Citation Nr: 21071247 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 15-11 160 DATE: November 30, 2021 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) with associated alcohol use disorder is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his PTSD with secondary alcohol use disorder is related to a stressor event during his Reserve service while stationed at Aviano Air Base in April 1999, which is corroborated by credible supporting evidence. CONCLUSION OF LAW Service connection for PTSD with associated alcohol use disorder is warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty in the Navy from June 1973 to June 1977 and in the Air Force Reserve from March 29, 1998 to August 5, 1998 and from April 5, 1999 to August 30, 1999. This case is before the Board of Veterans' Appeals (Board) on appeal from a May 2011 Department of Veterans Affairs (VA) rating decision, which denied reopening of a claim of service connection for PTSD. In August 2018, a Travel Board hearing was held before the undersigned. In March 2021, the Board reopened the claim and remanded the case to the agency of original jurisdiction (AOJ) for further development of the claim on the merits. In October 2021, after his case was returned to the Board's docket, the Veteran revoked the power of attorney of his agent, and has continued his appeal pro se (unrepresented). Entitlement to service connection for a psychiatric disorder claimed as PTSD The Veteran contends that he has PTSD related to stressors in service. Initially, his claimed stressors pertained to his Navy service, but he later alleged new stressors that were associated with his Air Force Reserve service while stationed at Aviano Air Base in Italy in 1999. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link, or causal nexus, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). It is not in dispute that the Veteran has a psychiatric disability. A report of VA examination in December 2002 shows a diagnosis of major depression, with a notation that the Veteran reported he "began experiencing depression in response to witnessing the World Trade Center attacks" on September 11. During the examination, he reported military stressors involving being in a war zone in Kosovo in 1999 (but denied any combat or armed conflict as he was "away from the action") and two stories about viewing dead bodies while in the Navy. Vet Center records show, as indicated in an October 2002 statement, that the Veteran was being seen for PTSD-related symptoms and severe depression (he received treatment to 2004 and additional treatment records in 2019 note a diagnosis of chronic PTSD). A report of VA examination in October 2010 shows diagnoses of PTSD and mood disorder, with the former related to events in Kosovo (specifically, exposure to the bombing of a civilian train in 1999) and the latter related to the impact of the PTSD on his social and occupational functioning. In a March 2011 statement, a treating doctor noted the Veteran was receiving medication for anxiety and PTSD. The doctor also indicated that three years earlier the Veteran was exchanging "war stories" with his son who had returned from Iraq, and it was then that he first recalled the traumatic incident of civilian deaths on a train that emerged from a tunnel right after a jet had taken out a bridge ("a confluence of buried war memories had emerged from [the Veteran]"). In a May 2011 statement, a VA physician noted that the Veteran was in treatment for PTSD and depression. A January 2020 letter from a VA psychiatrist notes that she has treated the Veteran for the past couple of months and was familiar with his diagnosis (PTSD) and treatment. She felt the medical record "substantiates" his report of "PTSD symptoms stemming from his exposure to a bombing of a civilian train while serving in a combat zone in Aviano NATO base in Italy in 1999." She also stated that his diagnosis was further exacerbated by "exposure to the World Trade Center terrorist attack" (although not the initial inciting cause of his PTSD). She also related his PTSD to "exposure to orders of forced protection to bring Air Force personnel on base from hotels and apartment buildings due to the dangers posed by enemy forces in 1999." In July 2021 the Veteran underwent VA psychiatric examination to clarify the nature of his mental disability (under the DSM-5); his diagnoses were PTSD and alcohol use disorder (secondary to PTSD, representing the Veteran's "misguided efforts to manage" his PTSD symptoms). In a report dated in August 2021, the examining clinical psychologist remarked that regarding a diagnosis of mood disorder including depression, it was "unnecessary" because it was "captured within the PTSD diagnosis." The examiner listed the sole stressor underpinning the PTSD diagnosis as the Veteran's observance in a live-feed video room [emphasis added] at Aviano Air Base in 1999 of the bombing (by a friendly jet on assignment to blow up a bridge in Kosovo) of a passenger train crossing the bridge, resulting in civilian casualties. The examiner found this stressor was not related to the Veteran's fear of hostile military or terrorist activity but met criterion A [relevant to an element substantiating a PTSD diagnosis under DSM-5] and was therefore adequate to support the diagnosis of PTSD. Considering the foregoing, the Board finds the Veteran has a current diagnosis of PTSD with associated alcohol use disorder, and that competent medical evidence shows his PTSD is related to the claimed stressor of having viewed a live video feed of an (unintentional) bombing of a passenger train in Kosovo from an operations room at Aviano Air Base in April 1999. Accordingly, the first and third elements for establishing service connection are satisfied. 38 C.F.R. § 3.304(f). The remaining question for the Board is whether the Veteran has met the second (and final) element needed to establish service connection for PTSD. Specifically, it must be determined whether there is credible supporting evidence that the claimed in-service stressor occurred. Regarding the claimed (non-combat) stressor in service, service personnel and other evidence in the claims file, including various lay statements, confirm that the Veteran was activated and deployed to Aviano Air Base in support of Operation Joint Forge and Allied Force in April 1999 (his awards include a Kosovo Campaign Medal) and that his military occupational specialty (MOS) was services craftsman. An annual performance review covering the period of February 1999 to November 1999 indicates that his duties included directing daily operations of the dining facility, managing facilities and equipment, and supervising a continuous, effective training program to provide high quality products and services. Additional duties included serving as Lodging NCOIC, Training NCO, Safety NCO, and NCOIC Fitness Center, and he worked as a liaison between "tent city and main base" with sole responsibility for billeting 600 deployed multi-service forces. In his hearing testimony, the Veteran described how at the Aviano, Italy air base he watched a live video feed of an accidental destruction of a civilian train on a railway bridge (the mission of the NATO jet was only to destroy the bridge). He stated that it was not his duty to be in the operations room where the live feed was shown but that he happened to be there collecting data for daily tally reports. In other statements, he recounted his duties in the flight operations room and the bombing incident that he viewed that put him in a "zombie like trance." In lay statements received in 2010 and 2011, his brother, ex-wife, and employer noted that he was never the same after his return from his Kosovo assignment in 1999 and that the events of September 11 (two years later) were a triggering event for him. Additional evidence includes a (poorly rendered) image, from an online National Archives and Records Administration website, of USAF personnel at an Aviano Air Base operations room in support of aircraft involved in NATO airstrikes against Bosnian Serbs (a better image was also supplied). In an October 2021 memorandum, an individual (J.H.), purportedly with the commander's staff, USAF, concerned with "combat and awards," indicated that the Veteran's MOS of services craftsman was consistent with his duties to submit situation reports, which involved the "monitoring of 'Inbound and Outbound Flights' to determine logistical support for wartime activities." Information from an internet website (Wikipedia), a NATO press conference transcript, and a (New York Times) newspaper article show that on April 12, 1999, NATO aircraft fired two missiles and accidently hit a passenger train while it was passing across a railway bridge at Grdelica gorge in Serbia, resulting in 14 civilian deaths and another 16 wounded (the Veteran reported that he believed there were 100 casualties). The bombing occurred during Operation Allied Force where the transport links, especially major bridges, became strategic and economic targets. The train was traveling fast, and the bomb was too close to the target to divert in time. This information was also confirmed in February 2015 when the VA sought to corroborate the Veteran's stressor through a military department (then known as the U.S. Armed Services Center for Research of Unit Records, or CURR), which was unable to document if the Veteran actually viewed the incident on the television or live feed, as claimed. The corroboration of the stressor in this case is complicated because it essentially requires that there be evidence to place the Veteran in the operations control room at the time that images of the train bombing were transmitted there in April 1999. The Board deems his claims about this stressor in service to be reasonably credible. There is no evidence to suggest that his presence in the operations control room was unlikely, implausible, or untrue. He described this particular stressor testifying under oath; his statements about having viewed the live video feed of the tragedy have been consistent throughout the record. While his testimony alone is not enough to establish the non-combat stressor, the totality of the evidence is in relative equipoise on the matter of whether there has been stressor corroboration. The Veteran testified that there were perhaps five people in the room with the live feed, watching the bombing of the railway and train. Although he has not furnished a statement from any of those individuals attesting to his presence in the operations room at that time, or any contemporaneous letters/documents in which he had described the event to another individual, he has submitted additional circumstantial evidence pertaining to his duties while at Aviano Air Base in April 1999 and at least one supporting statement of an individual who conveyed that the Veteran's duties may well have placed him in the operations room because he would have been tasked with submitting situation reports that required monitoring in/outbound flights for reasons of ascertaining logistical support needs; the Board acknowledges that identifying the individuals in the live feed room may be difficult, if at all possible. The Board acknowledges that such evidence does not unequivocally place the Veteran in the operations room. However, after weighing the statements, testimony, and circumstantial evidence, the Board finds the evidence to be in relative equipoise as to whether the alleged in-service stressor of being an actual witness to the bombing of a passenger train in Kosovo from an operations room at Aviano Air Base in April 1999 occurred. After applying the governing law to the facts of this case, and invoking the reasonable doubt doctrine, the Board concludes that the Veteran has PTSD with associated alcohol use disorder that is related to his claimed stressor in service, and that there is credible supporting evidence of the occurrence of the stressor. Accordingly, service connection for PTSD with associated alcohol use disorder is warranted. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.102, 3.304(f). George R. Senyk Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Debbie Breitbeil, 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.