Citation Nr: 20004791 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 18-46 151A DATE: January 21, 2020 ORDER Service connection for a psychiatric disability, to include anxiety and depression, is granted. FINDING OF FACT The Veteran has been diagnosed with a psychiatric disability, to include anxiety and depression, which is related to his in-service stressor. CONCLUSION OF LAW The criteria for service connection for a psychiatric disability, to include anxiety and depression, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1967 to April 1969 in the U.S. Army. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran contends that he has an acquired psychiatric disability that is related to his service in Vietnam, including combat duties, protecting his crew, and carrying dead bodies. See October 2019 Appellate Brief. The Veteran also contends that his acquired psychiatric disability is related to his stress while trying to get a reassignment in the military due to his mother being sick. Id. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Entitlement to service connection for posttraumatic stress disorder (PTSD) requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that a claimed in-service stressor occurred; and (3) a link, established by medical evidence, between current symptoms and the in-service stressor. 38 C.F.R. §§ 3.304(f), 4.125. 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 conditions or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the in-service stressor. 38 U.S.C. § 1154(b) and 38 C.F.R. § 3.304(f); See Cohen v. Brown, 10 Vet. App. 128 (1997). The Board notes that VA, effective March 19, 2015, amended the portion of the Rating Schedule dealing with mental disorders to replace outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), with references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). See 80 Fed. Reg. 14308 (Mar. 19, 2015). VA directed that the changes be applied only to applications for benefits received by VA or pending before the agency of original jurisdiction (AOJ) on or after August 4, 2014, but not to claims certified to, or pending before, the Board, the Court of Appeals for Veterans Claims (CAVC), or the United Stated Court of Appeals for the Federal Circuit. Id. As the Veteran’s claim was received in June 2017, which was after August 4, 2014, DSM-5 (not DSM-IV) guidelines must be considered in determining whether the Veteran meets the diagnostic criteria for a psychiatric disability. Id. The Board finds that the Veteran has a current disability. The Veteran’s VA treatment records show that the Veteran has a diagnosis of depression and anxiety. See August 2017 VA Treatment Record. Therefore, the Board finds that the Veteran has a current psychiatric disability, including anxiety and depression. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Board finds that the Veteran does not have a PTSD diagnosis conforming to the DSM-5 criteria. The Veteran was afforded a VA examination in September 2017. The VA examiner found that the Veteran does not have a diagnosis of PTSD or a mental disorder that conforms to DSM-5 criteria. The Veteran’s VA treatment records note that the Veteran has a PTSD diagnosis, however the diagnosis conforms to the DSM-IV criteria. See December 2014 VA Treatment Record. The Veteran submitted a letter from his private therapist stating that the Veteran attends counseling for treatment for PTSD. See May 2017 Medial Treatment Record. The private therapist stated that the Veteran’s symptoms include periods of anxiety, suicide ideation with no immediate plan, lack of motivation, impaired impulse control, illogical thinking, exaggerated startle response at times, night disturbances, control issues, social withdrawal and isolation, bouts of irritability and anger outbursts, emotional numbing, lack of trust, black and white thinking, and difficulties establishing and maintaining relationships. Id. However, the private therapist stated that the Veteran’s PTSD meets the DSM-IV criteria. Id. There is no evidence of record suggesting that the Veteran has a PTSD diagnosis that conforms to the DSM-5. Regarding the second element, the Board finds that the Veteran is a combat Veteran under 38 U.S.C. § 1154 and has an in-service stressor related to combat. The record shows that Veteran served in the Republic of Vietnam from April 1968 to April 1969. See Service Personnel Records. The Veteran was awarded the Combat Infantry Badge and the Army Commendation Medal with “V” Device. Id. Notably, the Veteran was awarded the Army Commendation Medal with “V” Device “for heroism in connection with ground operations against a hostile force in the Republic of Vietnam.” Id. The Veteran submitted lay statements about his time in Vietnam, which are consistent with the Veteran’s service personnel records. See May 2017 Correspondence; see also May 2017 Statement in Support of Claim. Specifically, the Veteran stated that while he was in Vietnam, his company was attacked by the enemy and he feared that his life was over. Id. Therefore, given the evidence that the Veteran engaged in combat with the enemy, and resolving doubt in the Veteran’s favor, the Board finds the Veteran’s statements credible and establish the occurrence of an in-service stressor related to combat. Finally, as to the third element, the Board finds that there is nexus between the Veteran’s psychiatric disability and his in-service stressor. The Veteran’s private therapist stated that she believes that his PTSD symptomatology, including the anxiety and depression, is related to his military service in Vietnam and the traumas that he experienced and witnessed. See May 2017 Medical Treatment Record. As such, the Board finds that the preponderance of the evidence shows the Veteran’s diagnosed anxiety and depression are related to active military service. Accordingly, entitlement to service connection for a psychiatric disability, to include anxiety and depression, is warranted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Kernen, Associate 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.