Citation Nr: 20049965 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 16-57 536 DATE: July 28, 2020 ORDER Entitlement to service connection for acquired psychiatric disorders, diagnosed as posttraumatic stress disorder (PTSD), unspecified anxiety disorder, and bereavement, is granted. FINDINGS OF FACT Resolving reasonable doubt in the Veteran's favor, the probative evidence of record demonstrates the Veteran's acquired psychiatric disability, diagnosed as unspecified anxiety disorder and bereavement, is related to active service and the Veteran has a current diagnosis of PTSD related to a verified in-service stressor. CONCLUSIONS OF LAW The criteria for entitlement to service connection for acquired psychiatric disorders, to include PTSD, unspecified anxiety disorder, and bereavement, have been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1967 to February 1970, including service in the Republic of Vietnam from February 1968 to February 1970. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for PTSD and unspecified anxiety disorder with bereavement. A Notice of Disagreement (NOD) was submitted in June 2014; a Statement of the Case was issued in October 2016; and a VA Form 9 (substantive appeal) was received in November 2016. The Veteran testified before the undersigned Veterans Law Judge in June 2020; a copy of the hearing transcript has been associated with the record. Service Connection Generally, to establish service connection a Veteran must show: "(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 incurred or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 131516 (Fed. Cir. 2009). Service connection for PTSD requires medical evidence diagnosing this disorder based on examination findings and in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. §§ 3.304 (f), 4.125(a). Diagnoses of PTSD by health care professionals are presumed to be in accordance with applicable governing medical criteria. See Cohen v. Brown, 10 Vet. App. 128, 139-40 (1997). 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. 38 C.F.R. § 3.304 (f)(2); see also 38 U.S.C. § 1154 (b) (2012). If a stressor claimed by a Veteran is related to the Veteran's fear of hostile military activity, and a 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 PTSD, a Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor, as long as the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service and there is no clear and convincing evidence to the contrary. 38 C.F.R. § 3.304 (f) (3). "Fear of hostile military activity" is defined to mean 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. Id. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and unspecified anxiety disorder with bereavement. The Veteran contends that his psychiatric disorder(s), variously diagnosed as PTSD and unspecified anxiety disorder with bereavement, is related to his active duty service. During his Board hearing, he testified that he witnessed many combat-related injuries/causalities (“I had good friends that got direct hits with mortars”), saw/smelled decomposing bodies, and was in an area that received in-coming mortar rounds while serving in Vietnam. He explained that his duties while attached to an Engineer Battalion included repairing bridges and roads and clearing trees away from the perimeter. He testified that he attempted suicide on three occasions shortly after separation from service and that he has continued to experience psychiatric symptomatology since that time. Personnel records confirm that the Veteran served in the Republic of Vietnam from February 1968 to February 1970 and that he was attached to an Engineer Battalion (Construction) as part of the Counter Offensive Phases IV and V. The Veteran is competent to report that he experienced/witnessed various events that involved actual or threatened death or serious injury, as described above in his hearing testimony. Moreover, the Board finds that the Veteran's reports of traumatic events are credible because they are consistent with the nature, location, time, and circumstances of his duties. At a minimum, he was in fear of attack and witnessed traumatic events. Additionally, although service treatment records are silent for complaints, treatment, and/or diagnoses related to a psychiatric disorder, personnel records do reflect that the Veteran received an Article 15 punishment (for possession of beer) during his Vietnam service. Thereafter, the Veteran testified that he was did not know anything about PTSD and that he largely self-medicated with alcohol until he sought treatment from VA mental health services in 2013. The Veteran was afforded a VA PTSD examination April 2014. The VA psychiatrist determined that the Veteran did not meet the DSM-5 criteria for a PTSD; however, unspecified anxiety disorder and bereavement were diagnosed. The examiner noted that it was not possible to differentiate between what symptoms were attributable to each diagnosis. The examiner accepted the reports of traumatic events (i.e., receiving incoming mortar rounds and witnessing death) and that they were adequate to support a diagnosis of PTSD and were related to fear of hostile military or terrorist activity. The examiner also determined that the Veteran met PTSD Criterion A, B, C, and E. The examiner then noted that the Veteran had been “exposed to multiple combat traumas and has no pre-military of mental health issues.” The examiner opined, “It is at least likely as not that the Veteran's mental condition is related to his military service.” VA mental health treatment records dated in 2013 reflect ongoing diagnoses of PTSD (DSM-5) in association with the Veteran’s service in Vietnam. In this case, it is undisputed that the Veteran served in Vietnam and experienced multiple stressors related to a fear of hostile military activity. The Veteran did not report or seek care for mental health symptoms until approximately 2013 as he testified that he was essentially unaware of PTSD and largely self-medicated with alcohol. However, a lack of a history of care is not sufficient to find the Veteran's reports not credible. Since 2013, the Veteran has received regular VA care including for mental health symptoms, although the evaluations by VA clinicians and examiners has been different in both nature and severity leading to different diagnoses. The April 2014 VA psychologist confirmed that the Veteran’s claimed stressors were related to his fear of hostile military activity and that the stressors were adequate to support a diagnosis of PTSD. While the April 2014 examiner ultimately found that the Veteran did not meet Criterion D, there is other evidence of record, including VA mental health treatment records dated in 2013-2014, which confirms that the Veteran does, in fact, meet the full diagnostic criteria for PTSD under the DSM-5. Moreover, the April 2014 examiner unequivocally related his unspecified anxiety disorder and bereavement to in-service events. In short, the Veteran has been variously diagnosed with unspecified anxiety disorder, bereavement, and PTSD (DSM-5) by VA mental health clinicians and/or a VA examiner; he has stressors that are related to his service in Vietnam that meet Criteria A of the PTSD criteria; and a VA examiner has attributed his anxiety and bereavement disorders to service. Resolving any remaining reasonable doubt in favor of the Veteran, the Veteran's psychiatric disability, to include PTSD, unspecified anxiety disorder, and bereavement, is attributable to his military service. Therefore, service connection is granted. (Continued on next page) DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Hoeft 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.