Citation Nr: 18151104 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 16-48 679 DATE: November 16, 2018 ORDER Entitlement to service connection for specified trauma and stressor-related disorder is granted. FINDING OF FACT The Veteran’s specified trauma and stressor-related disorder is related to service. CONCLUSION OF LAW The criteria for service connection for specified trauma and stressor-related disorder are met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018).   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1968 to January 1972. He served in the United States Navy. Entitlement to service connection for specified trauma and stressor-related disorder Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110 (2014); 38 C.F.R. § 3.303(a) (2018). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2018). In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2018); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).   Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309 (2018); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran alleges that his psychiatric disorder is related to active service. In a July 2015 Statement in Support of Claim, the Veteran reported that he received two gunshot wounds to the right leg and right arm while on active duty. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). During an August 2016 VA examination, the Veteran was diagnosed with specified trauma and stressor-related disorder. Furthermore, during the period on appeal, the Veteran was also diagnosed with posttraumatic stress disorder (PTSD), chronic, and anxiety disorder, not otherwise specified, rule out non-combat related PTSD. See VA treatment records from October 2011, November 2011, March 2012, May 2012, July 2012, and November 2012. Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran’s service treatment records (STRs) show that the Veteran was shot by an unknown assailant in Dublin, Ireland on July 28, 1970. A September 1970 Report of Medical Treatment, Hospitalization, and Allied Services document the Veteran’s injury from a gunshot in the right upper arm and right lower leg from an unknown assailant in Dublin, Ireland, and was admitted to St. Vincent Hospital in Dublin, Ireland for treatment. The record also showed that the Veteran incurred the injury in the line of duty and was not due to his own misconduct. The Veteran’s December 1971 separation examination noted scars on the Veteran’s right forearm and right mid-thigh. The Veteran’s April 1968 Enlistment examination did not note any scars. Third, the Board finds that the evidence of record does support a finding that the Veteran’s specified trauma and stressor-related disorder is related to active service. In a July 2015 Statement in Support of Claim, the Veteran alleged that his psychological implications resulted from the two gunshot wounds he sustained in service. The Veteran reported that he lived most of his life trying to suppress his state of fear. He further reported that it has affected his sleep, sense of security, and made him leery of other people. The Veteran stated that he had many triggers, including loud noises, bangs, firecrackers, and crowds, and that he re-lived the event almost daily but did not like to use the word flashback. The Veteran reported feeling helpless, harbored resentment that he has been unable to overcome, and experienced extreme anxiousness. On his September 2016 Substantive Appeal, the Veteran indicated that he experienced lack of sleep, bad dreams, mistrust of others, helplessness, and avoidance. The Board finds these statements competent and credible, based on the Veteran’s consistency in describing the in-service event and symptomatology. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (holding that a lay witness is competent to testify to that which the witness has actually observed and is within the realm of his personal knowledge); Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, or demeanor of a witness), aff’d, 78 F.3d 604 (Fed. Cir. 1996). Second, the most probative medical evidence of record demonstrates that the specified trauma and stressor-related disorder is related to the in-service injury. In an October 2011 VA Mental Health Initial Evaluation Note, the Veteran was diagnosed with anxiety not otherwise specified rule out noncombat-related PTSD and rule out cluster B personality traits. The Veteran reported that he had been shot twice during military service. The Veteran also reported that he thought about the incident on a regular basis and is the first thought of the day when he awakens. The Veteran also stated that he tended to avoid groups, closeness in relationships, and events or celebrations with fireworks. The Veteran stated that he had increased anxiety with fireworks due to noise and flash similar to gunshots, experienced hypervigilance of diminished sleep, and needed the television on at night as a self-calming. During a November 2011 VA Mental Health Initial Evaluation Note, the Veteran complained that he had worsening PTSD symptoms and that they were becoming troublesome because he was becoming less active. The Veteran reported that he was gradually cutting back on work and was less physically active. The Veteran stated that any loud noises such as fireworks, or a car backfiring will trigger memories of Dublin and that he avoids those situations whenever possible. The Veteran described avoiding big social gatherings, avoiding movies or TV shows with shooting, worrying a lot, and gaining weight. He denied hallucinations, panic attacks, and mania. The Veteran noted that he has had fleeting suicidal thoughts at different times in life, but has never had a plan or intent. VA treatment notes from November 2011, March 2012, May 2012, July 2012, and November 2012 show that the Veteran had a diagnosis of PTSD, chronic. A January 2013 VA examination was conducted. The examiner opined that the Veteran did not have a diagnosis of PTSD or any other diagnosed mental health disorder. The examiner noted that the Veteran was currently in mental health treatment for PTSD, attended weekly group therapy, was never violent, suicidal, or hospitalized, and had a negative history for mental illness. The examiner also indicated that the Veteran denied nightmares, night terrors, and flashbacks, but that he occasionally thought about the incident. After examination, the examiner concluded that the Veteran’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale given was that the Veteran did not meet the diagnostic criteria for a mental health diagnosis.   An August 2016 VA examination was conducted upon a review of the claims file. The examiner found that the Veteran did not have a diagnosis of PTSD, but did have a diagnosis of specified trauma and stressor-related disorder. The examiner noted the Veteran actively had anxiety. The Veteran reported that he experienced significant sleep impairment since being shot and reported having bad dreams related to the incident. The Veteran also reported that he experienced mistrust of strangers and had intermittent anxiety related to meeting new people or if people were behind him. The Veteran also stated that loud bangs and firecrackers startle him and cause intrusive thoughts and sleep impairment. The examiner concluded that although the Veteran did not report any significant behaviors of avoidance or negative mood or cognition as required for a diagnosis of PTSD, a diagnosis of specified trauma and stressor-related disorder was appropriate. The examiner opined that it was at least as likely as not that the Veteran’s specified trauma and stressor-related disorder was related to his gunshot wounds he experienced in service based on a review of the records and the Veteran’s self-report. The Board assigns the most probative weight to the August 2016 VA examination report. The opinion was rendered after a review of the records and consideration of the Veteran’s lay statements, including a description of the in-service event and subsequent symptomatology. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that review of the claims file by a VA examiner, without more, does not automatically render the opinion persuasive, and conversely a private medical opinion may not be discounted solely for a lack of claims file review, because the central issue is whether the examiner was informed of the relevant facts in rendering a medical opinion). When read in conjunction with VA treatment records from October 2011 through November 2012, the evidence supports a finding that the Veteran’s specific trauma and stressor-related disorder is related to active service. In contrast, the Board gives no probative weight to the January 2013 VA examination report because the examiner did not provide an explanation as to why the evidence did not support a diagnosis of a mental health disorder. Therefore, the most probative evidence of record indicates that the Veteran’s current unspecified trauma and stressor-related disorder is related to service. Hence, service connection for unspecified trauma and stressor-related disorder is granted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. The Board notes that the benefit granted herein is service connection for specified trauma and stressor-related disorder, although the issue on appeal was previously characterized as entitlement to service connection for PTSD. There are diagnoses of PTSD and anxiety disorder during the appeal period. However, the 2016 VA examination report found that the stressor-related disorder was the only mental health diagnosis. This opinion was provided upon a review of the claims file, to include the relevant medical records that contained the other diagnoses. Accordingly, the Board accords this opinion significant probative value and service connection as noted above is warranted. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Nguyen, Associate Counsel