Citation Nr: 18160412
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 15-14 491
DATE:	December 26, 2018
Entitlement to service connection for generalized anxiety disorder with depression is granted.
Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded.
The evidence is at least in equipoise as to whether the Veteran’s currently diagnosed generalized anxiety disorder with depression was incurred in his active military service.
The criteria for service connection for generalized anxiety disorder with depression have been met.  38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018).
The Veteran served on active duty from November 1984 to November 2004.  Service in Southwest Asia is indicated by the record.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia.
Entitlement to service connection for generalized anxiety disorder with depression.
Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Diseases diagnosed after discharge may still be service connected when all the evidence, including pertinent service records, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).
In this matter, the Veteran contends that he has generalized anxiety disorder that was incurred during his active military service.  For the reasons set forth below, the Board finds that service connection is warranted based upon the evidence of record.
The Veteran served on active duty from November 1984 to November 2004.  The evidence shows that he served in Southwest Asia from January 2003 to July 2003 as a motor transport operator.  The Veteran has described experiencing intense stress and fear for his life during his service in Southwest Asia during Operation Enduring Freedom and Operation Iraqi Freedom.  See, e.g., the Veteran’s statements dated November 2012 and February 2014.  To this end, the Veteran’s July 2003 post-deployment assessment documents his report that he felt he was in great danger of being killed during his deployment.
The Veteran’s post-service treatment records dated in September 2011 document diagnoses of generalized anxiety disorder and depression, not otherwise specified (NOS).
In a November 2012 statement, the Veteran’s spouse explained that, since returning from Iraq, he has been moody, angry, and distant.
The Veteran was afforded a VA examination in March 2013, at which time the examiner confirmed a diagnosis of generalized anxiety disorder (GAD) with symptoms of depression.  The examiner reviewed the Veteran’s medical history and noted that the Veteran’s experience of his sister’s pre-service motor vehicle accident and injuries at an early age do “not appear to have led to a diagnosis of anxiety.”  Rather, the examiner explained, “[h]is military service appears to have been the onset of symptoms, including sleep disturbance and irritability.”  He stated, “I find it more likely than not his GAD is due to his experiences in the Army while in Iraq.  Depression is a common sequelae to anxiety disorders.  In this case, his symptoms of depression are considered secondary to GAD.”
Accordingly, the Veteran is diagnosed with generalized anxiety disorder with depression, which the March 2013 VA examiner determined was incurred during his military service.  The Board therefore finds that the evidence is at least in equipoise as to whether the criteria for entitlement to service connection have been met.  As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for generalized anxiety disorder with depression is warranted.  See 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2017).
Entitlement to service connection for PTSD is remanded.
In addition, the Veteran contends that he developed PTSD as a result of his active military service.  He has asserted fear of hostile military activity during his service in Southwest Asia.  See the Veteran’s statement dated November 2012 and February 2014.  The Board observes that the Veteran’s stressor statements are consistent with his service in the Southwest Asia, which is demonstrated by the record.
In his August 2015 VA Form 9, the Veteran reported that he is receiving psychological treatment from Dr. H. at the Morgantown VA clinic, who has diagnosed him with PTSD within the past “several years.”  See the VA Form 9 dated August 2015.  A review of the claims file shows that only Veteran’s VA treatment records dated prior to March 2013 are of record.  As such, to ensure that all due process requirements are met and that the record is complete, the AOJ should undertake appropriate action to obtain all pertinent, outstanding records dating from March 2013.
The Veteran was afforded a VA psychological examination in March 2013 at which time the examiner reported that the Veteran’s symptoms do not meet the diagnostic criteria for PTSD under DSM-IV criteria.  Rather, as indicated above, the examiner diagnosed the generalized anxiety disorder, which has been service connected herein.
Significantly, the Board additionally notes that since the March 2013 examination was conducted, VA amended 38 C.F.R. § 4.125(a) to indicate that a diagnosis of a mental disorder, to include PTSD, must conform to the standards set in the DSM-5.  The amendments are applicable to the Veteran’s claim.  See 38 C.F.R. § 4.125; 79 Fed. Reg. 45,093, 45,094-096 (Aug. 4, 2014); 80 Fed. Reg. 14,308 (Mar. 19, 2015) (final) (providing that for claims that were initially certified for appeal to the Board, the Court, or the U.S. Court of Appeals for the Federal Circuit prior to August 4, 2014, DSM-IV will apply.  For all applications for benefits received by VA or pending before the AOJ on or after August 4, 2014, DSM-5 will apply).  As the Veteran’s claim was first certified for appeal in June 2015, DSM-5 applies to the claim.  As noted, the March 2013 VA examiner concluded that the Veteran did not meet the criteria for a diagnosis of PTSD under DSM-IV.
Thus, the Board finds that remand of this issue is warranted in order to afford the Veteran with a VA psychiatric examination that uses DSM-5, in accordance with current VA regulations.
The matter is REMANDED for the following action:
1. Obtain all outstanding records of VA evaluation and/or treatment of the Veteran.  Follow the procedures set forth in 38 C.F.R. § 3.159(c) with respect to requesting records from Federal facilities from March 2013.  All records/responses received should be associated with the claims file.
2. Schedule the Veteran for a VA examination to determine the etiology of his claimed PTSD.  All indicated tests and studies should be conducted.  The contents of the electronic claims file must be made available to the examiner for review in connection with the examination.
Following examination of the Veteran and review of the entire claims file, the psychiatrist is requested to provide an opinion as to whether the Veteran meets the criteria for a diagnosis of PTSD under the DSM-5 criteria.  If not, the examiner should specify which of the criteria are not met.  If the Veteran does meet the PTSD criteria, the examiner shall specify the stressors supporting the diagnosis.
If the diagnosis of PTSD is based upon a stressor involving fear of hostile military or terrorist activity, the examiner shall so state.
In answering these questions, the examiner should address the Veteran’s assertions of continuity of symptomatology dating from his military service.  The medical reasons for accepting or rejecting the Veteran’s statements regarding continuity since service should be set forth in detail.
If the examiner determines that he or she cannot provide an opinion without resorting to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined.  In particular, the examiner should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion.

Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K. K. Buckley, Counsel 

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