Citation Nr: 18159950 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 17-46 585A DATE: December 20, 2018 ORDER Service connection for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The competent and probative evidence is at least in equipoise as to whether the Veteran’s current PTSD had its onset in or is otherwise related to the Veteran’s period of active service. CONCLUSION OF LAW The criteria for entitlement to service connection for PTSD have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1974 to September 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in March 2018, at which time it was remanded for further development. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for PTSD. After review of the record, the Board finds that the criteria for service connection for PTSD have been met. The record contains a competent diagnosis of PTSD. 09/07/2018, C&P Exam. Accordingly, the Board finds competent evidence of a current disorder. The Veteran contends that PTSD is due to an in-service incident in which a firearm was accidentally discharged and the bullet ricocheted around the room. Contemporaneous statements taken immediately following the incident corroborate that the incident occurred as described in March 1976. 03/23/2011, Military Personnel Records. The Veteran contends that following the in-service incident, he had nightmares and intrusive thoughts regarding the accidental discharge, had trouble sleeping, experienced difficulty concentrating, and often found himself crying. 11/26/2018, Correspondence. Lay statements from the Veteran’s sister and spouse describing a change in personality following the in-service incident, such as being more irritable, easily frustrated, and reserved, and that he experienced sleep problems. Additionally, the Veteran constantly talked about guns in the arms room, and that he could have died or killed someone. 03/19/2015, Buddy Statement. The Veteran states that he did not use substances prior to the incident, and that after the trauma, his first sergeant gave him drugs to help him relax and sleep, which led to a severe substance abuse problem. 11/26/2018, Correspondence. The Veteran also contends that he was treated for substance use in service and that his work performance declined following the accidental discharge, however, the record does not contain evidence of in-service treatment for substance use, and his work performance reviews following the incident are outstanding. 03/12/2008, Military Personnel Records. In September 1987, VA received a claim for service connection for a nervous condition, which the Veteran contended began in 1976, and that he received treatment at that time. 09/15/1987, Application. In November 1987, the Veteran received mental health treatment after he ran over his son while high, and was diagnosed with cocaine dependence and acute PTSD. 11/23/1987, Medical-Government. Additionally, the record indicates that the Veteran was involved in a post-service motor vehicle accident resulting in the death of the other driver. A March 2015 private treatment note indicates that it is likely the Veteran has two disorders – conventional PTSD immediately following the accidental discharge, and a second condition triggered by PTSD, possibly posttraumatic personality disorder. 03/31/2015, Medical-Non-Government. An April 2015 progress note states that it is clear the Veteran had PTSD during service. 08/31/2015, Medical-Non-Government. A February 2017 letter indicates that the Veteran is currently in treatment for PTSD related to the in-service trauma. 03/02/2017, Medical- Non-Government. In an August 2017 letter, a private therapist opined that the in-service incident impacted the Veteran, evidenced by subsequent behavior and symptoms which were not previously present, including sleepless nights, fears of dying, suicidal ideation, and depression. Additionally, the Veteran reports experiencing recurrent, involuntary, and intrusive memories of the event; recurring distressing dreams and flashbacks related to the event; persistent inability to experience positive emotions (thereby turning to drugs); altered sense of reality; inability to remember important aspects of the event; efforts to avoid memories of the event; sleep disturbance; irritable behavior and angry outbursts; concentration problems; and exaggerated startle response. The therapist also opined that the post-service vehicular accidents further contributed to his diagnostic symptoms to the point he sought treatment. 09/22/2017, Medical-Non-Government. A September 2018 VA examination indicates that the in-service incident is adequate to support the diagnosis of PTSD, and that the Veteran’s response to the trauma involved fear, helplessness, or horror. Additionally, the examination indicates that the Veteran satisfies the remaining criteria for PTSD, including experiencing intrusion symptoms associated with the traumatic event and beginning after the traumatic event; persistent avoidance of stimuli associated with the traumatic event and beginning after the traumatic event; having negative alterations in cognition and mood associated with the traumatic event, beginning or worsening after the traumatic event; and having marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event. 09/07/2018, C&P Exam. In light of the above, and resolving reasonable doubt in favor of the Veteran, the Board finds that the competent and probative evidence is at least in equipoise as to whether PTSD had its onset during or is otherwise related to the Veteran’s period of service. In sum, as all three service connection elements have been established by competent, credible, and probative evidence, the Board finds that service connection is warranted. (CONTINUED ON THE NEXT PAGE)   The Board acknowledges that in September 2018, a VA examiner opined that PTSD is less likely than not related to service; however, the Board assigns the opinion little probative weight, as it fails to consider and address lay evidence regarding changes in behavior following the incident or substance abuse to treat mental health symptoms. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.A. Gelber, Associate Counsel