text:
Citation Nr: 1554165
Decision Date: 12/29/15    Archive Date: 01/07/16

DOCKET NO.  11-06 043	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina

THE ISSUE

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

REPRESENTATION

Appellant represented by:	Mary M. Markovich, Attorney

ATTORNEY FOR THE BOARD

Christine C. Kung, Counsel

INTRODUCTION

The Veteran served on active duty from January 1977 to January 1981.

This matter comes on appeal before the Board of Veterans' Appeals (Board) from an October 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office in Winston-Salem, North Carolina (RO).

The Board remanded the appeal in September 2011 to obtain private psychiatric treatment records and to attempt to verify the Veteran's stressor thorough the Irvine Police Department.  The Agency of Original Jurisdiction (AOJ) substantially complied with the remand order, and the Board finds that it may proceed with a decision at this time.  See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (Fed. Cir. 2002).

In an April 2014 decision, the Board denied service connection for PTSD.  The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court or CAVC).  In July 2015, the Court vacated that Board's decision and remanded the case to the Board for readjudication in compliance with a July 2015 Joint Motion.  The Court found that the Board erred by failing to provide an adequate statement of reasons or bases for its findings as to the credibility and probative value of the accounts of the Veteran and Gunnery Sergeant W.C. with regard to an in-service assault.  The appeal is once again before the Board for review.

FINDINGS OF FACT

1.  An in-service stressor sufficient to cause PTSD is corroborated by evidence of record.

2.  The Veteran has a current DSM-IV diagnosis of PTSD.

3.  Currently diagnosed PTSD is related to a verified in-service stressor.

CONCLUSION OF LAW

Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for PTSD are met.  38 U.S.C.A. §§ 1101, 1110, 5107, 5121 (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2015).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Duties to Notify and Assist

The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance in substantiating a claim for VA benefits.  38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.326(a) (2014).  The Board is granting service connection for PTSD.  Because this decision constitutes a full grant of the benefits sought on appeal, no further discussion regarding VCAA notice or assistance duties is required.

Service Connection Laws and Regulations

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service.  38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service.  Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004);
see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown,
7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996).  In this case, PTSD is not a "chronic diseases" listed under 38 C.F.R. § 3.309(a) and the Veteran has not been diagnosed with psychosis; therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) do not apply.  Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

In adjudicating a claim for service connection for PTSD, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence.  Hayes v. Brown, 5 Vet. App. 60, 66 (1993); see also 38 U.S.C.A. § 1154(a); 38 C.F.R.
§ 3.304(f).  The evidence necessary to establish the occurrence of an in-service stressor for PTSD will vary depending on whether or not the veteran "engaged in combat with the enemy."  Id.

If VA determines that a veteran engaged in combat with the enemy and that the alleged stressor is related to combat, then the veteran's lay testimony or statements are accepted as conclusive evidence of the occurrence of the claimed stressor.
38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f).  No further development or corroborative evidence is required, provided that the claimed stressor is "consistent with the circumstances, conditions, or hardships of the veteran's service."  Id.

If, however, VA determines that the veteran did not engage in combat with the enemy or that the alleged stressor is not related to combat, the veteran's lay testimony by itself is not sufficient to establish the occurrence of the alleged stressor.  Instead, the record must contain service records or other evidence to corroborate the veteran's testimony or statements.  See Moreau v. Brown, 9 Vet. App. 389, 394 (1996).

The question of whether a veteran was exposed to a stressor in service is a factual one, and VA adjudicators are not bound to accept uncorroborated accounts of stressors or medical opinions based upon such accounts.  Wood v. Derwinski, 1 Vet. App. 190 (1991), aff'd on reconsideration, 1 Vet. App. 406 (1991).  Hence, whether a stressor was of sufficient gravity to cause or support a diagnosis of PTSD is a question of fact for medical professionals and whether the evidence establishes the occurrence of stressors is a question of fact for adjudicators.

The law provides that, if a PTSD claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident.  Gallegos v. Peake, 22 Vet. App. 329 (2008).  Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these 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.  38 C.F.R. § 3.304(f)(3).

Additionally, under 38 C.F.R. § 3.304(f), VA can submit any evidence, including alternate source evidence, to a medical or mental health professional for interpretation. Bradford v. Nicholson, 20 Vet. App. 200 (2006).  Most significantly, for claims involving an in-service personal assault, after-the-fact medical evidence can be used to establish a stressor.  Id; Patton v. West, 12 Vet. App. 272, 278 (1999).

If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor.  38 C.F.R. § 3.304(f)(3).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant.  Gabrielson v. Brown, 7 Vet. App. 36, 39-40   (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).  Competency of evidence differs from weight and credibility.  Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted.  Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Service Connection Analysis

The Veteran contends in various lay statements, to include an August 2009 stressor statement that in November 1977, while stationed in El Toro, California, he went to a pub off base to play pool, and was threatened with death by a man with a rifle.  In a later September 2010 statement, the Veteran identified the name of the pub as Peyton Place.  The Board finds that the Veteran has claimed service connection for PTSD due to non-combat stressors; therefore, the claimed stressor must be corroborated by credible supporting evidence.  See Moreau, 9 Vet. App. 389.

After a review of all the evidence, the Board finds that the evidence is at least in equipoise on the question of whether the Veteran's claimed in-service stressor of an in-service assault has been corroborated by the evidence of record.  The Board finds that the Veteran is competent to describe the in-service assault with a deadly weapon, and the Board finds that the Veteran's statements and testimony are credible as his descriptions of such events have been consistent throughout the record.  While the RO attempted to corroborate the Veteran's testimony through official sources, service personnel records do not confirm the Veteran's report of the incident in November 1977, and correspondence with the Irvine Police Department dated in November 2010 and November 2012 shows that they do not keep records of assaults for more than 10 years.  The Board finds, however, that the Veteran has provided sufficient corroborating evidence in the form of lay statements provided by Gunnery Sargent W.C.  A March 2009 statement from W.C. shows that he and the Veteran were stationed together in El Toro, California in 1977, and that they went to the pub together to play pool during the incident in question.  W.C. more recently submitted a notarized affidavit in November 2015 in which he describes the same incident in more detail.  W.C.'s statements indicate that while he and the Veteran were playing pool, a civilian stranger came up to the Veteran and started acting aggressively.  In response, the Veteran prepared to leave and return to base and was in the parking lot when the stranger pulled a rifle out of the trunk of his car, pointed it at the Veteran, and told him, "Today, you are going to die."  W.C. stated that he witnessed the incident from the doorway of the pub.  The bartender was able to talk the man down, and the Veteran and W.C. ran back to base while he was distracted.  They reported the incident to the Barrack Sergeant, who was later informed that the police had been called and removed the man from the premises.  The Board finds that W.C.'s statement corroborates the occurrence of the Veteran's reported in-service assault.  Resolving all reasonable doubt in favor of the Veteran, the Board finds that the reported in-service stressful event of an in-service assault has been corroborated by lay evidence of record.

The Veteran has a current DSM-IV diagnosis of PTSD related to the verified in-service assault.  Service treatment records do not reflect any psychiatric treatment or complaints.  Private treatment records from Dr. E.H. show that the Veteran was initially evaluated for PTSD in March 2009.  At that time, he described his in-service stressor of being threatened with a gun and reported the onset of nightmares in 1977.  In the initial evaluation and in a more comprehensive September 2011 evaluation, the Veteran was assessed with chronic PTSD and chronic major depression, related to the verified in-service assault.  The Veteran was treated by Dr. E.H. with medication management and psychotherapy.  Progress notes from Dr. E.H. are of record.  An additional October 2015 PTSD evaluation, completed by Dr. E.M. is also of record.

The Board finds that the diagnoses of PTSD related to a verified in-service stressor provided by the Veteran's treating psychiatrist, when considered psychiatric treatment records, is probative as it was based on an accurate factual background, a discussion of the Veteran's in-service stressful incident, and psychiatric evaluation of the Veteran.  See Reonal, 5 Vet. App. at 461; Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (holding "It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion").  Dr. E.H. has provided DSM-IV diagnoses of PTSD related to the Veteran's in-service personal assault.  For these reasons, and resolving reasonable doubt in the Veteran's favor, the Board finds that the criteria for service connection for PTSD with depression have been met.  38 U.S.C.A.  § 5107(b); 38 C.F.R. § 3.102 (2015).

ORDER

Service connection for PTSD with depression is granted.

