Citation Nr: 22043345 Decision Date: 07/29/22 Archive Date: 07/29/22 DOCKET NO. 18-34 286 DATE: July 29, 2022 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is granted. FINDING OF FACT The Veteran has an acquired psychiatric disorder, to include a current diagnosis of PTSD, that is causally related to a verified in-service stressor. CONCLUSION OF LAW The criteria to establish entitlement to service connection for an acquired psychiatric disorder, to include PTSD, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable active-duty service with the United States Army from May 1995 to May 1999. His military occupational specialty was medic. Service treatment records (STRs) confirm that he was deployed to Kuwait in 1996. This matter is before the Board of Veteran's Appeals (Board) from a March 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for PTSD. In Clemons v. Shinseki, 23 Vet. App. 1 (2009), the United States Court of Appeals for Veteran's Claims (Court) held that the scope of a mental health disability claim includes any mental disorder that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record. See also 38 C.F.R. § 3.159 (a)(3). The Board notes that the claim was previously for PTSD. As such, in light of Clemons and the current evidence of record, the issue has been broadened and recharacterized as reflected above. The Veteran's appeal previously contained claims of service connection for bilateral knee disabilities and a dental disability. These claims were granted in a May 2018 rating decision. That award constitutes a full grant, and those claims have been resolved. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (holding that where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of the claim concerning "downstream" issues, such as the compensation level assigned for the disability and the effective date). Additionally, the Veteran did not appeal the earlier effective date for service connection for his lumbar disability in his Substantive Appeal VA Form 9 submitted in June 2018. This issue is not on appeal before the Board. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD The Veteran contends he is entitled to service connection for an acquired psychiatric disorder, to include PTSD. Generally, to establish service connection there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Pursuant to the requirements of 38 C.F.R. § 3.304 (f), service connection of a PTSD claim requires: (1) a diagnosis that conforms to the requirements of 38 C.F.R. § 4.125 (a); (2) a medical link between the diagnosis and an in-service stressor; and (3) credible supporting evidence of the occurrence of the in-service stressor. The requirements of 38 C.F.R. § 4.125 (a) indicate that the diagnosis of a mental disorder must conform to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (DSM-5). The Veteran has a current diagnosis of PTSD from VA treatment records and from VA treating psychologists and private mental health professionals. He has met the first element of service connection. The Veteran's service treatment records noted his reports of trouble sleeping and nightmares, along with fatigue due to stress reported in August 1996 during his deployment. The Veteran's entrance examination in April 1995 and his separation examination of March 1999 were silent as to any diagnosis, treatment, or complaint of mental health issues. The Veteran has described two different stressors during service. The first was his time on the border of Iraq during his deployment to Kuwait during which he engaged in stressful exercises with live fire and extracted wounded soldiers during exercises. The second was being a first responder after a tornado hit Ft. Stewart in Georgia where he was stationed. The Veteran described his involvement as the first medical person on scene and discovering the crushed body of a sergeant. See Statement in Support of Claim for PTSD submitted November 2015; November 2021 Hearing Transcript. The Veteran submitted articles noting a tornado hit Ft. Stewart in April 1998 with causalities noted, with the Veteran listed by name as one of the medics on site who helped "without regards for their own personal safety." The articles described the efforts of the medics in removing injured soldiers and civilian personnel from dangerous areas, and treating them, and that one person had died. See Correspondence Received January 12, 2021. The Veteran's lay statements and the submitted articles have provided credible supporting evidence of the occurrence of this second stressor. The Board finds that this stressor has been verified. However, without evidence of combat service, the Board cannot rely upon the Veteran's lay testimony alone to establish the first stressor. See 38 C.F.R. § 3.304 (f)(2). The remaining question for the Board is whether there is competent medical evidence providing a link between the Veteran's acquired psychiatric disorder and his in-service stressor. The Veteran submitted a statement from his family doctor, D.L., dated December 2015 that noted the Veteran suffered from severe anxiety disorder. Dr. D.L. provided another letter dated June 2018 noting his years of treating the Veteran. He stated that he had reviewed unspecified "medical records" and opined that the Veteran had PTSD that was the direct result of his traumatic experiences during service. The Veteran also submitted a June 7, 2022 letter from his treating therapist, S.S., who noted that he had treated the Veteran for PTSD and MDD since April 7, 2022. He noted that he had reviewed the Veteran's military records and found that these disorders were a "direct result of his service in the military." These opinions are not sufficient because they do not specify which stressor the opinions are based on. As such, the Board gives them little probative value. The Veteran received three different VA examinations in December 2015, May 2018, and July 2019. The Veteran testified in his VA hearing in November 2021 that the VA examinations were inadequate as they spent barely any time with him and did not ask him any questions. The December 2015 VA examiner found the Veteran's reported symptoms were likely exaggerated and due to the inconsistencies reported it precluded a diagnosis of a mental health disorder. The May 2018 VA examination report mostly copied the December 2015 VA examination report and found the Veteran's observable behaviors were not consistent with PTSD and that no diagnosis could be corroborated by objective measures. The July 2019 VA examination report mostly copied from the May 2018 VA examination report. That examiner also was unable to identify or provide a mental health disorder diagnosis. The Board notes all three examiners found that the stressor concerning the tornado at Ft. Stewart was adequate to support a diagnosis of PTSD, but determined that the Veteran did not have PTSD. The examinations all found the stressor involving duty in Iraq did not support a diagnosis of PTSD. The Board finds these opinions to be inadequate for VA purposes. Specifically, the examiners failed to reconcile their finding of no PTSD with the Veteran's VA treatment records, which include a PTSD diagnosis. Medical opinions have no probative value when they are based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 548 (1993). The Board gives great probative value to undated statements from the Veteran's VA psychologist, Dr. T.P., which were submitted in January 2021. The doctor noted that she had treated the Veteran in the VA PTSD program since March 2018 for PTSD. She opined that "it is more than likely" that the Veteran's PTSD symptoms resulted from witnessing the death of his sergeant. This opinion provides a link between the Veteran's PTSD and his verified stressor. In this case the evidence persuasively favors the claims of the Veteran, therefore the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). The Veteran's claim for service connection for an acquired psychiatric disorder, to include PTSD, is granted. Rebecca N. Poulson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C.A. Teich, 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.