Citation Nr: 18151984 Decision Date: 11/21/18 Archive Date: 11/20/18 DOCKET NO. 14-08 381 DATE: November 21, 2018 ORDER Entitlement to service connection for a psychiatric disability, to include posttraumatic stress disorder (PTSD) and major depressive disorder, is denied. Entitlement to service connection for a left collar bone disability is granted. Entitlement to service connection for a left shoulder disability is granted. FINDINGS OF FACT 1. There is no evidence that the Veteran has been diagnosed with PTSD and his current diagnosis is not causally related to his active service. 2. The evidence of record demonstrates that the Veteran’s current left collar bone disability manifested during service, or is otherwise related to his service. 3. The evidence of record demonstrates that the Veteran’s current left shoulder disability manifested during service, or is otherwise related to his service. CONCLUSIONS OF LAW 1. The criteria for service connection for a psychiatric disability to include posttraumatic stress disorder and major depressive disorder have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309, 3.385 (2017). 2. The criteria for service connection for a left collar bone, nondisplaced fracture deformity at the distal left clavicle, have been met. 38 U.S.C. §§1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a left shoulder degenerative changes have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1968 to August 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an June 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, AL. A hearing was scheduled for October 2014; however, the Veteran failed to appear at the hearing. Therefore, the hearing request is considered withdrawn. In September 2015, the Board remanded the Veteran’s appeal with instructions to obtain information from the Veteran regarding relevant records, to include service treatment records for a claimed motor vehicle accident in Germany, to verify the claimed PTSD stressors and to conduct VA examinations. The Veteran did not furnish the relevant information needed to conduct a records search, despite repeated attempts to contact the Veteran. Thus, a Joint Services Records Research Center (JSRRC) search for records to verify Veteran’s stressor was not accomplished. The VA examinations were conducted and are associated with the file. The Board is therefore satisfied that there has been satisfactory compliance with the instructions in its remand of September 2015. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Under the relevant laws and regulations, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). In general, service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Board must weigh any competent lay evidence and make a credibility determination as to whether it supports a finding of service incurrence; or, if applicable, continuity of symptomatology; or both, sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Layno v. Brown, 6 Vet. App. 465 (1994). The credibility of lay evidence may not be refuted solely by the absence of corroborating contemporaneous medical evidence, but it is a factor. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Other credibility factors are the lapse of time in recollecting events attested to, prior conflicting statements as opposed to consistency with other statements and evidence, internal consistency, facial plausibility, bias, interest, the length of time between alleged incurrence of disability and the earliest or first corroborating medical or lay evidence thereof, and statements given during treatment (which are usually given greater probative weight, particularly if close in time to the onset thereof). 1. Service connection for a psychiatric disability to include posttraumatic stress disorder and major depressive disorder The Veteran contends that he has PTSD from stressors related to military service. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), a link, established by the medical evidence, between current symptoms and a stressor in service; and credible supporting evidence that the claimed stressor in service occurred. 38 C.F.R. § 3.304(f). Unless PTSD is diagnosed in service and the in-service stressor is related to that service, combat or to fear of hostile military or terrorist activity or to a prisoner-of-war experience or to a personal assault, the Veteran’s lay testimony alone may not establish the occurrence of an alleged noncombat in-service stressor actually occurred. 38 C.F.R. § 3.304(f). A Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor if: (1) the claimed stressor is related to his fear of hostile military or terrorist activity; (2) the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service; and (3) a VA psychiatrist or psychologist, or contract equivalent, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and the Veteran’s symptoms are related to the claimed stressor. 38 C.F.R. § 3.304(f)(3). For purposes of this paragraph, “fear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. PTSD The Board finds that the Veteran does not have a diagnosis of PTSD under the applicable criteria. At no time during the appeal period has a diagnosis of PTSD been demonstrated. The Veteran was afforded a PTSD VA examination in April 2016 and was screened negative for PTSD. The examiner noted the Veteran’s claimed stressor which occurred while he was stationed in Germany. The Veteran claims that he witnessed the death of another service member in May 1969. See September 2010 Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder. The Veteran also claimed abuse from drill sergeants and being in a house fire as stressors triggering his claimed PTSD. VA attempted to and was unable to verify with JSRRC the reported circumstances surrounding the fatality of the service member identified by the Veteran. Additionally, in a medical opinion, the examiner noted that the Veteran did not mention the stressor once during his examination, despite numerous opportunities to discuss it. The examiner found this inconsistent with a diagnosis of PTSD, as such a stressor would have had an impact on the Veteran’s psyche. See April 2016 Medical Opinion. The examiner considered the Veteran’s entire file, lay statements and claimed stressors and found that even if the claimed stressors could be substantiated, this would not be sufficient to conclude with a diagnosis of PTSD. Instead, a VA examiner found that his condition was best diagnosed as adjustment disorder. See April 2016 VA Examination Report. To the extent the Veteran asserts that he has a current diagnosis of PTSD, the Board notes that he has not demonstrated the medical acknowledge or training necessary to diagnose himself with PTSD. Service connection for PTSD requires medical evidence diagnosing the condition. See 38 C.F.R. § 3.304(f). Consequently, the Veteran’s assertion that he has PTSD is not competent evidence of a PTSD diagnosis. See Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014). The Board finds the April 2016 VA examination to be highly probative as to the question of whether the Veteran has a diagnosis of PTSD. Thus, as no diagnosis of PTSD has been demonstrated at any time during the appeal period, the Board finds that the preponderance is against the Veteran’s claim for service connection for PTSD. 38 C.F.R. §§ 3.304(f), 4.125(a); Cohen v. Brown, 10 Vet. App. 128, 139 (1997). As such, service connection for PTSD is not warranted. Other Acquired Psychiatric Disorder The Veteran has been diagnosed with adjustment disorder. See April 2016 VA Examination Report. Thus, the first element of service connection for an acquired psychiatric disorder has been met. Concerning the second element, the evidence of record does not support in-service injury or disease. The Veteran’s service treatment records are silent as to any psychiatric treatment. The Veteran’s diagnosed mental disorder was not manifested until well after military service and appears to be related to other events in the Veteran’s life, such as the death of a sibling, and being trapped in a house fire in Chicago. The earliest evidence of any mental disorder was when Veteran was documented to have psychological decompensation following his brother’s death in 2002 with a diagnosis of dysthymia. He had follow up visits in 2005 where he was diagnosed with depression. As such, an in-service injury or disease reasonably associated with the claimed disability is not established. Likewise, no competent evidence links any current psychiatric disorder to service. The Board has carefully considered the statements and contentions of the Veteran, but finds that the weight of the medical evidence is contrary to those contentions. Although the Veteran is capable of describing the history in this case as well as any symptoms, his statements cannot serve to address the question of causation because those are medical questions beyond the purview of lay knowledge. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds that the evidence of record is not sufficient to demonstrate a relationship between the Veteran’s service and his current psychiatric condition. Accordingly, service connection for the Veteran’s psychiatric condition is not warranted. In reaching this decision, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. 38 U.S.C. § 5107 (b). 2. Service connection for a left collar bone disability and left shoulder disability The Veteran contends that his current left collar bone and left shoulder disability are related to an injury incurred during service. He reported that while in service in Germany, he was a passenger in a vehicle, which turned over and he was pinned down inside, causing injury to his left collar bone and shoulder. See October 2010 Statement in Support of Claim. The question for the Board is whether the evidence of record demonstrates that it is at least as likely as not that Veteran’s current conditions are etiologically related to an in-service injury. The Veteran was afforded a VA examination in April 2016. The examiner found that the Veteran had a possible old distal left clavicle injury and mild degenerative findings in the left shoulder, including evidence for chronic rotator cuff disease. X-rays also support a history of injury to the left clavicle. The examiner diagnosed the Veteran with degenerative arthritis in the left shoulder. Thus, the first element of service connection is satisfied. The next element to establish is an in-service injury. The service treatment records do not reflect any left shoulder area complaints or injury. However, there is evidence the service treatment records may be incomplete, and for his part, the Veteran has provided statements regarding an in-service injury vehicle accident which contention has remained consistent throughout the claim. In these circumstances, and resolving reasonable doubt in the Veteran’s favor, it may be concluded an in-service injury occurred. In regard to a nexus between the shoulder and collar bone conditions and in-service injury, at the April 2016 VA examination, the VA examiner found that the Veteran’s shoulder and collar bone conditions (described as old nondisplaced fracture deformity at the distal left clavicle, and degenerative changes) are as least as likely as not incurred in or caused by the claimed in service injury. Accordingly, resolving any reasonable doubt in the Veteran’s favor, it may be concluded the Veteran’s left shoulder and collar bone disability were incurred in service and thus, service connection may be granted. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Jaigirdar, Associate Counsel