Citation NR: 9712522 Decision Date: 04/09/97 Archive Date: 04/18/97 DOCKET NO. 97-06 346 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUE Entitlement to service connection for a psychiatric disorder. REPRESENTATION Appellant represented by: Oregon Department of Veterans' Affairs ATTORNEY FOR THE BOARD L.M. Brown, Associate Counsel INTRODUCTION The veteran served on active duty from July 1979 to August 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 1996 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for a psychiatric disorder. CONTENTIONS OF APPELLANT ON APPEAL The veteran and his representative essentially contend that the RO committed error by denying service connection for a psychiatric disorder. The veteran asserts that his psychiatric disorder was started and created by military service. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1996), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran has not submitted a well-grounded claim for service connection for a psychiatric disorder. FINDING OF FACT Service connection cannot be granted for a personality disorder; there is no medical evidence of a nexus between any current psychiatric disorder and a disease or injury in service. CONCLUSION OF LAW The claim for service connection for a psychiatric disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1996); 38 C.F.R. § 3.303(c) (1996). REASONS AND BASES FOR FINDING AND CONCLUSION Factual Background The veteran's December 1978 enlistment examination report contains no findings related to a psychiatric disorder. A December 1980 service medical record shows a psychiatric evaluation requested by the veteran's commanding officer. No report of the findings is of record. In May 1981 the veteran reported various troubling situations; the examiner noted mental status within normal limits and anxiety reaction. The veteran's June 1982 separation examination report shows that he was found to be psychiatrically normal and, on a Report of Medical History completed by the veteran at the time of the separation examination, he reported no history or current problem with depression or nervous trouble of any sort. September 1984 private medical records of St. Alphonsus Regional Medical Center show the veteran was admitted in September 1984 with a principal diagnosis of drug overdose and secondary diagnoses of (1) suicide attempt, situational depression secondary to marital problems and (2) dehydration. The veteran ingested Tylenol, Tylenol 3 and Ecotrin, then called his estranged wife who called paramedics. A neuropsychiatric note indicates that the veteran had current marital problems, but no prior mental problems. There is an impression of a suicide attempt and an overdose with probable Tylenol and aspirin. VA treatment records contain an April 1995 final summary the veteran left a homeless program, and was referred for mental evaluation. There was no evidence of significant thought or mood disorder, but there was pathology consistent with and an Axis II diagnosis of narcissistic personality disorder. No Axis I diagnosis was recorded. The veteran was hospitalized in a VA medical facility from May 31 to June 21, 1995. He had completed a nursing assistant’s program at Fort McCoy, but failed to appear for a job interview. He blamed the hospital staff for this failure. His mood was depressed and his affect was angry. He showed poor coping skills, tolerance level and insight; he exhibited impaired judgment, but laughingly denied suicidal ideation. There were no overt delusions and he denied hallucinations; there were no signs of psychosis or thought disorder. New job interviews were scheduled, and arrangements for public housing were made; however, the veteran became angry and left the hospital. The records show an Axis I diagnosis of late onset dysthymia versus adjustment disorder with depressed mood, and an Axis II diagnosis of narcissistic personality disorder with features of antisocial personality disorder. On June 22,1995, VA medical records show the veteran was depressed and angry. He threatened to jump off a roof or stand in front of a car. He claimed two suicide attempts 11 to 12 years earlier, and complained about treatment at another VA Medical Center. A physician’s note indicates a narcissistic personality disorder, and recent drinking after six months abstention. The veteran claimed feeling useless and wanting to die, but had no other complaints or medical problems. He claimed to have been hit by a car, but had no injuries secondary to the incident. In July 1995, the veteran was hospitalized with a complaint of post-traumatic stress disorder. A week of observation indicated that the veteran's complaints of poor sleep and nightmares were doubtful. Upon notice that he was to be discharged due to lack of mental illness, the veteran became demanding, then verbally abusive and violent. He attempted to attack the attending physician, then damaged government property at the nurse’s station. He was eventually restrained by and released to police custody. It is noted that he had no Axis I disorder, and that his personality disorder was considered untreatable. The staff psychiatrist noted that the veteran was competent and responsible for his actions. The fianl summary contains an Axis I diagnosis of malingering and an Axis II diagnosis of mixed personality disorder with narcissistic and antisocial features. The October 1995 private medical report of the Brown County Human Services Department details results of a psychiatric evaluation. The veteran voiced suicidal thoughts and claimed numerous past suicide attempts, which led to an appointment at a Crisis Center. The veteran reported prior unsuccessful suicide attempts. Mental status examination revealed dress, grooming and hygiene that were within normal limits. The veteran's mood was somewhat dysthymic; his affect was constricted and mood congruent. He denied psychopathology such as visual or auditory hallucinations and delusions. Memory and orientation were within normal limits, but the veteran gave a history of not being able to get along with people or hold a job. The veteran claimed thoughts of guilt, hopelessness and helplessness. His energy was down, concentration was variable and his appetite was all right. He denied suicidal inclinations. The examiner noted that the veteran is chronically unable to maintain social functioning or job functioning due to a mental disability. There is an Axis I diagnosis of dysthymia with chronic, major depression, and an Axis II diagnosis of antisocial personality disorder by history and personality disorder, not otherwise specified. In November 1995, the veteran submitted a document detailing inservice stressors. He described a head injury sustained during a basic training exercise that caused temporary loss of consciousness. At his first duty station in Germany, he claims to have felt disillusionment, disappointment and paranoia after he was choked and threatened by a neighbor whose offer of drugs he reported to a superior. The veteran described meeting a German maternal uncle whose untimely death caused sadness. After a visit to the uncle’s family he allegedly received a letter from the Defense Intelligence Agency ordering an end to contact with foreign nationals and threatening loss of his security clearance and position in the battalion. He claims these events made him extremely paranoid. The veteran said that his job was very stressful due to such events as anti-American embassy pickets and the activities of German terrorist organizations. He described interpersonal problems with his new roommate and with other service members based on his report of alleged drug sales. These events caused him to feel scared and emotionally drained. Subsequently, he was sent to a safe house and then to a new unit, where he learned of his sister’s death, and later of his brother’s death. Several incidents of misconduct resulted in non-judicial discipline, denial of a Good Conduct Medal, and a bar to reenlistment. The December 1995 lay statement of W.B. states that she noticed changes in the veteran's physical condition after he returned from military service in 1982. She attributed these changes to events in service, and opined that he has depression and headaches. She also stated that the veteran has been rejected by his family, is not accepted socially, is weak emotionally and has very low self esteem. Analysis The threshold question that must be resolved with regard to a claim is whether the veteran has presented evidence that the claim is well-grounded. See 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1996); Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). A well-grounded claim is a plausible claim, meaning a claim that appears to be meritorious. See Murphy, 1 Vet.App. at 81. An allegation of a disorder that is service connected is not sufficient; the veteran must submit evidence in support of the claim that would “justify a belief by a fair and impartial individual that the claim is plausible.” See 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). The quality and quantity of the evidence required to meet this statutory burden depends upon the issue presented by the claim. Grottveit v. Brown, 5 Vet.App. 91, 92-93 (1993). A well-grounded claim requires (1) medical evidence of the current existence of the claimed disability, (2) evidence of a disease or injury in service, which can be lay or medical evidence, depending on the circumstances, and (3) medical evidence of a nexus between the current disability and a disease or injury in service. Caluza v. Brown, 7 Vet.App. 498 (1995). Service connection may be established when the facts, shown by evidence, demonstrate that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C.A. § 1131 (West 1991 & Supp. 1996); 38 C.F.R. § 3.303 (1996). A personality disorder is not a disease or injury within the meaning of applicable legislation. 38 C.F.R. § 3.303(c) (1996). Where a veteran served continuously for 90 days or more during a period of war or during peacetime service after December 31, 1946, and a psychosis becomes manifest to a degree of 10 percent within 1 year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1996). First, a claim for service connection requires a currently- diagnosed disability. The record reveals that the veteran has a personality disorder. Service connection cannot be granted for a personality disorder, however, because a personality disorder is not a “disease or injury,” and service connection can only be granted for disability resulting from “disease or injury” incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(d) (1996). The most recent medical evidence, however, also contains a diagnosis of dysthymia with major depression. Therefore, the first requirement for a well- grounded claim, a medical diagnosis of current disability, is met. The second requirement for a well-grounded claim is evidence of a disease or injury in service. The service medical records show mental health evaluations in December 1980 and May 1981, and the May 1981 entry shows an anxiety reaction. Therefore, there is evidence of a pertinent disease or injury in service. The third requirement for a well-grounded claim, however, is not met, since the veteran has not presented medical evidence of a nexus between his current disorder and a disease or injury in service. The medical evidence concerning the veteran’s current disorder, other than a personality disorder, does not relate the disorder to service in anyway. Therefore, the claim is not well grounded and must be denied. Most of the arguments of the veteran’s representative, such as the validity of the findings in service, go to the merits of the claim. In addition, neither the veteran’s representative, the veteran, or the veteran’s friend, as laypersons, have the necessary medical knowledge to relate the veteran’s current disorder to service. See Grottveit v. Brown, supra. As it has been determined that a well-grounded claim for service connection for a psychiatric disorder has not been presented, the VA has no duty to assist the veteran in developing his claim. 38 U.S.C.A. § 5107(a). There is no indication that evidence exists that would make the claim well grounded. See Robinette v. Brown, 8 Vet.App. 69 (1995). ORDER Service connection for a psychiatric disorder is denied. WILLIAM J. REDDY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1996), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -