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Citation Nr: 1456128
Decision Date: 12/22/14    Archive Date: 01/02/15

DOCKET NO.  09-40 912	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Nashville, Tennessee

THE ISSUES

1.  Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) based on personal assault.

2.  Entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD).

REPRESENTATION

Appellant represented by:	The American Legion

WITNESSES AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

E. D. Anderson, Counsel

INTRODUCTION

The Veteran had active service from November 1965 to November 1967.

This appeal comes to the Board of Veterans' Appeals (Board) from a November 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee, which denied the Veteran's claims for service connection for PTSD and COPD.

In September 2009, the Veteran testified at a hearing at the RO in Atlanta, Georgia, before a Decision Review Officer (DRO).  A copy of the transcript has been associated with the record.

In his October 2009 VA Form 9 (substantive appeal), the Veteran requested a hearing before a Veterans Law Judge in Washington, DC at the Central Office.  A hearing was scheduled for him in February 2011, and the Veteran was notified via an October 2010 letter.  However, he failed to report at his scheduled time and thus far has not offered any explanation for his absence.  Accordingly, the Board will adjudicate the Veteran's appeal as if the hearing request had been withdrawn.  38 C.F.R. § 20.704(d) (2014).

The Board considers the Veteran's claim for service connection for PTSD as encompassing all psychiatric disorders evident in the record, pursuant to the decision of the United States Court of Appeals for Veterans Claims (Court) in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental health disability that could reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record).

In addition, regarding the Veteran's claim for a respiratory disorder, the Board notes that the Veteran originally claimed service connection for COPD.  However, the Veteran's service treatment records (STRs) and private medical treatment records reveal that the Veteran has been diagnosed with and treated for a cough along with sinusitis and bronchitis.  In Brokowski v. Shinseki, 23 Vet. App. 79 (2009) the Court extended the holding of Clemons to include disabilities outside of psychiatric disorders.  At this time, in order to comply with the above case-law and allow the broadest possible interpretation of his claims in light of the evidence of record, the Board has revised the Veteran's original claim in the title page.  In doing so, the Board is defining the Veteran's original claim to include all manifestations of his respiratory disorders as evident in the record.

In April 2011, the Board remanded this matter to the RO via the Appeals Management Center (AMC) in Washington, D.C. to provide the Veteran with VCAA notice and to afford the Veteran VA medical examinations.  The action specified in the April 2011 Remand completed, the matter has been properly returned to the Board for appellate consideration.  See Stegall v. West, 11 Vet. App. 268 (1998).

FINDINGS OF FACT

1.  The Veteran's reported in service stressor has been corroborated.

2.  The Veteran has an acquired psychiatric disability, to include PTSD, that was caused by the Veteran's active military service.

3.  The Veteran's current respiratory disability did not have onset during the Veteran's active service and was not caused or permanently aggravated by his active military service.

CONCLUSIONS OF LAW

1.  The criteria for entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) based on personal assault, have been met.  38 U.S.C.A. §§ 101, 1110, 1112 (West 2014); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2014).

2.  The criteria for entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD), have not been met.  38 U.S.C.A. §§ 101, 1110, 1112 (West 2014); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2014).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Board has reviewed all of the evidence in the claims folder, including all virtual records.  Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record.  Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence.  Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000).  Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to these claims.

The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant.  Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.  When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied.  Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Service Connection

Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service.  38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2014).  In general, service connection requires competent and credible evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability.  See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third elements is through a demonstration of continuity of symptomatology.  Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage v. Gober 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999).  Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post- service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology.  Savage, 10 Vet. App. at 495-96; see Hickson v. West, 12 Vet. App. 247, 253 (lay evidence of in-service incurrence is sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b).

PTSD

Establishing service connection for PTSD requires specific findings.  These are (1) a current medical 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.  See 38 C.F.R. § 3.304(f) (2014).  The diagnosis of PTSD must comply with the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, of the American Psychiatric Association (DSM-IV).  Id.; see also 38 C.F.R. § 4.125(a) (2014).

If PTSD is based on personal assault, as alleged in this case, evidence from sources other than the veteran's records may corroborate the occurrence of the stressor.  38 C.F.R. § 3.304(f)(3).  Examples of such evidence include, but are not limited to: records from law enforcement authorities, mental health counseling centers, hospitals or physicians; and statements from family members, roommates, fellow service members, or clergy.  Id.

Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in the mentioned 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.  Id.

The Veteran claims that he currently experiences PTSD due to events that occurred during his military service.  See, e.g., Veteran's April 2008 claim.  The Veteran has alleged that, during basic training, he was subject to abuse, harassment, and hazing by a corporal whose name he does not recall who was assisting the Veteran's drill instructors; in essence alleging that he experienced personal assaults during his military service.  See Veteran's April and July 2008 stressor statements, October 2009 VA Form 9, and DRO hearing transcript pages 1-2, 5-6.  The Veteran has indicated that the corporal abused him by forcing him to take a cold shower for one-half to one-and-a-half hours, striking him in the back of the head with a steel pot and helmet liner, and kicking him in the calf or leg.  Id.; see also July 2008 stressor statement and DRO hearing transcript pg. 2.  The Veteran further indicated that the corporal would return from town drunk and assault him, including throwing him out of his cot.  See Veteran's July 2008 stressor statement, and DRO hearing transcript pg. 2.  The Veteran has indicated that he threatened to report the corporal to the commanding officer, but the corporal threatened him with a court martial and punishment in the stockade if he persisted with his report, and the Veteran was afraid to fight back at the time.  Id.  The Veteran has also indicated that he tried to attack the corporal but "the tables got turned."  Id.

The Veteran has indicated that he had managed to put this history behind him after service, but, in the last four to five years, he has begun to experience bad dreams wherein he attempts to kill the corporal, and that he has attacked his wife in his sleep due to these dreams.  See Veteran's April and July 2008 stressor statements, and DRO hearing transcript pg. 2; see also private treatment record dated in May 2007 from B. W. R., MD.

As an initial matter, there is some uncertainty as to whether the Veteran has a current PTSD diagnosis.  In May 2011, a VA psychologist, Dr. L.K., concluded that the Veteran did not meet the criteria for PTSD, but rather diagnosed the Veteran with alcohol dependence in partial remission, cocaine abuse in reported admission, and a personality disorder not otherwise specified with Cluster B traits.  She affirmed these findings in a September 2012 addendum report.  However, the Veteran's current treating psychiatrist, Dr. H.V., has diagnosed the Veteran with PTSD and major depression, which she has attributed to the Veteran's claimed in service stressors.

The Board has weighed the fact that at least one of the Veteran's treatment providers, Dr. H.V., has found him credible in his account of in-service hazing.  This may be considered in the Board's evaluation of the evidence.   See Menegassi v. Shinseki, 638 F.3d 1379, 1382 (Fed. Cir. 2011) ("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.")

Under the benefit of the doubt rule, where there exists "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue.  Ashley v. Brown, 6 Vet. App. 52, 59 (1993); see also Massey v. Brown, 7 Vet. App. 204, 206-207 (1994).  Resolving all reasonable doubt in the Veteran's favor, the Board concludes that service connection for an acquired psychiatric disability, to include PTSD, has been established.  38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Respiratory Disability

The Veteran has also alleged that he currently experiences a respiratory disorder that is due to his military service.  See Veteran's April 2008 claim.  Specifically, he has indicated that he was treated for his current disorder during his military service.

Service treatment records do show that in May and August 1966, the Veteran was treated for a cold along with chest pain, coughing, and vomiting.  Then, in January 1967, he was treated for nasal issues, and in March 1967, he was diagnosed with sinusitis.  Finally, in September 1967, at the time of his separation examination, the Veteran provided a statement of his medical history wherein it was noted that he had a history of mild sinusitis that "responds to meds."  The AOJ has also obtained private treatment records from Dr. Ramsey, which indicate a diagnosis of acute sinusitis and bronchitis in October 2006, and treatment for a cough in February and March 2009.  VA outpatient treatment records show diagnoses of COPD, emphysema, and tobacco use disorder.  See, e.g., VA Primary Care Physician Note (March 26, 2012).

The Veteran has also alleged that his respiratory disorder is due to smoking due to stresses incurred during his military service.  See Veteran's April 2008 claim, July 2008 stressor statement, and DRO hearing transcript pg. 8.  The Board notes that, for claims received by VA after June 9, 1998, a disability or death will not be considered service-connected on the basis that it resulted from injury or disease attributable to the Veteran's use of tobacco products during service.  38 C.F.R. § 3.300(a).  The provisions of § 3.300(a), however, do not prohibit service connection if the disability resulted from a disease that can be service-connected on some basis other than the Veteran's use of tobacco products during service, or if the disability became manifest during service.  38 C.F.R. § 3.300(b)(1).

To address whether the Veteran's current respiratory problems were related to his in-service treatment or otherwise caused by his military service, the matter was referred for a VA medical opinion.  In an April 2011 opinion, a VA examiner concluded that it is less likely than not that the Veteran's in-service treatment for colds and sinusitis is related to any current respiratory condition.  The examiner explained that the Veteran was treated in service for upper respiratory infections, which are a common illness and not indicative of a chronic disability.  The examiner further opined that the cause of the Veteran's lung disorder is likely a long history of heavy smoking.  However, the examiner explained that "The Veteran's current respiratory disorder is related to his admitted history of use of tobacco products during military service only in the sense that he was a smoker then.  The current lung condition reflects many, many, pack/years of smoking."

Based on the above evidence, the Board finds that entitlement to service connection for a respiratory disability is denied.  As the Board has noted above, for claims received by VA after June 9, 1998, a disability or death will not be considered service-connected on the basis that it resulted from injury or disease attributable to the Veteran's use of tobacco products during service.  38 C.F.R. § 3.300(a).  Here, the Veteran's current respiratory problems have been attributed to his lengthy history of heavy smoking by the April 2011 VA examiner, and the Veteran has not submitted any evidence to the contrary.  Accordingly, service connection for the Veteran's respiratory disability must denied pursuant to 38 C.F.R. § 3.300(a).

Furthermore, although the April 2011 VA examiner considered whether the Veteran's treatment for colds and sinusitis on several occasions during his active service was evidence of a chronic disability, the examiner explained that upper respiratory infections such as the Veteran was treated for are a common illness and his treatment for it in service should not be considered evidence of a chronic disability.  The examiner concluded that it is less likely than not that the Veteran's current respiratory problems had onset in service or were caused by or related the Veteran's active military service.  Again, the Veteran has not submitted any medical evidence to the contrary.  While current VA and private treatment records reflect treatment for a number of respiratory complaints, none of the Veteran's treatment provider has opined that these conditions are related to the Veteran's service.

In addition, the April 2011 examiner opined that "I can see no evidence that any aspect of his military service caused his current lung condition . . . separate from his history of use of tobacco products." (emphasis added).  Thus, there is no indication that anything in service could have potentially caused or aggravated his respiratory disorder, aside from his use of tobacco products.  Moreover, the examiner opined that there were no "intercurrent ([o]ccuring in addition to and usually altering the course of another disease) causes unrelated to his military service."  Although the Board has now service-connected the Veteran's PTSD, there is no indication that this disability has aggravated the Veteran's respiratory disability.

To the extent that the Veteran has offered his own opinion concerning the etiology of his respiratory disability, he has not demonstrated that he has any knowledge or training in determining the etiology of such conditions.  In other words, he is a layman, not a medical expert.  The Board recognizes that there is no bright line rule that laypersons are not competent to offer etiology opinions.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (rejecting the view that competent medical evidence is necessarily required when the determinative issue is medical diagnosis or etiology).  Evidence, however, must be competent evidence in order to be weighed by the Board.  Whether a layperson is competent to provide an opinion as to the etiology of a condition depends on the facts of the particular case.

In Davidson, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) drew support from Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) for support for its holding.  Id.  In a footnote in Jandreau, the Federal Circuit addressed whether a layperson could provide evidence regarding a diagnosis of a condition and explained that "[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

Although the Veteran seeks to offer etiology opinions rather than provide diagnoses, the reasoning expressed in Jandreau is applicable.  The Board finds that the question of whether the Veteran currently has a respiratory disability due to his active military service is too complex to be addressed by a layperson.  This connection or etiology is not amenable to observation alone.  Rather it is common knowledge that such relationships are the subject of extensive research by scientific and medical professionals.  Hence, the Veteran's opinion of the etiology of his current disability is entitled to little to no probative weight.  The Board gives greater weight to the contemporaneous medical evidence and the opinion of the VA examiner.

Although the Board is sympathetic to the Veteran's argument that he began smoking in service due, in part, to the cigarettes he was provided by the military, Congress has spoken to this issue in 38 U.S.C.A. § 1103, and prohibited service connection for disabilities based upon effects of tobacco products.  The Board is obligated to follow the dictates of Congress, without regard to its own view of the matter.

For all the above reasons, entitlement to service connection for a respiratory disability, to include COPD, is denied.  The evidence in this case is not so evenly balanced so as to allow application of the benefit-of- the-doubt rule.  Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2014).

The Duty to Notify and Assist

Under the Veterans Claims Assistance Act (VCAA), when VA receives a complete or substantially complete application for benefits, it must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide.  38 C.F.R. § 3.159 (2014).  Here, the Veteran was provided with the relevant notice and information.  Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II).  He has not alleged any notice deficiency during the adjudication of his claim.  Shinseki v. Sanders, 129 S. Ct. 1696 (2009).

VA also has a duty to assist the Veteran in obtaining potentially relevant records, and providing an examination or medical opinion when necessary to make a decision on the claim.  Here, the Veteran's service records, VA records, and identified private treatment records have been obtained and associated with the claims file.  The Veteran was also provided with VA examinations which, collectively, contain a description of the history of the disabilities at issue; document and consider the relevant medical facts and principles; and provide opinions regarding the etiology of the Veteran's claimed conditions.  VA's duty to assist with respect to obtaining relevant records and an examination has been met.  38 C.F.R. § 3.159(c); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

Finally, the Veteran testified at an RO hearing.  The hearing was adequate as the DRO who conducted the hearing explained the issue and identified possible sources of evidence that may have been overlooked.  38 C.F.R. 3.103(c)(2); Bryant v. Shinseki, 23 Vet. App. 488 (2010).

ORDER

Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) based on personal assault, is granted.

Entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD), is denied.

