Citation Nr: 18155780 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 15-05 555 DATE: December 6, 2018 ORDER Entitlement to service connection for an acquired psychiatric disability, to include post-traumatic stress disorder, is denied. FINDING OF FACT The preponderance of the evidence indicates that the Veteran does not have an acquired psychiatric disability that was either incurred in or caused by his active duty service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder have not been satisfied. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A, 5107 (2017); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service with the U.S. Army from December 1989 to November 1992. During this time, he was awarded the Southwest Asia Service Medal, the Kuwait Liberation Medal, and the National Defense Service Medal, among other medals. This matter comes to the Board of Veterans’ Affairs (Board) on appeal from a March 2013 rating decision issued by the Department of Veterans Affairs (VA) regional office (RO) in Winston-Salem, North Carolina. The Board notes that the record reflects various psychiatric diagnostic impressions, including alcohol dependence, adjustment disorder with anxiety and depressed mood, cannabis disorder, persistent depressive disorder, and alcohol use disorder. See, e.g., November 2012 VA Initial Post Traumatic Stress Disorder Disability Benefits Questionnaire (DBQ) (diagnosing the Veteran with alcohol dependence and adjustment disorder with anxiety and depressed mood); November 2015 Greenville VA Clinic Mental Health Outpatient Note (diagnosing the Veteran with moderate alcohol disorder and cannabis disorder); April 2018 Greenville VA Clinic Psychiatry Attending Note (diagnosing the Veteran with persistent depressive disorder and alcohol use disorder). Because the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim and reported symptoms and all other information of record, the Board finds that it is more appropriate to characterize his mental health claims broadly, as a single claim of entitlement to service connection for an acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §1131; 38 C.F.R. § 3.303(a). In addition, disorders diagnosed after discharge may also still be service-connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service. 38 C.F.R. § 3.303(d). Generally, 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 - the “nexus” requirement. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). There is no categorical rule that medical evidence is required when the determinative issue is either medical etiology or a medical nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Therefore, the Board will assess the competence and credibility of lay statements as well. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). In adjudicating claims for VA benefits, the burden of proof only requires an approximate balance of the evidence for and against a claim. 38 U.S.C. 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1991). This low standard of proof is unique to the VA adjudicatory process, and the nation, in recognition of our debt to our veterans, has taken upon itself the risk of error in awarding such benefits. Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (citing Gilbert, 1 Vet. App. at 54). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. See id.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In this vein, the Board must determine, as a question of fact, both the weight and credibility of the evidence. Equal weight is not accorded to each piece of evidence contained in a record; every item does not have the same probative value. The Board must account for the evidence which it finds to be persuasive or unpersuasive, analyze the credibility and probative value of all material evidence submitted by and on behalf of a claimant, and provide the reasons for its rejection of any such evidence. See, e.g., Struck v. Brown, 9 Vet. App. 145, 152 (1996); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994); Abernathy v. Principi, 3 Vet. App. 461, 465 (1992); Simon v. Derwinski, 2 Vet. App. 621, 622 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164, 169 (1991). Entitlement to service connection for an acquired psychiatric disability The Veteran maintains that he has a current psychiatric disability that is attributable to stressors incurred during his active duty service. First, as concerning the requisite current diagnosis, the medical evidence of record reflects various psychiatric diagnoses, including alcohol dependence, adjustment disorder, alcohol disorder, cannabis disorder, and persistent depressive disorder. See, e.g., November 2012 VA Initial Post Traumatic Stress Disorder Disability Benefits Questionnaire (DBQ) (diagnosing the Veteran with alcohol dependence and adjustment disorder with anxiety and depressed mood); November 2015 Greenville VA Clinic Mental Health Outpatient Note (diagnosing the Veteran with moderate alcohol disorder and cannabis disorder); April 2018 Greenville VA Clinic Psychiatry Attending Note (diagnosing the Veteran with persistent depressive disorder and alcohol use disorder). Accordingly, the medical evidence establishes that the Veteran has a current acquired psychiatric disability. See Holton, 557 F.3d at 1366. Second, as concerning an in-service incurrence, the Board notes that the Veteran’s service treatment records, including his enlistment examination, are silent for complaints of or treatment for psychiatric symptomatology. Further, a mental health status examination administered in November 1992 reflects that the Veteran was observed to have a normal mental status at that time. See November 1992 Report of