Citation Nr: 18158313 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 07-07 267 DATE: December 14, 2018 ORDER Entitlement to service connection for post-traumatic stress disorder (PTSD) is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has a current diagnosis of PTSD. CONCLUSION OF LAW The criteria for entitlement to service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from October 1954 to August 1958 and from August 1960 to December 1973. He was stationed in Vietnam from February 1968 to December 1968, and from August 1969 to August 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2005 decision by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2012, the Board remanded the matter to the RO for further development. The Veteran’s claim was again remanded by the Board in an August 2017 decision to obtain an addendum opinion that addressed PTSD under Diagnostic and Statistical Manual of Mental Disorders-4 (DSM) rather than DSM-5. The Board finds that the RO has substantially complied with the August 2017 Board remand directive. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for PTSD The Veteran contends that he suffers from PTSD based upon experiences while stationed in Vietnam. The Veteran has indicated several times that while operating long supply routes in Vietnam, he was under constant danger of attack and he witnessed deceased bodies along the roads. See Statement in Support of Claim for PTSD dated July 2012. Generally, service connection may be established if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active duty service. 38 C.F.R. § 3.303. To that end, service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to the period of service, establishes the disease was incurred during active duty service. 38 C.F.R § 3.303 (d). In order to prove service connection, there must be competent and credible evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the current disability and the in- service disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as sensorineural hearing loss or psychoses, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). The use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The question for the Board is whether the Veteran has a current disability 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 the Veteran does not have a current diagnosis of PTSD, but rather an already service-connected diagnosis of major depressive disorder. 38 U.S.C. §§ 1110, 1131, 5107 (b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303 (a), (d). The Veteran was afforded a VA examination for a Mental Disorder in September 2010. The examiner determined that the Veteran’s symptoms are well below the threshold for PTSD. The Mississippi Scale for Combat-Related PTSD was administered and the Veteran scored a 94, far below the cutoff of 107 and below the average score of 130 of other Veterans in the same region. The examiner also considered a previous diagnosis of PTSD rendered by Dr. L.O. in 2009. However, the examiner observed that multiple providers had agreed in previous years that the Veteran did not meet the PTSD criteria, but did meet the criteria for major depressive disorder. The Veteran was afforded a VA examination for PTSD in March 2016 where the examining psychologist opined that the Veteran does not meet the diagnostic criteria for PTSD under DSM-5. The psychologist acknowledged that the Veteran experienced a traumatic event in Vietnam, had negative alterations in cognition and mood associated with the traumatic event, and had sleep disturbance associated with the traumatic event. Additionally, the psychologist determined that the Veteran had active symptoms of depressed mood, disturbances of motivation and mood, and inability to establish and maintain effective relationships. However, the psychologist opined that the Veteran continued to meet the diagnostic criteria for depression, not PTSD. The examining psychologist opined that although the Veteran maintained that observing dead bodies in Vietnam ruined his life, he does not meet the criteria for PTSD because he denied most symptoms attributed to PTSD. In November 2017, a VA examination was conducted where a VA examiner again opined that the Veteran does not meet the PTSD criteria under DSM-4 or DSM-5. The examining psychologist stated that under both DSM-4 and DSM-5, the Veteran must meet at least two arousal symptoms, which include irritability and anger, trouble with concentration, hypervigilance, startle response, and sleep disturbance. However, the examiner noted that the Veteran has consistently reported problems with sleep, but has denied all other arousal symptoms. The rationale provided for the examiner’s opinion was that many Veterans who served in Vietnam still struggle with symptoms of PTSD such as nightmares and intrusive thoughts, but they do not meet the full diagnostic criteria. Further, some providers may give a diagnosis of PTSD in these instances even though the Veterans do not meet the full criteria. However, the examiner found the Veteran’s situation to be slightly different. The examiner believed that the loss of the Veteran’s family members appeared to be the etiology of the Veteran’s symptoms and not necessarily the trauma the Veteran experienced in in Vietnam. The examiner supported this opinion by highlighting that the Veteran did well in the structure of military as long as his was still married with a family. After losing his family, the Veteran’s service was followed by AWOLs and court martials. The examiner added that the Veteran’s tendency to live in the past as he ages suggests a continued diagnosis of persistent depressive disorder rather than PTSD. The Board acknowledges that the Veteran’s VA treatment records indicate diagnoses of PTSD and continued treatment for PTSD. VA treatment records show that the Veteran first screened positive for PTSD in April 2005 with reported symptoms including recurrent intrusive thoughts and feelings of guilt, but a treating psychiatrist ruled out a diagnosis of PTSD. In May 2005, PTSD symptoms of nightmares and sleep disturbance were added, but the Veteran denied all other PTSD symptoms. In January 2007, Dr. L.O. diagnosed the Veteran with PTSD, chronic based on reported symptoms of nightmares, intrusive thoughts of Vietnam, feeling numb and unclean. Dr. L.O. did not evaluate the Veteran using the full diagnostic criteria when rendering his opinion. Treatment records show that the Veteran continued medication management for both PTSD and depression through 2009. The Board finds the opinions provided by the VA examiners in September 2010, March 2016, and November 2017 to be highly probative. The examiner’s opinions are highly probative because they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Both the March 2016 and November 2017 examiner concluded that the Veteran’s sole arousal symptom associated with PTSD is sleep disturbance. The Veteran denied all other symptoms. Additionally, this conclusion is supported by the Veteran’s VA treatment records which show that the Veteran only reported sleep disturbance beginning in 2005 and denied all other arousal symptoms associated with PTSD. The Board has considered the PTSD diagnosis provided by Dr. L.O. in January 2007, but gives little weight to the diagnosis because it was not based on the full diagnostic criteria required in DSM-4 or DSM-5. Further, all the other medical providers, with the exception of Dr. L.O., ruled out a diagnosis of PTSD and determined that the Veteran’s mental health symptoms are related to the Veteran’s service-connected depression. The evidence ruling out a diagnosis of PTSD and supporting a continued diagnosis of major depressive disorder is overwhelming. Accordingly, service connection for PTSD is not warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. While the Veteran contends that he has symptoms related to PTSD such as nightmares, recurrent thoughts, and difficulties sleeping and forming relationships, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical knowledge and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. In reaching the above decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. Gilbert, 1 Vet. App. at 54; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Hartford, Associate Counsel