____________________________________________
BRADLEY W. HENNINGS
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs

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text: include

text: posttraumatic

text: stress

text: disorder

text: PTSD

text: based

text: on

text: personal

text: assault

text: have

text: been

text: met

text: U

text: S

text: C

text: A

text: West

text: C

text: F

text: R

text: The

text: criteria

text: for

text: entitlement

text: to

text: service

text: connection

text: for

text: a

text: respiratory

text: disability

text: to

text: include

text: chronic

text: obstructive

text: pulmonary

text: disease

text: COPD

text: have

text: not

text: been

text: met

text: U

text: S

text: C

text: A

text: West

text: C

text: F

text: R

text: REASONS

text: AND

text: BASES

text: FOR

text: FINDINGS

text: AND

text: CONCLUSIONS

text: The

text: Board

text: has

text: reviewed

text: all

text: of

text: the

text: evidence

text: in

text: the

text: claims

text: folder

text: including

text: all

text: virtual

text: records

text: Although

text: the

text: Board

text: has

text: an

text: obligation

text: to

text: provide

text: reasons

text: and

text: bases

text: supporting

text: this

text: decision

text: there

text: is

text: no

text: need

text: to

text: discuss

text: in

text: detail

text: the

text: extensive

text: evidence

text: of

text: record

text: Indeed

text: the

text: Federal

text: Circuit

text: has

text: held

text: that

text: the

text: Board

text: must

text: review

text: the

text: entire

text: record

text: but

text: does

text: not

text: have

text: to

text: discuss

text: each

text: piece

text: of

text: evidence

text: Gonzales

text: v

text: West

text: F

text: d

text: Fed

text: Cir

text: Therefore

text: the

text: Board

text: will

text: summarize

text: the

text: relevant

text: evidence

text: where

text: appropriate

text: and

text: the

text: Board

text: s

text: analysis

text: below

text: will

text: focus

text: specifically

text: on

text: what

text: the

text: evidence

text: shows

text: or

text: fails

text: to

text: show

text: as

text: to

text: these

text: claims

text: The

text: Board

text: must

text: assess

text: the

text: credibility

text: and

text: weight

text: of

text: all

text: evidence

text: including

text: the

text: medical

text: evidence

text: to

text: determine

text: its

text: probative

text: value

text: accounting

text: for

text: evidence

text: which

text: it

text: finds

text: to

text: be

text: persuasive

text: or

text: unpersuasive

text: and

text: providing

text: reasons

text: for

text: rejecting

text: any

text: evidence

text: favorable

text: to

text: the

text: claimant

text: Equal

text: weight

text: is

text: not

text: accorded

text: to

text: each

text: piece

text: of

text: evidence

text: contained

text: in

text: the

text: record

text: every

text: item

text: of

text: evidence

text: does

text: not

text: have

text: the

text: same

text: probative

text: value

text: When

text: all

text: the

text: evidence

text: is

text: assembled

text: VA

text: is

text: responsible

text: for

text: determining

text: whether

text: the

text: evidence

text: supports

text: the

text: claim

text: or

text: is

text: in

text: relative

text: equipoise

text: with

text: the

text: appellant

text: prevailing

text: in

text: either

text: event

text: or

text: whether

text: a

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: a

text: claim

text: in

text: which

text: case

text: the

text: claim

text: is

text: denied

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: Service

text: Connection

text: Service

text: connection

text: may

text: be

text: granted

text: if

text: the

text: evidence

text: demonstrates

text: that

text: a

text: current

text: disability

text: resulted

text: from

text: an

text: injury

text: or

text: disease

text: incurred

text: or

text: aggravated

text: in

text: active

text: military

text: service

text: U

text: S

text: C

text: A

text: West

text: C

text: F

text: R

text: a

text: In

text: general

text: service

text: connection

text: requires

text: competent

text: and

text: credible

text: evidence

text: of

text: a

text: current

text: disability

text: in

text: service

text: incurrence

text: or

text: aggravation

text: of

text: a

text: disease

text: or

text: injury

text: and

text: a

text: nexus

text: between

text: the

text: claimed

text: in

text: service

text: disease

text: or

text: injury

text: and

text: the

text: current

text: disability

text: See

text: Shedden

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: Under

text: C

text: F

text: R

text: b

text: an

text: alternative

text: method

text: of

text: establishing

text: the

text: second

text: and

text: third

text: elements

text: is

text: through

text: a

text: demonstration

text: of

text: continuity

text: of

text: symptomatology

text: Barr

text: v

text: Nicholson

text: Vet

text: App

text: see

text: Savage

text: v

text: Gober

text: Vet

text: App

text: see

text: also

text: Clyburn

text: v

text: West

text: Vet

text: App

text: Continuity

text: of

text: symptomatology

text: may

text: be

text: established

text: if

text: a

text: claimant

text: can

text: demonstrate

text: that

text: a

text: condition

text: was

text: noted

text: during

text: service

text: evidence

text: of

text: post

text: service

text: continuity

text: of

text: the

text: same

text: symptomatology

text: and

text: medical

text: or

text: in

text: certain

text: circumstances

text: lay

text: evidence

text: of

text: a

text: nexus

text: between

text: the

text: present

text: disability

text: and

text: the

text: post

text: service

text: symptomatology

text: Savage

text: Vet

text: App

text: at

text: see

text: Hickson

text: v

text: West

text: Vet

text: App

text: lay

text: evidence

text: of

text: in

text: service

text: incurrence

text: is

text: sufficient

text: in

text: some

text: circumstances

text: for

text: purposes

text: of

text: establishing

text: service

text: connection

text: C

text: F

text: R

text: b

text: PTSD

text: Establishing

text: service

text: connection

text: for

text: PTSD

text: requires

text: specific

text: findings

text: These

text: are

text: a

text: current

text: medical

text: diagnosis

text: of

text: PTSD

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: actually

text: occurred

text: and

text: medical

text: evidence

text: of

text: a

text: causal

text: nexus

text: between

text: current

text: symptomatology

text: and

text: the

text: specific

text: claimed

text: in

text: service

text: stressor

text: See

text: C

text: F

text: R

text: f

text: The

text: diagnosis

text: of

text: PTSD

text: must

text: comply

text: with

text: the

text: criteria

text: set

text: forth

text: in

text: the

text: Diagnostic

text: and

text: Statistical

text: Manual

text: of

text: Mental

text: Disorders

text: th

text: edition

text: of

text: the

text: American

text: Psychiatric

text: Association

text: DSM

text: IV

text: Id

text: see

text: also

text: C

text: F

text: R

text: a

text: If

text: PTSD

