Citation Nr: 21069705 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 19-23 222 DATE: November 19, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is granted. FINDING OF FACT It is as likely as not the Veteran's acquired psychiatric disorder, including especially his PTSD, is attributable to his military service. CONCLUSION OF LAW Resolving all reasonable doubt in his favor, the criteria are met for his entitlement service connection for an acquired psychiatric disorder, including for PSTD. 38 U.S.C. §§ 1131, 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 June 1960 to June 1964. This appeal to the Board of Veterans' Appeals (Board) is from an August 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified in support of this claim during a hearing in September 2021 before the undersigned Veterans Law Judge (VLJ) of the Board. A transcript of the hearing is of record. Entitlement to service connection for an acquired psychiatric disorder, including PTSD The Veteran asserts that he has PTSD from stressful events during his service, including especially an explosion while stationed in the Philippines. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Generally, to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of a relevant injury or disease, and (3) a nexus, or link, between the current disability and the disease or injury in service. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159(a)(2). Conversely, competent medical evidence is necessary where the determinative question requires medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence also may mean statements conveying sound medical principles found in medical treatises. As well, competent medical evidence may include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran contends that he is entitled to service connection for PTSD in addition to his already determined to be service-connected claustrophobia that has been rated as 30-percent disabling effectively since October 7, 2014. There are particular requirements for establishing service connection for PTSD in 38 C.F.R. § 3.304(f) that are separate from those for establishing service connection generally. See Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Establishing service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (meaning in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM)); 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). Ordinarily, separately diagnosed injuries are rated individually and then combined into a single rating to determine the overall impairment of a veteran's condition. 38 C.F.R. § 4.25. However, VA regulations prevent claimants from receiving multiple awards for the same impairment simply because that impairment could be labeled in different ways, known as pyramiding. 38 C.F.R. § 4.14. "The basis of disability evaluations is the ability of the body as a whole, or of the psyche, to function under the ordinary conditions of daily life including employment." 38 C.F.R. § 4.10. With respect to mental health disorders, the amount of impairment is measured by the social and occupational difficulties caused by a veteran's disorder. 38 C.F.R. § 4.130. The Court has addressed the applicability of this regulation in the context of mental health disorders. Amberman v. Shinseki, 570 F.3d 1377 (2009). In that case, the Court held that "the critical element is that none of the symptomatology for any one of these conditions is duplicative of, or overlapping with, the symptomatology of the other...conditions." Id. at 1381 (quoting Estaban v. Brown, 6 Vet. App. 259 (1994)) (emphasis original to Estaban) (ellipses denotes only that the specific number of conditions being analyzed in Estaban, reproduced in Amberman, have been removed). Thus, Amberman holds that where any of the symptoms of one service-connected mental health disability overlap with the symptoms of any other disability, it is appropriate to rate the two disabilities together as a combined manifestation under the criteria set forth in 38 C.F.R. § 4.130. That said, the Court also has explained that a claim for a mental disorder is not limited to the specific disorder claimed and requires considering all diagnoses and their possible attribution to the Veteran's military service. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). Here, a March 2013 letter from the Veteran's treating VA psychologist, received by VA in September 2017, provides a diagnosis of specific phobia, claustrophobia and acrophobia. This psychologist noted that these manifested as acute anxiety and panic attacks. In April 2019, the Veteran underwent a VA psychiatric examination for mental disorders other than PTSD. During this examination, the examiner found that the Veteran's only diagnosed psychiatric disorder was claustrophobia. There was no diagnosis of PTSD rendered and, thus, no additional PTSD VA examination was completed. The examiner found that the Veteran's claustrophobia symptoms included anxiety, chronic sleep impairment, mild memory loss, and difficulty in adapting to stressful circumstances. An October 2019 rating decision resultantly granted the Veteran service connection for his claustrophobia, retroactively effective from October 7, 2014. A more recent July 2020 VA treatment record, however, shows the Veteran presented for mental health care and created a new treatment plan with his psychologist based on his reported symptoms including panic attacks, nightmares, and anxiety. This treating psychologist surmised, "it appears that the claustrophobia is better subsumed under PTSD given the connection to trauma reminders" and that they "discussed how his claustrophobia is related to his trauma in the Philippines and thus a diagnosis of PTSD better captures his presentation rather than agoraphobia [an anxiety disorder] or panic disorder." The Veteran since has continued to seek mental health treatment through VA for his PTSD and claustrophobia. The Board finds that treating VA psychologist's diagnosis and assessment supporting the Veteran's claim for PTSD (meaning in addition to the claustrophobia that it subsumes) to be highly probative and, in fact, determinative of the ultimate disposition. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). This treating psychologist accounted for the entirety of the Veteran's acquired psychiatric disability symptoms and attributed them to a stressful event during his service, the explosion in the Philippines, and provided an up-to-date diagnosis accurately reflecting his current mental disorder and encapsulating the entirety of it. During his even more recent September 2021 hearing before this Board, the Veteran testified that he believes his recent PTSD diagnosis is the result of the same stressful event during his service that gave rise to his entitlement to service connection for claustrophobia more specifically, the explosion in the Philippines. Because all psychiatric disorders, with the exception of eating disorders, are evaluated under the General Rating Formula for Mental Disorders, a single evaluation generally will be assigned that encompasses all of the Veteran's overlapping psychiatric symptoms. While separate ratings may be warranted for different psychiatric disorders in some circumstances, Amberman, 570 F.3d at 1381 ("We recognize that bipolar disorder and PTSD could have different symptoms and it could therefore be improper in some circumstances for VA to treat these separately diagnosed conditions as producing only the same disability"), separate ratings are not warranted in this case given the specific medical findings. To reiterate, the evidence of record is clear that the Veteran's acquired psychiatric disorder symptoms include panic attacks, anxiety, and nightmares, all of which are documented on his April 2019 VA examination under the diagnosis of claustrophobia. Later, the July 2020 treating VA psychologist explained those same symptoms would be more accurately characterized as PTSD subsuming the diagnosis of claustrophobia, as the incident giving rise to the Veteran's acquired psychiatric diagnoses was the same event during his service in the Philippines. This means that the July 2020 VA psychologist was recharacterizing the Veteran's claustrophobia as PTSD and attributing the same symptoms to this new diagnosis. Thus, the Veteran is not entitled to service connection and a separate rating for symptoms or impairment owing to PTSD, meaning in addition to the 30 percent rating he already has for his claustrophobia. Rather, his disability is more appropriately characterized as an acquired psychiatric disorder that is inclusive of PTSD and claustrophobia. Accordingly, service connection for an acquired psychiatric disorder, to include PTSD plus the claustrophobia, is granted. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Pak 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.