Citation Nr: 21009704 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 15-35 211 DATE: February 23, 2021 ORDER Service connection for posttraumatic stress disorder (PTSD) is denied. REMANDED Service connection for major depressive disorder (MDD). FINDINGS OF FACT 1. The Veteran had active duty from January 1984 to February 1987. His service from February 1987 to November 1988 was other than honorable. He has been 100 percent disabled since May 2019. 2. The Veteran has been diagnosed with PTSD, but did not engage in combat with the enemy and has no verified in-service stressor. CONCLUSION OF LAW PTSD was not incurred in service. 38 U.S.C. §§ 1101, 1112, 1131 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, in January 2019, the Board remanded the appeal for additional development, to include an examination. At that time, the issue was styled as a single acquired psychiatric disorder, to include PTSD and MDD, in accordance with Clemons v. Shinseki, 23 Vet. App. 1 (2009). However, the Board has restyled the issues of PTSD and MDD as two separate claims as MDD requires further development. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection for PTSD specifically requires: (1) a diagnosis of the disorder made in accordance with the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V); (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) a link established by medical evidence between current symptoms and an in-service stressor. 38 C.F.R. §§ 3.304(f), 4.125(a). The evidence necessary to establish the incurrence of a recognizable stressor during service to support a claim of service connection for PTSD will vary depending on whether a veteran engaged in combat with the enemy. The determination as to whether a veteran “engaged in combat with the enemy” is made, in part, by considering military citations that expressly denote as much. However, the Board may not rely strictly on combat citations or a veteran’s military occupational specialty to determine if he or she engaged in combat; rather, other supportive evidence may also be accepted. If there is no combat experience, or if there is a determination that the veteran engaged in combat but that the claimed stressor is not related to such combat, there must be independent evidence to corroborate the veteran’s statement as to the occurrence of the claimed stressor. The veteran’s testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor. Further, an opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of a stressor. As to a current disorder, the Veteran has been diagnosed with PTSD. Specifically, multiple medical treatment notes, as well as a September 2020 VA examination, diagnosed PTSD. Therefore, a current disorder has been shown and the first element of service connection has been met. Next, the evidence does not show that the Veteran engaged in combat with the enemy. Specifically, service treatment records (STRs) and service personnel records do not suggest that he engaged with the enemy. Further, he does not allege that his PTSD is due to combat. Therefore, the record does not establish combat participation. As such, in order to grant service connection for PTSD, the record must contain credible evidence that corroborates the Veteran’s statements about the occurrence of any alleged stressors. In September 2011 and May 2019 medical treatment notes, the Veteran reported that while serving aboard the USS New Orleans, he witnessed a close friend go overboard. He said that the ship did not turn around to rescue his friend, who ultimately drowned. The Veteran additionally described witnessing two men from his unit die after stepping on live wires that were hidden under snow during cold weather training, and experiencing violent memories of seeing a plane crash on the deck of his aircraft carrier with multiple casualties. Finally, in his September 2020 VA examination, he described doing guard duty near a morgue and hearing the voice of a deceased friend talking to him. The medical evidence has established a link between the Veteran’s current symptoms and his reported stressors. Specifically, a September 2020 VA examination found symptoms indicative of PTSD based on the Veteran’s to actual or threatened death by directly experiencing the traumatic event and witnessing the traumatic event in person. The examiner noted that his symptoms were not the product of fear of hostile military or terrorist activity, but ultimately opined that the Veteran met the DSM-V criteria for PTSD and that his PTSD stemmed from military trauma. Therefore, a nexus has been established and the third element of service connection has been met. However, as to the second element of service connection for PTSD- credible supporting evidence that the claimed in-service stressor occurred- the evidence does not support the claim. Specifically, the claimed stressor has not been verified. The record contains only the Veteran’s account of his stressors. However, a July 2013 formal finding determined that there was insufficient evidence to verify his report. Furthermore, while the September 2020 examiner opined that it was at least as likely as not that his PTSD was the product of his in-service trauma, after-the-fact medical evidence cannot be the sole evidence corroborating the occurrence of the claimed stressors. Based on the above, the record does not establish that the Veteran engaged with the enemy. While the evidence of record establishes a nexus between the claimed in-service stressors and his current diagnosis, it does not confirm the claimed stressors. Accordingly, the medical evidence does not support the claim of service connection for PTSD, and there is no doubt to be otherwise resolved. The Board has considered lay statements offered by the Veteran regarding the etiology of his PTSD. Lay witnesses are competent to report symptoms and describe their observations because this requires only personal knowledge as it comes to them through their senses. However, they are not competent to offer opinions as to the etiology of any current disorder due to the medical complexity of the matters involved. Such competent evidence has been provided by the medical personnel who have examined the Veteran during his current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to the lay statements that have been submitted. In light of the above discussion, service connection for PTSD is denied, and there is no doubt to be otherwise resolved. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND In multiple medical treatment notes, clinicians offered that the Veteran’s in-service stressors resulted in a psychiatric disorder, to include an anxiety disorder NOS and MDD. Most recently, he was diagnosed with PTSD and MDD in the September 2020 VA examination. The September 2020 examiner opined that the Veteran’s primary diagnosis was PTSD, and that MDD was secondary to PTSD; however, the examiner did not address whether a direct relationship existed between MDD and the Veteran’s service. Accordingly, further development is required to determine the nature and etiology of MDD. The matter is REMANDED for the following actions: 1. Identify and obtain any pertinent, outstanding VA and private treatment records not already of record and associate them with the claims file. 2. Direct the claims file to an appropriate clinician for an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s MDD is etiologically related to service. 3. If the clinician determines that an examination is necessary in order to provide the requested opinions, then one should be scheduled. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Spigelman, 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.