text:
Citation Nr: 1456911
Decision Date: 12/31/14    Archive Date: 01/09/15

DOCKET NO.  12-24 527	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in North Little Rock, Arkansas

THE ISSUE

1. Whether new and material evidence has been submitted sufficient to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD).

2. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD.

REPRESENTATION

Appellant represented by:	Disabled American Veterans

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Dustin Ware, Associate Counsel

INTRODUCTION

The Veteran had active military service from March 1973 to August 1974.

This case comes before the Board of Veterans' Appeals (Board) on appeal of a March 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Little Rock, Arkansas.

The Veteran testified before the Board at a September 2013 hearing at the RO.  A transcript of the hearing is of record.

FINDINGS OF FACT

1. A November 2005 Board decision denied the Veteran's claim for entitlement to service connection for PTSD.  The Veteran was notified of his appellate rights, but did not complete an appeal of the Board decision.

2. Evidence received since the November 2005 Board decision is not cumulative of the evidence of record at the time of the last prior denial as it relates to an unestablished fact necessary to substantiate the claim of service connection for PTSD and raises a reasonable possibility of substantiating the Veteran's claim of service connection.

3. The competent evidence of record demonstrates the Veteran suffers from PTSD due to the circumstances of his active service.

CONCLUSIONS OF LAW

1. The November 2005 Board decision that denied the Veteran's claim of entitlement to service connection for PTSD is final.  38 U.S.C.A. § 7266 (West 2002).

2. Evidence received since the November 2005 Board decision, in connection with Veteran's claim of entitlement to service connection for PTSD, is new and material; the claim is reopened.  38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2014).

3. PTSD was incurred as a result of active duty service.  38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. §§ 3.303, 3.304(f) (2014).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Duties to Notify and Assist

Since the entire benefit sought on appeal has been granted, no purpose would be served by undertaking an analysis of whether there has been compliance with the notice and duty to assist requirements set out at 38 U.S.C.A. §§ 5100, 5102-5103A, 5106, 5107, 5126 (West 2002).  See, e.g., Bernard v. Brown, 4 Vet. App. 384 (1993); VAOPGCPREC 16-92, 57 Fed. Reg. 49,747 (1992).

Analysis

Under 38 U.S.C.A. § 7104, Board decisions must be based on the entire record, with consideration of all the evidence.  The law requires only that the Board address its reasons for rejecting evidence favorable to the claimant.  Timberlake v. Gober, 14 Vet. App. 122 (2000).  The Board must review the entire record, but does not have to discuss each piece of evidence.  Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied.  38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

I. Claim to Reopen

The previous final denial of the Veteran's claim of entitlement to service connection for PTSD is a November 2005 Board decision.  A VA Form 4597, Board of Veterans' Appeals Notice, was attached to that decision and neither the Veteran, nor a representative, filed a notice of appeal to the United States Court of Appeals for Veterans Claims.  Therefore, the Board's November 2005 decision became final.  38 U.S.C.A. §§ 7104, 7266 (West 2002); 38 C.F.R. § 20.1100 (2014).

A final decision cannot be reopened unless new and material evidence is presented. 38 U.S.C.A. § 5108.  The Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to that claim. Knightly v. Brown, 6 Vet. App. 200 (1994).

New evidence means existing evidence not previously submitted to agency decision makers.  Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim.  New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim.  38 C.F.R. § 3.156(a).

The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low."  See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010).  Furthermore, consideration is not limited to whether the newly submitted evidence relates specifically to the reason the claim was last denied, but instead should include whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary's duty to assist or through consideration of an alternative theory of entitlement.  Id. at 118.

Only evidence presented since the last final denial on any basis (either upon the merits of the case, or upon a previous adjudication that no new and material evidence has been presented) will be evaluated in the context of the entire record.  Evans v. Brown, 9 Vet. App. 273 (1996).  Finally, for the purpose of establishing whether new and material evidence has been received, the credibility of the evidence, but not its weight, is to be presumed.  Justus v. Principi, 3 Vet. App. 510, 513 (1992).

The evidence received since the November 2005 Board decision includes statements by the Veteran, statements by the Veteran's wife and by acquaintances of the Veteran, non-VA treatment records, VA treatment records, multiple VA examinations, records of job performance counseling, a record of a Defense Personnel Records Information Retrieval System (DPRIS) inquiry, and a Board hearing transcript.  Significantly, an October 2010 VA examination diagnosed PTSD based on a stressor that is verified by the DPRIS inquiry when viewed in light of other evidence of record.

Therefore, the Board concludes that the Veteran's October 2010 VA examination and the DPRIS inquiry are new and material with respect to the issue of service connection for PTSD.  The evidence is new as it has not previously been included in the record.  This evidence is material as it relates to an unestablished fact necessary to substantiate the claim, namely evidence of a diagnosis of PTSD based on a verified stressor.  Furthermore, this evidence is not cumulative or redundant and raises a reasonable possibility of substantiating the Veteran's claim of service connection and, thus, constitutes new and material evidence.  See Shade, 24 Vet. App. at 118.  Consequently, the Veteran's claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD, must be reopened.

II. Service Connection

The Veteran contends that service connection is warranted for an acquired psychiatric disorder, specifically PTSD due to stressors that occurred during active duty service.

Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (2014); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred.  38 C.F.R. § 3.304(f).  In this case, the Veteran contends that multiple noncombat-related stressors occurred at Fort Sill, Oklahoma causing his PTSD.  As the Veteran's claimed stressor does not involve being engaged in combat with the enemy, his lay testimony alone is not enough to establish the occurrence of the alleged stressors.  See Moreau v. Brown, 9 Vet. App. 389, 395 (1996), Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996).  To that end, the record must contain service records or other corroborative evidence that substantiates or verifies the Veteran's statements as to the occurrence of the claimed stressor(s).  See West (Carlton) v. Brown, 7 Vet. App. 70, 76 (1994); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993).

In the instant case, the record contains a difference of opinion as to whether the Veteran's symptomatology supports a diagnosis of PTSD.  In this regard, the Board observes that a February 2005 non-VA treatment note from a Dr. S. indicates a diagnosis of PTSD.  Axis I diagnoses of PTSD are throughout the Veteran's VA treatment records.  June 2008, March 2009, July 2009, June 2010, and October 2010 VA Treatment Notes.  Alternatively, a January 2009 VA examiner stated "[w]hile the veteran does display some symptoms which would be consistent with a posttraumatic stress disorder diagnosis, the severity, intensity, and specificity does not at this time meet criteria for a full diagnosis."  A January 2010 VA examination for mental disorders, other than PTSD and eating disorders, noted no "evidence of another psychiatric disorder in today's examination other than posttraumatic stress disorder symptoms, but they were not fully evaluated."

In light of this, an October 2010 VA examiner was asked to address the conflicting evidence.  The VA examiner opined that a "veteran can have PTSD symptoms which are present, but not at a severity of frequency necessary to meet diagnostic criteria."  The VA examiner's rational points towards this being the case in the previous VA examinations.  Additionally, the VA examiner makes a specific note of the fact that the January 2010 VA examination was not for PTSD and, as admitted by the VA examiner who performed the exam, the PTSD symptoms were not fully evaluated.  Concerning the private treatment records it was noted that they "related stressor to military service but did not provide enough specifics to show diagnostic criteria was met."  Whatever the case was previously, the VA examiner concluded that the October 2010 VA examination revealed the Veteran presently "presenting symptoms in sufficient frequency and severity to meet diagnostic criteria" for a diagnosis of PTSD.

Finally, the Veteran has been consistently diagnosed with a depressive disorder.  A June 2012 VA examiner was asked to comment on how a depressive disorder is related to the now diagnosed PTSD.  The VA examiner responded that the Veteran did not meet the criteria for a diagnosis of PTSD.  Specifically noting the Veteran did not adequately display Criterion C (persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness) and Criterion D (persistent symptoms of increased arousal, not present before the trauma).

In deciding whether the Veteran has a current diagnosis of PTSD, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others.  Evans v. West, 12 Vet. App. 22, 30 (1998).  That responsibility is particularly onerous where medical opinions diverge.  At the same time, the Board is mindful that it cannot make its own independent medical determinations and that there must be plausible reasons for favoring one medical opinion over another.  Id.; see also Colvin v. Derwinski, 1 Vet. App 171 (1991).

In considering the evidence in its entirety, and resolving all doubt in favor of the Veteran, the Board finds the Veteran is currently diagnosed with PTSD.  The January 2009 and June 2012 VA examiner find the Veteran displays symptoms of PTSD but not the severity or intensity required for a diagnosis.  This weighs against finding a diagnosis.  The January 2010 examination was for depression and not for PTSD; nevertheless, PTSD symptoms were observed but not fully evaluated.  As PTSD symptoms were not fully evaluated this examination weighs little in finding either for or against a diagnosis of PTSD.  The October 2011 VA examination, the Veteran's VA treatment records, and the non-VA treatment records of Dr. S all weigh in favor of a diagnosis of PTSD.  The Board acknowledges that the October 2010 VA examiner noted that private treatment records related stressors to military service but did not provide enough specifics to show diagnostic criteria for PTSD were met.  However, the Board notes that a "PTSD diagnosis by a mental-health professional must be presumed (unless evidence shows to the contrary) to have been made in accordance with the applicable DSM criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor."  Cohen v. Brown, 10 Vet. App. 128, 140 (1997).  Further, "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."  Id.  As such, the Board finds the evidence is at least in equipoise regarding a current diagnosis of PTSD; therefore, the Board has determined that a current diagnosis of PTSD is present in the instant case.

Next, the Board must determine whether the record establishes that the Veteran's reported in-service stressors occurred.  As noted Veteran contends that multiple noncombat-related stressors occurred at Fort Sill, Oklahoma causing his PTSD.  The most important of these stressors is the death, by motor vehicle accident, of Sergeant W.C.B.  The Veteran reports witnessing the incident.  Veteran's Statement Titled "Life in The Army" received October 2009, January 2009 Veteran's Statement.  The Veteran notes that he regularly interacted with Sergeant W.C.B. because they were friends and this enhanced the emotional impact of his death.  Statement in Support of Claim for Service Connection PSTD received January 2007.

When it comes to verifying the stressor a September 2011 DPRIS inquiry determined a Sergeant W.C.B died, while a passenger of a government vehicle, around the time the Veteran claims to have witnessed the accident.  The DPRIS inquiry could not confirm the location of the death other than that it occurred in the United States.  However, an undated news article submitted by the Veteran reveals that Sergeant W.C.B. died at Fort Sill in a motor vehicle accident.  Additionally, an October 2010 statement from M.W., Jr., who claims to have witnessed the incident, indicates the Veteran was present and witnessed the accident.  With this in mind, the Board finds the Veteran lay testimony is supported by credible evidence that the claimed in-service stressor occurred.

The remaining question, therefore, is whether there is competent medical evidence linking the Veteran's PTSD to his in-service stressor.  In diagnosing PTSD, the October 2011 VA examiner specifically noted two in-service stressors that contributed to the PTSD diagnosis.  One of the stressors was the death of a Sergeant by motor vehicle accident.

In Gilbert v. Derwinski, 1 Vet. App. 49 (1990), the United States Court of Appeals for Veterans Claims (Court) found that "a Veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." Further, the Court specifically stated that entitlement need not be established beyond a reasonable doubt, by clear and convincing evidence, or by a fair preponderance of the evidence.  Under the benefit of the doubt doctrine established by Congress, when the evidence is in "relative equipoise, the law dictates that the Veteran prevails."  Id.

Therefore, as discussed above, affording the Veteran the benefit of the doubt he is currently diagnosed with PTSD.  Furthermore, the October 2011 VA examination links the Veteran PTSD diagnosis to the in-service stressor reported by the Veteran.  Finally, the Board finds Veteran's lay testimony in regards to his in-service stressor is supported by credible evidence of record.  Consequently, resolving all doubt in favor of the Veteran, the Board finds service connection for PTSD is warranted, and the Veteran's claim is granted.  See 38 C.F.R. § 3.304(f).

ORDER

New and material evidence having been submitted, the claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is reopened.

Service connection for PTSD is granted, subject to the laws and regulations governing the payment of monetary benefits.

____________________________________________
MILO H. HAWLEY
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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text: context

text: of

text: the

text: entire

text: record

text: Evans

text: v

text: Brown

text: Vet

text: App

text: Finally

text: for

text: the

text: purpose

text: of

text: establishing

text: whether

text: new

text: and

text: material

text: evidence

text: has

text: been

text: received

text: the

text: credibility

text: of

text: the

text: evidence

text: but

text: not

text: its

text: weight

text: is

text: to

text: be

text: presumed

text: Justus

text: v

text: Principi

text: Vet

text: App

text: The

text: evidence

text: received

text: since

text: the

text: November

text: Board

text: decision

text: includes

text: statements

text: by

text: the

text: Veteran

text: statements

text: by

text: the

text: Veteran

text: s

text: wife

text: and

text: by

text: acquaintances

text: of

text: the

text: Veteran

text: non

text: VA

text: treatment

text: records

text: VA

text: treatment

text: records

text: multiple

text: VA

text: examinations

text: records

text: of

text: job

text: performance

text: counseling

text: a

text: record

text: of

text: a

text: Defense

text: Personnel

text: Records

text: Information

text: Retrieval

text: System

text: DPRIS

text: inquiry

text: and

text: a

text: Board

text: hearing

text: transcript

text: Significantly

text: an

text: October

text: VA

text: examination

text: diagnosed

text: PTSD

text: based

text: on

text: a

text: stressor

text: that

text: is

text: verified

text: by

text: the

text: DPRIS

text: inquiry

text: when

text: viewed

text: in

text: light

text: of

text: other

text: evidence

text: of

text: record

text: Therefore

text: the

text: Board

text: concludes

text: that

text: the

text: Veteran

text: s

text: October

text: VA

text: examination

text: and

text: the

text: DPRIS

text: inquiry

text: are

text: new

text: and

text: material

text: with

text: respect

text: to

text: the

text: issue

text: of

text: service

text: connection

text: for

text: PTSD

text: The

text: evidence

text: is

text: new

text: as

text: it

text: has

text: not

text: previously

text: been

text: included

text: in

text: the

text: record

text: This

text: evidence

text: is

text: material

text: as

text: it

text: relates

text: to

text: an

text: unestablished

text: fact

text: necessary

text: to

text: substantiate

text: the

text: claim

text: namely

text: evidence

text: of

text: a

text: diagnosis

text: of

text: PTSD

text: based

text: on

text: a

text: verified

text: stressor

text: Furthermore

text: this

text: evidence

text: is

text: not

text: cumulative

text: or

text: redundant

text: and

text: raises

text: a

text: reasonable

text: possibility

text: of

text: substantiating

text: the

text: Veteran

text: s

text: claim

text: of

text: service

text: connection

text: and

text: thus

text: constitutes

text: new

text: and

text: material

text: evidence

text: See

text: Shade

text: Vet

text: App

text: at

text: Consequently

text: the

text: Veteran

text: s

text: claim

text: of

text: entitlement

text: to

text: service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: PTSD

text: must

text: be

text: reopened

text: II

text: Service

text: Connection

text: The

text: Veteran

text: contends

text: that

text: service

text: connection

text: is

text: warranted

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: specifically

text: PTSD

text: due

text: to

text: stressors

text: that

text: occurred

text: during

text: active

text: duty

text: service

text: Service

text: connection

text: for

text: PTSD

text: requires

text: medical

text: evidence

text: diagnosing

text: the

text: condition

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: a

text: link

text: established

text: by

text: medical

text: evidence

text: between

text: current

text: symptoms

text: and

text: an

text: in

text: service

text: stressor

text: and

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: occurred

text: C

text: F

text: R

text: f

text: In

text: this

text: case

text: the

text: Veteran

text: contends

text: that

text: multiple

text: noncombat

text: related

text: stressors

text: occurred

text: at

text: Fort

text: Sill

text: Oklahoma

text: causing

text: his

text: PTSD

text: As

text: the

text: Veteran

text: s

text: claimed

text: stressor

text: does

text: not

text: involve

text: being

text: engaged

text: in

text: combat

text: with

text: the

text: enemy

text: his

text: lay

text: testimony

text: alone

text: is

text: not

text: enough

text: to

text: establish

text: the

text: occurrence

text: of

text: the

text: alleged

text: stressors

text: See

text: Moreau

text: v

text: Brown

text: Vet

text: App

text: Dizoglio

text: v

text: Brown

text: Vet

text: App

text: To

text: that

text: end

text: the

text: record

text: must

text: contain

text: service

text: records

text: or

text: other

text: corroborative

text: evidence

text: that

text: substantiates

text: or

text: verifies

text: the

text: Veteran

text: s

text: statements

text: as

text: to

text: the

text: occurrence

text: of

text: the

text: claimed

text: stressor

text: s

text: See

text: West

text: Carlton

text: v

text: Brown

text: Vet

text: App

text: Zarycki

text: v

text: Brown

text: Vet

text: App

text: In

text: the

text: instant

text: case

text: the

text: record

text: contains

text: a

text: difference

text: of

text: opinion

text: as

text: to

text: whether

text: the

text: Veteran

text: s

text: symptomatology

text: supports

text: a

text: diagnosis

text: of

text: PTSD

text: In

text: this

text: regard

text: the

text: Board

text: observes

text: that

text: a

text: February

text: non

text: VA

text: treatment

text: note

text: from

text: a

text: Dr

text: S

text: indicates

text: a

text: diagnosis

text: of

text: PTSD

text: Axis

text: I

text: diagnoses

text: of

text: PTSD

text: are

text: throughout

text: the

text: Veteran

text: s

text: VA

text: treatment

text: records

text: June

text: March

text: July

text: June

text: and

text: October

text: VA

text: Treatment

text: Notes

text: Alternatively

text: a

text: January

text: VA

text: examiner

text: stated

text: w

text: hile

text: the

text: veteran

text: does

text: display

text: some

text: symptoms

text: which

text: would

text: be

text: consistent

text: with

text: a

text: posttraumatic

text: stress

text: disorder

text: diagnosis

text: the

text: severity

text: intensity

text: and

text: specificity

text: does

text: not

text: at

text: this

text: time

text: meet

text: criteria

text: for

text: a

text: full

text: diagnosis

text: A

text: January

text: VA

text: examination

text: for

text: mental

text: disorders

text: other

text: than

text: PTSD

text: and

text: eating

text: disorders

text: noted

text: no

text: evidence

text: of

text: another

text: psychiatric

text: disorder

text: in

text: today

text: s

text: examination

text: other

text: than

text: posttraumatic

text: stress

text: disorder

text: symptoms

text: but

text: they

text: were

text: not

text: fully

text: evaluated

text: In

text: light

text: of

text: this

text: an

text: October

text: VA

text: examiner

text: was

text: asked

text: to

text: address

text: the

text: conflicting

text: evidence

text: The

text: VA

text: examiner

text: opined

text: that

text: a

text: veteran

text: can

text: have

text: PTSD

text: symptoms

text: which

text: are

text: present

text: but

text: not

text: at

text: a

text: severity

text: of

text: frequency

text: necessary

text: to

text: meet

text: diagnostic

text: criteria

text: The

text: VA

text: examiner

text: s

text: rational

text: points

text: towards

text: this

text: being

text: the

text: case

text: in

text: the

text: previous

text: VA

text: examinations

text: Additionally

text: the

text: VA

text: examiner

text: makes

text: a

text: specific

text: note

text: of

text: the

text: fact

text: that

text: the

text: January

text: VA

text: examination

text: was

text: not

text: for

text: PTSD

text: and

text: as

text: admitted

text: by

text: the

text: VA

text: examiner

text: who

text: performed

text: the

text: exam

text: the

text: PTSD

text: symptoms

text: were

text: not

text: fully

text: evaluated

text: Concerning

text: the

text: private

text: treatment

text: records

text: it

text: was

text: noted

text: that

text: they

text: related

text: stressor

text: to

text: military

text: service

text: but

text: did

text: not

text: provide

text: enough

text: specifics

text: to

text: show

text: diagnostic

text: criteria

text: was

text: met

text: Whatever

text: the

text: case

text: was

text: previously

text: the

text: VA

text: examiner

text: concluded

text: that

text: the

text: October

text: VA

text: examination

text: revealed

text: the

text: Veteran

text: presently

text: presenting

text: symptoms

text: in

text: sufficient

text: frequency

text: and

text: severity

text: to

text: meet

text: diagnostic

text: criteria

text: for

text: a

text: diagnosis

text: of

text: PTSD

text: Finally

text: the

text: Veteran

text: has

text: been

text: consistently

text: diagnosed

text: with

text: a

text: depressive

text: disorder

text: A

text: June

text: VA

text: examiner

text: was

text: asked

text: to

text: comment

text: on

text: how

text: a

text: depressive

text: disorder

text: is

text: related

text: to

text: the

text: now

text: diagnosed

text: PTSD

text: The

text: VA

text: examiner

text: responded

text: that

text: the

text: Veteran

text: did

text: not

text: meet

text: the

text: criteria

text: for

text: a

text: diagnosis

text: of

text: PTSD

text: Specifically

text: noting

text: the

text: Veteran

text: did

text: not

text: adequately

text: display

text: Criterion

text: C

text: persistent

text: avoidance

text: of

text: stimuli

text: associated

text: with

text: the

text: trauma

text: and

text: numbing

text: of

text: general

text: responsiveness

text: and

text: Criterion

text: D

text: persistent

text: symptoms

text: of

text: increased

text: arousal

text: not

text: present

text: before

text: the

text: trauma

text: In

text: deciding

text: whether

text: the

text: Veteran

text: has

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: it

text: is

text: the

text: responsibility

text: of

text: the

text: Board

text: to

text: weigh

text: the

text: evidence

text: and

text: decide

text: where

text: to

text: give

text: credit

text: and

text: where

text: to

text: withhold

text: the

text: same

text: and

text: in

text: so

text: doing

text: accept

text: certain

text: medical

text: opinions

text: over

text: others

text: Evans

text: v

text: West

text: Vet

text: App

text: That

text: responsibility

text: is

text: particularly

text: onerous

text: where

text: medical

text: opinions

text: diverge

text: At

text: the

text: same

text: time

text: the

text: Board

text: is

text: mindful

text: that

text: it

text: cannot

text: make

text: its

text: own

text: independent

text: medical

text: determinations

text: and

text: that

text: there

text: must

text: be

text: plausible

text: reasons

text: for

text: favoring

text: one

text: medical

text: opinion

text: over

text: another

text: Id

text: see

text: also

text: Colvin

text: v

text: Derwinski

text: Vet

text: App

text: In

text: considering

text: the

text: evidence

text: in

text: its

text: entirety

text: and

text: resolving

text: all

text: doubt

text: in

text: favor

text: of

text: the

text: Veteran

text: the

text: Board

text: finds

text: the

text: Veteran

text: is

text: currently

text: diagnosed

text: with

text: PTSD

text: The

text: January

text: and

text: June

text: VA

text: examiner

text: find

text: the

text: Veteran

text: displays

text: symptoms

text: of

text: PTSD

text: but

text: not

text: the

text: severity

text: or

text: intensity

text: required

text: for

text: a

text: diagnosis

text: This

text: weighs

text: against

text: finding

text: a

text: diagnosis

text: The

text: January

text: examination

text: was

text: for

text: depression

text: and

text: not

text: for

text: PTSD

text: nevertheless

text: PTSD

text: symptoms

text: were

text: observed

text: but

text: not

text: fully

text: evaluated

text: As

text: PTSD

text: symptoms

text: were

text: not

text: fully

text: evaluated

text: this

text: examination

text: weighs

text: little

text: in

text: finding

text: either

text: for

text: or

text: against

text: a

text: diagnosis

text: of

text: PTSD

text: The

text: October

text: VA

text: examination

text: the

text: Veteran

text: s

text: VA

text: treatment

text: records

text: and

text: the

text: non

text: VA

text: treatment

text: records

text: of

text: Dr

text: S

text: all

text: weigh

text: in

text: favor

text: of

text: a

text: diagnosis

text: of

text: PTSD

text: The

text: Board

text: acknowledges

text: that

text: the

text: October

text: VA

text: examiner

text: noted

text: that

text: private

text: treatment

text: records

text: related

text: stressors

text: to

text: military

text: service

text: but

text: did

text: not

text: provide

text: enough

text: specifics

text: to

text: show

text: diagnostic

text: criteria

text: for

text: PTSD

text: were

text: met

text: However

text: the

text: Board

text: notes

text: that

text: a

text: PTSD

text: diagnosis

text: by

text: a

text: mental

text: health

text: professional

text: must

text: be

text: presumed

text: unless

text: evidence

text: shows

text: to

text: the

text: contrary

text: to

text: have

text: been

text: made

text: in

text: accordance

text: with

text: the

text: applicable

text: DSM

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: Cohen

text: v

text: Brown

text: Vet

text: App

text: Further

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: Id

text: As

text: such

text: the

text: Board

text: finds

text: the

text: evidence

text: is

text: at

text: least

text: in

text: equipoise

text: regarding

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: therefore

text: the

text: Board

text: has

text: determined

text: that

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: is

text: present

text: in

text: the

text: instant

text: case

text: Next

text: the

text: Board

text: must

text: determine

text: whether

text: the

text: record

text: establishes

text: that

text: the

text: Veteran

text: s

text: reported

text: in

text: service

text: stressors

text: occurred

text: As

text: noted

text: Veteran

text: contends

text: that

text: multiple

text: noncombat

text: related

text: stressors

text: occurred

text: at

text: Fort

text: Sill

text: Oklahoma

text: causing

text: his

text: PTSD

text: The

text: most

text: important

text: of

text: these

text: stressors

text: is

text: the

text: death

text: by

text: motor

text: vehicle

text: accident

text: of

text: Sergeant

text: W

text: C

text: B

text: The

text: Veteran

text: reports

text: witnessing

text: the

text: incident

text: Veteran

text: s

text: Statement

text: Titled

text: Life

text: in

text: The

text: Army

text: received

text: October

text: January

text: Veteran

text: s

text: Statement

text: The

text: Veteran

text: notes

text: that

text: he

text: regularly

text: interacted

text: with

text: Sergeant

text: W

text: C

text: B

text: because

text: they

text: were

text: friends

text: and

text: this

text: enhanced

text: the

text: emotional

text: impact

text: of

text: his

text: death

text: Statement

text: in

text: Support

text: of

text: Claim

text: for

text: Service

text: Connection

text: PSTD

text: received

text: January

text: When

text: it

text: comes

text: to

text: verifying

text: the

text: stressor

text: a

text: September

text: DPRIS

text: inquiry

text: determined

text: a

text: Sergeant

text: W

text: C

text: B

text: died

text: while

text: a

text: passenger

text: of

text: a

text: government

text: vehicle

text: around

text: the

text: time

text: the

text: Veteran

text: claims

text: to

text: have

text: witnessed

text: the

text: accident

text: The

text: DPRIS

text: inquiry

text: could

text: not

text: confirm

text: the

text: location

text: of

text: the

text: death

text: other

text: than

text: that

text: it

text: occurred

text: in

text: the

text: United

text: States

text: However

text: an

text: undated

text: news

text: article

text: submitted

text: by

text: the

text: Veteran

text: reveals

text: that

text: Sergeant

text: W

text: C

text: B

text: died

text: at

text: Fort

text: Sill

text: in

text: a

text: motor

text: vehicle

text: accident

text: Additionally

text: an

text: October

text: statement

text: from

text: M

text: W

text: Jr

text: who

text: claims

text: to

text: have

text: witnessed

text: the

text: incident

text: indicates

text: the

text: Veteran

text: was

text: present

text: and

text: witnessed

text: the

text: accident

text: With

text: this

text: in

text: mind

text: the

text: Board

text: finds

text: the

text: Veteran

text: lay

text: testimony

text: is

text: supported

text: by

text: credible

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: occurred

text: The

text: remaining

text: question

text: therefore

text: is

text: whether

text: there

text: is

text: competent

text: medical

text: evidence

text: linking

text: the

text: Veteran

text: s

text: PTSD

text: to

text: his

text: in

text: service

text: stressor

text: In

text: diagnosing

text: PTSD

text: the

text: October

text: VA

text: examiner

text: specifically

text: noted

text: two

text: in

text: service

text: stressors

text: that

text: contributed

text: to

text: the

text: PTSD

text: diagnosis

text: One

text: of

text: the

text: stressors

text: was

text: the

text: death

text: of

text: a

text: Sergeant

text: by

text: motor

text: vehicle

text: accident

text: In

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: the

text: United

text: States

text: Court

text: of

text: Appeals

text: for

text: Veterans

text: Claims

text: Court

text: found

text: that

text: a

text: Veteran

text: need

text: only

text: demonstrate

text: that

text: there

text: is

text: an

text: approximate

text: balance

text: of

text: positive

text: and

text: negative

text: evidence

text: in

text: order

text: to

text: prevail

text: Further

text: the

text: Court

text: specifically

text: stated

text: that

text: entitlement

text: need

text: not

text: be

text: established

text: beyond

text: a

text: reasonable

text: doubt

text: by

text: clear

text: and

text: convincing

text: evidence

text: or

text: by

text: a

text: fair

text: preponderance

text: of

text: the

text: evidence

text: Under

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: established

text: by

text: Congress

text: when

text: the

text: evidence

text: is

text: in

text: relative

text: equipoise

text: the

text: law

text: dictates

text: that

text: the

text: Veteran

text: prevails

text: Id

text: Therefore

text: as

text: discussed

text: above

text: affording

text: the

text: Veteran

text: the

text: benefit

text: of

text: the

text: doubt

text: he

text: is

text: currently

text: diagnosed

text: with

text: PTSD

text: Furthermore

text: the

text: October

text: VA

text: examination

text: links

text: the

text: Veteran

text: PTSD

text: diagnosis

text: to

text: the

text: in

text: service

text: stressor

text: reported

text: by

text: the

text: Veteran

text: Finally

text: the

text: Board

text: finds

text: Veteran

text: s

text: lay

text: testimony

text: in

text: regards

text: to

text: his

text: in

text: service

text: stressor

text: is

text: supported

text: by

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