text:
Citation Nr: 1631836
Decision Date: 08/10/16    Archive Date: 08/23/16

DOCKET NO.  09-37 598	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Indianapolis, Indiana

THE ISSUE

Entitlement to service connection for a chronic acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), Major Depressive Disorder (MDD), and anxiety.

REPRESENTATION

Veteran represented by:	Veterans of Foreign Wars of the United States

WITNESS AT HEARING ON APPEAL

The Veteran

ATTORNEY FOR THE BOARD

Mary E. Rude, Associate Counsel

INTRODUCTION

The Veteran had verified active duty from December 1981 to May 1982.  She had additional duty with the Indiana Army National Guard/Army Reserve.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2008 rating decision of the Indianapolis, Indiana, Regional Office (RO).

In February 2009, the Veteran attended a Decision Review Officer (DRO) hearing at the RO, and in August 2010, the Veteran attended a Board hearing before the undersigned.  The transcripts of these hearings have been associated with the claims file.

In May 2011 and July 2014, the Board remanded the issue for additional evidentiary development.  It has now been returned to the Board for adjudication.

The claims file is now entirely in VA's secure electronic processing systems, Virtual VA and Veterans Benefits Management System (VBMS).

FINDING OF FACT

The preponderance of the competent evidence of record is against finding that the Veteran has a chronic acquired psychiatric disorder, to include PTSD, MDD, and anxiety, which is related to active service or any period of INACDUTRA or ACDUTRA.

CONCLUSION OF LAW

A chronic acquired psychiatric disorder was not incurred in or aggravated by active duty service.  38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2015).

REASONS AND BASES FOR FINDING AND CONCLUSION

I.  Duties 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); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2015).  VA is required to notify the claimant and his or her representative of any information, and any medical or lay evidence, not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide.  38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002).

VA has fulfilled the above requirements.  In a February 2008 VCAA notice letter, the Veteran was duly informed of the evidence needed to establish entitlement to service connection for PTSD.  The issue was last readjudicated in a June 2015 supplemental statement of the case.  Accordingly, no further development is required with respect to the duty to notify.

Next, VA has a duty to assist a claimant in the development of a claim.  This duty includes assisting in the procurement of service treatment records and all relevant pre-and post-service treatment records, and by providing an examination, when necessary.  38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159.

In May 2008, the RO issued a Formal Finding on the Unavailability of Records indicating that the Veteran's service treatment records were unavailable for review.  Although the memorandum did not properly list the steps taken to obtain these records, the record adequately indicates that a proper request was made for the Veteran's active service records, but no records were found.  Several of the Veteran's National Guard examinations are of record, and furthermore, the Veteran has asserted that her psychiatric problems began in 1985 or 1986, after the birth of her son, which is both after her National Guard service and several years after her active duty from December 1981 to May 1982.  The Board therefore finds that further attempts to obtain her active service records would be both futile and irrelevant to the questions currently at issue.  Furthermore, the Board does not dispute the Veteran's assertions that she requested maternity leave in 1985 while serving in the National Guard and that her request was refused by her superior officer; confirmation of these events through service records is therefore unnecessary.

This case was previously remanded in May 2011 and July 2014.  The Board finds that all prior remand instructions have been adequately completed.  A VA examination was held in May 2011, and the examination and opinion are adequate to decide the claim, as were based upon consideration of the Veteran's medical history, and they sufficiently inform the Board of the examiner's judgment and essential rationale.  See Monzingo v. Shinseki, 26 Vet. App. 97, 105-106 (2012).  Adequate attempts were made to obtain all private treatment records identified by the Veteran; unfortunately, responses from these providers indicated that no records were found or was destroyed, and the Veteran was adequately notified of this fact.  The Board finds that further attempts to acquire additional private records would therefore be futile.  Gagne v. McDonald, 27 Vet. App. 397, 403 (2015) (A search is futile "where it is apparent that the sought-after records are either not in existence or not in the possession of the record's custodian.").  The Board notes, however, that many of the records identified by the Veteran have been obtained through the Social Security Administration, and therefore have been available for review.  The Board therefore finds that there has been substantial compliance with the remand directives.  See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 104-05 (2008).

In addition to the documentary evidence, testimonial statements are of record, including testimony provided by the Veteran at a February 2009 RO hearing and at an August 2010 Board hearing.  At these hearings, the issue on appeal was clearly identified, the elements required to establish if service connection is warranted were explained, and suggestions were made regarding the submission of necessary favorable evidence.  The Veteran had an opportunity to present additional testimony on the essential elements necessary to prove the claim, and all hearing duties are found to be satisfied.  See 38 C.F.R. § 3.103(c) (2015); Bryant v. Shinseki, 23 Vet. App. 488, 492 (2010).

In sum, the Board finds that VA has complied with the VCAA's notification and assistance requirements, and any error in notice and development assistance cannot "reasonably affect the outcome of the case," and hence will not affect "the essential fairness of the [adjudication]" for the service connection claim at issue.  See ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998); Mayfield v. Nicholson, 19 Vet. App. 103 (2005).

II.  Analysis

The Veteran asserts that service connection for chronic PTSD or other psychiatric disorder is warranted as she has been diagnosed with chronic PTSD secondary to several stressful events, which occurred during her periods of active duty and active duty for training with the Army National Guard.  In her November 2007 claim, the Veteran advanced that her PTSD was secondary to the premature birth of R., her son, during a period of advanced individual training.  In an April 2008 written statement, the Veteran related that she encountered the remains of a fellow servicewoman, who had committed suicide by jumping from a water tower, during her period of Army basic training at Fort Jackson, South Carolina.

At a February 2009 DRO hearing, the Veteran testified that although she was having trouble with her pregnancy in 1985, her sergeant insisted that she continue to perform drills and would not let her go on maternity leave.  DRO Hearing Transcript 4-5.  She stated that she "ended up giving birth at 24 weeks" and her "son ha[d] been an invalid ever since."  Id. at 4-5.  She then testified that her son was born in April 1985, and that her drills began in June 1985.  Id. at 6.  She also stated that one of the women in her unit had committed suicide.  Id. at 9.

At the Veteran's July 2010 Board hearing, the Veteran testified she had been harassed by her Army National Guard superiors when she requested maternity leave and subsequently experienced the premature birth and associated disability of her son.  Board Hearing Transcript 3-4.  She stated that she was told by her doctor that there was a possibility that her premature delivery "could have stemmed from doing too much physical [training]."  Id. at 5.

Generally, service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service.  38 U.S.C.A. § 1131;
38 C.F.R. § 3.303(a).  Service connection requires evidence satisfying three criteria:  (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the disease or injury incurred or aggravated during service.
Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Active military, naval, or air service includes any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty.  38 U.S.C.A. § 101(21), (24) (West 2014); 38 C.F.R. § 3.6(a), (d) (2015).  ACDUTRA includes full-time duty performed for training purposes by members of the National Guard of any state.  38 U.S.C.A. §§ 101(22); 38 C.F.R. § 3.6(c)(3).  Thus, service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing ACDUTRA, or from an injury incurred or aggravated while performing INACDUTRA.  38 U.S.C.A. §§ 101(24), 106.

There are particular requirements for establishing PTSD in 38 C.F.R. § 3.304(f), which are separate from the general requirements for establishing service connection in 38 C.F.R. § 3.303.  See Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010).  Establishing service connection for PTSD requires (1) a diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor.  38 C.F.R. § 3.304(f).  A mental health diagnosis should conform to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) (or, prior to 2014, the Fourth Edition [DSM-IV]).  38 C.F.R. § 4.125 (2015).

What constitutes credible supporting evidence that a claimed in-service stressor occurred depends on the nature of the claimed stressor.  If the evidence establishes 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.  VA has consistently defined "engaged in combat with the enemy" to require a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality.  See VAOPGCPREC 12-99 (October 18, 1999).  For stressors unrelated to combat, credible supporting evidence is necessary in order to grant service connection.  "Credible supporting evidence" of a noncombat stressor may be obtained from service records or other sources.  Moreau v. Brown, 9 Vet. App. 389 (1996).

This claim for service connection for PTSD is potentially subject to the revision to 38 C.F.R. § 3.304 effective July 13, 2010.  See 38 C.F.R. § 3.304(f)(3).  That revision provides that, in certain circumstances, a veteran who has been diagnosed with PTSD by a VA or VA-contracted psychiatrist or psychologist based on a claimed stressor that is related to the veteran's fear of hostile military or terrorist activity may establish the occurrence of the claimed in-service stressor with lay testimony alone.  In this case, however, the Veteran has not argued to the Board that her stressors are based on fear of hostile military or terrorist activity, nor is there any evidence that the Veteran served in the vicinity or at the time of any military or terrorist activity.  This provision therefore does not apply in the current case.

