Citation Nr: 18146008 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 17-29 830 DATE: October 30, 2018 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The Veteran does not have a diagnosis of PTSD at any point during the appellate time period. CONCLUSION OF LAW The criteria for entitlement to service connection for posttraumatic stress disorder (PTSD) have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1992 to February 1995 in the United States Army. He had did not have any foreign service. 1. Entitlement to service connection for posttraumatic stress disorder (PTSD) Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012). For veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including psychoses, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2018). To establish a right to compensation for a present disability on a direct basis, a Veteran must show: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303 (a); see also Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran contends that he has PTSD due to his in-service diagnosis of HIV of which he was notified on Christmas Day. Service connection for PTSD specifically requires medical evidence establishing a diagnosis of the disability, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f) (2018). If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 C.F.R. § 3.304(f)(1); see also 38 U.S.C. § 1154(b) (2012). Similarly, if a stressor claimed by a veteran is related to the Veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 C.F.R. § 3.304(f)(3). Otherwise, the law requires verification of a claimed stressor. Where a determination is made that the Veteran did not “engage in combat with the enemy,” or the claimed stressor is unrelated to combat, the Veteran’s lay testimony alone will not be enough to establish the occurrence of the alleged stressor. See Moreau v. Brown, 9 Vet. App. 389, 395 (1996); Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). In such cases, the record must include service records or other credible evidence that supports and does not contradict the Veteran’s testimony. Doran v. Brown, 6 Vet. App. 283, 289 (1994). Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. See Moreau, 9 Vet. App. at 395-396; Cohen v. Brown, 10 Vet. App. 128, 42 (1997). The Veteran has been awarded service connection for HIV-related illness and for major depressive disorder infection secondary to service-connected HIV illness. The Veteran’s service treatment records do not include any diagnoses of PTSD or symptoms that have been medically attributed to PTSD that have been in effect for the entire period of the appeal. In the years following service, treatment records indicate diagnoses of various mental health disorders, including major depressive disorder, polysubstance abuse, dysthymia, bipolar affective disorder, and borderline personality traits. In July 2010, the Veteran was noted to have no trauma / PTSD history. Various PTSD screenings over the years also were negative. An August 2012 psychiatry assessment, however, included a positive PTSD screen. At that time, the Veteran reported childhood sexual trauma. Despite the foregoing, the diagnoses included only cannabis dependence, alcohol abuse, questionable depression, cocaine abuse in remission, dysthymia, and major depressive disorder. There was no diagnosis of PTSD. In June 2014, the Veteran had a noted history of recurrent major depressive disorder since leaving the military and specifically since finding out that he had HIV on Christmas Day in 1992. At that time, the treatment provider indicated that the Veteran did not have any life-threatening experiences attributable to PTSD. A March 2015 VA treatment record indicated that the Veteran had a court order to attend an assessment appointment regarding PTSD. At that time, the Veteran described how during active service he learned that he was HIV positive and had ongoing trauma issues as a result. The treatment provider, however, concluded that the Veteran did not meet criterion A for a diagnosis of PTSD. In a March 2015 statement, the Veteran contend that he had PTSD due to his discovery during service that he had tested positive for HIV. The Veteran received notification on Christmas Day “that I am dying and there was no cure for my disease. My life ended that day. I have relieved this day in every thought [and] every dream I’ve had since this date. At times I experience anxiety attacks and when connected with my depression issue often have thoughts of suicide.” In June 2015, the Veteran had an appointment with a VA staff psychologist who noted that the Veteran had “PTSD symptoms and substance abuse” and the assessment was substance use disorder / PTSD. The Veteran was afforded a VA mental disorders examination in July 2015. The examiner considered the Veteran’s contentions, but diagnosed only depressive disorder and polysubstance dependence. The Veteran discussed issues with anger, depression, and sleep problems. The Veteran also indicated that he had “almost daily” dreams or daydreams about when in 1992 a female doctor told the Veteran “that I was dying.” In April 2016, the treatment record indicated that the Veteran was having increased nightmares associated with “his known diagnosis of PTSD.” In August 2016, the Veteran was seen following trauma, “From HIV diagnosis being told on Christmas Day and death of significant other by murder on Christmas Day.” The treatment provider, however, noted that prior records indicated that the death of his referenced significant other occurred in 2012 after service. The treatment provider concluded that, as had been found in the March 2015 review, the Veteran did not meet criterion A for a diagnosis of PTSD. Again, the Veteran contends that he has PTSD due to his in-service diagnosis of HIV and his notification of that diagnosis on Christmas Day. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of PTSD and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). Multiple treatment providers and VA examiners have considered whether the Veteran’s symptoms warrant a diagnosis of PTSD and have found that the Veteran did not have PTSD. Specifically, and as discussed above, multiple treatment professionals have discussed how the Veteran does not have criterion A for a diagnosis of PTSD. In reaching that conclusion, the Board acknowledges that there is potentially conflicting evidence as to the existence of PTSD during the appellate time period. As discussed above, multiple VA treatment records include diagnoses of PTSD. By contrast and as discussed above, the March 2015 and August 2016 VA treatment providers and the multiple VA examiners specifically considered the Veteran’s claims and the other evidence of record, including the VA treatment records diagnosing PTSD, and concluded that the Veteran did not meet the DSM criteria for PTSD, specifically criterion A. Given these multiple findings throughout the appellate time period, the Board concludes that the Veteran did not meet the criteria for a diagnosis of PTSD at any time on appeal. The Board finds the medical professional’s findings compelling. The Board acknowledges that VA may presume that a diagnosis made by a mental health care professional was made in accordance with the DSM-IV, see Cohen v. Brown, 10 Vet. App. 128, 140 (1997); however, in this case, in light of the multiple medical professionals’ specific conclusions that include a detailed rationale and the absence of any evidence that the treatment providers diagnosing PTSD examined the Veteran’s service treatment records, personnel files, or early post-service records, the Board finds the conclusions of the VA examiners and supporting treatment providers to be of significantly greater probative weight and ultimately to outweigh the notations of PTSD. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (explaining that factors affecting the probative value of a medical opinion are whether the opinion is based on sufficient facts or data, is the product of reliable principles reliably applied to the facts, and the reasoning employed by the expert). (Continued on the next page)   While the Veteran believes he has a current diagnosis of PTSD, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board finds such a diagnosis particularly difficult given the myriad other mental health diagnoses since the Veteran’s separation from service. Consequently, the Board gives more probative weight to the competent medical evidence. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. J. Houbeck, Counsel