Citation Nr: 21041216 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-58 510 DATE: July 8, 2021 ORDER Entitlement to service connection for psychiatric disorders, to include posttraumatic stress disorder (PTSD), due to military sexual trauma (MST), is granted. FINDING OF FACT A preponderance of the evidence indicates the Veteran's psychiatric disorders, to include PTSD, are due to MST. CONCLUSION OF LAW The criteria for entitlement to service connection for psychiatric disorders, to include PTSD, due to MST, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1974 to March 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) dated in May 2014. In December 2018, the Board remanded this matter for additional development and consideration. The issue has now been returned to the Board for further appellate consideration. As is further discussed below, the Board finds that there has been substantial compliance with the directives of the prior remand. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection 1. Entitlement to service connection for psychiatric disorders, to include PTSD due to MST is granted. For the following reasons, entitlement to service connection for psychiatric disorders, to include PTSD due to MST is granted. Service connection for PTSD requires: (1) medical evidence establishing a diagnosis of the disorder; (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. See 38 C.F.R. § 3.304(f). The diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which provides that all psychiatric diagnosis must conform to the American Psychiatric Association's DSM. Id. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Because sexual assault is an extremely personal and sensitive issue, many incidents are not officially reported, which creates a proof problem with respect to the occurrence of the claimed stressor. In such situations, it is not unusual for there to be an absence of service records documenting the alleged events. The victims of such trauma may not necessarily report the full circumstances of the trauma for many years after the trauma. Thus, when a PTSD claim is based on in-service sexual assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. See 38 C.F.R. § 3.304(f)(5); Patton v. West, 12 Vet. App. 272, 277 (1999). 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 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). Additionally, corroboration of every detail of a claimed stressor is not required; rather, a veteran only needs to offer independent evidence of a stressful event that is sufficient to imply their personal exposure. See Pentecost v. Principi, 16 Vet. App. 124, 128 (2002). Further, medical opinion evidence may be submitted for use in determining whether the occurrence of a stressor is corroborated. See Menegassi v. Shinseki, 638 F.3d 1379, 1382 (Fed. Cir. 2011). Factual Background The Veteran's service treatment records (STR) are silent with respect to a sexual assault. See STR-Medical. In September 2012, treatment records from VAMC Kansas City note the Veteran was diagnosed with PTSD-MST as Axis-I. See September 2012 VAMC Kansas City at 1. In October 2012, the treatment notes reveal "the Veteran endorsed the full triad of PTSD symptoms, meeting the criteria for PTSD." See October 2012 VAMC Kansas City at 73. The treatment record further noted the Veteran displayed severe depressive symptoms. Id. at 73. At that time the Veteran was diagnosed with PTSD, chronic (MST). Treatment records from June 2015, note the Veteran displayed stressors in-service indicative of PTSD associated with MST. See June 2015 VAMC Kansas City. Dr. C. P. noted the Veteran did "request another duty assignment without justification after her sexual assault, requesting a daytime job as she feared going out at night." Id. Dr. C. P. went on to opine that the Veteran's PTSD "is at least as likely as not caused by her reported sexual assault considering her behavior after the event". Id. The Veteran has reported that, in February 1975 she was raped by her drill instructor after he found out that she had gone out the night before and missed curfew. He advised her to meet him in a stair well later, which is where she was raped her. About a week later, this drill sergeant told her that if she was nice to another man who was in uniform, her curfew violation would not be exposed. This man did the same thing to her in the stairwell and then afterward, he and the drill sergeant laughed and told her to go to class. See January 2014 Statement in Support of Claim; June 2014 Notice of Disagreement (NOD); October 2015 Statement in Support of Claim; October 2016 Statement in Support of Claim; November 2016 VA Form 9, July 2020 Veteran Lay statement. The Veteran has submitted several lay statements from close family members who report significant personality changes in the last several years, resulting in the Veteran's increased isolation. See January 2019 Lay Statement; January 2019 Lay Statement; January 2019 Lay Statement; April 2021 Lay Statement. In November 2019, the Veteran presented to a VA mental disorders (other than PTSD and eating disorders) Disability Benefits Questionnaire (DBQ) examination where she was diagnosed with major depressive disorder and generalized anxiety disorder. See November 2019 VA Mental Disorders DBQ. The examiner reviewed the Veteran's claims file and administered testing in accordance with the Diagnostic and Statistical Manual for Mental Disorders - Fifth Edition (DSM-5). The examiner opined "that it is not more likely than not that Veteran suffers from PTSD and there are no markers to establish that a military sexual assault occurred during her military service." Id. at 8. VA psychiatric treatment records dated March 2020 note the Veteran is currently diagnosed with PTSD and major depressive disorder recurrent mild. See March 2020 VAMC Kansas City at 3. Analysis The Veteran contends that her diagnosed PTSD is due to MST. The incident of MST is not documented in her service treatment or personnel records, nor does the Veteran contend that she ever reported the incident. However, the Veteran has reported that, in February 1975 she was raped by her drill instructor and subsequently sexual assaulted a second time approximately a week later. See January 2014 Statement in Support of Claim; June 2014 Notice of Disagreement (NOD); October 2015 Statement in Support of Claim; October 2016 Statement in Support of Claim; November 2016 VA Form 9, July 2020 Veteran Lay statement. In November 2019, the Veteran underwent a VA examination in which the examiner concluded that the Veteran did not meet the criterion for a diagnosis of PTSD. See November 2019 VA Mental Disorders DBQ. In making this determination, the examiner noted that although the Veteran reported symptoms of PTSD that she attributes retroactively to MST, however, the timing of the Veteran's psychiatric disorders are " related to emotional stress associated with her daughter's death, marital discord, and difficulties in the parenting of her granddaughter, and they do not appear to be related to her military service." Id. at 8. However, the Veteran's VA treatment records indicate that she has a current diagnosis of PTSD, major depressive disorder, and that she participates in therapy related to her reported MST. See March 2020 VAMC Kansas City at 3; see November 2019 VA Mental Disorders DBQ. Additionally, treatment records from June 2015, note the Veteran displayed stressors in-service indicative of PTSD associated with MST. See June 2015 VAMC Kansas City. Dr. C. P. noted the Veteran did "request another duty assignment without justification after her sexual assault, requesting a daytime job as she feared going out at night." Id. Dr. C. P. went on to opine that the Veteran's PTSD "is at least as likely as not caused by her reported sexual assault considering her behavior after the event." Id. Furthermore, treatment records from October 2012 note "the Veteran endorsed the full triad of PTSD symptoms, meeting the criteria for PTSD." See October 2012 VAMC Kansas City at 73. The treatment record further noted the Veteran displayed severe depressive symptoms. Id. at 73. At that time, the Veteran was diagnosed with PTSD, chronic (MST). In light of the Veteran's October 2012 and June 2015 treatment records noting the Veteran displayed stressors in-service indicative of PTSD associated with MST and endorsing symptoms meeting the criteria for PTSD associated with MST, the Board finds that the evidence is at least in equipoise regarding the question of whether the Veteran's current psychiatric disorders, to include PTSD, due to MST were incurred in service. For these reasons, and resolving reasonable doubt in favor of the Veteran, the Board finds that the criteria for service connection for psychiatric disorders, to include PTSD, due to MST have been met. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 49. K. Anderson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David B. Scheirich, 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.