The Board has considered all of the evidence discussed above, but finds that entitlement to service connection for a chronic acquired psychiatric disorder is not warranted.  The weight of the competent and probative medical opinions of record is against finding that the Veteran has a current diagnosis of PTSD or any other chronic acquired psychiatric disorder which is related to her military service.

April 1981, May 1982, and February 1985 National Guard evaluations of the Veteran found her psychiatric status to be normal.

The Veteran's private treatment records show regular complaints related to depression.  In September 2002, the Veteran reported that her symptoms first began in 1986.  The Veteran attended counseling throughout 2003 and 2004, and the treatment records show reports of problems with her life stressors of caring for her disabled son and dealing with the death of her other son and her parents.  She reported having insomnia and feeling anxiety and depression.  She reported that she first started receiving psychiatric treatment in 1987.  In an April 2004 psychiatric assessment, the Veteran reported her difficulties related to the murder of her son, caring for her disabled son, and the death of her father.  She reported having decreased sleep due to thinking about the death of her son and crying daily.  The Veteran made no mention of problems related to service.  She was diagnosed with severe major depression.

The Veteran was evaluated by a private psychiatrist in January 2005.  She reported that she was discharged from the Army in 1986 due to her son's health problems.  She discussed the various stressors in her life, including finding her father dead, the murder of her son, her husband's attempted suicide, and the death of her son's nurse.  She was diagnosed with PTSD, major depression, and bereavement.  In her May 2004 Social Security Administration evaluation, the Veteran reported that a "woman doctor" gave her some a shot "too soon when he was an infant," which caused his medical problems.  At a July 2004 Social Services evaluation, she reported that her son became ill when he had a bad reaction from a shot and that she had flashbacks of being raped at age 13.  She was diagnosed with depressive disorder.

At a November 2004 Social Services evaluation, the Veteran stated that she had PTSD due to "[t]he murder of my son.  This is what's caused me to be in the situation I'm in."  At another point in the interview, the Veteran referenced having intrusive thoughts, nightmares, and flashbacks pertaining to being raped while an adolescent.  She stated that her son had an allergic reaction to a vaccination as a baby, and this left him debilitated.  She stated that her depression began due to that, and that she left the National Guard in 1986 due to her depression.  She later stated that she left the National Guard because her "son was fighting for his life."  The Veteran discussed her stressors extensively, but did not mention any stressors caused by her service.  She was diagnosed with PTSD, major depressive disorder, panic disorder, and obsessive compulsive disorder.

April 2006 letters from the Veteran's social worker and psychiatrist stated that the Veteran was diagnosed with major depression recurrent and PTSD.  An April 2006 disability evaluation noted that the Veteran had symptoms of depression, anxiety, and anhedonia caused by "[n]umerous traumatic events resulting in loss of family members."  In May 2006, it was noted that the Veteran was discharged from the Army in 1986 due to her son's health problems.  Various life traumas were listed, including finding her father dead and the murder of her son.  She was diagnosed with PTSD, major depression, and bereavement.  Continued counseling in 2006 and 2007 show treatment for depression due to life stressors such as problems with her husband and caring for her son.

In February 2011, the Veteran reported that her son was born early due to harassment from her sergeant in the National Guard.  At a May 2011 VA evaluation for treatment by a clinical nurse specialist, the Veteran reported being raped at age 12.  When asked about military sexual trauma, she reported that her superior "told her to show up or she would be discharged," and that she threw off her rank and told him that she did not care.  She stated that she attributed her son's illness to being ordered by her military superior to come to work and complete her clerical duties.  The examiner diagnosed the Veteran with adjustment disorder with mixed anxious and depressed mood.  The examiner wrote that she could not state that the Veteran had experienced military sexual trauma, as she had "clearly stated that her physician had refused to relieve her of any military duties, and that "requesting a soldier who is subordinate in rank to complete their designated assignment is a duty and does not constitute sexual harassment-or in fact, any form of harassment."  She wrote that the Veteran's most significant stressor was providing total care for her grown son.  An addendum by a staff psychiatrist wrote that the Veteran had no history given of any conduct of a sexual nature or sexual assault, and no history of sexual harassment.

The Veteran attended a VA psychiatric examination in May 2011 with a clinical psychologist who performed an in-person examination of the Veteran and reviewed the claims file.  The Veteran reported that while she was pregnant, she was not dismissed from drills and as a result her son was born prematurely.  She stated that her superior snatched her collar and demoted her during the disagreement over her participation in physical training.  She also reported that she once "saw white stuff" on the ground which she later learned were the remains of a fellow service member who committed suicide.  She stated that she believed her son was born prematurely due to the stress she experienced in dealing with her sergeant and that this resulted in her PTSD.  The examiner diagnosed the Veteran with MDD and anxiety, and stated that the Veteran did not meet the criteria for a diagnosis of PTSD, as she did not have an adequate stressor and her reported symptoms of difficulty sleeping, social isolation, and inability to focus were due to her depression.  The examiner stated that the Veteran's psychiatric disorder was less likely as not a result of service, explaining that the Veteran had reported that her depression and anxiety symptoms were related to her dependent son's physical condition and her deceased son's murder.  The examiner wrote that the Veteran was also concerned about financial stressors and other current ongoing family issues, and summarized her findings by stating that "[r]eview of available evidence indicate that the Veteran's symptoms are related to her dependent son's physical condition and her deceased son's murder."

The Veteran has also submitted treatment records for her son, R., which show that in 1986 and 1987 he was treated for encephalopathy of unclear origin precipitated by tonsillitis and a fever.  More recent treatment records show that the Veteran's son is nonverbal and has quadriparesis/spastic quadriplegia and seizures, requiring constant care.

The Board has carefully reviewed the medical records outlined above, but finds that the weight of the evidence is against finding that the Veteran's current psychiatric diagnoses had their onset during or are related to her military service.

The evidence of record does establish that the Veteran has a current psychiatric disability, which has been variously diagnosed as PTSD, MDD, anxiety disorder, and adjustment disorder.  She has thus met the current disability requirement.

The evidence does not show, however, that she incurred a psychiatric disorder during her active service, or that her current diagnosis is related to her active service.  The Veteran's active duty period of service is from December 1981 to May 1982.  The Veteran herself has not indicated that any traumatic event occurred to her at this time, or that her psychiatric problems had their onset at this time.  Rather, the Veteran asserts that her psychiatric disorder is related to negative experiences which occurred during her service in the National Guard.

The Board accepts that the Veteran had additional periods of INACDUTRA and ACDUTRA in the years following her separation from active duty in 1982, and that the events that she has described involving a disagreement with her superior officer over his refusal to grant her leave due to her pregnancy and the birth of her child occurred as she described, and that they likely occurred during a period of ACDUTRA.  See 38 U.S.C.A. §§ 101(24), 106.  Nevertheless, the overwhelming weight of the evidence indicates that the Veteran's current psychiatric disorders are not related to any event that occurred during her military service, but are instead attributed to the numerous, severe personal stressors in her life post-service, including the murder of her son and caring for her disabled son R.

The Veteran is competent to testify regarding her experiences of having a conflict with her superior officer in service and of seeing the possible remains of a fellow service member who committed suicide.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (lay testimony is competent to describe observations, but must be weighed against the other evidence of record).  Lay witnesses are also competent to opine on some questions of etiology, and the Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (2011).  The question of whether the Veteran's current psychiatric disorder is related to her in-service experiences is testimony as to an internal psychiatric process, unlike the immediately observable cause-and-effect relationship of the type as to which the courts have found lay evidence to be competent.  Compare Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) ("It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant") with Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Falzone v. Brown, 8 Vet. App. 398, 403 (1995) (lay person competent to testify to pain and visible flatness of his feet).  Diagnosing a psychiatric disability is a complex medical matter; determining whether a person's symptoms are merely the type of feelings that accompany the stress and worry that would normally accompany such unfortunate events, or whether these symptoms rise to the severity and frequency that would warrant a diagnosis of a psychiatric disorder requires psychiatric or psychological training.  The Veteran has not been shown to have the appropriate medical training and expertise to opine on this question, and her testimony in this regard is therefore not competent.

As to the medical evidence, the Board finds that it weighs against a nexus between any current psychiatric disability and service.  The Veteran's private treatment records show that she received counseling for problems related to caring for her disabled son, the death of her parents and other son, and sexual trauma in her adolescence.  Her April 2006 disability evaluation found that the Veteran's disorder was caused by the loss of her family members, and at her November 2004 Social Services evaluation, she reported many life stressors that led to her intrusive thoughts, nightmares, and flashbacks, but these did not include any event in service.  The Veteran's VA psychiatric evaluation found that the Veteran's psychiatric disorder was not a result of service, and that they were instead due to her dependent son's physical condition and her deceased son's murder.  As the examiner explained the reasons for his conclusions based on an accurate characterization of the evidence of record, this opinion is entitled to substantial probative weight.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  Furthermore, there are no conflicting medical opinions of record which contradict the findings of the VA examiner, and in fact her findings are fully consistent with the other medical evidence of record.

While the Board sympathizes with the Veteran's contention that her son's disability was in some way caused by either stress from arguing with her superior officer or physical strain from serving on ACDUTRA while she was pregnant, the evidence of record does not support this contention.  The medical records of the Veteran's son R. do show that he has a serious disability which requires constant care, but treatment records from 1986 and 1987 show that he had encephalopathy of unclear origin precipitated by tonsillitis and a fever.  The Veteran herself seems unsure of the cause of her son's illness, as her statements made prior to filing the current claim show that she believed the illness was caused by an adverse reaction to a vaccination.  The credibility of a witness can be impeached by a showing of interest, bias, inconsistent statements, or, to a certain extent, bad character.  See Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996).  Here, the Veteran's assertions are both inconsistent and lacking in probative value due to the Veteran's lack of medical training or expertise to allow her to form a medical judgment regarding the cause of her son's illness.  The Board finds no competent medical evidence linking the Veteran's son's illness to her military service, and no indication that the Veteran's post-service life stressors, which have clearly been shown to be the cause of her current psychiatric disorder, are related to her service in any way.

The Board also acknowledges that there are special provisions pertaining to corroboration of PTSD based on personal assault in service.  See 38 C.F.R. § 3.304(f)(5).  The Veteran has indicated that she believes her harassment in service should constitute "sexual harassment."  The Veteran's assertions are accepted at face value regarding being denied leave from service for her pregnancy and/or following the birth of her child, but such conduct does not constitute sexual harassment or military sexual trauma, and as such, the provisions of 38 C.F.R. § 3.304(f) are not applicable in this case.  This is manifestly evident to the Board based on the Veteran's own testimony, and is further indicated by the Veteran's May 2011 VA intake evaluation, at which the examiner found that the Veteran had clearly stated that her complaint was that she was not relieved from duty when she felt she should be, and this "does not constitute sexus harassment-or in fact, any form of harassment."

Finally, the Board notes that at no time has the Veteran been shown to have a diagnosis of psychosis, and thus consideration of whether the presumptions afforded for a chronic disease is not warranted at this time, nor are such presumptions applicable to periods of INACDUTRA and ACDUTRA.  See 38 U.S.C.A. §§ 1112, 1113, 1137 (West 2014); 38 C.F.R. §§ 3.307, 3.309 (2015); Smith v. Shinseki, 24 Vet. App. 40, 46-47 (2010).

In sum, the weight of the competent and probative evidence of record therefore fails to establish that the Veteran's psychiatric disorder had its onset during active duty service or any period of INACDUTRA or ACDUTRA, nor is it related to any event during service.  The preponderance of the evidence is thus against the claim for entitlement to service connection for a chronic acquired psychiatric disorder, to include PTSD, MDD, and anxiety.  In reaching the conclusion above the Board has considered the applicability of the benefit of the doubt doctrine.  However, as the preponderance of the evidence is against the claim, that doctrine is not applicable.  See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102.

ORDER

Entitlement to service connection for a chronic acquired psychiatric disorder, to include PTSD, MDD, and anxiety, is denied.

____________________________________________
K. A. KENNERLY
Acting Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

label: Sentence

text: Citation

text: Nr

text: Decision

text: Date

text: Archive

text: Date

text: DOCKET

text: NO

text: DATE

text: On

text: appeal

text: from

text: the

text: Department

text: of

text: Veterans

text: Affairs

text: Regional

text: Office

text: in

text: Indianapolis

text: Indiana

text: THE

text: ISSUE

text: Entitlement

text: to

text: service

text: connection

text: for

text: a

text: chronic

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: posttraumatic

text: stress

text: disorder

text: PTSD

text: Major

text: Depressive

text: Disorder

text: MDD

text: and

text: anxiety

text: REPRESENTATION

text: Veteran

text: represented

text: by

text: Veterans

text: of

text: Foreign

text: Wars

text: of

text: the

text: United

text: States

text: WITNESS

text: AT

text: HEARING

text: ON

text: APPEAL

text: The

text: Veteran

text: ATTORNEY

text: FOR

text: THE

text: BOARD

text: Mary

text: E

text: Rude

text: Associate

text: Counsel

text: INTRODUCTION

text: The

text: Veteran

text: had

text: verified

text: active

text: duty

text: from

text: December

text: to

text: May

text: She

text: had

text: additional

text: duty

text: with

text: the

text: Indiana

text: Army

text: National

text: Guard

text: Army

text: Reserve

text: This

text: matter

text: comes

text: before

text: the

text: Board

text: of

text: Veterans

text: Appeals

text: Board

text: on

text: appeal

text: from

text: a

text: June

text: rating

text: decision

text: of

text: the

text: Indianapolis

text: Indiana

text: Regional

text: Office

text: RO

text: In

text: February

text: the

text: Veteran

text: attended

text: a

text: Decision

text: Review

text: Officer

text: DRO

text: hearing

text: at

text: the

text: RO

text: and

text: in

text: August

text: the

text: Veteran

text: attended

text: a

text: Board

text: hearing

text: before

text: the

text: undersigned

text: The

text: transcripts

text: of

text: these

text: hearings

text: have

text: been

text: associated

text: with

text: the

text: claims

text: file

text: In

text: May

text: and

text: July

text: the

text: Board

text: remanded

text: the

text: issue

text: for

text: additional

text: evidentiary

text: development

text: It

text: has

text: now

text: been

text: returned

text: to

text: the

text: Board

text: for

text: adjudication

text: The

text: claims

text: file

text: is

text: now

text: entirely

text: in

text: VA

text: s

text: secure

text: electronic

text: processing

text: systems

text: Virtual

text: VA

text: and

text: Veterans

text: Benefits

text: Management

text: System

text: VBMS

text: FINDING

text: OF

text: FACT

text: The

text: preponderance

text: of

text: the

text: competent

text: evidence

text: of

text: record

text: is

text: against

text: finding

text: that

text: the

text: Veteran

text: has

text: a

text: chronic

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: PTSD

text: MDD

text: and

text: anxiety

text: which

text: is

text: related

text: to

text: active

text: service

text: or

text: any

text: period

text: of

text: INACDUTRA

text: or

text: ACDUTRA

text: CONCLUSION

text: OF

text: LAW

text: A

text: chronic

text: acquired

text: psychiatric

text: disorder

text: was

text: not

text: incurred

text: in

text: or

text: aggravated

text: by

text: active

text: duty

text: service

text: U

text: S

text: C

text: A

text: A

text: West

text: C

text: F

text: R

text: REASONS

text: AND

text: BASES

text: FOR

text: FINDING

text: AND

text: CONCLUSION

text: I

text: Duties

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: C

text: F

text: R

text: a

text: a

text: VA

text: is

text: required

text: to

text: notify

text: the

text: claimant

text: and

text: his

text: or

text: her

text: representative

text: of

text: any

text: information

text: and

text: any

text: medical

text: or

text: lay

text: evidence

text: not

text: of

text: record

text: that

text: is

text: necessary

text: to

text: substantiate

text: the

text: claim

text: that

text: VA

text: will

text: seek

text: to

text: provide

text: and

text: that

text: the

text: claimant

text: is

text: expected

text: to

text: provide

text: U

text: S

text: C

text: A

text: a

text: C

text: F

text: R

text: b

text: Quartuccio

text: v

text: Principi

text: Vet

text: App

text: VA

text: has

text: fulfilled

text: the

text: above

text: requirements

text: In

text: a

text: February

text: VCAA

text: notice

text: letter

text: the

text: Veteran

text: was

text: duly

text: informed

text: of

text: the

text: evidence

text: needed

text: to

text: establish

text: entitlement

text: to

text: service

text: connection

text: for

text: PTSD

text: The

text: issue

text: was

text: last

text: readjudicated

text: in

text: a

text: June

text: supplemental

text: statement

text: of

text: the

text: case

text: Accordingly

text: no

text: further

text: development

text: is

text: required

text: with

text: respect

text: to

text: the

text: duty

text: to

text: notify

text: Next

text: VA

text: has

text: a

text: duty

text: to

text: assist

text: a

text: claimant

text: in

text: the

text: development

text: of

text: a

text: claim

text: This

text: duty

text: includes

text: assisting

text: in

text: the

text: procurement

text: of

text: service

text: treatment

text: records

text: and

text: all

text: relevant

text: pre

text: and

text: post

text: service

text: treatment

text: records

text: and

text: by

text: providing

text: an

text: examination

text: when

text: necessary

text: U

text: S

text: C

text: A

text: A

text: C

text: F

text: R

text: In

text: May

text: the

text: RO

text: issued

text: a

text: Formal

text: Finding

text: on

text: the

text: Unavailability

text: of

text: Records

text: indicating

text: that

text: the

text: Veteran

text: s

text: service

text: treatment

text: records

text: were

text: unavailable

text: for

text: review

text: Although

text: the

text: memorandum

text: did

text: not

text: properly

text: list

text: the

text: steps

text: taken

text: to

text: obtain

text: these

text: records

text: the

text: record

text: adequately

text: indicates

text: that

text: a

text: proper

text: request

text: was

text: made

text: for

text: the

text: Veteran

text: s

text: active

text: service

text: records

text: but

text: no

text: records

text: were

text: found

text: Several

text: of

text: the

text: Veteran

text: s

text: National

text: Guard

text: examinations

text: are

text: of

text: record

text: and

text: furthermore

text: the

text: Veteran

text: has

text: asserted

text: that

text: her

text: psychiatric

text: problems

text: began

text: in

text: or

text: after

text: the

text: birth

text: of

text: her

text: son

text: which

text: is

text: both

text: after

text: her

text: National

text: Guard

text: service

text: and

text: several

text: years

text: after

text: her

text: active

text: duty

text: from

text: December

text: to

text: May

text: The

text: Board

text: therefore

text: finds

text: that

text: further

text: attempts

text: to

text: obtain

text: her

text: active

text: service

text: records

text: would

text: be

text: both

text: futile

text: and

text: irrelevant

text: to

text: the

text: questions

text: currently

text: at

text: issue

text: Furthermore

text: the

text: Board

text: does

text: not

text: dispute

text: the

text: Veteran

text: s

text: assertions

text: that

text: she

text: requested

text: maternity

text: leave

text: in

text: while

text: serving

text: in

text: the

text: National

text: Guard

text: and

text: that

text: her

text: request

text: was

text: refused

text: by

text: her

text: superior

text: officer

text: confirmation

text: of

text: these

text: events

text: through

text: service

text: records

text: is

text: therefore

text: unnecessary

text: This

text: case

text: was

text: previously

text: remanded

text: in

text: May

text: and

text: July

text: The

text: Board

text: finds

text: that

text: all

text: prior

text: remand

text: instructions

text: have

text: been

text: adequately

text: completed

text: A

text: VA

text: examination

text: was

text: held

text: in

text: May

text: and

text: the

text: examination

text: and

text: opinion

text: are

text: adequate

text: to

text: decide

text: the

text: claim

text: as

text: were

text: based

text: upon

text: consideration

text: of

text: the

text: Veteran

text: s

text: medical

text: history

text: and

text: they

text: sufficiently

text: inform

text: the

text: Board

text: of

text: the

text: examiner

text: s

text: judgment

text: and

text: essential

text: rationale

text: See

text: Monzingo

text: v

text: Shinseki

text: Vet

text: App

text: Adequate

text: attempts

text: were

text: made

text: to

text: obtain

text: all

text: private

text: treatment

text: records

text: identified

text: by

text: the

text: Veteran

text: unfortunately

text: responses

text: from

text: these

text: providers

text: indicated

text: that

text: no

text: records

text: were

text: found

text: or

text: was

text: destroyed

text: and

text: the

text: Veteran

text: was

text: adequately

text: notified

text: of

text: this

text: fact

text: The

text: Board

text: finds

text: that

text: further

text: attempts

text: to

text: acquire

text: additional

text: private

text: records

text: would

text: therefore

text: be

text: futile

text: Gagne

text: v

text: McDonald

text: Vet

text: App

text: A

text: search

text: is

text: futile

text: where

text: it

text: is

text: apparent

text: that

text: the

text: sought

text: after

text: records

text: are

text: either

text: not

text: in

text: existence

text: or

text: not

text: in

text: the

text: possession

text: of

text: the

text: record

text: s

text: custodian

text: The

text: Board

text: notes

text: however

text: that

text: many

text: of

text: the

text: records

text: identified

text: by

text: the

text: Veteran

text: have

text: been

text: obtained

text: through

text: the

text: Social

text: Security

text: Administration

text: and

text: therefore

text: have

text: been

text: available

text: for

text: review

text: The

text: Board

text: therefore

text: finds

text: that

text: there

text: has

text: been

text: substantial

text: compliance

text: with

text: the

text: remand

text: directives

text: See

text: Stegall

text: v

text: West

text: Vet

text: App

text: D

text: Aries

text: v

text: Peake

text: Vet

text: App

text: In

text: addition

text: to

text: the

text: documentary

text: evidence

text: testimonial

text: statements

text: are

text: of

text: record

text: including

text: testimony

text: provided

text: by

text: the

text: Veteran

text: at

text: a

text: February

text: RO

text: hearing

text: and

text: at

text: an

text: August

text: Board

text: hearing

text: At

text: these

text: hearings

text: the

text: issue

text: on

text: appeal

text: was

text: clearly

text: identified

text: the

text: elements

text: required

text: to

text: establish

text: if

text: service

text: connection

text: is

text: warranted

text: were

text: explained

text: and

text: suggestions

text: were

text: made

text: regarding

text: the

text: submission

text: of

text: necessary

text: favorable

text: evidence

text: The

text: Veteran

text: had

text: an

text: opportunity

text: to

text: present

text: additional

text: testimony

text: on

text: the

text: essential

text: elements

text: necessary

text: to

text: prove

text: the

text: claim

text: and

text: all

text: hearing

text: duties

text: are

text: found

text: to

text: be

text: satisfied

text: See

text: C

text: F

text: R

text: c

text: Bryant

text: v

text: Shinseki

text: Vet

text: App

text: In

text: sum

text: the

text: Board

text: finds

text: that

text: VA

text: has

text: complied

text: with

text: the

text: VCAA

text: s

text: notification

text: and

text: assistance

text: requirements

text: and

text: any

text: error

text: in

text: notice

text: and

text: development

text: assistance

text: cannot

text: reasonably

text: affect

text: the

text: outcome

text: of

text: the

text: case

text: and

text: hence

text: will

text: not

text: affect

text: the

text: essential

text: fairness

text: of

text: the

text: adjudication

text: for

text: the

text: service

text: connection

text: claim

text: at

text: issue

text: See

text: ATD

text: Corp

text: v

text: Lydall

text: Inc

text: F

text: d

text: Fed

text: Cir

text: Mayfield

text: v

text: Nicholson

text: Vet

text: App

text: II

text: Analysis

text: The

text: Veteran

text: asserts

text: that

text: service

text: connection

text: for

text: chronic

text: PTSD

text: or

text: other

text: psychiatric

text: disorder

text: is

text: warranted

text: as

text: she

text: has

text: been

text: diagnosed

text: with

text: chronic

text: PTSD

text: secondary

text: to

text: several

text: stressful

text: events

text: which

text: occurred

text: during

text: her

text: periods

text: of

text: active

text: duty

text: and

text: active

text: duty

text: for

text: training

text: with

text: the

text: Army

text: National

text: Guard

text: In

text: her

text: November

text: claim

text: the

text: Veteran

text: advanced

text: that

text: her

text: PTSD

text: was

text: secondary

text: to

text: the

text: premature

text: birth

text: of

text: R

text: her

text: son

text: during

text: a

text: period

text: of

text: advanced

text: individual

text: training

text: In

text: an

text: April

text: written

text: statement

text: the

text: Veteran

text: related

text: that

text: she

text: encountered

text: the

text: remains

text: of

text: a

text: fellow

text: servicewoman

text: who

text: had

text: committed

text: suicide

text: by

text: jumping

text: from

text: a

text: water

text: tower

text: during

text: her

text: period

text: of

text: Army

text: basic

text: training

text: at

text: Fort

text: Jackson

text: South

text: Carolina

text: At

text: a

text: February

text: DRO

text: hearing

text: the

text: Veteran

text: testified

text: that

text: although

text: she

text: was

text: having

text: trouble

text: with

text: her

text: pregnancy

text: in

text: her

text: sergeant

text: insisted

text: that

text: she

text: continue

text: to

text: perform

text: drills

text: and

text: would

text: not

text: let

text: her

text: go

text: on

text: maternity

text: leave

text: DRO

text: Hearing

text: Transcript

text: She

text: stated

text: that

text: she

text: ended

text: up

text: giving

text: birth

text: at

text: weeks

text: and

text: her

text: son

text: ha

text: d

text: been

text: an

text: invalid

text: ever

text: since

text: Id

text: at

text: She

text: then

text: testified

text: that

text: her

text: son

text: was

text: born

text: in

text: April

text: and

text: that

text: her

text: drills

text: began

text: in

text: June

text: Id

text: at

text: She

text: also

text: stated

text: that

text: one

text: of

text: the

text: women

text: in

text: her

text: unit

text: had

text: committed

text: suicide

text: Id

text: at

text: At

text: the

text: Veteran

text: s

text: July

text: Board

text: hearing

text: the

text: Veteran

text: testified

text: she

text: had

text: been

text: harassed

text: by

text: her

text: Army

text: National

text: Guard

text: superiors

text: when

text: she

text: requested

text: maternity

text: leave

text: and

text: subsequently

text: experienced

text: the

text: premature

text: birth

text: and

text: associated

text: disability

text: of

text: her

text: son

text: Board

text: Hearing

text: Transcript

text: She

text: stated

text: that

text: she

text: was

text: told

text: by

text: her

text: doctor

text: that

text: there

text: was

text: a

text: possibility

text: that

text: her

text: premature

text: delivery

text: could

text: have

text: stemmed

text: from

text: doing

text: too

text: much

text: physical

text: training

text: Id

text: at

text: Generally

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: coincident

text: with

text: or

text: aggravated

text: by

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: a

text: Service

text: connection

text: requires

text: evidence

text: satisfying

text: three

text: criteria

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: nexus

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: Shedden

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: Active

text: military

text: naval

text: or

text: air

text: service

text: includes

text: any

text: period

text: of

text: ACDUTRA

text: during

text: which

text: the

text: individual

text: concerned

text: was

text: disabled

text: or

text: died

text: from

text: a

text: disease

text: or

text: injury

text: incurred

text: in

text: or

text: aggravated

text: in

text: line

text: of

text: duty

text: or

text: any

text: period

text: of

text: inactive

text: duty

text: training

text: INACDUTRA

text: during

text: which

text: the

text: individual

text: concerned

text: was

text: disabled

text: or

text: died

text: from

text: injury

text: incurred

text: in

text: or

text: aggravated

text: in

text: line

text: of

text: duty

text: U

text: S

text: C

text: A

text: West

text: C

text: F

text: R

text: a

text: d

text: ACDUTRA

text: includes

text: full

text: time

text: duty

text: performed

text: for

text: training

text: purposes

text: by

text: members

text: of

text: the

text: National

text: Guard

text: of

text: any

text: state

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: c

text: Thus

text: service

text: connection

text: may

text: be

text: granted

text: for

text: disability

text: resulting

text: from

text: disease

text: or

text: injury

text: incurred

text: or

text: aggravated

text: while

text: performing

text: ACDUTRA

text: or

text: from

text: an

text: injury

text: incurred

text: or

text: aggravated

text: while

text: performing

text: INACDUTRA

text: U

text: S

text: C

text: A

text: There

text: are

text: particular

text: requirements

text: for

text: establishing

text: PTSD

text: in

text: C

text: F

text: R

text: f

text: which

text: are

text: separate

text: from

text: the

text: general

text: requirements

text: for

text: establishing

text: service

text: connection

text: in

text: C

text: F

text: R

text: See

text: Arzio

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: Establishing

text: service

text: connection

text: for

text: PTSD

text: requires

text: a

text: diagnosis

text: of

text: PTSD

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: actually

text: occurred

text: and

text: medical

text: evidence

text: of

text: a

text: causal

text: nexus

text: between

text: current

text: symptomatology

text: and

text: the

text: specific

text: claimed

text: in

text: service

text: stressor

text: C

text: F

text: R

text: f

text: A

text: mental

text: health

text: diagnosis

text: should

text: conform

text: to

text: the

text: Diagnostic

text: and

text: Statistical

text: Manual

text: of

text: Mental

text: Disorders

text: Fifth

text: Edition

text: DSM

text: V

text: or

text: prior

text: to

text: the

text: Fourth

text: Edition

text: DSM

text: IV

text: C

text: F

text: R

text: What

text: constitutes

text: credible

text: supporting

text: evidence

text: that

text: a

text: claimed

text: in

text: service

text: stressor

text: occurred

text: depends

text: on

text: the

text: nature

text: of

text: the

text: claimed

text: stressor

text: If

text: the

text: evidence

text: establishes

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: VA

text: has

text: consistently

text: defined

text: engaged

text: in

text: combat

text: with

text: the

text: enemy

text: to

text: require

text: a

text: veteran

text: have

text: participated

text: in

text: events

text: constituting

text: an

text: actual

text: fight

text: or

text: encounter

text: with

text: a

text: military

text: foe

text: or

text: hostile

text: unit

text: or

text: instrumentality

text: See

text: VAOPGCPREC

text: October

text: For

text: stressors

text: unrelated

text: to

text: combat

text: credible

text: supporting

text: evidence

text: is

text: necessary

text: in

text: order

text: to

text: grant

text: service

text: connection

text: Credible

text: supporting

text: evidence

text: of

text: a

text: noncombat

text: stressor

text: may

text: be

text: obtained

text: from

text: service

text: records

text: or

text: other

text: sources

text: Moreau

text: v

text: Brown

text: Vet

text: App

text: This

text: claim

text: for

text: service

text: connection

text: for

text: PTSD

text: is

text: potentially

text: subject

text: to

text: the

text: revision

text: to

text: C

text: F

text: R

text: effective

text: July

text: See

text: C

text: F

text: R

text: f

text: That

text: revision

text: provides

text: that

text: in

text: certain

text: circumstances

text: a

text: veteran

text: who

text: has

text: been

text: diagnosed

text: with

text: PTSD

text: by

text: a

text: VA

text: or

text: VA

text: contracted

text: psychiatrist

text: or

text: psychologist

text: based

text: on

text: a

text: claimed

text: stressor

text: that

text: is

text: related

text: to

text: the

text: veteran

text: s

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: may

text: establish

text: the

text: occurrence

text: of

text: the

text: claimed

text: in

text: service

text: stressor

text: with

text: lay

text: testimony

text: alone

text: In

text: this

text: case

text: however

text: the

text: Veteran

text: has

text: not

text: argued

text: to

text: the

text: Board

text: that

text: her

text: stressors

text: are

text: based

text: on

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: nor

text: is

text: there

text: any

text: evidence

text: that

text: the

text: Veteran

text: served

text: in

text: the

text: vicinity

text: or

text: at

text: the

text: time

text: of

text: any

text: military

text: or

text: terrorist

text: activity

text: This

text: provision

text: therefore

text: does

text: not

text: apply

text: in

text: the

text: current

text: case

text: The

text: Board

text: has

text: considered

text: all

text: of

text: the

text: evidence

text: discussed

text: above

text: but

text: finds

text: that

text: entitlement

text: to

text: service

text: connection

text: for

text: a

text: chronic

text: acquired

text: psychiatric

text: disorder

text: is

text: not

text: warranted

text: The

text: weight

text: of

text: the

text: competent

text: and

text: probative

text: medical

text: opinions

text: of

text: record

text: is

text: against

text: finding

text: that

text: the

text: Veteran

text: has

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: or

text: any

text: other

text: chronic

text: acquired

text: psychiatric

text: disorder

text: which

text: is

text: related

text: to

text: her

text: military

text: service

text: April

text: May

text: and

text: February

text: National

text: Guard

text: evaluations

text: of

text: the

text: Veteran

text: found

text: her

text: psychiatric

text: status

text: to

text: be

text: normal

text: The

text: Veteran

text: s

text: private

text: treatment

text: records

text: show

text: regular

text: complaints

text: related

text: to

text: depression

text: In

text: September

text: the

text: Veteran

text: reported

text: that

text: her

text: symptoms

text: first

text: began

text: in

text: The

text: Veteran

text: attended

text: counseling

text: throughout

text: and

text: and

text: the

text: treatment

text: records

text: show

text: reports

text: of

text: problems

text: with

text: her

text: life

text: stressors

text: of

text: caring

text: for

text: her

text: disabled

text: son

text: and

text: dealing

text: with

text: the

text: death

text: of

text: her

text: other

text: son

text: and

text: her

text: parents

text: She

text: reported

text: having

text: insomnia

text: and

text: feeling

text: anxiety

text: and

text: depression

text: She

text: reported

text: that

text: she

text: first

text: started

text: receiving

text: psychiatric

text: treatment

text: in

text: In

text: an

text: April

text: psychiatric

text: assessment

text: the

text: Veteran

text: reported

text: her

text: difficulties

text: related

text: to

text: the

text: murder

text: of

text: her

text: son

text: caring

text: for

text: her

text: disabled

text: son

text: and

text: the

text: death

text: of

text: her

text: father

text: She

text: reported

text: having

text: decreased

text: sleep

text: due

text: to

text: thinking

text: about

text: the

text: death

text: of

text: her

text: son

text: and

text: crying

text: daily

text: The

text: Veteran

text: made

text: no

text: mention

text: of

text: problems

text: related

text: to

text: service

text: She

text: was

text: diagnosed

text: with

text: severe

text: major

text: depression

text: The

text: Veteran

text: was

text: evaluated

text: by

text: a

text: private

text: psychiatrist

text: in

text: January

text: She

text: reported

text: that

text: she

text: was

text: discharged

text: from

text: the

text: Army

text: in

text: due

text: to

text: her

text: son

text: s

text: health

text: problems

text: She

text: discussed

text: the

text: various

text: stressors

text: in

text: her

text: life

text: including

text: finding

text: her

text: father

text: dead

text: the

text: murder

text: of

text: her

text: son

text: her

text: husband

text: s

text: attempted

text: suicide

text: and

text: the

text: death

text: of

text: her

text: son

text: s

text: nurse

text: She

text: was

text: diagnosed

text: with

text: PTSD

text: major

text: depression

text: and

text: bereavement

text: In

text: her

text: May

text: Social

text: Security

text: Administration

text: evaluation

text: the

text: Veteran

text: reported

text: that

text: a

text: woman

text: doctor

text: gave

text: her

text: some

text: a

text: shot

text: too

text: soon

text: when

text: he

text: was

text: an

text: infant

text: which

text: caused

text: his

text: medical

text: problems

text: At

text: a

text: July

text: Social

text: Services

text: evaluation

text: she

text: reported

text: that

text: her

text: son

text: became

text: ill

text: when

text: he

text: had

text: a

text: bad

text: reaction

text: from

text: a

text: shot

text: and

text: that

text: she

text: had

text: flashbacks

text: of

text: being

text: raped

text: at

text: age

text: She

text: was

text: diagnosed

text: with

text: depressive

text: disorder

text: At

text: a

text: November

text: Social

text: Services

text: evaluation

text: the

text: Veteran

text: stated

text: that

text: she

text: had

text: PTSD

text: due

text: to

text: t

text: he

text: murder

text: of

text: my

text: son

text: This

text: is

text: what

text: s

text: caused

text: me

text: to

text: be

text: in

text: the

text: situation

text: I

text: m

text: in

text: At

text: another

text: point

text: in

text: the

text: interview

text: the

text: Veteran

text: referenced

text: having

text: intrusive

text: thoughts

text: nightmares

text: and

text: flashbacks

text: pertaining

text: to

text: being

text: raped

text: while

text: an

text: adolescent

text: She

text: stated

text: that

text: her

text: son

text: had

text: an

text: allergic

text: reaction

text: to

text: a

text: vaccination

text: as

text: a

text: baby

text: and

text: this

text: left

text: him

text: debilitated

text: She

text: stated

text: that

text: her

text: depression

text: began

text: due

text: to

text: that

text: and

text: that

text: she

text: left

text: the

text: National

text: Guard

text: in

text: due

text: to

text: her

text: depression

text: She

text: later

text: stated

text: that

text: she

text: left

text: the

text: National

text: Guard

text: because

text: her

text: son

text: was

text: fighting

text: for

text: his

text: life

text: The

text: Veteran

text: discussed

text: her

text: stressors

text: extensively

text: but

text: did

text: not

text: mention

text: any

text: stressors

text: caused

text: by

text: her

text: service

text: She

text: was

text: diagnosed

text: with

text: PTSD

text: major

text: depressive

text: disorder

text: panic

text: disorder

text: and

text: obsessive

text: compulsive

text: disorder

text: April

text: letters

text: from

text: the

text: Veteran

text: s

text: social

text: worker

text: and

text: psychiatrist

text: stated

text: that

text: the

text: Veteran

text: was

text: diagnosed

text: with

text: major

text: depression

text: recurrent

text: and

text: PTSD

text: An

text: April

text: disability

text: evaluation

text: noted

text: that

text: the

text: Veteran

text: had

text: symptoms

text: of

text: depression

text: anxiety

text: and

text: anhedonia

text: caused

text: by

text: n

text: umerous

text: traumatic

text: events

text: resulting

text: in

text: loss

text: of

text: family

text: members

text: In

text: May

text: it

text: was

text: noted

text: that

text: the

text: Veteran

text: was

text: discharged

text: from

text: the

text: Army

text: in

text: due

text: to

text: her

text: son

text: s

text: health

text: problems

text: Various

text: life

text: traumas

text: were

text: listed

text: including

text: finding

text: her

text: father

text: dead

text: and

text: the

text: murder

text: of

text: her

text: son

text: She

text: was

text: diagnosed

text: with

text: PTSD

text: major

text: depression

text: and

text: bereavement

text: Continued

text: counseling

text: in

text: and

text: show

text: treatment

text: for

text: depression

text: due

text: to

text: life

text: stressors

text: such

text: as

text: problems

text: with

text: her

text: husband

text: and

text: caring

text: for

text: her

text: son

text: In

text: February

text: the

text: Veteran

text: reported

text: that

text: her

text: son

text: was

text: born

text: early

text: due

text: to

text: harassment

text: from

text: her

text: sergeant

text: in

text: the

text: National

text: Guard

text: At

text: a

text: May

text: VA

text: evaluation

text: for

text: treatment

text: by

text: a

text: clinical

text: nurse

text: specialist

text: the

text: Veteran

text: reported

text: being

text: raped

text: at

text: age

text: When

text: asked

text: about

text: military

text: sexual

text: trauma

text: she

text: reported

text: that

text: her

text: superior

text: told

text: her

text: to

text: show

text: up

text: or

text: she

text: would

text: be

text: discharged

text: and

text: that

text: she

text: threw

text: off

text: her

text: rank

text: and

text: told

text: him

text: that

text: she

text: did

text: not

text: care

text: She

text: stated

text: that

text: she

text: attributed

text: her

text: son

text: s

text: illness

text: to

text: being

text: ordered

text: by

text: her

text: military

text: superior

text: to

text: come

text: to

text: work

text: and

text: complete

text: her

text: clerical

text: duties

text: The

text: examiner

text: diagnosed

text: the

text: Veteran

text: with

text: adjustment

text: disorder

text: with

text: mixed

text: anxious

text: and

text: depressed

text: mood

text: The

text: examiner

text: wrote

text: that

text: she

text: could

text: not

text: state

text: that

text: the

text: Veteran

text: had

text: experienced

text: military

text: sexual

text: trauma

text: as

text: she

text: had

text: clearly

text: stated

text: that

text: her

text: physician

text: had

text: refused

text: to

text: relieve

text: her

text: of

text: any

text: military

text: duties

text: and

text: that

text: requesting

text: a

text: soldier

text: who

text: is

text: subordinate

text: in

text: rank

text: to

text: complete

text: their

text: designated

text: assignment

text: is

text: a

text: duty

text: and

text: does

text: not

text: constitute

text: sexual

text: harassment

text: or

text: in

text: fact

text: any

text: form

text: of

text: harassment

text: She

text: wrote

text: that

text: the

text: Veteran

text: s

text: most

text: significant

text: stressor

text: was

text: providing

text: total

text: care

text: for

text: her

text: grown

text: son

text: An

text: addendum

text: by

text: a

text: staff

text: psychiatrist

text: wrote

text: that

text: the

text: Veteran

text: had

text: no

text: history

text: given

text: of

text: any

text: conduct

text: of

text: a

text: sexual

text: nature

text: or

text: sexual

text: assault

text: and

text: no

text: history

text: of

text: sexual

text: harassment

text: The

text: Veteran

text: attended

text: a

text: VA

text: psychiatric

text: examination

text: in

text: May

text: with

text: a

text: clinical

text: psychologist

text: who

text: performed

text: an

text: in

text: person

text: examination

text: of

text: the

text: Veteran

text: and

text: reviewed

text: the

text: claims

text: file

text: The

text: Veteran

text: reported

text: that

text: while

text: she

text: was

text: pregnant

text: she

text: was

text: not

text: dismissed

text: from

text: drills

text: and

text: as

text: a

text: result

text: her

text: son

text: was

text: born

text: prematurely

text: She

text: stated

text: that

text: her

text: superior

text: snatched

text: her

text: collar

text: and

text: demoted

text: her

text: during

text: the

text: disagreement

text: over

text: her

text: participation

text: in

text: physical

text: training

text: She

text: also

text: reported

text: that

text: she

text: once

text: saw

text: white

text: stuff

text: on

text: the

text: ground

text: which

text: she

text: later

text: learned

text: were

text: the

text: remains

text: of

text: a

text: fellow

text: service

text: member

text: who

text: committed

text: suicide

text: She

text: stated

text: that

text: she

text: believed

text: her

text: son

text: was

text: born

text: prematurely

text: due

text: to

text: the

text: stress

text: she

text: experienced

text: in

text: dealing

text: with

text: her

text: sergeant

text: and

text: that

text: this

text: resulted

text: in

text: her

text: PTSD

text: The

text: examiner

text: diagnosed

text: the

text: Veteran

text: with

text: MDD

text: and

text: anxiety

text: and

text: stated

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: as

text: she

text: did

text: not

text: have

text: an

text: adequate

text: stressor

text: and

text: her

text: reported

text: symptoms

text: of

text: difficulty

text: sleeping

text: social

text: isolation

text: and

text: inability

text: to

text: focus

text: were

text: due

text: to

text: her

text: depression

text: The

text: examiner

text: stated

text: that

text: the

text: Veteran

text: s

text: psychiatric

text: disorder

text: was

text: less

text: likely

text: as

text: not

text: a

text: result

text: of

text: service

text: explaining

text: that

text: the

text: Veteran

text: had

text: reported

text: that

text: her

text: depression

text: and

text: anxiety

text: symptoms

text: were

text: related

text: to

text: her

text: dependent

text: son

text: s

text: physical

text: condition

text: and

text: her

text: deceased

text: son

text: s

text: murder

text: The

text: examiner

text: wrote

text: that

text: the

text: Veteran

text: was

text: also

text: concerned

text: about

text: financial

text: stressors

text: and

text: other

text: current

text: ongoing

text: family

text: issues

text: and

text: summarized

text: her

text: findings

text: by

text: stating

text: that

text: r

text: eview

text: of

text: available

text: evidence

text: indicate

text: that

text: the

text: Veteran

text: s

text: symptoms

text: are

text: related

text: to

text: her

text: dependent

text: son

text: s

text: physical

text: condition

text: and

text: her

text: deceased

text: son

text: s

text: murder

text: The

text: Veteran

text: has

text: also

text: submitted

text: treatment

text: records

text: for

text: her

text: son

text: R

text: which

text: show

text: that

text: in

text: and

text: he

text: was

text: treated

text: for

text: encephalopathy

text: of

text: unclear

text: origin

text: precipitated

text: by

text: tonsillitis

text: and

text: a

text: fever

text: More

text: recent

text: treatment

text: records

text: show

text: that

text: the

text: Veteran

text: s

text: son

text: is

text: nonverbal

text: and

text: has

text: quadriparesis

text: spastic

text: quadriplegia

text: and

text: seizures

text: requiring

text: constant

text: care

text: The

text: Board

text: has

text: carefully

text: reviewed

text: the

text: medical

text: records

text: outlined

text: above

text: but

text: finds

text: that

text: the

text: weight

text: of

text: the

text: evidence

text: is

text: against

text: finding

text: that

text: the

text: Veteran

text: s

text: current

text: psychiatric

text: diagnoses

text: had

text: their

text: onset

text: during

text: or

text: are

text: related

text: to

text: her

text: military

text: service

text: The

text: evidence

text: of

text: record

text: does

text: establish

text: that

text: the

text: Veteran

text: has

text: a

text: current

text: psychiatric

text: disability

text: which

text: has

text: been

text: variously

text: diagnosed

text: as

text: PTSD

text: MDD

text: anxiety

text: disorder

text: and

text: adjustment

text: disorder

text: She

text: has

text: thus

text: met

text: the

text: current

text: disability

text: requirement

text: The

text: evidence

text: does

text: not

text: show

text: however

text: that

text: she

text: incurred

text: a

text: psychiatric

text: disorder

text: during

text: her

text: active

text: service

text: or

text: that

text: her

text: current

text: diagnosis

text: is

text: related

text: to

text: her

text: active

text: service

text: The

text: Veteran

text: s

text: active

text: duty

text: period

text: of

text: service

text: is

text: from

text: December

text: to

text: May

text: The

text: Veteran

text: herself

text: has

text: not

text: indicated

text: that

text: any

text: traumatic

text: event

text: occurred

text: to

text: her

text: at

text: this

text: time

text: or

text: that

text: her

text: psychiatric

text: problems

text: had

text: their

text: onset

text: at

text: this

text: time

text: Rather

text: the

text: Veteran

text: asserts

text: that

text: her

text: psychiatric

text: disorder

text: is

text: related

text: to

text: negative

text: experiences

text: which

text: occurred

text: during

text: her

text: service

text: in

text: the

text: National

text: Guard

text: The

text: Board

text: accepts

text: that

text: the

text: Veteran

text: had

text: additional

text: periods

text: of

text: INACDUTRA

text: and

text: ACDUTRA

text: in

text: the

text: years

text: following

text: her

text: separation

text: from

text: active

text: duty

text: in

text: and

text: that

text: the

text: events

text: that

text: she

text: has

text: described

text: involving

text: a

text: disagreement

text: with

text: her

text: superior

text: officer

text: over

text: his

text: refusal

text: to

text: grant

text: her

text: leave

text: due

text: to

text: her

text: pregnancy

text: and

text: the

text: birth

text: of

text: her

text: child

text: occurred

text: as

text: she

text: described

text: and

text: that

text: they

text: likely

text: occurred

text: during

text: a

text: period

text: of

text: ACDUTRA

text: See

text: U

text: S

text: C

text: A

text: Nevertheless

text: the

text: overwhelming

text: weight

text: of

text: the

text: evidence

text: indicates

text: that

text: the

text: Veteran

text: s

text: current

text: psychiatric

text: disorders

text: are

text: not

text: related

text: to

text: any

text: event

text: that

text: occurred

text: during

text: her

text: military

text: service

text: but

text: are

text: instead

text: attributed

text: to

text: the

text: numerous

text: severe

text: personal

text: stressors

text: in

text: her

text: life

text: post

text: service

text: including

text: the

text: murder

text: of

text: her

text: son

text: and

text: caring

text: for

text: her

text: disabled

text: son

text: R

text: The

text: Veteran

text: is

text: competent

text: to

text: testify

text: regarding

text: her

text: experiences

text: of

text: having

text: a

text: conflict

text: with

text: her

text: superior

text: officer

text: in

text: service

text: and

text: of

text: seeing

text: the

text: possible

text: remains

text: of

text: a

text: fellow

text: service

text: member

text: who

text: committed

text: suicide

text: Jandreau

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: Buchanan

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: lay

text: testimony

text: is

text: competent

text: to

text: describe

text: observations

text: but

text: must

text: be

text: weighed

text: against

text: the

text: other

text: evidence

text: of

text: record

text: Lay

text: witnesses

text: are

text: also

text: competent

text: to

text: opine

text: on

text: some

text: questions

text: of

text: etiology

text: and

text: the

text: Board

text: must

text: determine

text: on

text: a

text: case

text: by

text: case

text: basis

text: whether

text: a

text: particular

text: condition

text: is

text: the

text: type

text: of

text: condition

text: that

text: is

text: within

text: the

text: competence

text: of

text: a

text: lay

text: person

text: See

text: Davidson

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: Kahana

text: v

text: Shinseki

text: Vet

text: App

text: n

text: The

text: question

text: of

text: whether

text: the

text: Veteran

text: s

text: current

text: psychiatric

text: disorder

text: is

text: related

text: to

text: her

text: in

text: service

text: experiences

text: is

text: testimony

text: as

text: to

text: an

text: internal

text: psychiatric

text: process

text: unlike

text: the

text: immediately

text: observable

text: cause

text: and

text: effect

text: relationship

text: of

text: the

text: type

text: as

text: to

text: which

text: the

text: courts

text: have

text: found

text: lay

text: evidence

text: to

text: be

text: competent

text: Compare

text: Clemons

text: v

text: Shinseki

text: Vet

text: App

text: It

text: is

text: generally

text: the

text: province

text: of

text: medical

text: professionals

text: to

text: diagnose

text: or

text: label

text: a

text: mental

text: condition

text: not

text: the

text: claimant

text: with

text: Jandreau

text: F

text: d

text: at

text: lay

text: witness

text: capable

text: of

text: diagnosing

text: dislocated

text: shoulder

text: Falzone

text: v

text: Brown

text: Vet

text: App

text: lay

text: person

text: competent

text: to

text: testify

text: to

text: pain

text: and

text: visible

text: flatness

text: of

text: his

text: feet

text: Diagnosing

text: a

text: psychiatric

text: disability

text: is

text: a

text: complex

text: medical

text: matter

text: determining

text: whether

text: a

text: person

text: s

text: symptoms

text: are

text: merely

text: the

text: type

text: of

text: feelings

text: that

text: accompany

text: the

text: stress

text: and

text: worry

text: that

text: would

text: normally

text: accompany

text: such

text: unfortunate

text: events

text: or

text: whether

text: these

text: symptoms

text: rise

text: to

text: the

text: severity

text: and

text: frequency

text: that

text: would

text: warrant

text: a

text: diagnosis

text: of

text: a

text: psychiatric

text: disorder

text: requires

text: psychiatric

text: or

text: psychological

text: training

text: The

text: Veteran

text: has

text: not

text: been

text: shown

text: to

text: have

text: the

text: appropriate

text: medical

text: training

text: and

text: expertise

text: to

text: opine

text: on

text: this

text: question

text: and

text: her

text: testimony

text: in

text: this

text: regard

text: is

text: therefore

text: not

text: competent

text: As

text: to

text: the

text: medical

text: evidence

text: the

text: Board

text: finds

text: that

text: it

text: weighs

text: against

text: a

text: nexus

text: between

text: any

text: current

text: psychiatric

text: disability

text: and

text: service

text: The

text: Veteran

text: s

text: private

text: treatment

text: records

text: show

text: that

text: she

text: received

text: counseling

text: for

text: problems

text: related

text: to

text: caring

text: for

text: her

text: disabled

text: son

text: the

text: death

text: of

text: her

text: parents

text: and

text: other

text: son

text: and

text: sexual

text: trauma

text: in

text: her

text: adolescence

text: Her

text: April

text: disability

text: evaluation

text: found

text: that

text: the

text: Veteran

text: s

text: disorder

text: was

text: caused

text: by

text: the

text: loss

text: of

text: her

text: family

text: members

text: and

text: at

text: her

text: November

text: Social

text: Services

text: evaluation

text: she

text: reported

text: many

text: life

text: stressors

text: that

text: led

text: to

text: her

text: intrusive

text: thoughts

text: nightmares

text: and

text: flashbacks

text: but

text: these

text: did

text: not

text: include

text: any

text: event

text: in

text: service

text: The

text: Veteran

text: s

text: VA

text: psychiatric

text: evaluation

text: found

text: that

text: the

text: Veteran

text: s

text: psychiatric

text: disorder

text: was

text: not

text: a

text: result

text: of

text: service

text: and

text: that

text: they

text: were

text: instead

text: due

text: to

text: her

text: dependent

text: son

text: s

text: physical

text: condition

text: and

text: her

text: deceased

text: son

text: s

text: murder

text: As

text: the

text: examiner

text: explained

text: the

text: reasons

text: for

text: his

text: conclusions

text: based

text: on

text: an

text: accurate

text: characterization

text: of

text: the

text: evidence

text: of

text: record

text: this

text: opinion

text: is

text: entitled

text: to

text: substantial

text: probative

text: weight

text: See

text: Nieves

text: Rodriguez

text: v

text: Peake

text: Vet

text: App

text: Furthermore

text: there

text: are

text: no

text: conflicting

text: medical

text: opinions

text: of

text: record

text: which

text: contradict

text: the

text: findings

text: of

text: the

text: VA

text: examiner

text: and

text: in

text: fact

text: her

text: findings

text: are

text: fully

text: consistent

text: with

text: the

text: other

text: medical

text: evidence

text: of

text: record

text: While

text: the

text: Board

text: sympathizes

text: with

text: the

text: Veteran

text: s

text: contention

text: that

text: her

text: son

text: s

text: disability

text: was

text: in

text: some

text: way

text: caused

text: by

text: either

text: stress

text: from

text: arguing

text: with

text: her

text: superior

text: officer

text: or

text: physical

text: strain

text: from

text: serving

text: on

text: ACDUTRA

text: while

text: she

text: was

text: pregnant

text: the

text: evidence

text: of

text: record

text: does

text: not

text: support

text: this

text: contention

text: The

text: medical

text: records

text: of

text: the

text: Veteran

text: s

text: son

text: R

text: do

text: show

text: that

text: he

text: has

text: a

text: serious

text: disability

text: which

text: requires

text: constant

text: care

text: but

text: treatment

text: records

text: from

text: and

text: show

text: that

text: he

text: had

text: encephalopathy

text: of

text: unclear

text: origin

text: precipitated

text: by

text: tonsillitis

text: and

text: a

text: fever

text: The

text: Veteran

text: herself

text: seems

text: unsure

text: of

text: the

text: cause

text: of

text: her

text: son

text: s

text: illness

text: as

text: her

text: statements

text: made

text: prior

text: to

text: filing

text: the

text: current

text: claim

text: show

text: that

text: she

text: believed

text: the

text: illness

text: was

text: caused

text: by

text: an

text: adverse

text: reaction

text: to

text: a

text: vaccination

text: The

text: credibility

text: of

text: a

text: witness

text: can

text: be

text: impeached

text: by

text: a

text: showing

text: of

text: interest

text: bias

text: inconsistent

text: statements

text: or

text: to

text: a

text: certain

text: extent

text: bad

text: character

text: See

text: Caluza

text: v

text: Brown

text: Vet

text: App

text: aff

text: d

text: per

text: curiam

text: F

text: d

text: Fed

text: Cir

text: Here

text: the

text: Veteran

text: s

text: assertions

text: are

text: both

text: inconsistent

text: and

text: lacking

text: in

text: probative

text: value

text: due

text: to

text: the

text: Veteran

text: s

text: lack

text: of

text: medical

text: training

text: or

text: expertise

text: to

text: allow

text: her

text: to

text: form

text: a

text: medical

text: judgment

text: regarding

text: the

text: cause

text: of

text: her

text: son

text: s

text: illness

text: The

text: Board

text: finds

text: no

text: competent

text: medical

text: evidence

text: linking

text: the

text: Veteran

text: s

text: son

text: s

text: illness

text: to

text: her

text: military

text: service

text: and

text: no

text: indication

text: that

text: the

text: Veteran

text: s

text: post

text: service

text: life

text: stressors

text: which

text: have

text: clearly

text: been

text: shown

text: to

text: be

text: the

text: cause

text: of

text: her

text: current

text: psychiatric

text: disorder

text: are

text: related

text: to

text: her

text: service

text: in

text: any

text: way

text: The

text: Board

text: also

text: acknowledges

text: that

text: there

text: are

text: special

text: provisions

text: pertaining

text: to

text: corroboration

text: of

text: PTSD

text: based

text: on

text: personal

text: assault

text: in

text: service

text: See

text: C

text: F

text: R

text: f

text: The

text: Veteran

text: has

text: indicated

text: that

text: she

text: believes

text: her

text: harassment

text: in

text: service

text: should

text: constitute

text: sexual

text: harassment

text: The

text: Veteran

text: s

text: assertions

text: are

text: accepted

text: at

text: face

text: value

text: regarding

text: being

text: denied

text: leave

text: from

text: service

text: for

text: her

text: pregnancy

text: and

text: or

text: following

text: the

text: birth

text: of

text: her

text: child

text: but

text: such

text: conduct

text: does

text: not

text: constitute

text: sexual

text: harassment

text: or

text: military

text: sexual

text: trauma

text: and

text: as

text: such

text: the

text: provisions

text: of

text: C

text: F

text: R

text: f

text: are

text: not

text: applicable

text: in

text: this

text: case

text: This

text: is

text: manifestly

text: evident

text: to

text: the

text: Board

text: based

text: on

text: the

text: Veteran

text: s

text: own

text: testimony

text: and

text: is

text: further

text: indicated

text: by

text: the

text: Veteran

text: s

text: May

text: VA

text: intake

text: evaluation

text: at

text: which

text: the

text: examiner

text: found

text: that

text: the

text: Veteran

text: had

text: clearly

text: stated

text: that

text: her

text: complaint

text: was

text: that

text: she

text: was

text: not

text: relieved

text: from

text: duty

text: when

text: she

text: felt

text: she

text: should

text: be

text: and

text: this

text: does

text: not

text: constitute

text: sexus

text: harassment

text: or

text: in

text: fact

text: any

text: form

text: of

text: harassment

text: Finally

text: the

text: Board

text: notes

text: that

text: at

text: no

text: time

text: has

text: the

text: Veteran

text: been

text: shown

text: to

text: have

text: a

text: diagnosis

text: of

text: psychosis

text: and

text: thus

text: consideration

text: of

text: whether

text: the

text: presumptions

text: afforded

text: for

text: a

text: chronic

text: disease

text: is

text: not

text: warranted

text: at

text: this

text: time

text: nor

text: are

text: such

text: presumptions

text: applicable

text: to

text: periods

text: of

text: INACDUTRA

text: and

text: ACDUTRA

text: See

text: U

text: S

text: C

text: A

text: West

text: C

text: F

text: R

text: Smith

text: v

text: Shinseki

text: Vet

text: App

text: In

text: sum

text: the

text: weight

text: of

text: the

text: competent

text: and

text: probative

text: evidence

text: of

text: record

text: therefore

text: fails

text: to

text: establish

text: that

text: the

text: Veteran

text: s

text: psychiatric

text: disorder

text: had

text: its

text: onset

text: during

text: active

text: duty

text: service

text: or

text: any

text: period

text: of

text: INACDUTRA

text: or

text: ACDUTRA

text: nor

text: is

text: it

text: related

text: to

text: any

text: event

text: during

text: service

text: The

text: preponderance

text: of

text: the

text: evidence

text: is

text: thus

text: against

text: the

text: claim

text: for

text: entitlement

text: to

text: service

text: connection

text: for

text: a

text: chronic

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: PTSD

text: MDD

text: and

text: anxiety

text: In

text: reaching

text: the

text: conclusion

text: above

text: the

text: Board

text: has

text: considered

text: the

text: applicability

text: of

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: However

text: as

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: claim

text: that

text: doctrine

text: is

text: not

text: applicable

text: See

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: ORDER

text: Entitlement

text: to

text: service

text: connection

text: for

text: a

text: chronic

text: acquired

text: psychiatric

text: disorder

text: to

text: include

text: PTSD

text: MDD

text: and

text: anxiety

text: is

text: denied

text: K

text: A

text: KENNERLY

text: Acting

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs