Citation Nr: 21006446 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 17-38 106 DATE: February 4, 2021 ORDER Entitlement to service connection for a psychiatric disorder, diagnosed as generalized anxiety disorder (GAD), is granted. FINDINGS OF FACT 1. Competent and probative medical evidence establishes a causal link between GAD and military service. 2. The Veteran has reported three in-service stressors for his PTSD: (1) a panicky reaction to hearing about the Khobar Towers bombing from another service-member while stationed in Riyadh, Saudi Arabia; (2) worries about car bombs and poor security while deployed to Al Dhafra Air Base, United Arab Emirates; and (3) seeing the apparent outline of a man’s body while stationed in Ahmed Al Jaber Air Base, Kuwait. The Veteran’s reported stressors are not verified. 3. There is not a diagnosis of PTSD based on corroborated in stressor events. CONCLUSION OF LAW The criteria for service connection for a psychiatric disorder, diagnosed as GAD, are met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from September 1981 to September 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in November 2020. A transcript is of record. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with § 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 it is established through military citation or other supportive evidence that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(2). See also 38 U.S.C. § 1154(b) and 38 C.F.R. § 3.304(d); Gaines v. West, 11 Vet. App. 353 (1998) (Board must make a specific finding as to whether the Veteran engaged in combat). To gain the benefit of a relaxed standard for proof of service incurrence of an injury or disease, 38 U.S.C. § 1154(b) requires that the veteran have actually participated in combat with the enemy. See VAOPGCPREC 12-99. If VA determines either that the veteran did not engage in combat with the enemy or that the veteran did engage in combat, but that the alleged stressor is not combat related, the veteran's lay testimony, by itself, is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain credible supporting evidence that corroborates the veteran's testimony or statements. 38 C.F.R. § 3.304(f); Stone v. Nicholson, 480 F.3d 1111 (Fed. Cir. 2007); Cohen v. Brown, 10 Vet. App. 128, 147 (1997); Moreau v. Brown, 9 Vet. App. 389, 395 (1996). However, corroboration of every detail of a claimed stressor, including the veteran’s personal participation, is not required; rather, a veteran only needs to offer independent evidence of a stressful event that is sufficient to imply his or her personal exposure. See Pentecost v. Principi, 16 Vet. App. 124, 128 (2002) (quoting Suozzi v. Brown, 10 Vet. App. 307 (1997)). Where the claimed in-service stressor is related to the veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. Id. § 3.304(f)(3). “[F]ear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Id. 1. Entitlement to service connection for a psychiatric disorder. The Veteran seeks service connection a mental disorder related to stressors that reportedly occurred while stationed in Saudi Arabia, United Arab Emirates, and Kuwait during his active service. At the outset, the Board notes that service connection for PTSD and GAD was initially denied in an August 2014 rating decision. The Veteran has sought to reopen claims for a psychiatric disorder numerous times since that rating decision, and review of the file reflects new and material evidence was received within a year of each rating decision that readjudicated entitlement to service connection. Therefore, service connection for a psychiatric disorder, on the merits and without consideration of whether new and material evidence is needed, is warranted. See 3.156(b); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011). The Veteran has reported three in-service stressors, related to deployments during his active service. First, the Veteran reported a strong, panicky reaction to hearing about the Khobar Towers bombing from another service-member while stationed in Riyadh, Saudi Arabia. He stated that he worried that it could have been his base. After the bombing he reported that he worked as Security Police Augmentee, working 12-hour night shifts on roof tops walking around the base perimeter. Second, the Veteran reported worries about general poor security while deployed to Al Dhafra Air Base, United Arab Emirates. He stated that the gate just had a 2-inch thick rope going across the gravel road for security. Further, he reported that the gate guards checked the vehicle after it was parked off base very rarely, and that they let their guard down all the time. He indicated that while he was deployed there, he felt jumpy. Third, the Veteran reported seeing the apparent outline of a man’s body on a wall while stationed in Ahmed Al Jaber Air Base, Kuwait. He indicated that he had to pick up paper supplies stored in Kuwait Aircraft Bunkers that were severely damaged by allied bombs. He reported that when he was looking around for his other supplies, he walked closer to the wall and could see an outline of a man’s body in what he believed was blood. He reported getting a lot of headaches and a shaky feeling. A review of the Veteran’s service personnel records shows that he served tours in Riyadh, Saudi Arabia, in Al Dhafra, United Arab Emirates, and in Al Jaber Air Base, Kuwait. There is no evidence, and the Veteran did not report at his hearing before the undersigned, that he engaged in combat. In July 2015, the AOJ made a formal finding that it lacked the information required to verify the second and third stressors. The finding indicated that there was a lack of adequate evidence necessary to request verification from the Joint Services Records Research Center (JSRCC). It stated that the information received in April 2014, was incomplete with no specific stressors identified. Regarding the first stressor incident, the Khobar Towers bombing that occurred on June 25, 1996, the Veteran did not directly witness this specific incident personally or respond to the scene. Rather, he learned about it through a second-hand account from a fellow service-member, who described stories of what she saw and what it was like being there. As the Veteran did not have personal exposure to this reported stressor event- this is not a stressor that may serve as a basis to grant PTSD. See Pentecost v. Principi, 16 Vet. App. 124, 128 (2002) (quoting Suozzi v. Brown, 10 Vet. App. 307 (1997)). The Veteran served at tours of duty at bases in Saudi Arabia, United Arab Emirates, and Kuwait; however, the Veteran’s lay testimony is not sufficient to corroborate the existence of the second and third stressor events. The Veteran’s DD 214 reflects a military occupational specialty of services craftsman. The DD 214 also shows he was awarded the Air Force Outstanding Unit Award with Valor Device, among other awards. Although this award suggests that some members of the Veteran’s unit engaged in combat, it does not demonstrate that the Veteran himself did so. Such an award, if given on the basis of valor in actions against the enemy, may be utilized to confirm combat involvement and the existence of a stressor leading to the onset of PTSD. In this case, however, service department records do not include the written commendation or the recommendation of a commanding officer for that award, and, as such, it is not now possible to ascertain why the unit was commended for valor. The Veteran’s service department records also do not reflect that he engaged in combat or that he was awarded other medals indicative of combat service. Moreover, the Veteran has not asserted that he engaged with combat with the enemy during any of his deployments to the Gulf. For these reasons, the Veteran is not considered a ‘combat veteran’ and his lay testimony alone is not sufficient to corroborate his reported stressors. The Veteran has not described a personal assault against his person. There is no official corroboration of the events the Veteran reports. The Board therefore finds the reported second and third stressors are not corroborated. While the Veteran’s specific stressors were not verified, additional consideration pursuant to 38 C.F.R. § 3.304(f)(3) was given in this case. To the extent the second or third stressors are related to his “fear of hostile military or terrorist activity,” no VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, has confirmed that they are adequate to support a diagnosis of PTSD and that the Veteran's symptoms are related to the claimed stressor. See 38 C.F.R. § 3.304 (f)(3). The Veteran was afforded a VA examination in July 2014. The examiner noted a history of deployments to Saudi Arabia, Kuwait, and United Arab Emirates. During each of his deployments, the examiner noted that the Veteran felt in fear for his life, and also felt that his fellow soldiers did not take the potentially dangerous situation seriously. Prior mental health treatment showed that, in 2007, the Veteran had what appeared to be some sort of mental health breakdown, which he described as an anxiety attack. The examiner found that the Veteran did not meet the diagnostic criteria for PTSD. However, the Veteran did suffer from a relative severe anxiety disorder which seriously impaired his quality of life. The examiner opined that, based on the Veteran’s reports, these fears arose during the Veteran’s deployments abroad during his military career. The Veteran also submitted a May 2016 letter from his social worker. She noted that the Veteran’s deployments caused him to feel very uncomfortable and anxious. The Veteran also reported that he entered a bunker where he saw blood splatter from a past bombing. She found the Veteran meets the criteria for diagnosis of PTSD, with delayed expression. The Veteran submitted an October 2020 letter from Dr. M.D. in support of his claim. The letter indicates the Veteran reported seeing blood splattered on walls in the shape of a human, walking perimeter fences with his assault rifle in war-torn areas, having to check for car bombs, and seeing places where had recently been destroyed on news feeds. Dr. M.D. provided a diagnosis of PTSD and opined that some of the Veteran’s symptoms are a direct result of his service in the military. Notably, the stressful events described in this letter are not verified and are not of the sort even capable of verification. The VA examiner, a psychologist, determined that the Veteran does not have a diagnosis of PTSD. The examiner reviewed the claims file, performed a clinical examination, and support his opinion with provided a cogent rationale. Thus, his opinion is probative. The May 2016 and October 2020 opinions have been considered. To the extent that those clinicians provided diagnoses of PTSD, they were not based on a verified or corroborated in-service stressor. As the probative evidence of record does not establish a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); credible supporting evidence that the claimed in-service stressors actually occurred; and medical evidence of a link between current symptomatology and the claimed in-service stressors, service connection for PTSD is not warranted. Although service connection for PTSD is not warranted, the record reflects several other non-PTSD psychiatric diagnoses. Private treatment notes reveal that in February 2014, the Veteran presented with a longstanding history of depression and anxiety. Treatment providers diagnosed MDD, GAD, and OCD traits. The July 2014 VA examiner provided a diagnosis of GAD and opined that this anxiety disorder and its symptoms arose during the Veteran’s deployments abroad during his military career. The Veteran submitted a private disability benefits questionnaire (DBQ) dated February 2015. The physician assistant completing the report noted symptoms of increased anger outbursts, and irritability while working. She diagnosed MDD, GAD, and OCD. She opined that it is at least as likely as not that the Veteran’s symptoms began during military service. A rationale was not provided. As note, the Veteran submitted an October 2020 letter from Dr. M.D. in support of his claim. Dr. M.D. indicated that the Veteran had been under his care since September 2015. He noted diagnoses of PTSD, OCD with mixed behavioral acts and thoughts, MDD, and GAD. He noted that the Veteran reported flashbacks to his military services, is hypervigilant, and is able to tie his symptoms directly back to his military service. Dr. M.D. opined that some of the Veteran’s symptoms are a direct result of his service in the military. Based on review of the medical evidence, the Board concludes that service connection for GAD is warranted. The July 2014 VA examiner opined that the Veteran’s anxiety disorder and its symptoms arose during the Veteran’s deployments abroad during his military career. As noted, the examiner reviewed the claims file, performed a clinical examination, and support his opinion with provided a cogent rationale. Hence, his opinion is probative and persuasive. There is no opinion to the contrary. To the extent other private providers provided diagnoses of MDD and OCD and indicated the diagnoses (or symptoms) are linked to military service, these opinions are not probative or persuasive. The private clinician who submitted a DBQ and opined the Veteran’s symptoms of MDD and OCD at least as likely as not began during military service, provided no rationale for this opinion and there is no indication that she reviewed the Veteran’s claims file. Hence, this opinion lacks probative value. In a similar fashion, the October 2020 nexus opinion from Dr. M.D. is not probative. Dr. M.D. opined that some of the Veteran’s symptoms are a direct result of his service in the military but stopped short of linking the clinical diagnoses to service. Moreover, no rationale was provided for the opinion and while he may have treated the Veteran since 2015, it is not apparent that he reviewed the Veteran’s claims file. For these reasons, service connection for MDD and OCD is not warranted. In sum, the Board finds there is competent and probative evidence sufficient to link the GAD disorder to military service, but not OCD or MDD. As the diagnoses of PTSD are not based on corroborated stressor events, PTSD is not service-connected. In reaching this conclusion, the Board advises that all psychiatric disorders are rated under the General Rating Formula for Mental Disorders which provides the same criteria for rating generalized anxiety disorder (GAD), PTSD, MDD, and OCD. 38 C.F.R. § 4.130. Therefore, separate ratings cannot be simultaneously assigned under separate Diagnostic Codes for GAD, PTSD, MDD, and OCD as this would constitute impermissible pyramiding under 38 C.F.R. § 4.14 (which provides that the evaluation of the same manifestation under different diagnoses are to be avoided). Accordingly, service connection for a psychiatric disorder diagnosed as GAD is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Lauritzen, 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.