Citation Nr: A19001568 Decision Date: 09/25/19 Archive Date: 09/25/19 DOCKET NO. 190208-2714 DATE: September 25, 2019 ORDER Entitlement to service connection for an acquired psychiatric condition to include anxiety, depression, and posttraumatic stress disorder is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has an acquired psychiatric disability, to include anxiety, depression, and posttraumatic stress disorder, which manifested in service, within one year of separation from service, or that is otherwise etiologically related to service. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for an acquired psychiatric condition to include anxiety, depression, and posttraumatic stress disorder have not been met. 38 U.S.C. §§ 1131, 1154, 5107 (2014); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with VA’s decision on their claim to seek review. The Veteran chose to participate in VA’s test program RAMP, the Rapid Appeals Modernization Program. This decision has been written consistent with the new AMA framework. The Veteran had honorable active duty service with the United States Army from March 1969 to December 1970. The Veteran selected the Higher-Level Review lane when he submitted the RAMP election form in March 2018. Accordingly, the July 2018 RAMP rating decision considered the evidence of record as of the date VA received the RAMP election form. The Veteran timely appealed this RAMP rating decision to the Board and requested direct review of the evidence considered by the Board of Veterans Appeals. Service connection, generally Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. § 1110, 1131 (2014); 38 C.F.R. §§ 3.303 (a), 3.304 (2018). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical ‘nexus’ requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303 (a) (2018). Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a) and (b) (2018). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 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 (2014); 38 C.F.R. § 3.102 (2018); 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 the matter, the benefit of the doubt will be given to the Veteran. Id. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue. 1. Entitlement to service connection for an acquired psychiatric condition to include anxiety, depression, and posttraumatic stress disorder (PTSD) The Veteran contends that he is entitled to service connection for an acquired psychiatric disorder, to include anxiety, depression, and PTSD. However, as discussed more fully below, the evidence of record fails to show that his mental health condition was caused by or otherwise related to active service. Review of service treatment records revealed normal physical findings at enlistment in April 1968. The Veteran was deemed qualified for active service. In a report of medical history, bearing the same date, the Veteran denied any experience with excessive worry, nervous trouble, nightmares, or depression. No psychiatric diagnoses were referenced in a report of medical examination at separation in December 1970. In the comments section, the Veteran indicated that he was in good health with no changes in his medical condition. Review of military personnel records indicates that the Veteran’s official military occupation was listed as a clerk typist. However, the record also shows that he was awarded the National Defense Service Medal, Vietnam Combat Medal, Vietnam Service Medal, two Overseas Service Bars. Therefore, combat exposure is conceded. Post-service, the Veteran reported symptoms including anxiety, depression, hypervigilance, social avoidance and difficulty being alone. In May 2014, the Veteran underwent an initial mental health evaluation. During the clinical interview, he indicated that he was stationed in the Republic of Vietnam for 10 months. Post service, the Veteran described symptoms including sleep disturbance, nightmares, and re-experiencing the sound of gunfire. No specific trauma or recurrent memories were identified. He contends that his symptoms following separation with periodic worsening. A current diagnosis of anxiety not otherwise specified (NOS) with mild claustrophobia was indicated. A global assessment functioning (GAF) score of 70 was also assigned. In November 2014, a telephone encounter record listed complaints of anxiety with ruminating thoughts over the national news and hypervigilance. The Veteran denied any suicidal ideations. The prior diagnosis of generalized anxiety was confirmed. Prescribed medications included Celexa and Citalopram Hydrobromide. In a mental health note, dated April 2015, the Veteran was described as slightly anxious, with avoidance behavior and no evidence of suicidal ideations. According his wife, he suffers from fear of being alone, has difficulty showering when home alone, and frequently double checks the locks. In August 2016, a mental health record indicated that the Veteran complained of worsening anxiety. He acknowledged non-compliance with prescribed medication, Celexa. Other symptoms included excessive worry and claustrophobia. The Veteran was advised of the benefits of compliance with the prescribed medications. A mental health note, dated August 2017, indicated that the Veteran was diagnosed with depression. Current symptoms included anxiety in close situations, hypervigilance, and difficulty/fear of leaving the house. He denied suicidal or homicidal ideations. In March 2018, the Veteran reported current symptoms including worsening anxiety, depression, decreased activity, loss of interest, and a depressed mood. He also endorsed distress due to the recent loss of his sister-in-law. In a lay statement, dated September 2014, the Veteran reported two in-service stressors. While stationed in the Republic of Vietnam, he described hearing the sounds of gunfire and explosives on a nightly basis. According to the Veteran, a fellow soldier and pilot went missing while on flight patrol over Pleiku. At the time, the soldier was in pursuit of enemy soldiers (Vietcong). He contends that the pilot and soldier was never heard from again. In a second incident, the Veteran reported being lost with his platoon while on patrol. He stated that he and his fellow soldiers were terrified until their position was located and a rescue was executed. In February 2019, the Veteran’s wife submitted a lay statement. Therein, she reported personal knowledge of his symptoms including sleep disturbance, claustrophobia, and fear of being alone. During sleep, she reported being awakened by the Veteran punching her out due to subjective fear that she was attacking him. In February 2015, the Veteran was afforded a VA examination. During the clinical evaluation, the Veteran endorsed good relationships with his fellow soldiers while on active duty. In his role as a clerk typist, the Veteran stated that he was responsible for drafting correspondence to notify family members of the death of a soldier. He also reported participation in a training mission in which he and other soldiers from his unit were on patrol in the jungle when they became lost. The Veteran stated that he and the other soldiers were terrified. Prior to their rescue, they encountered armed soldiers from another company. No shots were fired. The Veteran also described witnessing a fellow soldier being struck by a mortar. Despite his contentions, service treatment records were silent for any complaints of psychiatric symptoms or related treatment during active service. Nevertheless, the Veteran contends that he suffered from symptoms of anxiety and fearfulness during active service. The Veteran’s background reflects two marriages. His first marriage resulted in one child, however, it ended in divorce. The Veteran has two children with his second wife. Although is parents are deceased, he endorsed contact with his siblings and other family. The Veteran denied having any close friendships but regularly attends church services. He also stated that he enjoys cooking. After separation, the Veteran obtained an undergraduate degree and worked as a teacher for 16 years. He also earned a master’s degree and worked as an assistant principal for 14 years. Toward the end of his career, the Veteran intervened in a fight between two girls and tore his rotator cuff. He underwent surgery and numerous hours of physical therapy to recovery from his injury. In 2009, the Veteran opted to retire due to concerns regarding the possibility of a subsequent injury while working in a similar capacity. In 2014, the Veteran took a six-month teaching position and performed well in that role. No other employment was acknowledged. No occupational difficulties were identified. Review of his post-service medical history shows that his initial mental health evaluation occurred in May 2014. During the clinical evaluation, he described fear of being alone, anxiety, claustrophobia, sleep disturbance, and recurrent traumatic memories. The Veteran endorsed periodic alcohol and marijuana use without problematic effects. Reportedly, his alcohol use has been in remission since 2013. On examination, the Veteran’s identified symptoms included anxiety, suspiciousness, chronic sleep impairment, mild memory loss, and re-experiencing. According to the VA examiner, his symptoms result in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Based upon the forgoing, the examiner opined that it is less likely than not that the Veteran’s generalized anxiety disorder was incurred in or caused by active service, to include as due to traumatic events experienced while stationed in Vietnam. In support of the stated conclusion, the examiner noted the Veteran’s complaints of distress from other life events and suggested a causally linkage between his current subjective distress and his other life events rather than traumatic experiences in Vietnam. In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible. However, as to the etiology of a particular claimed disability, the issue of causation of a medical condition is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In the instant case, there is no evidence that Veteran possesses the required training to diagnose a depressive disorder or opine as to its etiology. To the extent his statements may be competent, the Board ultimately assigns greater probative weight to the medical evidence of record, to include opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. In this case, the Board acknowledges receipt of the Veteran’s September 2014 lay statement in which he referenced exposure to traumatic events, including being lost while on patrol in the jungle. In a separate statement from his wife, she indicated that he suffers from fear of being alone, anxiety, and social avoidance. While lay contentions are acknowledged, as to the finding of “nexus,” the Board accords more probative weight to the competent medical evidence, to include the February 2015 VA opinion which was reasonably drawn from the record and provided supportive rationale for all conclusions indicated. While the Board recognizes the Veteran’s subjective belief that his psychiatric symptoms are causally related to active service, to include traumatic experiences during service in the Republic of Vietnam, the evidence of record does not support his assertion. Service treatment records are silent for symptoms or treatment for psychiatric symptoms. Post-service treatment records note an initial complaint of symptoms in May 2014. Thereafter, the Veteran’s symptoms “appear” to be related to occupational stressors. On examination in February 2015, the examiner found no causal linkage between the Veteran’s current diagnosis and active service, to include as due to “reported” in-service stressors. While the Board is sympathetic to the Veteran’s complaints of symptoms, the evidence of record fails to show a causal linkage to active service or his alleged service-related stressors. In fact, the record fails to show that the Veteran’s complaints of symptoms have been causally related to active service. Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for an acquired psychiatric disorder, to include anxiety, depression, and PTSD must be denied. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Whitaker, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.