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Citation Nr: 1709261
Decision Date: 03/24/17    Archive Date: 04/07/17

DOCKET NO.  07-00 021A	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Roanoke, Virginia

THE ISSUE

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

REPRESENTATION

Veteran represented by:	Eric A. Gang, Attorney at Law

ATTORNEY FOR THE BOARD

P.S. Rubin, Counsel

INTRODUCTION

The Veteran had active duty service in the U.S. Marine Corps from February 1973 to September 1975 and in the U.S. Air Force from February 1985 to October 1985.  He also served in the Air Force Reserve, Marine Corps Reserve, and Army and Air National Guards of various states from 1975 to 1995.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2005 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California.  Jurisdiction of case has since been transferred to the RO in Roanoke, Virginia.  That office forwarded his appeal to the Board.

A review of the Virtual VA paperless claims processing system and the Veterans Benefits Management System (VBMS) reveals additional service treatment records, service personnel records, attorney letters, Veterans Service Organizations (VSO) briefs, and VA treatment records that have been reviewed by the Board.

In an earlier December 2010 Board decision, the Board denied the Veteran's claim for service connection for PTSD.  The Veteran appealed the Board's December 2010 decision to the United States Court of Appeals for Veterans Claims (Court).

In a July 2011 Order, the Court vacated and remanded the Board's decision as to issue of service connection for PTSD, for proceedings consistent with a Joint Motion for Remand (Joint Motion).

Upon return from the Court, in May 2012 and May 2016, the Board remanded the PTSD issue for further development.  The case has been returned to the Board for further appellate consideration.

FINDINGS OF FACT

1.  There is credible supporting evidence of the Veteran's in-service exposure to noncombat-related stressors in the Marine Corps in April 1975 during Operations Eagle Pull and Frequent Wind, involving evacuations in Cambodia and Vietnam.  These stressors included rockets and bombs heard on the outskirts of the cities, mass evacuations of embassy and civilian personnel with panic and unsanitary conditions, and witnessing the bodies of 30 dead marines.

2.  There is an approximate balance of favorable and unfavorable evidence as to whether the Veteran has a current diagnosis of PTSD that is related to the confirmed in-service stressors from Cambodia and Vietnam.

CONCLUSION OF LAW

Resolving all reasonable doubt in his favor, the Veteran has PTSD with depression that was incurred in active military service.  38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304(f), 3.310, 4.125(a) (2016).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

I.  VA's Duty to Notify and Assist

The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits.  38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2014); Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2015).  The VCAA applies to the instant service connection claim for an acquired psychiatric disorder, to include PTSD.  However, the Veteran was provided adequate VCAA notice for the appeal in May 2004, August 2004, December 2004, April 2005, June 2005, March 2006, and April 2006.  Also, the May 2004 letter included a copy of a VA form with specific instructions for identifying PTSD stressors.

Moreover, if any defect in VCAA notice or assistance is found, such defect is not prejudicial to the Veteran, given the completely favorable disposition of the PTSD and depression appeal.  Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993).

II.  Service Connection for PTSD

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, 1131; 38 C.F.R. § 3.303(a).  In addition, disorders diagnosed after discharge may also still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service.   38 C.F.R. § 3.303(d).   See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).  As a general matter, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement.  Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Service connection for PTSD has unique evidentiary requirements.  It generally requires:  (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-IV); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor.  38 C.F.R. § 3.304(f).  See also Cohen v. Brown, 10 Vet. App. 128 (1997).

Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the DSM-IV and replace them with references to the recently updated Diagnostic and Statistical Manual (Fifth Edition) (the DSM-5).  See 79 Fed. Reg. 45,094 (August 4, 2014).  VA adopted as final, without change, this interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board on or before August 4, 2014.  See Schedule for Rating Disabilities - Mental Disorders and Definition of Psychosis for Certain VA Purposes, 80 Fed. Reg. 14,308 (March 19, 2015).  In the present case, the RO certified the Veteran's PTSD appeal to the Board in August 2007, several years prior to August 4, 2014.  Thus, DSM-IV is still the governing directive.  That is, the amended 38 C.F.R. § 4.125 conforming to the DSM-5 is not applicable in the present case.  In any event, the Board will still consider any private or VA examiner's discussion of both the DSM-IV and DSM-5 in adjudicating the current Veteran's PTSD claim, in order to provide the Veteran with every benefit of the doubt.

If it is established through military citation or other supportive evidence that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships 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)(2). See also 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d); Gaines v. West, 11 Vet. App. 353 (1998) (Board must make a specific finding as to whether the Veteran engaged in combat).  To gain the benefit of a relaxed standard for proof of service incurrence of an injury or disease, 38 U.S.C.A. § 1154(b) requires that the veteran have actually participated in combat with the enemy.  See VAOPGCPREC 12-99.

If VA determines either that the veteran did not engage in combat with the enemy or that the veteran did engage in combat, but that the alleged stressor is not combat related, the veteran's lay testimony, by itself, is not sufficient to establish the occurrence of the alleged stressor.  Instead, the record must contain credible supporting evidence that corroborates the veteran's testimony or statements.  38 C.F.R. § 3.304(f); Stone v. Nicholson, 480 F.3d 1111 (Fed. Cir. 2007); Cohen v. Brown, 10 Vet. App. 128, 147 (1997); Moreau v. Brown, 9 Vet. App. 389, 395 (1996).

However, corroboration of every detail of a claimed stressor, including the veteran's personal participation, is not required; rather, a veteran only needs to offer independent evidence of a stressful event that is sufficient to imply his or her personal exposure.  See Pentecost v. Principi, 16 Vet. App. 124, 128 (2002) (quoting Suozzi v. Brown, 10 Vet. App. 307 (1997)).  In other words, a veteran's presence with the unit at the time such attacks occurred corroborates his statement that he experienced such attacks personally.  Suozzi v. Brown, 10 Vet. App. 307, 311 (1997).

The final requirement of 38 C.F.R. § 3.304(f) is medical evidence of a nexus between the claimed in-service stressor and the current disability.  However, such after-the-fact medical nexus evidence generally cannot also be the sole evidence of the occurrence of the claimed stressor.  Moreau, 9 Vet. App. at 396.

Effective July 13, 2010, if a stressor claimed by a veteran is related to that 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 a 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 that veteran's service, a veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor.  38 C.F.R. § 3.304(f)(3).

"[F]ear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.  See id.

A veteran must have experienced, witnessed, or have been confronted by an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of that veteran or others, and that veteran's response to the event or circumstance must have involved a psychological or psycho-physiological state of fear, helplessness, or horror.  The occurrence of an actual event or circumstance is necessary.  In making this determination, VA must duly consider the places, types, and circumstances of a veteran's service as shown by the service record, the official history of each organization in which such a veteran served, a veteran's medical records, and all pertinent medical and lay evidence.  The new rule is limited to cases in which the claimed stressor is related to a veteran's fear of hostile military or terrorist activity.  See 75 Fed. Reg. 39,843 (Jul. 13, 2010).

With regard to an actual diagnosis of PTSD, lay persons are not categorically incompetent to speak on matters of medical diagnosis or etiology.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).  The Board must consider the type of condition specifically claimed and whether it is readily amenable to lay diagnosis or probative comment on etiology.  See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).  In this regard, the Federal Circuit recently held that "PTSD is not the type of medical condition that lay evidence . . . is competent and sufficient to identify."  Young v. McDonald, 766 F.3d 1348, 1352-53 (Fed. Cir. 2014).  Regardless, the Board acknowledges the Veteran is competent to report psychiatric symptoms both during and after service.  See 38 C.F.R. § 3.159(a)(2); Jandreau, 492 F.3d at 1377 (discussing that Veteran is competent to report a contemporaneous medical diagnosis); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (discussing general competency of a Veteran to report psychiatric symptoms).

That is, lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Davidson, 581 F.3d at 1316.  See also Jandreau, 492 F.3d at 1376-77.

In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine.  38 U.S.C.A. 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991).

The Veteran contends that he has PTSD as the result of exposure to noncombat-related stressors during his service with the Marine Corps from February 1973 to September 1975.  Specifically, he states that while serving as an Amtrac crewman in the Marine Corps in April 1975 during Operations Eagle Pull and Frequent Wind, involving evacuations in Cambodia and Vietnam, he was confronted with several traumatic stressors.  These stressors included hearing rockets and bombs on the outskirts of the cities, witnessing the mass evacuations of embassy and civilian personnel with panic and unsanitary conditions, and witnessing the bodies of 30 dead Marines.  He asserts these incidents were extremely traumatic for him.  He believes his mental problems began during his Vietnam and Cambodia service, and have continued to this day.  The Veteran alleges PTSD-related symptoms since service to include nightmares, insomnia, flashbacks, re-experiencing, intrusive thoughts, avoidance, hypervigilance, detachment, numbness, paranoia, depression, and anxiety.  The Veteran does not assert he received any therapy or treatment for his psychiatric problems until 1997, many years after active duty service.  See March 2008 Veteran's statement; February 2012 buddy statement from soldier who served with the Veteran; April 2012 private counselor opinion; December 2016 VA psychological examination.

Upon review of the evidence of record, the Board grants the appeal for service connection for PTSD with depression.

Initially, the Veteran's service personnel records (SPRs) and Reports of Separation from the Armed Forces (DD Form 214s) do not reflect receipt of medals, badges, or decorations that specifically denote combat with the enemy.  His military occupational specialty (MOS) was an Amtrac crewman, which is not indicative of combat.  Moreover, his SPRs indicate he did not participate in any combat campaigns and received no wounds due to combat.  Thus, the combat provisions are not for application.  38 C.F.R. § 3.304(f)(2).  See also 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d) (pertaining to combat Veterans).

