Citation Nr: 18149670 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 06-37 426A DATE: November 13, 2018 ORDER Service connection for an acquired psychiatric disorder is denied. FINDINGS OF FACT 1. The Veteran had active service from June 1970 to November 1971. 2. An acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) was not incurred in service and is not etiologically or causally related to service. CONCLUSION OF LAW An acquired psychiatric disorder was not incurred in or caused by active service. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310(a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION 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. The evidence, as reviewed below, does not show a diagnosis of any chronic disease. Therefore, service connection on a presumptive basis is not for application. Service connection for PTSD requires medical evidence establishing a diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). The Veteran claims he developed an acquired psychiatric disorder due to service. As an initial matter, he has been diagnosed with a personality disorder. Personality disorders are not diseases or injuries within the meaning of the law providing compensation; therefore, to the extent that he is claiming service connection for a personality disorder, the appeal is denied. Service connection may be warranted for either a separate, acquired psychiatric disorder or for a permanent worsening of a personality disorder. The Board has also considered whether the Veteran has an acquired psychiatric disorder other than a personality disorder. Prison medical records consistently show both individual and group treatment for PTSD. In these records, he claimed PTSD from Vietnam service, although military personnel records show he did not serve in Vietnam. In July 2011, a correctional facility outpatient evaluation found no diagnosis or an impression of rule-out situational depression. A July 2017 private medical record showed a discharge diagnosis of major depressive disorder (MDD), although a detailed treatment report was not included. An April 2018 VA primary care note lists depression as an active problem, alongside the Veteran’s physiological disorders, and a May 2018 VA primary care note listed depression and PTSD as active problems, again alongside his other physiological disorders. In contrast, May 1973 private hospital records noted diagnoses of sociopathy with no true clinical depression, and passive dependent personality with schizoid and anti-social traits. An October 1990 prison medical evaluation showed a diagnosis of exhibitionism and antisocial personality disorder. Further, May 2015, November 2017, and July 2018 VA examiners all diagnosed the Veteran with personality disorders rather than psychiatric disorders. The May 2015 VA examiner diagnosed an unspecified personality disorder, and found that the Veteran’s behavior during service was more likely due to his personality disorder rather than instances of a separate psychiatric disorder, reasoning that a personality disorder was characterized by a pattern of behavior that deviates markedly form the expectations of culture and impacts impulse control, interpersonal functioning, affectivity and cognition. The November 2017 VA examiner diagnosed the Veteran with antisocial personality disorder, but did not find a separate psychiatric disorder. The examiner specifically noted that based on history and symptoms, the Veteran did not meet the criteria for PTSD of any other Axis I mental disorder under the DSM-V. Finally, the July 2018 VA examiner also diagnosed the Veteran with antisocial personality disorder. The examiner also specifically noted that his symptoms did not meet the criteria for PTSD or any other trauma-related disorder under the DSM-IV or DSM-V, and that his report of mood changes and depressive symptoms were part of antisocial personality disorder. The examiner further explained that the diagnosis of major depressive disorder in July 2017 would be expected without reviewing a full medical history, which would instead reveal his depressive symptoms as part of a personality disorder rather than a separate disorder. Thus, the examiner found, any depressive symptoms in his medical history were not separate or additional diagnoses. These three examination reports are more probative than the medical evidence showing diagnoses separate from a personality disorder. First, in his prison treatment records which noted PTSD diagnoses, he cited Vietnam service that is not supported by the evidence. Thus, the VA examiners’ reports, after reviewing his medical evidence and military history, finding no such diagnosis is more probative than a psychologist listing that diagnosis in notes for group treatment on the basis of incorrect factual information given by the Veteran. As for the July 2017 private discharge record that noted a diagnosis of major depressive disorder, there is no accompanying rationale or explanation of the diagnosis. No medical professional stated whether the Veteran’s medical or military history was reviewed prior to making the diagnosis. Further, the July 2018 VA examiner specifically addressed this diagnosis, reviewed the medical and military history, and explained why the diagnosis of major depressive disorder was, in fact, the misconstrued symptoms of a personality disorder. The private medical record is not discounted solely because it is unclear whether the Veteran’s claims file was not reviewed; rather, the VA examiner’s opinion is more probative not only because the claims file was unquestionably reviewed but also because the examiner directly engaged with and explained the July 2017 MDD diagnosis in the context of the Veteran’s broader medical history, recharacterizing it as depressive symptoms of a personality disorder. Given that the evidence showing he has a current diagnosis personality disorder, and no separate psychiatric disorder, the weight of the medical evidence is against finding a current disability for service-connection purposes. Next, the evidence weighs against the permanent worsening of a personality disorder. The three VA examiners all found that by definition, personality disorders begin at an early age. The May 2015 VA examiner found that it was less likely than not that his personality disorder was permanently aggravated by active service, finding his pattern of behavior during and following service consistent with the symptoms of a personality disorder. The November 2017 VA examiner similarly found that antisocial personality disorder had not worsened beyond its usual course, noting the Veteran’s symptoms during and after service did not demonstrate worsening. No medical opinion has been submitted that posits service permanently aggravated an underlying personality disorder. No medical evidence has shown progression of a personality disorder consistent with permanent worsening. As such, the medical evidence weighs against service connection due to a theory of aggravation. The Board has considered the Veteran’s lay statements that he has an acquired psychiatric disorder caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, he is not competent to offer an opinion as to whether a permanently worsening of his current personality disorder, nor is he competent to diagnose himself with an acquired psychiatric disorder due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the examination reports and clinical findings than to his statements. Finally, the Veteran 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 Brendan A. Evans, Associate Counsel