Citation Nr: 18151665 Decision Date: 11/19/18 Archive Date: 11/19/18 DOCKET NO. 16-36 785 DATE: November 19, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is granted. REMANDED Entitlement to service connection for right hand scarring is remanded. Entitlement to service connection for right hand neuropathy/nerve damage (also claimed as defense stab wounds, thumb, index, middle and ring fingers) is remanded. FINDINGS OF FACT 1. The Veteran was in sound condition upon entrance to service in January 1966. 2. The Veteran was injured in his right hand while in-service. 3. A diagnosis of PTSD based on a claimed in-service stressor has been offered. 4. Credible supporting evidence that the claimed in-service stressor occurred has been submitted. 5. The most probative evidence reflects that the Veteran's PTSD is the result of an in-service stressor event. CONCLUSIONS OF LAW The criteria for service connection for an acquired psychiatric disorder, to include PTSD, are met. 38 U.S.C. §§ 1110, 1111, 1112, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from January 1966 to May 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2017). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. It may include statements conveying sound medical principles found in medical treatises. Competent medical evidence may include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1) (2017). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2) (2017). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 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 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board notes that it has reviewed all of the evidence in the record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim being decided. Service Connection 1. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) The Veteran submitted a claim to establish service connection for PTSD in March 2013. The Veteran asserts that he has PTSD resulting from an incident while he was in service; specifically, the alleged incident stems from a racially motivated attack against the Veteran by two other servicemembers with a knife while the Veteran was being held in the stockade in Fort Bragg. The attack left the Veteran with an injured right hand. For the reasons discussed below, the Board concludes that the evidence of record supports the Veteran's assertions, and that service connection for PTSD is warranted under the controlling laws. The Veteran was diagnosed with PTSD in 1994, and letters from the Veteran’s private physician dated April 2013, June 2013, May 2015, and September 2015 confirm the diagnosis of PTSD, and thus, the first element has been demonstrated. Concerning the second element, evidence of in-service psychiatric symptoms and/or a confirmed in-service stressor, the records appear to be incomplete and no longer retained due to the age of the files, however there are notes in the Veteran’s Service Treatment Record relating to an injury to the Veteran’s right hand, and personnel records place him in the location of the attack at the time, and note medical treatment without explaining the purpose for the treatment. Defense Personnel Records Information Retrieval System (DPRIS) was contacted to try and locate unit records pertaining to the United States Army, Garrison Troop Command in Fort Bragg, North Carolina for the calendar years 1968 and 1969. In March 2016, DPRIS coordinated efforts with the National Archives and Records Administration, however they were not able to locate the requested unit records, or obtain any historical incident reports regarding the alleged incident. In an effort to corroborate the Veteran’s account of the incident, a March 2013 lay statement was provided by a colleague that was also in the Fort Bragg stockade. The colleague heard the incident as it was taking place, but did not see it. The lay statement does explain that the colleague did see the Veteran the following day and noticed the Veteran’s right hand bandages. The colleague also notes that the Veteran explained the incident that occurred the previous day. The Board notes that this information circumstantially confirms the Veteran's reported stressor, and his service personnel records confirm his presence in the area of the incident. The March 2013 lay statement is considered competent and credible, as such, the second element has been met. Concerning the last element required for service connection, evidence of a medical nexus between the Veteran's PTSD and any incident of service, the Board observes that the private nexus opinion is favorable to the Veteran’s appeal. Specifically, the April 2013 private psychiatric assessment report includes a clinician’s medical opinion that the Veteran's PTSD is the result of his reported stressor event. There is no medical evidence contradicting the opinion concerning the etiology of the Veteran's PTSD. The Board finds the April 2013 medical nexus opinion to be persuasive, as it is based on accurate facts and is supported by a rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (a medical opinion that contains only data and conclusions is accorded no weight). In the present case, the opining medical professional was fully aware of the Veteran's service and medical history, and the opinion is congruent with the medical and lay evidence of record. Bloom v. West, 12 Vet. App. 185, 187 (1999); Black v. Brown, 10 Vet. App. 297, 284 (1997). The Board further notes that a supporting VA medical opinion is not necessary to help prove the personal assault because there is already sufficient circumstantial evidence to support the incident as described by the Veteran. As such, the nexus element is demonstrated, the evidence reflects that the Veteran's PTSD is due to his confirmed in-service stressor, and thus, service connection for a psychiatric disability, to include PTSD, is warranted. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.304 (2017). REASONS FOR REMAND 1. Entitlement to service connection for right hand scarring is remanded Regrettably, a remand is necessary for further evidentiary development of the Veteran's appeal. As the Veteran's lay statements and treatment records indicate that the Veteran may have a disability that could be related to service, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 70 (2006). Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature, etiology, and severity for any right hand scarring the Veteran may have. 2. Service connection for right hand neuropathy/nerve damage (also claimed as defense stab wounds, thumb, index, middle and ring fingers) is remanded. Regrettably, a remand is necessary for further evidentiary development of the Veteran's appeal. As the Veteran's lay statements and treatment records indicate that the Veteran may have a disability that could be related to service, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 70 (2006). Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature, etiology, and severity of any current right hand neuropathy/nerve damage the Veteran may have. The matter is REMANDED for the following action: 1. Any outstanding VA treatment records should be associated with the claims file. If no records are available, the claims folder must indicate this fact. Any additional records identified by the Veteran during the course of the remand should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. After the above development has been completed and all records have been associated with the claims file, the Veteran must be afforded a VA examination by an examiner with appropriate expertise to determine the nature, etiology, and severity of the Veteran's claimed right hand disability, to include neuropathy/nerve damage and scarring. Any and all studies, tests, and evaluations that are deemed necessary should be performed. The claims folder, including a copy of this remand, should be reviewed by the examiner. The examination report should note review of these records, and the VA and private treatment records. The examiner should then: (a) Provide a specific diagnosis for any current right hand disability, to include neuropathy/nerve damage and scarring. (b) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that any right hand disability, to include neuropathy/nerve damage and scarring, originated during, or is etiologically related to, active duty service. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. The examiner is advised that the Veteran is considered competent to be able to report injuries and symptoms, and that his reports must be considered in formulating the requested opinions. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. R. Montalvo, Associate Counsel