Citation Nr: 18151209 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 14-23 908 DATE: November 16, 2018 ORDER Entitlement to service connection for a psychiatric disability is denied. FINDING OF FACT A preponderance of the competent and credible evidence of record is against a finding that the Veteran’s psychiatric disability is not related to active service. CONCLUSION OF LAW The criteria for entitlement to service connection for a psychiatric disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran’s appeal was previously remanded by the Board for additional development. In light of treatment records that have been obtained and associated with the record, the obtaining of the requested medical opinion, and the further adjudicatory actions taken by the Agency of Original Jurisdiction, the Board finds that there has been substantial compliance with the prior remand. Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008); Dyment v. West, 13 Vet. App. 141 (1999). 1. Entitlement to service connection for a psychiatric disability Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Service incurrence will be presumed for certain chronic diseases, such as psychoses, if manifest to a compensable degree within the year after active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. The medical treatment records shows that the Veteran has a current diagnosis of a psychiatric disability. The question is whether any current psychiatric disability was caused by the Veteran’s active duty. The Board finds that the preponderance of the evidence is against a finding that any current psychiatric disability was incurred in service or is related to service. The service medical records do not show any complaints of psychiatric symptoms. An August 1978 service medical record shows that the Veteran was previously hyperventilating. He was put in a cold shower, and the Veteran reported feeling much better after the shower. No psychiatric diagnosis was made. The June 1982 service separation examination report shows that the Veteran was psychiatrically normal. In August 2017, the Veteran saw a private psychologist. The Veteran reported that while he was on active duty, he was exposed to numerous traumatic incidents. The Veteran stated that he saw a woman being raped, and he saw the rape of an 11 year-old boy who slit his throat. It was also noted that the Veteran received multiple disciplinary actions while on active duty and was restricted from carrying a firearm, even though he was a rifleman. The examiner diagnosed bipolar II disorder, at least as likely as not to have been caused of aggravated by active duty service. The examiner opined that it was highly likely that the stress-related conditions while in service combined with a likely underlying genetic vulnerability explained the Veteran’s current psychiatric condition. On VA examination in September 2018, the examiner diagnosed unspecified personality disorder. The examiner specified that no other mental disorder was diagnosed. The examiner noted the documented in-service treatment for hyperventilating and the military personnel records which documented multiple disciplinary actions. The examiner further reviewed the August 2017 letter written by the private psychologist. The examiner opined that the Veteran was a highly unreliable historian. The examiner noted many inconsistencies within the Veteran’s report to her versus what was documented in VA and military records. After reviewing numerous inconsistencies, the examiner stated that the Veteran’s self-report was so inconsistent and contradictory that it was not possible to obtain an accurate assessment of his history or psychiatric presentation from the Veteran himself. The examiner noted a prior reference to a diagnosis of PTSD, but explained it was not possible to assess symptomatology associated with trauma due to the extremely high level of variance in the Veteran’s reporting of his trauma history. The examiner further noted the Veteran’s diagnosis of bipolar disorder versus schizoaffective disorder but found that the Veteran did not describe any clear hypomaniac or manic symptoms. The examiner felt that the only diagnosis that could be assigned with any confidence was a diagnosis of unspecified personality disorder, and the examiner explained why that diagnosis was appropriate. The examiner opined that the prior diagnoses in the records, including bipolar disorder ante PTSD, were invalid because they were based on incorrect historical and clinical information. The examiner noted that the prior providers did not have access to the Veteran’s records or did not review the entire history of records, and so the other providers could not detect the gross inaccuracies in the Veteran’s report. The examiner opined that the Veteran’s unspecified personality disorder was less likely than not caused by or related to active service or related to the Veteran’s in-service treatment for hyperventilation syndrome. The examiner explained that personality disorders by nature are related to childhood and adolescent development, and the Veteran’s personality disorder was not influenced by service to any significant degree. After considering the evidence of record, the Board finds that service connection is not warranted for a psychiatric disability. A psychosis was not shown within one year following separation from service. Therefore, presumptive service connection is not warranted. Concerning direct service connection, while the Veteran currently has a diagnosed psychiatric disability, the most probative evidence of record does not associate that disability with the Veteran’s service. The August 2017 private opinion was provided by a psychologist. That psychologist has the education and training to offer competent medical opinions. However, the psychologist did not provide the level of in-depth discussion of the nature of the diagnosed disability as the September 2018 VA examiner, and did not demonstrate a review of the documented evidence and history. Additionally, it appears that the August 2017 private psychologist’s opinion was based simply on the Veteran’s self-reported history, and a medical evaluation that is merely a recitation of a Veteran’s self-reported and unsubstantiated history has no probative value. Sanchez-Benitez v. West, 13 Vet. App. 282 (1999); Swann v. Brown, 5 Vet. App. 229 (1993); Godfrey v. Brown, 8 Vet. App. 113 (1995). The Board finds the September 2018 VA examiner’s opinion to be the most probative evidence of record. The September 2018 VA examination report outlines the reasons why the examiner felt that the current disability was less likely to be related to service. The examiner considered the Veteran’s self-report, the service treatment records, the post-service records to specifically include the August 2017 private psychologist opinion, and explained the factors behind the determination that the Veteran’s psychiatric disability was less likely to be related to service. Additionally, the Veteran’s prior psychiatric diagnoses were acknowledged and discussed. The Board finds the September 2018 VA examination report to be the most persuasive evidence of record. Among the factors for assessing the probative value of a medical opinion are the physician’s access to the claims file and the thoroughness and detail of the opinion. Hayes v. Brown, 5 Vet. App. 60 (1993) (it is the responsibility of the Board to assess the credibility and weight to be given the evidence); Wood v. Derwinski, 1 Vet. App. 190 (1992). The probative value of medical evidence is based on the physician’s knowledge and skill in analyzing the data, and the medical conclusion the examiner reaches. As is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. Guerrieri v. Brown, 4 Vet. App. 467 (1993). The September 2018 VA examiner also specifically noted the Veteran’s lack of credibility. The Board has reviewed the evidence and also finds contradictory statements which indicate a lack of credibility. The Veteran’s reported dates, longevity, branches, service locations, and service experiences have been variously reported, with many contradictions. The Board also notes that personality disorders are not disabilities for which service connection can be established. 38 C.F.R. § 3.303. While the private examiner diagnosed bipolar disorder, the VA examiner explained that diagnosis was not appropriate and provided a plausible rationale. The Board finds that VA examiner’s opinion is more persuasive as access to the Veteran’s records and history provided a more sound evidentiary basis for the examiner’s conclusions. Accordingly, after a careful review of the evidence of record, the Board finds that the preponderance of the evidence is against the claim. The preponderance of the evidence is against a finding of a causal connection between the Veteran’s service and the current psychiatric disability. The Board is sympathetic to the Veteran in that it is clear he sincerely believes his current psychiatric disability is directly related to service. However, the most probative evidence of record does not support that contention. As the preponderance of the evidence is against the claim of entitlement to service connection for a psychiatric disability, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Layton, Counsel