Citation Nr: 21062785 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 16-23 784 DATE: October 12, 2021 ORDER Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), depressive disorder, dysthymia, and substance use disorder, is granted. FINDINGS OF FACT 1. The Veteran has PTSD that resulted from stressors during service that are related to fear of hostile military or terrorist activity. 2. The Veteran's substance use disorder is related to his PTSD. 3. The Veteran's dysthymia and depressive disorder are related to his PTSD. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include PTSD, depressive disorder, dysthymia, and substance use disorder, are 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 October 1966 to September 1968. He appeals a December 2013 rating decision by the Agency of Original Jurisdiction (AOJ). In a June 2019 decision, the Board denied the Veteran's claim of entitlement to service connection for an acquired psychiatric disability. The Veteran appealed the denial to the Court of Appeals for Veterans Claims (Court). In April 2020, the Court granted a Joint Motion for Partial Remand (JMPR) filed by representatives for both parties and remanded the claims to the Board for further proceedings consistent with the JMPR. The case has returned to the Board for further appellate proceedings. A veteran is entitled to VA disability compensation if there is a current disability resulting from personal injury or disease incurred in, or aggravated by, active service. 38 U.S.C. §§ 1110, 1131. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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. See Shedden v. Principi, 381 F.3d 1163, 1167 (2004). Service connection for PTSD requires medical evidence establishing a diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). Within the legal framework for evaluating claims of service connection for PTSD, the sufficiency of a stressor is a medical determination, while the occurrence of the stressor is a legal determination. Sizemore v. Principi, 18 Vet. App. 264 (2004). The Veteran contends that he has PTSD that resulted from his active duty service. The claims file contains references by the Veteran to various stressors. In a February 2017 statement, the Veteran reported "fear of being killed while on guard duty in the towers in Vietnam." See February 2017 Veteran statement. The Veteran discussed how "some of his peers got killed while they were on guide [sic] duty. He was put on guard duty for several times. One of his peers were motared [sic] and killed." See September 2013 VA Psychiatric Progress Note. The Veteran described an "incident in Vietnam where shots were fired from the enemy" across a river and he was "charged with protecting. Veteran stated he experienced intense fear that he would be shot." See July 2019 VA PTSD Assessment Progress Notes. The Veteran also recounted seeing wounded soldiers while at Cam Ranh. See July 2009 Intake Assessment. If a veteran claims his stressor is related to fear of hostile military or terrorist activity and a psychiatrist (or psychologist) confirms that the claimed stressor adequately supports a diagnosis of PTSD and that his symptoms are related to the stressor, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor, provided the stressor is consistent with the places, types, and circumstances of the veteran's service. 38 C.F.R. § 3.304(f)(3). Here, the Veteran's record reflects that he served Vietnam from August 1967 to June 1968. See DD Form 214. Although there is no direct evidence or documentation that corroborates the duties and stressors described by the Veteran, the nature of his described duties is consistent with the Veteran's deployment and the Board finds the Veteran credible in his description of his in-service stressors. Certainly, those stressors are related to the Veteran's fear of hostile military activity. Therefore, the Board finds the referenced stressors consistent with the places and circumstances of the Veteran's service. Additionally, while the November 2013 VA examiner did not find a link between the Veteran's claimed stressors and a diagnosis of PTSD, VA psychologist Dr. L.D.M. acknowledged that the Veteran's claimed in-service stressors met the Criteria A element for a diagnosis PTSD. See July 2019 VA PTSD Assessment Progress Notes. Furthermore, the Veteran submitted an August 2021 private psychological evaluation that diagnosed him with PTSD with dissociative symptoms, with delayed expression. See August 2021 Dr. M.L.C. medical opinion. Dr. M.L.C. ultimately opined that the Veteran's PTSD is a direct result of his active duty service in Southeast Asia. He stated that the Veteran meets the diagnostic criteria for PTSD as he was exposed to threatened death or serious injury on several occasions, including guard duty work in Vietnam. Id. He reviewed the Veteran's record, considered his lay statements and provided the Board with a thoughtful medical opinion; thus, the Board finds Dr. M.L.C.'s opinion probative. In summation, Dr. M.L.C. found a medical link between the Veteran's in-service stressors and his current psychiatric symptoms, which he diagnosed as PTSD. Also, the Veteran's probative lay statements regarding his fear of hostile military or terrorist activity during his service in Vietnam, corroborated by military personnel records, establish the occurrence of his in-service stressors. Therefore, service connection for PTSD is warranted. Further, the record reflects that the Veteran has other psychiatric diagnoses, namely dysthymia, depressive disorder, and a substance use disorder, diagnosed as opiate use disorder and stimulant use disorder. See August 2021 Dr. M.L.C. medical opinion; see also November 2013 VA examination report. Dr. M.L.C. opined that the Veteran's opiate use disorder and stimulant use disorder are a direct result of his PTSD. See August 2021 Dr. M.L.C. medical opinion. As such, service connection is also warranted for a substance use disorder as secondary to PTSD. Additionally, Dr. M.L.C. opined that the Veteran's dysthymia and depressive symptomatology are captured in the criteria for PTSD. See August 2021 Dr. M.L.C. medical opinion. Specifically, he stated that the depressive disorder symptoms are "clear, and focused on trauma based-illness." Id. In other words, his depressive symptoms are secondary to that of his PTSD and the stressors that caused his PTSD. As such, service connection is also warranted for a dysthymia and depressive disorder secondary to the Veteran's PTSD. (Continued on the next page) Thus, based on the medical and lay evidence of record, the Veteran's claim is at least in equipoise. Affording the Veteran the benefit of the doubt, the Board grants service connection for an acquired psychiatric disability, to include PTSD, depressive disorder, dysthymia, and substance use disorder. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Katie Poe, 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.