text:
Citation Nr: 1455570
Decision Date: 12/17/14    Archive Date: 12/24/14

DOCKET NO.  12-28 467	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Louisville, Kentucky

THE ISSUE

Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD).

REPRESENTATION

Veteran represented by:	Disabled American Veterans

WITNESS AT HEARING ON APPEAL

The Veteran

ATTORNEY FOR THE BOARD

John Francis, Counsel

INTRODUCTION

The Veteran served on active duty from November 1963 to April 1969.  He is the recipient of numerous awards and decorations, to include the Combat Infantryman Badge and the Purple Heart with an Oak Leaf Cluster.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky, which denied service connection for PTSD.

The record reflects that the Veteran has been diagnosed with major depressive disorder in addition to PTSD.  The United States Court of Appeals for Veterans Claims (Court) has held 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.  Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).  Therefore, the Board has recharacterized the Veteran's claim as shown on the first page of this decision as entitlement to service connection for an acquired psychiatric disorder, to include PTSD.

In September 2013, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge sitting at the RO.  A transcript of the hearing is associated with the claims file.  At such time, the Veteran submitted additional evidence consisting of VA treatment records dated through May 2013 with a waiver of RO consideration.  38 C.F.R. § 20.1304(c) (2014).  Therefore, the Board may properly consider such newly received evidence.

The Board notes that, in addition to the paper claims file, the Veteran also has electronic Virtual VA and Veteran Benefits Management System (VBMS) paperless claims files.  A review of the documents in Virtual VA reveals that, with the exception of a copy of the September 2013 Board hearing transcript and VA treatment records dated through November 2012, which were considered by the RO in the November 2012 supplemental statement of the case, they are either duplicative of the evidence in the paper claims file or are irrelevant to the issue on appeal.  Further, the Veteran's VBMS file does not contain any documents at this time.

FINDING OF FACT

Resolving all doubt in his favor, the Veteran's current acquired psychiatric disorder, diagnosed as PTSD and major depressive disorder, is, at least in part, due to traumatic events during combat in Vietnam.

CONCLUSION OF LAW

The criteria for service connection for PTSD and major depressive disorder are met.  38 U.S.C.A. §§ 1110, 1154, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125 (2014).

REASONS AND BASES FOR FINDING AND CONCLUSION

As the Board's decision to grant service connection for PTSD and major depressive disorder is completely favorable, no further action is required to comply with the Veterans Claims Assistance Act of 2000 and implementing regulations.

The Veteran served as a U.S. Army infantryman with combat service in the Republic of Vietnam.  He was awarded the Combat Infantryman Badge and the Purple Heart with an Oak Leaf Cluster.  He contended in an April 2012 statement and in testimony at the September 2013 Board hearing that he experienced PTSD arising from traumatic events in combat including firefights, mortar and rocket attacks, and observing the deaths of several fellow soldiers.  The Veteran also submitted an undated statement from a fellow soldier (received in September 2013) that confirmed the Veteran's participation in combat action.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C.A. § 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).

Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)].

Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., in accordance with DSM-IV); 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).

According to the DSM-IV criteria, a diagnosis of PTSD requires that a Veteran have been exposed to a traumatic event, and that he experience a number of specified current symptoms.  The traumatic event, or stressor, involves having experienced, witnessed, or being confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.  In addition, the response must involve intense feelings of fear, hopelessness, or horror.  See American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994).  In Cohen v. Brown, 10 Vet. App. 128, 140 (1997), the United States Court of Appeals for Veterans Claims held that "a clear (that is, unequivocal) PTSD diagnosis by a mental-health professional must be presumed (unless evidence shows to the contrary) to have been made in accordance with the applicable DSM criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor."

Satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service even though there is no official record of such incurrence or aggravation.  38 C.F.R. § 3.304(d); see also Collette v. Brown, 82 F.3d 389 (Fed. Cir. 1996) (under 38 U.S.C.A. §1154(b), a combat Veteran's assertions of an event during combat are to be presumed if consistent with the time, place and circumstances of such service).  In cases where the Veteran engaged in combat, the Federal Circuit has held that the presumption found in § 1154(b) applies not only to the potential cause of a disability, but also to whether a disability itself was incurred while in service. See Reeves v. Shinseki, 682 F.3d 988, 999 (Fed. Cir. 2012).  The combat presumption, however, does not alleviate the requirement that the evidence show current disabilities attributable to the past in-service disorder.  See generally Clyburn v. West, 12 Vet. App. 296, 303 (1999).

The "current disability" requirement for service connection will be met when there is a disability at the time of filing or during the pendency of a claim.  McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).  The Board may also make a factual finding as to whether an earlier diagnosis is sufficiently proximate to the filing of a claim so as to constitute evidence of a "current diagnosis."  Romanowsky v. Shinseki, 26 Vet. App. 289, 293-94 (2013).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt is given to the claimant.  38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

The Veteran's service treatment records include the reports of treatment for several combat shrapnel and head injuries.  The records, including the reports of discharge physical examinations in December 1968 and March 1969, are silent for any mental health symptoms, diagnoses, or treatment.  Following his tour of duty in Vietnam, the Veteran received military discipline on many occasions for periods of absence without leave and striking an officer and was under consideration for a discharge for unsatisfactory performance.  In May 1969, a military psychiatrist examined the Veteran and found no underlying medically disqualifying emotional illness.  In a September 2013 statement, the Veteran attributed his post-Vietnam behavior to the onset of PTSD.  The Veteran initially received an other than honorable discharge, which was upgraded to a general discharge under honorable conditions in May 1978.

Records of VA outpatient medical care starting in September 2010 show a history of surgery and disabilities of the lower extremities.  Although several PTSD screening questionnaires were negative, the Veteran was referred for a mental health evaluation for symptoms of anxiety and depression.  In a report of a telephone interview in late September 2010, a VA psychologist noted the Veteran's reports of experiencing an unspecified traumatic events and suicidal ideations in the past, and current feelings of lack of energy and interest and difficulty sleeping.  The psychologist also noted symptoms of unspecified disturbing memories, nightmares, and avoidance behaviors.  The psychologist diagnosed a generalized anxiety disorder that "may meet the criteria for PTSD."

Two days later, the Veteran underwent an in-person mental health examination by a VA psychiatrist.  The Veteran again reported experiencing suicidal and homicidal ideations in the past and olfactory hallucinations of rifle smoke that reminded him of Vietnam.  The Veteran was also experiencing chronic pain from several serious workplace injuries and surgery that forced him to retire and created financial distress.  The psychiatrist diagnosed only a depressive episode without further explanation.  The Veteran began periodic VA outpatient mental health treatment.  In November 2010, the attending psychologist continued to diagnose a depressive disorder, mentioning the Veteran's struggle with VA for benefits and general references to past military experiences.

The RO received the Veteran's claim for service connection for PTSD in November 2010, and the Veteran underwent a VA mental health examination in January 2011.  The VA psychologist did not review the claims file, but found the Veteran to be a reliable historian and noted detailed summaries of the Veteran's combat experiences, post-combat performance problems and discipline, the death of his first wife in 1999, remarriage in 2001 with a supportive relationship, and physical disabilities that caused his retirement in March 2009.  On examination, the psychologist noted the Veteran's report of a "fair" mood and difficulty sleeping because of physical pain, but no other deficits.  The psychologist acknowledged that the Veteran's combat experiences would be sufficient to meet the event criteria for a diagnosis of PTSD, but that no diagnosis of a mental health disorder was appropriate because the symptoms were limited to expected reactions to stressors such as the death of his first wife and unwanted forced retirement due to medical issues and related financial distress, and not to the events in military service.

The Veteran stopped VA outpatient mental health treatment in February 2011 but returned to seek primary care in April 2012.  A primary care physician noted the Veteran's reports of irritable mood, flashbacks, and nightmares about his experiences in Vietnam triggered while driving and smelling smoke.  The physician referred the Veteran for further mental health care.  In May 2012, a licensed social worker noted the Veteran's reports of his current family situation and inability to work because of his multiple physical disabilities.  The Veteran reported symptoms of irritability, depression, and interrupted sleep as well as occasional panic attacks, but there was no mention by the Veteran or the examiner of any events in service.  The social worker diagnosed depression associated with adjustment to mobility deficits.  In a follow-up examination the same day, a VA psychiatrist noted that the Veteran's mood was "down but not overly so" and that symptoms of PTSD were greatly reduced.

In subsequent treatment encounters in July 2012 and August 2012, the attending psychiatrist diagnosed both major depressive disorder and related PTSD with diminishing symptoms that did not interfere with activities.  However, in August 2012, the psychiatrist noted that the Veteran was not depressed on that occasion.  In October 2012, the VA social worker noted some improvement in isolative behaviors, anger issues, and disturbed sleep with the use of medication, but that the Veteran continued to display a depressed mood caused by thoughts of his fellow soldiers killed in Vietnam, how he was treated during service, his physical disabilities, and the death of his first wife.  In November 2012, the Veteran was diagnosed with major depressive disorder.  VA treatment records dated from February 2013 through May 2013 show diagnoses of major depressive disorder and PTSD, and ongoing treatment for such disorders from the Veteran's treating psychiatrist, psychologist, and social worker.

During the September 2013 Board hearing, the Veteran testified that he was currently under treatment in an intensive program at a VA mental health clinic for PTSD, major depression, and anxiety disorder since April 10, 2013, and that his psychiatrist had associated the disorders with his combat service.

The Board finds that service connection for PTSD and major depressive disorder is warranted.  As an initial matter, the Board finds that the Veteran's reports of his traumatic events during combat in Vietnam and current symptoms are competent because they are observable by lay persons and have been accepted without challenge by all clinicians and the January 2011 examiner and are consistent with his service records.  Moreover, as the Veteran served in combat, his lay statements are sufficient to verify his in-service stressors.

The Board acknowledges that there is competent evidence both for and against a finding that the Veteran has a current psychiatric disorder related to his in-service combat stressors.  The VA psychologist in January 2011 provided a detailed history and comprehensive report of his examination in which he acknowledged the combat events and found that they met the traumatic event criteria.  However, he found that the Veteran did not have any diagnosed psychiatric disorder on that one occasion, but did not have access to or mention the nature of the VA outpatient care that was provided prior to his examination.

On the other hand, outpatient clinicians in 2010 diagnosed depression and possible PTSD, albeit with little detailed rationale.  Nevertheless, the clinicians acknowledged the combat events as well as the death of the Veteran's first wife, his workplace injuries and surgery, and his involuntary retirement.  In 2012, the outpatient clinicians affirmatively diagnosed mild symptoms of depression and PTSD without conditional language, but again with little detailed analysis or rationale, referring to both physical disabilities as a cause for depression and combat events as causes for nightmares, intrusive memories, and irritability.  However, beginning in February 2013, VA treatment records reflect diagnoses of PTSD and major depressive disorder, and ongoing treatment for such disorders from the Veteran's treating psychiatrist, psychologist, and social worker.  Moreover, the Veteran's testimony regarding a 2013 intensive mental health treatment program for PTSD, depression, and anxiety, which he reported had been related to his in-service combat stressors, is competent and credible in light of his ongoing treatment for such disorders.

Therefore, resolving all doubt in favor of the Veteran, the Board finds that the competent and credible evidence shows that diagnoses of PTSD and major depressive disorder were rendered during portions of the pendency of the Veteran's claim and such were, at least in part, related to traumatic events during combat in Vietnam.  Consequently, service connection for such acquired psychiatric disorders is warranted.  38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert, supra.

ORDER

Service connection for PTSD and major depressive disorder is granted.

____________________________________________
A. JAEGER
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

label: Sentence

text: Citation

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text: Louisville

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text: THE

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text: disease

text: was

text: incurred

text: or

text: aggravated

text: in

text: combat

text: will

text: be

text: accepted

text: as

text: sufficient

text: proof

text: of

text: service

text: connection

text: if

text: the

text: evidence

text: is

text: consistent

text: with

text: the

text: circumstances

text: conditions

text: or

text: hardships

text: of

text: such

text: service

text: even

text: though

text: there

text: is

text: no

text: official

text: record

text: of

text: such

text: incurrence

text: or

text: aggravation

text: C

text: F

text: R

text: d

text: see

text: also

text: Collette

text: v

text: Brown

text: F

text: d

text: Fed

text: Cir

text: under

text: U

text: S

text: C

text: A

text: b

text: a

text: combat

text: Veteran

text: s

text: assertions

text: of

text: an

text: event

text: during

text: combat

text: are

text: to

text: be

text: presumed

text: if

text: consistent

text: with

text: the

text: time

text: place

text: and

text: circumstances

text: of

text: such

text: service

text: In

text: cases

text: where

text: the

text: Veteran

text: engaged

text: in

text: combat

text: the

text: Federal

text: Circuit

text: has

text: held

text: that

text: the

text: presumption

text: found

text: in

text: b

text: applies

text: not

text: only

text: to

text: the

text: potential

text: cause

text: of

text: a

text: disability

text: but

text: also

text: to

text: whether

text: a

text: disability

text: itself

text: was

text: incurred

text: while

text: in

text: service

text: See

text: Reeves

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: The

text: combat

text: presumption

text: however

text: does

text: not

text: alleviate

text: the

text: requirement

text: that

text: the

text: evidence

text: show

text: current

text: disabilities

text: attributable

text: to

text: the

text: past

text: in

text: service

text: disorder

text: See

text: generally

text: Clyburn

text: v

text: West

text: Vet

text: App

text: The

text: current

text: disability

text: requirement

text: for

text: service

text: connection

text: will

text: be

text: met

text: when

text: there

text: is

text: a

text: disability

text: at

text: the

text: time

text: of

text: filing

text: or

text: during

text: the

text: pendency

text: of

text: a

text: claim

text: McClain

text: v

text: Nicholson

text: Vet

text: App

text: The

text: Board

text: may

text: also

text: make

text: a

text: factual

text: finding

text: as

text: to

text: whether

text: an

text: earlier

text: diagnosis

text: is

text: sufficiently

text: proximate

text: to

text: the

text: filing

text: of

text: a

text: claim

text: so

text: as

text: to

text: constitute

text: evidence

text: of

text: a

text: current

text: diagnosis

text: Romanowsky

text: v

text: Shinseki

text: Vet

text: App

text: When

text: there

text: is

text: an

text: approximate

text: balance

text: of

text: positive

text: and

text: negative

text: evidence

text: regarding

text: any

text: issue

text: material

text: to

text: the

text: determination

text: of

text: a

text: matter

text: the

text: benefit

text: of

text: the

text: doubt

text: is

text: given

text: to

text: the

text: claimant

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: The

text: Veteran

text: s

text: service

text: treatment

text: records

text: include

text: the

text: reports

text: of

text: treatment

text: for

text: several

text: combat

text: shrapnel

text: and

text: head

text: injuries

text: The

text: records

text: including

text: the

text: reports

text: of

text: discharge

text: physical

text: examinations

text: in

text: December

text: and

text: March

text: are

text: silent

text: for

text: any

text: mental

text: health

text: symptoms

text: diagnoses

text: or

text: treatment

text: Following

text: his

text: tour

text: of

text: duty

text: in

text: Vietnam

text: the

text: Veteran

text: received

text: military

text: discipline

text: on

text: many

text: occasions

text: for

text: periods

text: of

text: absence

text: without

text: leave

text: and

text: striking

text: an

text: officer

text: and

text: was

text: under

text: consideration

text: for

text: a

text: discharge

text: for

text: unsatisfactory

text: performance

text: In

text: May

text: a

text: military

text: psychiatrist

text: examined

text: the

text: Veteran

text: and

text: found

text: no

text: underlying

text: medically

text: disqualifying

text: emotional

text: illness

text: In

text: a

text: September

text: statement

text: the

text: Veteran

text: attributed

text: his

text: post

text: Vietnam

text: behavior

text: to

text: the

text: onset

text: of

text: PTSD

text: The

text: Veteran

text: initially

text: received

text: an

text: other

text: than

text: honorable

text: discharge

text: which

text: was

text: upgraded

text: to

text: a

text: general

text: discharge

text: under

text: honorable

text: conditions

text: in

text: May

text: Records

text: of

text: VA

text: outpatient

text: medical

text: care

text: starting

text: in

text: September

text: show

text: a

text: history

text: of

text: surgery

text: and

text: disabilities

text: of

text: the

text: lower

text: extremities

text: Although

text: several

text: PTSD

text: screening

text: questionnaires

text: were

text: negative

text: the

text: Veteran

text: was

text: referred

text: for

text: a

text: mental

text: health

text: evaluation

text: for

text: symptoms

text: of

text: anxiety

text: and

text: depression

text: In

text: a

text: report

text: of

text: a

text: telephone

text: interview

text: in

text: late

text: September

text: a

text: VA

text: psychologist

text: noted

text: the

text: Veteran

text: s

text: reports

text: of

text: experiencing

text: an

text: unspecified

text: traumatic

text: events

text: and

text: suicidal

text: ideations

text: in

text: the

text: past

text: and

text: current

text: feelings

text: of

text: lack

text: of

text: energy

text: and

text: interest

text: and

text: difficulty

text: sleeping

text: The

text: psychologist

text: also

text: noted

text: symptoms

text: of

text: unspecified

text: disturbing

text: memories

text: nightmares

text: and

text: avoidance

text: behaviors

text: The

text: psychologist

text: diagnosed

text: a

text: generalized

text: anxiety

text: disorder

text: that

text: may

text: meet

text: the

text: criteria

text: for

text: PTSD

text: Two

text: days

text: later

text: the

text: Veteran

text: underwent

text: an

text: in

text: person

text: mental

text: health

text: examination

text: by

text: a

text: VA

text: psychiatrist

text: The

text: Veteran

text: again

text: reported

text: experiencing

text: suicidal

text: and

text: homicidal

text: ideations

text: in

text: the

text: past

text: and

text: olfactory

text: hallucinations

text: of

text: rifle

text: smoke

text: that

text: reminded

text: him

text: of

text: Vietnam

text: The

text: Veteran

text: was

text: also

text: experiencing

text: chronic

text: pain

text: from

text: several

text: serious

text: workplace

text: injuries

text: and

text: surgery

text: that

text: forced

text: him

text: to

text: retire

text: and

text: created

text: financial

text: distress

text: The

text: psychiatrist

text: diagnosed

text: only

text: a

text: depressive

text: episode

text: without

text: further

text: explanation

text: The

text: Veteran

text: began

text: periodic

text: VA

text: outpatient

text: mental

text: health

text: treatment

text: In

text: November

text: the

text: attending

text: psychologist

text: continued

text: to

text: diagnose

text: a

text: depressive

text: disorder

text: mentioning

text: the

text: Veteran

text: s

text: struggle

text: with

text: VA

text: for

text: benefits

text: and

text: general

text: references

text: to

text: past

text: military

text: experiences

text: The

text: RO

text: received

text: the

text: Veteran

text: s

text: claim

text: for

text: service

text: connection

text: for

text: PTSD

text: in

text: November

text: and

text: the

text: Veteran

text: underwent

text: a

text: VA

text: mental

text: health

text: examination

text: in

text: January

text: The

text: VA

text: psychologist

text: did

text: not

text: review

text: the

text: claims

text: file

text: but

text: found

text: the

text: Veteran

text: to

text: be

text: a

text: reliable

text: historian

text: and

text: noted

text: detailed

text: summaries

text: of

text: the

text: Veteran

text: s

text: combat

text: experiences

text: post

text: combat

text: performance

text: problems

text: and

text: discipline

text: the

text: death

text: of

text: his

text: first

text: wife

text: in

text: remarriage

text: in

text: with

text: a

text: supportive

text: relationship

text: and

text: physical

text: disabilities

text: that

text: caused

text: his

text: retirement

text: in

text: March

text: On

text: examination

text: the

text: psychologist

text: noted

text: the

text: Veteran

text: s

text: report

text: of

text: a

text: fair

text: mood

text: and

text: difficulty

text: sleeping

text: because

text: of

text: physical

text: pain

text: but

text: no

text: other

text: deficits

text: The

text: psychologist

text: acknowledged

text: that

text: the

text: Veteran

text: s

text: combat

text: experiences

text: would

text: be

text: sufficient

text: to

text: meet

text: the

text: event

text: criteria

text: for

text: a

text: diagnosis

text: of

text: PTSD

text: but

text: that

text: no

text: diagnosis

text: of

text: a

text: mental

text: health

text: disorder

text: was

text: appropriate

text: because

text: the

text: symptoms

text: were

text: limited

text: to

text: expected

text: reactions

text: to

text: stressors

text: such

text: as

text: the

text: death

text: of

text: his

text: first

text: wife

text: and

text: unwanted

text: forced

text: retirement

text: due

text: to

text: medical

text: issues

text: and

text: related

text: financial

text: distress

text: and

text: not

text: to

text: the

text: events

text: in

text: military

text: service

text: The

text: Veteran

text: stopped

text: VA

text: outpatient

text: mental

text: health

text: treatment

text: in

text: February

text: but

text: returned

text: to

text: seek

text: primary

text: care

text: in

text: April

text: A

text: primary

text: care

text: physician

text: noted

text: the

text: Veteran

text: s

text: reports

text: of

text: irritable

text: mood

text: flashbacks

text: and

text: nightmares

text: about

text: his

text: experiences

text: in

text: Vietnam

text: triggered

text: while

text: driving

text: and

text: smelling

text: smoke

text: The

text: physician

text: referred

text: the

text: Veteran

text: for

text: further

text: mental

text: health

text: care

text: In

text: May

text: a

text: licensed

text: social

text: worker

text: noted

text: the

text: Veteran

text: s

text: reports

text: of

text: his

text: current

text: family

text: situation

text: and

text: inability

text: to

text: work

text: because

text: of

text: his

text: multiple

text: physical

text: disabilities

text: The

text: Veteran

text: reported

text: symptoms

text: of

text: irritability

text: depression

text: and

text: interrupted

text: sleep

text: as

text: well

text: as

text: occasional

text: panic

text: attacks

text: but

text: there

text: was

text: no

text: mention

text: by

text: the

text: Veteran

text: or

text: the

text: examiner

text: of

text: any

text: events

text: in

text: service

text: The

text: social

text: worker

text: diagnosed

text: depression

text: associated

text: with

text: adjustment

text: to

text: mobility

text: deficits

text: In

text: a

text: follow

text: up

text: examination

text: the

text: same

text: day

text: a

text: VA

text: psychiatrist

text: noted

text: that

text: the

text: Veteran

text: s

text: mood

text: was

text: down

text: but

text: not

text: overly

text: so

text: and

text: that

text: symptoms

text: of

text: PTSD

text: were

text: greatly

text: reduced

text: In

text: subsequent

text: treatment

text: encounters

text: in

text: July

text: and

text: August

text: the

text: attending

text: psychiatrist

text: diagnosed

text: both

text: major

text: depressive

text: disorder

text: and

text: related

text: PTSD

text: with

text: diminishing

text: symptoms

text: that

text: did

text: not

text: interfere

text: with

text: activities

text: However

text: in

text: August

text: the

text: psychiatrist

text: noted

text: that

text: the

text: Veteran

text: was

text: not

text: depressed

text: on

text: that

text: occasion

text: In

text: October

text: the

text: VA

text: social

text: worker

text: noted

text: some

text: improvement

text: in

text: isolative

text: behaviors

text: anger

text: issues

text: and

text: disturbed

text: sleep

text: with

text: the

text: use

text: of

text: medication

text: but

text: that

text: the

text: Veteran

text: continued

text: to

text: display

text: a

text: depressed

text: mood

text: caused

text: by

text: thoughts

text: of

text: his

text: fellow

text: soldiers

text: killed

text: in

text: Vietnam

text: how

text: he

text: was

text: treated

text: during

text: service

text: his

text: physical

text: disabilities

text: and

text: the

text: death

text: of

text: his

text: first

text: wife

text: In

text: November

text: the

text: Veteran

text: was

text: diagnosed

text: with

text: major

text: depressive

text: disorder

text: VA

text: treatment

text: records

text: dated

text: from

text: February

text: through

text: May

text: show

text: diagnoses

text: of

text: major

text: depressive

text: disorder

text: and

text: PTSD

text: and

text: ongoing

text: treatment

text: for

text: such

text: disorders

text: from

text: the

text: Veteran

text: s

text: treating

text: psychiatrist

text: psychologist

text: and

text: social

text: worker

text: During

text: the

text: September

text: Board

text: hearing

text: the

text: Veteran

text: testified

text: that

text: he

text: was

text: currently

text: under

text: treatment

text: in

text: an

text: intensive

text: program

text: at

text: a

text: VA

text: mental

text: health

text: clinic

text: for

text: PTSD

text: major

text: depression

text: and

text: anxiety

text: disorder

text: since

text: April

text: and

text: that

text: his

text: psychiatrist

text: had

text: associated

text: the

text: disorders

text: with

text: his

text: combat

text: service

text: The

text: Board

text: finds

text: that

text: service

text: connection

text: for

text: PTSD

text: and

text: major

text: depressive

text: disorder

text: is

text: warranted

text: As

text: an

text: initial

text: matter

text: the

text: Board

text: finds

text: that

text: the

text: Veteran

text: s

text: reports

text: of

text: his

text: traumatic

text: events

text: during

text: combat

text: in

text: Vietnam

text: and

text: current

text: symptoms

text: are

text: competent

text: because

text: they

text: are

text: observable

text: by

text: lay

text: persons

text: and

text: have

text: been

text: accepted

text: without

text: challenge

text: by

text: all

text: clinicians

text: and

text: the

text: January

text: examiner

text: and

text: are

text: consistent

text: with

text: his

text: service

text: records

text: Moreover

text: as

text: the

text: Veteran

text: served

text: in

text: combat

text: his

text: lay

text: statements

text: are

text: sufficient

text: to

text: verify

text: his

text: in

text: service

text: stressors

text: The

text: Board

text: acknowledges

text: that

text: there

text: is

text: competent

text: evidence

text: both

text: for

text: and

text: against

text: a

text: finding

text: that

text: the

text: Veteran

text: has

text: a

text: current

text: psychiatric

text: disorder

text: related

text: to

text: his

text: in

text: service

text: combat

text: stressors

text: The

text: VA

text: psychologist

text: in

text: January

text: provided

text: a

text: detailed

text: history

text: and

text: comprehensive

text: report

text: of

text: his

text: examination

text: in

text: which

text: he

text: acknowledged

text: the

text: combat

text: events

text: and

text: found

text: that

text: they

text: met

text: the

text: traumatic

text: event

text: criteria

text: However

text: he

text: found

text: that

text: the

text: Veteran

text: did

text: not

text: have

text: any

text: diagnosed

text: psychiatric

text: disorder

text: on

text: that

text: one

text: occasion

text: but

text: did

text: not

text: have

text: access

text: to

text: or

text: mention

text: the

text: nature

text: of

text: the

text: VA

text: outpatient

text: care

text: that

text: was

text: provided

text: prior

text: to

text: his

text: examination

text: On

text: the

text: other

text: hand

text: outpatient

text: clinicians

text: in

text: diagnosed

text: depression

text: and

text: possible

text: PTSD

text: albeit

text: with

text: little

text: detailed

text: rationale

text: Nevertheless

text: the

text: clinicians

text: acknowledged

text: the

text: combat

text: events

text: as

text: well

text: as

text: the

text: death

text: of

text: the

text: Veteran

text: s

text: first

text: wife

text: his

text: workplace

text: injuries

text: and

text: surgery

text: and

text: his

text: involuntary

text: retirement

text: In

text: the

text: outpatient

text: clinicians

text: affirmatively

text: diagnosed

text: mild

text: symptoms

text: of

text: depression

text: and

text: PTSD

text: without

text: conditional

text: language

text: but

text: again

text: with

text: little

text: detailed

text: analysis

text: or

text: rationale

text: referring

text: to

text: both

text: physical

text: disabilities

text: as

text: a

text: cause

text: for

text: depression

text: and

text: combat

text: events

text: as

text: causes

text: for

text: nightmares

text: intrusive

text: memories

text: and

text: irritability

text: However

text: beginning

text: in

text: February

text: VA

text: treatment

text: records

text: reflect

text: diagnoses

text: of

text: PTSD

text: and

text: major

text: depressive

text: disorder

text: and

text: ongoing

text: treatment

text: for

text: such

text: disorders

text: from

text: the

text: Veteran

text: s

text: treating

text: psychiatrist

text: psychologist

text: and

text: social

text: worker

text: Moreover

text: the

text: Veteran

text: s

text: testimony

text: regarding

text: a

text: intensive

text: mental

text: health

text: treatment

text: program

text: for

text: PTSD

text: depression

text: and

text: anxiety

text: which

text: he

text: reported

text: had

text: been

text: related

text: to

text: his

text: in

text: service

text: combat

text: stressors

text: is

text: competent

text: and

text: credible

text: in

text: light

text: of

text: his

text: ongoing

text: treatment

text: for

text: such

text: disorders

text: Therefore

text: resolving

text: all

text: doubt

text: in

text: favor

text: of

text: the

text: Veteran

text: the

text: Board

text: finds

text: that

text: the

text: competent

text: and

text: credible

text: evidence

text: shows

text: that

text: diagnoses

text: of

text: PTSD

text: and

text: major

text: depressive

text: disorder

text: were

text: rendered

text: during

text: portions

text: of

text: the

text: pendency

text: of

text: the

text: Veteran

text: s

text: claim

text: and

text: such

text: were

text: at

text: least

text: in

text: part

text: related

text: to

text: traumatic

text: events

text: during

text: combat

text: in

text: Vietnam

text: Consequently

text: service

text: connection

text: for

text: such

text: acquired

text: psychiatric

text: disorders

text: is

text: warranted

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Gilbert

text: supra

text: ORDER

text: Service

text: connection

text: for

text: PTSD

text: and

text: major

text: depressive

text: disorder

text: is

text: granted

text: A

text: JAEGER

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs