Citation Nr: 21040103 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 17-51 979 DATE: July 2, 2021 ORDER Service connection for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The Veteran's PTSD was at least as likely as not related to his active service. CONCLUSION OF LAW The criteria for service connection for PTSD have been met. 38 U.S.C. §§ 1110, 1154(b); 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.125. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1967 to March 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a September 2019 travel Board hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the electronic claims file. Unfortunately, the Veteran died in November 2019 during the pendency of the appeal. The Appellant is the Veteran's surviving spouse and was properly substituted as the claimant in February 2020. As the substituted claimant, the Appellant seeks service connection for PTSD. The Appellant contends that the Veteran's PTSD was caused by multiple stressors during his active service, including: coming under fire from rockets and mortars almost every night when assigned to a landing zone in Vietnam; seeing a solider burn to death; working on teams that took out whole villages; and being shot at with an RPG. See, generally, July 2015 Psychiatry Consult, August 2015 Social Work Note, August 2015 VA Examination, October 2015 Social Work Note, September 2019 Hearing Transcript. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection for a disability requires competent evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service; and (3) a causal relationship or nexus between the current disability and any injury or disease during service. See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). With respect to PTSD, service connection requires medical evidence diagnosing the disorder in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between the 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 the evidence establishes that a 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, his lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 C.F.R. § 3.304 (f)(1); see also, 38 U.S.C. § 1154(b). Otherwise, the law requires verification of a claimed stressor. The Veteran's personnel and service treatment records are associated with the claims file. His personnel records show that he served as a basic field artilleryman, with principal duties as a prime mover/driver and assistant gunner, in Vietnam from 1968 to 1969. See DA Form 20, Enlistment Qualification Record. He received the Vietnam Campaign Medal with '60 device and the Vietnam Service Medal. A portion of his scanned DA Form 20 was cut-off, making it unclear which campaigns he may have served in. The Board notes that, although the Veteran's personnel records do not reflect receipt of any medals specifically indicative of combat, the determination as to whether a veteran engaged in combat is not determined simply by reference to existence or nonexistence of certain awards or MOS. See Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). Rather, the combat determination should be made on a case by case basis. VAOPGCPREC 12-99 (October 18, 1999). The Veteran credibly testified to coming under fire by enemy forces and otherwise fearing for his life during his service in combat zones. Based on the Veteran's credible testimony and the place, type, and circumstances of his service shown in his personnel records, the Board finds that the Veteran engaged in combat with the enemy during active service and his claimed stressor(s) are related to that combat, entitling him to the combat presumption. See 38 U.S.C. § 1154(b). The Veteran was afforded a VA examination in August 2015 to assess his PTSD claim. The examiner ultimately concluded that the Veteran's symptoms did not meet the full diagnostic criteria for PTSD under DSM-5. He diagnosed the Veteran with adjustment disorder and alcohol use disorder, and opined that these disorders were a lifelong pattern of behavior and not related to the service. The Veteran's VA treatment records are also associated with the claims file. He was negatively screened for PTSD in July 2003, July 2004, July 2005, August 2006, August 2011, and August 2012. He was diagnosed with PTSD per DSM-V standards in July of 2015 at a VA Psychiatry Consult related to his military service, with his treating psychiatrist noting that the Veteran had not previously been seen by a psychiatrist. His psychiatrist detailed his PTSD symptoms, noting that he reported feeling ashamed, embarrassed, and guilty because of his combat Vietnam experience. The Veteran also reported his PTSD-related symptoms and stressor events at an August 2015 Social Work Consult, and his licensed social worker echoed the July 2015 PTSD diagnosis per DSM-V standards. A different VA psychiatrist evaluated the Veteran in May 2017 and April 2018 and recorded diagnoses of PTSD and depressive disorder. Shortly before his death, the Veteran was evaluated by a private psychologist who concluded he did not have PTSD, but generalized anxiety disorder. The Board has considered the Veteran's lay statements, including his own statements and those made by his wife, the Appellant. In the September 2015 Notice of Disagreement (NOD), he stated that he waited many years to file his PTSD claim due to shame and embarrassment and that the horrors from Vietnam were buried in the back of his head for many years. At the December 2019 Social Work Follow-Up Session, the Appellant and a friend of the Veteran expressed concern that the Veteran was not forthcoming with providers regarding his PTSD symptoms. After reviewing the lay and medical evidence, including the conflicting diagnoses, the Board finds that service connection is warranted for PTSD. While there is no credible supporting evidence, beyond the Veteran's statements, that his claimed stressors occurred, the exception outlined in 38 C.F.R. § 3.304(f)(2) has been satisfied. Specifically, the evidence shows that the Veteran engaged in combat with the enemy, the stressor is related to that combat, there is no clear and convincing evidence to the contrary, and the claimed stressor is consistent with the circumstances of his service. See 38 C.F.R. § 3.304(f)(2). Thus, his lay testimony alone may establish the occurrence of the claimed in-service stressor. The Board finds that his lay statements are sufficient to established that his claimed in-service stressors occurred. See id. The Board further finds that the remaining elements for service connection have been met. The Veteran was diagnosed with PTSD by a VA psychiatrist in July 2015, noting that his PTSD was related to his combat service. The diagnosis was carried forward by another VA psychiatrist in 2017 and 2018. The Board has weighed this diagnosis against the August 2015 VA examiner's conclusion that he did not have a diagnosis of PTSD, and finds that the evidence is in relative equipoise. While some mental health professionals concluded a different diagnosis was warranted, that does not necessarily mean he did not also have PTSD, as various psychiatric disorders can co-exist. Resolving reasonable doubt in favor of the Appellant, the Board finds that the Veteran had a diagnosis of PTSD related to his reported in-service stressors. Accordingly, the Board finds that service-connection is warranted for PTSD, and the Appellant's claim is granted. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Tierno 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.