Citation Nr: 18148167 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 17-11 211 DATE: November 6, 2018 ORDER Entitlement to service connection for a shoulder disability is denied. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, and alcoholism, is denied. FINDINGS OF FACT 1. The Veteran’s shoulder disability did not manifest during active service, and there is no indication that a shoulder disability is related to his active service. 2. The Veteran’s alcohol use disorder was not caused or aggravated by a service-connected disability. 3. Personality disorders are not diseases or injuries subject to compensation benefits within the meaning of applicable law. 4. A psychiatric disorder, other than alcohol use disorder and a personality disorder, did not manifest during active service and there is no indication that a psychiatric disorder is related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a shoulder disability are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 2. The criteria for service connection for a psychiatric disorder, to include PTSD, depression, and alcoholism, are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2006 to June 2007 in the United States Army. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Veteran requested a hearing before the Board, which was scheduled for a date in November 2017. His hearing request is deemed withdrawn because he failed to report for this hearing, and no request for postponement has been received. See 38 C.F.R. §§ 20.703, 20.704 (2018). Service Connection Claims 1. Shoulder Disability The Veteran maintains that he has a current shoulder disability that was incurred during his active service. An August 2006 service treatment record indicated that the Veteran complained of pain with certain movements in his left shoulder for 4-5 days. He denied experiencing any specific trauma or injury. The initial assessment was shoulder strain infraspinatus muscle. Another record indicated that he reported that he was doing upper body exercises one evening and was in pain the next day. He did not notice any severe pain, popping, or snapping. The assessment was strain of rotator cuff with indications of impingement; potentially rotator cuff tendonitis. Prior to discharge, in March 2007, the Veteran reported experiencing a strained rotator cuff; he complained of sharp pain and left shoulder limitation of motion. A March 2007 Report of Medical examination indicated that his upper extremities were normal. In July 2014, the Veteran filed a claim for service connection for a shoulder injury. A July 2014 VA treatment record indicated that there was no limited motion in any of the Veteran’s joints except the right shoulder, which had limited abduction above 90 degrees. In August 2014, he complained of right shoulder pain. An X-ray of the right shoulder showed no osseous abnormality. In his October 2014 notice of disagreement (NOD), the Veteran indicated that he disagreed with the decision denying service connection for a right shoulder disability. A September 2016 private medical record indicated that the Veteran complained of right shoulder pain since being involved in a motor vehicle accident two days prior. X-rays of the right shoulder were negative. During an August 2017 VA examination, the Veteran reported that during service, he felt pain in his left shoulder while raising his rifle overhead during a training drill. He stated that he was given stretching exercises and an ice pack and told to follow up in three days if there was no improvement. He did not follow up and had not sought any treatment for his left shoulder since then. He stated that he experienced flare ups of left shoulder pain about four days a week. The examiner noted that during questioning, the Veteran stated that it was his right shoulder that was service related, but then changed his mind when reminded of the private medical records showing treatment for right shoulder pain following a motor vehicle accident. On examination of the left shoulder, flexion was limited to 140 degrees, and abduction was limited to 130 degrees. There was no objective evidence of localized tenderness or pain on palpation, and no objective evidence of crepitus. The examiner noted that the Veteran had been diagnosed with a left shoulder strain in 2006. The examiner opined that it was less likely than not that his current shoulder condition was related to the incident during active service. The examiner noted the mild nature of the strain described, along with the fact that no further treatment was sought, the length of time that had elapsed, and the fact that the Veteran’s upper extremities were normal at his separation examination. In this case, the Board finds the most probative evidence weighs against the claim. Although the Veteran was treated for a right shoulder pain in 2014 and 2016, there is no evidence of a right shoulder injury or disability during his active service. Furthermore, although he was treated for a left shoulder strain during service in 2006, there was no follow treatment and his upper extremities were normal at separation. After service, the first documentation of a left shoulder problem was during the August 2017 VA examination, over ten years after discharge. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In addition, the VA examiner opined that the Veteran’s currently claimed left shoulder disability was less likely than not related to the in-service left shoulder strain. There is no medical opinion to the contrary. The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced; however, to the extent those reports conflict with the contemporaneous medical evidence, the Board does not find those statements credible. Furthermore, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. The Board finds that evidence in this case does not reach the level of equipoise. See 38 U.S.C. § 5107(a); Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009); Skoczen v. Shinseki, 564 F.3d 1319, 1323-29 (Fed. Cir. 2009). Accordingly, entitlement to service connection for a shoulder disability is not warranted. 2. Psychiatric Disorder The Veteran maintains that his current psychiatric disorder was incurred in or is etiologically related to his active service. The Veteran’s service treatment records indicated that in February 2007, he was admitted for alcohol intoxication and suicidal ideation. He reported having depression for quite a while. The assessment was alcohol dependence with physiologic dependence and personality disorder NOS. A February 2007 treatment record assessed him with suicidal ideation and alcohol-induced mood disorder during intoxication. A Report of Mental Status Evaluation for consideration of discharge noted that the Veteran did not have a psychiatric disease or defect that warranted disposition through medical channels. It was noted that the Veteran’s maladjustment to military service reflected a life-long pattern of recurrent and immature behavior, as well as an inability to relate effectively to others. The psychiatrist stated that any future suicidal gesture/attempt would be attributed to his character and behavior rather than to any diagnosable psychiatric disease. A March 2007 record noted adjustment disorder with depressed mood. The Veteran was discharged from service and his March 2007 separation examination noted diagnoses of alcohol dependency with physiologic dependence and personality disorder NOS. A May 2007 treatment record noted depression. After service, a May 2014 private treatment record indicated that the Veteran was admitted after stating that he jumped out of a car when he was high and drunk and needed help. The diagnoses were polysubstance dependence, major depressive disorder, and PTSD. A June 2014 VA treatment record noted that the Veteran had entered a residential alcohol treatment program. He stated that he had suicidal thoughts since his military service. In July 2014, he reported experiencing a history of PTSD, depression, and anxiety. In August 2014, it was noted that he presented with symptoms of longstanding depression. The Veteran filed a claim for service connection for a psychiatric disorder, to include PTSD, in July 2014. In July 2014, the RO sent him a letter requesting that complete and return a PTSD stressor questionnaire and supply information regarding the stressful events resulting in PTSD. The Veteran did not respond to that letter. A July 2016 private treatment record indicated that the Veteran was hospitalized after binge drinking and talking about killing himself. The diagnoses were unspecified mood disorder, and alcohol use disorder. In September 2016, he was admitted after having consumed two-fifths of alcohol and experiencing some suicidal thoughts. He did not act on them and came to the hospital instead to sober up. He was hospitalized for two days and encouraged to attend an intensive outpatient treatment program. The discharge diagnoses were unspecified mood disorder versus substance-induced mood disorder, and alcohol use disorder. In October 2016, the Veteran admitted himself to the hospital for treatment of alcohol dependence and depression. He stated that he had been drinking about a half-gallon of vodka daily for the past two to three years. His longest period of sobriety in the past six months had been 20 days. The diagnoses were alcohol dependence, and mood disorder NOS. In December 2016, he sought follow up treatment for alcohol dependence. The diagnoses were alcohol dependence and major depressive disorder. A VA examination was conducted in August 2017. The diagnoses were alcohol use disorder and unspecified depressive disorder. The examiner stated that she was unable to clearly state whether the Veteran had major depressive disorder because criterion C was not met, i.e., the episode is not attributable to the physiological effects of substance or another medical condition. The examiner noted that the Veteran reported that his longest period of sobriety was 30 days and that although he had received treatment for depression, it was always in the context of substance abuse. Therefore, the examiner stated that his depression could best be categorized as substance induced mood disorder. Regarding PTSD, when the examiner questioned the Veteran, he stated that he was told that he could have PTSD from his military career by a provider. When asked about his trauma history, he reported, “The trauma of not receiving help when reaching out for help.” The examiner noted that this did not meet criterion A for PTSD. The examiner stated that the Veteran had depression, but that he did not meet the criteria for major depressive disorder because his low mood had been in the context of significant alcohol consumption. She noted that his prior suicidal gestures had been while intoxicated, including his first suicidal gesture in the military. Therefore, the examiner opined that it was as likely as not that his mental health symptoms in the military were related to alcohol use disorder (e.g., substance induced mood disorder). The examiner also opined that his depression did not appear to have been caused by his military service, noting that he reported an onset of depression while intoxicated from marital discord and abuse from his then wife. The examiner also opined that alcohol use disorder appeared to be the Veteran’s primary disability, noting that his pattern of use was a behavioral choice made by the individual rather than a direct result of the symptoms of any other mental health diagnoses or direct result of any military experience. The Board notes that, payment of compensation for a disability that is a result of a Veteran’s own alcohol or drug abuse is prohibited by law. 38 U.S.C. § 105(a) (2012); 38 C.F.R. §§ 3.1 (m), 3.301(d) (2018). Therefore, service connection for the Veteran’s alcohol use disorder on a direct basis is precluded by law. However, service-connected disability compensation may be awarded for an alcohol or drug abuse disability secondary to a service-connected disability or use of an alcohol or drug abuse disability as evidence of the increased severity of a service-connected disability. Allen v. Principi, 237 F.3d 1368, 1376 (Fed. Cir. 2001). Consequently, compensation will only result where there is clear medical evidence establishing that the alcohol or drug abuse disability is caused or aggravated by a veteran’s primary service-connected disability. Id. In this case, the evidence indicates that the Veteran’s alcohol abuse disorder was not caused or aggravated by a service-connected disability. In this case, the Board finds the most probative evidence weighs against the claim. Although the Veteran was treated for alcohol dependence and suicidal ideation during service, the psychiatrist who evaluated him at that time indicated that he did not have a diagnosable psychiatric disease. The August 2017 VA examiner also opined that the mental health problems that the Veteran had during service and since service were secondary to his alcohol consumption. The Board notes that there is no medical opinion to the contrary. Although he was given a diagnosis of a personality disorder during service, personality disorders are not diseases or injuries within the meaning of applicable legislation providing VA compensation benefits. 38 C.F.R. §§ 3.303(c), 4.9, 4.127 (2018). The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced; however, to the extent those reports conflict with the contemporaneous medical evidence, the Board does not find those statements credible. Furthermore, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. The Board finds that evidence in this case does not reach the level of equipoise. See 38 U.S.C. § 5107(a); Fagan, 573 F.3d at 1286; Skoczen, 564 F.3d at 1323-29. Accordingly, entitlement to service connection for a psychiatric disorder is not warranted. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mishalanie, Counsel