Mental Status Evaluation (DA Form 3822-R) (observing the Veteran as demonstrating normal behavior, a full level of alertness, unremarkable mood or affect, clear thinking process, normal thought content, and good memory, and determining that the Veteran did not have any psychiatric diseases or defects that would warrant medical attention). However, the Veteran has submitted statements during the pendency of the claim that he experienced psychologically stressful events during his active duty service in Iraq. See, e.g., June 2012 Statement in Support of Claim for Service Connection for PTSD (VA Form 21-0781) (reflecting that while in Iraq, the Veteran was on guard duty when a nuclear alarm went off and he began panicking and fearing that he would die); October 2012 Statement in Support of Claim (VA Form 21-4138) (indicating that the Veteran was surrounded by gunfire to the point that he did not know from which direction it was coming, and that as a result he was extremely fearful); November 2012 Statement in Support of Claim (VA Form 21-4138) (reiterating the Veteran’s fear when the nuclear alarm went off; recalling the smell of dead bodies; witnessing body parts that were burnt or covered in blood; and having an unexploded grenade with the pin removed land at his feet). In this regard, he is competent under the law to describe what he experienced while in military service. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (holding that a Veteran is competent to report what occurred during service because he is competent to testify as to factual matters of which he has first-hand knowledge); Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007) (holding that lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran’s DD Form 214 confirms that he served during the Persian Gulf War, for which service he was awarded the Southwest Asia Service Medal and the Kuwait Liberation Medal. Also, his DD Form 214 reflects that his principal duty was as a Man-Portable-Air-Defense-Systems (MANPADS) crewmember (Military Occupational Specialty (MOS) 16S1O) with the 1st Battalion 3rd Air Defense Artillery Regiment, further supporting his assertions. Thus, in the absence of evidence establishing the Veteran’s account as not credible, reasonable doubt will be resolved in his favor, and the occurrence of the claimed stressful events during his service is established, as it is consistent with the circumstances of his service. See 38 C.F.R. § 3.102. See also 38 U.S.C. § 1154(a) (Due consideration shall be given to the places, types, and circumstances of a Veteran’s service). Accordingly, an in-service injury or incurrence is established. See Holton, 557 F.3d at 1366. However, as to the third element, that of a nexus between the Veteran’s current acquired psychiatric disorder and the in-service stressor, the record does not contain medical evidence supporting a link between the Veteran’s acquired psychiatric disability and stressors related to his active service in Iraq. A VA examiner previously opined in November 2012 that the Veteran did not have PTSD, but instead diagnosed the Veteran as having alcohol dependence and adjustment disorder with anxiety and depressed mood. See November 2012 VA Initial Post-Traumatic Stress Disorder DBQ. He further opined that neither of these disabilities were related to his active service, including his reported stressors. Id. The examiner specified that it was possible to separate the Veteran’s symptoms, attributing his excessive use of alcohol and loss of relationships to the alcohol dependence diagnosis, and his depressed mood and anxiety to his adjustment disorder. Id. In arriving at this conclusion, the examiner explained that the Veteran’s occupational and social impairment was due to his use of alcohol as a way of coping, and further determined that the Veteran’s adjustment disorder was a result of his loss of employment and subsequent inability to find work. Id. While the examiner acknowledged that the Veteran had reported combat stressors, he noted that “[The Veteran] is reporting symptoms related to his military experience but these problems appear somewhat overstated or difficult to discern until his alcohol problems are resolved.” Id. The examiner further observed that the Veteran did not persistently re-experience the reported traumatic events, that he manifested avoidance of stimuli only through markedly diminished interest or participation in significant activities, and that he reported having 3 panic attacks in the past fifteen years. Id. With respect to the Veteran’s assertions that he currently has PTSD, although lay persons are competent to provide opinions on some medical issues, determining a diagnosis of a “mental illness” falls outside the realm of common knowledge of a lay person. In this regard, while the Veteran can competently report psychiatric symptoms, any opinion regarding the diagnosis of a particular psychiatric disability requires medical expertise that the Veteran has not demonstrated. See Jandreau, 492 F. 3d at 1376. The most probative evidence of record are the findings of the VA examiner that the Veteran does not currently have PTSD, but instead has other psychiatric disabilities that are unrelated to his active service. The weight of the evidence does not show that the Veteran has an acquired psychiatric disability, including PTSD, that was either incurred in or caused by his active service. Thus, the preponderance of the evidence is against the Veteran’s claim for entitlement to service connection for an acquired psychiatric disability, and the benefit-of-the-doubt doctrine is inapplicable. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Raj, Associate Counsel