Citation Nr: 18146674 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-07 473 DATE: October 31, 2018 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to an initial rating greater than 60 percent for coronary artery disease (CAD) is denied. REMANDED Entitlement to service connection for a back/neck condition is remanded. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded. Entitlement to service connection for erectile dysfunction is remanded. FINDINGS OF FACT 1. A preponderance of the evidence is against the finding that the Veteran had a diagnosis of PTSD any time during the appeal period. 2. The Veteran’s CAD was not manifested by chronic congestive heart failure, workload of 3 METs or less, or left ventricular dysfunction with an ejection fraction of less than 30 percent. CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125(a) (2017). 2. The criteria for an initial rating greater than 60 percent for CAD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.10, 4.14, 4.104, Diagnostic Code 7005 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1965 to April 1967. He died in November 2013. The appellant is the Veteran’s surviving spouse, who was substituted as the appellant in September 2018. See 38 U.S.C. § 5121A (2012) (allowing for substitution in case of death of a claimant who dies on or after October 10, 2008). These matters come before the Board of Veteran’s Appeals (Board) on appeal from an August 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for posttraumatic stress disorder (PTSD) A claimant is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. §§ 1110, 1131. Generally, to establish a right to compensation for a present disability, a claimant must show: (1) a present disability; (2) an 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Entitlement to service connection for PTSD in particular requires: (1) medical evidence diagnosing PTSD in accordance with the Diagnostic and Statistical Manual of Mental Disorders, (DSM); (2) a link between current symptoms and an in-service stressor, as established by medical evidence; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. §§ 3.304(f), 4.125(a). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Degmetich v. Brown, 104 F.3d 1328 (1997). The Veteran contended that he had PTSD due to his service in Vietnam. Specifically, the Veteran claimed that his tank was blown up and that it took him 14 days, while evading the enemy, to make it back to camp safely. See March 2012 VA examination. The Board finds that the preponderance of the evidence is against a finding that the Veteran had PTSD. Service treatment records reveal no complaints, treatment, or diagnosis of PTSD. VA outpatient treatment records reveal a positive PTSD screen in October 2011, noting that the Veteran experienced feelings of detachment, avoidance and being easily startled. See July 2012 CAPRI. However, there was no diagnosis of PTSD. VA outpatient treatment records also reveal a negative PTSD screen in October 2012. The Veteran was afforded a VA psychiatric examination in March 2012. Following an in-person examination and review of the Veteran’s claims file, the VA examiner opined that the Veteran does not meet the criteria for PTSD under the Diagnostic and Statistics Manual of Mental Disorders, Fourth Edition (DSM-IV). The VA examiner diagnosed the Veteran with anxiety disorder, which was service-connected in an August 2012 rating decision. The examiner stated that the Veteran’s reported in-service stressors are adequate to support a diagnosis of PTSD but that the Veteran does not meet the full criteria for PTSD as he did not exhibit symptoms of avoidance, re-experiencing the traumatic event, or increased arousal. As noted above, service connection may only be granted for a current disability. In this case, the evidence does not show that the Veteran had PTSD. While an October 2011 PTSD screen was positive, there was no diagnosis of PTSD in the outpatient treatment records and the March 2012 VA examiner concluded that the Veteran did not have PTSD. The Board finds that the March 2012 VA examiner’s opinion is highly probative as it was based upon a review of the Veteran’s history and records and is supported by a clear rationale. Thus, the most probative medical evidence of record indicates that the Veteran does not meet the criteria for a diagnosis of PTSD. With respect to the Veteran’s and Appellant’s assertions that the Veteran had PTSD, the Board notes that the Veteran was competent to report experiencing psychiatric symptoms. See Washington v. Nicholson, 19 Vet. App. 363 (2005). However, a diagnosis of a psychiatric disability requires not just observation of certain symptoms, but also specialized training to diagnose psychiatric disorders. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). In this case, the Veteran and Appellant are not competent to render a medical opinion as to whether the symptoms that he experienced are of the type and severity that would constitute a diagnosis of PTSD, as this is a medical determination that is too complex to be made based on lay observation alone. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Accordingly, the Veteran’s and Appellant’s assertions in this regard do not constitute competent or probative evidence in support of the claim for service connection for PTSD. In sum, the Board concludes that the preponderance of the evidence shows that the Veteran does not have a diagnosis of PTSD. Accordingly, entitlement to service connection is not warranted. 2. Entitlement to an initial rating greater than 60 percent for coronary artery disease (CAD) Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Here, the Veteran contends that his CAD is more severe than his disability rating would indicate. His CAD is currently evaluated as 60 percent disabling under DC 7005. Under Diagnostic Code 7005, for arteriosclerotic heart disease (CAD), a 60 percent evaluation is warranted for more than one episode of acute congestive heart failure in the past year, or; workload of greater than three METs but not greater than five METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005. A 100 percent rating is warranted for chronic congestive heart failure, or when a workload of three METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. Id. The evidence of record shows that the Veteran has not had congestive heart failure. See March 2012 VA examination report. Importantly, an echocardiogram conducted in March 2012 showed left ventricular ejection fraction (LVEF) of 80 percent. Further, the Veteran has exhibited dyspnea and fatigue with a workload of greater than 3 but less than 5 METs, which is consistent with activities such as light yard work, mowing lawn, and brisk walking. The March 2012 VA examiner opined that it is more likely that the Veteran’s METs was due to his lung cancer than his heart condition as the Veteran had a heart transplant and it appeared that the heart was functioning well as indicated by the 80 percent ejection fraction. The Board notes the Appellant contends that the Veteran’s cardiologist, Dr. E.M., stated that the Veteran’s heart was shot and that he needed a new one, however, in June 2016, it was noted that records from Dr. E.M. were not available. The medical evidence of record shows that the Veteran did not have chronic congestive heart failure, workload of 3 METs or less, or LVEF less than 30 percent throughout the appellate period. As a result, a disability rating greater than 60 percent for CAD is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for a back/neck condition is remanded. The Veteran was not provided with a VA examination prior to his death to assess the existence and etiology of his back and cervical spine condition. Post-service treatment records show diagnoses of cervical and lumbar spinal stenosis with accompanying symptoms in his arms. See January 2012 Medical Treatment Record. Further, the Appellant has provided correspondence that while in service the Veteran sustained a back injury from a grenade incident. See February 2016 Form 9. On his January 1967 separation examination, the Veteran noted that he experienced recurrent back pain. As the Veteran was not afforded a VA examination prior to his death, on remand, the claims file should be reviewed by a qualified VA clinician and a nexus opinion should be provided. 2. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded. The Veteran claimed that his COPD was secondary to his service-connected heart condition and residuals of his lung cancer. Post-service treatment records show a diagnosis of COPD. See May 2013 Medical Treatment Record. As the Veteran was not afforded a VA examination prior to his death, on remand, the claims file should be reviewed by a qualified VA clinician and an opinion regarding the etiology of the Veteran’s COPD should be provided. 3. Entitlement to service connection for erectile dysfunction is remanded. The Veteran claimed that his erectile dysfunction was secondary to his service-connected heart condition, residuals of lung cancer, and anxiety. See August 2012 Statement in Support of Claim. The Board notes the Veteran was not afforded a VA examination for his erectile dysfunction before his death, however, the Board finds that the Veteran’s post-service treatment records, to include a November 2011 VA treatment record, noted erectile problems. Further, the Board finds that symptoms associated with erectile dysfunction are also capable of lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds that there is competent evidence that the Veteran had a diagnosis of erectile dysfunction. As the Veteran was not afforded a VA examination prior to his death, on remand, the claims file should be reviewed by a qualified VA clinician and a nexus opinion should be provided. The matters are REMANDED for the following action: 1. A qualified VA clinician should review the Veteran’s claims file and provide the following opinions: (a.) Whether it is at least as likely as not that the Veteran’s cervical and lumbar spinal stenosis was either incurred in, or is otherwise related to, the Veteran’s active duty service. The examiner should discuss the Veteran’s and Appellant’s contentions that the Veteran injured his back during a grenade attack in service and the Veteran’s complaints of recurrent back pain on his January 1967 separation examination. (b.) Whether it is at least as likely as not that the Veteran’s COPD was caused OR aggravated by his service-connected disabilities, to include his heart condition and residuals of lung cancer. (c.) Whether it is at least as likely as not that the Veteran’s erectile dysfunction was caused OR aggravated by his service-connected disabilities, to include his heart condition and residuals of lung cancer. 2. After the above development has been completed, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case, and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Brandt