Citation Nr: 18159341 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 16-60 993 DATE: December 18, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and depression diagnosed as polysubstance abuse, is granted. FINDING OF FACT Resolving all doubt in the Veteran’s favor, evidence of record shows that he has a current diagnosis of PTSD that is causally related to his reported stressors during combat service in Iraq. CONCLUSION OF LAW An acquired psychiatric disorder, to include PTSD, was incurred in active military service. 38 U.S.C. §§ 1101, 1110, 1154, 5103, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service in the United States Army/United States Army Reserve (USAR) from June 1999 to October 1999 and from February 2003 to May 2004. The Veteran was also a member of the Army National Guard with periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) from 1999 to 2011. This matter comes before the Board of Veterans’ Appeals (Board) from rating decisions rendered in July 2012, August 2013, February 2014, and January 2015. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, GAD, and depression diagnosed as polysubstance abuse The Veteran has asserted that he has an acquired psychiatric disorder, to include PTSD, as a result of in-service stressors. The Veteran reported that his stressors centered events while stationed in Iraq during active service, including witnessing near daily mortar attacks and being in constant fear while driving fuel trucks or performing guard duty. The Veteran and his family members have continually asserted that he was never diagnosed with any mental health condition prior to service and that his behaviors/symptoms changed after active duty in Iraq. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d) (2017). Service connection may be established under the provisions of 38 C.F.R. § 3.303(b) when the evidence, regardless of its date, shows that a veteran had a chronic condition in service or during the applicable presumptive period. For certain chronic disorders, such as psychosis, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). In addition, service connection on the basis of continuity of symptomatology can only be established for the chronic diseases as specified at 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection for PTSD requires that the record show: (1) a current medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); (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) (2017). A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which mandates that, for VA purposes, all mental disorder diagnoses must conform to the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM). 38 C.F.R. § 3.304(f). For cases certified to the Board after August 4, 2014, a diagnosis of PTSD must be in accordance with the DSM-5. 38 C.F.R. § 4.125 (2017). The Veteran filed his claim for service connection in 2012 and jurisdiction over the present appeal was conferred to the Board in September 2017. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 U.S.C. § 1154(b) (2012); 38 C.F.R. § 3.304(f) (2017). Available service treatment records did not reveal any treatment, findings, or diagnosis of PTSD. An April 2004 Report of Medical Assessment noted findings of substance abuse and anxiety. The Veteran’s DD Form 214 reflected that his MOS was Petroleum Supply Specialist. He served in Iraq and Kuwait and was awarded Imminent Danger Area pay as well as a Combat Action Badge (for actively engaging or being engaged by the enemy). Post-service VA treatment records dated from 2004 to 2018 detailed findings of rule out PTSD, rule out cognitive disorder NOS, chronic PTSD, GAD, depressive disorder NOS, depression, mood disorder secondary to traumatic brain injury, and substance abuse. The Veteran sought treatment for PTSD as well as reported to treatment providers that his chronic, lifelong anxiety worsened after his time in Iraq. In April 2014, a VA psychiatrist added PTSD as a primary diagnosis and indicated that the Veteran’s predominant symptoms appeared consistent with PTSD from combat experience, superimposed on GAD. In a July 2015 statement, the Veteran’s treating VA psychiatrist indicated that the Veteran’s diagnostic picture was historically complicated. It was noted that although symptoms of GAD had been clear and diagnosed since 2010, chronic underlying PTSD symptoms became more evident following establishment of a period of sobriety in 2014. The psychiatrist opined that the Veteran’s GAD was aggravated during his time abroad with development of PTSD during his deployment. In July 2012, January 2015, and April 2018 VA PTSD examination reports, VA examiners indicated that the Veteran did not meet the criteria for a PTSD diagnosis under the DSM-IV and DSM-5 criteria and opined that other diagnosed psychiatric disorders were present prior to military service. For example, the July 2012 VA examiner opined that the Veteran’s currently diagnosed GAD predated his military service and was less likely than not exacerbated beyond the normal progression from his military service. The examiner further opined that the Veteran’s currently diagnosed polysubstance abuse predated his military service and was less likely than not related to his active duty service. The Board has determined that entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is warranted. As the record reflects that the Veteran is in receipt of the Combat Action Badge, his reported stressors related to such combat service may be established by his testimony alone. The Board further acknowledges that the Veteran has a current medical diagnosis of PTSD based on his reported in-service stressors. Evidence of record contains contrary opinions concerning whether the Veteran has a current diagnosis of PTSD, or another acquired psychiatric disorder, related to his combat service. While the Board is cognizant that the July 2012, January 2015, and April 2018 VA examiners found that the Veteran did not have a diagnosis of PTSD that conformed to DSM-IV and DSM-5 criteria, VA treatment providers who saw the Veteran on a routine basis clearly opined that he had a current PTSD diagnosis related to his deployment to Iraq during the period of active service from February 2003 to May 2004. The Board further acknowledges that the Veteran has been diagnosed with various psychiatric disorders, including GAD, depression, mood disorder, and polysubstance abuse. However, the benefit sought on appeal is granted in a manner consistent with the fact that the most probative evidence shows that the proper diagnosis for the Veteran’s current, service-related psychiatric disorder is PTSD. Based on the foregoing discussion and with resolution of all reasonable doubt in the Veteran’s favor, the Board finds that service connection for an acquired psychiatric disorder, to include PTSD, is warranted. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2017), Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. D. Deane, Counsel