Citation Nr: 21007895 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 16-57 246 DATE: February 11, 2021 ORDER Entitlement to service connection for acquired psychiatric disorders, to include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), is granted. FINDING OF FACT The Veteran has current diagnoses of PTSD and MDD that are proximately due to in-service stressors, and there is credible supporting evidence that the claimed in-service stressors occurred. CONCLUSION OF LAW The criteria for entitlement to service connection for acquired psychiatric disorders, to include PTSD and MDD, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1983 to April 1987. This matter comes before the Board of Veterans’ Appeals (Board) from an April 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In this regard, the Board liberally construes the Veteran’s October 2014 statement as a Notice of Disagreement (NOD) with the April 2014 rating decision. See 38 C.F.R. § 20.201 (2014). In January 2019, the Board issued a decision denying the Veteran’s claim of entitlement to service connection for an acquired psychiatric disorder. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In March 2020, the Court issued a Memorandum Decision vacating the January 2019 Board decision. Specifically, the Court found that the Board failed to consider evidence of record that weighed in favor of granting the Veteran’s claim and failed to fulfill its heightened duty to assist the Veteran in obtaining evidence to corroborate the claimed in-service stressors in light of his lost service treatment records. See Memorandum Decision at 4-7. In August 2020, the Board remanded the matter for the RO to undertake further development to verify the Veteran’s claimed in-service stressors and to obtain an examination and etiology opinion, which were furnished in October 2020. The Veteran relates his psychiatric disorders to stressors he experienced in service. See November 2016 VA Form 9 and attached Statement; November 2016 Veteran Affidavit; July 2015 NOD; April 2015 Veteran Affidavit. Specifically, the Veteran relates his disorders to three traumatic events in service; providing emergency care to a boy impaled by razor wire, performing CPR on a soldier who died, and experiencing a bombing. See April 2015 Veteran Affidavit. The Veteran reports that he was treated for depression in service and prescribed Prozac during that treatment. See November 2016 Veteran Affidavit; April 2015 Veteran Affidavit. 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. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease, event 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 (1) medical evidence diagnosing PTSD; (2) a link, established by medical evidence, between a Veteran’s present symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). If a stressor claimed by the Veteran is related to his fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, 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. 38 C.F.R. § 3.304(f)(3). With respect to the first element of service connection, the presence of a current disability, the medical evidence of record indicates current diagnoses of PTSD and MDD. See October 2020 VA examination (providing a diagnosis of PTSD that conforms to DSM-5 criteria); December 2013 VA psychiatry note (providing an assessment of MDD); April 1998 VA treatment note (providing a diagnosis of MDD). Although the October 2020 examiner indicated that PTSD is the Veteran’s only psychiatric disability and that depression is a symptom of his PTSD rather than a separate disability, the Veteran’s medical records indicate he has been diagnosed with this disability over the course of his psychiatric treatment. The variance in diagnoses is more likely due to different examiners describing his disorders in different terms. Accordingly, competent and credible medical evidence of record establishes that the Veteran has current diagnoses of acquired psychiatric disorders, to include PTSD and MDD, and the first element of service connection is, therefore, met. With respect to the second element of service connection for PTSD, a link between the Veteran’s diagnosed disabilities and service, the October 2020 VA examiner provided a positive nexus opinion linking the Veteran’s PTSD to the claimed in-service stressors. Specifically, the examiner, a VA-contracted doctor of psychology, opined that the Veteran’s PTSD was at least as likely as not due to his traumatic experiences in service. The examiner discussed the Veteran’s claimed in-service stressors and explained that it is “not uncommon for individuals who have experienced, witnessed, or learned about such stressors as [the] Veteran did while in the service” to acquire PTSD. This nexus opinion is highly probative in light of the detailed history of the Veteran’s symptomatology, the well-reasoned explanation, and the examiner’s expertise in diagnosing psychiatric disorders. Furthermore, there are no negative nexus opinions of record. Thus, competent, credible, and probative medical evidence of record connects the Veteran’s PTSD to his active duty service, and the second element of service connection for PTSD is met. With respect to the final element of service connection for PTSD, credible evidence supporting that the claimed in-service stressor occurred, and the second element for service connection for MDD, in-service incurrence of an event, the Veteran has described several stressors related to his service in Germany. In particular, the Veteran described a traumatic event when a bomb detonated inside a nightclub as he was walking out and some soldiers were killed in the explosion. See October 2020 VA examination; November 2016 Veteran Affidavit; April 2015 Veteran Affidavit; May 2014 VA mental health note. Because the Veteran’s military service records have been lost, there are no contemporaneous records documenting the occurrence of the claimed in-service stressor. See September 2013 VA Memorandum (formal finding of the unavailability of the Veteran’s service treatment records (STRs)). In addition, there is no other evidence of record establishing that this incident occurred, other than the Veteran’s own reports. Despite the lack of documented evidence, there is competent, credible, and probative lay evidence of record that supports that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f)(3). Here, the Board notes that the Veteran’s claimed in-service stressor regarding the bombing is related to “fear of hostile military or terrorist activity.” Id. In this regard, the October 2020 examiner, a VA-contracted doctor of psychology, noted that the bombing was related to fear of hostile military or terrorist activity and was adequate to support a diagnosis of PTSD. VA clinicians are skilled in identifying military trauma; thus, the examiner’s opinion linking the Veteran’s PTSD to the claimed stressor supports the Veteran’s assertion that the stressor occurred. In addition, the Veteran has provided consistent reports of the claimed in-service stressor in two notarized affidavits, and the stressor is consistent with the location of the Veteran’s service, as supported by his DD Form 214. 38 U.S.C. § 1154(a). Thus, all elements are established for service connection for PTSD, and the second element for direct service connection for MDD is met. Regarding the other two reported in-service events, given the Veteran’s missing STRs along with his competent, credible, and consistent reporting, the Board finds there is credible supporting evidence of the two other in-service stressors. Specifically, the Veteran reported stressors related to two separate incidents when he had to respond to a boy impaled by razor wire and when he had to perform resuscitation on a soldier who died of alcohol poisoning. See November 2016 Veteran Affidavit; April 2015 Veteran Affidavit; May 2014 VA mental health note. The October 2020 examiner noted that both stressors supported the diagnosis of PTSD, although they were not related to fear of hostile military or terrorist activity. As the Veteran has competently and credibly reported these stressors, and as they are consistent with his military occupational specialty as a medic, and given the Veteran’s missing STRs, the Veteran’s lay testimony establishes their occurrence. 38 U.S.C. § 1154(a). With respect to the third element of service connection for MDD, a nexus between service and the psychiatric disorders, a private psychiatrist provided a positive nexus opinion. In a March 2015 letter, Dr. W.L. opined that the Veteran’s “depression was caused or substantially contributed to by his military service.” In reaching this conclusion, the psychiatrist noted that he had reviewed the Veteran’s VA medical records and conducted a 1.5-hour psychiatric interview with the Veteran in October 2014. The psychiatrist knew that the Veteran experienced traumatic stressors in service and discussed those stressors in relation to the development of the Veteran’s post-service psychiatric symptomatology.. The March 2015 psychiatrist letter is competent, credible, and highly probative in that it was based on a thorough examination and review of the Veteran’s records, detailed in its account of the development of the Veteran’s psychiatric condition, and clear in linking the Veteran’s MDD to the stressors he experienced in service. In addition, there is no negative evidence regarding a nexus between MDD and the Veteran’s service. In sum, medical evidence of record establishes that the Veteran has current psychiatric diagnoses of PTSD and MDD. The Veteran’s competent and credible lay reports establish the occurrence of in-service traumatic events. With respect to one event in particular, the bombing, a VA-contracted psychologist noted that this event was related to fear of hostile military or terrorist activity and was adequate to support a diagnosis of PTSD. Furthermore, this event is consistent with the location of the Veteran’s service. Lastly, medical evidence establishes a positive nexus between the Veteran’s diagnosis of PTSD and the bombing in an October 2020 VA medical opinion and a positive nexus between MDD and other in-service stressors in a March 2015 psychiatrist letter. Accordingly, all elements of service connection are established, and the benefit sought on appeal is granted. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. deBruyn, 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.