Citation Nr: 22018158 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 19-00 361A DATE: March 28, 2022 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD), to include as due to military sexual trauma (MST), is granted. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, PTSD is shown to have developed as a result of MST during active service. CONCLUSION OF LAW The criteria for service connection for PTSD have been met. 38 U.S.C. §§ 1110, 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 from August 1983 to March 1988. This matter is before the Board of Veterans' Appeals (Board) on appeal of a July 2017 rating decision of the Department of Veterans Affairs (VA). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in December 2021. A transcript of the hearing is in the Veteran's file. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. "To establish a right to compensation for a present disability, a veteran must show: "(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" the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Establishing service connection for PTSD requires (1) a current diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128 (1997). Further, if a claim, as it is here, for PTSD is based on an in-service personal assault, evidence from sources other than the Veteran's service records may corroborate the Veteran's account of the in-service stressor. 38 C.F.R. § 3.304(f)(5). 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. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. Id. The Veteran contends that service connection is warranted because the claimed PTSD was caused by an in-service sexual assault. At his December 2021 Board hearing, the Veteran stated that when he was in individual training, he was attacked. Then, when he was stationed overseas, he was attacked by three military policeman and another person. He stated that he had a "busted forehead" and did not report the attack since the others were three military policemen. He noted being uncomfortable in crowds, experiencing nightmares, and secluding himself from others. He also noted taking medication for his condition. The Veteran has reported that the first MST occurred after working out when a man attacked him. See a July 2018 statement. His second MST experience was after he had worked out at a gym. Four men attacked him. Subsequently, a military police Sergeant assisted him after the incident. See a May 2017 statement. The Veteran was afforded a VA examination in May 2017. A diagnosis of PTSD was provided. The VA examiner noted a medical record review and indicated that the Veteran's symptoms were believed to be a part of the PTSD rather than separate diagnoses. The VA examiner opined that the PTSD diagnosis was at least as likely as not caused by or a result of the in-service MST-related marker(s). It was noted that the Veteran had no history of trauma before or after the reported sexual assault that would account for current symptoms. In a June 2017 medical addendum, the RO noted that the in-service PTSD markers indicated by the Veteran were a cut on the forehead, rectal bleeding, a break-up of a relationship, that the Veteran left Korea early, and that there was a change in behavior/started drinking and going to clubs. The RO indicated that the only potential marker found in the records was the cut on forehead. The rectal bleeding had occurred in 1983, well before the reported incident. The Veteran did not leave Korea early, and personnel files showed he completed his full year tour of duty in Korea. A relationship breakup was not found in the records and thus was not a potential marker. The service record showed no drinking or behavioral changes; thus, they were not a potential marker. The VA examiner stated that the cut on the forehead was proximal to the alleged assault. However, if other events (such as Veteran's report of leaving Korea early) were not substantiated, then the single head injury marker would not be sufficient to substantiate the stressor. A VA mental health treatment record, dated in September 2017, shows diagnoses of PTSD, chronic generalized anxiety disorder and recurrent, moderate, major depressive disorder. Here, although service treatment and/or personnel records do not specifically reflect the in-service sexual assault, the reported MST and subsequent lay statements indicate that an in-service personal assault occurred. The Board considers the Veteran's reports to be credible and finds no reason to doubt them. After considering the above, the Board finds that the evidence in relative equipoise as to whether the Veteran's PTSD is related to service, to include as due to MST. The June 2017 medical addendum is unfavorable in this regard; however, that opinion only serves to place the evidence in a state of relative equipoise with the May 2017 VA medical opinion and the Veteran's consistent statements of MST. Resolving all reasonable doubt in the Veteran's favor, the Board finds that service connection for PTSD due to MST is warranted. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Evans, A-L 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.