Citation Nr: 18145561 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 15-01 043 DATE: October 29, 2018 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT Resolving all doubt in the Veteran’s favor, the Veteran has a diagnosis of PTSD linked to his military service. CONCLUSION OF LAW The criteria for service connection for PTSD have been met. 38 U.S.C. §§ 1131, 5107 (West 2012); 38 C.F.R. §§ 3.303, 3.304, (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1969 to August 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. The Veteran appeared at a Board hearing before the undersigned Veterans Law Judge on July 2018. A transcript of the hearing is in the Veteran’s file. While a Statement of the Case is not in the file, the Veteran timely filed a substantive appeal and so the Board will treat the case as being certified for a final decision. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) Under the relevant laws and regulations, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2017). In general, service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App 370, 374 (2002). Service connection for PTSD generally requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (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 Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor if: (1) the claimed stressor is related to his fear of hostile military or terrorist activity; (2) the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service; and (3) a VA psychiatrist or psychologist, or contract equivalent, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and the Veteran’s symptoms are related to the claimed stressor. 38 C.F.R. § 3.304(f)(3). For purposes of this paragraph, “fear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted 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 from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 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 matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Veteran contends that he has an acquired psychiatric disorder, to include PTSD, which stems from in-service stressors during his active duty service in Vietnam. A review of the record shows that in March 2010, the Veteran was initially screened as positive for PTSD during treatment at a VA medical clinic. In a June 2013 VA examination, however, the examiner stated that the Veteran did not meet the criteria for PTSD, but rather for dysthymia with alcohol dependence in remission, which was less likely than not related to combat experience in Vietnam. In the report, the examiner referenced the Veteran's stressors, stating that they are adequate to support the diagnosis of PTSD, but then stated again that the Veteran does not meet the full criteria for PTSD. In a subsequent December 2013 examination, the examiner noted the Veteran was diagnosed with dysthymia, but believed that his symptoms were more accurately reflected as PTSD. A psychosocial assessment prepared by the examiner following the examination demonstrated a thorough review of the evidence and an opinion that the stressors outlined by the Veteran are the nexus between his current symptoms and his military experience in Vietnam. From January 2015 onward, the Veteran sought treatment at VA medical centers, which found the Veteran had unspecified depressive disorder. In July 2018, however, a private licensed professional counselor, who treated the Veteran, opined that he has PTSD was related to his service in Vietnam. She considered his symptoms and difficulties in relationships. The Veteran provided lay statements from his wife and sister-in-law. Both statements reiterated that the Veteran’s behavior drastically changed when he came back from Vietnam and he now has difficulties in relationships, with symptoms including anger and depression. Finally, the most recent VA examination, from August 2018, found that while the Veteran’s symptoms are consistent with depression, his symptoms are better accounted for by a PTSD diagnosis. Based on the foregoing, the evidence is at least in equipoise as to whether the Veteran has a diagnosis of PTSD. Next, there is credible supporting evidence to support an occurrence of the Veteran’s claimed in-service stressor. The Veteran was a crash and rescue firefighter in Vietnam. See Veteran’s DD-214. He reported his camp was frequently under rocket and mortar attacks and he feared for his life during those times. The Veteran’s statements are also consistent with the places, types, and circumstances of the Veteran’s service, as evidenced by the Veteran’s military records. See 38 U.S.C. § 1154(a). Moreover, the June 2013 VA examination, while negative for PTSD, stated that his stressors were adequate to support a diagnosis of PTSD. As such, the Board finds that the Veteran experienced the in-service stressors he claimed. 38 C.F.R. § 4.125 (a). Because the Veteran has a diagnosis of PTSD linked with his credibly established in-service stressors, service connection for PTSD is granted. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Jaigirdar, Associate Counsel