Citation Nr: 18141640 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 12-08 008 DATE: October 11, 2018 ORDER Entitlement to service connection for a psychiatric disability, to include posttraumatic stress disorder (PTSD) and psychosis, is denied. Entitlement to VA medical treatment for a psychosis under 38 U.S.C. § 1702(a) is denied. FINDINGS OF FACT 1. A psychiatric disability did not initially manifest in, and is not otherwise related to, the Veteran’s service. 2. The medical evidence of record does not include a PTSD diagnosis that conforms to the Diagnostic and Statistical Manual of Mental Disorders. 3. The Veteran did not develop an active psychosis within one or two years of his December 1969 separation from service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a psychiatric disability, to include PTSD and psychosis, have not been met. 38 U.S.C. §§ 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.304, 3.307. 3.309. 2. The criteria for entitlement to VA medical treatment for a psychosis under 38 U.S.C. § 1702(a) have not been met. 38 U.S.C. § 1702(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 1968 to December 1969, including in the Republic of Vietnam. In March 2015, he testified in support of these claims at a videoconference hearing held before the undersigned. The Board remanded these claims to the Agency of Original Jurisdiction for development October 2014 and June 2015. Entitlement to service connection for a psychiatric disability, to include PTSD The Veteran seeks service connection for a psychiatric disability, to include PTSD and psychosis, on a direct basis, as related to in-service stressors he allegedly experienced while serving in Vietnam. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A grant of service connection for PTSD requires medical evidence diagnosing this condition in accordance with 38 C.F.R. § 4.125 (must conform to DSM and be supported by findings in the examination report), credible supporting evidence that the claimed in-service stressor occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). Certain chronic diseases, including psychoses, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service (one year in the case of psychoses); or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). In written statements and during a VA examination conducted in November 2010, the Veteran contended that, in 1969, he served on guard duty at Long Binh. He had a military occupational specialty of mechanic, but was placed in security with HHC 12th Combat Aviation Group once arriving in Vietnam. While on guard duty, two men, whose identities he cannot recall but who were part of the 79th and right next door to his group, got killed in a rocket and mortar attack. The Veteran remembers there being three grenades that landed nearby and almost killed him, firefights and rocket and mortar attacks. He also stated that he remembers that, while being in Vietnam, he witnessed a village being set on fire and people being burned, and felt intense fear, helplessness and horror. He claims that his PTSD and a psychosis had their onset in service as he experienced those stressors. During the February 2017 VA examination, the Veteran reported that he also recalled witnessing a young boy being tortured and burned and a group of friends being blown up and smelling burnt hair. The questions for the Board are whether the Veteran has a current psychiatric disability, to include PTSD or any psychosis, that began during service or is at least as likely as not related to an in-service injury, event, or disease, and whether psychoses manifested within a year or two years of separation from service. The Board concludes that, while the Veteran has a current diagnosis of a psychiatric disability, variously characterized, as discussed below, and evidence shows that the Veteran served in Vietnam during the time alleged, including as a Security Guard, the preponderance of the evidence weighs against finding that the psychiatric disability, however diagnosed, began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The preponderance of the evidence also weighs against finding that a psychosis initially manifested within one year of the Veteran’s separation from service. VA treatment records show the Veteran was not diagnosed with a psychiatric disability, psychosis or otherwise, until 2005, three and a half decades after separation from service, within a year of sustaining two work-related back injuries that ended his job as a coal miner. Initially, the diagnoses were provisional. Thereafter, they varied. At an April 2005 VA Agent Orange examination, the examiner noted that the Veteran had a euthymic mood and, based on that, diagnosed “Rule out anxiety disorder.” In June 2005, during an outpatient visit, a provider noted a positive PTSD screen. Later that month, the Veteran presented complaining of depression and requested an intake evaluation. That provider diagnosed “Rule out PTSD and depressive disorder, not otherwise specified.” There was no follow-up, but in October 2006, the Veteran sought treatment for multiple medical conditions and reported that he had been depressed on and off for some time. The provider prescribed medication for depression. Thereafter, through April 2015, the Veteran received regular treatment for a psychiatric disability, variously diagnosed, including as depression; anxiety; depressive disorder, not otherwise specified; anxiety disorder, not otherwise specified; mood disorder; major depression; depression with psychotic features, and major depressive disorder, once with bereavement. This treatment included individual therapy with a social worker and medication management with a psychiatrist. VA treatment records dated since 2015 include PTSD diagnoses, but those diagnoses are insufficient to satisfy the current disability element of a claim for service connection for PTSD. A VA examiner concluded that during a February 2017 examination and the record supports that conclusion, showing that the diagnoses fail to conform to the DSM criteria. For instance, in March 2015, the Veteran underwent a diagnostic mental health study by his social worker, which consisted solely of a self-assessment. Based on this study, the social worker concluded that a “PTSD diagnosis is suggested.” However, the report of that study indicates that it should not be used, alone, for diagnostic purposes, but rather should be verified for accuracy and considered in conjunction with other diagnostic activities and procedures. In addition, a suggested diagnosis is ambiguous and speculative. Thereafter, in 2017 and 2018, chronic PTSD was occasionally noted as a medical problem or listed as a historical diagnosis, but always in conjunction with the Veteran’s other diagnoses, never when seen by the psychiatrist and never based on any testing or findings, conforming to DSM or otherwise. That diagnosis seemed to be carried over from the original. As the VA examiner explained in February 2017, based on appropriate testing, the Veteran did not meet the diagnostic criteria for a diagnosis PTSD. The Board finds that VA examiner’s findings to be highly persuasive and to outweigh the speculative and historical references to a PTSD diagnosis as that examiner conducted the most in depth review of the record and interview of the Veteran and analyzed the particular diagnostic criteria for a diagnosis of PTSD. As a result, that examiner found that the Veteran did not meet the criteria for a diagnosis of PTSD. While the Veteran is competent to report having experienced symptoms of sadness, depression and anxiety, as these symptoms are capable of lay observation, he is not competent to diagnose a psychiatric disability, to include PTSD, or to determine that his symptoms represent manifestations of such a disability. That issue is medically complex, requiring knowledge of mental health issues and an interpretation of complicated diagnostic testing. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When the VA examiner conducted testing in February 2017, the examiner ruled out PTSD, instead diagnosing unspecified depressive disorder with anxious distress and an unspecified personality disorder. Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran warrants a diagnosis of PTSD pursuant to the relevant diagnostic criteria and thus service connection for PTSD is not warranted. The question is thus whether the Veteran’s psychiatric disability is related to service in Vietnam, including any reported stressor. A rating decision and supplemental statement of the case noted that considering the capacity in which the Veteran served in Vietnam, the alleged stressors were consistent with the circumstances, conditions or hardships of his service. 38 C.F.R. § 3.304(f)(2). The February 2017 examiner addressed that, taking a detailed history, reviewing the claims file, preparing a comprehensive examination report, and opining that the Veteran’s psychiatric disability was less likely than not related to an in-service injury, event, or disease and was not incurred in service. The rationale included: (a) The disability’s onset was 2004 or 2005, after two back injuries that resulted in the loss of his job and a two-year period of stress, during which his wife was quite ill; (b) He had ongoing depressive symptoms since 2005, during which he ruminated about Vietnam, life changes, and reduced quality of life; and (c) Since 2005, other than PTSD, no VA doctor had diagnosed the Veteran with a psychiatric disability different than those noted above. The examiner’s opinion is probative, because it is based on an accurate medical history (records of 2011 treatment note the Veteran occasionally reporting having developed depression following 2004-2005 back injuries and work stoppage) and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). While the Veteran believes his psychiatric disability is related to an in-service injury, event, or disease, including his experiences in Vietnam, for the same reason noted above, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, requiring knowledge of the interaction between stress and mental health. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board finds his nexus opinion not probative. The Veteran’s psychiatric disability initially manifested decades after service and competent evidence establishes that that disability is not otherwise related to such service. Therefore, the criteria for entitlement to service connection for a psychiatric disability, to include PTSD and psychoses, have not been met. 38 U.S.C. §§ 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.304, 3.307. 3.309. Entitlement to VA medical treatment for a psychosis under 38 U.S.C. § 1702(a) The Veteran seeks medical treatment for a psychosis under 38 U.S.C. § § 1702. To be entitled to this benefit, the evidence must show that the Veteran developed an active psychosis within two years of discharge from active service. Here, the evidence indicates otherwise. As previously noted, for decades after service, the Veteran never reported or sought treatment for mental health symptoms and no doctor diagnosed any psychiatric disability. In fact, to date, no doctor has diagnosed any psychosis. In April 2015, the Veteran began reporting symptoms which doctors characterized as psychotic features. In February 2017, however, the VA examiner explained that, although the Veteran has occasionally exhibited features of a psychosis, he does not have psychosis. The Board finds that opinion persuasive and find that the preponderance of the evidence is against a finding that the Veteran meets the relevant diagnostic criteria for the diagnosis of any psychosis. Therefore, the claim must be denied. Harvey Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. N., Counsel