Citation Nr: 21069221 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 19-12 440A DATE: November 17, 2021 ORDER Service connection for posttraumatic stress disorder (PTSD) is granted. Service connection for an acquired psychiatric disorder, diagnosed as major depressive disorder, as secondary to service-connected PTSD, is granted. FINDINGS OF FACT 1. There is credible supporting evidence that corroborates the Veteran's claimed in-service stressor; there is competent medical evidence of a nexus between his PTSD and his in-service stressor. 2. The Veteran's major depressive disorder is caused by his service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD have been met. 38 U.S.C. §§ 1110,1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). 2. The criteria for service connection for a major depressive disorder, as secondary to service-connected PTSD, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1977 to July 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran presented testimony before the undersigned Veterans Law Judge. A transcript of the hearing has not yet been associated with the file; however, one is not necessary for a decision on the appeal. The claim of service connection for an acquired psychiatric disorder (claimed as PTSD) has been broadened and recharacterized in light of Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (a claim should not be limited to the disorder as characterized by the Veteran, but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim). Service Connection for PTSD The Veteran seeks service connection for PTSD, which he attributes to harassment by his military supervisor. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); 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). If a PTSD claim is based on in-service personal assault, evidence from sources other than a veteran's service records may corroborate his or her account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. 38 C.F.R. § 3.304 (f)(5). Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to, a request for a transfer to another military duty assignment, deterioration in work performance. Id. For the following reasons, service connection for PTSD is warranted. The medical evidence shows a diagnosis of PTSD, from the Veteran's treating attending psychiatrist, S. Bassey, MD, attending psychiatrist. See psychiatry attending notes (August 2016; May 2019); see also Cohen v. Brown, 10 Vet. App. 128, 153 (1997). The Board notes that there are two VA psychiatric examinations of record, conducted in March 2014 and January 2019, that show that the Veteran had symptoms of PTSD, but did not meet the full criteria for PTSD. It is the province of trained health care professionals to enter conclusions that require medical expertise, such as opinions as to diagnosis and causation. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). The PTSD diagnosis was made in accordance with 38 C.F.R. § 4.125 (a), and the diagnosis was based on the Veteran's in-service stressor, which is discussed below. See psychiatry attending note (May 2019); PTSD disability benefits questionnaire (DBQ) (June 2019). With respect to the in-service stressor, the Veteran asserts that when he was assigned to 43rd Engineers at Fort Benning, Georgia, his supervisor (Sergeant H.) harassed, traumatized, and humiliated him. Id. Specifically, the Veteran reports that during his service, his supervisor was prejudicial and determined to "ruin" the Veteran's military career. See PTSD disability benefits questionnaire (DBQ) (June 2019). The Veteran testified that after he reported the harassment to his chain of commander, he was threatened by his Sergeant H. and eventually demoted. The Veteran explained that during service, he received letters of commendation and that he advanced in his military career, but he was later demoted and discharged because of his behavioral actions, which eventually included the Veteran assaulting Sergeant H. See PTSD disability benefits questionnaire (DBQ) (June 2019); Board hearing notes (November 2021). As to whether there is credible supporting evidence that the reported in-service stressor occurred, the Veteran's service records reflect that earlier in his military career, he was promoted to a specialist in the 4th rank (SP4) in April 1979; was noted as "ranks with very best" and performed his duties in an outstanding manner in a June 1979 enlisted evaluation report; and in October 1980 he was awarded a Good Conduct Medal for his behavior, efficiency and fidelity in his active federal military service. Thereafter, in October 1981, the Veteran was assigned to 43rd Engineers at Fort Benning, Georgia. An October 1981 record of nonjudicial punishment proceedings under Article 15 reflects that the Veteran failed to go to his appointed place of duty and that his punishment included a suspended reduction in grade to private first class (PFC). In April 1982, the Veteran received two letters of commendation received while on temporary duty in Germany. Thereafter, his service personnel records include a June 1982 General Counseling form where the Veteran received counseling from a counselor, signed by MSG R.J.H., regarding the Veteran's absence from physical training without proper authorization. MSG R.J.H. wrote that the Veteran was counseled as to the proper procedures of being given time off, and that "initiative [and] attitude are low due to personal problems..." As a result, the Veteran's suspended reduction in grade was vacated and he was reduced to PFC; he also another Article 15 punishment in June 1982. The Veteran's July 1982 separation report reflects that he reported depression or excessive worry. The Veteran's DD Form 214 shows that his character of service was Under Honorable Conditions (General); reason is "unsuitability apathy, defective attitude and inability to expend effort constructively." A July 1983 Board action report demonstrates that the Veteran applied to upgrade his character of discharge through the Army Counsel of Review Boards in order to attempt to enlist in the Air Force and that he reported that his military service discharge was not based on his total Army career but on a small time that he was assigned to the 43rd Engineers. In a June 2019 statement, the Veteran's mother described how the Veteran's behavior changed while he was serving in the military. Specifically, the Veteran's mother stated that the Veteran prior to his military service, had no "major problems" and that he had a temperament and drank alcohol once he served in the military. In addition to the evidence above, in a June 2019 DBQ J. Duehl, LCSW, indicated that he had been treating the Veteran since 2013 and that he reported that he was personally harassed, traumatized and humiliated in service by his supervisor (Sergeant H.). J. Duehl explained that the Veteran indicated that during his military service, he received several letters of commendation based on his enthusiasm and professionalism; however, the Veteran indicated that his supervisor was prejudicial and that he was determined to "ruin" his military career and that he was demoted. He "emotionally collapsed" and threatened his supervisor and was administratively discharged (not court-martialed) without a hearing. The June 2019 DBQ is probative as to whether the Veteran's reported in-service stressor occurred, as he reported the in-service stressor to his treating social worker for treatment purposes. See Fed. R. Evid. 803(4) (noting that statements made to physicians for the purposes of diagnosis and treatment are exceptionally trustworthy and not excluded by the hearsay rule because the declarant has a strong motive to tell the truth in order to receive proper care); Rucker v. Brown, 10 Vet. App. 67, 73 (1997) ("[R]ecourse to the [Federal] Rules [of Evidence] is appropriate where they will assist in the articulation of the Board's reasons")). In this case, the Veteran's reports of his in-service stressor have been consistent with the evidence of record, including his service records. The Board finds that the Veteran's reports of his in-service stressor coupled with his service personnel records that illustrate that he excelled earlier in his military career and that after he was assigned to 43rd Engineers at Fort Benning in Georgia, he began experiencing behavior changes; his separation report showing that he reported that depression or excessive worry; and the Veteran's mother statement regarding his behavior changes that occurred during his military service, corroborate his account of the in-service stressor. While the Veteran's stressor is not a personal assault, the Board finds 38 C.F.R. § 3.304(f)(5) instructive as to the type of evidence that may corroborate the type of in-service stressor based on harassment the Veteran experienced. Therefore, there is credible supporting evidence corroborating the occurrence of the claimed in-service stressor. With respect as to whether there is a medical link between the Veteran's PTSD and his in-service stressor, in a June 2019 PTSD DBQ, J. Duehl, LCSW, indicated that the Veteran had been diagnosed as having PTSD (as he worked with the Veteran's treating psychiatrist (Dr. Bassy) who diagnosed PTSD) and that he had been treating the Veteran since 2013. J. Duehl indicated that he had been employed at a VA medical center for 20 years working with patients who have been diagnosed with PTSD, that he reviewed the Veteran's service records, and that he interviewed him. J. Duehl described the Veteran's in-service stressor and opined that the Veteran's PTSD was the result of his military service. Indeed, the Veteran's VA treatment record shows that he was treated and diagnosed as having PTSD by a VA psychiatrist, Dr. Bassy. See, e.g., VA treatment record (May 2019). In fact, Dr. Bassy wrote in the Veteran's VA treatment records that he was having PTSD symptoms, such as irritability, nightmares, hypervigilance "as [a] result of his experiences while serving in the military." The Board finds that the June 2019 opinion from J. Duehl and Dr. Bassy's notations in the Veteran's treatment records are entitled to high probative value as to whether the Veteran's PTSD is the result of his in-service stressor. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). In sum, the June 2019 opinion from J. Duehl, coupled with Dr. Bassy's notations in the Veteran's treatment records indicating that the Veteran's PTSD is the result of his in-service stressors/his military service, provide a medical link between the Veteran's PTSD and his in-service stressor. Accordingly, the Veteran has a current diagnosis of PTSD, there is competent medical evidence of a nexus between his PTSD and his in-service stressor, and credible evidence that the stressor occurred. In light of this evidence and resolving reasonable doubt in the Veteran's favor, the criteria for service connection for PTSD are met. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Service Connection on a Secondary Basis Service connection is warranted for disability proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a), (b). As a result of the decision above, service connection is in effect for PTSD. VA mental health care providers diagnosed a major depressive disorder. See, e.g., VA treatment record (March 2015). Accordingly, this case turns on whether the evidence shows that the Veteran's current major depressive disorder is related to a service-connected disability. The Board finds that collectively the evidence supports that the Veteran's major depressive disorder was the result of his service-connected PTSD. To this extent, the evidence shows that VA treatment providers, including the Veteran's treating psychiatrist (Dr. Bassy), associated the Veteran's depression symptoms with his PTSD. For example, a February 2016 VA treatment report shows that Dr. Bassy wrote that the Veteran was treated for his PTSD and depressive symptoms. Similarly, in a July 2018 VA treatment report, Dr. Bassy wrote that the Veteran was treated for his depression and PTSD. Also, Dr. Bassy indicated that the Veteran's PTSD symptoms included nightmares, flashbacks, irritability, and "depressive symptoms as well." In this case, there is no explicit opinion regarding whether the Veteran's major depressive disorder is caused by his service-connected PTSD. Notably, there is no medical opinion indicating a lack of causation between Veteran's major depressive disorder and his service-connected PTSD. As the above evidence provides a basis for granting service connection on a secondary basis, a remand for a request for a medical opinion could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"). In sum, the evidence supports that there is a causation relationship between the Veteran's major depressive disorder and his PTSD. Thus, resolving any reasonable doubt in the Veteran's favor, the Board finds that the Veteran's major depressive disorder was caused by his service-connected PTSD. Accordingly, service connection for major depressive disorder as secondary to the service-connected PTSD is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. To the extent that other psychiatric disorders have been diagnosed, there is no indication that there are distinct psychiatric symptoms attributable to such disorders, and all psychiatric symptoms will therefore be attributed to the now service-connected major depressive disorder. See Howell v. Nicholson, 19 Vet. App. 535, 540 (2006); Mittleider v. West, 11 Vet. App. 181, 182 (1998) (VA must apply the benefit of the doubt doctrine and attribute the inseparable effects of a disability to the claimant's service-connected disability). Consequently, consideration of whether other psychiatric disorders are related to the Veteran's military service or secondary to his service-connected PTSD or major depressive disorder is unnecessary. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Castillo, 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.