Citation Nr: A25035795 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 241022-484742 DATE: April 18, 2025 ORDER Entitlement to service connection for post-traumatic stress disorder (PTSD) is granted. FINDING OF FACT The Veteran's diagnosis of PTSD is valid and based on fear of hostile military or terrorist activity. CONCLUSION OF LAW The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 1154(b), 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304(d), 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 2006 to November 2006, and from February 2019 to September 2019, with additional service in the Naval Reserve. This case comes before the Board of Veterans' Appeals (Board) on appeal from an October 2024, rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). See Rating Decision - Narrative, dated October 3, 2024. Therefore, the AMA applies. See Pub. L. No. 115-55, 131 Stat. 1105 (2017); see also 38 C.F.R. § 3.2400(a)(1). The Veteran timely filed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), and selected the Direct Review Docket. See NOD, received October 22, 2024. Under the AMA, the evidentiary record the Board may consider depends on the evidence considered by the agency of original jurisdiction (AOJ) in the decision on appeal and the Veteran's docket selection on the NOD. The present appeal stems from disagreement with the October 3, 2024, rating decision which considered the evidence of record at the time. The Veteran selected the Direct Review Docket when submitting the NOD. As such, when considering the issue of entitlement to service connection for PTSD, the Board may only consider the evidence of record on October 3, 2024. See 38 C.F.R. §§ 3.2400, 3.2500, 3.2601. If evidence was submitted after October 3, 2024, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision, including the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Entitlement to Service Connection for PTSD The Veteran contends that her PTSD is caused by her active-duty service. See VA Form 21-4138 Statement in Support of Claim, received August 8, 2024. Establishing service connection generally requires (1) a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. §3.304(f). If a stressor claimed by a Veteran is related to the fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For these purposes, "fear of hostile military or terrorist activity" means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. §3.304 (f) (3). 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 (1990). If the positive and negative evidence is in approximate balance, which includes but is not limited to equipoise, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). At the outset, the Board notes that VA has conceded the Veteran's diagnosis of PTSD and service in Kuwait (an area associated with fear of hostile military or terrorist activity). See Rating Decision - Narrative, dated October 3, 2024. The Board is bound by these findings. 38 C.F.R. § 3.104(c). Additional relevant evidence includes, results of a VA examination, statements from the Veteran, and VA treatment records. The Veteran attended a VA examination in support of her claim for entitlement to service connection. See C&P Exam, received June 15, 2024. The examiner determined that the Veteran's PTSD disability manifested in several symptoms that ultimately caused occupational and social impairment with reduced reliability and productivity. Id. The examiner noted only one stressful event in which the Veteran reported encountering "a figure with a hoodie on headed to the head" at the same time as the Veteran. The individual "ran off", without incident, but the Veteran experienced stress and anxiety to such a degree that she began wetting the bed for fear of what might happen if she left her compartment to go to the bathroom. Id. The examiner opined that the stressful event was adequate to support a diagnosis of PTSD but did not involve hostile military or terrorist activity. Id. Instead, the examiner characterized the event as an in-service personal assault marked by the Veteran's bedwetting. Id. VA treatment records include similar reports from the Veteran. See VAMC Other Output / Reports at 14, received May 29, 2024. Specifically, that her encounter with a hooded individual caused such fear that she "screamed and ran back to [her] compartment." Id. When she reported the incident to her Chief she was largely ignored and advised that she, "should be happy that nothing happened to her..." Id. This led the Veteran to fear leaving her compartment to use the bathroom which resulted in bedwetting that continues present day. Id. The Board has carefully reviewed the evidence considered to be relevant and finds it approximately balanced in demonstrating a diagnosis of PTSD that has been attributed to the Veteran's in-service stressor. The June 2024 VA examiner confirmed that the Veteran's stressor met Criterion A for PTSD, as the Veteran directly experienced the traumatic event. Furthermore, the Veteran has consistently and credibly reported the details associated with her in-service stressor. Although the June 2024 examiner determined the incident did not involve hostile military or terrorist activity, no explanatory reasoning was provided. In the absence of clear and convincing evidence to the contrary, the Board finds the Veteran's report of events could be considered as typical of the places, conditions, and circumstances of service. Moreover, it is not only reasonable that the Veteran experienced the in-service event described, but also, that it left her in a psycho-physiological state of fear and helplessness as evidenced by her continued bedwetting. Accordingly, the Board will resolve all reasonable doubt in the Veteran's favor and find that the PTSD diagnosis is valid under applicable regulation and related to active-duty service. Entitlement to service connection for PTSD is granted. S. Kim Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Offutt, Marty N. (she/her/hers) 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.