Citation Nr: 18156465 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 11-33 931 DATE: December 10, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and factitious disorder, due to a disease or injury in service, to include specific in-service event, injury, or disease. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1982 to January 1985. Entitlement to service connection for an acquired psychiatric disorder The Veteran contends that he has a psychiatric condition that was caused by his military service. The question for the Board is whether the Veteran has a current disorder that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of factitious disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of factitious disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). For certain chronic disorders, to include psychosis, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In order to establish service connection for PTSD, the evidence of record must include a medical diagnosis of 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. 38 C.F.R. § 3.304(f). Turning to the evidence, July 2009 and August 2009 VA treatment records show that the Veteran had the diagnoses of PTSD and major depressive disorder. In June 2009, the Veteran filed a claim of service connection PTSD. He submitted a stressor statement in November 2010, that while stationed in Germany he was chased by wild boar and that he feared for his life. In October 2011, the Veteran also included a witness statement from a fellow service member who stated he witnessed the wild boars chasing the Veteran. An additional VA treatment note from July 2013 documents that the Veteran was involuntarily admitted for depression and for being a high suicide risk. However, after being discharged from the hospital, the Veteran reported during a follow up appointment with his VA treating mental health professional, that he was misunderstood by the admitting provider who evaluated him in that he was never a danger to himself. The Veteran further stated that while he did experience suicidal thoughts, he would never act on them. The veteran’s spouse verified the Veteran’s assertion. In August 2013, the Veteran was diagnosed with major depression, recurrent; anxiety disorder and rule out PTSD. In March 2016 the Veteran testified at a Board hearing. At the hearing the Veteran testified that he witnessed a fellow service member get electrocuted in front of him while trying to remove a pair of boots from some power lines near their military dorms with a metal pole. The Veteran also testified about when his wife attempted suicide by cutting her own throat with a knife and about a time when his uncle died in his arms, as additional non-service related stressors. Pursuant to a Board remand, the Veteran was given a VA examination in December 2016. During the examination, the examiner opined that the Veteran did not have a PTSD diagnosis that conformed to the DSM-5 criteria. The examiner did diagnose the Veteran with major depressive disorder, recurrent. The examiner reported that the Veteran was initially distressed about the interview, but was able to describe events in great detail, crying often. The Veteran primarily told the examiner how he felt his career and life had been unfair. The examiner reported that while describing his wife’s suicide attempt, the Veteran became increasingly angry and loud when talking about being “mad” at the military. In February 2017, the addendum VA medical opinion was submitted. In the addendum opinion, the examiner provided an updated diagnosis of personality disorder, mixed traits of borderline and histrionic. The examiner based this updated opinion on VA mental health outpatient notes from December 2016, where the Veteran’s treating mental health provider discussed this diagnosis with the Veteran. In, April 2017 the Veteran was given a neuropsychological evaluation. During the evaluation, the Veteran was given a battery of tests to provide a diagnostic clarification and to rule-out a noncredible presentation. The first observation reported by the evaluator was that the Veteran’s spouse accompanied him to the evaluation, but chose to wait in the waiting room during the evaluation, which is the evaluator found unusual in the setting of significant cognitive complaints. The evaluator also found the Veteran to be a poor historian, in that he had trouble recalling his wife’s name, how many children they had, or how to write his own name. However, the Veteran was able to provide details about his service-connection claim for PTSD. The Veteran’s test outcomes were found to be invalid. The results fell into the range meaning that the individual has exaggerated or fabricated symptoms. The neuropsychological evaluator opined, “An invalid or non-credible profile can be produced for a variety of reasons. In the context of a pending disability claim, secondary gain must be considered.” In April 2017 the Veteran was given a VA examination for an acquired psychiatric disorder other than PTSD, after which the examiner diagnosed factitious disorder. The examiner based this diagnosis on a battery of tests the Veteran took during a neuropsychological evaluation earlier that month to provide a diagnostic clarification and to rule-out a noncredible presentation. The VA examiner referenced the neuropsychological evaluation in the opinion stating: This was consistent with his presentation for my exam -he presented primarily as a personality disorder with no underlying psychiatric diagnosis. The neuropsychological testing further confirmed these results. In my opinion, there is no primary psychiatric diagnosis other than personality disorder and/or factitious disorder and review of the records indicates that these were the most like diagnoses at the time of active duty and discharge. There is no indication from the records that Veteran’s time in service caused psychiatric distress. In March 2018 VA