Citation Nr: 18149437 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 13-35 505 DATE: November 9, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder to include PTSD and adjustment disorder is denied. Entitlement to a rating in excess of 30 percent for anxiety disorder not otherwise specified (NOS) is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran currently has a confirmed diagnosis of PTSD related to an in-service stressor, and the most probative evidence in this case, overall, finds no PTSD at this time. 2. The Veteran’s anxiety disorder has been manifested by symptoms productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; reduced reliability, deficiencies in most areas. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for posttraumatic stress disorder (PTSD) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for an initial rating in excess of 30 percent for anxiety disorder, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code (DC) 9413. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1967 to February 1970. In February 2016 and November 2017, the Board remanded the claims for further development. The Board finds that the RO complied with its remand directives. Although a Veteran may only claim service connection for a psychiatric disorder, the claim cannot be limited only to that diagnosis, but must rather be considered a claim for any mental disability that may be reasonably encompassed. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Therefore, the Board has characterized the issue on the title page. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and adjustment disorder Service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. §§ 1110; 1131; 38 C.F.R. § 3.303. In order to prevail on the issue of service connection, generally, there must be medical evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Barr v. Nicholson, 21 Vet. App. 303 (2007); Pond v. West, 12 Vet. App. 341, 346 (1999). In addition, certain chronic diseases may be presumed to have been incurred during service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection for PTSD requires: (1) medical evidence establishing a diagnosis of the disorder; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) a link established by medical evidence, between current symptoms and an in-service stressor. 38 C.F.R. § 3.304 (f). The PTSD diagnosis must be made in accordance with the criteria of Diagnostic and Statistical Manual of Mental Disorders-V (DSM V). 38 C.F.R. § 4.125 (a). The VA implemented DSM 5, effective August 4, 2014 and DSM 5 applies to claims certified to the Board on and after August 4, 2014. In order to grant service connection for PTSD to a non-combat veteran, there must be credible evidence to support the veteran’s assertion that the stressful event occurred. A stressor need not be corroborated in every detail. Suozzi v. Brown, 10 Vet. App. 307, 311 (1997). Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. Cohen v. Brown, 10 Vet. App. 128, 142 (1997); Moreau v. Brown, 9 Vet. App. 389, 395-396 (1996). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Veteran contends he has a psychiatric disorder, to include PTSD that was incurred in or caused by his time in service. Initially, the Board notes that the Veteran’s records contain a diagnosis of PTSD in December 2011. However, in a subsequent evaluation in August 2012, the diagnosing provider appears to have changed their assessment to a diagnosis of “PTSD versus anxiety disorder”. See Grand Junction VAMC records dated August 7, 2012. The Veteran was afforded a VA examination for PTSD in March 2012. The examiner found that the Veteran did not meet the more stringent criteria for PTSD under DSM IV. The examiner found that although the Veteran described occasional symptoms that may be associated with PTSD, he did not describe symptoms that were sufficiently persistent or intense for a PTSD diagnosis. Stressors were confirmed, however, the examiner found that the Veteran’s symptoms did not create significant ongoing distress. The Veteran was afforded another VA examination for PTSD in April 2016. The examiner found that the Veteran did not meet the criteria for PTSD. The examiner also diagnosed the Veteran with other specified trauma and stressor-related disorder. The examiner noted that although the Veteran was exposed to numerous traumatic events during his deployment to Vietnam, he only described occasional symptoms associated with PTSD and does not meet all the requirements for a PTSD diagnosis. The Veteran is competent to describe the circumstances and incidents of his period of service and allege factual circumstances that then occurred. However, he is a lay person and is not competent to establish that he has PTSD related thereto. The Veteran is not competent to diagnose or offer opinion as to etiology of any current PTSD. The question regarding the diagnosis and etiology of such a disability is a complex medical issue that cannot to be addressed by a layperson. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The claim of service connection for PTSD must be denied. Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. §§ 1110, 1131. In the absence of proof of present disability, there can be no valid claim of service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As there is no current diagnosis of PTSD, service connection for PTSD must be denied. The Veteran has also been diagnosed with adjustment disorder with depressed mood. The April 2016 examiner noted that this condition was secondary to issues related to the Veteran’s phase in life, specifically his retirement from the United States Postal Service. The Veteran reported that he’s lost interest in performing activities he previously engaged in while working full time. The April 2016 examiner opined that the adjustment disorder is less likely than not incurred in or caused by service. The examiner noted that symptoms appear to be both secondary to the Veteran’s retirement and some decreased ability to engage in some physical activities following knee surgery. The Board finds the April 2016 opinion to be of great probative value. Accordingly, the Board finds that the preponderance of the evidence is against the claim of entitlement to service connection for an acquired psychiatric disability, to include PTSD and depressive disorder, is not warranted. 2. Entitlement to a disability rating in excess of 30 percent for anxiety disorder NOS The Veteran currently receives a 30 percent rating for his anxiety disorder. In this regard, it is very important for the Veteran to understand that the denial above does negatively impact the Veteran’s case overall. The Veteran’s disability, whether it is called PTSD or an anxiety disorder, is being evaluated. There is no effort in this case to decrease the evaluation of the problem simply because the Veteran’s has not been found to have PTST. The problem the Veteran is having with his psychiatric disorder is being considered, in total. No effort is being made to evaluate the problem separately. The Veteran currently receives a 30 percent rating for his anxiety disorder. He asserts that the currently assigned evaluation does not adequately reflect the severity of his disability. The Veteran’s anxiety disorder is currently rated under 38 C.F.R. § 4.130, DC 9413. Under the applicable rating criteria (same as PTSD), a 30 percent disability rating is warranted where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to symptoms such as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, and recent events). A 50 percent disability rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. A 100 percent disability evaluation is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time and place; memory loss for names of close relatives, own occupation, or own name. Id. The Veteran was afforded a VA examination on April 5, 2016. The examiner diagnosed the Veteran with other specified trauma or stressor-related disorder. The examiner explained that under the DSM IV this condition was previously known as anxiety disorder, not otherwise specified. The Veteran reported depressed mood, anxiety and occasional trouble sleeping. He denied obsessive thoughts or compulsive behaviors. The examiner opined that the aforementioned disorder causes occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. As such, the Board finds that the Veteran’s anxiety disorder symptomatology is most closely approximated by the assigned 30 percent disability rating. The Veteran’s anxiety disorder symptoms as a whole during the rating period are not of similar severity, frequency, and duration to those in the rating criteria for the assignment of a 50 percent (or higher) rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013). (Continued on the next page)   The preponderance of the evidence is against the Veteran’s claim of entitlement to an increased disability rating for an anxiety disorder in excess of 30 percent. There is no reasonable doubt to be resolved, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. John Crowley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD V. Woehlke, Associate Counsel