With respect to the non-combat stressors of hearing rockets and bombs on the outskirts of the cities, witnessing the mass evacuations of embassy and civilian personnel with panic and unsanitary conditions, and witnessing the bodies of 30 dead marines, that occurred at that time off the evacuations of Cambodia and Vietnam in April 1975, there is credible supporting evidence that exposure to these stressors occurred.  38 C.F.R. § 3.304(f); Cohen, 10 Vet. App. at 147; Moreau, 9 Vet. App. at 395.

In particular, the Veteran has submitted a February 2012 buddy statement from a soldier who served with the Veteran in Cambodia and Vietnam, verifying elements of exposure to the above stressors.  In addition, the Veteran's SPRs and DD Form 215s indicate that he took part in operations Eagle Pull and Frequent Wind.  Both of these operations involved recovery of embassy and civilians from Phnom Pen, Cambodia and Saigon, South Vietnam in April 1975.  The Veteran's military occupational specialty (MOS) in the Marine Corps as an Amtrac (amphibious tractor) crewman, also provides support for the fact that he was involved in the evacuations. The SPRs verify the Veteran was in a combat zone during coastal operations, patrols, etc., while evacuations were occurring in April 1975.  The Veteran's SPRs confirm the Veteran received the Armed Forces Expeditionary Medal with one bronze star, and the Humanitarian Service Medal with bronze numeral "2" for his service in "Operation Eagle Pull and Operation Frequent Wind 1975."  The Veteran also submitted various internet articles, publications, and eye-witness accounts of the situation in Saigon during the April 1975 evacuations, which described a scene of "confusion, panic, [and] anxiety" with "shells and rockets . . . pounding the outskirts" of the city.  Thus, this evidence of record shows it was highly plausible the Veteran experienced exposure to these stressors.  Moreover, under the amended PTSD regulation, the December 2016 VA psychological examiner further assessed that the Veteran's stressors were related to his "fear of hostile military or terrorist activity."  38 C.F.R. § 3.304(f)(3).  Again, a stressor need not be corroborated in every detail, including the Veteran's personal participation.  Pentecost, 16 Vet. App. at 128.  In summary, there is sufficient credible evidence to verify the occurrence of the Veteran's noncombat- related stressors in April 1975.  38 C.F.R. § 3.304(f).

The Veteran's service treatment records (STRs) dated from 1973 to 1975, and in 1985, as well as his National Guard / Reserve records dated from 1975 to 1995, do not reveal any treatment or diagnosis of PTSD or any other acquired psychiatric disorder.  The Veteran denied any depressive symptomatology at various STR and National Guard Reports of Medical History throughout the years up to 1995.  In any event, as to PTSD, an in-service diagnosis is not required.  See 38 C.F.R. § 3.304(f).

Post-service, it appears the Veteran was first treated for PTSD and depression in 1997, according to VA treatment records.  From 1997 to 2016, VA medical personnel in VA treatment records and VA examinations have rendered various diagnoses for the Veteran, to include the following:  depression, mental disorder NOS, mood disorder, adjustment disorder, personality change, schizotypal personality disorder, Asperger's, rule out (R/O) bipolar disorder, R/O psychosis NOS, R/O obsessive compulsive disorder (OCD), R/O anxiety NOS, and R/O mood disorder secondary to traumatic brain injury.

Post-service, with respect to the criteria of a current diagnosis of PTSD, the threshold consideration for any service connection claim is the existence of a current disability.  38 U.S.C.A. § 1110; 38 C.F.R. § 3.303; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).   In particular, aside from corroboration of an in-service stressor (this element is already met here), current medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-IV) is required, as well as competent evidence of a nexus between current PTSD symptomatology and his verified in-service stressor.  38 C.F.R. § 3.304(f).  See also Cohen v. Brown, 10 Vet. App. 128 (1997).

With regard to a diagnosis of PTSD based on his already confirmed in-service noncombat-related stressors from Operation Eagle Pull and Operation Frequent Wind in April 1975, the record is mixed and reflects several favorable and unfavorable medical opinions and treatment records.  However, upon review of this evidence, the Board concludes that the evidence of record is equally balanced in finding that the Veteran has a PTSD diagnosis due to the verified in-service stressors, in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-IV).

The Board must determine, as a question of fact, both the weight and credibility of the evidence.  Equal weight is not accorded to each piece of evidence contained in a record; every item does not have the same probative value.  The Board must account for the evidence which it finds to be persuasive or unpersuasive, analyze the credibility and probative value of all material evidence submitted by and on behalf of a claimant, and provide the reasons for its rejection of any such evidence.  See Struck v. Brown, 9 Vet. App. 145, 152 (1996); Caluza v. Brown, 7 Vet. App. 498, 506 (1995); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994); Abernathy v. Principi, 3 Vet. App. 461, 465 (1992); Simon v. Derwinski, 2 Vet. App. 621, 622 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164, 169 (1991).

It is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons or bases.  See Owens v. Brown, 7 Vet. App. 429, 433 (1995).

When VA undertakes to provide a medical examination or opinion, it must be adequate.  See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) ("[O]nce the Secretary undertakes the effort to provide an examination when developing a service-connection claim ..., he must provide an adequate one....").  An examination or opinion is adequate if it is "thorough and contemporaneous," considers the Veteran's prior medical examinations and treatment, and "describes the disability ... in sufficient detail so that the Board's 'evaluation of the claimed disability will be a fully informed one.'"  Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (quoting Ardison v. Brown, 6 Vet. App. 405, 407 (1994)); Green v. Derwinski, 1 Vet. App. 121, 124 (1991).  A medical examination report or opinion must also "contain not only clear conclusions with supporting data but also a reasoned medical explanation connecting the two."  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).  The Board errs by relying on an inadequate opinion.  Ardison v. Brown, 6 Vet. App. 405, 407 (1994).

With regard to favorable evidence, VA mental health practitioners in treatment records dated from 1997 to 2016 have at various times diagnosed the Veteran with PTSD in the context of the above in-service stressors.  See e.g., June 2005 VA Agent Orange History and Physical; 2004 VA Vet Center records; April 1997 VA treatment records.  The Veteran underwent VA PTSD screens in March 2007 and November 2009, and these PTSD screens were positive.  The positive PTSD screens were based on the Veteran's reports of nightmares based on his traumatic military experiences, avoiding situations that remind him of his stressors, being on guard, easily started, numbness, and detachment from others, activities, and surroundings.

With regard to favorable evidence, and most importantly, in April 2012, Ms. A.G., P.C.C., a private counselor, submitted a comprehensive medical opinion concluding that the Veteran has PTSD in accordance with the DSM-IV.  The PTSD diagnosis was deemed secondary to the Veteran's military service from Operations Eagle Pull and Frequent Wind during the Vietnam and Cambodia evacuations - from the chaos of evacuation and exposure to dead bodies.  He also has depressive symptoms secondary to PTSD and his military service.  The private counselor assessed that the Veteran has credibly described PTSD-related symptoms such as avoidance, re-experiencing, flashbacks, nightmares, depression, hyperarousal, insomnia, and anxiety in VA treatment records.  The private counselor did not perform a psychological examination on the Veteran when offering this opinion.  However, she did review extensive records in the Veteran's claims file.

Pursuant to 38 C.F.R. §4.125(a), if the diagnosis of a mental disorder does not conform to DSM-IV or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis.  Mental health professionals are experts and are presumed to know the DSM requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis.  As such, the Court has held that a PTSD diagnosis provided by a mental-health professional must be presumed to have been made in accordance with the applicable DSM-IV criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor, unless there is evidence to the contrary.  Cohen v. Brown, 10 Vet. App. 128, 140 (1997).  The DSM-IV cannot be used "as a basis for rejecting the Veteran's favorable medical evidence as to the sufficiency of a stressor or the adequacy of the Veteran's symptomatology."  Id.  As such, in order to make a finding that the Veteran in this case did not have a valid PTSD diagnosis, the Board must clearly articulate its reasons for finding that the PTSD diagnosis was not made in accordance with the DSM-IV requirements.  If the Board cannot support a conclusion that the diagnosis was not made in accordance with DSM-IV requirements, it must accept the diagnosis as valid.  In the present case, the Board will therefore accept the above PTSD diagnoses as valid and in accordance with the DSM-IV.

Conversely, with regard to the unfavorable evidence, it was a December 2016 VA neuropsychological examiner's medical opinion that the Veteran currently does not meet the full DSM-5 criteria for PTSD.  The Veteran's various in-service stressors during exposure to chaotic evacuations in Operations Eagle Pull and Frequent Wind in April 1975 were acknowledged.  The VA examiner added that these stressors were adequate and were related to the Veteran's fear of hostile military or terrorist activity.  However, even though the Veteran reported cardinal symptoms of PTSD and he met most of the criteria for PTSD under the DSM-5 (he met criteria A, B, D, E, F, G, and H), he nevertheless did not meet criterion "C."  That is, he failed to exhibit persistent avoidance of stimuli associated with the traumatic events.  The VA examiner reasoned that Veteran does not report consistent DSM-5 Criterion C avoidance behaviors, because he continues to seek out DAV and other veterans for support and assistance.  The Veteran also reported attending war movies such as "Saving Pvt. Ryan".  The Veteran was noted to be a very poor historian, responding to many clinical questions with rambling, circumstantial, and off-subject responses.  The Veteran has had marked difficulty providing specific index incidents for his reported PTSD symptoms.  The Veteran was often noted to deflect other questions and return back to his report of cardinal PTSD symptoms.  The Veteran's cognition appeared very loosely associated and occasionally difficult to understand in context. The Veteran's responses were often vague and nonspecific.  Instead, the VA examiner diagnosed the Veteran with schizotypal personality disorder, which preceded his military service.

But notably, the December 2016 VA examiner failed to discuss whether the Veteran met a PTSD diagnosis in the context of the applicable DSM-IV.  The VA examiner only addressed the criteria of the DSM-5.  This is significant in the instant case because "effortful avoidance" is a required symptom for a PTSD diagnosis in Criterion C of the DSM-5.  In contrast, the DSM-IV also included "effortful avoidance" in Criterion C, but it comprised of only two of the requisite seven symptoms, of which only three were required.  In other words, the DSM-IV did not dictate that "effortful avoidance" be present in a veteran in order to meet the criteria for PTSD.  The DSM-IV was more flexible on this issue, as opposed to the DSM-5.

As currently codified, VA law defines the "benefit of the doubt" doctrine as:

	When, after consideration of all evidence and material of record in this case before the Department with respect to benefits under laws administered by the Secretary, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination in the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.

38 U.S.C.A. § 5107(b).  See also 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Based on the foregoing, the Board finds that there is an approximate balance of positive and negative evidence on the PTSD issue.  Certain elements of both the positive and negative medical opinions in this case are probative.  Both sets of evidence have respective strengths and weaknesses.  In such situations, the benefit of the doubt is resolved in the Veteran's favor.  Given the law and the medical evidence of record, the Board is compelled to grant the Veteran the benefit of the doubt and allow service connection for PTSD.  See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102.

In making this determination, the Board is cognizant that VA may not order additional development for the sole purpose of obtaining evidence unfavorable to a claimant.  Mariano v. Principi, 17 Vet. App. 305, 312 (2003).

In addition, the Board has also considered whether the Veteran's PTSD claim raised the issue of whether service connection is warranted for any other acquired psychiatric disorder in addition to PTSD.  See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record).  In this regard, the record also shows the Veteran has depression as secondary to his service-connected PTSD.  See 38 C.F.R. § 3.310(a).  Specifically, in April 2012, Ms. A.G., P.C.C., a private counselor, assessed that the Veteran's depressive symptoms he has consistently displayed are a component of his current PTSD diagnosis.  In addition, VA mental health treatment records dated from 1997 to 2016 frequently discuss the Veteran's depressive symptoms, sometimes interwoven with a PTSD diagnosis.

The Board also notes that post-service, the Veteran has been diagnosed with mental disorder NOS, mood disorder, adjustment disorder, personality change, schizotypal personality disorder, Asperger's, rule out (R/O) bipolar disorder, R/O psychosis NOS, R/O obsessive compulsive disorder (OCD), R/O anxiety NOS, and R/O mood disorder secondary to traumatic brain injury.  However, there is no evidence or allegation of symptoms of these disorders during service, and no probative evidence linking these diagnoses to the Veteran's military service.

With regard to the Veteran's personality disorder diagnoses, personality disorders are not "diseases" or "injuries" within the meaning of applicable legislation.  38 C.F.R. §§ 3.303(c), 4.9, 4.127.  Defects are defined as "structural or inherent abnormalities or conditions which are more or less stationary in nature."  VAOPGCPREC 82-90.  It is therefore unnecessary to examine causality, or consider VA's presumption of soundness under 38 U.S.C.A. § 1111, because personality disorders cannot legally be service-related.  See Morris v. Shinseki, 678 F.3d 1346, 1354 (2012).  Thus, service connection is not warranted for the Veteran's personality disorders.

In any event, the present decision is considered a full grant of the benefits sought by the Veteran for his acquired psychiatric disorder claim to include PTSD.  In granting service connection for PTSD with depression, the RO should assign a disability rating or ratings that encompass the symptoms of these disorders.  See Amberman v. Shinseki, 570 F.3d 1377, 1381 (2009) (two defined diagnoses constitute the same disability for purposes of 38 C.F.R. § 4.14 if they have overlapping symptomatology, but bipolar disorder and PTSD could have different symptoms and it could therefore be improper in some circumstances for VA to treat these separately diagnosed conditions as producing only the same disability).

ORDER

Subject to the provisions governing the award of monetary benefits, service connection for PTSD with depression is granted.

____________________________________________
DAVID L. WIGHT
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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text: issued

text: by

text: the

text: Department

text: of

text: Veterans

text: Affairs

text: VA

text: Regional

text: Office

text: RO

text: in

text: San

text: Diego

text: California

text: Jurisdiction

text: of

text: case

text: has

text: since

text: been

text: transferred

text: to

text: the

text: RO

text: in

text: Roanoke

text: Virginia

text: That

text: office

text: forwarded

text: his

text: appeal

text: to

text: the

text: Board

text: A

text: review

text: of

text: the

text: Virtual

text: VA

text: paperless

text: claims

text: processing

text: system

text: and

text: the

text: Veterans

text: Benefits

text: Management

text: System

text: VBMS

text: reveals

text: additional

text: service

text: treatment

text: records

text: service

text: personnel

text: records

text: attorney

text: letters

text: Veterans

text: Service

text: Organizations

text: VSO

text: briefs

text: and

text: VA

text: treatment

text: records

text: that

text: have

text: been

text: reviewed

text: by

text: the

text: Board

text: In

text: an

text: earlier

text: December

text: Board

text: decision

text: the

text: Board

text: denied

text: the

text: Veteran

text: s

text: claim

text: for

text: service

text: connection

text: for

text: PTSD

text: The

text: Veteran

text: appealed

text: the

text: Board

text: s

text: December

text: decision

text: to

text: the

text: United

text: States

text: Court

text: of

text: Appeals

text: for

text: Veterans

text: Claims

text: Court

text: In

text: a

text: July

text: Order

text: the

text: Court

text: vacated

text: and

text: remanded

text: the

text: Board

text: s

text: decision

text: as

text: to

text: issue

text: of

text: service

text: connection

text: for

text: PTSD

text: for

text: proceedings

text: consistent

text: with

text: a

text: Joint

text: Motion

text: for

text: Remand

text: Joint

text: Motion

text: Upon

text: return

text: from

text: the

text: Court

text: in

text: May

text: and

text: May

text: the

text: Board

text: remanded

text: the

text: PTSD

text: issue

text: for

text: further

text: development

text: The

text: case

text: has

text: been

text: returned

text: to

text: the

text: Board

text: for

text: further

text: appellate

text: consideration

text: FINDINGS

text: OF

text: FACT

text: There

text: is

text: credible

text: supporting

text: evidence

text: of

text: the

text: Veteran

text: s

text: in

text: service

text: exposure

text: to

text: noncombat

text: related

text: stressors

text: in

text: the

text: Marine

text: Corps

text: in

text: April

text: during

text: Operations

text: Eagle

text: Pull

text: and

text: Frequent

text: Wind

text: involving

text: evacuations

text: in

text: Cambodia

text: and

text: Vietnam

text: These

text: stressors

text: included

text: rockets

text: and

text: bombs

text: heard

text: on

text: the

text: outskirts

text: of

text: the

text: cities

text: mass

text: evacuations

text: of

text: embassy

text: and

text: civilian

text: personnel

text: with

text: panic

text: and

text: unsanitary

text: conditions

text: and

text: witnessing

text: the

text: bodies

text: of

text: dead

text: marines

text: There

text: is

text: an

text: approximate

text: balance

text: of

text: favorable

text: and

text: unfavorable

text: evidence

text: as

text: to

text: whether

text: the

text: Veteran

text: has

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: that

text: is

text: related

text: to

text: the

text: confirmed

text: in

text: service

text: stressors

text: from

text: Cambodia

text: and

text: Vietnam

text: CONCLUSION

text: OF

text: LAW

text: Resolving

text: all

text: reasonable

text: doubt

text: in

text: his

text: favor

text: the

text: Veteran

text: has

text: PTSD

text: with

text: depression

text: that

text: was

text: incurred

text: in

text: active

text: military

text: service

text: U

text: S

text: C

text: A

text: A

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text: F

text: R

text: f

text: a

text: REASONS

text: AND

text: BASES

text: FOR

text: FINDINGS

text: AND

text: CONCLUSION

text: I

text: VA

text: s

text: Duty

text: to

text: Notify

text: and

text: Assist

text: The

text: Veterans

text: Claims

text: Assistance

text: Act

text: of

text: VCAA

text: in

text: part

text: describes

text: VA

text: s

text: duties

text: to

text: notify

text: and

text: assist

text: claimants

text: in

text: substantiating

text: a

text: claim

text: for

text: VA

text: benefits

text: U

text: S

text: C

text: A

text: A

text: West

text: Honoring

text: America

text: s

text: Veterans

text: and

text: Caring

text: for

text: Camp

text: Lejeune

text: Families

text: Act

text: of

text: Pub

text: L

text: No

text: Stat

text: C

text: F

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text: a

text: a

text: The

text: VCAA

text: applies

text: to

text: the

text: instant

text: service

text: connection

text: claim

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: PTSD

text: However

text: the

text: Veteran

text: was

text: provided

text: adequate

text: VCAA

text: notice

text: for

text: the

text: appeal

text: in

text: May

text: August

text: December

text: April

text: June

text: March

text: and

text: April

text: Also

text: the

text: May

text: letter

text: included

text: a

text: copy

text: of

text: a

text: VA

text: form

text: with

text: specific

text: instructions

text: for

text: identifying

text: PTSD

text: stressors

text: Moreover

text: if

text: any

text: defect

text: in

text: VCAA

text: notice

text: or

text: assistance

text: is

text: found

text: such

text: defect

text: is

text: not

text: prejudicial

text: to

text: the

text: Veteran

text: given

text: the

text: completely

text: favorable

text: disposition

text: of

text: the

text: PTSD

text: and

text: depression

text: appeal

text: Bernard

text: v

text: Brown

text: Vet

text: App

text: II

text: Service

text: Connection

text: for

text: PTSD

text: Service

text: connection

text: may

text: be

text: granted

text: for

text: a

text: disability

text: resulting

text: from

text: disease

text: or

text: injury

text: incurred

text: in

text: or

text: aggravated

text: by

text: active

text: military

text: naval

text: or

text: air

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: a

text: In

text: addition

text: disorders

text: diagnosed

text: after

text: discharge

text: may

text: also

text: still

text: be

text: service

text: connected

text: if

text: all

text: the

text: evidence

text: including

text: pertinent

text: service

text: records

text: establishes

text: the

text: disorder

text: was

text: incurred

text: in

text: service

text: C

text: F

text: R

text: d

text: See

text: Combee

text: v

text: Brown

text: F

text: d

text: Fed

text: Cir

text: As

text: a

text: general

text: matter

text: service

text: connection

text: requires

text: competent

text: evidence

text: showing

text: the

text: existence

text: of

text: a

text: present

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: causal

text: relationship

text: between

text: the

text: present

text: disability

text: and

text: the

text: disease

text: or

text: injury

text: incurred

text: or

text: aggravated

text: during

text: service

text: the

text: so

text: called

text: nexus

text: requirement

text: Holton

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: quoting

text: Shedden

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: Service

text: connection

text: for

text: PTSD

text: has

text: unique

text: evidentiary

text: requirements

text: It

text: generally

text: requires

text: medical

text: evidence

text: diagnosing

text: the

text: condition

text: in

text: accordance

text: with

text: C

text: F

text: R

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text: i

text: e

text: DSM

text: IV

text: credible

text: supporting

text: evidence

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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: link

text: between

text: current

text: symptomatology

text: and

text: the

text: claimed

text: in

text: service

text: stressor

text: C

text: F

text: R

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text: See

text: also

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: Effective

text: August

text: VA

text: amended

text: the

text: portion

text: of

text: its

text: Schedule

text: for

text: Rating

text: Disabilities

text: dealing

text: with

text: mental

text: disorders

text: and

text: its

text: adjudication

text: regulations

text: that

text: define

text: the

text: term

text: psychosis

text: to

text: remove

text: outdated

text: references

text: to

text: the

text: DSM

text: IV

text: and

text: replace

text: them

text: with

text: references

text: to

text: the

text: recently

text: updated

text: Diagnostic

text: and

text: Statistical

text: Manual

text: Fifth

text: Edition

text: the

text: DSM

text: See

text: Fed

text: Reg

text: August

text: VA

text: adopted

text: as

text: final

text: without

text: change

text: this

text: interim

text: final

text: rule

text: and

text: clarified

text: that

text: the

text: provisions

text: of

text: this

text: interim

text: final

text: rule

text: do

text: not

text: apply

text: to

text: claims

text: that

text: have

text: been

text: certified

text: for

text: appeal

text: to

text: the

text: Board

text: or

text: are

text: pending

text: before

text: the

text: Board

text: on

text: or

text: before

text: August

text: See

text: Schedule

text: for

text: Rating

text: Disabilities

text: Mental

text: Disorders

text: and

text: Definition

text: of

text: Psychosis

text: for

text: Certain

text: VA

text: Purposes

text: Fed

text: Reg

text: March

text: In

text: the

text: present

text: case

text: the

text: RO

text: certified

text: the

text: Veteran

text: s

text: PTSD

text: appeal

text: to

text: the

text: Board

text: in

text: August

text: several

text: years

text: prior

text: to

text: August

text: Thus

text: DSM

text: IV

text: is

text: still

text: the

text: governing

text: directive

text: That

text: is

text: the

text: amended

text: C

text: F

text: R

text: conforming

text: to

text: the

text: DSM

text: is

text: not

text: applicable

text: in

text: the

text: present

text: case

text: In

text: any

text: event

text: the

text: Board

text: will

text: still

text: consider

text: any

text: private

text: or

text: VA

text: examiner

text: s

text: discussion

text: of

text: both

text: the

text: DSM

text: IV

text: and

text: DSM

text: in

text: adjudicating

text: the

text: current

text: Veteran

text: s

text: PTSD

text: claim

text: in

text: order

text: to

text: provide

text: the

text: Veteran

text: with

text: every

text: benefit

text: of

text: the

text: doubt

text: If

text: it

text: is

text: established

text: through

text: military

text: citation

text: or

text: other

text: supportive

text: evidence

text: that

text: the

text: veteran

text: engaged

text: in

text: combat

text: with

text: the

text: enemy

text: and

text: the

text: claimed

text: stressor

text: is

text: related

text: to

text: that

text: combat

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: that

text: the

text: claimed

text: stressor

text: is

text: consistent

text: with

text: the

text: circumstances

text: conditions

text: or

text: hardships

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: See

text: also

text: U

text: S

text: C

text: A

text: b

text: and

text: C

text: F

text: R

text: d

text: Gaines

text: v

text: West

text: Vet

text: App

text: Board

text: must

text: make

text: a

text: specific

text: finding

text: as

text: to

text: whether

text: the

text: Veteran

text: engaged

text: in

text: combat

text: To

text: gain

text: the

text: benefit

text: of

text: a

text: relaxed

text: standard

text: for

text: proof

text: of

text: service

text: incurrence

text: of

text: an

text: injury

text: or

text: disease

text: U

text: S

text: C

text: A

text: b

text: requires

text: that

text: the

text: veteran

text: have

text: actually

text: participated

text: in

text: combat

text: with

text: the

text: enemy

text: See

text: VAOPGCPREC

text: If

text: VA

text: determines

text: either

text: that

text: the

text: veteran

text: did

text: not

text: engage

text: in

text: combat

text: with

text: the

text: enemy

text: or

text: that

text: the

text: veteran

text: did

text: engage

text: in

text: combat

text: but

text: that

text: the

text: alleged

text: stressor

text: is

text: not

text: combat

text: related

text: the

text: veteran

text: s

text: lay

text: testimony

text: by

text: itself

text: is

text: not

text: sufficient

text: to

text: establish

text: the

text: occurrence

text: of

text: the

text: alleged

text: stressor

text: Instead

text: the

text: record

text: must

text: contain

text: credible

text: supporting

text: evidence

text: that

text: corroborates

text: the

text: veteran

text: s

text: testimony

text: or

text: statements

text: C

text: F

text: R

text: f

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text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: Moreau

text: v

text: Brown

text: Vet

text: App

text: However

text: corroboration

text: of

text: every

text: detail

text: of

text: a

text: claimed

text: stressor

text: including

text: the

text: veteran

text: s

text: personal

text: participation

text: is

text: not

text: required

text: rather

text: a

text: veteran

text: only

text: needs

text: to

text: offer

text: independent

text: evidence

text: of

text: a

text: stressful

text: event

text: that

text: is

text: sufficient

text: to

text: imply

text: his

text: or

text: her

text: personal

text: exposure

text: See

text: Pentecost

text: v

text: Principi

text: Vet

text: App

text: quoting

text: Suozzi

text: v

text: Brown

text: Vet

text: App

text: In

text: other

text: words

text: a

text: veteran

text: s

text: presence

text: with

text: the

text: unit

text: at

text: the

text: time

text: such

text: attacks

text: occurred

text: corroborates

text: his

text: statement

text: that

text: he

text: experienced

text: such

text: attacks

text: personally

text: Suozzi

text: v

text: Brown

text: Vet

text: App

text: The

text: final

text: requirement

text: of

text: C

text: F

text: R

text: f

text: is

text: medical

text: evidence

text: of

text: a

text: nexus

text: between

text: the

text: claimed

text: in

text: service

text: stressor

text: and

text: the

text: current

text: disability

text: However

text: such

text: after

text: the

text: fact

text: medical

text: nexus

text: evidence

text: generally

text: cannot

text: also

text: be

text: the

text: sole

text: evidence

text: of

text: the

text: occurrence

text: of

text: the

text: claimed

text: stressor

text: Moreau

text: Vet

text: App

text: at

text: Effective

text: July

text: if

text: a

text: stressor

text: claimed

text: by

text: a

text: veteran

text: is

text: related

text: to

text: that

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: a

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: that

text: veteran

text: s

text: service

text: a

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: F

text: ear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: means

text: that

text: a

text: veteran

text: experienced

text: witnessed

text: or

text: was

text: confronted

text: with

text: an

text: event

text: or

text: circumstance

text: that

text: involved

text: actual

text: or

text: threatened

text: death

text: or

text: serious

text: injury

text: or

text: a

text: threat

text: to

text: the

text: physical

text: integrity

text: of

text: the

text: veteran

text: or

text: others

text: such

text: as

text: from

text: an

text: actual

text: or

text: potential

text: improvised

text: explosive

text: device

text: vehicle

text: imbedded

text: explosive

text: device

text: incoming

text: artillery

text: rocket

text: or

text: mortar

text: fire

text: grenade

text: small

text: arms

text: fire

text: including

text: suspected

text: sniper

text: fire

text: or

text: attack

text: upon

text: friendly

text: military

text: aircraft

text: and

text: the

text: Veteran

text: s

text: response

text: to

text: the

text: event

text: or

text: circumstance

text: involved

text: a

text: psychological

text: or

text: psycho

text: physiological

text: state

text: of

text: fear

text: helplessness

text: or

text: horror

text: See

text: id

text: A

text: veteran

text: must

text: have

text: experienced

text: witnessed

text: or

text: have

text: been

text: confronted

text: by

text: an

text: event

text: or

text: circumstance

text: that

text: involved

text: actual

text: or

text: threatened

text: death

text: or

text: serious

text: injury

text: or

text: a

text: threat

text: to

text: the

text: physical

text: integrity

text: of

text: that

text: veteran

text: or

text: others

text: and

text: that

text: veteran

text: s

text: response

text: to

text: the

text: event

text: or

text: circumstance

text: must

text: have

text: involved

text: a

text: psychological

text: or

text: psycho

text: physiological

text: state

text: of

text: fear

text: helplessness

text: or

text: horror

text: The

text: occurrence

text: of

text: an

text: actual

text: event

text: or

text: circumstance

text: is

text: necessary

text: In

text: making

text: this

text: determination

text: VA

text: must

text: duly

text: consider

text: the

text: places

text: types

text: and

text: circumstances

text: of

text: a

text: veteran

text: s

text: service

text: as

text: shown

text: by

text: the

text: service

text: record

text: the

text: official

text: history

text: of

text: each

text: organization

text: in

text: which

text: such

text: a

text: veteran

text: served

text: a

text: veteran

text: s

text: medical

text: records

text: and

text: all

text: pertinent

text: medical

text: and

text: lay

text: evidence

text: The

text: new

text: rule

text: is

text: limited

text: to

text: cases

text: in

text: which

text: the

text: claimed

text: stressor

text: is

text: related

text: to

text: a

text: veteran

text: s

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

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text: Fed

text: Reg

text: Jul

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text: regard

text: to

text: an

text: actual

text: diagnosis

text: of

text: PTSD

text: lay

text: persons

text: are

text: not

text: categorically

text: incompetent

text: to

text: speak

text: on

text: matters

text: of

text: medical

text: diagnosis

text: or

text: etiology

text: Davidson

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: The

text: Board

text: must

text: consider

text: the

text: type

text: of

text: condition

text: specifically

text: claimed

text: and

text: whether

text: it

text: is

text: readily

text: amenable

text: to

text: lay

text: diagnosis

text: or

text: probative

text: comment

text: on

text: etiology

text: See

text: Woehlaert

text: v

text: Nicholson

text: Vet

text: App

text: In

text: this

text: regard

text: the

text: Federal

text: Circuit

text: recently

text: held

text: that

text: PTSD

text: is

text: not

text: the

text: type

text: of

text: medical

text: condition

text: that

text: lay

text: evidence

text: is

text: competent

text: and

text: sufficient

text: to

text: identify

text: Young

text: v

text: McDonald

text: F

text: d

text: Fed

text: Cir

text: Regardless

text: the

text: Board

text: acknowledges

text: the

text: Veteran

text: is

text: competent

text: to

text: report

text: psychiatric

text: symptoms

text: both

text: during

text: and

text: after

text: service

text: See

text: C

text: F

text: R

text: a

text: Jandreau

text: F

text: d

text: at

text: discussing

text: that

text: Veteran

text: is

text: competent

text: to

text: report

text: a

text: contemporaneous

text: medical

text: diagnosis

text: Buchanan

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: discussing

text: general

text: competency

text: of

text: a

text: Veteran

text: to

text: report

text: psychiatric

text: symptoms

text: That

text: is

text: lay

text: evidence

text: can

text: also

text: be

text: competent

text: and

text: sufficient

text: evidence

text: of

text: a

text: diagnosis

text: or

text: to

text: establish

text: etiology

text: if

text: the

text: layperson

text: is

text: competent

text: to

text: identify

text: the

text: medical

text: condition

text: the

text: layperson

text: is

text: reporting

text: a

text: contemporaneous

text: medical

text: diagnosis

text: or

text: lay

text: testimony

text: describing

text: symptoms

text: at

text: the

text: time

text: supports

text: a

text: later

text: diagnosis

text: by

text: a

text: medical

text: professional

text: Davidson

text: F

text: d

text: at

text: See

text: also

text: Jandreau

text: F

text: d

text: at

text: In

text: determining

text: whether

text: service

text: connection

text: is

text: warranted

text: the

text: Board

text: shall

text: consider

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: Alemany

text: v

text: Brown

text: Vet

text: App

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: The

text: Veteran

text: contends

text: that

text: he

text: has

text: PTSD

text: as

text: the

text: result

text: of

text: exposure

text: to

text: noncombat

text: related

text: stressors

text: during

text: his

text: service

text: with

text: the

text: Marine

text: Corps

text: from

text: February

text: to

text: September

text: Specifically

text: he

text: states

text: that

text: while

text: serving

text: as

text: an

text: Amtrac

text: crewman

text: in

text: the

text: Marine

text: Corps

text: in

text: April

text: during

text: Operations

text: Eagle

text: Pull

text: and

text: Frequent

text: Wind

text: involving

text: evacuations

text: in

text: Cambodia

text: and

text: Vietnam

text: he

text: was

text: confronted

text: with

text: several

text: traumatic

text: stressors

text: These

text: stressors

text: included

text: hearing

text: rockets

text: and

text: bombs

text: on

text: the

text: outskirts

text: of

text: the

text: cities

text: witnessing

text: the

text: mass

text: evacuations

text: of

text: embassy

text: and

text: civilian

text: personnel

text: with

text: panic

text: and

text: unsanitary

text: conditions

text: and

text: witnessing

text: the

text: bodies

text: of

text: dead

text: Marines

text: He

text: asserts

text: these

text: incidents

text: were

text: extremely

text: traumatic

text: for

text: him

text: He

text: believes

text: his

text: mental

text: problems

text: began

text: during

text: his

text: Vietnam

text: and

text: Cambodia

text: service

text: and

text: have

text: continued

text: to

text: this

text: day

text: The

text: Veteran

text: alleges

text: PTSD

text: related

text: symptoms

text: since

text: service

text: to

text: include

text: nightmares

text: insomnia

text: flashbacks

text: re

text: experiencing

text: intrusive

text: thoughts

text: avoidance

text: hypervigilance

text: detachment

text: numbness

text: paranoia

text: depression

text: and

text: anxiety

text: The

text: Veteran

text: does

text: not

text: assert

text: he

text: received

text: any

text: therapy

text: or

text: treatment

text: for

text: his

text: psychiatric

text: problems

text: until

text: many

text: years

text: after

text: active

text: duty

text: service

text: See

text: March

text: Veteran

text: s

text: statement

text: February

text: buddy

text: statement

text: from

text: soldier

text: who

text: served

text: with

text: the

text: Veteran

text: April

text: private

text: counselor

text: opinion

text: December

text: VA

text: psychological

text: examination

text: Upon

text: review

text: of

text: the

text: evidence

text: of

text: record

text: the

text: Board

text: grants

text: the

text: appeal

text: for

text: service

text: connection

text: for

text: PTSD

text: with

text: depression

text: Initially

text: the

text: Veteran

text: s

text: service

text: personnel

text: records

text: SPRs

text: and

text: Reports

text: of

text: Separation

text: from

text: the

text: Armed

text: Forces

text: DD

text: Form

text: s

text: do

text: not

text: reflect

text: receipt

text: of

text: medals

text: badges

text: or

text: decorations

text: that

text: specifically

text: denote

text: combat

text: with

text: the

text: enemy

text: His

text: military

text: occupational

text: specialty

text: MOS

text: was

text: an

text: Amtrac

text: crewman

text: which

text: is

text: not

text: indicative

text: of

text: combat

text: Moreover

text: his

text: SPRs

text: indicate

text: he

text: did

text: not

text: participate

text: in

text: any

text: combat

text: campaigns

text: and

text: received

text: no

text: wounds

text: due

text: to

text: combat

text: Thus

text: the

text: combat

text: provisions

text: are

text: not

text: for

text: application

text: C

text: F

text: R

text: f

text: See

text: also

text: U

text: S

text: C

text: A

text: b

text: and

text: C

text: F

text: R

text: d

text: pertaining

text: to

text: combat

text: Veterans

text: With

text: respect

text: to

text: the

text: non

text: combat

text: stressors

text: of

text: hearing

text: rockets

text: and

text: bombs

text: on

text: the

text: outskirts

text: of

text: the

text: cities

text: witnessing

text: the

text: mass

text: evacuations

text: of

text: embassy

text: and

text: civilian

text: personnel

text: with

text: panic

text: and

text: unsanitary

text: conditions

text: and

text: witnessing

text: the

text: bodies

text: of

text: dead

text: marines

text: that

text: occurred

text: at

text: that

text: time

text: off

text: the

text: evacuations

text: of

text: Cambodia

text: and

text: Vietnam

text: in

text: April

text: there

text: is

text: credible

text: supporting

text: evidence

text: that

text: exposure

text: to

text: these

text: stressors

text: occurred

text: C

text: F

text: R

text: f

text: Cohen

text: Vet

text: App

text: at

text: Moreau

text: Vet

text: App

text: at

text: In

text: particular

text: the

text: Veteran

text: has

text: submitted

text: a

text: February

text: buddy

text: statement

text: from

text: a

text: soldier

text: who

text: served

text: with

text: the

text: Veteran

text: in

text: Cambodia

text: and

text: Vietnam

text: verifying

text: elements

text: of

text: exposure

text: to

text: the

text: above

text: stressors

text: In

text: addition

text: the

text: Veteran

text: s

text: SPRs

text: and

text: DD

text: Form

text: s

text: indicate

text: that

text: he

text: took

text: part

text: in

text: operations

text: Eagle

text: Pull

text: and

text: Frequent

text: Wind

text: Both

text: of

text: these

text: operations

text: involved

text: recovery

text: of

text: embassy

text: and

text: civilians

text: from

text: Phnom

text: Pen

text: Cambodia

text: and

text: Saigon

text: South

text: Vietnam

text: in

text: April

text: The

text: Veteran

text: s

text: military

text: occupational

text: specialty

text: MOS

text: in

text: the

text: Marine

text: Corps

text: as

text: an

text: Amtrac

text: amphibious

text: tractor

text: crewman

text: also

text: provides

text: support

text: for

text: the

text: fact

text: that

text: he

text: was

text: involved

text: in

text: the

text: evacuations

text: The

text: SPRs

text: verify

text: the

text: Veteran

text: was

text: in

text: a

text: combat

text: zone

text: during

text: coastal

text: operations

text: patrols

text: etc

text: while

text: evacuations

text: were

text: occurring

text: in

text: April

text: The

text: Veteran

text: s

text: SPRs

text: confirm

text: the

text: Veteran

text: received

text: the

text: Armed

text: Forces

text: Expeditionary

text: Medal

text: with

text: one

text: bronze

text: star

text: and

text: the

text: Humanitarian

text: Service

text: Medal

text: with

text: bronze

text: numeral

text: for

text: his

text: service

text: in

text: Operation

text: Eagle

text: Pull

text: and

text: Operation

text: Frequent

text: Wind

text: The

text: Veteran

text: also

text: submitted

text: various

text: internet

text: articles

text: publications

text: and

text: eye

text: witness

text: accounts

text: of

text: the

text: situation

text: in

text: Saigon

text: during

text: the

text: April

text: evacuations

text: which

text: described

text: a

text: scene

text: of

text: confusion

text: panic

text: and

text: anxiety

text: with

text: shells

text: and

text: rockets

text: pounding

text: the

text: outskirts

text: of

text: the

text: city

text: Thus

text: this

text: evidence

text: of

text: record

text: shows

text: it

text: was

text: highly

text: plausible

text: the

text: Veteran

text: experienced

text: exposure

text: to

text: these

text: stressors

text: Moreover

text: under

text: the

text: amended

text: PTSD

text: regulation

text: the

text: December

text: VA

text: psychological

text: examiner

text: further

text: assessed

text: that

text: the

text: Veteran

text: s

text: stressors

text: were

text: related

text: to

text: his

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: C

text: F

text: R

text: f

text: Again

text: a

text: stressor

text: need

text: not

text: be

text: corroborated

text: in

text: every

text: detail

text: including

text: the

text: Veteran

text: s

text: personal

text: participation

text: Pentecost

text: Vet

text: App

text: at

text: In

text: summary

text: there

text: is

text: sufficient

text: credible

text: evidence

text: to

text: verify

text: the

text: occurrence

text: of

text: the

text: Veteran

text: s

text: noncombat

text: related

text: stressors

text: in

text: April

text: C

text: F

text: R

text: f

text: The

text: Veteran

text: s

text: service

text: treatment

text: records

text: STRs

text: dated

text: from

text: to

text: and

text: in

text: as

text: well

text: as

text: his

text: National

text: Guard

text: Reserve

text: records

text: dated

text: from

text: to

text: do

text: not

text: reveal

text: any

text: treatment

text: or

text: diagnosis

text: of

text: PTSD

text: or

text: any

text: other

text: acquired

text: psychiatric

text: disorder

text: The

text: Veteran

text: denied

text: any

text: depressive

text: symptomatology

text: at

text: various

text: STR

text: and

text: National

text: Guard

text: Reports

text: of

text: Medical

text: History

text: throughout

text: the

text: years

text: up

text: to

text: In

text: any

text: event

text: as

text: to

text: PTSD

text: an

text: in

text: service

text: diagnosis

text: is

text: not

text: required

text: See

text: C

text: F

text: R

text: f

text: Post

text: service

text: it

text: appears

text: the

text: Veteran

text: was

text: first

text: treated

text: for

text: PTSD

text: and

text: depression

text: in

text: according

text: to

text: VA

text: treatment

text: records

text: From

text: to

text: VA

text: medical

text: personnel

text: in

text: VA

text: treatment

text: records

text: and

text: VA

text: examinations

text: have

text: rendered

text: various

text: diagnoses

text: for

text: the

text: Veteran

text: to

text: include

text: the

text: following

text: depression

text: mental

text: disorder

text: NOS

text: mood

text: disorder

text: adjustment

text: disorder

text: personality

text: change

text: schizotypal

text: personality

text: disorder

text: Asperger

text: s

text: rule

text: out

text: R

text: O

text: bipolar

text: disorder

text: R

text: O

text: psychosis

text: NOS

text: R

text: O

text: obsessive

text: compulsive

text: disorder

text: OCD

text: R

text: O

text: anxiety

text: NOS

text: and

text: R

text: O

text: mood

text: disorder

text: secondary

text: to

text: traumatic

text: brain

text: injury

text: Post

text: service

text: with

text: respect

text: to

text: the

text: criteria

text: of

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: the

text: threshold

text: consideration

text: for

text: any

text: service

text: connection

text: claim

text: is

text: the

text: existence

text: of

text: a

text: current

text: disability

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Boyer

text: v

text: West

text: F

text: d

text: Fed

text: Cir

text: Brammer

text: v

text: Derwinski

text: Vet

text: App

text: In

text: particular

text: aside

text: from

text: corroboration

text: of

text: an

text: in

text: service

text: stressor

text: this

text: element

text: is

text: already

text: met

text: here

text: current

text: medical

text: evidence

text: diagnosing

text: PTSD

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: i

text: e

text: DSM

text: IV

text: is

text: required

text: as

text: well

text: as

text: competent

text: evidence

text: of

text: a

text: nexus

text: between

text: current

text: PTSD

text: symptomatology

text: and

text: his

text: verified

text: in

text: service

text: stressor

text: C

text: F

text: R

text: f

text: See

text: also

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: With

text: regard

text: to

text: a

text: diagnosis

text: of

text: PTSD

text: based

text: on

text: his

text: already

text: confirmed

text: in

text: service

text: noncombat

text: related

text: stressors

text: from

text: Operation

text: Eagle

text: Pull

text: and

text: Operation

text: Frequent

text: Wind

text: in

text: April

text: the

text: record

text: is

text: mixed

text: and

text: reflects

text: several

text: favorable

text: and

text: unfavorable

text: medical

text: opinions

text: and

text: treatment

text: records

text: However

text: upon

text: review

text: of

text: this

text: evidence

text: the

text: Board

text: concludes

text: that

text: the

text: evidence

text: of

text: record

text: is

text: equally

text: balanced

text: in

text: finding

text: that

text: the

text: Veteran

text: has

text: a

text: PTSD

text: diagnosis

text: due

text: to

text: the

text: verified

text: in

text: service

text: stressors

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: i

text: e

text: DSM

text: IV

text: The

text: Board

text: must

text: determine

text: as

text: a

text: question

text: of

text: fact

text: both

text: the

text: weight

text: and

text: credibility

text: of

text: the

text: evidence

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: a

text: record

text: every

text: item

text: does

text: not

text: have

text: the

text: same

text: probative

text: value

text: The

text: Board

text: must

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: analyze

text: the

text: credibility

text: and

text: probative

text: value

text: of

text: all

text: material

text: evidence

text: submitted

text: by

text: and

text: on

text: behalf

text: of

text: a

text: claimant

text: and

text: provide

text: the

text: reasons

text: for

text: its

text: rejection

text: of

text: any

text: such

text: evidence

text: See

text: Struck

text: v

text: Brown

text: Vet

text: App

text: Caluza

text: v

text: Brown

text: Vet

text: App

text: Gabrielson

text: v

text: Brown

text: Vet

text: App

text: Abernathy

text: v

text: Principi

text: Vet

text: App

text: Simon

text: v

text: Derwinski

text: Vet

text: App

text: Hatlestad

text: v

text: Derwinski

text: Vet

text: App

text: It

text: is

text: not

text: error

text: for

text: the

text: Board

text: to

text: favor

text: the

text: opinion

text: of

text: one

text: competent

text: medical

text: expert

text: over

text: that

text: of

text: another

text: when

text: the

text: Board

text: gives

text: an

text: adequate

text: statement

text: of

text: reasons

text: or

text: bases

text: See

text: Owens

text: v

text: Brown

text: Vet

text: App

text: When

text: VA

text: undertakes

text: to

text: provide

text: a

text: medical

text: examination

text: or

text: opinion

text: it

text: must

text: be

text: adequate

text: See

text: Barr

text: v

text: Nicholson

text: Vet

text: App

text: O

text: nce

text: the

text: Secretary

text: undertakes

text: the

text: effort

text: to

text: provide

text: an

text: examination

text: when

text: developing

text: a

text: service

text: connection

text: claim

text: he

text: must

text: provide

text: an

text: adequate

text: one

text: An

text: examination

text: or

text: opinion

text: is

text: adequate

text: if

text: it

text: is

text: thorough

text: and

text: contemporaneous

text: considers

text: the

text: Veteran

text: s

text: prior

text: medical

text: examinations

text: and

text: treatment

text: and

text: describes

text: the

text: disability

text: in

text: sufficient

text: detail

text: so

text: that

text: the

text: Board

text: s

text: evaluation

text: of

text: the

text: claimed

text: disability

text: will

text: be

text: a

text: fully

text: informed

text: one

text: Stefl

text: v

text: Nicholson

text: Vet

text: App

text: quoting

text: Ardison

text: v

text: Brown

text: Vet

text: App

text: Green

text: v

text: Derwinski

text: Vet

text: App

text: A

text: medical

text: examination

text: report

text: or

text: opinion

text: must

text: also

text: contain

text: not

text: only

text: clear

text: conclusions

text: with

text: supporting

text: data

text: but

text: also

text: a

text: reasoned

text: medical

text: explanation

text: connecting

text: the

text: two

text: Nieves

text: Rodriguez

text: v

text: Peake

text: Vet

text: App

text: The

text: Board

text: errs

text: by

text: relying

text: on

text: an

text: inadequate

text: opinion

text: Ardison

text: v

text: Brown

text: Vet

text: App

text: With

text: regard

text: to

text: favorable

text: evidence

text: VA

text: mental

text: health

text: practitioners

text: in

text: treatment

text: records

text: dated

text: from

text: to

text: have

text: at

text: various

text: times

text: diagnosed

text: the

text: Veteran

text: with

text: PTSD

text: in

text: the

text: context

text: of

text: the

text: above

text: in

text: service

text: stressors

text: See

text: e

text: g

text: June

text: VA

text: Agent

text: Orange

text: History

text: and

text: Physical

text: VA

text: Vet

text: Center

text: records

text: April

text: VA

text: treatment

text: records

text: The

text: Veteran

text: underwent

text: VA

text: PTSD

text: screens

text: in

text: March

text: and

text: November

text: and

text: these

text: PTSD

text: screens

text: were

text: positive

text: The

text: positive

text: PTSD

text: screens

text: were

text: based

text: on

text: the

text: Veteran

text: s

text: reports

text: of

text: nightmares

text: based

text: on

text: his

text: traumatic

text: military

text: experiences

text: avoiding

text: situations

text: that

text: remind

text: him

text: of

text: his

text: stressors

text: being

text: on

text: guard

text: easily

text: started

text: numbness

text: and

text: detachment

text: from

text: others

text: activities

text: and

text: surroundings

text: With

text: regard

text: to

text: favorable

text: evidence

text: and

text: most

text: importantly

text: in

text: April

text: Ms

text: A

text: G

text: P

text: C

text: C

text: a

text: private

text: counselor

text: submitted

text: a

text: comprehensive

text: medical

text: opinion

text: concluding

text: that

text: the

text: Veteran

text: has

text: PTSD

text: in

text: accordance

text: with

text: the

text: DSM

text: IV

text: The

text: PTSD

text: diagnosis

text: was

text: deemed

text: secondary

text: to

text: the

text: Veteran

text: s

text: military

text: service

text: from

text: Operations

text: Eagle

text: Pull

text: and

text: Frequent

text: Wind

text: during

text: the

text: Vietnam

text: and

text: Cambodia

text: evacuations

text: from

text: the

text: chaos

text: of

text: evacuation

text: and

text: exposure

text: to

text: dead

text: bodies

text: He

text: also

text: has

text: depressive

text: symptoms

text: secondary

text: to

text: PTSD

text: and

text: his

text: military

text: service

text: The

text: private

text: counselor

text: assessed

text: that

text: the

text: Veteran

text: has

text: credibly

text: described

text: PTSD

text: related

text: symptoms

text: such

text: as

text: avoidance

text: re

text: experiencing

text: flashbacks

text: nightmares

text: depression

text: hyperarousal

text: insomnia

text: and

text: anxiety

text: in

text: VA

text: treatment

text: records

text: The

text: private

text: counselor

text: did

text: not

text: perform

text: a

text: psychological

text: examination

text: on

text: the

text: Veteran

text: when

text: offering

text: this

text: opinion

text: However

text: she

text: did

text: review

text: extensive

text: records

text: in

text: the

text: Veteran

text: s

text: claims

text: file

text: Pursuant

text: to

text: C

text: F

text: R

text: a

text: if

text: the

text: diagnosis

text: of

text: a

text: mental

text: disorder

text: does

text: not

text: conform

text: to

text: DSM

text: IV

text: or

text: is

text: not

text: supported

text: by

text: the

text: findings

text: on

text: the

text: examination

text: report

text: the

text: rating

text: agency

text: shall

text: return

text: the

text: report

text: to

text: the

text: examiner

text: to

text: substantiate

text: the

text: diagnosis

text: Mental

text: health

text: professionals

text: are

text: experts

text: and

text: are

text: presumed

text: to

text: know

text: the

text: DSM

text: requirements

text: applicable

text: to

text: their

text: practice

text: and

text: to

text: have

text: taken

text: them

text: into

text: account

text: in

text: providing

text: a

text: PTSD

text: diagnosis

text: As

text: such

text: the

text: Court

text: has

text: held

text: that

text: a

text: PTSD

text: diagnosis

text: provided

text: by

text: a

text: mental

text: health

text: professional

text: must

text: be

text: presumed

text: to

text: have

text: been

text: made

text: in

text: accordance

text: with

text: the

text: applicable

text: DSM

text: IV

text: criteria

text: as

text: to

text: both

text: the

text: adequacy

text: of

text: the

text: symptomatology

text: and

text: the

text: sufficiency

text: of

text: the

text: stressor

text: unless

text: there

text: is

text: evidence

text: to

text: the

text: contrary

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: The

text: DSM

text: IV

text: cannot

text: be

text: used

text: as

text: a

text: basis

text: for

text: rejecting

text: the

text: Veteran

text: s

text: favorable

text: medical

text: evidence

text: as

text: to

text: the

text: sufficiency

text: of

text: a

text: stressor

text: or

text: the

text: adequacy

text: of

text: the

text: Veteran

text: s

text: symptomatology

text: Id

text: As

text: such

text: in

text: order

text: to

text: make

text: a

text: finding

text: that

text: the

text: Veteran

text: in

text: this

text: case

text: did

text: not

text: have

text: a

text: valid

text: PTSD

text: diagnosis

text: the

text: Board

text: must

text: clearly

text: articulate

text: its

text: reasons

text: for

text: finding

text: that

text: the

text: PTSD

text: diagnosis

text: was

text: not

text: made

text: in

text: accordance

text: with

text: the

text: DSM

text: IV

text: requirements

text: If

text: the

text: Board

text: cannot

text: support

text: a

text: conclusion

text: that

text: the

text: diagnosis

text: was

text: not

text: made

text: in

text: accordance

text: with

text: DSM

text: IV

text: requirements

text: it

text: must

text: accept

text: the

text: diagnosis

text: as

text: valid

text: In

text: the

text: present

text: case

text: the

text: Board

text: will

text: therefore

text: accept

text: the

text: above

text: PTSD

text: diagnoses

text: as

text: valid

text: and

text: in

text: accordance

text: with

text: the

text: DSM

text: IV

text: Conversely

text: with

text: regard

text: to

text: the

text: unfavorable

text: evidence

text: it

text: was

text: a

text: December

text: VA

text: neuropsychological

text: examiner

text: s

text: medical

text: opinion

text: that

text: the

text: Veteran

text: currently

text: does

text: not

text: meet

text: the

text: full

text: DSM

text: criteria

text: for

text: PTSD

text: The

text: Veteran

text: s

text: various

text: in

text: service

text: stressors

text: during

text: exposure

text: to

text: chaotic

text: evacuations

text: in

text: Operations

text: Eagle

text: Pull

text: and

text: Frequent

text: Wind

text: in

text: April

text: were

text: acknowledged

text: The

text: VA

text: examiner

text: added

text: that

text: these

text: stressors

text: were

text: adequate

text: and

text: were

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: However

text: even

text: though

text: the

text: Veteran

text: reported

text: cardinal

text: symptoms

text: of

text: PTSD

text: and

text: he

text: met

text: most

text: of

text: the

text: criteria

text: for

text: PTSD

text: under

text: the

text: DSM

text: he

text: met

text: criteria

text: A

text: B

text: D

text: E

text: F

text: G

text: and

text: H

text: he

text: nevertheless

text: did

text: not

text: meet

text: criterion

text: C

text: That

text: is

text: he

text: failed

text: to

text: exhibit

text: persistent

text: avoidance

text: of

text: stimuli

text: associated

text: with

text: the

text: traumatic

text: events

text: The

text: VA

text: examiner

text: reasoned

text: that

text: Veteran

text: does

text: not

text: report

text: consistent

text: DSM

text: Criterion

text: C

text: avoidance

text: behaviors

text: because

text: he

text: continues

text: to

text: seek

text: out

text: DAV

text: and

text: other

text: veterans

text: for

text: support

text: and

text: assistance

text: The

text: Veteran

text: also

text: reported

text: attending

text: war

text: movies

text: such

text: as

text: Saving

text: Pvt

text: Ryan

text: The

text: Veteran

text: was

text: noted

text: to

text: be

text: a

text: very

text: poor

text: historian

text: responding

text: to

text: many

text: clinical

text: questions

text: with

text: rambling

text: circumstantial

text: and

text: off

text: subject

text: responses

text: The

text: Veteran

text: has

text: had

text: marked

text: difficulty

text: providing

text: specific

text: index

text: incidents

text: for

text: his

text: reported

text: PTSD

text: symptoms

text: The

text: Veteran

text: was

text: often

text: noted

text: to

text: deflect

text: other

text: questions

text: and

text: return

text: back

text: to

text: his

text: report

text: of

text: cardinal

text: PTSD

text: symptoms

text: The

text: Veteran

text: s

text: cognition

text: appeared

text: very

text: loosely

text: associated

text: and

text: occasionally

text: difficult

text: to

text: understand

text: in

text: context

text: The

text: Veteran

text: s

text: responses

text: were

text: often

text: vague

text: and

text: nonspecific

text: Instead

text: the

text: VA

text: examiner

text: diagnosed

text: the

text: Veteran

text: with

text: schizotypal

text: personality

text: disorder

text: which

text: preceded

text: his

text: military

text: service

text: But

text: notably

text: the

text: December

text: VA

text: examiner

text: failed

text: to

text: discuss

text: whether

text: the

text: Veteran

text: met

text: a

text: PTSD

text: diagnosis

text: in

text: the

text: context

text: of

text: the

text: applicable

text: DSM

text: IV

text: The

text: VA

text: examiner

text: only

text: addressed

text: the

text: criteria

text: of

text: the

text: DSM

text: This

text: is

text: significant

text: in

text: the

text: instant

text: case

text: because

text: effortful

text: avoidance

text: is

text: a

text: required

text: symptom

text: for

text: a

text: PTSD

text: diagnosis

text: in

text: Criterion

text: C

text: of

text: the

text: DSM

text: In

text: contrast

text: the

text: DSM

text: IV

text: also

text: included

text: effortful

text: avoidance

text: in

text: Criterion

text: C

text: but

text: it

text: comprised

text: of

text: only

text: two

text: of

text: the

text: requisite

text: seven

text: symptoms

text: of

text: which

text: only

text: three

text: were

text: required

text: In

text: other

text: words

text: the

text: DSM

text: IV

text: did

text: not

text: dictate

text: that

text: effortful

text: avoidance

text: be

text: present

text: in

text: a

text: veteran

text: in

text: order

text: to

text: meet

text: the

text: criteria

text: for

text: PTSD

text: The

text: DSM

text: IV

text: was

text: more

text: flexible

text: on

text: this

text: issue

text: as

text: opposed

text: to

text: the

text: DSM

text: As

text: currently

text: codified

text: VA

text: law

text: defines

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: as

text: When

text: after

text: consideration

text: of

text: all

text: evidence

text: and

text: material

text: of

text: record

text: in

text: this

text: case

text: before

text: the

text: Department

text: with

text: respect

text: to

text: benefits

text: under

text: laws

text: administered

text: by

text: the

text: Secretary

text: there

text: is

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: in

text: the

text: matter

text: the

text: benefit

text: of

text: the

text: doubt

text: in

text: resolving

text: each

text: such

text: issue

text: shall

text: be

text: given

text: to

text: the

text: claimant

text: U

text: S

text: C

text: A

text: b

text: See

text: also

text: C

text: F

text: R

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: Based

text: on

text: the

text: foregoing

text: the

text: Board

text: finds

text: that

text: there

text: is

text: an

text: approximate

text: balance

text: of

text: positive

text: and

text: negative

text: evidence

text: on

text: the

text: PTSD

text: issue

text: Certain

text: elements

text: of

text: both

text: the

text: positive

text: and

text: negative

text: medical

text: opinions

text: in

text: this

text: case

text: are

text: probative

text: Both

text: sets

text: of

text: evidence

text: have

text: respective

text: strengths

text: and

text: weaknesses

text: In

text: such

text: situations

text: the

text: benefit

text: of

text: the

text: doubt

text: is

text: resolved

text: in

text: the

text: Veteran

text: s

text: favor

text: Given

text: the

text: law

text: and

text: the

text: medical

text: evidence

text: of

text: record

text: the

text: Board

text: is

text: compelled

text: to

text: grant

text: the

text: Veteran

text: the

text: benefit

text: of

text: the

text: doubt

text: and

text: allow

text: service

text: connection

text: for

text: PTSD

text: See

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: In

text: making

text: this

text: determination

text: the

text: Board

text: is

text: cognizant

text: that

text: VA

text: may

text: not

text: order

text: additional

text: development

text: for

text: the

text: sole

text: purpose

text: of

text: obtaining

text: evidence

text: unfavorable

text: to

text: a

text: claimant

text: Mariano

text: v

text: Principi

text: Vet

text: App

text: In

text: addition

text: the

text: Board

text: has

text: also

text: considered

text: whether

text: the

text: Veteran

text: s

text: PTSD

text: claim

text: raised

text: the

text: issue

text: of

text: whether

text: service

text: connection

text: is

text: warranted

text: for

text: any

text: other

text: acquired

text: psychiatric

text: disorder

text: in

text: addition

text: to

text: PTSD

text: See

text: Clemons

text: v

text: Shinseki

text: Vet

text: App

text: holding

text: that

text: the

text: scope

text: of

text: a

text: mental

text: health

text: disability

text: claim

text: includes

text: any

text: mental

text: disability

text: that

text: may

text: reasonably

text: be

text: encompassed

text: by

text: the

text: claimant

text: s

text: description

text: of

text: the

text: claim

text: reported

text: symptoms

text: and

text: the

text: other

text: information

text: of

text: record

text: In

text: this

text: regard

text: the

text: record

text: also

text: shows

text: the

text: Veteran

text: has

text: depression

text: as

text: secondary

text: to

text: his

text: service

text: connected

text: PTSD

text: See

text: C

text: F

text: R

text: a

text: Specifically

text: in

text: April

text: Ms

text: A

text: G

text: P

text: C

text: C

text: a

text: private

text: counselor

text: assessed

text: that

text: the

text: Veteran

text: s

text: depressive

text: symptoms

text: he

text: has

text: consistently

text: displayed

text: are

text: a

text: component

text: of

text: his

text: current

text: PTSD

text: diagnosis

text: In

text: addition

text: VA

text: mental

text: health

text: treatment

text: records

text: dated

text: from

text: to

text: frequently

text: discuss

text: the

text: Veteran

text: s

text: depressive

text: symptoms

text: sometimes

text: interwoven

text: with

text: a

text: PTSD

text: diagnosis

text: The

text: Board

text: also

text: notes

text: that

text: post

text: service

text: the

text: Veteran

text: has

text: been

text: diagnosed

text: with

text: mental

text: disorder

text: NOS

text: mood

text: disorder

text: adjustment

text: disorder

text: personality

text: change

text: schizotypal

text: personality

text: disorder

text: Asperger

text: s

text: rule

text: out

text: R

text: O

text: bipolar

text: disorder

text: R

text: O

text: psychosis

text: NOS

text: R

text: O

text: obsessive

text: compulsive

text: disorder

text: OCD

text: R

text: O

text: anxiety

text: NOS

text: and

text: R

text: O

text: mood

text: disorder

text: secondary

text: to

text: traumatic

text: brain

text: injury

text: However

text: there

text: is

text: no

text: evidence

text: or

text: allegation

text: of

text: symptoms

text: of

text: these

text: disorders

text: during

text: service

text: and

text: no

text: probative

text: evidence

text: linking

text: these

text: diagnoses

text: to

text: the

text: Veteran

text: s

text: military

text: service

text: With

text: regard

text: to

text: the

text: Veteran

text: s

text: personality

text: disorder

text: diagnoses

text: personality

text: disorders

text: are

text: not

text: diseases

text: or

text: injuries

text: within

text: the

text: meaning

text: of

text: applicable

text: legislation

text: C

text: F

text: R

text: c

text: Defects

text: are

text: defined

text: as

text: structural

text: or

text: inherent

text: abnormalities

text: or

text: conditions

text: which

text: are

text: more

text: or

text: less

text: stationary

text: in

text: nature

text: VAOPGCPREC

text: It

text: is

text: therefore

text: unnecessary

text: to

text: examine

text: causality

text: or

text: consider

text: VA

text: s

text: presumption

text: of

text: soundness

text: under

text: U

text: S

text: C

text: A

text: because

text: personality

text: disorders

text: cannot

text: legally

text: be

text: service

text: related

text: See

text: Morris

text: v

text: Shinseki

text: F

text: d

text: Thus

text: service

text: connection

text: is

text: not

text: warranted

text: for

text: the

text: Veteran

text: s

text: personality

text: disorders

text: In

text: any

text: event

text: the

text: present

text: decision

text: is

text: considered

text: a

text: full

text: grant

text: of

text: the

text: benefits

text: sought

text: by

text: the

text: Veteran

text: for

text: his

text: acquired

text: psychiatric

text: disorder

text: claim

text: to

text: include

text: PTSD

text: In

text: granting

text: service

text: connection

text: for

text: PTSD

text: with

text: depression

text: the

text: RO

text: should

text: assign

text: a

text: disability

text: rating

text: or

text: ratings

text: that

text: encompass

text: the

text: symptoms

text: of

text: these

text: disorders

text: See

text: Amberman

text: v

text: Shinseki

text: F

text: d

text: two

text: defined

text: diagnoses

text: constitute

text: the

text: same

text: disability

text: for

text: purposes

text: of

text: C

text: F

text: R

text: if

text: they

text: have

text: overlapping

text: symptomatology

text: but

text: bipolar

text: disorder

text: and

text: PTSD

text: could

text: have

text: different

text: symptoms

text: and

text: it

text: could

text: therefore

text: be

text: improper

text: in

text: some

text: circumstances

text: for

text: VA

text: to

text: treat

text: these

text: separately

text: diagnosed

text: conditions

text: as

text: producing

text: only

text: the

text: same

text: disability

text: ORDER

text: Subject

text: to

text: the

text: provisions

text: governing

text: the

text: award

text: of

text: monetary

text: benefits

text: service

text: connection

text: for

text: PTSD

text: with

text: depression

text: is

text: granted

text: DAVID

text: L

text: WIGHT

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs