Citation Nr: 18147866 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 16-39 061 DATE: November 7, 2018 ORDER Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. FINDINGS OF FACT 1. The Veteran had active service from October 1966 to July 1970. 2. At the time of his death, the Veteran did not have a diagnosis of PTSD which was related to a verified in-service stressor, or that began during active service. 3. The Veteran’s psychiatric disorder did not manifest during service or to a compensable degree within a year thereafter, was not continuous since service separation, and was not caused by any in-service disease or injury. CONCLUSION OF LAW An acquired psychiatric disorder, to include PTSD, was not incurred in or aggravated by service, and was not due to any incident of such service. 38 U.S.C. §§ 1110, 1112, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran died in December 2016 at the age of 69. The appellant has been properly substituted as his surviving spouse. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) medical evidence establishing a link between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). First, the Veteran was diagnosed with anxiety, depressive disorder, and psychosis with PTSD related symptoms. Accordingly, the first element of service connection is met. Next, the Board must consider whether there was an in-service incurrence. Importantly, the Veteran was found to be clinically normal at the time of the June 1970 separation examination. There was also no evidence of complaints of depression, psychosis, or any psychiatric during service. The service treatment records (STRs) were also silent for any psychiatric issues while in service. In November 1967, there was a single incident of an emergency hospitalization for alcohol treatment after the Veteran behaved aggressively and erratically. At that time, he admitted to drinking approximately a quart of vodka and was later admitted to the neuropsychiatric ward. Upon examination, he was found to be without deficits, and was admitted to sleep-off the intoxication for approximately eight hours. Upon waking, the treatment provider noted that the Veteran was completely normal, alert, and cooperative without evidence of a psychotic or neurotic personality behavior. He was released to full duty the next day, without any other recorded incidents in service. Importantly, no psychiatric disorder was ever diagnosed in service, and the single incident of erratic behavior due to intoxication seemingly resolved without residual and is insufficient to serve as an in-service incident. Furthermore, thereafter, the Veteran was not diagnosed with or treated for a psychiatric disability for many years following service. Thus, the medical evidence does not support an in-service incurrence of a psychiatric disorder. Next, to the extent that the Veteran was diagnosed with a psychosis, the psychiatric symptoms were not chronic and continuous since service separation. To this end, the treatment records were largely silent with respect to any psychiatric abnormalities following service until approximately 1995, 25 years after service separation. Specifically, in September 1995, he sought treatment for Xanax and alcohol abuse, which he reported began four years earlier. He was mentally evaluated and no mental health diagnoses were rendered except for alcohol and benzodiazepine dependence and withdrawal. Thus, based on this evidence, even if the Veteran was previously treated for psychiatric symptoms in, at the earliest the 1990s, this would date onset of recorded symptomatology to two decades after service separation. This lengthy period without complaint or treatment is one piece of evidence weighing against a finding of ongoing symptomatology. Additionally, while the Veteran went on to seek additional post-service treatment for psychiatric symptoms, no examiner has suggested his symptoms began in service. In November 2016, he was treated at a private facility for feelings of anxiety, depression, and hallucinations. He also reported a history of poor temper control, and hypervigilance. His wife noted that these symptoms had gotten progressively worse in the preceding year. The examiner diagnosed dementia and delirium with PTSD symptoms due to his reports of nightmares and flashbacks. The Veteran’s claims file was presented to a VA psychologist in May 2016, and he was also personally examined at that time. After examining the Veteran and reviewing the claims file, the examiner diagnosed depressive disorder and found that the Veteran did not meet the criteria for a PTSD diagnosis. While the appellant has alleged that the Veteran experienced psychiatric symptoms since service, the medical evidence does not support her statements. In fact, in July 2011, the Veteran filed a claim for service connection for several disabilities; however, a psychiatric disability, to include PTSD, was not claimed at that time. Likewise, as noted, the Veteran was examined in September 1995 for substance abuse disorders, at which time he did not report any psychiatric symptomatology, or allege any history of the same. He also denied any prior treatment. This evidence suggests that his symptoms had not been continuous since service, as he did not report any kind of psychiatric disorder when he filed his initial service connection claim for unrelated disabilities, and he denied any psychiatric symptomatology on a later evaluation. As noted above, the appellant has claimed onset of an acquired psychiatric disorder during or as a result of service. As a layperson, however, she is not competent to make a medical conclusion; thus, her statements regarding causation and aggravation are not competent evidence. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id; Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (lay evidence potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, psychiatric disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran and appellant’s statements cannot be accepted as competent medical evidence. She has also not stated she is reporting the conclusions as told to her or the Veteran by a competent expert, and their lay assertions have not later been confirmed by such an expert. As such, the preponderance of the evidence is against the claim for service connection for an acquired psychiatric disorder other than PTSD. Consequently, the appeal is denied. PTSD The appellant has also alleged that service connection for PTSD is appropriate based on several in-service stressors experienced by the Veteran. Importantly, a review of the treatment records does not reflect a definitive diagnosis of PTSD. A May 2016 VA examination found that he did not meet the diagnostic criteria for a PTSD diagnosis, and instead the examiner diagnosed a depressive disorder. Further, November 2016 private treatment records show that the Veteran reported a diagnosis of PTSD due to severe nightmares and flashbacks. However, the private treatment provider never evaluated or formally diagnosed PTSD. Instead, the disorders identified included dementia and delirium with PTSD symptoms. In order to grant service connection, the evidence must first demonstrate the current existence of the claimed disability. See Holton, 557 F.3d at 1366; Allen v. Brown, 7 Vet. App. at 439. Here, the evidence includes the Veteran’s medical history, to include medical records from private treatment providers detailing the treatment for his other psychiatric disorders. The treatment providers routinely listed his ongoing health concerns to include depressive disorder and psychosis; however, no diagnosis of PTSD was formally rendered. Service connection may not be granted for a diagnosis of a disability by history. Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). Accordingly, as PTSD has not been formally diagnosed, the appeal is denied. Finally, the appellant has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Yacoub, Associate Counsel