Citation Nr: 20004396 Decision Date: 01/17/20 Archive Date: 01/17/20 DOCKET NO. 17-05 304 DATE: January 17, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), anxiety, and panic disorder, is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his acquired psychiatric disorder is at least as likely as not related to his active military service in Southwest Asia during the Persian Gulf War. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include PTSD, anxiety, and panic disorder, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active military service from March 2004 to September 2004, January 2005 to January 2006, December 2007 to January 2009, and from March 2009 to September 2009, to include service in Southwest Asia during the Persian Gulf War. This issue is on appeal from a March 2016 rating decision. In November 2019, the Veteran testified at a Board hearing before the undersigned. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, anxiety, and panic disorder. The Veteran contends that he has experienced anxiety and panic attacks since returning from his first deployment to Southwest Asia in October 2005. In a January 2016 Statement in Support of Claim for Service Connection for PTSD, the Veteran reported that in May 2005 in Iraq, they were attacked with improvised explosive devices (IEDs) and mortar fire. He stated that someone was killed in action during this time. The Veteran was a Gunner during his Iraq service. The Veteran was on active duty during this time from January 2005 to January 2006, and his personnel records document deployments to Southwest Asia. Some of his experiences were described in great detail at his Board hearing. He is competent and credible to describe symptoms of anxiety and panic attacks. He testified that he did not report his symptoms or seek treatment for fear of his reenlistment being jeopardized. See November 2019 Board hearing transcript; see also January 2017 VA Form 9. The Board concludes that the Veteran has a current acquired psychiatric disorder that is related to his active military service in Southwest Asia during the Persian Gulf War. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In February 2016 and November 2017 Disability Benefits Questionnaires (DBQs), VA examiners found that the Veteran did not have Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) diagnoses of PTSD; instead, the Veteran had current diagnoses of panic disorder. In contrast, in a January 2016 medical opinion, the Minnesota Air National Guard’s Director of Psychological Health opined that her diagnostic impression of the Veteran was PTSD. At a February 2017 private psychiatric examination, Dr. G.V.K., the Veteran’s treating private physician, diagnosed the Veteran with PTSD and panic disorder. In a June   2017 PTSD DBQ filled out by Dr. G.V.K., the Veteran was diagnosed with PTSD with panic attacks under the DSM-V. The treatment records do not document any other psychiatric diagnoses. In February 2009, immediately following the Veteran’s active duty period from December 2007 to January 2009, a Post-Deployment Health Re-Assessment was conducted. Following an examination of the Veteran, the examiner determined that the Veteran’s Identified Concerns included: PTSD symptoms, depression symptoms, anger/aggression, suicidal ideation, social/family conflict, and alcohol use. Thus, the question becomes whether the current disability is related to service. On this question, there are probative opinions in favor of and against the claim. The evidence against the claim includes the February 2016 VA examiner, who opined that it was less as likely as not (i.e., unlikely) that the Veteran’s panic disorder is caused by his military experiences. The examiner opined that the Veteran has a history of panic attacks dating back to May 2012. The Veteran indicated that the panic attacks occur independent of his thoughts about his time as a military police officer and that the attacks are not necessarily triggered by military-related materials. Thus, the examiner found that the Veteran’s panic disorder emerged after his time in the military. The November 2017 VA examiner found that it is unlikely that the Veteran’s panic disorder is related to or caused by his reported military stressors. The examiner opined that the Veteran denied symptoms consistent with PTSD and reported an onset of 2012 for his panic symptoms. The examiner stated that this onset was well after the Veteran’s deployments, and the Veteran clearly indicated that there were no military/deployment related trigger for the initial or subsequent panic attacks. However, both VA examiners acknowledged that some of the Veteran’s stressors (to include being hit by an IED in 2005 in Iraq, seeing IEDs, and firing multiple rounds into a strange vehicle) were adequate to support a diagnosis of PTSD and were related to the Veteran’s fear of hostile military or terrorist activity. Neither   examiner addressed the Veteran’s contentions of not reporting his symptoms or seeking treatment for fear of his reenlistment being jeopardized. See November 2019 Board hearing transcript; see also January 2017 VA Form 9. The evidence in favor of the claim include a January 2016 medical opinion from the Minnesota Air National Guard’s Director of Psychological Health. The Director opined that a biopsychosocial of the Veteran revealed that his psychological health issues are related to extreme stress and repeated transitions from deployments and his military duty. The Director reasoned that the Veteran’s background does not include other traumas or incidents that would exacerbate any of this current symptoms and struggles. The evidence in favor of the claim also includes a February 2017 private medical opinion, in which the Veteran’s treating private physician examined the Veteran and reviewed in-service and private treatment records. Dr. G.V.K. opined that he disagreed with previous decisions, which found that the Veteran’s acquired psychiatric disorder was not due to his active military service. Instead, Dr. G.V.K. determined that the Veteran’s PTSD was secondary to his combat service in Iraq. The physician reasoned that the Veteran had no pre-military history of trauma or related symptoms, and his presentation is consistent with combat related PTSD. Dr. G.V.K. added that the fact that chronicity of disability was not established in the C&P process appears to overlook the severity of the Veteran’s condition and the associated distress he has experienced in living these conditions. The record of evidence is clearly weighted in favor of not only diagnoses related to service time, but the related impairments he has experienced. Again, Dr. G.V.K. diagnosed the Veteran with PTSD and panic disorder in this report. The June 2017 DBQ filled out by Dr. G.V.K. notes the Veteran’s reports of symptoms during service with symptoms persisting and intensifying since that time. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current acquired psychiatric disorder is related to his Southwest Asia service during his active duty. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for an acquired psychiatric disorder, to include PTSD, anxiety, and panic disorder, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shauna M. Watkins, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.