Citation Nr: 18138317 Decision Date: 09/25/18 Archive Date: 09/25/18 DOCKET NO. 15-35 381A DATE: September 25, 2018 ORDER Service connection for a fungal infection of the left thumb is denied. Service connection for posttraumatic stress disorder (PTSD) is granted. REMANDED Entitlement to service connection for polysubstance abuse, claimed as alcohol problems, is remanded. Entitlement to service connection for schizoaffective disorder is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has fungal infection of the left thumb due to a disease or injury in service. 2. Resolving reasonable doubt in the Veteran’s favor, his confirmed diagnosis for PTSD is is at least as likely as not related to in-service personal assault. CONCLUSIONS OF LAW 1. The criteria for fugus under finger and toe nails have not been met. 38 U.S.C. §§ 1010, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 4.125. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1987 to October 1991. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2013 rating decision from the Department of Veterans Affairs (VA) Regional office (RO) in Muskogee, Oklahoma. The Veteran’s did not specifically claim PTSD or schizoaffective disorder. Instead he filed a claim for a “mental disorder.” Based upon a review of the Veteran’s medical treatment records and VA examination, the claim was reclassified in accordance with Clemons v. Shinseki. 23 Vet. App. 1 (2009) (holding that when a Veteran makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). Service Connection Generally, service connection may be granted for disability or injury incurred in, or aggravated by, active military service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disorder, there must be (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 current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Under 38 C.F.R. § 4.125), if the diagnosis of a mental disorder does not conform to the AMERICAN PSYCHIATRIC ASSOCIATION: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (5th ed.) (hereinafter DSM) or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis. Service connection for PTSD specifically requires medical evidence establishing a diagnosis of the disability, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f). 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. See 38 C.F.R. § 3.304 (f)(1); see also, 38 U.S.C. § 1154 (b). Similarly, if a stressor claimed by a veteran is related to the Veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of posttraumatic stress disorder and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 C.F.R. § 3.304 (f)(3). Otherwise, the law requires verification of a claimed stressor. Where a determination is made that the Veteran did not “engage in combat with the enemy,” or the claimed stressor is unrelated to combat, the Veteran’s lay testimony alone will not be enough to establish the occurrence of the alleged stressor. See Moreau v. Brown, 9 Vet. App. 389, 395 (1996); Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). In such cases, the record must include service records or other credible evidence that supports and does not contradict the Veteran’s testimony. Doran v. Brown, 6 Vet. App. 283, 289 (1994). Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. See Moreau, 9 Vet. App. at 395-396; Cohen v. Brown, 10 Vet. App. 128, 42 (1997). 1. Fungal Infection of Left Thumb The Veteran has claimed service connection for a chronic fungal infection on his left thumb. He has asserted that it is a result of an injury to his thumb while in service. The Board concludes that the preponderance of the evidence is against the claim. A skin condition is not shown in service and the post service diagnosis for disorder is not etiologically linked to service, to include in-service injury to the thumb. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The condition is shown over a decade after service and competent evidence has not related the disorder to service. Service treatment records (STRs) reflect no complaints or findings for fungal infection of the left thumb or hand. A June 2013 VA medical opinion reflect that the Veteran’s fungal infection is less likely than not related to service, explaining that it was first documented in 2005, well over a decade after the Veteran left service, and an injury to the left thumb would unlikely cause a fungal infection. The Veteran has not presented a favorable medical opinion to weigh against the VA medical opinion. The Board accepts that the Veteran is competent to report his symptoms, the onset of those symptoms, and treatment. In this regard, lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, the Veteran has asserted that his condition began in service. However, the Board find that this is not credible in view of his denial of skin problems on October 1991 service separation examination. In fact, there are no documented complaints or finding for abnormal skin pathology of the left hand including thumb during active service. STRs, while indicating treatment of the thumb injury, show no findings for a fungal infection or other skin abnormality. Further, October 1991 service separation examination affirmatively notes the Veteran had normal skin. The Board assigns greater probative value to the normal STRs, the Veteran’s denial of skin problems at service separation, and the negative VA medical opinion coupled with the many years intervening service and the first documented abnormal findings. The STRs are highly probative as they were prepared contemporaneous with service and the reported incident. Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant). The VA medical opinion is probative as it was prepared by a skill, neutral medical professional with consideration of the Veteran’s theory of entitlement. Accordingly, on balance, the weight of the evidence is against the claim. There is no doubt to resolve because the evidence is not roughly in equipoise. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. PTSD The Veteran seeks service connection for PTSD. He contends that he has PTSD due to personal assault that occurred in service. The Board concludes that the evidence supports the claim of entitlement to service connection for PTST. First, the Veteran has a confirmed diagnosis of PTSD per May 2016 VA examination that is consistent with the criteria in the DSM. While a 2015 VA examination did not confirm a diagnosis of PTSD, the later May 2016 VA examination reflects that the Veteran may not have been demonstrating certain symptoms at the time of 2015 VA examination. The May 2016 VA examiner’s diagnosis was also confirmed by a later competency examination conducted in August 2017. Second, the May 2016 VA medical opinion reflects that the Veteran experienced personal assault in service and that his PTSD resulted therefrom. Third, the Veteran’s lay account of in-service personal assault considered in the context of behavioral changes in service and notice by his mother post service, tends to corroborate the Veteran’s account of the stressor incident. Although STRs do not show a personal assault occurred, sources other than STRs are sufficient to corroborate the incident’s occurrence. See 38 C.F.R. § 3.304(f)(5). For instance, the May 2016 VA examination reflects the Veteran’s abuse of drugs and alcohol are not uncommon as a result of the type of assault the Veteran reported; that there were other symptoms reported that are often used as markers that such an assault occurred; and that, based on his interview with the Veteran, he believed that the assault had occur and resulted in the Veteran’s PTSD. Also, the Veteran’s mother provided a detailed account of behavioral changes she observed following his service discharge. Therefore, the Board finds that it is at least as likely as not that the reported assault occurred. Accordingly, affording the Veteran the benefit of any doubt, the claim is granted. REASONS FOR REMAND Schizoaffective Disorder and Polysubstance Abuse Additional development is needed with regard to the claimed conditions of schizoaffective disorder and polysubstance abuse. The record has reasonably raised the possibility that the Veteran’s schizoaffective disorder and polysubstance abuse are aggravated by the Veteran’s PTSD. However, there are no medical opinions as to whether those conditions were aggravated by the Veteran’s PTSD. Therefore, a remand is necessary to obtain an opinion as to whether the Veteran’s claimed conditions of schizoaffective disorder and polysubstance abuse are at least as likely as not aggravated beyond their natural course by the Veteran’s service-connected PTSD. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s schizoaffective disorder and/or polysubstance abuse is at least as likely as not related to his diagnosed PTSD or if either has aggravated beyond its natural progression by his PTSD. C.A. SKOW Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Reed, Associate Counsel