Citation Nr: 23048965 Decision Date: 09/06/23 Archive Date: 09/06/23 DOCKET NO. 17-36 199A DATE: September 6, 2023 ORDER Service connection for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The evidence is in approximate balance as to whether the Veteran's current PTSD is caused by or related to his active service. CONCLUSION OF LAW The criteria for service connection for an PTSD have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1972 to February 1974. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified before the undersigned at a videoconference hearing. A transcript of that hearing has been associated with the virtual file and reviewed. This case was most recently before the Board in December 2022, at which time the Board remanded the matter for further development. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing entitlement to direct service connection generally 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 which is the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection for PTSD requires the following three elements: (1) a current medical diagnosis of PTSD (presumed to include the adequacy of the PTSD symptomatology and the sufficiency of a claimed in-service stressor in accordance with 38 C.F.R. § 4.125(a)), (2) credible supporting evidence that the claimed in-service stressor(s) actually occurred, and (3) medical evidence of a causal relationship between current symptomatology and the specific claimed in-service stressor(s). 38 C.F.R. § 3.304(f). In adjudicating a claim for service connection, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a). The evidence necessary to establish the occurrence of an in-service stressor for PTSD will vary depending on whether or not the veteran "engaged in combat with the enemy." When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for PTSD. The Veteran contends that his PTSD is related to traumatic experiences during his period of active service. Specifically, the Veteran contends that his psychiatric disorder is due to being physically assaulted by a sergeant while in boot camp. 12/11/2019 Hearing Transcript. The Veteran's contentions are partially corroborated by a photograph showing bruising to the face during active service, which the Veteran asserts was the result of physical assault. 12/11/2014 Correspondence, page 24. The Veteran is diagnosed with PTSD and has also been diagnosed with anxiety. 10/30/2020, C&P Exam; see also 12/28/2018, Medical Treatment Records Non-Government Facility, page 84 (showing a June 2017 diagnostic impression of anxiety). As such, this competent evidence satisfied the first element of service connection. Recently, a December 2022 Board decision found the October 2020 VA examination, wherein the examiner opined that the Veteran's PTSD is less likely than not related to service, to be inadequate because the examiner's rationale was merely based on the examiner finding the Veteran's contentions regarding the in-service assault as not shown in the service records. Additionally, the examiner did not provide an opinion regarding the Veteran's diagnosed anxiety. So, the Board remanded and directed the Agency of Original Jurisdiction (AOJ) to obtain an addendum opinion to determine the etiology of the Veteran's acquired psychiatric disability. The clinician was further directed to consider the Veteran's contentions regarding in-service physical assault as credible. 12/19/2022, BVA Decision. Subsequently, in a May 2023 addendum opinion, the clinician opined that the Veteran's PTSD is less likely than not related to his active service. The clinician remarked that the Veteran's current PTSD may be related to more recent stressors that occurred after separation from service. The clinician also asserted that the Veteran's in-service stressor did not meet the diagnostic criteria for PTSD, but rather is an expected experience designed to promote team bonding, stress tolerance, and resilience. The rationale is, at best, unclear as to whether the examiner is suggesting that the Veteran's report of incurring repeated physical assaults by an officer was a team building exercise. 05/07/2023, C&P Exam; 05/07/2023, C&P Exam. An August 2023 medical opinion was provided by a private clinician, who is a clinical psychologist with over 20 years of experience in providing evaluations, including assessments for malingering, symptom exaggeration, and misdiagnosis, as well as recent experience in veteran evaluation services. The clinician opined that the Veteran's current PTSD is at least as likely as not related to his claimed in-service stressor. The clinician noted that the Veteran was credible based on the consistency of his reporting and the lack of evidence indicative of over ascribing symptoms. The clinician also indicated that the Veteran likely did not seek medical attention at the clinic during active service due to fear of retaliation, given that the purported perpetrator of physical assault was an officer. The clinician considered the prior VA examinations and noted that the May 2023 VA clinician merely disputed the diagnosis of PTSD based on in-service trauma. However, this clinician indicated that the Veteran's description of physical assault during service would meet the diagnostic criteria for PTSD. 08/16/2023, Medical Treatment Record - Non-Government Facility. The Board finds that the evidence is at least in approximate balance regarding the material nexus issue of whether the Veteran's acquired psychiatric disorder is related to his active service. 38 U.S.C. § 5107(b). For example, the Board places more weight on August 2023 medical opinion, as the clinician considered the entirety of the claims file and provided a thorough rationale in support of his opinion. On the other hand, the May 2023 addendum opinion is of less probative weight because the rationale was not clear as to whether the clinician considered the Veteran's contention that he was assaulted by an officer, rather than experiencing generalized stress from team building exercises. Additionally, the above medical opinions may serve to corroborate in-service stressor if based on personal assault. See Menegassi v. Shinseki, 638 F.3d 1379, 1382 (Fed. Cir. 2011) (holding that "under 38 C.F.R. § 3.304(f)(5), medical opinion evidence may be submitted for use in determining whether the occurrence of a stressor is corroborated"). As such, as all three service connection elements have been established, the Board finds that service connection for PTSD is warranted. 38 C.F.R. §§ 3.102, 3.303, 3.304(f). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Han, David 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.