Citation Nr: 20032995 Decision Date: 05/12/20 Archive Date: 05/12/20 DOCKET NO. 17-01 611 DATE: May 12, 2020 ORDER Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is granted. FINDINGS OF FACT The evidence of record is at least in equipoise as to whether the Veteran has an acquired psychiatric disorder related to service, to include a current diagnosis of PTSD that is causally related to a verified in-service stressor. CONCLUSIONS OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1977 to June 1999. A Board hearing was held before the undersigned Veterans Law Judge in February 2020, and a transcript of the hearing is of record. The Veteran and his representative requested a 60-day continuance to obtain additional medical evidence in support of his claim for entitlement to service connection for PTSD. In February 2020, the Veteran submitted medical evidence from his mental health treatment provider, Dr. J.B, and waived review by the agency of original jurisdiction (AOJ). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection for PTSD requires medical evidence diagnosing the condition, a link established by medical evidence between the current symptoms and an in-service stressor, and credible evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). Service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Historically, the Veteran filed a claim for entitlement to service connection for PTSD in April 2004. See April 2004 VA Form 21-4138. The Veteran reported that he began to experience symptoms of an acquired psychiatric disorder while stationed in Korea in the 1980’s. See April 2004 Statement in Support of Claim for PTSD. The Veteran reported that he believed there was an odor on him that he could not remove or wash away. The Veteran reported that he began to distance himself from friends and family. The Veteran also reported that he served in the Gulf War, and that a military barracks was blown up near his unit. See also DD Form 214 (Veteran served in Southwest Asia from August 1990 to March 1991, and was awarded the Bronze Star Medal). Additionally, the Veteran reported trouble sleeping when he returned from the Gulf War that has continued to the present, and that he began experiencing symptoms of paranoia within the last couple of years. See also September 1997 and January 1999 Report of Medical History (Veteran reported frequent trouble sleeping). In support of his claim, the Veteran submitted VA mental health treatment records. In January 2004, the Veteran sought VA psychiatric emergency services for symptoms of sleep disturbances and paranoia. The provider noted the Veteran was hesitant and embarrassed to talk about his symptoms. The Veteran reported that upon return from a one-year assignment in Korea he was more socially withdrawn, irritable, that he disliked crowds, and was suspicious of others. The provider indicated the Veteran reported a kind of olfactory hallucination. In a February 2004 VA mental health assessment, the Veteran was diagnosed with delusional disorder, mixed type. The Veteran was denied entitlement to service connection for PTSD in a July 2004 rating decision on the grounds that the Veteran did not have an in-service stressor for PTSD, there was no evidence in service treatment records for a chronic psychological problem, and the medical evidence of record failed to show PTSD was clinically diagnosed. Within one year of the July 2004 rating decision, the Veteran provided VA treatment records indicating the Veteran had fixed somatic delusion for years and a current diagnosis of delusional disorder, mixed type, and depressive disorder not otherwise specified. See September 2004 VA treatment records. Additionally, the Veteran’s spouse submitted a statement reporting that the Veteran would not eat when he returned from his one-year assignment in Korea, that he avoided people, and took long showers multiple times throughout the day. See December 2004 correspondence from Mrs. V.H. Mrs. V.H. reported the Veteran did not seek mental health treatment for fear that he would be separated from service. Mrs. V.H. also reported that she gave birth to their daughter while the Veteran was deployed in support of the Gulf War in 1990. Mrs. V.H. reported that she and the baby almost died during the birth, and that the Veteran was not allowed to return from his deployment until months later. Mrs. V.H. reported that after the Veteran returned, he would sit and do nothing else at home. The Veteran was afforded a VA mental disorders examination in March 2005. The Veteran reported he experienced problems with separation from his family when he was stationed in Korea. The Veteran denied alcohol problems, but reported using amphetamines in Korea. The Veteran reported emotional problems and delusional thinking since being stationed in Korea. Additionally, the Veteran reported Scud missiles flying overhead during his service in the Gulf War, including one that hit a nearby building killing many service members. The Veteran reported he did not seek mental health treatment in service, despite the urging of his spouse, because he feared stigma associated with seeking help for mental health problems. The examiner indicated the Veteran had a diagnosis of amphetamine dependence in remission, and amphetamine induced psychotic disorder with delusions. In an August 2005 rating decision, entitlement to service connection for a delusional disorder was denied. Notably, service personnel records were added to the claims file in April 2009. An annual evaluation report noted that the Veteran was assigned to a unit within the PATRIOT Air Defense Battalion while serving in support of Operation Desert Shield. The Board finds such records are relevant to the Veteran’s claim for entitlement to service connection for PTSD based on his report of Scud missiles flying overhead during the Gulf War, to include a missile hitting a nearby building and killing many service members. See also November 2011 VA Form 21-0781 and online article (noting an Iraqi Scud missile struck an American Army barracks killing 28 soldiers on February 25, 1991). As VA has received relevant service department records after the initial rating decision, the Veteran’s claim for entitlement to an acquired psychiatric disorder, to include PTSD, must be reconsidered on its merits without first reopening the claim. 