Citation Nr: 18146828 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 08-22 440 DATE: November 1, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include paranoid delusional disorder and major depressive disorder, is denied. FINDING OF FACT No in-service event, disease, or injury caused or aggravated an acquired psychiatric disability. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disability, to include paranoid delusional disorder and major depressive disorder, have not been met. 38 U.S.C. §§ 1101, 1131, 5107 (2012); 38 C.F.R. §§ 3.6, 3.102, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Army from August 1981 to August 1984, with active duty for training (ACDUTRA) in the Army National Guard from July 1980 to October 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The Veteran appeared at a Travel Board hearing in June 2010. A transcript is of record. The case was remanded in December 2010, following a re-opening of the claim subsequent to the previous last final denial of record (a Board decision in October 2006). In addition, the claim was remanded in June 2012 and March 2016 for evidentiary development. Review of the completed development reveals that substantial compliance with the remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). In April 2018, the Board sent the case out for a Veterans Health Administration (VHA) clarifying medical opinion. Service Connection Entitlement to VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a claimant 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.” Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A veteran will be considered to have been in sound condition when examined and accepted for service, except as to disorders noted on entrance into service, or when clear and unmistakable evidence demonstrates that the disability existed prior to service and was not aggravated by service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111 (2012); 38 C.F.R. § 3.304(b). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability of benefits. 38 U.S.C. § 1154(a) (2012). Although a lay person is competent in certain situations to provide a diagnosis of a simple condition, a lay person is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). 1. Entitlement to service connection for an acquired psychiatric disorder, to include paranoid delusional disorder and major depressive disorder The Veteran contends he has an acquired psychiatric disorder that began prior to entering active duty, and was aggravated by his military service. At an April 2003 Decision Review Officer (DRO) hearing, the Veteran testified that he reported having depression on his military entrance examination. The Veteran stated that after making the Army aware of his psychological problems, he was not provided any treatment. He testified that he began to experiment with cannabis and received counseling through a drug treatment program while in service. Additionally, the Veteran stated his depression worsened when he was not promoted as expected. The Board concludes that, while the Veteran has current psychiatric diagnoses, and evidence shows that the Veteran reported having depression at his service entrance examination, the preponderance of the evidence weighs against finding that the Veteran’s current diagnoses were aggravated by or otherwise related to his military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service treatment records show that on the Veteran’s enlistment medical history report in July 1981, the Veteran indicated he experienced depression or excessive worry. The examiner noted on the report that the Veteran’s depression was due to financial issues, and he denied suicidal ideation. The Veteran was not found to have a psychiatric disorder during his service entrance physical examination. Treatment records from 1983 show the Veteran received counseling for cannabis use, and he was noted to have satisfactory progress. In April 1984, the Veteran was hospitalized following a motor vehicle accident due to driving while intoxicated. He did not report any psychiatric trauma caused by the accident. In July 1984, the Veteran received a court martial conviction for assault, breach of the peace, and use of an altered ration card to wrongfully purchase cigarettes. He was sentenced to a rank reduction to Private and confinement at hard labor for 30 days. At service separation in July 1984, the Veteran did not report being depressed, nor was he found to have any psychiatric disorder upon physical examination. No formal diagnosis for a psychiatric disorder was rendered during service. The claims file contains employment records from 1994, 1997, and 1999 that indicate the Veteran was required to take leave from his job due to his psychological condition, and that he met with an Employee Assistance Program counselor regarding symptoms of depression and anxiety. Social Security Administration (SSA) records dated from 1998 to 2004 show the Veteran reported having psychiatric symptoms caused by work-related stress that began in September 1997. In a February 2000 psychiatric examination, the Veteran stated he developed symptoms of anxiety, depression, and paranoia while working at the United States Post Office. He was diagnosed with delusional disorder and paranoid personality disorder. The Veteran underwent another SSA psychiatric evaluation in March 2004, where he reported that depression and paranoia prevent him from working. He also stated that he began drinking and smoking marijuana as a teenager, and that he was in a traumatic motor vehicle accident in 1983 caused by intoxication. The examiner stated the Veteran’s reported symptoms are consistent with posttraumatic stress disorder (PTSD) associated with the car accident. However, the Board notes that service records show the Veteran denied having any psychological effects immediately following the in-service car accident. Further, based on the Veteran’s reports, his symptoms onset more than a decade after service separation, and he did not state they were aggravated or caused by his military service. A review of private medical records indicates that in April 1997, the Veteran related a history of depression, anxiety and hypervigilance after being assaulted and harassed by a former co-worker, and reported additional stressors due to separating from his wife and financial issues. In August 1999, the Veteran reported having stress for the past two years due to his employment at the Post Office. In the private medical records, the Veteran and his physicians do not suggest that a connection exists between the Veteran’s psychological symptoms and his military service. The Veteran also sought mental health treatment from VA beginning in 1999. The majority of VA treatment notes show the Veteran complained of depression, anxiety, and paranoia primarily related to a hostile work environment, which led to him being placed on an indefinite leave of absence. However, in October 1999, the Veteran reported his symptoms were present during military service. A VA mental health physician also noted in January 2001 that the Veteran appeared to have had mental problems while in service that have continued since discharge. In March 2006, the Veteran was afforded a VA examination. He reported that he was depressed because of family problems when he entered the military. The examiner diagnosed paranoid delusional disorder and depression with anxiety. He opined that it was as likely as not that the Veteran’s depression existed in the military based on his description and history, and the car accident exacerbated his symptoms. As discussed in detail in the March 2016 Board remand, an additional VA medical opinion was requested to address (1) whether alcohol abuse demonstrated at the time of the Veteran’s motor vehicle accident constituted a symptom of an acquired psychiatric disorder; (2) to determine whether the Veteran experienced a psychiatric disorder prior to service entry and, if so, such disorder clearly and unmistakably underwent an increase in severity in service not due to the natural progression of the disease process; and (3) should it not be indicated that psychiatric issues predated service, that such a disorder at least as likely as not had causal origins in service. The VA medical addendum opinions were issued in July 2016. Following a review of the Veteran’s file, the examiner opined that the claimed condition was less likely than not incurred in or caused by military service. The examiner explained that it is clearly and unmistakably likely that the Veteran did not exhibit depression prior to his entrance into active duty. He stated the Veteran reported a family history of depression, but his symptoms of depression onset over 20 years ago during service. The examiner also opined that it is at least as likely as not that depression had causal origins in active service. As rationale, the examiner stated the Veteran reports that his depression onset during service with progression over the last ten years. In November 2016, the RO requested the examiner to clarify the July 2016 opinion by specifying what in-service injury, event or illness caused the Veteran’s current mental health issues since there is no clinical evidence of in-service treatment for his condition. The VA examiner submitted an addendum in December 2016. He opined it is at least as likely as not that the Veteran exhibited depression prior to entrance into active duty. The examiner stated that alcohol use at the time of the 1984 accident was a stand-alone usage unrelated to substance abuse. He also opined the motor vehicle accident was an aggravation of the Veteran’s depression, but there are no medical records to confirm a diagnosis of depression. Because the VA examiner’s December 2016 opinions did not cite to any evidence from the record to establish how he reached his conclusions and did not reference the Veteran’s failure to be promoted and other in-service behavioral problems, the Board sent the matter for a VHA medical opinion. VHA examiner opinions were provided in June 2018. The VHA examiner opined that it is less likely than not that the Veteran suffered any mental health condition, including depression, prior to joining the military. He explained that though there was a notation on the entrance examination of depression or excessive worry, there was no formal diagnosis of any mental health condition and it was notated the depression was a situational issue related to financial stresses. The examiner stated there is no other evidence of pre-military mental health issues. The examiner also opined that it is at least as likely as not that the Veteran does not have a mental health condition which had its origin during service, a pre-military mental health condition which was exacerbated beyond its expected progression by anything that happened on active duty, or was caused by anything which happened while on active duty. He further opined that it is at least as likely as not that any current diagnosed mental health condition began after leaving military service and is not associated with military service. In support of his opinion, the VHA examiner provided thorough rationale. He stated there is no evidence in the record that any mental health condition was associated with the Veteran’s alcohol abuse, and it did not appear, according to available information, that alcohol was being used to self-medicate another mental health condition. The examiner also noted the behavioral problems and court martial convictions for criminal issues in 1984. He concluded that while the Veteran might reasonably be expected to be angry, anxious, or depressed about these issues, it would not constitute a symptom of a chronic mental health condition. According to the examiner, it would have been situational frustration related to facing the consequences of his criminal activities, which is supported by the fact that the Veteran did not report, nor was diagnosed with, any mental health problems at service separation or within one year of discharge. The examiner also noted the Veteran’s reports that he became depressed in October 1994, and sought treatment in 1997. Additionally, the VHA examiner addressed the prior VA examinations, which he determined were self-contradictory and neither positive or negative regarding the connection of the Veteran’s mental health condition to his military service. The examiner noted that other than the Veteran’s self-reports, there is no other evidence to support a finding that the Veteran’s psychiatric condition began during service and continued to the present. After thorough consideration of the evidence of record, the Board finds that service connection for an acquired psychiatric disability, to include paranoid delusional disorder and major depressive disorder, is not warranted. The Board notes that the VHA examiner reviewed the entire claims file, addressed the inconsistencies within prior VA examination reports, and provided well-supported rationale with references to the Veteran’s statements, personnel records, and medical records. The Board thus finds the VHA examiner’s opinion to be of greater probative value than that of all the VA examiner’s findings, which did not include complete, supported opinions. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (noting that factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion.); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the Board finds that the Veteran did not suffer a mental health condition prior to service entry that was aggravated during service, nor are his current psychiatric disorders etiologically related to his service. While the Veteran believes his psychiatric conditions were aggravated and/or caused by his military service, he is not competent to provide nexus opinions in this case. The issues are medically complex, as they require specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Veteran’s report of depression at service entrance was determined to be situational and related to his stress about finances. He was never formally diagnosed with a mental health condition during service, and he did not report having a psychiatric condition at service separation. The VHA examiner determined that the Veteran driving while intoxicated during service was an isolated incident, and any frustration he may have felt regarding his military reprimands was situational and did not constitute evidence of a chronic mental health condition. Further, the Veteran’s own post-service reports contradict his claim that his current psychiatric conditions are related to his military service. It was in 1994, a decade after service discharge, when the Veteran reported symptoms of depression and anxiety specifically related to work stress. When he sought mental health treatment in 1997, he again reported his symptoms were due to his work environment. None of the Veteran’s private or VA mental health physicians have provided opinions that would support a finding that his current psychiatric disorders are etiologically linked to military service. Accordingly, the claim of entitlement to service connection for an acquired psychiatric disorder, to include paranoid delusional disorder and major depressive disorder, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). T.D. JONES Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Miller, Associate Counsel