Citation Nr: 18144717 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 16-06 321 DATE: October 25, 2018 ORDER New and material evidence having been received, the claim to reopen service connection for PTSD is granted. Entitlement to service connection for PTSD is granted. FINDINGS OF FACT 1. A claim for service connection for PTSD was denied in a July 2010 rating decision. The Veteran did not appeal the July 2010 rating decision. 2. The evidence received since the July 2010 rating decision is new and material and raises a reasonable possibility of substantiating the claim for service connection claim for PTSD. 3. PTSD is related to in-service stressors. CONCLUSIONS OF LAW 1. The July 2010 rating decision which denied service connection for PTSD is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. 2. New and material evidence has been received sufficient to reopen the claim of entitlement to service connection for PTSD. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for service connection for PTSD have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from August 1979 to August 1982, from January 1991 to September 1991, from January 2004 to March 2005, and from November 2007 to January 2009. Service Connection 1. Whether new and material evidence has been received to reopen service connection for PTSD Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. New evidence is defined as evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. See 38 C.F.R. § 3.156 (a). At the time of the prior final rating decision in July 2010, the claim was denied based on lack of a current diagnosis of PTSD. VA treatment records since the prior final rating decision reflect diagnoses of PTSD, stressor statements indicating treatment for PTSD related to duties as a nurse, and a medical opinion from a VA psychologist. The Board finds that the evidence submitted since the prior final rating decision is new as it was not previously of record. The evidence is also material, as it relates to the existence of a current diagnosis of PTSD related to an in-service stressor. Accordingly, the claim of entitlement to service connection for PTSD is reopened. 2. Entitlement to service connection for PTSD The Veteran seeks service connection for PTSD. The Veteran has reported stressors in service related to his duties as a nurse treating severely wounded soldiers at Landstuhl Medical Center in Germany and experiencing mortar attacks during his service in Iraq. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). In addition to the general requirements for service connection, PTSD claims require: (1) medical evidence diagnosing the condition; (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f). A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125 (a), which provides that all psychiatric diagnoses must conform to the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-V). 38 C.F.R. § 3.304 (f). VA revised the regulation governing adjudication of claims for service connection for PTSD, effective July 13, 2010. See 75 Fed. Reg. 39,843 (since codified at 38 C.F.R. § 3.304 (f)(3)). Under this standard, 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, provided the 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 stressor. Personnel records show that the Veteran was a surgical nurse during his period of service from November 2007 to January 2009 and that he served in Iraq from February 2008 to November 2008. In an October 2009 statement, the Veteran indicated that he worked on the hospital trauma floors during the assaults on Fallujah and saw severely wounded and dead soldiers on a daily basis. He stated that certain events triggered nightmares and memories. The Veteran stated that, when he was in Iraq in 2008, his base was attacked with rockets and mortars. A VA psychiatry treatment noted dated in April 2010 showed an Axis I diagnosis of PTSD. The record noted a history of multiple military-associated psychologically traumatic experiences. A statement from a VA psychologist dated in October 2013 showed a diagnosis of combat-related PTSD. A June 2018 VA examination showed a DSM-V diagnosis of PTSD. The psychologist based the diagnosis on stressors of being attacked by the enemy in Iraq and witnessing and treating severely wounded soldiers. The psychologist essentially opined that the Veteran’s current symptoms and diagnosis of PTSD are caused by or a result of hostile enemy attacks and being a witness to casualties in the Iraq War. On review, the Board finds that service connection for PTSD is warranted. The Veteran’s stressors are credible and consistent with the circumstances of his service as a nurse. VA and private medical records reflect a diagnosis of PTSD according to DSM-V criteria. While the January 2010 VA examination did not show a current diagnosis of PTSD, there is sufficient subsequent competent evidence of record to establish a current diagnosis of PTSD according to DSM-V standards and a link to the Veteran’s current PTSD and his in-service stressors. Accordingly, the criteria for service connection for PTSD have been met. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Catherine Cykowski