ptsd Ptsd/mst Denial

[lp56]

Thank you in advance for sensitivity to these questions. I entered the army in 1976 and the two years I spent in the military was nothing but sexual harassment, intimidation, sexual battery and even rape. Reporting to my superiors what was happening to me only made it worse; in fact, my superiors were very often the ones coercing, intimidating and assaulting me. It is gut-wrenching to think or speak about all the horrible things that happened to me, but I will say that I was so despondant and desperate to get out of the army and away from all the abuse I was suffering that I actually married the soldier who raped and impregnated me. Suicide and abortion were the alternatives. At the time, I made the only choice I could to survive. While married, my ex did horrible things to my children, which gave me the courage to divorce. I have been diagnosed with PTSD due to MST from several VA doctors and the C&P examiner. I have been in therapy for over 2 years. It took over 30 years to confide in a professional about what happened in the military and although I have documented all the stressors well and have many letters from family and friends and one year of psych records, I have no official police reports or medical evidence except the pregnancy to corroborate my claims. My claim was denied because the examiner said it is "unlikely" anyone would marry the person who raped them. They also said one of my journal entries said I laughed with my ex. They also said my PTSD was more likely due from my daughter being molested, which was not service connected. There was no mention whatsoever of any of the other reported MST I documented in my claim or that were in my psych records and how any of that caused my PTSD.

I plan to file a NOD, but want to make sure I do it correctly. Here are my questions about the NOD. Should I send in any additional information, such as more psych records and letter from pastor who counseled me with the NOD? The psych records document everything if someone would only read them. Should the NOD be a standard letter with the required info or should I address the reasons why they denied me? Should I have lawyer represent me or wait to see if I need to appeal further? I was really expecting a Women Veteran Coordinator to contact me because of the sensitivity of the MST claim, but I was not contacted. I am hoping someone with more experience and sensitivity with MST will review my case. I really appreciate any advice on what to do next. Thank you.

[lp56]

Here is the exact reasons for my denial

REASONS FOR DECISION:

1. Service connection for post-traumatic stress disorder

Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with 38 CFR 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred.

Your 2 page personal statement dated February 5, 2011, the letter to Maria dated May 22, 2006, the statements from Jennifer Smith, Deborah Titus, Phil Glasser and Andrea Zuniga, the journal entries from December 10, 1977 through March 13, 1980, the 21 page VA Form 21-0781, Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD), dated February 15, 2011, and the VA Form 21-4138, Statement in Support of Claim, dated February 17, 2011, have all been considered when determining your claim. You are claiming that you were raped by your husband in service and then married him after the rape, and you are claiming that you were sexually assaulted numerous times in service. Based on your claim, an examination was conducted on May 4, 2011. This examiner has provided a diagnosis of posttraumatic stress disorder, and the examiner has stated that your symptoms are consistent with your reports that your ex-husband molested your daughter and that you are preoccupied with intrusive thoughts and images of this event. Your examiner has also stated that you report being raped in service and then married him. Your examiner has stated that it is extremely uncommon for a traumatized rape victim to marry their assailant and that it is less likely than not that your current diagnosis of posttraumatic stress disorder is related to your active duty service and that it is not supported by the military service records. The examiner also reviewed your diary journals which show that you were miserable in your job and wished your ex-husband was there to make you laugh. Therefore, your claim for service connection for post-traumatic stress disorder is denied since available medical evidence is insufficient to confirm a link between current symptoms and in service stressor.

Service connection for post-traumatic stress disorder is denied based on your service treatment record which shows no diagnosis or treatment for this condition while on active duty service. In addition, medical evidence has not been received providing a link between it and your active duty service. Therefore, your claim for service connection for post-traumatic stress disorder is denied.

Ip56,

Pull out your rating decision that denied PTSD and post exactly what and all,

that is stated in the Reasons and Bases Section.

Edited November 8, 2011 by lp56

[carlie]

The only way I can see this claim issue ever getting granted is by way

of complete life and military records review and an opinion from a Psychiatrist

stating this is all related to the military and you made whatever decisions you made

due to Stockholm syndrome as Wings referred to in an earlier post.

This is going to be an almost impossible nut to crack - but this specific BVA decision

is proof - that it can be done.

This is a long read - read it SEVERAL times !

This is the EXACT type of medical evidence you will be required to have.

This BVA cases DOES NOT SET PRECEDENCE (as no BVA cases do).

http://www.va.gov/vetapp10/Files4/1034853.txt

Citation Nr: 1034853

Decision Date: 09/15/10 Archive Date: 09/21/10

DOCKET NO. 95-24 299A ) DATE ) )

On appeal from theDepartment of Veterans Affairs Regional Office in Atlanta, Georgia

THE ISSUE Entitlement to service connection for posttraumatic stress disorder (PTSD).

REPRESENTATION Appellant represented by:

Joseph Moore, Attorney

ATTORNEY FOR THE BOARDJ Fussell

INTRODUCTION

The Veteran served on active duty from June 1974 to January 1975. This matter is before the Board of Veterans' Appeals (Board) on appeal of a December 2007 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

A June 2003 decision of the Board of Veterans' Appeal (Board) found that new and material evidence had been presented to reopen a claim for service connection for an acquired psychiatric disorder, other than PTSD, and remanded issues of whether new and material evidence had been presented to reopen a claim for service connection for a chronic urinary tract infection, entitlement to an initial compensable rating for trichomonas vaginitis, and entitlement to a compensable rating for multiple noncompensably rated service-connected disorders under 38 C.F.R. § 3.324, prior to December 6, 1999.

At the time of the 2003 Board decision, a claim for service connection for PTSD was referred to the RO for initial consideration. The claim for service connection for PTSD was denied and the Veteran perfected an appeal from that rating decision. Thereafter, an August 2009 Board decision addressed service connection for an acquired psychiatric disorder other than PTSD and also service connection for PTSD on the merits but also noted that all other pending issues had been resolved.

That Board decision found that the Veteran had an anxiety disorder which pre-existed her active service but which was aggravated by her military service and granted service connection for an anxiety disorder. That Board decision also denied service connection for PTSD. The Veteran appealed the denial of service connection for PTSD to the United States Court of Appeals for Veterans Claims (Court).

Pursuant to a Joint Motion for Remand, the Court entered an Order in April 2010 vacating that part of the August 2009 Board decision which denied service connection for PTSD and remand the claim for readjudication in compliance with the instructions in the Joint Motion. The Joint Motion noted that the 2009 Board decision had failed to discuss two pieces of favorable evidence, a July 2009 private medical opinion and a July 2009 letter from a psychologist of the Atlanta Vet Center.

These pieces of evidence reportedly contradicted an October 2000 VA examiner's diagnosis of "anxiety neurosis" resulting from childhood abuse and they also commented upon the Veteran's apparent behavioral changes subsequent to an alleged personal stressor of an inservice rape (by the man whom she eventually married). Additionally, the Joint Motion found that the Board decision noted an October 8, 2002, VA outpatient treatment (VAOPT) record which contained a notation that the Veteran denied military sexual trauma.

Both the Board and a VA examiner used this history to discount the Veteran's credibility. However, the Board had failed to consider that the same VAOPT record indicated that the Veteran was not aware of any prostate cancer or any diagnosis of prostate cancer. Since the Veteran is a female, who therefore has no prostate, this was an inconsistent or questionable record which required explanation prior to its use to rebut the Veteran's credibility.

Also, the Board had stated in the 2009 decision "that credible supporting evidence of occurrence of the in-service stressor cannot consist solely of after-the-fact medical nexus evidence. See Moreau v. Brown, 9 Vet. App. 389, 396 (1996)." However, the Board had not considered the holding in Patton v. West, 12 Vet. App. 272, 280 (1999) that VA had provided for special evidentiary development procedures in personal assault cases and, so, the statement in Moreau was "not operative." Thus, the Board should address whether the medical opinions provided fell within the holding in Patton, 12 Vet. App. 280.

FINDINGS OF FACT1. The Veteran had active military service but did not serve in a combat zone, did not engage in combat, and PTSD was not diagnosed during service. 2. There is credible corroborating evidence of behavior changes in the Veteran consistent with those reasonable expected following her having experienced an inservice sexual assault. CONCLUSION OF LAWPTSD was incurred in active service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2009).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Veterans Claims Assistance Act (VCAA)The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate a claim.

The Veteran's service connection claim for PTSD has been considered with respect to VA's duty to notify and assist. Given the favorable outcome noted below, no conceivable prejudice to the Veteran could result from this adjudication. See Bernard v. Brown, 4 Vet. App. 384, 393 (1993). BackgroundAn April 1974 service enlistment examination report is negative for complaints, findings or diagnosis of a psychiatric disorder. A July 1974 service treatment record contains an impression of probable anxiety.

A November 4, 1974 report shows the Veteran had a positive pregnancy test.

Other service treatment records in November 1974 show that the Veteran was hospitalized for abdominal pain and that the diagnoses included an anxiety neurosis. She was again seen in November 1974 at which time she experienced depression and she reported having had psychiatric treatment at age 14 and stated that her father often threatened her life with a gun. She complained of many stressful situations and reported constant depression and headaches.

A discharge summary from the USPHS Hospital, dated November 12th, shows the examiner noted the Veteran had a long history of chronic anxiety neurosis. The diagnoses included chronic anxiety neurosis.A separation examination in January 1975 revealed the Veteran had a normal psychiatric examination. An August 1975 discharge summary from the University of Texas Medical Branch Hospital shows that the Veteran was hospitalized for approximately two weeks. Her chief complaint was that she was depressed and was afraid of hurting her seven-week-old baby.

She stated that when she went home with the baby she felt inadequate and unsure as to how to care for the baby. She was afraid she would hurt the baby because the baby got on her nerves. The final diagnoses were situational adjustment reaction and inadequate personality.

During a May 1980 psychiatric examination the Veteran reported that while in the Coast Guard she was extremely nervous and could not adjust. She stated that she has always been a nervous person and easily upset. She stated that she had a nervous breakdown after she had her first child because she was unable to handle him and slapped him when he was two weeks old.

She stated that she became terribly upset and wanted to kill herself. She reported that the baby was hospitalized and that she was admitted to a psychiatric unit in July 1975 following this incident. The diagnosis was anxiety neurosis.A September 1980 hospital summary shows that the Veteran was admitted due to having a 20-pound weight loss over the past two months.

At admission the Veteran described crying spells, increased fatigue, hypersominia with some suicidal ideation, and feelings of guilt concerning her marital relationship. The discharge diagnoses were transient situational disturbance, mental maladjustment, dependent personality disorder, and weight loss of undetermined etiology.A hospital summary covering the period of December 1980 to January 1981 reveals that the Veteran was admitted from the emergency room where she presented following the ingestion of a small number of Librium and Fiorinal tablets.

She reported having marital problems and that her attempts to win his affection back had been unsuccessful. She stated that she wrote a letter to her husband, called him, and then took the tablets. The examiner stated that this was clearly a manipulative maneuver to gain her husband's affection back. The examiner stated that the Veteran never intended to hurt herself. Her discharge diagnoses were reactive depression and drug overdose. During a RO hearing in September 1995 the Veteran testified that she did not undergo psychiatric treatment prior to service but instead was evaluated on one occasion prior to her admission to a girl's home because of an abusive childhood.

She testified that during service she was diagnosed with anxiety neurosis, but did not receive treatment for it. She also testified that after service she first saw a psychiatrist in July 1975 following the birth of her son and that afterward she received psychiatric treatment from the VA Medical Center in New Orleans from 1980 to 1982. VA outpatient treatment records from May 1996 to May 1998 show treatment for a variety of complaints including sleep difficulties. From January to June 1998, the Veteran received psychiatric treatment. It was reported that she had anxiety and stress from her dealings with her stepson. She reported having been abused in the past. Major depression and rule out PTSD were diagnosed. The examiner noted a past history of abuse and trauma.

VA outpatient records dated from January 1998 note "rule out PTSD."During a September 2001 Travel Board hearing, the Veteran's representative referred to the Veteran's service medical records including the enlistment examination which showed her psychiatric status was normal as well as subsequent service medical records in November 1974, which show a diagnosis of anxiety neurosis.

The Veteran testified that she was sexually assaulted during service and that she currently has PTSD due to that incident. She was among the first group of women admitted to the Coast Guard and that she felt threatened and intimidated by the men who did not want her to be there. Received in September 2001 is a statement from a retired clinical social worker who stated that she had known the Veteran since 1971. The clinical social worker stated that she was previously employed, as a counselor at a school for girls when the Veteran had been a resident student. The social worker indicated that the Veteran did not have a psychiatric diagnosis during her residence at the school. The social worker indicated that after high school, the Veteran continued to correspond with her while in the Coast Guard.

The Veteran had confided that a fellow guardsmen had raped her and when she discovered that she was pregnant her mother refused support of any type.

The Veteran had then married her attacker.

According to the social worker the Veteran was admitted to VA Medical Center in New Orleans in September 1980 and December 1980 and received psychiatric diagnoses upon both discharges. Also received in September 2001 is a statement dated in May 2001 from J. W. which states the Veteran was her student in High School from 1972 to 1973 and during that time she did not receive psychiatric care and was not given psychiatric medication.

In a September 2001 statement the Veteran stated that she had a psychiatric disorder due to her service experiences.

VA outpatient records dated from November 2001 contain diagnoses of PTSD. The Veteran submitted a September 2001 letter from a friend and retired social worker, V.M. who stated that as a counselor at the boarding school the Veteran attended she had known the Veteran since 1971. V.M. further reported that the Veteran had told her that she had been raped in service and that she had married the fellow serviceman who raped her when she found out that she was pregnant. V.M. stated that she concurred with the diagnosis by the Vet Center that the Veteran had PTSD.

The Veteran submitted a September 2001 letter from a Vet Center psychologist who stated that the Veteran had PTSD due to being raped in service.An October 8, 2002, VAOPT record indicates that the Veteran denied military sexual trauma in the past. That record also indicates that "he is not aware that he has had or been diagnosed with Prostate Cancer." Other historical information was recorded including matters such as tobacco and alcohol use, colon cancer, breast cancer, heart disease, diabetes, and hypertension.

This record reflects, at the bottom, the Veteran's name and claim number. When examined by VA in November 2003, the physician opined that the Veteran's anxiety disorder predated service. The November 2003 VA examiner opined that the Veteran's anxiety disorder was aggravated by the stress of pregnancy.In January 2009 VHA opinion was obtained. After reviewing the three volumes of records if was found that the Veteran had an anxiety neurosis related to the abuse she experienced as a child prior to her military service.

Her symptoms and disability became more pronounced following the birth of her child and were not related to military sexual trauma. In July 2009 a clinical psychologist of the Atlanta Vet Center stated that she had treated the Veteran since May 2001. The psychologist had evaluated and treated Veterans with PTSD at a variety of VA hospitals since 1987 and had also done VA compensation and pension examinations. In response to the January 2009 VHA opinion, the clinical psychologist stated that although several clinicians and teachers familiar with the Veteran during her high school years had stated that the psychiatrist associated with the Catholic girls residential high school the Veteran attended never diagnosed her with a mental illness, whether she was diagnosed or treated for psychiatric problems prior to acceptance into the Coast Guard was irrelevant.

Also, veterans often denied a history of military sexual trauma when first treated by VA. They are afraid of admitting such a thing and having it entered into their medical chart, expecting and having experienced the "blame the victim" attitude frequently exhibited toward them. The psychologist further stated that she had done extensive work to help make it easier and less threatening for veterans to report that they had experienced military sexual trauma.

It should be considered that the Veteran had spent her high school years at a Catholic high school and that she was a frightened, innocent 18 year old girl who was about to be put out of the Coast Guard because she was pregnant. She had no familial support and no one to whom to turn. Her choices were limited. Rather than risk having his career ruined by a charge of fraternization, her superior officer married her. It was not unheard of for women to give birth to babies which are the result of rape, and for women with PTSD to have a difficult time post-partum. The clinical psychologist went on the state that the opinion offered by a civilian employed by VA was based upon his belief that the Veteran suffered an anxiety neurosis prior to service, could not be offered as a reason to deny service connection for PTSD.

The opinion of that VA clinician was that the Veteran's symptoms and disability became more pronounced following the birth of her child, and not as a result of being coerced into sex by her superior officer, contracting a sexually transmitted disease (STD) from him, becoming pregnant, and losing her position in the Coast Guard, which was her only means of supporting herself, because of the pregnancy.

It was the clinical psychologist's opinion that the Veteran's psychological problems were a direct result of her experience of date-rape, verbal and emotional abuse, and sexual harassment in the Coast Guard. A private psychiatrist submitted a report, prepared in July 2009, stating that he had reviewed medical records and performed an interview with the Veteran.

Following her graduation from a Catholic boarding school she entered the U.S. Coast Guard at age 18 but experienced consistent sexual harassment and was raped by a serviceman. She felt that her life was threatened by superior officers. The men she worked with frequently told her that she did not belong in the Coast Guard and they were going to "get rid of her." She became pregnant during service as a result of being raped and suffered extreme emotional distress for which she sought and received mental health treatment for anxiety and depression, and required treatment for an STD. She was discharged from military service because during that period of time the military discharged any woman who became pregnant.

She married the man that raped her and he was consistently abusive to her. She had married him because, having been raised a Catholic, she felt that was the appropriate thing to do. She described a steady and deteriorating sequence of symptoms immediately following her sexual assault.

She described a rather complex combination of symptoms, including flashbacks, nightmares, suicidality, and hypervigilance. She did not have any co-morbid substance abuse disorder or significant co-morbid medical problems other than chronic back pain. She continued to experience intense fear, helplessness, recurrent and intrusive recollections and distressing dreams of her trauma, and flashbacks. During the interview the Veteran became tearful and silent when the subject of her inservice sexual assault was discussed by the examiner.

She described persistent avoidance of any stimuli that reminded her of that trauma. She also described symptoms of outbursts of anger, difficulty concentrating, and an exaggerated startle response.

Her primary diagnosis was PTSD. Records of her inpatient hospitalization in August 1975 noted that she had a history of child abuse, having been beaten by her mother before the Veteran was of school age. During that hospitalization she was afraid that she might hurt her newborn child. The discharge diagnosis at that time was a situational adjustment reaction and inadequate personality. These were no longer considered valid or reasonable diagnoses in the field of psychiatry. More recent documentation clearly indicated her sexual assault and subsequent development of PTSD. It was also quite clear that attending providers had established a causal relationship between the event of her sexual assault and the development of PTSD. During her current mental status examination there was a significant change in her mental status when discussing her inservice trauma in that her affect became profoundly more flattened, and she had long periods of silence and crying spells.

The examiner stated that he found the Veteran to be credible and that she met all the criteria for a diagnosis of PTSD. She had been consistently described by her treating VA psychiatrist as credible.

The examiner concurred with the prior VA diagnoses of PTSD. The examiner stated that the January 2009 VA opinion had drawn several erroneous conclusions. First, although there was child abuse, the Veteran had been admitted into the Coast Guard in sound condition.

Her hospitalization in 1975 was prior to the psychiatric field clearly understood the symptoms and diagnosis of PTSD. Also, the literature was clear that victims of sexual assault would initially leave out details, not report the assault or minimize the event. In the Veteran's case, as her symptoms became more profound and treatment was initiated, she was able to discuss the inservice assault. While the Veteran may have had a post-partum reaction in 1975 and concerns of harming her child, this set of symptom was not mutually exclusive from PTSD and could have been directly related to her PTSD.

As to her symptoms becoming more severe after the birth of her child, the symptoms of PTSD could steadily become worse over time. Her diagnostic history as well as current and prior mental status examinations clearly documented her PTSD. In fact, although she had a co-morbid diagnosis of major depressive disorder and generalized anxiety disorder, the overwhelming symptoms she currently experienced were a direct result of her inservice sexual assault.

Also, the VA opinion obtained in January 2009 was not based on an examination of the Veteran. With respect to the Veteran having married the man that raped her during service, this was by no means an uncommon occurrence. Psychiatric literature is filled with discussion of patients who respond positively to their aggressor, something commonly known as "identification with the aggressor" and equated to the

Stockholm Syndrome.

In fact, her history of childhood abuse would make it more likely for her to marry her aggressor. Thus, the January 2009 VA opinion endorsed the exact opposite conclusion that would be consistent with the current thinking in psychiatric medicine regarding the etiology of the Veteran's PTSD.

The examiner further stated that the Veteran's PTSD symptoms had likely manifested immediately after her assault. Her PTSD was clearly the result of her inservice experiences. Her current working diagnosis was PTSD and she had an historical diagnosis of major depressive disorder. She met all of the DSM-IV criteria of PTSD.

This opinion was based upon an extensive review of medical records and a personal interview of the Veteran. Law and RegulationsTo establish service connection for PTSD, a veteran must satisfy three evidentiary requirements.

First, a current medical diagnosis of PTSD.

Second, credible evidence of the occurrence of the stressor.

Third, medical evidence of a causal nexus between the specific claimed in-service stressor and the current PTSD symptomatology. See 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128, 138 (1997).

"If the claimed stressor is not combat[]related, the appellant's lay testimony regarding in-service stressors is insufficient to establish the occurrence of the stressor and must be corroborated by 'credible supporting evidence.'" Doran v. Brown, 6 Vet. App. 283, 289 (1994).

"Credible supporting evidence" is not limited to service department records, but can be from any source. See Cohen, 10 Vet. App. at 147. If a PTSD claim is based on in-service personal assault, evidence from sources other than a veteran's service records may corroborate a veteran's account of the stressor incident.

Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy.

Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources.

Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(3).

Recently, 38 C.F.R. § 3.304(f)(3) was amended to relax the requirement of corroborating evidence of an inservice stressor in cases in which PTSD is diagnosed during service.

However, because PTSD was not diagnosed during service in this case, that amendment is not applicable here.

An opinion by a mental health professional based on a postservice examination of the veteran cannot be used to establish the occurrence of the stressor. Moreau v. Brown, 9 Vet. App. 389, 396 (1996) (addressing a claim for service connection for PTSD based on a combat stressor).

"[M]ore than medical nexus evidence is required to fulfill the requirement for 'credible supporting [stressor] evidence.'" Id. However, in Patton v. West, 12 Vet. App. 272, 280 (1999) it was held that "[t]hese quoted categorical statements were made in the context of [] PTSD diagnoses other than those arising from personal assault." Because VA had "provided for special evidentiary-development procedures, including interpretation of behavioral changes [] the above categorical statements in Cohen [] and Moreau [] are not operative."

Patton, at 280. In addition, the Court noted that in two places the MANUAL M21-1, Part III, 5.14©(3) and (9), appears improperly to require that the existence of an in-service stressor be shown by "the preponderance of the evidence." Any such requirement, however, would be inconsistent with the benefit of the doubt, or equipoise, doctrine contained in 38 U.S.C. § 5107(b). Patton v. West, 12 Vet. App. 272, 280 (1999).

The Board must determine whether the weight of the evidence supports each claim or is in relative equipoise, with the appellant prevailing in either event. Only if the weight of the evidence is against the appellant's claim, may the claim be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski 1 Vet. App. 49 (1990).

AnalysisInitially, the Board notes that the prior grant of service connection for an anxiety disorder was not appealed to the Court and, so, remains in effect. There is evidence that the Veteran has a personality disorder. Developmental defects, such as personality disorders that are characterized by developmental defects or pathological trends in the personality structure manifested by a lifelong pattern of action or behavior, are not diseases or injuries within the meaning of applicable legislation in the absence of superimposed disease or injury, which there is none in this particular instance. 38 C.F.R. § 3.303©.

Thus, to the extent that the Veteran has a personality disorder, service connection is not warranted for such psychiatric disability. Service connection for PTSD under 38 C.F.R. § 3.304(f) requires evidence of a stressor and a diagnosis of PTSD.

These are mandatory criteria and are not optional, i.e., a distinct means for establishing service connection separate from the general provisions of service connections set forth in 38 C.F.R. § 3.303. This very matter was recently addressed by the United States Court of Appeals for the Federal Circuit (Federal Circuit).

In Arzio v. Shinseki, No. 2009-7107, slip op. at 2 (Fed.Cir. April 19, 2010); 2010 WL 1540169 (Fed.Cir.) the Federal Circuit noted that the appellant "argued that [38 C.F.R. §§ 3.303 and 3.304(f) provide alternative methods by which a veteran may obtain service-connected benefits for PTSD."

Further, "there is nothing in [38 C.F.R. § ]3.303 -- which is a broad regulatory provision addressing general service connection principles--that suggests that a veteran can establish service connection for PTSD without meeting the criteria enumerated in [38 C.F.R. § ]3.304(f)." Arzio, at 3.

In sum, the Federal Circuit held that "when [38 C.F.R. §§ ]3.303 and 3.304 are read together, it is evident that they do not provide alternative methods of establishing service connection, but instead work in tandem to delineate the circumstances under which a veteran can establish service connection for PTSD." Arzio, at 4. "Simply put, while [38 C.F.R. § ]3.303 mandates that there be a link between a current disability and military service, [38 C.F.R. § ]3.304(f) sets forth the evidence necessary, in the context of claims for PTSD disability compensation, to establish that link." Arzio, at 4.

It is undisputed from the record that the Veteran has been unequivocally diagnosed several times with PTSD.

It is also clear that the diagnoses of PTSD by mental health professionals were based upon the Veteran's account of an in-service sexual assault as the precipitating cause of her PTSD.

Therefore, the only remaining disputed issue is whether the Veteran has submitted credible evidence to establish that the claimed in-service assault actually occurred. In Forcier v. Nicholson, 19 Vet. App. 414 (2006) the Court stated that as to behavioral changes of a veteran seeking service connection for PTSD due to an alleged personal assault, the Board was not permitted to interpret behavioral changes or abnormalities to make conclusions or inferences that were "illogical, improper, and unsupported by the record" in order to find that there was no corroborative personal assault stressor evidence.

Forcier, at 427 (in which the Board found that having been AWOL was more consistent with a history of disciplinary problems and misconduct rather than a result of sexual assault and that inservice abuse of alcohol was due to lack of aptitude for service than an assault). Here, lay statements from those who know the Veteran demonstrate that her behavior changed after military service. These are consistent with two interpretations. The first is that the postservice behavioral changes were due to her already service-connected anxiety disorder.

The second is that the behavioral changes are consistent with her trauma of having been raped during service. As to this, a comparison is in order. Specifically, there is some evidence that the Veteran was significantly affected by her childhood abuse. On the other hand, the behavioral changes after service are much greater than any changes she had displayed prior to her active military service.

There are some inconsistencies in the Veteran's history. Specifically, the October 2002 VAOPT record indicates that she denied a history of sexual trauma. But the Board must now specifically address another notation contained within that same VAOPT in which it was reported that the Veteran (a female) was unaware of any prostate cancer or diagnosis thereof. As to this, the documentation at the foot of that VAOPT record clearly shows that it is, in fact, a treatment record of the Veteran in this case and not merely some VAOPT of another VA patient which was erroneously co-mingled with the VAOPT records of the Veteran in this case.

Moreover, the Board cannot explain the notation concerning prostate cancer, other than to note that a number of clinical histories were obtained from the Veteran at that time and that the record is apparently a pre-printed form which was not correctly used in this case.

Significantly, it must also be observed that the recent reports from a private psychologist and a private psychologist, both of whom are familiar with the Veteran's history, note that it is not unusual for a victim of a personal assault to initially minimize the impact of or deny to occurrence of a past sexual assault. Otherwise, and more recently, the Veteran's narrative history overall has been consistent.

Specifically, she has not denied having had emotional abuse in her childhood and she has been consistent in relating events surrounding her inservice assault.

The evidence as a whole simply does not show that the inservice sexual trauma did not play a role in her development of PTSD.

In other words, it is equally as reasonable to interpret the evidence on file as showing that her having experience an inservice sexual assault led to her developing PTSD as to conclude otherwise. This is particularly true since the Veteran's psychiatric treatment pre-dates the general acceptance of the diagnosis of PTSD.

In fact, VA began using the diagnosis of PTSD in 1980 in conformity with DSM-III. See VAOPGCPREC 26-97 (July 16, 1997)). Also of significant probative value are the favorable July 2009 reports from a clinical psychologist and private psychiatrist, both of whom are aware of the Veteran's clinical history and well verse in the psychiatric aspects of patients subjected to sexual assault.

Thus, with the favorable resolution of doubt in favor of the Veteran, the preponderance of the evidence is in favor of the claim for service connection for PTSD.

ORDER

Entitlement to service connection for PTSD is granted.

____________________________________________

DEBORAH W. SINGLETONVeterans Law Judge,

Board of Veterans' Appeals Department of Veterans Affairs

[Wings]

Ditto what Carlie said! Read several times! I've attached the txt document and the link is http://www.va.gov/ve...es4/1034853.txt

P.S. Good find Carlie, in fact the only case of Stockholm Syndrome at the BVA for all total years. Did you find anything at CAVC? `Wings

Citation Nr 1034853.txt

Edited November 8, 2011 by Wings

[11cvolley]

Here is the exact reasons for my denial

I hope for the best for you and someday the VA does right by you. Its never an easy road for our type of claim. Get a VA lawyer, continue treatment, and hold onto hope. You'll always be in God's thoughts and I'll pray for you.

[usmcgirl]

@ Wings and Carlie : That was what I have been looking for pertaining to my case, But let me re read it a couple more times to be sure. So DOUBLE thank you ladies. @ Ip56 Keep the faith. All is not lost and you are not alone. There are more on this ghost of a battlefield with you.

[lp56]

I will definetely follow the advice to read this case multiple times. I very much appreciate the help and encouragement from all and I am actually looking forward to the DRO hearing coming up. They are giving me an hour for the hearing, so I plan to be very organized and hopefully not stray from my case or become unable to adequately present my evidence because of emotions.

My letter from the RO said a VSO representative would be there and I have already been sent contact information for that rep. I hate to overanalyze the timeliness of my DRO request and the scheduling of a hearing so quickly, but I can't help but think this is happening too quickly based on all the forums I have read. I really wasn't expecting to hear from the RO this soon because I believed this process could take months if not years. Does anyone think the quick response to a DRO hearing is a good sign or a bad sign? I really want to approach this hearing as a non-threatening process or I will be very nervous about it.

@ Wings and Carlie : That was what I have been looking for pertaining to my case, But let me re read it a couple more times to be sure. So DOUBLE thank you ladies. @ Ip56 Keep the faith. All is not lost and you are not alone. There are more on this ghost of a battlefield with you.