

I wonder if he got his MD certification by now-dont know if it is the same doc- but maybe-is he from the Phillipines?

You might want to check this guy out on Healthgrades.com

and see if he is qualified doctor-

and even try to get another C & P by complaining to the director of this VAMC.

http://query.nytimes.com/gst/fullpage.html...mp;pagewanted=3

[john999]

Lflint

The C&P doctor just did not like you for some reason. Did he speak poor English? If you did something to piss him off this was his revenge. It is as simple as that for these creeps. You can ask for a new C&P and if that fails then you do the appeal thing. In the meantime get you own doctor to write a report to contradict this QTC guy point for point. I had the same thing done to me by a doctor who said I was a fraud because I had a college degree in psychology. That was the basis of his C&P and I ended up at the BVA wasting a few years. That was before I came here and learned a few things. There should be a primer course for anyone going for a mental C&P exam. It is like walking through a minefield if you don't know what is happening. Every word out of your mouth can be used against you. I had about 10 C&P exams over the years and one good one out of that 10.

Lflint

The C&P doctor just did not like you for some reason. Did he speak poor English? If you did something to piss him off this was his revenge. It is as simple as that for these creeps. You can ask for a new C&P and if that fails then you do the appeal thing. In the meantime get you own doctor to write a report to contradict this QTC guy point for point. I had the same thing done to me by a doctor who said I was a fraud because I had a college degree in psychology. That was the basis of his C&P and I ended up at the BVA wasting a few years. That was before I came here and learned a few things. There should be a primer course for anyone going for a mental C&P exam. It is like walking through a minefield if you don't know what is happening. Every word out of your mouth can be used against you. I had about 10 C&P exams over the years and one good one out of that 10.

[cowgirl]

John, two things you mentioned have me thinking.

Well, ok, it sounds a bit paranoid, but here goes. Do you think that QTC and VA doctors tape/media record their examinations? Its true that every word one speaks during a visit or examination can be used against them, but only if there is a record of it. I have noticed my civilian doctor transcripts are minimal in nature, very medical focused and nearly no patient quotes, except for call-ins to the office.

And the second thing, how does a veteran ask for a new C&P without prejudice to their claim? Meaning what is the best way to go about it that reduces the amount of prejudice a veteran feels in trying to get a more fair evaluation?

Your thoughts o'wise one? thanks. cg

You can ask for a new C&P and if that fails then you do the appeal thing. In the meantime get you own doctor to write a report to contradict this QTC guy point for point

. Edited March 3, 2008 by cowgirl

[Testvet]

Riverside, Ca are you using Loma Linda VA? Or is this a local Riverside Doc? I grew up there my parents are buried at Riverside National....at March AFB last time I was there Riverside didn't have a VA medical office

[Josephine]

Would this Dr. Abejuela be the same doctor that you saw?

Sorry it is a long BVA case, but his name is mentioned several times.

Betty

Citation Nr: 0312435

Decision Date: 06/10/03 Archive Date: 06/16/03

DOCKET NO. 93-24 281 ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in Los

Angeles, California

THE ISSUE

Entitlement to service connection for a nervous disorder.

REPRESENTATION

Appellant represented by: The American Legion

WITNESSES AT HEARING ON APPEAL

The veteran and his spouse

ATTORNEY FOR THE BOARD

Nancy S. Kettelle, Counsel

INTRODUCTION

The veteran served on active duty from June 1956 to July

1959.

This matter came to the Board of Veterans' Appeals (Board) on

appeal from a June 1991 rating action of the Department of

Veterans Affairs (VA), Regional Office (RO) in Los Angeles,

California. In that rating decision, the RO denied

entitlement to service connection for a nervous disorder.

The veteran and his wife testified before a hearing officer

at the RO in March 1993, and the Board remanded the case to

the RO for development in October 1995, March 1998, and

December 2000. The case has been returned to the Board and

is ready for appellate review. A January 2003 letter from

the veteran requesting additional time to submit information

was received at the Board in May 2003. In view of the

favorable action taken further delay for submissions from the

veteran is not considered necessary.

FINDINGS OF FACT

1. The RO has notified the veteran of the evidence needed to

substantiate his claim, and has obtained and developed all

evidence necessary for the equitable disposition of the

claim.

2. Competent medical evidence relates the veteran's current

psychiatric disability, variously diagnosed as bipolar

disorder and anxiety disorder, to his military service.

CONCLUSION OF LAW

The veteran's current psychiatric disability, variously

diagnosed as bipolar disorder and anxiety disorder, was

incurred in active service. 38 U.S.C.A. §§ 1131, 5103,

5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303

(2002).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Veterans Claims Assistance Act

There has been a significant change in the law during the

pendency of this appeal. On November 9, 2000, the President

signed into law the Veterans Claims Assistance Act of 2000

(VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000). Among

other things, this law redefines the obligations of VA with

respect to notice and the duty to assist. This change in the

law is applicable to all claims filed on or after the date of

enactment of the VCAA, or filed before the date of enactment

and not yet final as of that date. 38 U.S.C.A. § 5103A (West

2002); see Karnas v. Derwinski, 1 Vet. App. 308 (1991).

On receipt of a claim for benefits VA will notify the veteran

of the evidence that is necessary to substantiate the claim.

VA will also inform the veteran which information and

evidence, if any, that he is to provide and which information

and evidence, if any, VA will attempt to obtain on his

behalf. VA will also request that the veteran provide any

evidence in his possession that pertains to the claim.

38 C.F.R. § 3.159; Quartuccio v. Principi, 16 Vet. App. 183,

187 (2002). In general, the VCAA provides that VA will make

reasonable efforts to help the veteran obtain evidence

necessary to substantiate the claim, unless no reasonable

possibility exists that such assistance would aid in

substantiating the claim. VA's duty includes making efforts

to obtain his service medical records, if relevant to the

claim; other relevant records pertaining to service; VA

medical records; and any other relevant records held by any

other source. The veteran is also required to provide the

information necessary to obtain this evidence, including

authorizations for the release of medical records. In a

claim for compensation benefits, the duty to assist includes

providing a VA medical examination or obtaining a medical

opinion if VA determines that such an examination or opinion

is necessary to make a decision on the claim. 38 C.F.R.

§ 3.159.

In this case, the RO provided the veteran a statement of the

case in August 1991 and supplemental statements of the case

in August 1996, August 1997, April 2000, July 2000 and

December 2002. In those documents, the RO informed the

veteran that it had reviewed service medical records, VA

examination reports and VA medical records in conjunction

with his claims. In those documents, the RO also notified

the veteran of the requirements for direct service connection

as well as service connection on a presumptive basis for

psychoses. In a letter dated in October 2001, the RO told

the veteran about the VCAA and notified him that he should

identify the names and addresses of health care providers who

had treated him for his claimed disability and notified him

that VA would attempt to obtain those records but that it was

still his responsibility to make sure the records were

received by VA. In the December 2002 supplemental statement

of the case, the RO outlined the provisions of the VCAA in

detail. In view of the decision in this case, the Board is

satisfied that the veteran has been adequately advised what

evidence he should submit and what evidence VA would obtain

on his behalf, in accordance with Quartuccio v. Principi, 16

Vet. App. 183 (2002).

As to the duty to assist, the RO arranged for psychiatric

examination of the veteran and obtained medical opinions in

conjunction with the claim. In addition, the RO obtained the

veteran's service medial records, VA outpatient records and

some of the private medical records identified by the

veteran. In support of his claim, the veteran has submitted

VA treatment records as well as private treatment records and

statements form private psychiatrists and psychologists. In

addition, the veteran and his wife testified at a hearing at

the RO in March 1993. Further, the veteran and his

representative have provided written argument in conjunction

with his claim.

Based on the foregoing, the Board concludes that the veteran

has received adequate notice and that relevant data has been

obtained for determining the merits of the veteran's claim

and that no further assistance is required to substantiate

his claim.

Law and regulations

Service connection may be established for a disability

resulting from disease or injury incurred in or aggravated by

active service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. The

mere fact of an in-service injury is not enough; there must

be chronic disability resulting from that injury. For the

showing of chronic disease in service, there is required a

combination of manifestations sufficient to identify the

disease entity and sufficient observation to establish

chronicity at the time. If chronicity in service is not

established, a showing of continuity of symptoms after

discharge is required to support the claim. 38 C.F.R. §

3.303(b). Service connection may be granted on a presumptive

basis for certain chronic diseases, including psychoses, if

such is shown to have been manifest to a compensable degree

within one year following the date of separation from

service. 38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R.

§§ 3.307, 3.309. Service connection may also be granted for

any disease diagnosed after discharge when all of the

evidence establishes that the disease was incurred in

service. 38 C.F.R. § 3.303(d).

In order to establish service connection, there must be (1)

medical evidence of a current disability; (2) medical, or in

certain circumstances, lay evidence of the in-service

incurrence or aggravation of a disease or injury; and (3)

medical evidence of a nexus between the claimed in-service

disease or injury and the current disability. Hickson v.

West, 12 Vet. App. 247, 253 (1999).

Standard of review

After the evidence has been assembled, it is the Board's

responsibility to evaluate the entire record. See

38 U.S.C.A. § 7104(a) (West 2002). When there is an

approximate balance of evidence regarding the merits of an

issue material to the determination of the matter, the

benefit of the doubt in resolving each such issue shall be

given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R.

§§ 3.102, 4.3 (2002). In Gilbert v. Derwinski, 1 Vet. App.

49, 53 (1990), the United States Court of Appeals for

Veterans Claims (Court) stated that "a veteran need only

demonstrate that there is 'an approximate balance of positive

and negative evidence' in order to prevail." To deny a

claim on its merits, the preponderance of the evidence must

be against the claim. See Alemany v. Brown, 9 Vet. App. 518,

519 (1996), citing Gilbert, 1 Vet. App. at 54.

Background and analysis

The veteran contends that his current psychiatric disability

started in service, and he has stated and testified that he

often felt depressed and nervous during service. He

testified at the March 1993 hearing that on one occasion in

service he sought treatment at the urging of a friend and was

treated for nervousness. He testified that he was on board

ship at the time and was given medication and was kept in

sickbay for three days. He also testified that although he

received no other treatment for nervousness in service, he

received treatment for physical injuries after three men

assaulted him while he was on liberty. He testified that

ever since that incident he had had nightmares of someone

coming after him with a weapon, like a gun or a knife, and

trying to kill him.

The veteran's service medical records show that at service

entrance in June 1956, he denied a history of nervous trouble

of any sort, and on psychiatric evaluation, he was found to

be clinically normal. Sick call treatment records show that

in April 1957 he complained of nervousness and was treated

with Equanil. The treatment record does not show the

disposition at that time, i.e., whether the veteran was or

was not immediately returned to duty. A later entry, dated

in December 1957 shows that the veteran was treated with

aspirin with codeine and hot soaks for complaints of chest

pain and right and left mandible pain after having been

"jumped" the previous night. At the veteran's separation

examination in June 1956, the veteran was evaluated as

psychiatrically normal.

The veteran asserts that he has current psychiatric

disability related to his feelings of being depressed and

nervous in service as well as his nightmares in service. On

review of the entire record, the Board concludes that the

weight of the evidence is at least in equipoise on this

matter, warranting a grant of service connection for the

veteran's current psychiatric disability, variously diagnosed

as bipolar disorder and anxiety disorder. In this regard,

the veteran's service medical records do document treatment

of nervousness on one occasion and although they do not

confirm that the veteran remained in sickbay for three days,

they are not inconsistent with such a finding as the record

entry does not indicate that the disposition was immediate

return to duty. The records further confirm that the veteran

was assaulted while in service as the veteran was treated for

physical complaints after he was "jumped." Further, they

indicate that the injuries were of sufficient severity to

warrant skull X-rays in January 1958.

A November 1992 notarized statement from the veteran's former

brother-in-law corroborates the veteran's assertions

pertaining to the onset of his feelings of depression and

nervousness in service. The brother-in-law, who knew the

veteran before, during and after service stated that before

service the veteran was a fun-loving and free-spirited type

of person, but that during service he and other family

members noticed a big difference in the veteran's attitude

when they saw him while he was on leave. The brother-in-law

said that the veteran had become depressed and moody and not

the same person. The Board further notes that the veteran's

current contentions regarding his feelings in service are

consistent with history he provided at a psychiatric

evaluation by Donald S. Patterson, M.D., in May 1975 in

conjunction with his application for Social Security

disability benefits. At that time the veteran reported that

he was depressed quite often during service, but was not seen

by a military psychiatrist and did not mention the feelings

of depression to a chaplain. He also reported that three men

assaulted him while he was on liberty and that he believed

his depressions had been more severe since then.

The earliest available post-service medical records

pertaining to the veteran's claim are clinical records from

Palo Alto-Stanford Medical Center showing that in October

1966 the veteran was diagnosed as having psychoneurosis,

chronic anxiety state with conversion reaction. In a

November 1966 entry, the physician noted that the veteran had

a long-standing history of neurotic behavior and that his

present symptoms represented a continuation of that behavior.

Valium was prescribed, and further psychiatric consultation

was recommended.

The Board notes that the veteran has referred to earlier

post-service psychiatric treatment beginning with having been

seen by a neuropsychiatrist, Dr. Henry Colony, in 1960 and

1961. At the March 1993 hearing the veteran testified that

Dr. Colony had died, but that at VA's request he had provided

Dr. Colony's name and address in 1975 in conjunction with

another claim, but VA had made no attempt to obtain Dr.

Colony's records at that time when they more likely would

have been available. In any event, reports and clinical

records from other physicians show that the veteran has for

many years, including in records long-predating the current

claim, given a history of treatment by Dr. Colony in the 1960

- 1961 period, and having received a diagnosis of

schizophrenia and treatment with Thorazine at that time. At

the March 1993 hearing, the veteran testified that he had to

be off work at that time and when he returned to work Dr.

Colony wrote a note that he had schizophrenia. The veteran

testified that at that time he did not know what that meant

and that when he found out, he was very embarrassed to take

that note back to work.

Additionally, although the veteran has reported other medical

treatment for his psychiatric symptoms between the time he

saw Dr. Colony and the time he was seen at the Palo Alto-

Stanford Medical Center, there are no records in the file

that document this. The Palo Alto-Stanford Medical Center

records do state that the veteran's complaints had responded

transiently to Librium, Vitamin B12 and Valium, only to

recur, which, in the Board's judgment, indicates at least

some treatment between the time the veteran was reportedly

treated with Thorazine and late 1966.