text: is

text: based

text: on

text: personal

text: assault

text: as

text: alleged

text: in

text: this

text: case

text: evidence

text: from

text: sources

text: other

text: than

text: the

text: veteran

text: s

text: records

text: may

text: corroborate

text: the

text: occurrence

text: of

text: the

text: stressor

text: C

text: F

text: R

text: f

text: Examples

text: of

text: such

text: evidence

text: include

text: but

text: are

text: not

text: limited

text: to

text: records

text: from

text: law

text: enforcement

text: authorities

text: mental

text: health

text: counseling

text: centers

text: hospitals

text: or

text: physicians

text: and

text: statements

text: from

text: family

text: members

text: roommates

text: fellow

text: service

text: members

text: or

text: clergy

text: Id

text: Evidence

text: of

text: behavior

text: changes

text: following

text: the

text: claimed

text: assault

text: is

text: one

text: type

text: of

text: relevant

text: evidence

text: that

text: may

text: be

text: found

text: in

text: the

text: mentioned

text: sources

text: Examples

text: of

text: behavior

text: changes

text: that

text: may

text: constitute

text: credible

text: evidence

text: of

text: the

text: stressor

text: include

text: but

text: are

text: not

text: limited

text: to

text: a

text: request

text: for

text: a

text: transfer

text: to

text: another

text: military

text: duty

text: assignment

text: deterioration

text: in

text: work

text: performance

text: substance

text: abuse

text: episodes

text: of

text: depression

text: panic

text: attacks

text: or

text: anxiety

text: without

text: an

text: identifiable

text: cause

text: or

text: unexplained

text: economic

text: or

text: social

text: behavior

text: changes

text: Id

text: The

text: Veteran

text: claims

text: that

text: he

text: currently

text: experiences

text: PTSD

text: due

text: to

text: events

text: that

text: occurred

text: during

text: his

text: military

text: service

text: See

text: e

text: g

text: Veteran

text: s

text: April

text: claim

text: The

text: Veteran

text: has

text: alleged

text: that

text: during

text: basic

text: training

text: he

text: was

text: subject

text: to

text: abuse

text: harassment

text: and

text: hazing

text: by

text: a

text: corporal

text: whose

text: name

text: he

text: does

text: not

text: recall

text: who

text: was

text: assisting

text: the

text: Veteran

text: s

text: drill

text: instructors

text: in

text: essence

text: alleging

text: that

text: he

text: experienced

text: personal

text: assaults

text: during

text: his

text: military

text: service

text: See

text: Veteran

text: s

text: April

text: and

text: July

text: stressor

text: statements

text: October

text: VA

text: Form

text: and

text: DRO

text: hearing

text: transcript

text: pages

text: The

text: Veteran

text: has

text: indicated

text: that

text: the

text: corporal

text: abused

text: him

text: by

text: forcing

text: him

text: to

text: take

text: a

text: cold

text: shower

text: for

text: one

text: half

text: to

text: one

text: and

text: a

text: half

text: hours

text: striking

text: him

text: in

text: the

text: back

text: of

text: the

text: head

text: with

text: a

text: steel

text: pot

text: and

text: helmet

text: liner

text: and

text: kicking

text: him

text: in

text: the

text: calf

text: or

text: leg

text: Id

text: see

text: also

text: July

text: stressor

text: statement

text: and

text: DRO

text: hearing

text: transcript

text: pg

text: The

text: Veteran

text: further

text: indicated

text: that

text: the

text: corporal

text: would

text: return

text: from

text: town

text: drunk

text: and

text: assault

text: him

text: including

text: throwing

text: him

text: out

text: of

text: his

text: cot

text: See

text: Veteran

text: s

text: July

text: stressor

text: statement

text: and

text: DRO

text: hearing

text: transcript

text: pg

text: The

text: Veteran

text: has

text: indicated

text: that

text: he

text: threatened

text: to

text: report

text: the

text: corporal

text: to

text: the

text: commanding

text: officer

text: but

text: the

text: corporal

text: threatened

text: him

text: with

text: a

text: court

text: martial

text: and

text: punishment

text: in

text: the

text: stockade

text: if

text: he

text: persisted

text: with

text: his

text: report

text: and

text: the

text: Veteran

text: was

text: afraid

text: to

text: fight

text: back

text: at

text: the

text: time

text: Id

text: The

text: Veteran

text: has

text: also

text: indicated

text: that

text: he

text: tried

text: to

text: attack

text: the

text: corporal

text: but

text: the

text: tables

text: got

text: turned

text: Id

text: The

text: Veteran

text: has

text: indicated

text: that

text: he

text: had

text: managed

text: to

text: put

text: this

text: history

text: behind

text: him

text: after

text: service

text: but

text: in

text: the

text: last

text: four

text: to

text: five

text: years

text: he

text: has

text: begun

text: to

text: experience

text: bad

text: dreams

text: wherein

text: he

text: attempts

text: to

text: kill

text: the

text: corporal

text: and

text: that

text: he

text: has

text: attacked

text: his

text: wife

text: in

text: his

text: sleep

text: due

text: to

text: these

text: dreams

text: See

text: Veteran

text: s

text: April

text: and

text: July

text: stressor

text: statements

text: and

text: DRO

text: hearing

text: transcript

text: pg

text: see

text: also

text: private

text: treatment

text: record

text: dated

text: in

text: May

text: from

text: B

text: W

text: R

text: MD

text: As

text: an

text: initial

text: matter

text: there

text: is

text: some

text: uncertainty

text: as

text: to

text: whether

text: the

text: Veteran

text: has

text: a

text: current

text: PTSD

text: diagnosis

text: In

text: May

text: a

text: VA

text: psychologist

text: Dr

text: L

text: K

text: concluded

text: that

text: the

text: Veteran

text: did

text: not

text: meet

text: the

text: criteria

text: for

text: PTSD

text: but

text: rather

text: diagnosed

text: the

text: Veteran

text: with

text: alcohol

text: dependence

text: in

text: partial

text: remission

text: cocaine

text: abuse

text: in

text: reported

text: admission

text: and

text: a

text: personality

text: disorder

text: not

text: otherwise

text: specified

text: with

text: Cluster

text: B

text: traits

text: She

text: affirmed

text: these

text: findings

text: in

text: a

text: September

text: addendum

text: report

text: However

text: the

text: Veteran

text: s

text: current

text: treating

text: psychiatrist

text: Dr

text: H

text: V

text: has

text: diagnosed

text: the

text: Veteran

text: with

text: PTSD

text: and

text: major

text: depression

text: which

text: she

text: has

text: attributed

text: to

text: the

text: Veteran

text: s

text: claimed

text: in

text: service

text: stressors

text: The

text: Board

text: has

text: weighed

text: the

text: fact

text: that

text: at

text: least

text: one

text: of

text: the

text: Veteran

text: s

text: treatment

text: providers

text: Dr

text: H

text: V

text: has

text: found

text: him

text: credible

text: in

text: his

text: account

text: of

text: in

text: service

text: hazing

text: This

text: may

text: be

text: considered

text: in

text: the

text: Board

text: s

text: evaluation

text: of

text: the

text: evidence

text: See

text: Menegassi

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: under

text: C

text: F

text: R

text: f

text: medical

text: opinion

text: evidence

text: may

text: be

text: submitted

text: for

text: use

text: in

text: determining

text: whether

text: the

text: occurrence

text: of

text: a

text: stressor

text: is

text: corroborated

text: Under

text: the

text: benefit

text: of

text: the

text: doubt

text: rule

text: where

text: there

text: exists

text: an

text: approximate

text: balance

text: of

text: positive

text: and

text: negative

text: evidence

text: regarding

text: the

text: merits

text: of

text: an

text: issue

text: material

text: to

text: the

text: determination

text: of

text: the

text: matter

text: the

text: Veteran

text: shall

text: prevail

text: upon

text: the

text: issue

text: Ashley

text: v

text: Brown

text: Vet

text: App

text: see

text: also

text: Massey

text: v

text: Brown

text: Vet

text: App

text: Resolving

text: all

text: reasonable

text: doubt

text: in

text: the

text: Veteran

text: s

text: favor

text: the

text: Board

text: concludes

text: that

text: service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disability

text: to

text: include

text: PTSD

text: has

text: been

text: established

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: Respiratory

text: Disability

text: The

text: Veteran

text: has

text: also

text: alleged

text: that

text: he

text: currently

text: experiences

text: a

text: respiratory

text: disorder

text: that

text: is

text: due

text: to

text: his

text: military

text: service

text: See

text: Veteran

text: s

text: April

text: claim

text: Specifically

text: he

text: has

text: indicated

text: that

text: he

text: was

text: treated

text: for

text: his

text: current

text: disorder

text: during

text: his

text: military

text: service

text: Service

text: treatment

text: records

text: do

text: show

text: that

text: in

text: May

text: and

text: August

text: the

text: Veteran

text: was

text: treated

text: for

text: a

text: cold

text: along

text: with

text: chest

text: pain

text: coughing

text: and

text: vomiting

text: Then

text: in

text: January

text: he

text: was

text: treated

text: for

text: nasal

text: issues

text: and

text: in

text: March

text: he

text: was

text: diagnosed

text: with

text: sinusitis

text: Finally

text: in

text: September

text: at

text: the

text: time

text: of

text: his

text: separation

text: examination

text: the

text: Veteran

text: provided

text: a

text: statement

text: of

text: his

text: medical

text: history

text: wherein

text: it

text: was

text: noted

text: that

text: he

text: had

text: a

text: history

text: of

text: mild

text: sinusitis

text: that

text: responds

text: to

text: meds

text: The

text: AOJ

text: has

text: also

text: obtained

text: private

text: treatment

text: records

text: from

text: Dr

text: Ramsey

text: which

text: indicate

text: a

text: diagnosis

text: of

text: acute

text: sinusitis

text: and

text: bronchitis

text: in

text: October

text: and

text: treatment

text: for

text: a

text: cough

text: in

text: February

text: and

text: March

text: VA

text: outpatient

text: treatment

text: records

text: show

text: diagnoses

text: of

text: COPD

text: emphysema

text: and

text: tobacco

text: use

text: disorder

text: See

text: e

text: g

text: VA

text: Primary

text: Care

text: Physician

text: Note

text: March

text: The

text: Veteran

text: has

text: also

text: alleged

text: that

text: his

text: respiratory

text: disorder

text: is

text: due

text: to

text: smoking

text: due

text: to

text: stresses

text: incurred

text: during

text: his

text: military

text: service

text: See

text: Veteran

text: s

text: April

text: claim

text: July

text: stressor

text: statement

text: and

text: DRO

text: hearing

text: transcript

text: pg

text: The

text: Board

text: notes

text: that

text: for

text: claims

text: received

text: by

text: VA

text: after

text: June

text: a

text: disability

text: or

text: death

text: will

text: not

text: be

text: considered

text: service

text: connected

text: on

text: the

text: basis

text: that

text: it

text: resulted

text: from

text: injury

text: or

text: disease

text: attributable

text: to

text: the

text: Veteran

text: s

text: use

text: of

text: tobacco

text: products

text: during

text: service

text: C

text: F

text: R

text: a

text: The

text: provisions

text: of

text: a

text: however

text: do

text: not

text: prohibit

text: service

text: connection

text: if

text: the

text: disability

text: resulted

text: from

text: a

text: disease

text: that

text: can

text: be

text: service

text: connected

text: on

text: some

text: basis

text: other

text: than

text: the

text: Veteran

text: s

text: use

text: of

text: tobacco

text: products

text: during

text: service

text: or

text: if

text: the

text: disability

text: became

text: manifest

text: during

text: service

text: C

text: F

text: R

text: b

text: To

text: address

text: whether

text: the

text: Veteran

text: s

text: current

text: respiratory

text: problems

text: were

text: related

text: to

text: his

text: in

text: service

text: treatment

text: or

text: otherwise

text: caused

text: by

text: his

text: military

text: service

text: the

text: matter

text: was

text: referred

text: for

text: a

text: VA

text: medical

text: opinion

text: In

text: an

text: April

text: opinion

text: a

text: VA

text: examiner

text: concluded

text: that

text: it

text: is

text: less

text: likely

text: than

text: not

text: that

text: the

text: Veteran

text: s

text: in

text: service

text: treatment

text: for

text: colds

text: and

text: sinusitis

text: is

text: related

text: to

text: any

text: current

text: respiratory

text: condition

text: The

text: examiner

text: explained

text: that

text: the

text: Veteran

text: was

text: treated

text: in

text: service

text: for

text: upper

text: respiratory

text: infections

text: which

text: are

text: a

text: common

text: illness

text: and

text: not

text: indicative

text: of

text: a

text: chronic

text: disability

text: The

text: examiner

text: further

text: opined

text: that

text: the

text: cause

text: of

text: the

text: Veteran

text: s

text: lung

text: disorder

text: is

text: likely

text: a

text: long

text: history

text: of

text: heavy

text: smoking

text: However

text: the

text: examiner

text: explained

text: that

text: The

text: Veteran

text: s

text: current

text: respiratory

text: disorder

text: is

text: related

text: to

text: his

text: admitted

text: history

text: of

text: use

text: of

text: tobacco

text: products

text: during

text: military

text: service

text: only

text: in

text: the

text: sense

text: that

text: he

text: was

text: a

text: smoker

text: then

text: The

text: current

text: lung

text: condition

text: reflects

text: many

text: many

text: pack

text: years

text: of

text: smoking

text: Based

text: on

text: the

text: above

text: evidence

text: the

text: Board

text: finds

text: that

text: entitlement

text: to

text: service

text: connection

text: for

text: a

text: respiratory

text: disability

text: is

text: denied

text: As

text: the

text: Board

text: has

text: noted

text: above

text: for

text: claims

text: received

text: by

text: VA

text: after

text: June

text: a

text: disability

text: or

text: death

text: will

text: not

text: be

text: considered

text: service

text: connected

text: on

text: the

text: basis

text: that

text: it

text: resulted

text: from

text: injury

text: or

text: disease

text: attributable

text: to

text: the

text: Veteran

text: s

text: use

text: of

text: tobacco

text: products

text: during

text: service

text: C

text: F

text: R

text: a

text: Here

text: the

text: Veteran

text: s

text: current

text: respiratory

text: problems

text: have

text: been

text: attributed

text: to

text: his

text: lengthy

text: history

text: of

text: heavy

text: smoking

text: by

text: the

text: April

text: VA

text: examiner

text: and

text: the

text: Veteran

text: has

text: not

text: submitted

text: any

text: evidence

text: to

text: the

text: contrary

text: Accordingly

text: service

text: connection

text: for

text: the

text: Veteran

text: s

text: respiratory

text: disability

text: must

text: denied

text: pursuant

text: to

text: C

text: F

text: R

text: a

text: Furthermore

text: although

text: the

text: April

text: VA

text: examiner

text: considered

text: whether

text: the

text: Veteran

text: s

text: treatment

text: for

text: colds

text: and

text: sinusitis

text: on

text: several

text: occasions

text: during

text: his

text: active

text: service

text: was

text: evidence

text: of

text: a

text: chronic

text: disability

text: the

text: examiner

text: explained

text: that

text: upper

text: respiratory

text: infections

text: such

text: as

text: the

text: Veteran

text: was

text: treated

text: for

text: are

text: a

text: common

text: illness

text: and

text: his

text: treatment

text: for

text: it

text: in

text: service

text: should

text: not

text: be

text: considered

text: evidence

text: of

text: a

text: chronic

text: disability

text: The

text: examiner

text: concluded

text: that

text: it

text: is

text: less

text: likely

text: than

text: not

text: that

text: the

text: Veteran

text: s

text: current

text: respiratory

text: problems

text: had

text: onset

text: in

text: service

text: or

text: were

text: caused

text: by

text: or

text: related

text: the

text: Veteran

text: s

text: active

text: military

text: service

text: Again

text: the

text: Veteran

text: has

text: not

text: submitted

text: any

text: medical

text: evidence

text: to

text: the

text: contrary

text: While

text: current

text: VA

text: and

text: private

text: treatment

text: records

text: reflect

text: treatment

text: for

text: a

text: number

text: of

text: respiratory

text: complaints

text: of

text: the

text: Veteran

text: s

text: treatment

text: provider

text: has

text: opined

text: that

text: these

text: conditions

text: are

text: related

text: to

text: the

text: Veteran

text: s

text: service

text: In

text: addition

text: the

text: April

text: examiner

text: opined

text: that

text: I

text: can

text: see

text: no

text: evidence

text: that

text: any

text: aspect

text: of

text: his

text: military

text: service

text: caused

text: his

text: current

text: lung

text: condition

text: separate

text: from

text: his

text: history

text: of

text: use

text: of

text: tobacco

text: products

text: emphasis

text: added

text: Thus

text: there

text: is

text: no

text: indication

text: that

text: anything

text: in

text: service

text: could

text: have

text: potentially

text: caused

text: or

text: aggravated

text: his

text: respiratory

text: disorder

text: aside

text: from

text: his

text: use

text: of

text: tobacco

text: products

text: Moreover

text: the

text: examiner

text: opined

text: that

text: there

text: were

text: no

text: intercurrent

text: o

text: ccuring

text: in

text: addition

text: to

text: and

text: usually

text: altering

text: the

text: course

text: of

text: another

text: disease

text: causes

text: unrelated

text: to

text: his

text: military

text: service

text: Although

text: the

text: Board

text: has

text: now

text: service

text: connected

text: the

text: Veteran

text: s

text: PTSD

text: there

text: is

text: no

text: indication

text: that

text: this

text: disability

text: has

text: aggravated

text: the

text: Veteran

text: s

text: respiratory

text: disability

text: To

text: the

text: extent

text: that

text: the

text: Veteran

text: has

text: offered

text: his

text: own

text: opinion

text: concerning

text: the

text: etiology

text: of

text: his

text: respiratory

text: disability

text: he

text: has

text: not

text: demonstrated

text: that

text: he

text: has

text: any

text: knowledge

text: or

text: training

text: in

text: determining

text: the

text: etiology

text: of

text: such

text: conditions

text: In

text: other

text: words

text: he

text: is

text: a

text: layman

text: not

text: a

text: medical

text: expert

text: The

text: Board

text: recognizes

text: that

text: there

text: is

text: no

text: bright

text: line

text: rule

text: that

text: laypersons

text: are

text: not

text: competent

text: to

text: offer

text: etiology

text: opinions

text: See

text: Davidson

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: rejecting

text: the

text: view

text: that

text: competent

text: medical

text: evidence

text: is

text: necessarily

text: required

text: when

text: the

text: determinative

text: issue

text: is

text: medical

text: diagnosis

text: or

text: etiology

text: Evidence

text: however

text: must

text: be

text: competent

text: evidence

text: in

text: order

text: to

text: be

text: weighed

text: by

text: the

text: Board

text: Whether

text: a

text: layperson

text: is

text: competent

text: to

text: provide

text: an

text: opinion

text: as

text: to

text: the

text: etiology

text: of

text: a

text: condition

text: depends

text: on

text: the

text: facts

text: of

text: the

text: particular

text: case

text: In

text: Davidson

text: the

text: U

text: S

text: Court

text: of

text: Appeals

text: for

text: the

text: Federal

text: Circuit

text: Federal

text: Circuit

text: drew

text: support

text: from

text: Jandreau

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: for

text: support

text: for

text: its

text: holding

text: Id

text: In

text: a

text: footnote

text: in

text: Jandreau

text: the

text: Federal

text: Circuit

text: addressed

text: whether

text: a

text: layperson

text: could

text: provide

text: evidence

text: regarding

text: a

text: diagnosis

text: of

text: a

text: condition

text: and

text: explained

text: that

text: s

text: ometimes

