Citation Nr: 21012897 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-34 306 DATE: March 5, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, variously diagnosed as PTSD, other specified trauma- and stressor-related disorder, and depressive disorder, is granted. FINDING OF FACT Resolving all reasonable doubt in the Veteran's favor, the Veteran's acquired psychiatric disorders, variously diagnosed as PTSD, other specified trauma- and stressor-related disorder, and depressive disorder, are related to active service, including his fear of hostile military or terrorist activity. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, variously diagnosed as PTSD, other specified trauma- and stressor-related disorder, and depressive disorder, are met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102 , 3.303, 3.304 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty March 2008 to July 2008 and from November 2009 to December 2010, to include service in Afghanistan in support of Operation Enduring Freedom (OEF) from February 2010 to November 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2013 and March 2014 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In pertinent part, the January 2013 rating decision denied the Veteran’s service connection claim for PTSD, while the March 2014 reopened and confirmed the previous PTSD denial and denied a separate claim of entitlement to service connection for unspecified depressive disorder. Notably, in September 2013, within one year of the January 2013 rating decision, the Veteran submitted a claim to reopen service connection for PTSD, and, in November 2013, he submitted new and material evidence to support his claim. As a result, the January 2013 rating decision did not become final as to this matter. See 38 C.F.R. § 3.156. Further, although the RO developed the claims for unspecified depressive disorder and PTSD and as separate issues, in Clemons v. Shinseki, 23 Vet. App. 1 (2009), the United States Court of Appeals for Veterans Claims (hereinafter "the Court") held that an initial claim of entitlement service connection for PTSD should also be read as including other psychiatric disorder diagnoses reasonably raised by the symptoms described and all information obtained in support of the claim. Therefore, the matters are addressed as a single issue on appeal. Lastly, the Veteran withdrew his request for a Board hearing in November 2017 correspondence. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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 38 C.F.R. § 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 a claimed in-service stressor is related to the Veteran's 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 posttraumatic stress disorder 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). The Veteran contends that he has an acquired psychiatric disorder that is related to his active duty service. In numerous statements of record, the Veteran reported that he was in close proximity to fuel trucks being bombed/blown up by enemy forces while stationed at a combat operating post (COB) on the Afghanistan-Pakistan border. See, e.g., July 2015 Stressor Statement; March 2015 VA Mental Health Treatment Record; and June 2015 VA Examination Report. He has otherwise endorsed general fear of hostile military or terrorist activity while serving in Afghanistan. In this case, the Board finds that the evidence supports the Veteran's claim for service connection for an acquired psychiatric disorder. With regard to a current disability, the Veteran has current diagnoses of PTSD, other specified trauma-and stressor-related disorder, and other specified depressive disorder. See October 2013 and March 2015 VA Mental Health Treatment Record (diagnosing PTSD (DSM-IV and V) and depressive disorder); March 2014 VA Examination Report (diagnosing depressive disorder); June 2015 VA Examination Report (diagnosing other specified trauma and stressor-related disorder and depressive disorder); and Vet Center Treatment Records (diagnosing PTSD and depressive disorder). Thus, the first element of service connection is met. With regard to an in-service stressor event, as noted, the Veteran attributes his current disorders to various incidents in-service, to include witnessing fuel tanks being blown up while serving in Afghanistan in/around July 2010. The Veteran’s service records reflect that he was deployed to Afghanistan in support of OEF from February 2010 to November 2010. See DD Form 214 (noting Veteran served in designated imminent danger pay area). His military occupational specialty (MOS) was that of an indirect fire infantryman. He has competently and credibly reported that he was exposed to the aforementioned stressor event(s), and, given his MOS and his purported area of operation in Afghanistan, the Board finds the claimed stressor(s) are consistent with the places, types, and circumstances of the Veteran's service. In short, there is credible supporting evidence that the claimed in-service stressor(s) occurred. 38 U.S.C. § 1154(a) The remaining question is whether there is competent evidence establishing a connection between the Veteran's psychiatric disorders and service. On that matter, the evidence is in conflict. In November 2012, a VA examiner found that the Veteran did not meet the criteria for PTSD or any other mental disorder. In November 2013, J.W. (LCSW, MSW), the Veteran’s longtime treating readjustment counselor at the Hartford Vet Center, stated that the Veteran had endured traumatic events during his combat mission and has experienced the symptoms/effects of PTSD since his return. In March 2014, a VA examiner diagnosed “Other Unspecified Depressive Disorder” and opined that it was “not possible to render a mental disorder diagnosis and state, with a 50/50 or greater probability, that it is causally related to his military service. To do so would require speculation that goes well beyond the evidence available at this time.” Notably, the examiner acknowledged the Veteran’s reported in-service stressor of seeing fuel trucks being blown up and conceded that it was related to a fear of hostile military activity and sufficient to support a PTSD diagnosis, but indicated that the Veteran did not respond to questions related to PTSD criteria B and C. In August 2014, the Veteran’s J.W. (LCSW, MSW), the Veteran’s longtime treating readjustment counselor at the Hartford Vet Center, stated that he had reviewed the previous 2012 and 2014 C&P examinations and wanted to “put forth his professional opinion that [the Veteran] suffers from PTSD due to his experiences in Afghanistan and that the first C&P exam can be more easily explained by a few words, denial, naivety, and fear.” J.W. explained that the Veteran did not want to believe that anything was wrong with him after returning from Afghanistan and that he was fearful of not finding gainful employment if diagnosed with PTSD (noting that he was currently employed as a security guard and had ambitions to be a police officer). J.W. noted that neither he nor the Veteran could account for the 2014 VA examiner’s finding that the Veteran did not respond to questions relating to PTSD criteria B and C because he clearly has a fear (reactivity) to fuel trucks as he inspected them for bombs while serving in Afghanistan. J.W. went on to explain that the Veteran was exposed to daily, traumatic events or situations in which death and devastation was always a factor. He felt intense fear, helplessness, or horror in response to those events. J.W. noted that 2010 was the deadliest year in Afghanistan and that the Veteran had been stationed at COB Monty during this time. He noted that the Veteran manned the checkpoints where the fuel trucks passed through and that he had to inspect the fuel trucks for explosive devices. J.W. stated that the Veteran endorsed avoidance, symptoms of arousal and hypervigilance (startles with fuel trucks), and re-experiencing the events in Afghanistan on a daily basis. In March 2015, a VA psychiatrist diagnosed PTSD and depressive disorder (DSM-5) based on the Veteran’s stressor event of being near a fuel truck that blew up in July 2010. In June 2015, a VA examiner diagnosed unspecified depressive disorder and other specified trauma- and stressor-related trauma. The examiner stated that the symptoms of the latter included anxiety in the context of seeing and being around fuel trucks, with avoidance of gas stations as much as possible (and especially when a fuel truck is unloading), and emotional and physiological reactance to fuel trucks (Veteran reports feeling sweaty, hot, with rapid heartbeat in reaction to seeing a fuel truck). Although the examiner clearly related the diagnosis of other specified trauma- and stressor-related trauma to the in-service stressor of witnessing fuel trucks explode, she concluded that it could not “be stated with 50/50 or greater probability that the Veteran’s current mental health symptoms are directly related to his military service and deployment; would be speculation to do so.” This opinion is equivocal; on balance it actually supports the notion that the Veteran’s psychiatric disability is related to service. The Board has reviewed the aforementioned medical opinions with respect to nexus and finds that the evidence in support of the Veteran's claim is no less probative than the evidence against it. Considering the Veteran's competent and credible lay statements regarding in-service stressors; the VA treatment records documenting psychological symptoms proximate to service; the comprehensive mental health assessment from J.W. in 2014; and the evaluation from the VA psychiatrists in March 2015 and June 2015, the evidence is at least in relative equipoise as to whether the Veteran's psychiatric disorders are related to service, to include his fear of hostile military or terroristic activity during service. Resolving reasonable doubt in the Veteran's favor, service connection for an acquired psychiatric disorder, variously diagnosed as PTSD, other specified trauma- and stressor-related disorder, and other specified depressive disorder, is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Hoeft 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.