Citation Nr: 18150546 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 15-04 675 DATE: November 15, 2018 November 15, 2018 ORDER Service connection for posttraumatic stress disorder (PTSD) is denied. Service connection for an acquired psychiatric disorder, to include anxiety disorder and depressive disorder, is denied. REMANDED An initial rating in excess of 10 percent for a left wrist disability. An initial compensable rating for chronic left 2nd finger strain. An initial compensable rating for chronic left 3rd finger strain. An initial compensable rating for chronic left 4th finger strain. An initial compensable rating for chronic left 5th finger strain. FINDINGS OF FACT 1. The Veteran had active service from November 1992 to May 1993, and from January to October 2012, with periods of Reserve service. 2. A diagnosis of PTSD is not shown. 3. An acquired psychiatric disorder, to include an anxiety disorder and a depressive disorder, was not shown in service and is not etiologically or causally related to service. CONCLUSIONS OF LAW 1. PTSD was not incurred in or a result of active service. 38 U.S.C. §§ 1112, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2017). 2. An acquired psychiatric disorder was not incurred in or a result of service. 38 U.S.C. §§ 1112, 1131, 5103(a), 5103A, 5107 (W2012); 38 C.F.R. §§ 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 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. PTSD In addition to the laws and regulations outlined above, service connection for PTSD requires medical evidence diagnosing the condition 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 claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of a veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(f). The Veteran contends that she has PTSD as the result of her experiences in Afghanistan during service. Military personnel records (MPRs) confirm her active duty service in the Afghanistan theater of operations during service. Service treatment records (STRs) do not reflect complaints of or diagnoses for PTSD or any associated symptomatology. In an April 2013 VA examination, the examiner found that the Veteran did not meet the criteria for a diagnosis of PTSD. The examiner reasoned that while the Veteran reported a stressful event during service, she reported no emotional reactions consistent with criterion 2 as required for a PTSD diagnosis. She additionally denied most symptoms of PTSD. A diagnosis of anxiety and depressive disorder was confirmed, however. Similarly, VA treatment records noted that while some PTSD symptomatology was present, a diagnosis of PTSD was not warranted. Depressive disorder and anxiety disorder continued to be diagnosed. Congress has specifically limited entitlement for service-connected disease or injury to cases where such incidents have resulted in disability. Brammer, 3 Vet. App. at 225 (1992). A current disability means a disability shown by competent evidence to exist. Chelte v. Brown, 10 Vet. App. 268 (1997); see McClain, 21 Vet. App. at 319. In the present case, service connection for PTSD must be denied as a diagnosis of the claimed disability is not of record. Because the medical evidence does not support a finding that the Veteran has PTSD, the criteria for service connection for this disorder have not been met. See Brammer, 3 Vet. App. at 225. For these reasons, the appeal is denied. Acquired Psychiatric Disorder Notwithstanding the above, the Board has considered entitlement to service connection for an acquired psychiatric disorder other than PTSD but finds that the evidence weighs against the claim. Initially, the Veteran has been diagnosed with a depressive disorder and an anxiety disorder, not otherwise specified. Accordingly, a current disorder is shown and the first element of service connection has been met. Next, STRs are negative for any diagnosis of or treatment for a psychiatric disability or symptoms. Specifically, STRs from both periods of the Veteran’s active service are negative for complaints of, treatment for, or a diagnosis of a psychiatric disorder. Specifically, an April 1992 separation examination, as well as a March 2009 entrance examination, and a September 2012 separation examination all revealed a normal psychiatric evaluation. Further, the Veteran repeatedly and explicitly denied any emotional problems, anxiety or depression, as well as seeking any counseling for combat stress or any behavioral health concerns at July 2012 and September 2012 examinations. Thus, medical evidence does not support an in-service incurrence. To the extent that the Veteran claims a medical nexus, she began seeking treatment for psychiatric complaints less than a year following her separation from service. Accordingly, she was afforded a VA examination in April 2013. The examiner diagnosed the Veteran with anxiety disorder, not otherwise specified but found no evidence of psychosis. The examiner opined that the Veteran’s psychiatric disorder was less likely than not a result of, related to, or caused by active duty reasoning that while she reported an in-service stressor, she reported no emotional reaction to the stressor. Further, the examiner opined that any symptomatology from her in-service stressor appeared to cause minimal disturbance. The examiner stated that the anxiety disorder was more likely than not stemming from the Veteran’s son’s violent plot against the family, as well as his incarceration and drug problems. The examiner reasoned that since most of the Veteran’s symptoms seemed to be associated with marital and familial stress, and she reported no emotional reactions to her military stressors, her anxiety disorder was less likely than not a result of her active service. Additionally, while the Veteran went on to seek additional post-service treatment for psychiatric symptoms, no examiner has suggested these began in service or were a result of service. Instead, a review of VA treatment records revealed that she continued to discuss mostly her familial issues and focus on issues with her son and husband. Considering the totality of the record, the preponderance of the evidence weighs against a grant of service connection for an acquired psychiatric disorder other than PTSD. In this regard, the Board places significant probative weight on the April 2013 VA examination report which was ordered to specifically address the issue on appeal. Further, there is no indication from the record that the examination was inadequate for rating purposes. Specifically, the examiner interviewed the Veteran, thoroughly reviewed the medical record and considered her statements of onset and symptomatology, while providing sufficient reasoning for the rendered opinion. Moreover, there is no contradictory medical evidence of record. The Board has also considered the Veteran’s lay statements that her psychiatric disorder was caused by service. She is competent to report symptoms because this requires only personal knowledge as it comes to her through her senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, she is not competent to offer an opinion as to the etiology of her current disorders due to the medical complexity of the matters 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 report and clinical findings than to her statements. As such, the medical records are more probative than her lay assertions of a connection with service. She has also not stated she is reporting the conclusions as told to her by a competent expert, and her lay assertions have not later been confirmed by such an expert. As such, the preponderance of the evidence weighs against the claim for service connection for an acquired psychiatric disorder. Consequently, because a preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply and the appeal is denied. 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). REASONS FOR REMAND With respect to the remaining issues on appeal, the Veteran contends that her service-connected finger and wrist disabilities are more disabling than the current ratings reflect. Since her last VA examination in May 2013, VA treatment records have suggested worsening manifesting as increased pain and weakened grip as she began working as a massage therapist. As such, an updated examination should be scheduled. The matters are REMANDED for the following actions: 1. Identify and obtain any pertinent, outstanding VA and private treatment records an associate them with the record. 2. Schedule the Veteran for an examination to determine the current severity of her service-connected wrist and finger disabilities. The examiner should provide a full description of both disabilities and report all signs and symptoms necessary for evaluating the disability under the rating criteria. Information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups should be obtained. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state why that is so. 3. Thereafter, the AOJ should consider all of the evidence of record and readjudicate the claims on appeal. If the benefit sought is not granted, issue a supplemental statement of the case to the Veteran and her representative, and allow an appropriate time to respond before returning the case to the Board. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Yacoub, Associate Counsel