Citation Nr: 18144887 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 17-07 319 DATE: October 25, 2018 ORDER Service connection for posttraumatic stress disorder is granted. Eligibility for assistance in acquiring specially adapted housing is granted. FINDINGS OF FACT 1. The Veteran has a current diagnosis of PTSD related to his experience observing catastrophic injuries as a medic during his active military service. 2. The Veteran has permanent and total service-connected disability resulting in the effective loss of use of the bilateral lower extremities, such as to preclude locomotion without the aid of a cane, crutches, or wheelchair. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in the Veteran’s favor, the criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 1111, 1131, 1154, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304(f), 4.125(a). 2. The criteria for eligibility for assistance in acquiring specially adapted housing are met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. §§ 3.102, 3.809. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from December 1971 to August 1975. 1. Entitlement to service connection for posttraumatic stress disorder Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 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 stressor occurred. 38 C.F.R. § 3.304(f). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, reasonable doubt shall be resolved in favor of the claimant. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim). The Veteran asserts that he suffers from PTSD relating to in-service stressors involving witnessing catastrophic injuries while performing duties as a medic in the Air Force. The Veteran’s service personnel records confirm that he served as a medical service specialist in both intensive care and emergency services units in Turkey and stateside at the University Air Force Academy Hospital. In an April 2015 memorandum, the PTSD/JSRRC coordinator reviewed the Veteran’s official personnel records and found that while it could not be confirmed what the Veteran personally experienced or witnessed during his treatment of patients, based on the Veteran’s statements, his military occupational specialty, and the verifiable unit information, his described stressors providing medical care to severely injured people should be conceded. As the Veteran’s described stressors are consistent with the circumstances and conditions of his service, the Board agrees. The Veteran’s VA treatment records include a February 2015 PTSD evaluation note which indicates that after questioning the Veteran and performing a number of tests over a 180 minute period, the Veteran was found to currently meet the diagnostic criteria for both PTSD and major depressive disorder. The Veteran was noted to be fully cooperative with the interview and assessment, to fully answer questions openly and without hesitation to the best of his ability, and to have a conservative response style such that he was hesitant to link his current symptoms to his traumatic experiences. The Veteran’s validity profile on the evaluations was within normal limits and there was no evidence that the Veteran exaggerated or minimized his current symptoms; the evaluator concluded that his profile is valid for interpretation. The profile suggested that the Veteran likely experienced a disturbing traumatic event in the past that continues to be a source of distress, including symptoms of hypervigilance, social detachment, ruminative cognitions, bitterness and cynicism, and significant symptoms of depression. Going through each of the diagnostic criteria for PTSD, the Veteran endorsed clinically significant symptoms of intrusions, avoidance, negative alterations in mood/beliefs, and hyperarousal. The psychologist concluded that the Veteran therefore met the criteria for a diagnosis of PTSD. The Veteran’s VA treatment records document that he continued to seek mental health care and was accepted for participation in a PTSD comparative effectiveness research study, during which he evidenced increased stress upon engaging in trauma-focused therapy. When considering the evidence of record under the aforementioned laws and regulations, the Board finds that the evidence is at least equally balanced so as to allow for resolution of the doubt in the Veteran’s favor in finding that he has a current diagnosis of PTSD. In so finding, the Board acknowledges that a June 2015 VA examination report found that the Veteran’s described stressor did not meet the initial criterion for PTSD, with the examiner opining that taking care of people with medical issues and trauma is not the type of event that typically results in PTSD, and a January 2016 PTSD Disability Benefit Questionnaire indicated that the Veteran did not have avoidance of stimuli or negative alterations in cognitions and mood associated with the traumatic event and therefore did not have PTSD. However, these reports include little rationale for discounting the Veteran’s competent lay statements regarding his symptoms or for seemingly disregarding the earlier in-depth VA PTSD evaluation and diagnosis. Resolving all reasonable doubt in the Veteran’s favor, the Veteran has a current diagnosis of PTSD related to his conceded in-service stressors involving the provision of care to severely injured persons; an award of service connection is therefore warranted. 2. Eligibility for assistance in acquiring specially adapted housing Specially adapted housing is available to a veteran who has a permanent and total service-connected disability due to: (1) amyotrophic lateral sclerosis rated as 100 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8017; (2) blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; (3) full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk; or (4) the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbows. Specially adapted housing is also available to a veteran with a permanent and total disability that precludes locomotion without the aids of braces, crutches, canes, or a wheelchair due to: (5) the loss, or loss of use, of both lower extremities; (6) the loss or loss of use of one lower extremity, together with residuals of organic disease or injury which so affect the functions of balance and propulsion; or, (7) the loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion. 38 U.S.C. § 2101(a); 38 C.F.R. § 3.809(a), (b), (d). The phrase “preclude locomotion” is defined as the necessity for regular and constant use of a wheelchair, braces, crutches or canes as a normal mode of locomotion, although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809(c). The Veteran is in receipt of service connection benefits for degenerative disc disease of the lumbar spine with associated bilateral lower extremity radiculopathy. In a November 2015 rating decision, the Regional Office granted a total disability rating based upon individual unemployability, and basic eligibility to Dependents’ Educational Assistance was established based on a finding that the evidence showed that the Veteran had a total service-connected disability, permanent in nature. The evidence of record demonstrates that the Veteran’s chronic low back pain and bilateral lower extremity radiculopathy result in significant interference with standing and ambulation, with the Veteran describing extreme pain in the back after standing for as little as two minutes. While a June 2015 VA examiner concluded that a great deal of the Veteran’s difficulty walking is due to his nonservice-connected bilateral ankle condition, the Board finds the Veteran’s description of back and leg pain with resultant disturbance of locomotion and interference with standing both consistent and credible. When considering the evidence of record, in the context of eligibility for benefits under 38 C.F.R. § 3.809 only, the Veteran’s permanent and total service-connected disability is found to result of effective loss of use of both lower extremities, such as precludes locomotion without the use of ambulatory aids such as a cane, crutches, or wheelchair. The Veteran is thus found to meet the criteria for eligibility for assistance in acquiring specially adapted housing under 38 C.F.R. § 3.809. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Solomon, Counsel