Citation Nr: 21040907 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 20-27 569 DATE: July 7, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, namely posttraumatic stress disorder (PTSD), is granted. FINDING OF FACT Resolving all doubt in favor of the Veteran, his acquired psychiatric disorder is etiologically related to his active service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, namely PTSD, have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from October 1980 to October 1984. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in Indianapolis, Indiana. The Veteran and his spouse testified at a virtual video conference hearing before the undersigned Veterans Law Judge (VLJ) of the Board in April 2021. A transcript of the hearing has been associated with the claims file. Relevant to the Veteran's claim of entitlement to service connection for an acquired psychiatric disorder, such was originally adjudicated by the RO as a claim for entitlement to service connection for other specified personality disorder mixed with personality features (claimed as PTSD) only. However, in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) held that, in determining the scope of a claim, the Board must consider the claimant's description of the claim; symptoms described; and the information submitted or developed in support of the claim. In light of the Court's decision in Clemons, the Board has recharacterized the issue on appeal as entitlement to service connection for an acquired psychiatric disorder, to include PTSD, major depression, panic disorder, and anxiety disorder. Finally, in April 2021, the Veteran requested that the Board wait an additional 90 days, until July 1, 2021, to allow the Veteran to submit additional evidence in support of his claim. The requested extension period has now expired. Additional evidence was received after the April 2021 Board hearing and during this requested extension period. Service Connection Acquired Psychiatric Disorder The Veteran seeks service connection for an acquired psychiatric disorder. Specifically, the Veteran asserts that his symptoms began during active service as a result of a personal attack involving a knife that occurred while stationed in the Philippines. See e.g. Board hearing transcript, April 1, 2021; see also VA Form 21-0781a, Statements in Support of Claim for PTSD, May 31, 2018, and June 6, 2018; see also Correspondence, July 12, 2018; and see VA Form 9, June 16, 2020. Additionally, the Veteran reported he was poisoned during his time in the Philippines, and was afraid he was going to die. See VA Form 21-0781a, Statement in Support of Claim, May 20, 2018. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishment of service connection for PTSD requires: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). If a PTSD claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases, and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(5). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Turning to the evidence, service treatment records are unremarkable for complaints of, treatment for, or diagnoses of any acquired psychiatric disorder. Initially, the Board notes that post-service treatment records confirm diagnoses of an anxiety disorder, PTSD, and depression. see VA treatment record, December 19, 2001; see VA treatment provider letter, July 23, 2018; see Private psychiatric evaluation, June 1, 2021. A February 2018 statement was submitted by the Veteran's brother. At that time, the author reported he was stationed with the Veteran on the U.S.S. Midway in the Philippines together in the 1980s, that the Veteran had a drink in a local restaurant and became very sick due to poison. The author stated that the Veteran was very scared and began sleeping with him on the ship following the incident. In a May 2018 statement, the Veteran reported he was held at knife point by four or five men in the Philippines and was stabbed. He reported he believed he was going to die. An August 2018 statement submitted by the Veteran's wife noted that the Veteran's demeanor changed during his active service and that he sounded angry and was irritable in the letters he wrote to her. The Veteran's wife reported that the Veteran's change in demeanor began in service and has continued since. See also Third party correspondence, April 11, 2021. At his April 2021 Board hearing, the Veteran testified that he was held at knife point in February of 1984 while serving aboard the U.S.S. Bristol County in the Philippines. He testified that he was with two shipmates who were searching for American cigarettes and followed a man into a regular house. The Veteran was waiting outside, and was lured inside by a local man; when inside, he saw four or five men holding knives and attacked him in an attempt to take his wallet. The Veteran testified he sustained a small poke injury to his chest and was able to escape. The Veteran testified that following this incident, he began exhibiting symptoms of PTSD such as an exaggerated startle response, irritability, anxiety, and a change in demeanor. The Veteran's wife testified that she noticed a change in the Veteran's demeanor in the letters that she received, and that his symptoms have continued to the present day. The Veteran's wife testified that the Veteran's demeanor changed from before service due to the knife attack incident and has continued since. An April 2021 statement submitted by the Veteran's shipmate, R.S. In his statement, the author reported that he was in the Philippines with the Veteran and another shipmate in 1984 while serving aboard the U.S.S. Bristol County. At that time, the author reported that they were in a house, and several men came in with knives and yelled for money; they fought their way out of the home and they all feared for their lives. Turning to the question of whether there is an etiological relationship between the Veteran's diagnosed acquired psychiatric disorder and his service, the Board notes that the record contains contradicting opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (stating that the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board will consider each of these opinions below. A July 2018 opinion from Dr. P.S., the Veteran's VA psychiatrist, stated that the Veteran had a diagnosis of PTSD and that the author had treated the Veteran in individual therapy between approximately September 2014 and August 2016. The psychiatrist noted the Veteran's reported trauma in active service while stationed in the Philippines of being held at knifepoint. She stated that "[s]ince that experience, [the Veteran has] had symptoms of PTSD including nightmares and intrusive thoughts... [The Veteran experiences] negative believes because of the trauma and have persistent, negative emotional states because of the trauma." This opinion had clear conclusions and supporting data, as well as reasoned medical explanations connected the Veteran's acquired psychiatric disorder to his service. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). This opinion is being afforded probative weight. The Veteran was afforded a VA examination in August 2018. At that time, the examiner opined that the Veteran did not meet the diagnostic criteria for a diagnosis of PTSD under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), and had another mental disorder diagnosis. The examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness because the Veteran did not meet the full diagnostic criteria of PTSD and there were no markers in the available medical records that corroborated his report of being poisoned in the Philippines during service. This opinion had clear conclusions and supporting data, as well as reasoned medical explanations connected the Veteran's acquired psychiatric disorder to his service. Barr v. Nicholson, supra; Stefl v. Nicholson, supra; Nieves-Rodriguez v. Peake, supra. This opinion is being afforded probative weight. A June 2021 opinion completed by Dr. T.F., a private psychologist, was submitted. The private psychologist diagnosed the Veteran with PTSD with associated depression and anxiety symptoms. After a review of the evidence and an interview with the Veteran, the psychologist opined that it was at least as likely as not that the Veteran's mental health symptoms, to include PTSD, depression, and anxiety, were due to the incident when he was threatened by a knife by a group of men during his military service. The psychologist noted that the incident was corroborated by R.S., and was consistent with other markers in his life, such as the Veteran's wife. indicating a dramatic change in behavior. The psychologist found that the history was consistent with a change in the Veteran's behavior was consistent with PTSD and inconsistent with a personality disorder. The psychologist noted that the August 2018 VA examination report of record and the July 2018 letter by Dr. P.S., and included such evidence in his analysis. This opinion also had clear conclusions and supporting data, as well as reasoned medical explanations connected the Veteran's acquired psychiatric disorder to his service. Barr v. Nicholson, supra; Stefl v. Nicholson, supra; Nieves-Rodriguez v. Peake, supra. This opinion is being afforded great probative weight. In sum, the Veteran has competently and credibly reported symptoms of an acquired psychiatric disorder that began during active service and have continued since. The Veteran has current diagnoses of an acquired psychiatric disorder, namely PTSD. There is one etiology opinion against the claim and two etiology opinions for the claim. Moreover, there is no sufficient basis for the Board to reject this supportive opinions and to further develop the claim. Cf. Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (holding that, because it is not permissible for VA to undertake additional development to obtain evidence against an appellant's case, VA must provide an adequate statement of reasons or bases for its decision to pursue such development where such development could be reasonably construed as obtaining additional evidence for that purpose). Accordingly, the Board finds that the preponderance of the evidence is for the claim and entitlement to service connection for an acquired psychiatric disorder, namely PTSD, is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.