Citation Nr: 21040466 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 16-17 812 DATE: July 3, 2021 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The Veteran's PTSD is etiologically related to service. CONCLUSION OF LAW The criteria for service connection for PTSD have been met. See 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1997 to August 1997; December 2004 to February 2006; and April 2020 to June 2020, with additional service in the Army National Guard and Army Reserves. This matter comes to the Board of Veterans' Appeals (Board) from an October 2011 rating decision that denied a claim of service connection for PTSD. The Veteran testified before a Decision Review Officer in January 2015 and before the undersigned Veterans Law Judge in an August 2019 Travel Board hearing. Copies of both hearing transcripts have been associated with the record. In December 2019, the Board granted a claim of service connection for anxiety and remanded a claim of service connection for PTSD. The Board instructed the agency of jurisdiction (AOJ) to obtain the Veteran's treatment records from a Veteran's Center; verify the Veteran's reported stressor of her convoy from Kuwait to Baghdad; and schedule a new VA examination. As a preliminary matter, the Board finds substantial compliance with the December 2019 decision. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). Following remand, the AOJ obtained the treatment records from the Veteran's Center and verified the Veteran's reported stressor. While the AOJ scheduled a new VA examination, the Veteran initially cancelled the examination and did not reschedule it. After the AOJ issued the October 2020 Supplemental Statement of the Case, the Veteran attended a VA telehealth examination in November 2020. Therefore, all remand directives have been fulfilled. While the Veteran has not waived initial AOJ review of the reports from the November 2020 examination, the Board finds that there is no prejudice to the Veteran in considering this evidence in the first instance because this decision constitutes a full grant of the benefit sought. Entitlement to service connection for PTSD is granted. 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 the current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). If a stressor claimed by a veteran is related to 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. See 38 C.F.R. § 3.304(f)(3). The standard of proof is set forth in 38 U.S.C. § 5107. A veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. In written pleadings and in oral testimony, the Veteran contends that service connection for PTSD is warranted. In a December 2010 VA Form 21-0781, the Veteran reported that she was in a three-day convoy from Kuwait to Baghdad that involved a shooting and a vehicle rollover. She also indicated that the compound area where she lived received mortar fire on occasion and random rifle fire. In a December 2004 Pre-Deployment Health Assessment, the Veteran denied seeking mental health care or counseling in the past 12 months. The provider noted no problems after the interview/exam and stated that the Veteran was deployable. From January 2005 to January 2006, the Veteran served in Kuwait/Iraq with a military occupational specialty (MOS) of human resources specialist. Service treatment records during this deployment did not show complaints, treatment. or a diagnosis of PTSD. In an undated Post-Deployment Health Assessment, the Veteran reported that she felt that she was in great danger of being killed. Although she was not currently interested in receiving help for stress or emotional problems, she reported that, within the past two weeks, she sometimes had little interest or pleasure in doing things. In a June 2006 Post-Deployment Health Reassessment, the Veteran reported difficulty breathing, problems sleeping or still feeling tired after sleeping, and increased irritability. She also reported that, within the past month, she had a few or several days where she had little interest or pleasure in doing things and a few or several days where she felt down, depressed, or hopeless. At an August 2011 VA examination, the Veteran's symptoms included a depressed mood and anxiety. The examiner diagnosed the Veteran with anxiety and stated that the Veteran's symptoms did not meet the DSM-IV criteria for PTSD. The examiner opined that it was at least as likely as not that the Veteran's anxiety was caused by or the result of her military experiences. In 2016, the Veteran attended several sessions with a readjustment counselor at a Veteran's Center. The Veteran reported significant anxiety since returning from deployment, to include anxiety related to fear of hostile activity and constant threat of being hit at any time by mortars. In July 2016, the readjustment counselor stated that the Veteran's symptoms met the DSM-5 criteria for PTSD. In July 2020, the local Joint Services Records Research Center (JSRRC) coordinator stated that the Veteran served in an area of potential hostile military or terrorist activity and conceded the Veteran's stressor of her convoy. At a November 2020 VA telehealth examination, the Veteran reported, among other symptoms, a depressed mood, anxiety, suspiciousness, weekly or less often panic attacks, chronic sleep impairment, and disturbances of motivation and mood. The Veteran also reported two in-service stressors: (1) being on high alert during a convoy from Kuwait to Baghdad and (2) exposure to mortars and gunfire while stationed in Baghdad. The examiner opined that the Veteran's symptoms met the DSM-5 criteria for PTSD. The examiner noted that the Veteran was previously found not to meet the criteria for PTSD and was instead diagnosed with anxiety, but the examiner stated that Veteran endorsed symptoms associated with PTSD on the June 2006 Post-Deployment Health Reassessment and was diagnosed with PTSD in 2016 by a readjustment counselor. The examiner stated that the in-service stressors were adequate to support the diagnosis of PTSD and were related to fear of hostile military or terrorist activity. The examiner opined that the Veteran's PTSD was at least as likely as not incurred in or caused by military service. As a preliminary matter, the Board finds that the Veteran was in sound condition at the entrance of service in December 2004 based on the Pre-Deployment Health Assessment. Turning to the issue of service connection for PTSD, the Board finds that the Veteran has a disability of PTSD based on the DSM-5 criteria. The Board accords probative weight to the November 2020 VA examiner's diagnosis because the examiner provided a well-reasoned and persuasive rationale. The Board notes that the examiner's diagnosis is also consistent with the July 2016 readjustment counselor's diagnosis. The Board accords limited probative value to the August 2011 VA examiner's diagnosis. While the August 2011 VA examiner stated that he reviewed the Veteran's claims file, the Board notes that the examiner did not mention or consider the symptoms identified in the June 2006 Post-Deployment Health Reassessment that the November 2020 VA examiner stated were associated with PTSD. Resolving any reasonable doubt in the Veteran's favor, the evidence of record establishes a disability of PTSD. The Board further finds a link, established by medical evidence, between the Veteran's current symptoms and claimed in-service stressors. The Board accords probative weight to the November 2020 VA examiner's opinion because the examiner provided a well-reasoned and persuasive rationale. The Board notes that the examiner's opinion is also consistent with the treatment records from the Veteran's Center and with the August 2011 VA examiner's opinion. While the August 2011 VA examiner's opinion was based on a diagnosis of anxiety instead of PTSD, this opinion nonetheless links the Veteran's symptoms to her military experience, and the Board has explained why the evidence of record establishes a disability of PTSD. The Board finally finds that credible evidence supports the claimed in-service stressors. The Board notes that the July 2020 local JSRRC coordinator conceded the Veteran's stressor of her convoy. Moreover, the claimed in-service stressors are consistent with the places, types, and circumstances of the Veteran's service. The Veteran's statements are sufficient to establish the occurrence of the reported stressors because the November 2020 VA examiner opined that the claimed stressors were adequate to support a diagnosis of PTSD and that the Veteran's symptoms were related to the claimed stressors, and the Board notes that there is no clear and convincing evidence to the contrary. Based on the foregoing and resolving reasonable doubt in favor of the Veteran, the Board concludes that the Veteran has PTSD related to an in-service stressor with credible supporting evidence that the in-service stressor occurred. Accordingly, the Board finds that service connection for PTSD is warranted. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ormson, 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.