Citation Nr: 18148123 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-07 703 DATE: ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, anxiety, and intermittent explosive disorder, is denied. FINDING OF FACT 1. The preponderance of the evidence is against a finding that the Veteran has an acquired psychiatric disorder, to include PTSD, depression, anxiety, and intermittent explosive disorder. 2. The Veteran has been diagnosed with general personality disorder, which is not a disability for VA purposes. CONCLUSION OF LAW The criteria for service connection on the basis of an acquired psychiatric disorder, to include PTSD, depression, anxiety, and intermittent explosive disorder, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.384, 4.125 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1977 to December 1991. This matter comes before the Board of Veterans’ Appeals (Board) from a June 2015 rating decision issued by the Department of Veteran Affairs (VA) Regional Office in Muskogee, Oklahoma. I. Legal Criteria Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (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. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). Service connection for PTSD requires medical evidence diagnosing the disability in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the in-service stressor occurred. 38 C.F.R. § 3.304(f). The Board must analyze the credibility and probative value of the evidence, account for the evidence it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the Veteran. This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. A lay person is competent to report to the onset and continuity of the symptomatology. Moreover, lay evidence may be competent and sufficient evidence of a diagnosis or nexus if (1) the particular condition at issue is the type of condition that is within the competence or common knowledge of a lay person, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. The Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person. A veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Concerning the Veteran’s claim for service connection for an acquired psychiatric disorder, to include PTSD, in Clemons v. Shinseki, the United States Court of Appeals for Veterans Claims (Court) noted the Board should consider alternative current disorders within the scope of the filed claim. Clemons v. Shinseki, 23 Vet. App. 1 (2009). In light of Clemons, the Board has framed the issue as entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depression, anxiety, and intermittent explosive disorder, as reflected on the title page. II. Analysis. (a) PTSD The Veteran contends that he has PTSD, which is related to service as a result of personal trauma he experienced while on active duty. Review of the record shows that the Veteran received the Purple Heart Medal during service, and thus, service connection for PTSD would be appropriate if he had a diagnosis of PTSD. However, after a careful review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding that the Veteran has a diagnosis of PTSD. The Veteran submitted a private letter from a clinical psychologist, dated February 2015. Based upon an administration of a Detailed Assessment of Posttraumatic Stress (DAPS) test and an administration of a Personality Assessment Inventory (PAI), the psychologist opined that the Veteran’s psychological profile indicated a broad range of “clinical features suggesting a multiple diagnosis.” The psychologist found marked distress, “severe impairment in functioning,” paranoid ideation, social isolation, and dysfunctional thinking patters that included “magical and possible delusional thinking.” The psychologist concluded in his letter that that the Veteran’s symptoms were “consistent with the diagnosis of PTSD” and that he believed the Veteran was “suffer[ing] from severe PTSD resulting from his active duty service in the military.” The psychologist requested a second opinion from a VA mental health professional that should evaluate the Veteran’s “PTSD, depression, anxiety, and [i]ntermittent [e]xplosive [d]isorder.” In a May 2015 VA compensation exam, the psychologist determined that the Veteran did not meet the diagnostic criteria for PTSD under DSM-5 criteria, and, instead, had a diagnosis of a general personality disorder. The examiner explained that while the Veteran experienced several stressful events in his service, as evidenced by his Purple Heart Medal, he denied re-experiencing these events through persistent intrusive thoughts or recurrent nightmares. The examiner added that the Veteran denied trying to avoid reminders or situations that lead him to recall his military service. He wrote that the Veteran did not describe having ongoing negative beliefs or mood associated with the traumatic event. The examiner stated that while the Veteran reported having problems with anger, he described situations in which anger would be within the normal range of human experience. The examiner added that the Veteran did not report other changes in physiological arousal or reactivity associated with his deployment experiences. The Board finds the VA opinion to be more probative than the private opinion as to whether the Veteran has a diagnosis of PTSD because the VA examiner explained in detail how he came to the conclusion as to the finding that the Veteran did not meet the criteria for PTSD. The examiner laid out what criteria for a diagnosis of PTSD the Veteran did not have and also provided a detailed description of the Veteran’s history and psychiatric symptoms. The examiner made it clear that his conclusion that the Veteran does not meet the criteria for a diagnosis of PTSD was based on a thorough evaluation of the Veteran and a review of the record with an acknowledgment that the Veteran had received a Purple Heart Medal. The private psychologist, however, provided a cursory finding that the Veteran’s psychological symptoms were “consistent with” a diagnosis of PTSD, but did not explain what those symptoms were and how they met the criteria for a diagnosis of PTSD, which lessens the probative value of this opinion. For these reasons, the Board finds the opinion by the VA psychologist to be more probative of the Veteran’s psychiatric diagnosis, which is that the Veteran does not meet the criteria for a diagnosis of PTSD, and, instead, has a general personality disroder. As the more probative evidence does not support a current diagnosis of PTSD, the Veteran is not entitled to service connection for PTSD. (b) Depression, Anxiety, Intermittent Explosive Disorder Upon review of the evidence of record, the Board finds that the preponderance of the evidence is against the Veteran having an acquired psychiatric disorder. April and May 2009 Department of Defense treatment records document the Veteran’s visits to Fort Reynolds medical center wherein medical staff screened the Veteran during these two visits, and the Veteran denied having anxiety, depression, sleep disturbances, anhedonia, decreased functioning ability, and suicidal or homicidal thoughts. These notations demonstrate that the Veteran has not having psychiatric symptoms at that time. The Veteran’s VA treatment records document that in March 2015, the Veteran was screened for depression, and the Veteran denied having little interest or pleasure in doing things or feeling down, depressed, or hopeless. This shows that the Veteran denied having symptoms consistent with depression. In the February 2015 private psychologist’s letter, the psychologist described the Veteran’s symptoms as “marked distress, “severe impairment in functioning,” paranoid ideation, social isolation, and dysfunctional thinking patters that included “magical and possible delusional thinking.” In the May 2015 VA examination report, the VA psychologist diagnosed the Veteran with a general personality disorder. The examiner noted that the Veteran described having a “longstanding pattern of suspicion of other people.” The examiner also observed that “[d]ocumentation suggested the Veteran has additional delusional ideation and magical thinking” and noted that while the was talking in the interview, there was no evidence of a psychotic disorder. In other words, the examiner specifically considered whether the Veteran had a psychotic disorder and did not find such disorder. The examiner further noted a diagnosis for Traumatic Brain Injury (TBI). The examiner noted the TBI caused headaches and sleep problems, but the Veteran’s suspiciousness and increased irritability were attributable to general personality disorder. As noted above, the May 2015 VA examination by a psychologist is thorough. The psychologist addressed the Veteran’s history, his relevant occupational and educational history, the Veteran’s stressors, his receipt of a Purple Heart Medal, and whether the Veteran met the criteria for a diagnosis of PTSD and provided an opinion that was based upon review of the record and the Veteran’s psychiatric history. The VA psychologist concluded that the Veteran had a general personality disorder and not an acquired psychiatric disorder. The examiner was able to describe upon what facts he based the finding of the general personality disorder. The private psychologist, in mentioning the diagnoses of depression, anxiety, and intermittent personality disorder, was recommending that the Veteran be given an evaluation by a VA mental health professional for a second opinion. It is not clear whether the private psychologist believed the Veteran had each of these diagnoses or thought that the Veteran may have these diagnoses and thought a second opinion should be obtained. Regardless, the Board finds that the private psychologist’s diagnoses acquired psychiatric disorders are outweighed by the detailed findings made by the VA psychologist, who determined that the Veteran did not have an acquired psychiatric disorder and, instead, has a general personality disorder. The Board notes that a diagnosis of a personality disorder is not eligible for VA compensation, as personality disorders are not diseases for VA compensation purposes-i.e., they are not a condition that may be service connected. 38 C.F.R. §§ 3.303(c), 4.9 (2017); Beno v. Principi, 3 Vet. App. 439, 441 (1992). Thus, service connection based on the diagnosed personality disorder may not be granted. The Board concludes that the preponderance of the evidence is against a finding that the Veteran has an acquired psychiatric disorder that is related to service. In reaching this determination, the Board has considered the benefit of the doubt doctrine, but has determined that it is not applicable because the preponderance of the evidence is against a claim for an acquired psychiatric disorder, to include depression, anxiety, and intermittent explosive disorder. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. H. Vasil, Associate Counsel