38 C.F.R. § 3.156(c). In an August 2009 VA mental health note, the Veteran reported that he served as a mechanic during the Persian Gulf War, and was assigned to a PATRIOT missile unit. The Veteran reported that he experienced incoming Scud missiles on several occasions, and that he feared for his life. The provider indicated the Veteran reported some avoidance symptoms related to his experiences in the Gulf War. In an October 2009 VA mental health note, the Veteran was administered several objective psychological tests. In a December 2009 VA addendum, the provider noted the results of the psychological tests were consistent with a diagnosis of PTSD. In December 2011, the Veteran reported an incident in service where he was with another service member that was shot outside a dance club. See December 2011 VA Form 21-0781; see also December 2012 correspondence from the Veteran. The Veteran indicated the gunman started to pursue him after shooting the other service member, and the Veteran ripped through a vine fence and fled into a wooded area. See also May 2017 VA PTSD examination. The Veteran reported he sought treatment in service for scratches he sustained in running away from the gunman. Service treatment records document that the Veteran was treated for lacerations to the back, legs, and feet in June 1979. The Veteran indicated to the provider at the time that he was injured going through branches while running away from an assailant carrying a pistol. The June 1979 service treatment record indicates the Veteran reported that police were notified of the incident. The Veteran was afforded a VA PTSD examination in June 2013. The examiner indicated the Veteran did not meet the diagnostic criteria for PTSD, but had a current diagnosis of anxiety disorder, not otherwise specified. In a July 2013 VA medical opinion, the examiner reported the Veteran’s current symptoms of an acquired psychiatric disorder were likely the residual effect of longterm use of amphetamine abuse/dependence, and that the diagnosis of an anxiety disorder on examination in June 2013 was less likely than not caused by an in-service stressor. In a December 2016 VA mental health note, the Veteran indicated that his wife and daughter had life-threatening complications when his daughter was born in November 1990. The Veteran was deployed from August 1990 to March 1991, and he reported that he was not allowed to go home and thought he would not survive the Gulf War. See also DD Form 214. The provider noted a diagnosis of schizoaffective disorder and PTSD. The Veteran was afforded another VA PTSD examination in April 2017. The Veteran reported a history of mental health symptoms beginning in 1979 after witnessing a fellow service member being shot, and being chased by the same gunman. The Veteran reported fixed delusional beliefs about body odor following a one-year assignment in Korea. The Veteran denied a history of drug abuse. The examiner indicated the Veteran did not meet the diagnostic criteria for PTSD, but had a current diagnosis of schizoaffective disorder, depressive type, and amphetamine use disorder in full sustained remission. In a May 2017 medical opinion, the examiner reported the medical evidence of record supporting a PTSD diagnosis did not describe PTSD symptoms. In this case, the Board assigns little probative weight to the March 2005 VA examiner’s diagnoses of amphetamine dependence, in remission, and amphetamine induced psychotic disorder; the July 2013 VA medical opinion that the Veteran’s psychiatric symptoms are a residual effect of longterm use of amphetamine abuse/dependence; and the May 2017 VA medical opinion that Veteran does not have a diagnosis of PTSD. The Board observes that the Veteran has received VA mental health treatment on many occasions, and such records do not indicate a diagnosis of amphetamine dependence, in remission, or amphetamine induced psychotic disorder. Although the Veteran has offered conflicting statements as to amphetamine use during his service in Korea in 1982, the Board assigns probative value to an August 1983 service treatment record in which the Veteran specifically denied amphetamine use. See August 1983 Alcohol and Drug Abuse Prevention and Control Program Client Intake Record; see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the Veteran). Besides contradictory statements made by the Veteran 25 years after the purported amphetamine use, there is no evidence to support that the Veteran used amphetamines in service. In consideration of the entire record, the Board finds the evidence is at the very least in equipoise as to whether the Veteran has an acquired psychiatric disorder related to service, to include a current diagnosis of PTSD that is causally related to a verified in-service stressor. Service treatment records confirm that the Veteran received lacerations to his body during service when he ran through the woods from an assailant armed with a pistol, providing credible supporting evidence of an in-service personal assault. Additionally, military personnel records confirm that the Veteran was assigned to a unit within the PATRIOT Air Defense Battalion while serving in support of Operation Desert Shield, providing credible supporting evidence that the Veteran experienced incoming Scud missiles. The Board finds the testimony from the Veteran and Mrs. V.H. that symptoms of the Veteran’s acquired psychiatric disorder manifested in service to be credible, to include sleep disturbances and emotional problems. See also September 1997 and January 1999 Report of Medical History (Veteran reported frequent trouble sleeping). In relation to the Veteran’s claim for entitlement to service connection for PTSD, the results of objective psychological testing performed by VA in October 2009 revealed a diagnosis consistent with PTSD. The Veteran’s long-time psychiatrist reported the Veteran has a diagnosis of PTSD, related to traumatic events in service, and schizoaffective disorder. See February 2020 letter from Dr. J.B. The Board places great weight on Dr. J.B.’s diagnoses of PTSD and schizoaffective disorder that are based on multiple evaluations over time, and for which the Veteran currently receives treatment. Cohen v. Brown, 10 Vet. App. 128, 140 (1997) (a clear PTSD diagnosis by a mental-health professional must be presumed to have been made in accordance with the applicable DSM criteria, unless evidence shows to the contrary). Resolving reasonable doubt in favor of the Veteran, the Board finds that it is at least as likely as not that the Veteran’s acquired psychiatric disorder is related to service, to include a current diagnosis of PTSD causally related to a verified in-service stressor. Accordingly, entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is granted. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Mask, 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.