Citation Nr: 1322584 Decision Date: 07/16/13 Archive Date: 07/24/13 DOCKET NO. 10-02 895 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, including anxiety, depression, agoraphobia, adjustment disorder, and posttraumatic stress disorder (PTSD) due to a personal assault. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Rutkin, Joshua M. INTRODUCTION The Veteran served on active duty from January to December 2005. She appealed to the Board of Veterans' Appeals (Board) from a December 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). FINDINGS OF FACT 1. Although she had a history of depression and anxiety prior to entering service, the Veteran was not found to have any existing psychiatric disorders when examined for acceptance into service. 2. During her service a chronic psychiatric disorder, including depression and "severe" anxiety, manifested and resulted in her going absent without leave (AWOL), being hospitalized, and eventually receiving an early medical separation, and she since has had several additional hospitalizations and has continued to experience essentially the same symptoms as she did in service. 3. A VA psychiatrist found that any pre-existing psychiatric disorder was aggravated during the Veteran's service beyond its natural progression by a personal or sexual assault. 4. It is at least likely as not she has PTSD and other mental illness as a result of that especially traumatic event during her service. CONCLUSION OF LAW Resolving all reasonable doubt in her favor, a psychiatric disorder, including her anxiety, depression, agoraphobia, adjustment disorder, and PTSD, is the result of injury during her service. 38 U.S.C.A. §§ 1110, 1111, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION In deciding this claim, the Board has reviewed all of the evidence in the claims file, both the physical claims file and electronic ("Virtual VA") claims file, and has an obligation to provide an adequate statement of reasons or bases supporting its decision. See 38 U.S.C.A. § 7104(d)(1) (West 2002); Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). While the Board must review the entire record, it need not discuss each and every piece of evidence, certainly not in exhaustive detail. See id. The analysis below therefore focuses only on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the claimant). The Board must assess the credibility and weight of all evidence, so both the medical and lay evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive and providing reasons for rejecting any evidence favorable to the claimant. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. When the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The preponderance of the evidence must weigh against a claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). I. VA's Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), sets forth VA's duties to notify and assist a claimant in substantiating a claim for VA benefits upon receipt of a complete or substantially complete application. The VCAA was codified as amended at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, and the implementing VA regulations are codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The Veteran's claim of entitlement to service connection for a psychiatric disorder, including anxiety, depression, agoraphobia, adjustment disorder, and PTSD, is being granted rather than denied. Therefore, the Board need not discuss whether there has been compliance with the VCAA's duty-to-notify-and-assist obligations because even if the Board were to assume, for the sake of argument, there has not been, this still ultimately would be inconsequential and therefore only amount to at most nonprejudicial, i.e., harmless error. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Shinseki v. Sanders 556 U.S. 396, 407, 410 (2009). See also 38 C.F.R. § 20.1102. II. Analysis Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). The U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court) has distinguished two evidentiary requirements for establishing entitlement to service connection depending on the type of disorder being claimed. For any disorder not defined by VA as a "chronic disease," the Federal Circuit held that a three-element test must be satisfied under subsection 3.303(a) of the regulations in order to establish entitlement to service connection. Walker v. Shinseki, 708 F.3d 1331, 1333 (citing Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004))). Specifically, the evidence must show (1) the existence of a current disability; (2) in-service incurrence or aggravation of a relevant disease or an injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the so-called "nexus" requirement). Id. However, claims for chronic diseases - namely those listed in 38 C.F.R. § 3.309(a) - benefit from a somewhat more relaxed evidentiary showing under subsection 3.303(b). See Walker, 708 F.3d at 1339 (holding that "[t]he clear purpose of the regulation is to relax the requirements of § 3.303(a) for establishing service connection for certain chronic diseases"). Specifically, when a chronic disease is established during active service, then subsequent manifestations of the same chronic disease at any later date, however remote, will be entitled to service connection, unless clearly attributable to causes unrelated to service ("intercurrent causes"). 38 C.F.R. § 3.303(b). In order to establish the existence of a chronic disease in service, the evidence must show a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Id. Thus, the mere manifestation during service of potentially relevant symptoms (such as joint pain in a claim for arthritis or abnormal heart action in a claim for heart disease) does not establish a chronic disease at that time unless the identity of the disease is established and its chronicity may not be legitimately questioned. Id. If chronicity in service is not established, then a showing of continuity of symptoms after discharge is required to support the claim. Id. The Federal Circuit noted that the requirement of showing a continuity of symptomatology after service under subsection 3.303(b) is a distinct and lesser evidentiary burden than the nexus element of the three-part test discussed above: "The primary difference between a chronic disease that qualifies for § 3.303(b) analysis, and one that must be tested under § 3.303(a), is that the latter must satisfy the 'nexus' requirement of the three-element test, whereas the former benefits from presumptive service connection . . . or service connection via continuity of symptomatology" (emphasis added). Walker, 708 F.3d at 1338-1339. Thus, showing a continuity of symptomatology after service is an "alternative path to satisfaction of the standard three-element test for entitlement to disability compensation" for chronic diseases. Id. at 1338; see also id. at 1336 (observing that section 3.303(b) provides a "second route by which a veteran can establish service connection for a chronic disease"). A continuity of symptoms after service itself "establishes the link, or nexus" to service and also "confirm[s] the existence of the chronic disease while in service or [during the] presumptive period." Id. at 1338. In other words, while a current disability must always be established in any service connection claim, the evidence required to show that the disability was incurred in or aggravated by active service differs according to whether the disability is defined as a chronic disease. If the disability in question is not defined as a chronic disease, then a "medical nexus" between active service and the claimed disability must be established. If the claimed disability is considered a chronic disease, then a relationship to service may be established by a chronicity in service or a continuity of symptoms after service, which is a more relaxed evidentiary showing. Not all diseases that may be considered "chronic" from a medical standpoint qualify for the more relaxed evidentiary standard under section 3.303(b). Rather, the Federal Circuit held that this subsection only applies to the specific chronic diseases listed in 38 C.F.R. § 3.309(a). Id. Thus, if the claimed disability is not one of the chronic diseases enumerated in section 3.309(a), then the more relaxed continuity-of-symptomatology standard does not apply, and "the 'nexus' requirement of the three-element test" must be satisfied in order to establish entitlement to service connection benefits. Id. Psychoses are among the conditions identified in 38 C.F.R. § 3.309(a) as chronic. According to 38 C.F.R. § 3.384, a "psychosis" includes the following specific disorders: brief psychotic disorder, delusional disorder, psychotic disorder due to general medical condition, psychotic disorder not otherwise specified (NOS), schizoaffective disorder, schizophrenia, schizophreniform disorder, shared psychotic disorder, and substance-induced psychotic disorder. Specific to claims for PTSD, there must be medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125(a) (2012), credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f) (2012). With regard to the requirement that be credible supporting evidence that the claimed in-service stressor occurred, section 3.304(f) sets forth circumstances that are exceptions and allow a claimant's lay testimony, alone, to establish the occurrence of the alleged stressor. However, these exceptions do not apply when the alleged stressor involves a personal assault by another service member. See id.; see also Acevedo v. Shinseki, 25 Vet App. 286, 291-93 (2012) (holding that the relaxed evidentiary burden for establishing an in-service stressor related to fear of hostile military or terrorist activity did not apply to a PTSD claim based on a personal assault perpetrated by another service member merely because the claimant alleged that the stressor was related to such fear). The available evidentiary sources for corroboration of a claimed stressor are not limited to service records (as previously required prior to the adoption of 38 C.F.R. § 3.304(f)), but may also include other sources of evidence. See Cohen, 10 Vet. App. at 143 (citing to M21-1, Part VI, para 7.46(f) (Sept. 21, 1992); M21-1, Subch. XII, para 50.45(d) (1989)). Indeed, VA considers a wide range of evidence in PTSD claims based on an alleged personal assault or military sexual trauma (MST). See 38 C.F.R. § 3.304(f)(5). In general, "after-the-fact medical nexus evidence," such as a VA examiner's finding that a claimant's PTSD was caused by the alleged in-service stressor, cannot by itself serve as credible supporting evidence of the claimed in-service stressor. See Moreau, 9 Vet. App. at 396. However, there is an exception to this rule in service connection claims for PTSD based on an alleged personal assault or MST. In such cases, the Court held that medical nexus evidence may constitute "credible supporting evidence" of the claimed stressor. See Patton v. West, 12 Vet. App. 272, 279-80 (1999); see also 38 C.F.R. § 3.304(f)(5) (providing that VA may submit any evidence it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred). Moreover, in service connection claims for PTSD based on personal assault, "alternative sources" of information may be used to corroborate an in-service stressor because official service records may be devoid of evidence of the incident. Many victims of personal assault, especially sexual assault and domestic violence, do not file official reports either with military or civilian authorities. See Patton , 12 Vet. App. at 278. Thus, a broad range of evidence is considered to determine whether there are indications of the alleged in-service personal assault or MST, which may be sufficient to support the occurrence of the assault notwithstanding the fact that more direct evidence is lacking. See VBA Training Letter No. 11-05 (Dec. 2, 2011). Specifically, under 38 C.F.R. § 3.304(f)(4): If a [PTSD] claim is based on in-service personal assault, evidence from sources other than the Veteran's service records may corroborate the Veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. A veteran is considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111. A history of conditions existing prior to service recorded at the time of the entrance examination does not constitute a notation of such conditions for the purpose of establishing whether the Veteran was of sound condition at enlistment. See 38 C.F.R. § 3.304(b)(1). However, the recording of such a history in the entrance examination will be considered together with all other material evidence in determinations as to inception of the disability at issue. See id. In order to rebut the presumption of sound condition, VA must show by clear and unmistakable evidence both (1) that the disease or injury existed prior to service and (2) that the disease or injury was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); VAOPGCPREC 3-03 (July 16, 2003). Thus, when the presumption of sound condition applies, the claimant is not required to establish aggravation by showing that the pre-existing disease or injury increased in severity during service. See VAOPGCPREC 3-03. Rather, the burden remains with VA to show by clear and unmistakable evidence that the pre-existing disease or injury was not aggravated by service. See id.; Wagner, 370 F.3d at 1096. VA may find a lack of aggravation if the clear and unmistakable evidence shows that there was no increase in disability during service, or that any increase in disability was due to the natural progress of the preexisting condition. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (2012); Wagner, 370 F.3d at 1096. If this burden is met, then the veteran is not entitled to service connection benefits. Wagner, 370 F.3d at 1096. On the other hand, if the presumption of soundness applies and VA fails to show by clear and unmistakable evidence that the pre-existing condition was not aggravated by active service, then the presumption has not been rebutted. See id. at 370 F.3d at 1094 (holding that Congress intended to "convert aggravation claims to ones for service connection when the government fails to overcome the presumption of soundness under section 1111"). In that case, the claim will be considered as a normal claim for service connection and, if granted, no deduction for the degree of disability existing at the time of entrance will be made. Id. at 1096 (citing 38 C.F.R. § 3.322). In other words, the claim may not be denied, nor benefits deducted, on the basis of a finding that the disability in question pre-existed active service, if VA does not also meet its evidentiary burden of showing that the disability was not aggravated during service. See id. The clear-and-unmistakable-evidence standard is a much more formidable evidentiary burden to meet than the preponderance-of-the-evidence standard. See Vanerson v. West, 12 Vet. App. 254, 258 (1999) (noting that the clear-and-unmistakable-evidence standard is more demanding than the clear-and-convincing-evidence standard, which in turn is higher than the preponderance-of-the-evidence standard). It is an "onerous" and "very demanding" evidentiary standard, requiring that the evidence be "undebatable." See Cotant v. West, 17 Vet. App. 116, 131 (2003) (citing Laposky v. Brown, 4 Vet. App. 331, 334 (1993)). Although the Veteran had a history of anxiety and depression prior to entering active service, the clear and unmistakable evidence does not show both that she entered service with a pre-existing psychiatric disorder and that it was not aggravated beyond its natural progression. The March 2004 enlistment examination report reflects that the Veteran was found to be psychiatrically normal on clinical evaluation. In the accompanying March 2004 report of medical history, the Veteran indicated that she had a history of depression or excessive worry. It was noted in this form that she was treated for depression in 2000 and prescribed Celexa for one month and Paxil for four months. It was further noted that she had not been on any medications for four years and that her private physician stated that the Veteran's prognosis was excellent. In a separate March 2004 medical prescreen report, it was similarly noted that the Veteran had been prescribed medication for minor depression (Celexa) for three months in September 2000 due to "family problems." Thus, while the entrance examinations show that the Veteran had a history of depression, this history does not constitute a "notation" of an existing psychiatric disorder at the time of entry, and thus the Veteran is presumed to be of sound condition at enlistment. See 38 C.F.R. § 3.304(b)(1). The presumption of soundness has not been rebutted by clear and unmistakable evidence. The service treatment records show that in May 2005 the Veteran went absent without leave (AWOL) and was subsequently hospitalized in June 2005 at an Army hospital upon her return for depression and anxiety. Specifically, according to the Veteran's statements during her hospitalization, she had been placed on temporary leave due to multiple stress fractures, as confirmed by an April 2005 service treatment record. Prior to being placed on leave, she stated that she had been given a "hard time" and ridiculed by other service members and her drill sergeant for her physical limitations due to the stress fractures. She stated that they did not believe her when she attributed her pain and consequent physical limitations to her stress fractures. When the time came to return to her unit, she could not "face it all over again" and had a "mental breakdown." She thus returned to her family home without leave. She stated that she attempted suicide at this time through taking an overdose of pills, but that her mother made her regurgitate the pills. She also saw a civilian psychiatrist at this time. She further related that she had "suffered [with] anxiety for years" but was always able to "contain it" until the end of basic training and advanced individual training (AIT). She stated that since she was a child she would have difficulty with anxiety when going out in public, and described frequent episodes of "panic-type symptoms" occurring off and on throughout her life. She was diagnosed with a chronic generalized anxiety disorder of serious severity, with "external precipitory stress" associated with the "army environment [sic]." It was noted that she had a "genetic predisposition to anxiety." She was also diagnosed with an adjustment disorder with symptoms of depression at this time. In an August 2005 report of medical history, the Veteran endorsed a history of nervous trouble, frequent trouble sleeping, depression or excessive worry, and an attempted suicide. The post-service treatment records show that the Veteran has continued to experience ongoing mental health issues. A December 2007 private psychological evaluation report reflects that the Veteran reported severe panic attacks two to three times a week since active service, feelings of impending doom, and an intense fear of being in public situations, which triggered panic. She also reported fleeting psychotic symptoms about once a week. It was noted that the Veteran had been diagnosed with anxiety and depression in grade school and that these disorders "resurfaced in the military in 2005." The Veteran stated that after her in-service hospitalization, she received outpatient psychotherapy with a counselor on a weekly basis for over eight weeks prior to her discharge. The treating psychologist diagnosed her with a panic disorder with agoraphobia, as well as severe major depressive disorder, recurrent, with psychotic symptoms in partial remission. At an August 2008 VA examination performed in connection with this claim, the Veteran provided a history similar to the one discussed in the preceding paragraph. After examining the Veteran and reviewing the file, the examiner rendered diagnoses of a panic disorder with agoraphobia, generalized anxiety disorder, social anxiety disorder, and major depressive disorder. An October 2012 VA examination report reflects that the Veteran had been hospitalized for fourteen days in 2009 for suicidal thoughts, and also hospitalized in 2011 for seven days for suicidal thoughts. The Veteran also submitted a service connection claim for PTSD. In a February 2012 statement, she related an incident of being sexually assaulted during active service while off base on a weekend pass, and stated that after the attack she went AWOL. She stated that since the assault her pre-existing anxiety had increased, and that she experienced flashbacks of the assault, nightmares, panic attacks, and sleep impairment. She also indicated that she had not remembered the assault until she went through therapy. The August 2012 VA examination report reflects a thorough review of the claims file and examination of the Veteran by a VA psychologist. The psychologist diagnosed her with PTSD with agoraphobia and bipolar disorder. He stated that the latter diagnosis was not "a new and separate condition," but rather reflected her "movement from depression to anxiety and back again." He concluded that the Veteran's PTSD with agoraphobia was caused by the personal assault, noting that her symptoms arose from the trauma and lead to the Veteran having difficulty with male relationships, panic that prevented her from normal work and social relationships, and depression that kept her unmotivated. The examiner further opined that the Veteran's depression clearly and unmistakably existed prior to service, but was aggravated beyond its natural progression. He explained that the Veteran was depressed from "adolescent changes" but did not have the phobias, fears, and anxieties, nightmares, and "deep depression" that came after the sexual trauma. Based on the above evidence, the Board finds that whatever the nature of the Veteran's depression and anxiety prior to entering active service, there is no clear and unmistakable evidence showing that they were not aggravated by active service beyond the natural progression of these disorders. On the contrary, the evidence shows that severe depression and anxiety, resulting in the Veteran's going AWOL, attempting suicide, and subsequently being hospitalized and medically separated from active service, did not manifest until several months after the Veteran's entry. In this regard, the evidence shows that although the Veteran had been diagnosed with depression and prescribed medication in 2000, she had not taken any medication for depression for several years prior to entering active service, and that her private physician believed she had an excellent prognosis. Moreover, no psychological disorder was found on clinical evaluation at her enlistment examination, despite the fact that the examiner was on notice of the Veteran's history of depression. Thus, these disorders were clearly less severe, and apparently quite stable, when she entered service. Nevertheless, in June 2005 she was diagnosed with a "severe" chronic generalized anxiety disorder, for which she was hospitalized and which lead to an early separation from service. Thus, as the evidence shows that the Veteran's anxiety was much more severe after entering active service than at the time of entry, the presumption of soundness has not been rebutted with clear and unmistakable evidence that any pre-existing anxiety or depression was not aggravated beyond its natural progression during service. See 38 U.S.C.A. § 1111; Wagner, 370 F.3d at 1096. Indeed, it was noted in the June 2005 hospitalization records that the severe anxiety was "precipitated" by the stress of the Army environment. Further, as discussed below, the Veteran's in-service MST has been corroborated, and the August 2012 examiner found that this MST aggravated the Veteran's pre-existing psychiatric disorders beyond their natural progression, in addition to causing PTSD. Accordingly, as the presumption of soundness has not been rebutted, the Veteran's claim will be addressed as one for service connection for a psychiatric disorder incurred in active service, rather than for a pre-existing disorder aggravated by active service. See Wagner, 370 F.3d at 1094, 1096. Although the June 2005 Army hospital report states that the Veteran had a "genetic predisposition" to anxiety, such a predisposition does not weigh against the claim. In this regard, service connection for a disease (as opposed to a defect) of congenital or familial (hereditary) origin may be granted if the disease did not manifest until after service or was aggravated during service beyond its natural progression. VAOGC 8-88 (Sept. 29, 1988) (reissued as VAOPGCPREC 67-90 (July 18, 1990) (noting that diseases of hereditary origin can be incurred or aggravated in service if their symptomatology did not manifest itself until after entry on duty). VA's General Counsel have held that the mere genetic or other familial predisposition to develop the symptoms, even if the individual is almost certain to develop the condition at some time in his or her lifetime, does not constitute having the disease. VAOGC 8-88; see also VAOGC 1-85 (Mar. 5, 1985) (reissued as VAOPGCPREC 82-90 (July 18, 1990). Moreover, as already discussed, the competent evidence shows that the Veteran's anxiety and depression did manifest beyond their natural progression. Because the Veteran was diagnosed with a chronic, severe anxiety disorder and depression during active service, and because the post-service medical evidence shows that she has continued to have similar psychiatric problems and diagnoses ever since that time, for which she sought treatment in 2007 and was twice hospitalized in 2009 and 2011, the Board finds that a medical nexus has been established between her current psychiatric disorders and her psychiatric symptoms in service. Indeed, the August 2012 VA examiner found that the Veteran's current depression and anxiety were aggravated beyond their natural progression by active service. Although this opinion was based on the assumption that the Veteran had been sexually assaulted during service, the Board finds that the evidence corroborates this stressor, as discussed below, and thus the opinion is consistent with and supported by the evidence of record. Accordingly, the competent and probative evidence establishes a medical nexus between the Veteran's current depression and anxiety disorders-variously diagnosed as a panic disorder with agoraphobia, generalized anxiety disorder, social anxiety disorder, and major depressive disorder-and the psychiatric disorders that manifested during active service. Thus, the three-element test set forth in Shedden is satisfied, and service connection for the Veteran's anxiety and depressive disorders, as variously diagnosed, is established. See Shedden, 381 F.3d at 1166-67; Walker, 708 F.3d at 1338-1339. With regard to the Veteran's alleged in-service sexual assault and resulting PTSD, the totality of the evidence supports the occurrence of this stressor. Specifically, the Veteran's behavior changes during service in the form of her period of AWOL, the seemingly sudden onset of severe psychiatric symptoms requiring hospitalization in June 2005 and leading to an early medical discharge from military service, her credible February 2012 statement explaining she did not at first remember the trauma until after undergoing therapy, and the August 2012 examiner's findings that the Veteran had PTSD as a result of an in-service MST, together corroborate the Veteran's MST. See VBA Training Letter No. 11-05; 38 C.F.R. § 3.304(f)(4); see also Patton, 12 Vet. App. at 279-80. Therefore, as the October 2012 VA examination report supports a nexus between the Veteran's PTSD and the in-service sexual assault, service connection for PTSD is established. See 38 C.F.R. § 3.304(f). Accordingly, the evidence is at least in equipoise with respect to this claim. Consequently, the benefit-of-the-doubt rule applies, and service connection for a psychiatric disorder, including anxiety, depression, agoraphobia, adjustment disorder, and PTSD due to a personal assault, is granted. See 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. ORDER Service connection for a psychiatric disorder, including anxiety, depression, agoraphobia, adjustment disorder, and PTSD due to a personal assault, is granted. ____________________________________________ KEITH W. ALLEN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs