Citation Nr: 20003389 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 16-13 595 DATE: January 14, 2020 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include chronic adjustment disorder with depressed mood, is granted. FINDINGS OF FACT 1. The evidence of record reflects that the Veteran does not have a competent diagnosis of PTSD. 2. The Veteran’s current diagnosis of adjustment disorder with depressed mood is casually related to his military service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for PTSD have not been met. 38 U.S.C. §§ 1101, 1131, 1154, 5103, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 2. The criteria for entitlement to service connection for chronic adjustment disorder with depressed mood have been met. 38 U.S.C. §§ 1101, 1131, 1154, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1981 to May 1985. He also served on active duty from January 1987 to December 1988; however, pursuant to a January 2004 VA administrative decision, the Veteran’s second period of service is a bar to VA benefits because his discharge for that period of service was not under conditions other than dishonorable. See January 2004 Administrative Decision. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection for PTSD requires a medical diagnosis of PTSD 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). The above cited regulation, 38 C.F.R. § 4.125(a), refers to the American Psychiatric Associations’ Diagnostic and Statistical Manual for Mental Disorders, 4th ed. (1994) as the source of criteria for the diagnosis of claimed psychiatric disorders. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM, Fourth Edition (DSM-IV) and replace them with references to the updated DSM-5. Because the Veteran’s appeal was certified to the Board in November 2017, this claim is governed by the DSM-5. If a stressor claimed by a Veteran is related to his fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. Fear of hostile military or terrorist activity means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others. 38 C.F.R. § 3.304(f)(3). 1. Entitlement to service connection for posttraumatic stress disorder (PTSD) In June 2013, the Veteran filed a claim seeking service connection for PTSD and, in support of his claim, has identified two events during service that he believes caused his current psychiatric symptoms and disability. The first event occurred on his birthday in June 1982 when he was taken to view the body of his best friend, PFC Crumety, who has been killed in a forklift accident. The Veteran has stated that, while he did not see his friend die, he believed the death was racially motivated and that his commanding officer was responsible. See e.g., January 2014 stressor statement; August 2014 VA examination; January 2018 Disability Benefits Questionnaire (DBQ); March 2019 VA examination. The second stressor involved learning that three fellow Marines died during a bombing in Lebanon. See September 2014 Notice of Disagreement; March 2019 VA examination. There is conflicting evidence of record regarding whether the Veteran has a competent diagnosis of PTSD. In support of his claim, the Veteran submitted a January 2018 PTSD DBQ that was completed by a private clinician, Dr. Valette. While Dr. Valette’s report provides a diagnosis of PTSD according to the DSM-5, a closer review of the report shows that he used the diagnostic criteria from the DSM-IV to evaluate the Veteran. In this regard, the Board notes that the DSM-IV utilizes 6 criteria (A through F) to diagnose PTSD, which are identified in the January 2018 PTSD DBQ from Dr. Valette, whereas the DSM-5 utilizes 9 criteria (criterion A through I) to diagnose PTSD, as reflected in the August 2014 and March 2019 VA examination reports. In this context, the Board finds significant that the clinicians who conducted the August 2014 and March 2019 VA examinations declined to render a diagnosis of PTSD according to the DSM-5 criteria, albeit for different reasons. The August 2014 VA examiner stated that the Veteran’s reported stressors were not adequate to support a diagnosis of PTSD but, nevertheless, diagnosed him with an unspecified personality and anxiety disorder, as well as alcohol, cocaine, and marijuana use disorders. By contrast, while the March 2019 VA examiner determined the Veteran’s first stressor is adequate to support a diagnosis of PTSD, he noted the Veteran did not meet criterion H, e.g., the disturbance caused by his current symptoms are not attributable to the physiological effects of a substance or other medical condition and, instead, rendered a diagnosis of chronic adjustment disorder with depressed mood. The Board finds probative that, after review of the record and conducting a comprehensive mental status examination utilizing the DSM-5 criterion, both VA clinicians declined to render a diagnosis of PTSD but diagnosed the Veteran with a different psychiatric disability. Therefore, the Board finds the January 2018 PTSD DBQ from Dr. Valette is not considered competent medical evidence of a diagnosis of PTSD, as the diagnosis is not based upon the DSM-5 criterion that are applicable in this case. The Board acknowledges that VA clinicians who have provided outpatient treatment have noted the Veteran has a diagnosis of PTSD and rule out PTSD. See e.g., VA treatment records dated February 2017 and January 2018. However, the Board finds probative that there is no indication that the notations of PTSD and rule out PTSD were based upon comprehensive mental status examinations that utilized the DSM-5 criteria. In fact, subsequent treatment records specifically indicate the Veteran’s diagnoses that were based upon the DSM-5 criteria, which do not include PTSD. See e.g., August 2018 VA treatment record. Therefore, the Board finds that the preponderance of the evidence weighs against a finding that the Veteran has a competent diagnosis of PTSD in accordance with the DSM-5. In making this determination, the Board notes that PTSD is not a condition that can be diagnosed by a lay person. See Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014). Therefore, the Board finds service connection for PTSD is not warranted because the record does not show the Veteran has a competent diagnosis of that disability. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). 2. Entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include chronic adjustment disorder with depressed mood The Board again notes that the Veteran has been diagnosed with psychiatric disabilities other than PTSD. The VA treatment records associated with the claims file contain several different diagnoses, including anxiety disorders (including cocaine-induced anxiety, clinical anxiety, and generalized anxiety disorder), personality disorders (including anti-social and paranoid personality disorder), and adjustment disorder with mixed disturbance of emotions, including anxiety. See e.g., VA treatment records dated March 2012 and October 2015; VA treatment records dated July 2016 and February 2017; August 2018 VA treatment record. While considered competent medical evidence, the treatment records do not generally indicate whether the diagnoses were rendered according to the DSM-5 criteria and, thus, are not considered the most probative evidence of record regarding the Veteran’s diagnosis. Indeed, the Veteran was afforded two VA examinations to clarify his diagnoses. As noted, the August 2014 VA examiner diagnosed him with an unspecified personality and anxiety disorder, as well as alcohol, cocaine, and marijuana use disorders. However, the examiner opined that the Veteran’s disabilities are less likely than not caused by or a result of his military service because the evidence showed that his symptoms and behaviors, such as drinking alcohol and difficulties in relationships, occurred prior to the Veteran’s reported stressors. The Veteran has expressed disagreement with the rationale provided by the August 2014 VA examiner, as he noted that he did not have any psychiatric symptoms or behaviors before service and that his mental health status changed after the death of his best friend. See March 2016 VA Form 9. The Veteran’s service treatment records are consistent with his assertions in that they do not reflect any complaints or treatment for psychiatric problems, substance abuse, or disciplinary problems prior to 1983; however, the service records clearly show the Veteran had various disciplinary issues during his second period of service which resulted in his other than honorable discharge. See e.g., January 2004 Administrative Decision. Therefore, the Board finds the rationale provided by the August 2014 VA examiner is inconsistent with the other evidence of record and, thus, his opinion is afforded no probative value. Nevertheless, the Board notes that the March 2019 VA examiner diagnosed the Veteran with chronic adjustment disorder with depressed mood, which he opined is as likely as not caused by or a result of his military service, particularly the distressing experiences to which he was exposed during service. The Board acknowledges that the Veteran’s first stressor has been verified by the service department, as the evidence shows that a PFC Crumety was killed by accident in June 1982. See December 2015 Report of Casualty. The Board also notes that the March 2019 VA examiner noted the relationship between the in-service trauma and the Veteran’s current symptoms. As the Veteran’s current diagnosis of chronic adjustment disorder with depressed mood has been attributed to his military service, the Board finds service connection is warranted. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.J. Turnipseed, 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.