received casualty records confirming an electrocution death of a person at Ft. Hood in April 1983. The person electrocuted was an electric power crew worker attempting to repair a burned out electrical disconnect on a utility pole. He was leaning up against his utility truck when a gust of wind blew the power lines into the truck he was leaning on causing fatal injuries. Pursuant to the Board’s March 2018 remand, the Veteran was given a VA examination in April 2018 to address the conflicting medical opinions and diagnoses of PTSD, major depressive disorder and personality disorder or any other psychiatric disorder and whether any of these disorders were related to the Veteran’s service. The examiner opined that the Veteran had factitious disorder which is not a mental disorder diagnosis. In the opinion, the examiner reviewed the Veteran’s history over the years of receiving the diagnoses of PTSD, major depressive disorder and personality disorder. The examiner stated these diagnoses were based on the Veteran’s self-reports, but that the examiner was unable to find objective evidence to support those diagnosis and that the other providers that initially gave a diagnosis of PTSD subsequently amended their diagnosis. The examiner also discussed the PTSD diagnosis and stressors, stating “It is the opinion of this examiner that while the Veteran does report experiencing stressors during his military service, at present, the symptoms listed above are not sufficient to support the clinical diagnosis of PTSD, according to DSM-5 Diagnostic Criteria.” To support the opinion, the examiner’s rationale was: Currently there is no objective evidence to substantiate the clinical diagnosis of PTSD, Depression or any other mental health diagnosis, according to DSM-5 Diagnostic Criteria. Current, objective Neuropsychological Testing completed by Dr. K.M., Ph.D. on 4/7/2017 does not support the diagnoses of PTSD or a mood disorder. -Moreover, [the Veteran’s] results from todays examination (PCL, PTSD checklist and PHQ-9) were invalid and suggestive of over-endorsement or exaggeration making it difficult to interpret any current level of impairment without resorting to speculation. The VA examiner further opined, “Based on this evaluation, it is the opinion of this examiner that the Veteran meets DSM-5 Diagnostic Criteria for Factitious Disorder that it is less likely than not (less than a 50 percent probability) caused by or a result of his military service.” The examiner’s rationale was This diagnosis was first applied 4/24/2017, 20 + years after his military service concluded. Dr K.M., Ph.D. states, “In the context of a pending disability claim, secondary gain must be considered. This does not mean [the Veteran] is free from cognitive or emotional symptoms. However, the manner in which he has approached the evaluation prevents me from being able to characterize any true deficits and symptoms.” IMPRESSIONS: Invalid Test Results, Factitious Disorder. The Board finds that entitlement to service connection for an acquired psychiatric disorder is not warranted. During the period on appeal the Veteran has been variously diagnosed with PTSD, major depressive disorder, anxiety disorder, personality disorder and factitious disorder. The Veteran has reported being chased by wild boar and witnessing a fellow service-member die from electrocution as stressors precipitating his psychiatric complaints. However, although VA records research revealed that a person did die from an electrocution at Fort Hood in April 1983, the details provided by the Veteran are very different than those provided to VA in the official report. The Board also notes, that the Veteran’s original stressor provided at the outset of his PTSD claim was not raised by the Veteran as a stressor during his hearing. The Board also finds the neuropsychological evaluation probative in its findings that the Veteran’s is likely exaggerating or fabricating his symptoms. This was consistent with the April 2017 and April 2018 VA examinations which the Board finds competent, credible and probative in the diagnosis of factitious disorder. Particularly with the evidence that during the neuropsychological evaluation, the Veteran was unable to recall the name of his wife, who had just dropped him off and was waiting for him in the waiting area, how many children they had or how to write his name. Yet, the Veteran was able to recall the details of his PTSD claim. The Board agrees with the April 2016 neuropsychological evaluator and the April 2018 examiner that this type of cognitive response is inconsistent. Therefore, the remaining issue for the Board is whether it is likely that the Veteran’s diagnosed factitious disorder was caused or is related to service. On this issue, the Board finds the April 2018 VA medical opinion probative in that it is less likely than not that the Veteran’s factitious disorder was caused by or a result of his military service. Therefore, service connection for an acquired psychiatric disorder, to include PTSD and factitious disorder, is not warranted. The Board acknowledges the Veteran’s lay statements regarding his in-service stressors and how his life has been affected by this condition. However, in light of the current factitious disorder diagnosis, and the results of the validation testing during his neuropsychological evaluation indicating that the Veteran is exaggerating or fabricating his symptoms, the Board finds that the Veteran’s reports and statements are not credible. (Continued on the next page)   In sum, the Board finds that the preponderance of the evidence demonstrates that the Veteran is not entitled to service connection for an acquired psychiatric disorder, to include PTSD and factitious disorder. 38 U.S.C § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Thus, the benefit of the doubt doctrine is not for application. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Perkins, Michael