Citation Nr: 18145243 Decision Date: 10/30/18 Archive Date: 10/26/18 DOCKET NO. 12-14 699 DATE: October 30, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and persistent depressive disorder, is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, the medical evidence shows a diagnosis of an acquired psychiatric disorder, to include PTSD and persistent depressive disorder, based on a claimed in-service stressor. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include PTSD and persistent depressive disorder, have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1988 to May 1991. This matter is on appeal from a September 2010 rating decision. The Veteran testified before the undersigned Veterans Law Judge during a November 2012 hearing. The Board remanded this matter in July 2015. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and persistent depressive disorder Service connection is granted on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran is seeking entitlement to service connection for an acquired psychiatric disorder. He has advanced that he developed an acquired psychiatric disorder, to include PTSD, while serving as a medical specialist and aide driver in Korea and the Desert Storm conflict. He reported that during this time, he was a medic assigned to a tank battalion which was initially positioned in Saudi Arabia and crossed the border into Iraq in 1991 and engaged in approximately 100 hours of combat. See September 2010 VA examination report. He stated that he saw many disturbing events in Iraq but was most significantly disturbed by seeing a mother and young girl killed. Id. He also reported seeing dead bodies stacked on one another and thousands of enemy troops. See October 2015 VA examination report. Service connection for PTSD requires medical evidence establishing a diagnosis of the condition, 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. 38 C.F.R. § 3.304(f) (2017). Within the legal framework for evaluating claims of service connection for PTSD, the sufficiency of a stressor is a medical determination, while the occurrence of the stressor is a legal determination. Sizemore v. Principi, 18 Vet. App. 264 (2004). First, the Board finds that the weight of the evidence is at least in equipoise as to whether the Veteran has a current diagnosis of an acquired psychiatric disorder, to include PTSD and persistent depressive disorder. In an August 2009 private treatment record from Pathways Behavioral Health Services, the Veteran was given a DSM-IV diagnosis of PTSD. Moreover, in VA treatment records, a clinical psychologist rendered a diagnosis of PTSD. See, e.g., April 2013 VA mental health consult. The Board acknowledges that the September 2010 VA examiner found that the Veteran did not have a DSM-IV diagnosis of PTSD, and that the October 2015 VA examiner found that the Veteran did not have a DSM-5 diagnosis of PTSD. However, as the Veteran’s appeal was certified before August 4, 2014, the Board finds that the October 2015 examiner used the wrong diagnostic criteria (DSM-5). Based on the above, and resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran has a current diagnosis of PTSD. Next, there is credible supporting evidence of a stressor. The Veteran has consistently reported the in-service stressor, detailed above. See, e.g., August 1999 VA examination report, November 2008 statement, August 2009 private treatment record from Pathways Behavioral Health Services, October 2009 VA treatment record, September 2010 VA examination report, November 2012 hearing testimony, and April 2013 VA mental health consult. The record confirms that the Veteran served in Korea and Saudi Arabia as a medical specialist and aide driver. The Veteran has described feelings of helplessness and horror and traumatic thoughts and nightmares related to this stressor. The Board finds the Veteran’s account of the claimed in-service stressor to be credible and consistent with the circumstances of his service. 38 U.S.C. § 1154(a) (2012). Finally, the weight of the evidence is at least in equipoise as to whether the sufficiency of the stressor has been verified by a competent VA medical professional, along with a nexus between the confirmed in-service stressor and the diagnosed acquired psychiatric disorder. See Sizemore, 18 Vet. App. 264 (2004). In this regard, the DSM-IV diagnosis of PTSD in the August 2009 private treatment record from Pathways Behavioral Health and in the April 2013 VA mental health consult with a VA clinical psychologist appears to be based off the Veteran’s reports regarding the in-service stressor from his service in the Gulf War, including seeing a deceased child in Iraq. The Board acknowledges that the September 2010 examiner found that although the Veteran had past diagnoses of major depressive disorder and PTSD, he did not exhibit or report symptoms which would lead to either of these diagnoses. Instead, the September 2010 examiner found that it was possible his past symptoms were related to his reaction to the onset of symptoms of multiple sclerosis. However, the Board notes that the Veteran’s first diagnosis of PTSD was in 1999, nearly a decade before he was diagnosed with multiple sclerosis in 2008. Moreover, although the October 2015 examiner found that the Veteran did not meet the full diagnostic criteria for a diagnosis of PTSD, the October 2015 examiner acknowledged that the Veteran reported a number of symptoms and characteristics consistent with PTSD and found that the Veteran’s reported stressor was adequate to support a diagnosis of PTSD. Based on the above, the Board finds that the Veteran has a diagnosis of PTSD based on a claimed in-service stressor. Here, the Veteran is competent to describe his in-service stressor, and his claimed stressor is consistent with the circumstances of his service. Further, resolving reasonable doubt in favor of the Veteran, the Board finds the August 2009 private treatment record from Pathways Behavioral Health and the April 2013 VA mental health consult to be competent and credible medical evidence that the Veteran’s PTSD is related to the claimed in-service stressor. Finally, the Veteran has also been given several diagnoses pertaining to a depressive disorder. See, e.g., August 2009 private treatment record from Pathways Behavioral Health Services, April 2013 VA mental health consult, and October 2015 VA examination report. Moreover, the October 2015 VA examiner gave a positive nexus opinion for the Veteran’s diagnosed persistent depressive disorder. The October 2015 examiner noted that the Veteran’s entrance examination did not identify any mental health issues, and the Veteran now had clear symptoms of persistent depressive disorder which are related to his identified in-service stressors. As such, service connection is also warranted for persistent depressive disorder. For these reasons, and resolving any reasonable doubt in favor of the Veteran, the Board finds that the criteria for service connection for an acquired psychiatric disorder, to include PTSD and persistent depressive disorder, have been met. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs