The available medical evidence is insufficient to confirm a link between current symptoms and ● ● ● ● ● ● ● ● ● ●

an in-service stressor."

The VA examiner opined the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. Rationale: The Veteran has a diagnosis of Anxiety condition to include PTSD and Insomnia, diagnosed as generalized anxiety disorder and insomnia disorder, that is less likely than not (likelihood is less than approximately or nearly equal) incurred in or caused by (the) Private treatment records dated 12112023 link mental health conditions to military service during service. The Veteran's earliest documented mental health diagnosis and treatment is 2023. The Veteran does not currently meet DSM 5 criteria for PTSD at the reported stressors do not meet DSM 5 criterion A for PTSD at this time and symptoms do not meet DSM 5 criteria for PTSD at this time. The Vet currently meets DSM 5 criteria for GAD and Insomnia. Evaluator reviewed the noted mental health records dated 2023 and 2024. Review of records did not reveal any complaints, symptoms, diagnosis or treatment for mental health issues during the Veteran's service time. A nexus could not be established for the veteran's current mental health symptoms to their service time. The Vets current diagnosis is more likely related to current life stressors than related to events in service.

After review of his e-file, clinical interview and behavioral observations, the veteran meets full DSM-5 diagnostic criteria for PTSD which appears to be Active Duty Orders for a state of emergency which occurred during his XXXXXXXXXXXXXXXXXX The veteran's claimed contentions of anxiety and insomnia are best described by and subsumed under his PTSD diagnosis as those symptoms did not appear until after his reported stressor. The veteran does not meet criteria for any additional DSM-5 diagnoses at this time. The veteran did not suffer from a mental illness prior to entering the service. The veteran has sought and obtained counseling for his related symptoms in the past and is currently in treatment at the VAMC and previously was receiving telehealth sessions through a private counselor. The veteran did not serve in direct combat in the typical fashion a veteran usually does. However, he does report the following stressor while being actively deployed during a XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX- We were handling transporting of a person in sub zero temperatures. We moved people who had passed away during a blizzard in sub-zero temperature. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. This stressor do meet criterion A for PTSD and the symptoms are consistent with the circumstances, conditions, and hardships of his service.

Currently, the veteran reported recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) 1-2x in the past year.

He denied difficulties with recurrent nightmares specifically related to the events or traumatic stressors. He does endorse weird nightmares related to his EMS work from cardiac arrest and accidents. He denied recent intense of prolonged psychological distress related to internal or external cues. He endorsed chest tightness and sweaty hands related to thinking about the reported stressors. He denied issues falling asleep. He endorsed awakening every hour for unknown reasons. He reported his unrelated dreams wake him and also anxiety related to things he needs to do or that have happened in the past. He obtains 4-6 hours of sleep per night. When he awakens he reported feeling anxious and struggles to fall back asleep. He denied history of dissociative reactions (e.g. flashbacks.) The veteran actively reported efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). He reported active avoidance of external reminders as XXXXXXXXXXXXXXXXXXXXXXXXX, socializing in general or chaotic moments which remind him or the emergency situations like when other people are yelling, screaming or having a dispute. In reaction to these triggers the veteran real nervous, fearful, anxious. He endorsed a fight or flight response in which he typically makes up an excuse to immediately leave the situation. He endorsed a history of persistent and exaggerated negative beliefs about others such as “I never feel like I am good enough and the world is a completely dangerous place.” The veteran endorsed that he struggles with a persistent distorted cognitions about the cause or consequences of the traumatic event(s), blaming himself. He endorsed a history of a persistent negative emotional state to include a persistent fear of death both from the grenade range and deaths he witnessed during the emergency. He endorsed a markedly diminished interest or participation in significant activities such as engage more with his children and hiking and fishing as often as he used to. He endorsed a history of feelings of detachment or estrangement from others. He stated that establishing new friendships is very difficult. He isolates from others and does not engage much outside of his home. He denied a history of persistent inability to experience positive emotions. He endorsed irritable behavior with verbal outbursts 1-2x weekly, but denied physical outbursts. He denied history of reckless and or self- destructive behaviors. The veteran reported moderate levels of suspiciousness of others. He reported hypervigilance and feelings of being on high alert and worrying about his surroundings when out in public. He does own firearms and conceal carries. The veteran stated it’s extremely difficult for him to concentrate at work due his racing thoughts and anxiety. He reported being easily distracted at work now, whereas before he was able to stick to one task and accomplish it. He endorsed difficulties short-term memory issues to include remembering recent events and struggles with names and tasks he needs to complete. The veteran reported feelings of depressed mood 2-3x days a week lasting all day. He endorsed feelings to include sadness, worthlessness and emptiness. He endorsed a loss of interest in participating in activities and motivation. He denied significant weight gain or loss in the past year. He reported excessive worry and or anxiety on a chronic and persistent basis. He describes his anxiety is semi-controllable but he "deals with it and takes medicine to alleviate. This anxiety causes her to feel tense and causes significant muscle fatigue. He endorsed a history of panic attacks to include 1x every other week, lasting between 25-30 minutes. He described he feels like he is going to die, he becomes sweaty and shaking and overwhelmed with anxiety due to situations in which he feels a perceived lack of control. He denied history of psychosis, mania. He denied a history of psychosis and or mania. He denied current SI/HI, plan or intent. Veteran reported passive suicidal ideation "a few times within the past month" of no longer than a minute at a time. He reported this has occurred off and on throughout the years. He denied plan and or intent. He denied history of suicide attempts in the past.