Citation Nr: 18149573 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-21 727 DATE: November 9, 2018 ORDER Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. FINDING OF FACT The Veteran has not had a current psychiatric disability, to include PTSD, throughout the appeal period. CONCLUSION OF LAW The criteria for service connection for a psychiatric disorder, to include PTSD, are not met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from July 1966 to July 1968, during which he was awarded the Combat Infantryman Badge (CIB) for his combat service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in April 2017. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). “To establish a right to compensation for a present disability, a Veteran 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”—the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). To be entitled to service connection for PTSD, as opposed to another mental health disorder, the record must include (1) medical evidence establishing a diagnosis of the condition under the Diagnostic and Statistical Manual 5 (DSM-V) in accordance with 38 C.F.R. § 4.125; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f); see also Cohen v. Brown, 10 Vet. App. 128, 138 (1997). The Veteran filed his service connection claim for a psychiatric disorder in October 2013. At that time, the Veteran indicated that he had recurring problems including being hyperactive, anger and resentment at how he was treated upon return from Vietnam, difficulty making close friends and keeping people at arm’s length, and guilt issues regarding seeing friends and people under his command killed. The Veteran initially underwent a VA psychiatric examination in September 2014. After interview with the Veteran, including notation of the Veteran’s significant combat experience in the Republic of Vietnam, the September 2014 VA examiner noted that the Veteran did not meet the criteria for a diagnosis of PTSD under the DSM-5 criteria, and that he did not have a mental disorder that conformed with any other DSM-5 criteria. The Board reflects that it appears that the Veteran was missing Criteria D, G, H, and I under the DSM-5 at that time for a diagnosis of PTSD. In the Remarks section, the examiner specifically noted that the Veteran was a high-functioning person. He additionally noted that the Veteran’s statements that he lacked friendships was not supported by his social history interview; his history also noted that he was able to control his frustration satisfactorily and that he was a “type-A” personality prior to military service. The examiner, however, did indicate that the Veteran was on an antidepressant at that time, and that it helped control his anger/frustration, noting that he was placed on that antidepressant many years ago after losing a union election. The examiner finally concluded that the Veteran’s psychiatric medication appeared “to be helping with his intensity level but functioning would not indicate significant problems such that assigning a mental disorder would be appropriate and it would not be considered [service connected] if it were.” VA treatment records document that the Veteran was treated by the VA Social Worker, C.S., who diagnosed the Veteran with PTSD in February 2014, following a positive PTSD screen in January 2014. During that treatment session, the VA Social Worker indicated that the Veteran had been put on Prozac 30 years ago for a while, but that the Veteran was now taking Viibryd (Vilazondone HCl), a known antidepressant. The Board, however, reflects that the VA Social Worker did not address the specific criteria of the DSM-5 relied on in making the diagnosis of PTSD at that time. The VA Social Worker also treated the Veteran in March 2014, April 2014, May 2014, July 2014, and May 2016, where the diagnosis of PTSD was continued. The Veteran’s other VA treatment records indicate notations of the PTSD diagnosis by his VA primary care physician, although the primary care physician does not ever specifically treat the Veteran for any psychiatric complaints; those notations appear to be continuations of the diagnosis from other VA treatment records, namely from the VA Social Worker, C.S. Those records, however, indicate that the Veteran is prescribed and VA manages his prescription of Prozac, to include a notation in a January 2016 VA treatment record that he takes that medication “for depression.” In his October 2014 notice of disagreement, the Veteran stated that he wanted an evaluation by another examiner, as he felt that the doctor did not conduct a proper examination. He further stated that he had several personal issues occurring on the date of his examination and that he “was not in the best state of mind for the interview.” He stated that it was mentally and physically a “terrible time for an evaluation,” due to his friend passing away the day after the examination and having sinus surgery three days prior to the examination. He finally asserted that he had suffered from issues related to PTSD for 45 years. The Veteran again requested another examination in his May 2016 substantive appeal, VA Form 9. He stated that he has suffered a “myriad of symptoms since his tour as an Infantry soldier in Vietnam.” He indicated that the VA Social Worker, C.S., had determined that he met the criteria for PTSD and that after his time with C.S., both he and C.S. believed that he was still suffering the after effects of combat. The Veteran underwent another VA examination with a different examiner in November 2016, at which time that examiner also indicated that the Veteran did not meet the diagnostic criteria for a diagnosis of PTSD or any other mental disorder under the DSM-5. That examiner, during the interview with the Veteran, also noted that the Veteran began psychiatric treatment in 2013 and has seen that VA provider “off and on” for 5-10 session, his last section being approximately 1.5 years ago. He also noted that the Veteran reported taking Prozac for the past 15 years after he lost a union election. Based on that examination report, it appears that examiner felt that the Veteran was missing Criteria D, G, H, and I under the DSM-5 for a diagnosis of PTSD. In the Remarks section, that examiner noted the Veteran was distressed when watching movie trailers and hearing “Amazing Grace,” although such did not meet the intense or prolonged psychological distress criteria; he also occasionally blamed himself for the deaths of people under his command, but such did not meet the persistent, distorted cognitions criteria. The examiner noted that the Veteran’s comments were more reflective of a strong work ethic and a sense of responsibility; the examiner, however, noted that the Veteran had survivor guilt once a week when seeing a news story or movie trailer. The examiner noted that he did not report a persistent negative emotional state and did not appear to avoid external reminders, as he intentionally watched the movie “Private Ryan.” The examiner finally concluded that the Veteran’s disturbance did not appear to cause a clinically significant distress or impairment in social, occupational, or other areas of functioning; he was a social person, who continued to interact with others without much difficulty, and the examiner stated that the Veteran’s “problems appeared related to his personality and high standards. . . . His strong work ethic most likely lead him to read books on PTSD and receive therapy that helped him manage his distress and prevented him from meeting the full criteria for clinical PTSD.” The Veteran has not identified nor has he submitted any private treatment records documenting any treatment for or diagnosis of PTSD or any other psychiatric disorders. Finally, in his April 2017 hearing, the Veteran again reported that he had been diagnosed with PTSD by a VA Social Worker, C.S., and that such diagnosis was in his VA treatment records. He further indicated that he discontinued his mental health treatment with C.S. due to taking care of his very sick spouse. The Veteran detailed several symptoms from which he suffered, which were substantially similar to those he reported during both of his above noted VA examinations and in his statements on appeal. Based on the foregoing evidence, the Board finds that service connection for a psychiatric disorder, to include PTSD, is not warranted at this time. Initially, the Board acknowledges the Veteran’s statements and assertions that he feels that he has PTSD related to his military service, particularly his combat service in the Republic of Vietnam. Although the Veteran is certainly competent to state the symptoms from which he suffers, he is not competent to diagnose a psychiatric disorder or otherwise opine as to the etiology of such a disorder in this case, as he lacks the requisite medical experience and expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Additionally, although the Board acknowledges that the VA Social Worker, C.S., has diagnosed the Veteran with PTSD related to his Vietnam experiences in this case, the Board finds that evidence is outweighed by the other, more probative evidence in this case that he does not have a current psychiatric disorder, including PTSD, under the DSM-5. Namely, C.S. in this case provided a diagnosis of PTSD in this case without providing an analysis under the DSM-5 regarding which signs and symptoms correlated with the criteria for a diagnosis of PTSD under the DSM-5. Instead, two different VA psychologists, with greater medical training and experience in rendering diagnoses of psychiatric disorders under the DSM-5, both found after examination of the Veteran that he did not warrant a diagnosis of PTSD or any other psychiatric disorder under the DSM-5. Significantly, both of the VA examiners in this case found that the Veteran did not meet Criteria D, G, H, and I under the DSM-5 for a diagnosis of PTSD, and both of those examiners provided a rationale for those findings. The Board finds that the VA examiners’ findings and conclusions regarding whether the criteria under the DSM-5 for a diagnosis of PTSD has been met is vastly more probative in this case than C.S.’s diagnosis of PTSD without explanation for his findings with respect to the DSM-5 criteria. Finally, the Board also acknowledges that it appears that the Veteran has a long history of prescription use of an antidepressant, Prozac, and that such appears to be related to “depression.” The Board, however, notes that no medical professional throughout the appeal period has diagnosed the Veteran with depression or any depressive disorder. Again, significantly, both the VA examiners contemplated the Veteran’s lay statements regarding symptomatology and, after examination of the Veteran and review of the claims file, found that he did not warrant a diagnosis under the DSM-5 for any other psychiatric disorder. Again, the Board finds that this evidence is the most probative evidence of record regarding the presence of a psychiatric disability in this case. In short, although the Board notes that the Veteran is clearly shown to have combat service in the Republic of Vietnam, the evidence of record at this time does not demonstrate that he has a current psychiatric disability. Accordingly, service connection for a psychiatric disorder, to include PTSD, must be denied based on the evidence of record at this time. See 38 C.F.R. §§ 3.303, 3.304; McClain v. Nicholson, 21 Vet. App. 319 (2007) (the requirement that a current disability be present is satisfied “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim . . . even though the disability resolves prior to the Secretary's adjudication of the claim.”); Brammer v. Derwinski, 3 Vet. App. 223 (1995) (Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability). In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Peters, Counsel