Citation Nr: 21068186 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 18-01 104 DATE: November 9, 2021 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT It is at least as likely as not that the Veteran's psychiatric disability, to include depressive disorder and posttraumatic stress disorder (PTSD), is related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for a psychiatric disability, to include depressive disorder and PTSD, have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from September 1968 to February 1972. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, 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 or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "[l]ay 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); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence"). Service connection must be considered on the basis of the places, types, and circumstances of his service as shown by his service records, the official history of each organization in which he served, his medical records, and all pertinent medical and lay evidence. See 38 C.F.R. § 3.303(a); see also Jandreau v. Nicholson, supra; and Buchanan v. Nicholson, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). 1. Entitlement to service connection for a psychiatric disability, to include depressive disorder and posttraumatic stress disorder (PTSD). The Veteran contends that his psychiatric disability, to include depression and PTSD, is related to his active duty service. Upon review of the claims file, the Board finds that the evidence supports the Veteran's contentions and as such, service connection is warranted. Turning to the element of a current disability, the claims file contains contradicting evidence which must be weighed by the Board. In favor of a current disability is a July 2021 correspondence from the Veteran's current mental health provider which diagnosed the Veteran with PTSD and depression. Weighing against the Veteran's claim is a VA clinician treatment note in January 2015. From the January 2015 treatment note, the Veteran appeared for a second consult and presented a portion of a July 2013 VA examination which included a statement that the Veteran's in-service stressor event was sufficient to support a diagnosis of PTSD. However, the clinician upon further investigation found that July 2013 VA examination did not ultimately conclude that the Veteran had a diagnosis of PTSD. Turning to this same July 2013, VA examination, the Board notes that while the VA examiner did not diagnosis the Veteran with PTSD at the time of the examination, he did not foreclose the possibility that the Veteran could later develop a diagnosis. Importantly, he wrote, "the [Veteran] does not appear to meet the criteria for PTSD at this time." (Emphasis added). Considering the foregoing, the Board finds the question of whether the Veteran has a current diagnosis of a psychiatric disability, to include PTSD, to be in equipoise. The Veteran's July 2021 correspondence from his current mental health clinician is highly probative on the matter of the Veteran's current condition; however, the Veteran's conduct as documented in a January 2015 treatment note is troubling. Ultimately, the Board finds that the July 2013 VA examiner's notation that implies that the Veteran could later develop PTSD bolsters the later July 2021 mental health clinician's diagnosis despite the incident in January 2015. As the question is placed in equipoise, the Board finds that the provision of 38 U.S.C. § 5107(b) control and the benefits of the doubt is provided to the Veteran. Turning to an in-service event, the Board finds that there is no dispute that the Veteran was exposed to event and situations as he described to his July 2013 VA examiner, recounted in his June 2021 hearing testimony, and described in his July 2021 correspondence. Moreover, the events as described by the Veteran are bolstered by the March 1970 correspondence sent by the Veteran to his mother describing the events and the situation that he encountered while on active duty. Considering the foregoing, the Board finds that the Veteran was exposed to in-service event as he described. Turning to the final element of service connection, a nexus, the Board finds that the Veteran's July 2021 correspondence from his treating clinician is probative on the matter of etiology. The rationale provided with the opinion applies valid medical principles and draws sound conclusions with supporting evidence. Furthermore, the Board finds that evidence especially probative given the unique position the Veteran's private clinician is in as a clinical professional that has treated the Veteran over a course of time. She is thus able to provide a more insightful opinion on the nature of the Veteran's disability. This unique position coupled with the clinician's exhaustive review of the Veteran's history and medical explanation of how it was reached his conclusion bolsters the physician opinion above all others. As the Court of Veterans Claims has held most of the probative value of a medical opinion comes from its reasoning and the Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board thus considers the Veteran's clinician's opinion from July 2021 to be probative and the only opinion on the matter of the etiology. The Board finds that all elements of service connection for a psychiatric disability, to include depressive disorder and PTSD, are met, and service connection is thus granted. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Acosta, 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.