Citation Nr: 21076563 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 13-35 505 DATE: December 27, 2021 ORDER Service connection for posttraumatic stress disorder (PTSD) is granted. REMANDED Entitlement to a rating in excess of 30 percent for anxiety disorder is remanded. FINDING OF FACT Resolving doubt in the Veteran's favor, he has a current diagnosis of PTSD that is related to in-service stressor events. CONCLUSION OF LAW The criteria for service connection for PTSD have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Marine Corps from July 1967 to February 1970. 1. Service connection for PTSD 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. § 1131; 38 C.F.R. § 3.303(a). Claims for service connection for PTSD require medical diagnosis conforming to the requirements of section 4.125(a), an in-service stressor accompanied by credible and supporting evidence that the stressor claimed to be the cause of the disorder occurred in service, and established medical evidence connecting the current disability to the stressor. 38 C.F.R. § 3.304(f); see 38 C.F.R. § 4.125(a); Cohen v. Brown, 10 Vet. App. 128, 138 (1997). If the evidence provides that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, the Veteran's lay statements alone may generally establish the occurrence of the stressor. 38 C.F.R. § 3.304(f)(2). The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). When there is an approximate balance of positive and negative evidence regarding any material issue, all reasonable doubt is resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Based on the evidence, the Board finds the criteria for service connection for PTSD have been met. 38 C.F.R. § 3.303. First, the evidence shows a current diagnosis of PTSD after resolving doubt in the Veteran's favor. VA mental health evaluations from December 2011 and June 2012 include diagnosis of PTSD. However, an August 2012 record lists the diagnosis as PTSD v. anxiety disorder, and VA treatment record also show diagnosis of anxiety disorder. The March 2012 VA examiner found the Veteran did not meet the criteria for diagnosis of PTSD, specifically criterion C, and instead diagnosed anxiety disorder, NOS. Similarly, the April 2016 examiner found the Veteran did not meet the full criteria for PTSD diagnosis and should be diagnosed with other trauma and stressor related disorder, which is the new term for the prior diagnosis of anxiety disorder, NOS. In evaluations from May 2016 and September 2018, the Veteran's treating counselor and psychologist from the Vet Center diagnosed him with PTSD. The Veteran was treated at the Vet Center for several years, and this PTSD diagnosis was never changed. Given the length of treatment, the Board finds the Veteran's treating providers have significant knowledge of his symptom presentation. As such, the opinions and diagnosis of the treating providers carries at least as much weight as the opinions and diagnoses of the VA examiners. The evidence is in relative equipoise as to whether the Veteran meets the criteria for PTSD diagnosis, and the benefit of the doubt is resolved in his favor to find that he has PTSD currently. Next, the evidence shows in-service stressor events. The Veteran has reported several stressor events in service, including receiving mortar and rocket fire at an airfield, witnessing another company bombed with napalm, and witnessing the deaths of several Marines. His DD Form 214 shows he received the Combat Action Ribbon and Navy Commendation Medal with V (for valor). All of the medical experts found that the Veteran met the criterion A stressor requirements for PTSD diagnosis. The Board finds the Veteran's reports of in-service stressors credible and consistent with his combat experience. Accordingly, the in-service element of service connection is also shown. Finally, the evidence shows that the Veteran's current disability is due to in-service stressors. The Veteran's treating providers found that his PTSD stemmed from his combat service. Additionally, although not finding he had a PTSD diagnosis, the May 2012 and April 2016 examiners found the Veteran's anxiety disorder and other trauma and stressor related disorder were due to his combat experiences. There is no evidence to suggest that the Veteran's PTSD is due to anything other than his service. A connection is established, and service connection for PTSD is warranted. REASONS FOR REMAND 1. Entitlement to a rating in excess of 30 percent for anxiety disorder is remanded. The Board has herein granted service connection for PTSD. Implementation of an award of service connection is a downstream issue completed by the Agency of Original Jurisdiction (AOJ). Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). In this case, however, the evidence suggests that the Veteran's anxiety disorder is part of his PTSD or that PTSD is the correct diagnosis for his mental health disability. As discussed above, the diagnoses of anxiety disorder, other trauma or stressor related disorder, and PTSD have been offered as alternative diagnoses for the Veteran's symptom presentation, rather than as multiple disorders. The VA examiners found the impact from the Veteran's mental health disability could not be separated from one diagnosis to the other and the symptoms were inexplicably intertwined. Additionally, PTSD and anxiety disorder are rated under the General Rating Formula for Mental Disorders, and the Veteran could not be assigned duplicate ratings for PTSD and anxiety disorder based on the same symptoms and disability presentation. See 38 C.F.R. §§ 4.14, 4.130. The Board finds the AOJ should consider in the first instance whether the grant of service connection for PTSD affects the Veteran's overall mental health rating and then return the issue to the Board if necessary. Moreover, the Veteran has stated on multiple occasions that he does not believe he should be awarded and is not seeking a rating in excess of 30 percent. He has not formally withdrawn his appeal but rather, asserts that he should receive the total 30 percent award instead of the 20 percent he receives. The Board understands the confusion in the Veteran's award percentage. While the Veteran has been awarded 30 percent for anxiety disorder, the process for combining VA disability awards is not as straightforward as simply adding the ratings together. Instead, disability ratings are combined using the combined ratings table found in the regulation at 38 C.F.R. § 4.25. Under the combined ratings table, the Veteran's 30 percent rating for anxiety combines with the 20 percent rating for hearing loss for a 44, which combines with the 10 percent rating for tinnitus for a 50 percent total rating. Previously, his 20 percent rating for hearing loss combined with the 10 percent rating for tinnitus for a 28, which was rounded up to 30 percent. Disability ratings for all veterans with multiple disabilities are assigned through the combined ratings table. To receive a combined rating in excess of 50 percent, the evidence must show that the Veteran's mental health disability warrants a rating in excess of 30 percent or he must file a new claim and have evidence showing his hearing loss warrants a rating in excess of 20 percent. The matters are REMANDED for the following action: 1. Implement the award of service connection for PTSD and determine how that award may affect the Veteran's mental health disability rating, currently on appeal as anxiety disorder. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.P. Armstrong 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.