In Dr. Patterson's May 1975 letter, he noted that the veteran

had been referred to a psychiatrist in 1971 because of having

taken an overdose of Valium or Librium, which had been

prescribed for him. Further, from January to March 1973 he

had been in a day care program following a 2 to 3 week

hospitalization during which he was placed on antidepressant

medication. Records from Santa Barbara Cottage Hospital show

the veteran was admitted on an emergent basis due to an acute

suicidal state in September 1975. He was noted to have a

fairly long history of major psychiatric difficulties and to

be in treatment with a Dr. Anthony Lapolla. He was

discharged in October 1975 with a diagnosis of depressive

neurosis. At a psychiatric evaluation conducted by Jesse R.

Freeland, M.D., in March 1976, the veteran described frequent

bouts of depression and suicide attempts as well as 'spells'

for many years, with prodromal scotomata and evident

unconsciousness. The veteran recalled feeling very depressed

as a child and said his mother was a very nervous person. He

said he was discharged from the navy because of depression.

The veteran also reported that 15 years before the March 1976

examination he saw Dr. Colony in Oakland and was given

Thorazine. After examination, Dr. Freeland stated that a

speculative diagnosis would be that of an affective type of

schizophrenia with an ictal and possibly a psychomotor

component.

In various letters, Anthony Lapolla, M.D., has stated that he

first treated the veteran in 1972 or 1973 through the Santa

Barbara Mental Health Service and that the veteran came with

a diagnosis of schizophrenia. In an April 1991 letter, Dr.

Lapolla outlined the history of his treatment of the veteran

since the early 1970s. He described the veteran's symptoms

and explained his rationale for diagnosing the veteran as

having manic-depressive illness. He noted that family

history indicated that several members of the veteran's

family, on his mother's side, suffered from depression of a

severe type. Dr. Lapolla noted that the veteran's adjustment

to military service was poor and that the veteran claimed he

was frequently depressed and could not adjust to the

"controlled" life of the Navy. In the April 1991 letter

Dr. Lapolla said it was his opinion that since an early age

the veteran had a mental illness, which became worse before

joining the Navy. Dr. Lapolla said it culminated during the

veteran's enlistment so that he was unable to make an

adjustment.

The record shows that in November 1991,with release from the

veteran, Dr. Lapolla requested copies of the veteran's

service medical records. Later, in a letter dated in

February 1993, Dr. Lapolla stated that the veteran's manic-

depressive illness became manifest after he enlisted in the

Navy, while aboard ship. Dr. Lapolla stated that much of the

veteran's behavior was part of this and his emotional

reaction to incidents he encountered.

VA outpatient records document treatment of the veteran at

mental health clinics from the early 1980s. Treatment

records show complaints of depression, paranoid delusions,

hallucinations, ideas of reference and bad dreams and include

diagnoses of manic-depressive illness and schizophrenia at

various times. Medication was prescribed on a continuing

basis.

Following Dr. Lapolla's retirement in 1993, the veteran

received treatment from private psychiatrists, T. Tice, M.D.,

and Richard M. Deamer, M.D, with continuing follow-up for

psychiatric medications from a VA clinic. At a VA mental

health clinic evaluation in May 1993, the veteran stated that

he had high and low mood swings, with the low moods

predominating. He also said that he had had auditory

hallucinations with his depressive episodes. He reported

that his mood swings started when he was 18 to 19 years old.

Various clinical records over the period from 1993 to 1999

show that the veteran's complaints included tenseness,

wanting to withdraw, panic attacks and anxiety dreams about 4

times a week in which he said he seemed to be chased and was

scared. He also complained of periods of feeling depressed

and periods of feeling anxious. Medications continued to be

prescribed and the diagnosis was bipolar disorder.

Clinical records from Dr. Tice show that in May 1995 he

described the veteran as a manic depressive since age 18 who

wanted psychiatric therapy and possibly medication. At that

time the veteran reported that he was on an aircraft carrier

in service and would feel depressed for about 2 weeks

followed by mania for 4 to 7 days. He also gave a history of

having been unconscious for a few minutes when he was mugged

at age 19 years. After examination, the impression was rule

out bipolar disorder with rapid cycling and rule out

schizoaffective disorder. In July 1995, the Dr. Tice's

assessment was schizoaffective disorder, bipolar type with

rapid cycling.

In multiple letters dated from 1993 to 2001, Eva A. Turner,

M.A., has reported that she worked with Dr. Lapolla from the

early 1970s until his retirement in 1993 and that she was

part of the team that handled the veteran's case when he

received treatment from Santa Barbara County Mental Health

Services and continued seeing the veteran after she and Dr.

Lapolla started in private practice together by 1976. In a

November 1999 letter, she stated that the veteran's diagnosis

was clearly post-traumatic stress syndrome superimposed on a

bipolar disorder, which she said meant that his depressive

periods were often gravely aggravated by extreme anxiety.

She said that the veteran continued to suffer flashbacks from

his navy experience and had periods when his depression

became morbidly severe. In other letters she stated that the

veteran had long, broad mood swings tending toward the

"down-side" of the spectrum and that these were accompanied

by agitated anxiety. She said that in therapy the veteran

had associated these feelings with his experiences in the

navy. Ms. Turner noted there were familial and personal

features in the veteran's history that represented tendencies

toward this kind of symptomology, but she said his first

manifestations apparently occurred while he was in the navy.

In her most recent letter, which is dated in December 2001,

Ms. Turner emphasized the veteran's personal experience in

the navy, mostly his feeling singled out, ganged up on,

teased and tormented by his shipmates, elicited his first

major psychiatric breakdown and had a lasting traumatic

effect on him.

Others who have treated the veteran have also associated the

veteran's psychiatric disability with his military service.

For example, records from the psychiatrist, Dr. Deamer, show

that he treated the veteran during the period from November

1996 to August 2001. In March 1997, Dr. Deamer noted that

the veteran reported the he first experience pressured

speech, euphoric/grandiose mood and racing thoughts while he

was on an aircraft carrier in the navy, and it was at this

time that he was given Equanil, which the veteran said gave

him some relief. He reported recurrent episodes of rapidly

fluctuating mood status ever since. Dr. Deamer's diagnostic

impression reported in March 1997 was bipolar disorder,

mixed. In a clinical entry dated in October 1999, Dr. Deamer

noted that the veteran told him about a beating he received

in service while on shore duty and about some sort of

physical altercation he had with one of his buddies while on

a ship. In a letter dated in October 1999, Dr. Deamer stated

that the veteran continued to suffer from bipolar disorder

and there were features of his clinical situation consistent

with PTSD. Dr. Deamer said it was a condition the veteran

experienced on active duty with the navy, and from which he

continued to suffer.

In addition to treatment from various psychiatrists, another

psychologist, Kent L. Coleman, Ph.D., also saw the veteran,

starting in 1995. In a letter dated in November 1999, Dr.

Coleman said that based on clinical information garnered from

interview, it appeared likely that the veteran's manic-

depressive disorder, chronic bipolar disorder, developed

during his enlistment in the navy and that he had suffered

from that condition ever since.

In a letter dated in June 2000, Dr. Coleman said that at the

veteran's request he had done a chart review and reviewed

prior medical records, including the veteran's service

medical records. Dr. Coleman stated that at his initial

meeting with the veteran in mid-1995 the veteran described

having highs and lows since the 1950s but said he did not

know what they were for a long period of time. Dr. Coleman

said the veteran described the onset as being prior to his

visit to sickbay in April 1957 where the sick call treatment

record described the complaint of nervousness and the veteran

was given Equanil. Dr. Coleman noted that Equanil is the

brand name for meprobamate, which is indicated for the

management of anxiety disorders or for the short-term relief

of the symptoms of anxiety. Dr. Coleman indicated that he

also reviewed post-service clinical records and professional

opinions of several clinicians and stated that he felt

comfortable in noting that the veteran's mental illness had

been long-standing, with all likelihood being manifested

during his years of military service. In support of his

opinion, Dr. Coleman noted the mean age of onset for a first

manic episode was in the early 20s and Dr. Lapolla's mention

of prodromal signs prior to enlistment, which Dr. Coleman

said was supportive of the view that the veteran's manic

depressive illness symptoms became manifest during his

military service.

Evidence against the veteran's claims comes from opinions by

two psychiatrists, Albert Shnaider, M.D., and Reynaldo

Abejuela, M.D. In a report dated in February 2000, Dr.

Shnaider stated that he interviewed the veteran and reviewed

medical records, including the veteran's service medical

records, provided by VA. After examination, the Axis I

diagnoses were bipolar disorder, depressed, and panic attack

disorder with agoraphobia. Dr. Shnaider stated that medical

logs from the navy do not contain any mental health

complaints or treatment records and that the medical records

do not reveal any significant psychiatric impairments or

complaints prior to the late 1960s. He said he thus believed

that the date of onset of the veteran's emotional instability

was in the late 1960s to early 1970s. He stated that he

believed it less likely [than not] that the veteran's

psychiatric disorders were related to his military service.

Dr. Shnaider said he based this conclusion on the fact that

there were no significant psychiatric treatments rendered or

complaints documented while the veteran was in the service.

Dr. Shnaider noted that he had been requested to consider

reports by Ms. Eva Turner and Dr. Lapolla. Dr. Shnaider said

he found no report from Ms. Turner. Dr. Shnaider referred to

an April 1991 letter from Dr. Lapolla, but he did not mention

Dr. Lapolla's February 1993 letter in which he stated that

the veteran's illness became manifest in service. Further,

the Board notes that in his report Dr. Shnaider stated that

records he reviewed included treatment records from Santa

Barbara County Mental Health dated between 1983 and 1987 and

an evaluation from Santa Barbara County Mental Health dated

October 31, 1986. The Board observes that while the record

includes VA outpatient records dated between 1982 and 1987,

including the report of an October 31, 1986, VA mental health

clinic diagnostic and disposition conference, the Board finds

no indication of the existence of records from Santa Barbara

County Mental Health for the same period.

In a report dated in March 2003, Dr. Abejuela stated that he

had not seen the veteran, but that his report was a review of

records to reconcile the findings and provide an opinion.

Dr. Abejuela referred to Dr. Shnaider's February 2000 report.

As did Dr. Shnaider, Dr. Abejuela referred to Santa Barbara

County Mental Health treatment records and an evaluation

report dated in the 1980s. Dr. Abejuela said that he

concurred with Dr. Shnaider that the etiology or nature of

the veteran's mental illness was idiopathic, which he said

meant they did not know what caused the veteran's bipolar

disorder. Dr. Abejuela also said that he concurred with Dr.

Shnaider that based on medical records and pertinent medical

evidence, they could only provide a range from the late 1960s

to the early 1970s regarding the date of onset for the

veteran's emotional instability. Dr. Abejuela said that

based on the medical evidence and records he had reviewed,

including Dr. Shnaider's report, he concurred with Dr.

Shnaider that it is less likely [than not] that the veteran's

psychiatric disorders are related to his military service.

He said the justification for this conclusion was that there

was no significant psychiatric treatment rendered nor were

there documented complaints while the veteran was in the

navy.

In a follow-up report dated in July 2002, Dr. Shnaider said

he had been asked to review his previous report and the prior

report prepared by Dr. Abejuela and render an opinion as to

the etiology and date of onset of the veteran's diagnosed

psychiatric disorders, whether it is as likely as not that

his diagnosed disorder is related to his military service.

In his July 2002 report, Dr. Shnaider noted that he had

earlier opined that there was insufficient evidence to

conclude that the veteran's current psychiatric diagnoses

began or were caused by military service.

In his July 2002 report, Dr. Shnaider provided a discussion

and then stated that he continued to believe that the

veteran's current bipolar disorder and panic attack disorder

was unlikely related to his military service. In the

discussion, Dr. Shnaider stated that he had reviewed Dr.

Coleman's June 2000 report. Dr. Shnaider stated that Dr.

Coleman mentioned that the patient has been experiencing

"depressive symptoms" since the fifties, but other than by

the veteran's own reporting of the timing of his symptoms did

not cite any specific medical records to substantiate the

veteran's complaints. In this regard, the Board's review of

Dr. Coleman's report shows that he stated "[a]t the initial

session, we discussed how he had been manifesting "manic

depressive" symptoms since the 1950s, however he did not

know what they were for a long period of time. He described

these highs and lows and just not being able to cope or

function (being super depressed for extended periods of time

and then having relatively short periods of manic activity).

Dr. Coleman went on to state "[h]e described the onset of

his manic depressive disorder as being prior to the visits to

sick bay on 4/28/57 where the Sick Call Treatment record

describes the complaint as nervousness and he was given

Equanil, brand name for meprobamate which is indicated for

the management of anxiety disorders or for the short-term

relief of the symptoms of anxiety." The Board observes that

Dr. Coleman spoke of the veteran discussing not only

depressive but also manic symptoms, and that Dr. Coleman

cited to the April 1957 entry in the veteran's service

medical record as objective evidence of treatment for anxiety

in service.

In his July 2002 report Dr. Shnaider stated that he observed

an inconsistency in the veteran's statements in that during

his interview with the veteran, the veteran reported that his

symptoms began in 1959 but in contrast he reported to Dr.

Coleman that his symptoms began in the sixties. Based on

this, Dr. Shnaider stated that the accuracy of the veteran's

memory with respect to his symptomatology was highly

questionable. Dr. Shnaider said that he did not believe this

lent any credence to the notion that the patient's

psychiatric illness began in earnest prior or during military

service. On review of the record, the Board can confirm that

in his February 2000 report Dr. Shnaider said " . . . he

reports that in 1959 he began experiencing significant mood

instability. . .." However, nowhere in Dr. Coleman's June

2000 report does he state that the veteran reported that his

symptoms began in the 1960s. The Board therefore finds that

Dr. Shnaider's conclusion as to the veteran's credibility is

without support in the record.

On further review of Dr. Shnaider's July 2002 report, the

Board finds Dr. Shnaider's reasoning and conclusions to be

equivocal, and therefore not dispositive of the issue at

hand. Dr. Shnaider stated, "[t]here are no medical records

available to substantiate the patient's symptomatology prior

to the sixties and seventies. Thus, my his best estimate

[is] that the veteran's current psychiatric disorders had

their onset in earnest in the early sixties." (Emphasis

added.) Dr. Shnaider went on to say that particularly due to

lack of evidence of significant psychiatric impairment as

documented in the veteran's service record as well as lack of

documentation of significant impairment until the sixties, he

believed it was not likely that the veteran's current

psychiatric diagnosis were related to his military service.

Dr. Shnaider ended that paragraph with the statement that

"t is just as likely as not that his complaints with

respect to depression and anxiety while in military service

are independent of and are not related to the patient's

current psychiatric diagnosis." In the paragraph that

followed, Dr. Shnaider again stated that upon reviewing all

medical records available, he did not find sufficient

evidence to indicate that the onset of the veteran's current

psychiatric diagnoses was prior to 1960. He stated that he

continued to believe that the veteran's current bipolar

disorder and panic attack disorder were unlikely to be

related to his military service.

The Board is unable to reconcile Dr. Shnaider's statements.

Had he said it was more likely than not that the veteran's

complaints with respect to depression and anxiety while in

military service are independent of and are not related to

the veteran's current psychiatric diagnosis, the Board could

find consistency in his Dr. Shnaider's position. Considering

Dr. Shnaider's statements as made, along the with

inaccuracies and other ambiguities in his reports, leads the

Board to conclude that it can place only limited weight of

probative value on his reports.

Turning to Dr. Abejuela's second report, which is dated in

August 2002, inaccuracies and misstatements in that document

lead the Board to the conclusion that it, and his prior

report, also have only limited weight of probative value. In

this regard, in the August 2002 report Dr. Abejuela states

repeatedly that the veteran was in service from June 1966 to

August 1969, while the veteran actually had active service

from June 1956 to August 1959.This puts in doubt the

conclusions reached by Dr. Abejuela. For example, referring

to his own March 2000 report Dr. Abejuela states "t was

concluded in March of 2000 that there was no significant

psychiatric treatment rendered, nor were there documented

complaints while the veteran was in the navy. The veteran

was in the navy between 1966 and 1969. All of the treatment

and symptoms in the records were after that. It was

concluded that the etiology was not military-related, but a

condition the veteran had while in the service."

Dr. Abejuela states that according to Dr. Lapolla, the

veteran began treatment in early 1970. Dr. Abejuela went on

to say that this, again, helped the conclusion that the

veteran's bipolar disorder and psychiatric illness did not

start in the military. The Board has reviewed the multiple

letters from Dr. Lapolla that are in the file. They state

not that the veteran first received psychiatric treatment in

the 1970, rather they state that Dr. Lapolla started treating

the veteran in the early 1970s. The Board notes, in

addition, that in his April 1991 letter, Dr. Lapolla reported

that the veteran came to him with a diagnosis of

schizophrenia.

An additional example of questionable interpretation by Dr.

Abejuela is his summary of information from the May 1975

report from Donald S. Patterson, M.D. Referring to Dr.

Patterson's report, Dr. Abejuela said, "the veteran had

problems from an early age. The veteran had a cruel parent

and there was a divorce of the parents when the veteran was

age 7 or 8. His mother died after that, and he had problems

with a very difficult childhood history." Examination of

Dr. Patterson's report shows that he did say that the

veteran's father was an extremely cruel parent and that there

was a divorce of the parents when the veteran was at the age

of 7 or 8. Dr. Patterson then said that the veteran's mother

died three years ago. He followed this with the statement

that at age 12, the veteran was placed away from his mother

to live with his older brother. Though not crucial to the

substance of the veteran's claim, the Board views Dr.

Abejuela's statement as suggesting that Dr. Patterson

reported that the veteran's mother died when the veteran was

a child, while Dr. Patterson in fact was reporting that the

veteran's mother died 3 years prior to his examination of the

veteran in May 1975.

The Board also notes that Dr. Abejuela referred to a

"psychiatric report by Dr. Freeland which is also reviewed

and dated 1999." On review of the record, the Board finds

only one report from a Dr. Freeland, and it is a report dated

in 1976, described earlier in this decision. Dr. Abejuela

also stated that he reviewed several handwritten notes from

"Dr. Allen" who was with VA. Review of the record reveals

no VA treatment records from a Dr. Allen, but does show

treatment records signed by a VA physician whose first name

is Allan.

Finally, the Board observes that Dr. Abejuela's discussion

contains ambiguous and conflicting statements. For example,

Dr. Abejuela stated that after reviewing all of the available

additional records, including Dr. Shnaider's February 2000

report, he still agreed with Dr. Shnaider that the etiology

and nature of the veteran's mental illness was idiopathic and

his bipolar disorder started at an early age, as indicated by

Dr. Lapolla. Later in the discussion, he said the onset was

"between 1960s to the early 1970s." In the following

paragraph, he stated that he still concluded "it is less

likely that the veteran's psychiatric disorder is related to

his military service because "there has been no significant

psychiatric treatment rendered nor were there any documented

complaints while the veteran was in the navy." He next said

the veteran's bipolar disorder could have been related to his

problems and childhood history as well as a lot of other

things other than his military service, and ended the

paragraph by saying "t is just that the condition may

have coincided or occurred when the veteran was in the

service." In the final paragraph, Dr, Abejuela said "The

etiology is idiopathic and the onset in the late 1960s to

1970s."

Based on the foregoing, the Board finds that the reports from

Drs. Shnaider and Dr. Abejuela are of limited weight of

probative value because of inaccuracies, ambiguities and

equivocal statements detailed above. The Board interprets

the statements to express the opinions that the veteran's

current disorder did not have its onset in service and is not

causally related to service, though it may have temporally

coincided with service. It is the Board's judgment that the

totality of the other evidence of record is at least in

equipoise with those opinions. In this regard, the Board

notes that after he reviewed the veteran's service medical

records, Dr. Lapolla, in 1993, stated that the veteran's

illness became manifest, after enlisting in the navy, aboard

ship. He said that much of the veteran's behavior was part

of this and his emotional reaction to incidents he

encountered. While the service medical records document only

one complaint of nervousness, they also confirm that the

veteran was assaulted in service. The history of the onset

of mood swings in service reported by the veteran over the

years since service is corroborated by the notarized

statement of his former brother-in-law who, unlike any

medical professional, not only had direct contact with the

veteran after service, but also knew and saw him before and

during service.

The Board further observes that the record strongly suggests

continuity of symptoms, particularly mood swings, including

periods of anxiety as well as depression, from the year

following service to the present. In this regard, the

veteran has reported treatment for nervousness and a

diagnosis of schizophrenia from a neuropsychiatrist, Dr.

Colony, in 1960 and 1961. The Board recognizes that the

Court has held the veteran's lay testimony concerning what

doctors purportedly told him is not competent medical

evidence. This is because the connection between what a

physician said and the layman's account of what the physician

purportedly said, filtered as it was through a layman's

sensibilities, is simply too attenuated and inherently

unreliable to constitute medical evidence. Robinette v.

Brown, 8 Vet. App. 69, 74 (1995). The Board observes,

however, that the veteran is competent to say that he

experienced nervousness at that time and to report that he

took Thorazine prescribed by that physician. In this regard,

the Board notes that Thorazine is a psychotropic drug used

for the management of manifestations of psychotic disorders.

Baker v. West, 11 Vet. App. 163, 164 (1998); Shockley v.

West, 11 Vet. App. 208, 211 (1998); Ashley v. Brown, 6 Vet.

App. 52, 54 (1998).

The record further includes medical evidence of the diagnosis

of chronic anxiety state with conversion reaction in October

1966. In a November 1966 entry, the physician noted that the

veteran had a long-standing history of neurotic behavior and

that his present symptoms represented a continuation of that

behavior. Valium was prescribed, and further psychiatric

consultation was recommended. Reference at that time to

prior treatment with Librium, Vitamin B12 and Valium

indicates at least some treatment between the time the

veteran was reportedly treated with Thorazine in 1960 and

1961 and documented treatment in late 1966. In this regard,

the Board notes that Librium is indicated in the management

of anxiety disorder. Shockley, 11 Vet. App. at 210.

Later medical records show continuing treatment of the

veteran's symptoms throughout the 1970s, 1980s, 1990s and

through to the most recent available treatment records dated

from 2000 to 2002. The terminology associated with the

diagnoses related to these symptoms has varied, including

schizoaffective disorder, manic-depressive disorder, and

bipolar disorder with PTSD and most recently bipolar disorder

with anxiety disorder. The symptoms reportedly associated

with these diagnoses, primarily mood swings with depression

and anxiety, have remained essentially the same over the

decades starting with the nervousness documented in service

and mood swings reported by the veteran to have occurred in

service and confirmed by a lay witness. Further, medical

professionals, including Ms. Turner, Dr. Coleman and Dr.

Deamer have specifically related the veteran's current

psychiatric disability to the symptoms that were manifest in

service and which have been shown to be present since then.

Resolving all doubt in favor of the veteran, the Board finds

that competent medical evidence relates the veteran's current

psychiatric disability, variously diagnosed as bipolar

disorder and anxiety disorder, to his military service

warranting the conclusion that his bipolar disorder and

anxiety disorder were incurred in service.

ORDER

Entitlement to service connection for bipolar disorder and

anxiety disorder is granted.

____________________________________________

STEVEN L. COHN

Veterans Law Judge, 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 corrections to the

advice in the form:

? These changes apply to the section entitled "Appeal to

the United States Court of Appeals for Veterans

Claims." (1) A "Notice of Disagreement filed on or

after November 18, 1988" is no longer required to

appeal to the Court. (2) You are no longer required to

file a copy of your Notice of Appeal with VA's General

Counsel.

? In the section entitled "Representation before VA,"

filing a "Notice of Disagreement with respect to the

claim on or after November 18, 1988" is no longer a

condition for an attorney-at-law or a VA accredited

agent to charge you a fee for representing you.

Edited March 4, 2008 by Josephine