text: the

text: layperson

text: will

text: be

text: competent

text: to

text: identify

text: the

text: condition

text: where

text: the

text: condition

text: is

text: simple

text: for

text: example

text: a

text: broken

text: leg

text: and

text: sometimes

text: not

text: for

text: example

text: a

text: form

text: of

text: cancer

text: Jandreau

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: Although

text: the

text: Veteran

text: seeks

text: to

text: offer

text: etiology

text: opinions

text: rather

text: than

text: provide

text: diagnoses

text: the

text: reasoning

text: expressed

text: in

text: Jandreau

text: is

text: applicable

text: The

text: Board

text: finds

text: that

text: the

text: question

text: of

text: whether

text: the

text: Veteran

text: currently

text: has

text: a

text: respiratory

text: disability

text: due

text: to

text: his

text: active

text: military

text: service

text: is

text: too

text: complex

text: to

text: be

text: addressed

text: by

text: a

text: layperson

text: This

text: connection

text: or

text: etiology

text: is

text: not

text: amenable

text: to

text: observation

text: alone

text: Rather

text: it

text: is

text: common

text: knowledge

text: that

text: such

text: relationships

text: are

text: the

text: subject

text: of

text: extensive

text: research

text: by

text: scientific

text: and

text: medical

text: professionals

text: Hence

text: the

text: Veteran

text: s

text: opinion

text: of

text: the

text: etiology

text: of

text: his

text: current

text: disability

text: is

text: entitled

text: to

text: little

text: to

text: no

text: probative

text: weight

text: The

text: Board

text: gives

text: greater

text: weight

text: to

text: the

text: contemporaneous

text: medical

text: evidence

text: and

text: the

text: opinion

text: of

text: the

text: VA

text: examiner

text: Although

text: the

text: Board

text: is

text: sympathetic

text: to

text: the

text: Veteran

text: s

text: argument

text: that

text: he

text: began

text: smoking

text: in

text: service

text: due

text: in

text: part

text: to

text: the

text: cigarettes

text: he

text: was

text: provided

text: by

text: the

text: military

text: Congress

text: has

text: spoken

text: to

text: this

text: issue

text: in

text: U

text: S

text: C

text: A

text: and

text: prohibited

text: service

text: connection

text: for

text: disabilities

text: based

text: upon

text: effects

text: of

text: tobacco

text: products

text: The

text: Board

text: is

text: obligated

text: to

text: follow

text: the

text: dictates

text: of

text: Congress

text: without

text: regard

text: to

text: its

text: own

text: view

text: of

text: the

text: matter

text: For

text: all

text: the

text: above

text: reasons

text: entitlement

text: to

text: service

text: connection

text: for

text: a

text: respiratory

text: disability

text: to

text: include

text: COPD

text: is

text: denied

text: The

text: evidence

text: in

text: this

text: case

text: is

text: not

text: so

text: evenly

text: balanced

text: so

text: as

text: to

text: allow

text: application

text: of

text: the

text: benefit

text: of

text: the

text: doubt

text: rule

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: The

text: Duty

text: to

text: Notify

text: and

text: Assist

text: Under

text: the

text: Veterans

text: Claims

text: Assistance

text: Act

text: VCAA

text: when

text: VA

text: receives

text: a

text: complete

text: or

text: substantially

text: complete

text: application

text: for

text: benefits

text: it

text: must

text: notify

text: the

text: claimant

text: of

text: the

text: information

text: and

text: evidence

text: not

text: of

text: record

text: that

text: is

text: necessary

text: to

text: substantiate

text: a

text: claim

text: which

text: information

text: and

text: evidence

text: VA

text: will

text: obtain

text: and

text: which

text: information

text: and

text: evidence

text: the

text: claimant

text: is

text: expected

text: to

text: provide

text: C

text: F

text: R

text: Here

text: the

text: Veteran

text: was

text: provided

text: with

text: the

text: relevant

text: notice

text: and

text: information

text: Pelegrini

text: v

text: Principi

text: Vet

text: App

text: Pelegrini

text: II

text: He

text: has

text: not

text: alleged

text: any

text: notice

text: deficiency

text: during

text: the

text: adjudication

text: of

text: his

text: claim

text: Shinseki

text: v

text: Sanders

text: S

text: Ct

text: VA

text: also

text: has

text: a

text: duty

text: to

text: assist

text: the

text: Veteran

text: in

text: obtaining

text: potentially

text: relevant

text: records

text: and

text: providing

text: an

text: examination

text: or

text: medical

text: opinion

text: when

text: necessary

text: to

text: make

text: a

text: decision

text: on

text: the

text: claim

text: Here

text: the

text: Veteran

text: s

text: service

text: records

text: VA

text: records

text: and

text: identified

text: private

text: treatment

text: records

text: have

text: been

text: obtained

text: and

text: associated

text: with

text: the

text: claims

text: file

text: The

text: Veteran

text: was

text: also

text: provided

text: with

text: VA

text: examinations

text: which

text: collectively

text: contain

text: a

text: description

text: of

text: the

text: history

text: of

text: the

text: disabilities

text: at

text: issue

text: document

text: and

text: consider

text: the

text: relevant

text: medical

text: facts

text: and

text: principles

text: and

text: provide

text: opinions

text: regarding

text: the

text: etiology

text: of

text: the

text: Veteran

text: s

text: claimed

text: conditions

text: VA

text: s

text: duty

text: to

text: assist

text: with

text: respect

text: to

text: obtaining

text: relevant

text: records

text: and

text: an

text: examination

text: has

text: been

text: met

text: C

text: F

text: R

text: c

text: Barr

text: v

text: Nicholson

text: Vet

text: App

text: Finally

text: the

text: Veteran

text: testified

text: at

text: an

text: RO

text: hearing

text: The

text: hearing

text: was

text: adequate

text: as

text: the

text: DRO

text: who

text: conducted

text: the

text: hearing

text: explained

text: the

text: issue

text: and

text: identified

text: possible

text: sources

text: of

text: evidence

text: that

text: may

text: have

text: been

text: overlooked

text: C

text: F

text: R

text: c

text: Bryant

text: v

text: Shinseki

text: Vet

text: App

text: ORDER

text: Entitlement

text: to

text: service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disability

text: to

text: include

text: posttraumatic

text: stress

text: disorder

text: PTSD

text: based

text: on

text: personal

text: assault

text: is

text: granted

text: Entitlement

text: to

text: service

text: connection

text: for

text: a

text: respiratory

text: disability

text: to

text: include

text: chronic

text: obstructive

text: pulmonary

text: disease

text: COPD

text: is

text: denied

text: BRADLEY

text: W

text: HENNINGS

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs