Citation Nr: 18146611 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-23 173 DATE: October 31, 2018 ORDER The claim of entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. The claim of entitlement to service connection for a right knee disability is granted. FINDINGS OF FACT 1. The Veteran engaged in combat with the enemy. 2. An in-service stressor consistent with the circumstances, conditions, or hardships of the Veteran’s service sufficient to cause PTSD is established by the Veteran’s service records, medical treatment records, and competent lay testimony. 3. The Veteran has a current DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) diagnosis of PTSD. 4. The currently diagnosed PTSD is related to service in combat situations. 5. The Veteran has a current disability of his right knee. 6. The Veteran has an in-service incurrence of an injury, disease, or event. 7. There is a causal connection between the Veteran’s present disability and an in-service event. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for (PTSD) have been satisfied. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.304, 4.125 (2018). 2. The criteria for establishing entitlement to service connection for a right knee condition have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service with the United States Army from March 2002 to December 2008. This matter is before the Board of Veterans’ Appeals (Board) from an October 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Service Connection Entitlement to service connection for PTSD Generally, to establish entitlement to service connection there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). Pursuant to the requirements of 38 C.F.R. § 3.304 (f) (2018), service connection of a PTSD claim requires: (1) a diagnosis that conforms to the requirements of 38 C.F.R. § 4.125 (a) (2018); (2) a medical link between the diagnosis and an in-service stressor; and (3) credible supporting evidence of the occurrence of in-service stressor. Pursuant to 38 C.F.R. § 4.125 (a) (2018) the diagnosis of a mental disorder must conform to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Since his pending appeal, the Veteran received and submitted additional medical evidence indicating a clear and competent diagnosis of PTSD. A PTSD Disability Benefits Questionnaire (DBQ) dated May 24, 2017, and a May 11, 2017, psychological examination were completed by a private licensed psychologist who diagnosed the Veteran with PTSD. She states that the Veteran, “provides significant evidence of anxiety and clearly exhibits Posttraumatic Stress Disorder.” The medical link between the diagnosis and the Veteran’s in-service stressor is clear. The private examination indicated that “it is at least as likely as not” that the Veteran’s diagnosis of PTSD is directly tied to his time in service. The examiner reviews the Veteran’s records and mentions his seeking of treatment while in Iraq, being treated with medication since his tour of duty for symptoms related to PTSD, and seeking treatment after separating from service. That additionally, the Veteran continued to seek help from the VA, with his records continuing to list PTSD as a concern since his leaving the service and even listed PTSD as an active diagnosis in January 2016. These 2017 examinations found that the in-service stressor was directly related to the Veteran’s service during helicopter rescue missions where he was exposed to combat with the enemy and fatalities of civilians, combatants, and other service members. The fact that the examinations found that the occurrence of the in-service stressor was supported by credible evidence, by reviewing the service records of the Veteran, noting his military occupational specialty (MOS) of helicopter service and flight waivers and his lay statements detailing his helicopter evacuation and rescue missions tends to suggest that it is at least as likely as not that the Veteran’s PTSD manifested as a result of active military service. The VA examinations from October 2012 (referenced above) indicate that the in-service stressor was supported by credible evidence. If the evidence establishes that the Veteran engaged in combat with the enemy then the Veteran’s lay statements alone may be used to establish the occurrence of the in-service stressor. The lay statements of the Veteran are consistent and credible and do not require further verification, but the VA examination of October 2012 corroborates the Veteran’s lay statements of the in-service stressor. The combat stressor is considered to have been established as to the Veteran’s exposure to combat with the enemy. 38 C.F.R. § 3.304 (f) (2018). The negative opinion contained in the October 2012 VA examination is not afforded significant probative weight as compared to the positive opinions of June 2010 and the May 2017 diagnoses. The two positive exams show a more thorough and in-depth discussion of the Veteran’s symptoms and meeting of the criteria required for a diagnosis of PTSD. That the Veteran’s records also indicate a clear and consistent concern of PTSD even before he separated from the Army, in July 2008. The preponderance of the evidence shows that the Veteran’s PTSD was incurred in-service. Entitlement to service connection for a right knee disability. The Veteran contends that he is entitled to service-connection for a right knee disability that began in service. Generally, to establish service connection there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the issue will be resolved in favor of the Veteran. 38 U.S.C § 5107 (2012); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran’s medical records from August 2012 indicate a current diagnosis of right knee arthralgia and said diagnosis remains throughout his medical records, which is also the first mention of a right knee issue post service. The VA examination and DBQ of October 16, 2012, indicate lay testimony from the Veteran about jumping in and out of a helicopter did, “damaged [sic] to my knee” and mentions that his right knee pain has continued ever since he was evaluated for it during service. The current disability criterion is found to be met. The Veteran’s in-service treatment records upon entering service in February 2002 indicate no problems with his knees. The Veteran’s service records of October 2005 however, show the Veteran was diagnosed with patellofemoral syndrome at a doctor visit at Fort Benning, GA. In the Veteran’s February 2008 medical exam he marked a box indicating knee trouble, then on July 2, 2008, in a Post-Deployment Health Assessment (PDHA) he marked a box noting “swollen, stiff, or painful joints”, and in his separation exam on September 9, 2008, he specifically notes that his knee is still a concern in considering his health. The VA examination of October 16, 2012, indicated that the Veteran’s right knee strain was “less likely as not (less than 50/50 probability) incurred in or caused by the complaints of the right knee documented August 2008.” The VA examiner also indicates that the Veteran complained of right knee pain in August 2008 but his separation examination in September 2008 showed a checked box of “normal lower extremities” and that there was no treatment within one year of the Veteran’s separation from duty in December 2008. The VA examination of October 2012 fails to consider the documented in-service medical records, the entire separation exam of the Veteran, and the lay statements of the Veteran. Due to these discrepancies the VA examination is found to be less credible and given less weight considering the clear indications of consistent knee issues in-service and in their omission the VA exam’s credibility is lost. The Board finds that the Veteran’s in-service incurrence, in-service diagnosis, in-service records, his lay statements of knee trouble, the indications of stiff and swollen joints, and the indicated concerns of his knee during service to be probative, competent, and credible. The Board concludes that the probative evidence remaining outweighs the less than credible VA examination’s opinion of the Veteran’s knee issue being “less likely as not” occurring during service. This Board therefore finds that there is a causal relationship between the present disability and the in-service injury or event. In the record there is a balance of both positive and negative evidence regarding the material issue of whether there is a causal relationship between the current right knee disability of the Veteran and the in-service incurrence of right knee issues, and the benefit of the doubt is resolved in favor of the Veteran. See 38 U.S.C § 5107 (2012). The Board finds that the Veteran is entitled to service-connection for his right knee disability. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.A. Teich, Associate Counsel