Citation Nr: 18144704 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 16-20 101 DATE: October 25, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and an other specified trauma and stressor disorder, but to exclude depression, is granted. FINDING OF FACT After affording the Veteran the benefit of the doubt, his current acquired psychiatric disorder is caused by or otherwise related to his active duty service. CONCLUSION OF LAW The criterial for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and an other specified trauma and stressor disorder, but to exclude depression, have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.304, 4.125 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from January 1966 to May 1969 and from January 1972 to March 1985. The Agency of Original Jurisdiction (AOJ) certified the present appeal as entitlement to service connection for PTSD, also claimed as depression and anxiety. The law provides that VA must broadly consider claims and when a veteran asserts service connection, he does so for symptoms regardless of how those symptoms are diagnosed or labeled. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The record indicates that the Veteran’s claim for entitlement to service connection for depression as secondary to a low back disorder was denied by a February 1998 rating decision. To date, the Veteran has not filed an application to reopen the claim of entitlement to service connection for depression and he has not asserted that his depression symptoms are caused by his active duty service. Furthermore, as is discussed in more detail below, while the Veteran has been diagnosed with PTSD during the appeal under the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th edition, (DSM-IV), the most recent VA examination report shows that he has been diagnosed with an other specified trauma and stressor disorder pursuant to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5). Thus, after considering the contentions and evidence of record, the Board has re-characterized the issue of entitlement to service connection for PTSD as it is listed on the title page of this decision. The Veteran contends that his current acquired psychiatric disorder is caused by his active duty service. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions or hardships of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 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, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of posttraumatic stress disorder 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. Otherwise, the law requires verification of a claimed stressor. VA is required to evaluate the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the official history of each organization in which the Veteran served, the Veteran’s military records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a) (2012). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2017). In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a) (2012). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. Initially, the Board notes that the Veteran has a current acquired psychiatric disability. Specifically, the record contains numerous VA treatment records during which the Veteran was diagnosed with PTSD under the DSM-IV criteria. Most recently in February 2016, a VA examiner determined that the Veteran did not meet the criteria for a PTSD diagnosis under the DSM-5 criteria; however, this examiner diagnosed the Veteran with an other specified trauma and stressor related disorder. Thus, the first element of service connection is met. Regarding the second and third elements of service connection, or an in-service occurrence and the nexus requirement, the Veteran’s service treatment records show that he did not receive any mental health treatment, apart from treatment for alcohol dependence, and he did not complain of any acquired psychiatric disorder during his long period of active duty service. However, the Veteran alleged numerous stressors during the February 2016 VA examination, including mortars hitting the base where he was stationed in Vietnam, members of the Navy shooting guns all the time, and witnessing wounded or dead soldiers. His DD Form 214 and other service personnel records indicate that he served in the Republic of Vietnam in 1967. After reviewing the pertinent records, providing an in-person psychiatric examination, and noting the Veteran’s self-reported symptoms and history, the February 2016 VA examiner opined that the Veteran’s other specified trauma and stressor related disorder was at least as likely as not (50 percent or greater probability) incurred in or caused by in-service witnessing of traumatic events involving terrorist activity. The examiner explained that although the Veteran did not meet the criteria for a diagnosis of PTSD under the DSM-5 criteria, his treatment records showed a history of meeting the full criteria for PTSD. She further explained that the Veteran reported witnessing several in-service stressors that meet the criteria for a significant stressor for PTSD or an other trauma-related disorder. Based on the evidence of record, including the findings in the February 2016 VA examination report, VA has already conceded that that the Veteran was in fear of hostile military or terrorist activity while stationed in Vietnam, as indicated in a July 2018 supplemental statement of the case (SSOC). Given this evidence, and after affording the Veteran the benefit of the doubt, his current acquired psychiatric disorder is caused by or otherwise related to his active duty service, to include his fear of hostile military or terrorist activity as determined by a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted. The Board’s findings are buttressed by the fact that the claims file does not contain a medical opinion showing that the Veteran’s current acquired psychiatric disorder, to include other specified trauma and stressor related disorder, is not caused by or otherwise related to the Veteran’s active duty service. Accordingly, after affording the Veteran the benefit of the doubt, the Board concludes the evidence is in equipoise in showing that service connection for an acquired psychiatric disorder is warranted. Thus, the claim must be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Hodzic, Counsel