Citation Nr: 21071056 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 18-54 027 DATE: November 29, 2021 ORDER Service connection for an acquired psychiatric disability, to include posttraumatic stress disorder, is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his acquired psychiatric disability, to include posttraumatic stress disorder, is at least as likely as not related to his active military service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disability, to include posttraumatic stress disorder, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from December 2008 until his honorable discharge in August 2012, with service in Afghanistan from March 2009 to March 2010. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 decision by a Regional Office of the United States Department of Veterans Affairs (VA). In December 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. In December 2020, the Board remanded the case to the VA Regional Office for further development. Specifically, the Board directed the VA Regional Office to obtain a VA examination and opinion addressing the etiology of the Veteran's acquired psychiatric disorder, which the VA Regional Office accomplished. The case now returns to the Board. Evidentiary Standards In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 12829 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim. Service Connection VA provides compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Service connection for posttraumatic stress disorder (PTSD) is specifically governed by 38 C.F.R. § 3.304(f), which requires: (1) medical evidence diagnosing the condition in accordance with the Diagnostic Statistical Manual of Mental Disorders (DSM-5), 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor occurred, and (3) a link, established by the medical evidence, between current symptoms and an in-service stressor. Analysis The Veteran's VA medical records indicate he is under the care of VA psychiatrists. According to his medical records, he was initially diagnosed with PTSD around 2014, and has continued to have PTSD since. See, e.g., April 2014 VA Mental Health Note (documenting a diagnosis of PTSD under the DSM-5); June 2016 VA Psychiatry Medication Management Note (documenting continuing treatment for PTSD); October 2019 Psychiatry Medication Management Note (documenting continuing treatment for PTSD). In February 2021, the Veteran was afforded a VA examination, consistent with the Board's remand directive, to address his psychiatric disorder. The examiner found that the Veteran did not meet the criteria to establish PTSD under the DSM-5 because, although he stated he witnessed a rocket landing that shook the ground under him, he was not harmed, and he did not witness harm to another. The examiner concluded that this event was inadequate to sustain Criteria A of the DSM-5 ("The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): Direct exposure. Witnessing the trauma. Learning that a relative or close friend was exposed to a trauma."). The Board does not find one diagnosis any more credible or probative than another diagnosis. Importantly, "a clear (that is, unequivocal) PTSD diagnosis by a mental-health professional must be presumed (unless evidence shows to the contrary) to have been made in accordance with the applicable DSM criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor" because "[m]ental health professionals are experts and are presumed to know the DSM requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis." Cohen v. Brown, 10 Vet. App. 128, 140 (1997). In this instance, the Board finds no evidence to conclude that the Veteran's treating VA mental health professionals did not diagnose him in accordance with the DSM-5 criteria. Thus, the Board presumes the VA mental health professionals found sufficient evidence of an in-service stressor to diagnose the Veteran with PTSD. (Continued on the next page) Also relevant to this discussion is the VA examiner's acknowledgement that the medical evidence is in "equipoise." He acknowledged the Veteran's VA mental health records, noting a diagnosis of and treatment for PTSD in 2014. Yet, he came to a different conclusion about the Veteran's in-service stressor. The Board notes that the question posed to a mental health professional as to a diagnosis of PTSD is different than the question posed to the Board, which is whether service connection is warranted. Hence, different standards apply to the Board. In particular, the Board is required to grant service connection when the evidence is in relative equipoise, not exact equipoise. Lynch v. McDonough, 999 F.3d 1391 (2021) (a claimant is to receive the benefit of the doubt when there is an "approximate balance" of positive and negative evidence) (citing 38 U.S.C. § 5107(b)). Applying Lynch, the Board concludes the evidence is in approximate balance as to whether the Veteran has PTSD related to his in-service stressor. Therefore, the Board affords the Veteran the benefit of the doubt and concludes that he has PTSD connected to his military service. Accordingly, service connection for an acquired psychiatric disorder, to include PTSD, is granted. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. F. Sawka, 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.