____________________________________________
K. J. Alibrando
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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text: adjudicators

text: The

text: law

text: provides

text: that

text: if

text: a

text: PTSD

text: claim

text: is

text: based

text: on

text: in

text: service

text: personal

text: assault

text: evidence

text: from

text: sources

text: other

text: than

text: the

text: veteran

text: s

text: service

text: records

text: may

text: corroborate

text: the

text: veteran

text: s

text: account

text: of

text: the

text: stressor

text: incident

text: Gallegos

text: v

text: Peake

text: Vet

text: App

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: rape

text: crisis

text: centers

text: mental

text: health

text: counseling

text: centers

text: hospitals

text: or

text: physicians

text: pregnancy

text: tests

text: or

text: tests

text: for

text: sexually

text: transmitted

text: diseases

text: and

text: statements

text: from

text: family

text: members

text: roommates

text: fellow

text: service

text: members

text: or

text: clergy

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: these

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: C

text: F

text: R

text: f

text: Additionally

text: under

text: C

text: F

text: R

text: f

text: VA

text: can

text: submit

text: any

text: evidence

text: including

text: alternate

text: source

text: evidence

text: to

text: a

text: medical

text: or

text: mental

text: health

text: professional

text: for

text: interpretation

text: Bradford

text: v

text: Nicholson

text: Vet

text: App

text: Most

text: significantly

text: for

text: claims

text: involving

text: an

text: in

text: service

text: personal

text: assault

text: after

text: the

text: fact

text: medical

text: evidence

text: can

text: be

text: used

text: to

text: establish

text: a

text: stressor

text: Id

text: Patton

text: v

text: West

text: Vet

text: App

text: If

text: a

text: stressor

text: claimed

text: by

text: a

text: veteran

text: is

text: related

text: to

text: the

text: veteran

text: s

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: and

text: a

text: VA

text: psychiatrist

text: or

text: psychologist

text: or

text: a

text: psychiatrist

text: or

text: psychologist

text: with

text: whom

text: VA

text: has

text: contracted

text: confirms

text: that

text: the

text: claimed

text: stressor

text: is

text: adequate

text: to

text: support

text: a

text: diagnosis

text: of

text: PTSD

text: and

text: that

text: the

text: veteran

text: s

text: symptoms

text: are

text: related

text: to

text: the

text: claimed

text: stressor

text: in

text: the

text: absence

text: of

text: clear

text: and

text: convincing

text: evidence

text: to

text: the

text: contrary

text: and

text: provided

text: the

text: claimed

text: stressor

text: is

text: consistent

text: with

text: the

text: places

text: types

text: and

text: circumstances

text: of

text: the

text: veteran

text: s

text: service

text: the

text: veteran

text: s

text: lay

text: testimony

text: alone

text: may

text: establish

text: the

text: occurrence

text: of

text: the

text: claimed

text: in

text: service

text: stressor

text: C

text: F

text: R

text: f

text: In

text: rendering

text: a

text: decision

text: on

text: appeal

text: the

text: Board

text: must

text: analyze

text: the

text: credibility

text: and

text: probative

text: value

text: of

text: the

text: evidence

text: account

text: for

text: the

text: evidence

text: which

text: it

text: finds

text: to

text: be

text: persuasive

text: or

text: unpersuasive

text: and

text: provide

text: the

text: reasons

text: for

text: its

text: rejection

text: of

text: any

text: material

text: evidence

text: favorable

text: to

text: the

text: claimant

text: Gabrielson

text: v

text: Brown

text: Vet

text: App

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: Competency

text: of

text: evidence

text: differs

text: from

text: weight

text: and

text: credibility

text: Competency

text: is

text: a

text: legal

text: concept

text: determining

text: whether

text: testimony

text: may

text: be

text: heard

text: and

text: considered

text: by

text: the

text: trier

text: of

text: fact

text: while

text: credibility

text: is

text: a

text: factual

text: determination

text: going

text: to

text: the

text: probative

text: value

text: of

text: the

text: evidence

text: to

text: be

text: made

text: after

text: the

text: evidence

text: has

text: been

text: admitted

text: Rucker

text: v

text: Brown

text: Vet

text: App

text: Layno

text: v

text: Brown

text: Vet

text: App

text: see

text: also

text: Cartright

text: v

text: Derwinski

text: Vet

text: App

text: although

text: interest

text: may

text: affect

text: the

text: credibility

text: of

text: testimony

text: it

text: does

text: not

text: affect

text: competency

text: to

text: testify

text: Service

text: Connection

text: Analysis

text: The

text: Veteran

text: contends

text: in

text: various

text: lay

text: statements

text: to

text: include

text: an

text: August

text: stressor

text: statement

text: that

text: in

text: November

text: while

text: stationed

text: in

text: El

text: Toro

text: California

text: he

text: went

text: to

text: a

text: pub

text: off

text: base

text: to

text: play

text: pool

text: and

text: was

text: threatened

text: with

text: death

text: by

text: a

text: man

text: with

text: a

text: rifle

text: In

text: a

text: later

text: September

text: statement

text: the

text: Veteran

text: identified

text: the

text: name

text: of

text: the

text: pub

text: as

text: Peyton

text: Place

text: The

text: Board

text: finds

text: that

text: the

text: Veteran

text: has

text: claimed

text: service

text: connection

text: for

text: PTSD

text: due

text: to

text: non

text: combat

text: stressors

text: therefore

text: the

text: claimed

text: stressor

text: must

text: be

text: corroborated

text: by

text: credible

text: supporting

text: evidence

text: See

text: Moreau

text: Vet

text: App

text: After

text: a

text: review

text: of

text: all

text: the

text: evidence

text: the

text: Board

text: finds

text: that

text: the

text: evidence

text: is

text: at

text: least

text: in

text: equipoise

text: on

text: the

text: question

text: of

text: whether

text: the

text: Veteran

text: s

text: claimed

text: in

text: service

text: stressor

text: of

text: an

text: in

text: service

text: assault

text: has

text: been

text: corroborated

text: by

text: the

text: evidence

text: of

text: record

text: The

text: Board

text: finds

text: that

text: the

text: Veteran

text: is

text: competent

text: to

text: describe

text: the

text: in

text: service

text: assault

text: with

text: a

text: deadly

text: weapon

text: and

text: the

text: Board

text: finds

text: that

text: the

text: Veteran

text: s

text: statements

text: and

text: testimony

text: are

text: credible

text: as

text: his

text: descriptions

text: of

text: such

text: events

text: have

text: been

text: consistent

text: throughout

text: the

text: record

text: While

text: the

text: RO

text: attempted

text: to

text: corroborate

text: the

text: Veteran

text: s

text: testimony

text: through

text: official

text: sources

text: service

text: personnel

text: records

text: do

text: not

text: confirm

text: the

text: Veteran

text: s

text: report

text: of

text: the

text: incident

text: in

text: November

text: and

text: correspondence

text: with

text: the

text: Irvine

text: Police

text: Department

text: dated

text: in

text: November

text: and

text: November

text: shows

text: that

text: they

text: do

text: not

text: keep

text: records

text: of

text: assaults

text: for

text: more

text: than

text: years

text: The

text: Board

text: finds

text: however

text: that

text: the

text: Veteran

text: has

text: provided

text: sufficient

text: corroborating

text: evidence

text: in

text: the

text: form

text: of

text: lay

text: statements

text: provided

text: by

text: Gunnery

text: Sargent

text: W

text: C

text: A

text: March

text: statement

text: from

text: W

text: C

text: shows

text: that

text: he

text: and

text: the

text: Veteran

text: were

text: stationed

text: together

text: in

text: El

text: Toro

text: California

text: in

text: and

text: that

text: they

text: went

text: to

text: the

text: pub

text: together

text: to

text: play

text: pool

text: during

text: the

text: incident

text: in

text: question

text: W

text: C

text: more

text: recently

text: submitted

text: a

text: notarized

text: affidavit

text: in

text: November

text: in

text: which

text: he

text: describes

text: the

text: same

text: incident

text: in

text: more

text: detail

text: W

text: C

text: s

text: statements

text: indicate

text: that

text: while

text: he

text: and

text: the

text: Veteran

text: were

text: playing

text: pool

text: a

text: civilian

text: stranger

text: came

text: up

text: to

text: the

text: Veteran

text: and

text: started

text: acting

text: aggressively

text: In

text: response

text: the

text: Veteran

text: prepared

text: to

text: leave

text: and

text: return

text: to

text: base

text: and

text: was

text: in

text: the

text: parking

text: lot

text: when

text: the

text: stranger

text: pulled

text: a

text: rifle

text: out

text: of

text: the

text: trunk

text: of

text: his

text: car

text: pointed

text: it

text: at

text: the

text: Veteran

text: and

text: told

text: him

text: Today

text: you

text: are

text: going

text: to

text: die

text: W

text: C

text: stated

text: that

text: he

text: witnessed

text: the

text: incident

text: from

text: the

text: doorway

text: of

text: the

text: pub

text: The

text: bartender

text: was

text: able

text: to

text: talk

text: the

text: man

text: down

text: and

text: the

text: Veteran

text: and

text: W

text: C

text: ran

text: back

text: to

text: base

text: while

text: he

text: was

text: distracted

text: They

text: reported

text: the

text: incident

text: to

text: the

text: Barrack

text: Sergeant

text: who

text: was

text: later

text: informed

text: that

text: the

text: police

text: had

text: been

text: called

text: and

text: removed

text: the

text: man

text: from

text: the

text: premises

text: The

text: Board

text: finds

text: that

text: W

text: C

text: s

text: statement

text: corroborates

text: the

text: occurrence

text: of

text: the

text: Veteran

text: s

text: reported

text: in

text: service

text: assault

text: Resolving

text: all

text: reasonable

text: doubt

text: in

text: favor

text: of

text: the

text: Veteran

text: the

text: Board

text: finds

text: that

text: the

text: reported

text: in

text: service

text: stressful

text: event

text: of

text: an

text: in

text: service

text: assault

text: has

text: been

text: corroborated

text: by

text: lay

text: evidence

text: of

text: record

text: The

text: Veteran

text: has

text: a

text: current

text: DSM

text: IV

text: diagnosis

text: of

text: PTSD

text: related

text: to

text: the

text: verified

text: in

text: service

text: assault

text: Service

text: treatment

text: records

text: do

text: not

text: reflect

text: any

text: psychiatric

text: treatment

text: or

text: complaints

text: Private

text: treatment

text: records

text: from

text: Dr

text: E

text: H

text: show

text: that

text: the

text: Veteran

text: was

text: initially

text: evaluated

text: for

text: PTSD

text: in

text: March

text: At

text: that

text: time

text: he

text: described

text: his

text: in

text: service

text: stressor

text: of

text: being

text: threatened

text: with

text: a

text: gun

text: and

text: reported

text: the

text: onset

text: of

text: nightmares

text: in

text: In

text: the

text: initial

text: evaluation

text: and

text: in

text: a

text: more

text: comprehensive

text: September

text: evaluation

text: the

text: Veteran

text: was

text: assessed

text: with

text: chronic

text: PTSD

text: and

text: chronic

text: major

text: depression

text: related

text: to

text: the

text: verified

text: in

text: service

text: assault

text: The

text: Veteran

text: was

text: treated

text: by

text: Dr

text: E

text: H

text: with

text: medication

text: management

text: and

text: psychotherapy

text: Progress

text: notes

text: from

text: Dr

text: E

text: H

text: are

text: of

text: record

text: An

text: additional

text: October

text: PTSD

text: evaluation

text: completed

text: by

text: Dr

text: E

text: M

text: is

text: also

text: of

text: record

text: The

text: Board

text: finds

text: that

text: the

text: diagnoses

text: of

text: PTSD

text: related

text: to

text: a

text: verified

text: in

text: service

text: stressor

text: provided

text: by

text: the

text: Veteran

text: s

text: treating

text: psychiatrist

text: when

text: considered

text: psychiatric

text: treatment

text: records

text: is

text: probative

text: as

text: it

text: was

text: based

text: on

text: an

text: accurate

text: factual

text: background

text: a

text: discussion

text: of

text: the

text: Veteran

text: s

text: in

text: service

text: stressful

text: incident

text: and

text: psychiatric

text: evaluation

text: of

text: the

text: Veteran

text: See

text: Reonal

text: Vet

text: App

text: at

text: Nieves

text: Rodriguez

text: v

text: Peake

text: Vet

text: App

text: holding

text: It

text: is

text: the

text: factually

text: accurate

text: fully

text: articulated

text: sound

text: reasoning

text: for

text: the

text: conclusion

text: not

text: the

text: mere

text: fact

text: that

text: the

text: claims

text: file

text: was

text: reviewed

text: that

text: contributes

text: probative

text: value

text: to

text: a

text: medical

text: opinion

text: Dr

text: E

text: H

text: has

text: provided

text: DSM

text: IV

text: diagnoses

text: of

text: PTSD

text: related

text: to

text: the

text: Veteran

text: s

text: in

text: service

text: personal

text: assault

text: For

text: these

text: reasons

text: and

text: resolving

text: reasonable

text: doubt

text: in

text: the

text: Veteran

text: s

text: favor

text: the

text: Board

text: finds

text: that

text: the

text: criteria

text: for

text: service

text: connection

text: for

text: PTSD

text: with

text: depression

text: have

text: been

text: met

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: ORDER

text: Service

text: connection

text: for

text: PTSD

text: with

text: depression

text: is

text: granted

text: K

text: J

text: Alibrando

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs