Citation Nr: 18149608 Decision Date: 11/13/18 Archive Date: 11/09/18 DOCKET NO. 16-45 116 DATE: November 13, 2018 ORDER Service connection for posttraumatic stress disorder (PTSD) is granted. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDING OF FACT The weight of the evidence supports the finding that the Veteran has PTSD that either began during service or was otherwise caused by in-service stressors. CONCLUSION OF LAW The criteria for service connection for PTSD have been met. 38 U.S.C. §§1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1988 to August 1988 and from March 1989 to October 1992. Service Connection - PTSD The Veteran is seeking service connection for PTSD, which he believes resulted from his service as a combat medical specialist in Southwest Asia (Iraq) between December 1990 and May 1991 during which time he treated wounded soldiers and witnessed a lot of death. 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 military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 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 (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for PTSD specifically requires that the record show: (1) a current medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125, (2) combat status or credible supporting evidence that the claimed in-service stressor actually occurred; (3) medical evidence of a causal nexus between diagnosed PTSD and the claimed in-service stressor. 38 C.F.R. § 3.304 (f); see also Cohen v. Brown, 10 Vet. App. 128 (1997). The agency of original jurisdiction (AOJ) has determined that service records are consistent with the circumstances of the stressful incidents described by the Veteran, therefore, the in-service stressor (serving as a combat medic in Southeast Asia and witnessing the combat casualty) has been conceded. The next step is to determine whether there is a current diagnosis of PTSD and whether there is a causal link between the PTSD and the in-service stressor. The Veteran was afforded a VA examination in February 2013, at which the examiner concluded that the Veteran met the Criterion A but failed to meet the rest of the criteria for a diagnosis of PTSD under DSM-IV. The examiner diagnosed the Veteran with alcohol-induced mood disorder and opined that the Veteran’s mood disorder was most likely associated with social and family issues rather than service related issues. The Veteran provided a psychological evaluation conducted by a private psychologist in January 2018, in which the psychologist concluded that the Veteran met all criteria for a diagnosis of PTSD under DSM-5 and diagnosed the Veteran with PTSD and alcohol use disorder, secondary to PTSD. The psychologist opined that it was more likely than not that the Veteran’s PTSD started with his active service duty as a combat medic. As such, this opinion not only diagnosed PTSD, but also linked it to a corroborated stressor from service. Of note, VA implemented DSM-5, effective August 4, 2014, and determined that the DSM-5 applies to claims certified to the Board on and after August 4, 2014. See Definition of Psychosis for Certain VA Purposes, 79 Fed. Reg. 45,093-94 (Aug. 4, 2014). As the Veteran’s service connection claim for PTSD was originally certified to the Board in September 2016, the DSM-5 shall apply in this case. With regard to the PTSD diagnosis, the Board finds that the weight of the evidence supports the finding of a current diagnosis of PTSD. While the VA examiner concluded that the Veteran did not meet the all required criteria for a PTSD diagnosis, the Board notes that the VA examination was conducted using DSM-IV standard, which while it was the applicable standard at the time the examination was conducted, it is no longer the proper standard for this case at this time. Conversely, the private psychologist diagnosed the Veteran with PTSD pursuant to the DSM-5. Regardless, both examinations resulted in medical conclusions which were grounded in the evidence of record and supported by full findings. As such, the evidence of record is in relative equipoise as to whether the Veteran has PTSD as a result of his military service. Therefore, reasonable doubt is resolved in the Veteran’s favor, and service connection for PTSD is granted. REASONS FOR REMAND The AOJ denied the Veteran’s claim for individual unemployability based on that the service connection for PTSD was denied and the Veteran did not have a single disability rated at 60 percent or a combined rating of at least 70 percent with one disability rated at 40 percent; and that the evidence did not demonstrate that the Veteran was unable to secure or follow substantially gainful occupation solely due to service connected conditions. 38 C.F.R. § 4.16(a). As service connection for PTSD has now been granted, the TDIU claim should be readjudicated following the assignment of a rating for PTSD. The matter is REMANDED to AOJ for the following action: Re-adjudicate the claim for individual unemployability after assigning a rating for PTSD. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Q. Wang, Associate Counsel