Citation Nr: 18144026 Decision Date: 10/23/18 Archive Date: 10/22/18 DOCKET NO. 15-10 888 DATE: October 23, 2018 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The Veteran’s PTSD is related to the fear of hostile activity. CONCLUSION OF LAW PTSD was incurred in wartime service. 38 U.S.C. §§ 1110; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304(f)(3). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 2007 to July 2011. The Veteran was stationed in Iraq from April 2008 to September 2008. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an January 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). A hearing was held via video conference before the undersigned Veterans Law Judge (VLJ) in June 2018. During the hearing, the VLJ clarified that the issue on appeal was service connection for a psychiatric disorder, identified potential evidentiary deficits, and clarified the type of evidence that would support the Veteran’s claim. The actions of the VLJ supplement the VCAA and comply with any related duties owed during a hearing. See 38 C.F.R. § 3.103. 1. Entitlement to service connection for psychiatric disorder. The Veteran contends that he has a psychiatric disability, which is connected to his service. The Board concludes that the Veteran has PTSD that is due to service and is related to his exposure to mortar attacks while deployed in Iraq. 38 U.S.C. § 1110); 38 C.F.R. § 3.303. There are particular requirements for establishing PTSD in 38 C.F.R. § 3.304(f) that are separate from establishing service connection generally. See Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with DSM-5 and C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressed occurred. 38 C.F.R. § 3.304(f). If a stressor claimed by a veteran is related to the veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. “Fear of hostile military or terrorist activity” means a veteran experienced, witnessed, or was confused with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as rocket or mortar fire, and the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 C.F.R. § 5107(b). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Veteran underwent a thorough and detailed private examination in August 2018. The private examiner made a diagnosis of PTSD, Axis 1 related to his documented service in Iraq. He examined the Veteran’s medical reports dated January 28, 2009; December 15, 2010; and January 31, 2011. The private examiner stated the Veteran “meets DSM-5 criteria for PTSD without question.” He stated the Veteran meets criterion A of the DSM-5 because the Veteran was exposed to a trauma when he experienced a life-threatening stressor through mortar attacks while stationed in Iraq and the Veteran’s response involved intense fear, helplessness, or horror. Criterion B is present because the Veteran has intrusive memories of his service in Iraq, distressing recollections of the attacks when exposed to unexpected loud noises, and recurrent distressing dreams of the attacks. The examiner stated that the Veteran meets Criterion C of the DSM-5 because the Veteran avoids leaving his home as much as possible, has trouble going into work, and avoids thinking about memories associated with the Army and Iraq. According to the private examiner, the Veteran’s symptoms satisfy Criterion D because the Veteran describes his time in Iraq as one long day where everything happened at once. Additionally, the Veteran avoids going into big crowds because he feels like he will be an “easy target.” Also, the Veteran reports feeling detached. The Veteran meets Criterion E because he has persistent symptoms of increased arousal that were not present before his exposure to mortar attacks. For example, since the trauma, the Veteran has difficulty falling or staying asleep; irritability or outbursts of anger; hypervigilance; and exaggerated startle response. Criterion F is met because the duration of the Veteran’s symptoms have lasted longer than one month. Criterion G is met because the Veteran’s PTSD symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specifically, the Veteran’s symptoms cause significant impairment in his marriage and in his relationships with his children and coworkers. The Veteran becomes angry with his children when they cry and does not like being around his coworkers while at work. Finally, the private examiner concluded that the Veteran’s symptoms are not due to medication or drugs. Therefore, Criterion H is met here. The Veteran received a VA examination in February 2012. The VA examiner concluded that the Veteran did not currently have PTSD in February 2012 under DSM-IV. The VA examiner identified the Veteran’s stressor as every other night mortar attacks within the vicinity. The VA examiner stated that the stressor was related to the Veteran’s fear of hostile military or terrorist activity. Further, the Veteran served in Iraq from April 2008 to September 2008. The Veteran reports being shocked by the frequent mortar attacks where he had to run for shelter in the bunkers. The Veteran states he relives the mortar attacks. According to the Veteran, the memory and shock of the attacks do not go away. Both the VA examiner and the private examiner found a link between the stressor and the Veteran’s symptoms. The VA examination found that the Veteran’s exposure to and fear of mortar attacks sufficient to satisfy criterion A for a diagnosis of PTSD, but noted that the Veteran did not meet other criteria for PTSD under DSM-IV. Additionally, the VA examiner found that the stressor is related to the Veteran’s fear of hostile military or terrorist activity. The private examiner also found that the Veteran satisfied criteria A. Further, the private examiner noted that the Veteran’s difficulty sleeping, irritability, hypervigilance, and exaggerated startle response were not present before the Veteran’s exposure to mortar attacks while stationed in Iraq. Resolving reasonable doubt in the Veteran’s favor, the Board concludes the evidence supports a finding of a nexus between the Veteran’s PTSD and the stressor. The Veteran’s symptoms are related to the claimed stressor, which is consistent with fear of hostile military activity. For the foregoing reasons, the Board finds that the evidence shows that the Veteran has a diagnosis of PTSD, that the diagnosis is related due to an in-service stressor, and that a link exists between his diagnosis and the in-service stressor. Therefore, entitlement to service connection for PTSD is warranted under 38 C.F.R. § 3.304(f). H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.S. Garlick, Law Clerk