Citation Nr: 19126972 Decision Date: 04/09/19 Archive Date: 04/08/19 DOCKET NO. 13-15 408 DATE: April 9, 2019 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include depression, a cognitive disorder, and posttraumatic stress disorder (PTSD) based on combat exposure and / or alleged military sexual trauma (MST) is denied. FINDINGS OF FACT 1. The weight of the evidence is against a finding that any current acquired psychiatric disorder manifested during, or as a result of, the Veteran’s active duty service. 2. The preponderance of the evidence is against finding that the Veteran’s hypertension is due to a disease or injury in service, to include a specific in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, depression, and a cognitive disorder, claimed as due to MST, have not been met. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. 2. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the United States Army from December 1952 to November 1954 and from August 1955 to January 1956. He served on the Korean peninsula during the Korean War. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from October 2011 and July 2012 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico. In January 2016, the Board remanded the appeal for the RO to schedule the Veteran for a Travel Board hearing. In a November 2016 statement, the Veteran withdrew his pending Travel Board hearing request. Therefore, the Travel Board hearing request is considered withdrawn. See 38 C.F.R. § 20.704(e). In February 2018, the Board, inter alia, remanded the claims remaining on appeal for further development. Service Connection In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Entitlement to service connection for an acquired psychiatric disorder, to include depression, a cognitive disorder, and posttraumatic stress disorder (PTSD) based on combat exposure and / or alleged military sexual trauma (MST) is denied. The regulations contain additional provisions addressing PTSD: “Service connection for posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance with § 4.125(a) of this chapter; 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). Section 4.125(a) provides that, for VA compensation purposes, the diagnosis of a mental disorder must conform to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.), i.e. DSM-IV. 38 C.F.R. § 4.125 (a). For claims received by, or pending before the AOJ, on or after August 4, 2014, the provisions of 38 C.F.R. § 4.125 have been amended to require that a PTSD diagnosis conform to the Fifth Edition (DSM-5). See 38 C.F.R. §§ 4.125, 4.130; 79 Fed. Reg. 45093 (Aug. 4, 2014). The Board has reviewed all of the evidence in the Veteran’s claims file. Although there is an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his or her behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran asserts that he was sexually assaulted in service. See May 2017 e-mail correspondence. The Veteran also asserts that his PTSD is related to his combat tour in Korea. See April 2011 statement in support of claim. The Board accepts as credible the lay evidence relating to the in-service sexual assaults. However, in order for service connection to be warranted, a current psychiatric disorder must be found to relate back to such incident(s), or other incidents of service. The Veteran’s service treatment records (STRs) are silent for any complaint, treatment, or diagnoses of psychiatric disabilities or reflect any complaint of assault or sexual assault. The Veteran was afforded a VA examination in July 2012. While the examiner did not diagnose the Veteran with PTSD, the examiner diagnosed a depressive disorder. The examiner opined that the Veteran’s psychiatric disability was less likely than not incurred in or caused by the Veteran’s claimed in-service injury, event, or illness. The examiner expressed that the Veteran does not currently meet the full criteria for PTSD. With regard to a depressive disorder, the examiner reasoned that there was no evidence of psychiatric complaints, findings, or treatment during or within one year of leaving military service. The examiner also noted that the Veteran was diagnosed with an adjustment disorder in 2010 and that his stressor was identified as coping with back pain and leg cramps. The examiner noted that no follow up psychiatric intervention was reported or documented and there is also no significant social or occupational impairment reported or documented. The Veteran was again afforded a VA examination in May 2018. The examiner noted that the Veteran did not meet the DSM-V criteria for PTSD. The examiner instead diagnosed the Veteran with a mild neurocognitive disorder. The examiner documented the Veteran’s report of the stressor that he was attacked but that he does not recall the date or place the attack took place. The examiner concluded that the Veteran did not exhibit any behavioral changes during or after service that are reflective of a military sexual trauma (MST). The examiner reasoned that the Veteran was discharged from active service in 1954 and re-entered service in 1955, from which he was discharged in 1956, and married three months after his separation from military service. The examiner also reasoned that the Veteran had three children and worked until he suffered a back injury. The examiner also reasoned that based on medical literature, the Veteran never exhibited any of the markers of a sexual trauma. The examiner also concluded that the Veteran did not meet the DSM-I through DSM-V criteria for PTSD based on the alleged in-service MST. The examiner also opined that it was less likely than not that the Veteran’s mild neurocognitive disorder is due to or related to his military service. The examiner reasoned that there was no treatment, complaints, or diagnoses of any psychiatric disorder during service and that there is no relation between the Veteran’s military service and the psychiatric condition diagnosed in 2010. After having carefully reviewed the evidence of record, the Board finds that the preponderance of the evidence is against a finding that an acquired psychiatric disorder, to include PTSD, depression, and a cognitive disorder, had its onset in service. Initially, the Board notes that the record includes no competent medical opinion establishing a nexus or medical relationship between a current acquired psychiatric disability and events during the Veteran’s active service, and the Veteran has not presented, identified, or alluded to the existence of, any such opinion. In addition, the Board finds the July 2012 and May 2018 VA medical opinions to be of high probative value. Both examiners gave definitive conclusions and supported the given opinion by a rationale that considers the evidence of record as well as a personal evaluation of the Veteran. The Board finds these medical opinions have adequate reasons and bases to explain the conclusions reached. The Board has considered the lay statements that the Veteran has presented in this claim. Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, an etiology of an acquired psychiatric disorder, to include PTSD, depression, and a cognitive disorder, falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). To the extent that the Veteran believes that he has an acquired psychiatric disability, to include PTSD, depression, and a cognitive disorder that is due to his period of service, as a lay person, he is not competent to give such diagnosis. Therefore, the Board concludes that the medical evidence is of greater probative value than the lay contentions of the Veteran. In summary, the Board finds that the preponderance of the evidence weighs against finding in favor of service connection for an acquired psychiatric disorder, to include PTSD, depression, and a cognitive disorder. Because the evidence fails to establish that any current psychiatric disability was incurred in or caused by military service, the Veteran’s claim does not satisfy the criteria for service connection. Therefore, the benefit-of-the-doubt rule does not apply and the service connection claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for hypertension is denied. At an April 2018 VA examination, the Veteran was diagnosed with hypertension. Therefore, he has established a current disability. However, the preponderance of the evidence is against the finding of an in-service event, injury, or diagnosis. The Veteran’s service treatment records (STRs) are silent with regard to a diagnosis or complaint of hypertension. However, the Veteran’s STRs do document an elevated blood pressure reading of 160/80. At separation, the Veteran was not diagnosed with hypertension and during the April 2018 VA examination, the Veteran reported that he was first diagnosed with hypertension in 1990. Moreover, the April 2018 VA examiner opined that the Veteran’s current hypertension is less likely than not related to his military service and reasoned that the Veteran did not develop a sustained elevation of blood pressure during service that is required to meet the definition for hypertension. The examiner noted that the Veteran’s elevated blood pressure of 160/80 occurred in a treatment record in which he was also diagnosed with “warts on penis.” The examiner reasoned that blood pressure can increase during moments of emotional stress but that this effect is transitory and that because it does not persist beyond the proximity of the stressful event, that it does not permanently elevate blood pressure, and thus does not cause hypertension. For the foregoing reasons, the evidence does not establish that the Veteran had hypertension during active service or to a compensable degree within one year of separation from active service, or that his hypertension is otherwise related to active service. Accordingly, hypertension was not incurred in or aggravated by service, nor may it be presumed to have so been incurred. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hammad Rasul, Associate Counsel