Citation Nr: 20009668 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 14-19 707 DATE: February 5, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder, currently diagnosed as other trauma and stressor related disorder, is granted. FINDING OF FACT Resolving all reasonable doubt in his favor, the Veteran is diagnosed with an acquired psychiatric disorder, currently diagnosed as other trauma and stressor related disorder, that is causally or etiologically due to service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, currently diagnosed as other trauma and stressor related disorder, have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1969 to January 1971 and January 1979 to January 1998. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from a September 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in May 2017 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In March 2018, the Board remanded this claim for additional development. The Board notes the Veteran originally claimed entitlement to service connection for posttraumatic stress disorder (PTSD); this appeal is expanded from the Veteran’s original claim to include all acquired psychiatric disorders. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (finding a claimant without medical expertise cannot be expected to precisely delineate the diagnosis of his mental illness). Entitlement to service connection for an acquired psychiatric disorder. The Veteran seeks entitlement to service connection for an acquired psychiatric disorder, claimed as PTSD. Under the relevant laws and regulations, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2019). In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Establishment of service connection for PTSD requires: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304 (f). If a stressor claimed by a Veteran is related to the Veteran’s “fear of hostile military or terrorist activity” and a VA or VA-contracted psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor so long as there is not clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service. For purposes of this section, “fear of hostile military or terrorist activity” means that “a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others,... and the Veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.” 38 C.F.R. § 3.304 (f)(3). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value. Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. The Board finds the requirements for service connection have been met. First, the Veteran reports two particular stressors, as described in a September 2011 VA Form 21-0781 and the September 2011 and March 2014 VA examinations. The first stressor involved participating in a “mad minute” in Vietnam where several grenades were thrown nearby, causing injuries to some of his fellow soldiers. The second stressor occurred when the Veteran was performing guard duty and saw the enemy in the distance. He phoned in for an artillery strike, which resulted in unexploded grenades and seeing the body of an enemy soldier. The next morning, the Veteran was instructed to pick up an unexploded grenade but refused; another soldier picked it up and it exploded, throwing rocks over everyone. The Board notes that the RO has had difficulty verifying the Veteran’s asserted stressors, which has resulted in multiple requests for verification over the course of two years, post remand. As noted by the Veteran’s representative, the RO has still not requested research on the Veteran’s correct unit. See January 2020 Appellate Brief Presentation. The Board declines to remand this case yet again and further delay disposition of this appeal. The Court of Appeals for Veterans Claims reiterated in Wise that “[b]y requiring only an ‘approximate balance of positive and negative evidence’ to prove any issue material to a claim for Veterans benefits, 38 U.S.C. § 5107 (b), the nation, ‘in recognition of our debt to our Veterans,’ has ‘taken upon itself the risk of error’ in awarding such benefits.” Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (citing Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990)). Here, the Veteran’s stressors and assertions of fear during his Vietnam service is consistent with the circumstances, conditions, or hardships of his service while he was deployed. Furthermore, both the September 2011 and March 2014 VA examiners confirmed that both stressors met Criterion A for a diagnosis of PTSD and involved fear of hostile military or terrorist activity. As such, the Board concedes a stressor, or in-service event of fear of hostile military activity. See 38 C.F.R. § 3.304 (f)(3). Second, the Board notes that there have been conflicting opinions as to whether the Veteran has an Axis I diagnosis of PTSD or another acquired psychiatric disorder. VA treatment records contain multiple diagnoses of psychiatric disorders, including PTSD, anxiety disorder, and depression. As noted in VA treatment records, the Veteran has sought treatment for his psychiatric symptoms for many years, was diagnosed with PTSD, and has attended PTSD group therapy since 2012. During the September 2011 VA examination, the examiner stated that the Veteran’s symptoms were best characterized as an anxiety disorder. The examiner noted that the Veteran reported experiencing more symptoms of PTSD when he first came back from Vietnam, but these symptoms have improved over time. The examiner stated that at the time of the examination, the Veteran was not reporting any significant re-experiencing symptoms, with the exception of physiological reactivity to triggers and he was not reporting significant avoidance of reminders of Vietnam; however, he did note some detachment in relationships and emotional numbing, which could also be associated with depressive features. In a March 2014 VA examination, the examiner explained that the Veteran did not meet the full criteria for PTSD; however, he has significant emotional and behavioral symptoms that, based on review of records and the Veteran’s reports, are more likely than not related to his fear of hostile military or terrorist activity stemming from service in Vietnam. The examiner opined that the Veteran’s diagnosis using the DSM-IV would be anxiety disorder. Continuing, the examiner explained that the DSM-5 does not have this diagnosis though, and the most comparable diagnosis is the Veteran’s currently assigned diagnosis of other trauma and stressor related disorder, which reflects significant emotional/behavioral symptoms that stem from traumatic incidents. In this case, the Board finds that the evidence is at least evenly balanced. The Veteran is currently diagnosed with other trauma and stressor related disorder. The medical evidence not only indicates the Veteran has a diagnosis but links this diagnosis to his experiences during service. The Board finds no adequate basis to reject the evidence of record that is favorable to the Veteran, based on a lack of credibility or probative value. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Evans v. West, 12 Vet. App. 22, 26 (1998). In light of the discussion above, while the evidence is not unequivocal, it has nonetheless placed the record in relative equipoise. As such, the Veteran’s service connection for an acquired psychiatric disorder, currently diagnosed as other trauma and stressor related disorder, is granted. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Andersen, 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.