Citation Nr: 20002003 Decision Date: 01/09/20 Archive Date: 01/09/20 DOCKET NO. 15-30 897 DATE: January 9, 2020 ORDER Service connection for an acquired psychiatric disorder is denied. Service connection for hypertension is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the current acquired psychiatric disability began during active service, or is otherwise related to an in-service injury or disease. 2. The Veteran’s hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease, to include environmental exposures in Southwest Asia during the Persian Gulf War. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1117, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 1988 to June 1991, to include service in Southwest Asia. In an October 2018 decision, the Board of Veterans’ Appeals (Board) remanded issues on appeal for additional development. The Board determined that a new VA examination would be necessary to determine the nature and etiology of any currently diagnosed psychiatric disorders. The Board noted that the previous findings from a VA PTSD examination did not align with the records indicating that the Veteran had been diagnosed with depressive neurosis, adjustment disorder with mixed emotional features, personality disorder, not otherwise specified (NOS), and depressive disorder NOS. With respect to the hypertension claim, the Board noted that the June 2013 VA examination offered an inadequate explanation about why exposure to environmental hazards in Southwest Asia were not linked to the Veteran’s hypertension. There has been at least substantial compliance with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, in order to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). 1. Entitlement to service connection for an acquired psychiatric disorder The Veteran asserts that he has PTSD and other acquired psychiatric disorders related to his active duty inservice, specifically his service in Southwest Asia. See December 2012 application for compensation and/or pension. The Board notes that the Veteran has been diagnosed with major depressive disorder, recurrent, alcohol use disorder in remission, and personality disorder. See, e.g., April 2019 VA opinion. The Board next finds that the Veteran has not been diagnosed with PTSD. The Veteran’s service treatment records are silent to any complaints, treatment, or diagnosis of PTSD. The May 1991 service separation examination report shows a normal psychiatric evaluation, and the concurrent report of medical history shows that the Veteran explicitly denied psychiatric symptoms such depression, excessive worry, and nervous trouble of any sort. Post-service treatment records indicate that the Veteran has been diagnosed with depressive neurosis, adjustment disorder with mixed emotional features, personality disorder NOS, and depressive disorder NOS. A June 2013 VA examiner indicated that the Veteran did not meet the criteria for PTSD. In April 2019, a VA examiner offered an opinion addressing the etiology of the Veteran’s current psychiatric conditions. The examiner noted that the Veteran’s prior diagnosis of alcohol use disorder was considered resolved because the Veteran had been sober for several years. The examiner opined that the Veteran’s current acquired psychiatric disorder was less likely than not incurred in or caused by service. It was reasoned that the totality of the record does not support any nexus between the Veteran’s mental health symptoms and his military service. The examiner noted the Veteran’s buddy statement, but explained that the chronology of mental health treatment (first sought in 2012) did not support a finding of continuous mental health symptoms. The Board has considered the lay statement by K.H., who noted that he had known the Veteran since 1983, and upon the Veteran’s return from active service, the Veteran was moody, angry, and depressed at times. While the Veteran and K.H. are competent to describe the Veteran’s psychiatric symptoms at any given time, under the facts of this case, the Veteran and K.H. are not competent to render a psychiatric diagnosis and/or opine on the etiology of the Veteran’s acquired psychiatric disabilities. Such an opinion would require medical training and expertise, which they are not shown to have. See Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) (holding that “PTSD is not the type of medical condition that lay evidence... is competent and sufficient to identify”); Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (holding that a claimant without medical expertise cannot be expected to precisely delineate the diagnosis of his mental illness). The VA examiner’s opinion from April 2019 was demonstrably fully informed of the pertinent factual premises of the case and provided a fully articulated opinion with supporting reasoned analysis explaining why the Veteran’s current psychiatric disabilities did not have their onset during active duty or were otherwise causally or etiologically related to service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-304 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value for a medical opinion). There is no benefit of the doubt that could be resolved in the Veteran’s favor, since there is no medical evidence to the contrary. Notably, no medical professional has linked the Veteran’s acquired psychiatric disability to his active duty in service. Based on the foregoing, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s acquired psychiatric disability was not incurred in service nor are they otherwise causally or etiologically related to service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for an acquired psychiatric disability, and the claim must be denied. Because 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. 2. Entitlement to service connection for hypertension The Veteran asserts that his hypertension is a chronic disability caused by his service in Southwest Asia. Hypertension is considered a chronic disease under 38 C.F.R. § 3.309(a). Therefore, the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on “chronic” symptoms in service and continuous symptoms since service are applicable. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of chronic diseases in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). While hypertension is among the chronic diseases subject to presumptive service connection, the evidence does not show that symptoms of his hypertension were chronic in service, continuous after service separation, or that the Veteran’s hypertension manifested to a compensable degree within one year following his military service. Service treatment records show no complaints of, treatment for, or diagnosis of hypertension. The May 1991 service separation examination report shows a normal clinical evaluation of the heart and vascular systems, and the concurrent report of medical history shows that the Veteran explicitly denied hypertension symptoms, to include high blood pressure. The Veteran was not diagnosed with hypertension until 2005. See April 2019 medical opinion by Dr. E.W. The Board next finds that the Veteran’s hypertension was not incurred in service and is not otherwise causally or etiologically related to service. In an April 2019 opinion, a VA examiner opined that it is less likely than not that the Veteran’s hypertension is related to his active duty service. It was reasoned that blood pressure readings found in the service treatment records did not meet the criteria for a diagnosis of hypertension, that the Veteran has a family history of hypertension, and that the hypertension diagnosis was in 2005, many years after service discharge. Service connection may also be established for a Persian Gulf Veteran who exhibits indications of a qualifying chronic disability resulting from undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2016, and cannot be attributed to any known clinical diagnosis by history, physical examination, or laboratory tests. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). Service connection may be granted for a disability due to undiagnosed illness of a Veteran who served in the Southwest Asia Theater of Operations during the Persian Gulf War. Among the requirements are “objective indications of a chronic disability” resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as fatigue, signs or symptoms involving the skin, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper and lower) sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. If the signs or symptoms have been medically attributed to a diagnosed (rather than undiagnosed) illness, the Persian Gulf War presumption of service connection does not apply. VAPGCPREC 8-98 (Aug. 3, 1998) (cited at 63 Fed. Reg. 56,703 (Oct. 22, 1998). The April 2019 VA examiner noted that hypertension is a known condition with etiology, and, therefore, is less likely than not related to environmental exposures in service. While the Veteran is competent to describe the dates of high blood pressure readings or report a previous diagnosis of hypertension, under the facts of this case, he is not competent to render a medical diagnosis and/or opine on the etiology of his hypertension. Such an opinion would require medical training and expertise, which he is not shown to have. The April 2019 VA examiner’s opinion was demonstrably fully informed of the pertinent factual premises of the case and provided a fully articulated opinion with supporting reasoned analysis explaining why the Veteran’s current disability was unrelated to service. See Nieves-Rodriguez v. Peake, supra. There is no benefit of the doubt that could be resolved in the Veteran’s favor, since there is no medical evidence to the contrary. Notably, no medical professional has linked the Veteran’s hypertension to his active duty service or any environmental hazards in Southwest Asia. Based on the foregoing, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s hypertension was not incurred in service nor is it otherwise causally or etiologically related to service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for hypertension, and the claim must be denied. Because 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. J. Ragheb Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board F. Lanton, Associate 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.