Citation Nr: 18145014 Decision Date: 10/29/18 Archive Date: 10/25/18 DOCKET NO. 09-34 963 DATE: October 29, 2018 ORDER Entitlement to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), is denied. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of PTSD 2. The Veteran’s current acquired psychiatric disorder was not incurred in-service and is not related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and MDD, have not all been met. 38 U.S.C. §§ 1101, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1974 to June 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s claim for entitlement to service connection for an acquired psychiatric disorder was originally denied in a February 1996 rating decision, which became final. An October 2012 Board decision granted reopening of the claim for service connection for an acquired psychiatric disorder, and remanded the claim for an additional VA examination. This case was also before the Board in March 2016 and July 2017. The July 2017 remand directed the RO to schedule the Veteran for an additional VA examination to determine the etiology of the Veteran’s psychiatric disorder. The Veteran attended a VA examination in June 2018, and the examiner addressed the etiology of the Veteran’s diagnosis. Accordingly, the remand directives were substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for an acquired psychiatric disorder Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a). “To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”- the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). To establish entitlement to service connection for PTSD, the record must contain the following: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). The Board finds that there is no probative evidence in the record showing that the Veteran has a current diagnosis of PTSD. The probative evidence of record indicates the Veteran has a current mental health diagnosis of MDD. The preponderance of the evidence is against finding that the Veteran’s MDD is related to or caused by his active service. The Veteran contends that he has PTSD or an additional acquired psychiatric disorder due to a motorcycle accident that occurred while he was in the military. The Veteran has also contended that his PTSD is due to being sexually assaulted by other service-members while in the military. The Veteran’s service treatment records (STRs) confirm he was in a motorcycle accident in May 1975. In addition, in May 1975, the Veteran presented to sick bay requesting something for his nerves. The Veteran was described as emotionally distraught, but it was attributed to a situational reaction. The June 1975 separation examination indicates normal psychiatric findings. The Veteran attended VA examinations in April 2009, September 2010, May 2014, May 2016, and June 2018. The April 2009 and September 2010 examinations found that the Veteran did not have a diagnosis of PTSD. However, neither examiner considered the Veteran’s reported stressor of sexual assault in service. The examiner found that the Veteran did have additional mental health diagnoses, mood disorder and depressive disorder, but did not provide and opinion as to whether it was at least as likely as not that these diagnoses were related to his service. The May 2014 examiner found that the Veteran did not have a diagnosis of PTSD or MDD, but did have a diagnosis of unspecified personality disorder. The May 2016 VA examiner found the Veteran did not have a diagnosis of PTSD, but he did have diagnoses of unspecified personality disorder and unspecified depressive disorder. The 2016 VA examiner stated that the Veteran’s personality disorder was not related to service, but did not specifically discuss whether the Veteran’s depressive disorder was related to service. The June 2018 VA examiner found the Veteran’s symptoms do not meet the diagnostic criteria for PTSD under the DSM-5 criteria. The examiner found that the Veteran’s reported stressor of sexual assault during service was adequate to support a diagnosis of PTSD, however, the Veteran’s symptoms were not consistent with a diagnosis of PTSD. The examiner stated the Veteran had a current diagnosis of MDD. However, the examiner found that the Veteran’s MDD was less likely than not caused by or incurred in his military service. The Veteran reported symptoms due to his current psychosocial circumstances and did not mention that these symptoms were related to military events. The examiner also addressed the 2016 VA examiner’s diagnosis of a personality disorder, but found that based on the current evaluation and evidence there was not enough evidence to diagnose the Veteran with a personality disorder. The record also contains an April 2012 private psychologist assessment. The psychologist found the Veteran had the diagnoses of PTSD, MDD, generalized anxiety disorder, and pain disorder. The psychologist stated that the Veteran’s assault in the military met the criteria for a stressor for PTSD, and the Veteran’s symptoms of depression and anxiety were secondary to his trauma symptoms and chronic pain. The Veteran’s VA medical center records indicate some positive screens for depression and PTSD and some treatment for mental health symptoms. However, treating records do not indicate that the Veteran has been engaged in specialty mental health treatment within the VA system. The Board finds the June 2018 VA examination the most probative evidence of the Veteran’s current psychiatric disorders. The examiner found the Veteran did not meet the diagnostic criteria for PTSD, but did have a diagnosis of MDD. The examiner reviewed the entire record, including the prior VA examinations, private evaluation, and the Veteran’s service treatment records. The examiner performed psychological and personality assessments and provided detailed rationale for the mental health diagnosis. As such, the Veteran has a current diagnosis of MDD and therefore meets the first element of service connection. The Veteran’s STRs contain treatment for the motorcycle accident and treatment for mental health symptoms. Therefore, the second element of service connection has been met. This case turns on nexus, specifically whether the Veteran’s in-service events and symptoms are related to his current psychiatric disability. The preponderance of evidence is against finding a nexus between the Veteran’s in-service symptoms and current psychiatric disorder. The Board finds the June 2018 VA examiner’s opinion to be the most probative evidence of record as to whether the Veteran’s psychiatric disorder is related to his service. As noted above, this examiner had the most complete view of the record, and provided rationale for his findings. The Board finds the 2012 private assessment is less probative evidence. The private evaluator’s finding that the Veteran is diagnosed with PTSD is inconsistent with all the VA examinations of record. In addition, the evaluator did not have the benefit of reviewing the complete medical records as the June 2018 VA examiner did. As such, the Board finds the 2012 private assessment less probative than the June 2018 VA examination. The Board has also considered the Veteran’s statements that his psychiatric disorder was caused by his active service. However, whether the Veteran’s acquired psychiatric disorder is related to his active service is a complex medical question, and is not within the realm of knowledge of a lay person or determinable by observation with one’s senses. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Therefore, the Veteran’s statement is not competent evidence and not probative. The preponderance of the evidence weighs against a grant of service connection for the Veteran’s acquired psychiatric disorder, to include PTSD and MDD. As such, the claim of entitlement to service connection for an acquired psychiatric disorder must be denied. There is no reasonable doubt to be resolved as to this issue. 38 U.S.C. § 5107(b), 38 C.F.R. § 3.102. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Norah Patrick, Associate Counsel