Citation Nr: 20007286 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 11-26 520A DATE: January 28, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for a skin disorder of the left forehead and lower jawline, to include as due to herbicide exposure, is denied. Entitlement to service connection for a heart disorder, to include as due to herbicide exposure, is denied. FINDINGS OF FACT 1. The preponderance of the competent evidence does not demonstrate that the Veteran currently experiences a DSM-V diagnosed psychiatric disorder, nor has he experienced one during the pendency of the appeal or recent to the filing of the claim. 2. The Veteran’s skin disorder did not incur during and was not caused by active duty service. 3. The Veteran’s heart disorder does not meet the criteria of ischemic heart disease; and the heart disorder did not incur during and was not caused by active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for entitlement to service connection for a skin disorder of the left forehead and lower jawline have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 3. The criteria for entitlement to service connection for a heart disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1969 to March 1971, to include verified service in the Republic of Vietnam from August 1970 to March 1971. In October 2012, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. The Board remanded the matters for further development in September 2014 and November 2017. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To prevail on the issue of service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury 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 The Veteran has asserted entitlement to service connection for PTSD. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (conforming to the American Psychiatric Association ‘s Diagnostic and Statistical Manual of Mental Disorders (DSM); 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). If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions or hardships of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d) (pertaining to combat Veterans). However, if the Veteran did not engage in combat, he can still be service connected for PTSD if a stressor claimed by the Veteran is related to his “fear of hostile military or terrorist activity” and a VA or VA-contracted psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor so long as there is not clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service. 38 C.F.R. § 3.304(f)(3). For purposes of this section, “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, such as from an actual or potential improvised explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.” Id. Service treatment records do not show complaints, treatment or a diagnosis of a psychiatric disorder during his service. At separation, he did not indicate he had any nervous trouble of any sort. The preponderance of the medical evidence shows that the Veteran does not meet the diagnostic criteria required for a PTSD diagnosis. In a September 2010 private mental health examination, the Veteran was diagnosed with PTSD. The Veteran was afforded VA PTSD examinations in September 2010 and May 2017, and the examiners found the Veteran’s symptoms did not meet criteria for any mental health disorder according to the DSM-IV and DSM-V respectively. The Veteran was provided a VA addendum opinion in November 2017. The examiner noted the Veteran experienced fearful situations during his service in Vietnam. However, the examiner found that the Veteran’s signs and symptoms did not rise to the level of warranting a DSM-V diagnosis. The Veteran endorsed no items related to negative alterations in mood or cognitions, and he endorsed only one item related to heightened arousal and reactivity associated with his traumatic experiences. Finally, the Veteran denied any residuals symptoms caused any significant impairment in areas related to social or occupational functioning, and therefore, the Veteran did not meet the criteria for PTSD. The examiner addressed the September 2010 private evaluation. In the private report, the Veteran reported intense symptoms when he returned from war, which was 30 years prior to the evaluation. The private examiner indicated the Veteran functioned well, and although he suffered from periodic symptoms of trauma, he reported himself to be generally free of significant distress. The Veteran provided a private diagnosis for PTSD; however, the examination report provides no indication of what criteria were used to reach said diagnosis. The Veteran was provided with two VA examinations, and based on DSM-IV and DSM-V criteria, the Veteran was not provided any psychiatric disorders. The November 2017 addendum opinion provided a rationale for the negative diagnosis for PTSD, and addressed why the PTSD diagnosis in the private examination did not meet the necessary criteria. Therefore, the Board finds there is no current diagnosis of PTSD (or any other psychiatric disorder) in the Veteran’s record. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). In the absence of evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board has considered the Veteran’s lay statements. To the extent he contends that his PTSD is a result of his active duty service, the Board finds that as a lay person, he lacks the training or credentials provide such a diagnosis or a medical opinion. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, to the extent the Veteran seeks to provide a nexus between his claimed PTSD and his period of service, the Board finds that his statements in this regard are not competent. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the criteria for service connection for a psychiatric disorder including PTSD have not been met, and the Veteran’s claim is denied. The Board acknowledges the Veteran’s sincere belief that the claimed disorder is related to service. The Board has carefully reviewed the record in depth, but it has been unable to identify a basis upon which service connection may be granted. The Board has weighed the evidence of record, and finds that the preponderance of the evidence is against the claim. As such, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a skin disorder Aside from the general statutes and regulations, service connection may also be warranted if a Veteran was exposed to an herbicide agent during active military, naval, or air service, as certain enumerated diseases shall be service connected if the requirements of 38 C.F.R. § 3.307 are met, even though there is no record of such disease during service. The enumerated diseases associated with exposure does not include basal cell carcinoma. 38 C.F.R. § 3.309(e). Therefore, 38 C.F.R. § 3.309 is inapplicable. However, the claim must still be reviewed to determine if service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran was diagnosed with basal cell carcinoma of the left forehead and lower jawline. See August 2019 VA examination. The Veteran contends that his skin cancer was caused by sun exposure, to include sunburns he experienced during service in Vietnam and/or herbicide exposure. See October 2012 Board hearing. The Veteran’s service treatment records (STRs) are silent for complaints and/or treatment for skin disorders. The Veteran was provided with a VA opinion in May 2017, and the examiner found the Veteran’s skin disorder was caused by his 20 years of sun exposure as a state trooper. The Veteran was most recently afforded a VA examination and opinion in August 2019. The Veteran was diagnosed with basal cell carcinoma of the left forehead and lower jawline. The examiner provided a negative nexus opinion. The examiner noted that the Veteran’s STRs were silent for skin conditions of the forehead or face, and there was no definitive association with herbicide exposure and basal cell carcinoma. Although sun exposure does predispose individuals to basal cell carcinoma, there were 37 years between the in-service sun exposure and the diagnosis of the skin disorder. Sun exposure since active service, including 20 years of post-service employment as a trooper, would also be a strong factor in developing skin cancer. The Board notes there is no contrary medical evidence in the record to support a positive nexus opinion. The Board has considered the Veteran’s own assertions that his skin disorder was caused by active service. The Veteran is competent to report his in-service sunburns. See Jandreau, 492 F.3d. at 1376. However, the VA examiners are medical professionals who reviewed the claims file and considered the reported history. The examiners, in providing the requested medical opinions, utilized their expertise in reviewing the facts of this case and reached determinations based on medical principles. The Board thus finds the opinions of the VA examiners to be more probative than the Veteran’s lay contentions of a positive nexus between the Veteran’s active service and skin disorder developed decades after separation. See Layno, 6 Vet. App. at 470. The medical evidence outweighs the lay evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Therefore, the preponderance of the evidence is against finding that the Veteran’s skin disorders are related to an in-service injury, event, or disease. 38 U.S.C. § 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 55. Thus, the claim is denied. 3. Entitlement to service connection for a heart disorder The enumerated diseases associated with exposure to herbicide agents include ischemic heart disease, but cardiomyopathy is not on this list. 38 C.F.R. § 3.309(e), Note 2. The Board has thus also considered the claim on a direct service connection basis. Combee, 34 F.3d at 1039. The Veteran’s STRs are silent for complaints and/or treatment for any cardiac disorders. VA treatment records from November and December 2009, dated prior to the April 2010 claim, list coronary artery disease, but no explanation was given for this diagnosis. The Veteran was afforded a VA examination in May 2010. The VA examiner noted that the Veteran was diagnosed with cardiomyopathy in 2002. The examiner diagnosed the Veteran with dilated cardiomyopathy, and specifically noted that the Veteran did not have ischemic heart disease or an ischemic heart condition. The Veteran was afforded a VA opinion in May 2017. The examiner opined that the Veteran did not have an ischemic heart condition but had dilated cardiomyopathy from unknown causes, and recent studies did not show an ischemic heart condition. The Veteran was most recently afforded a VA opinion in November 2017. He underwent heart catherization that showed normal arteries, and he was therefore previously diagnosed with cardiomyopathy. He had no history of coronary artery bypass graft surgery, stent replacement, myocardial infractions, or congestive heart failure. The Veteran never had ischemic heart disease. The etiology of cardiomyopathy is often unknown, but can be related to diabetes, obesity, hypertension, alcohol abuse, and exposure to certain heavy metals. Herbicide exposure is not a known etiology for the condition, and therefore the cardiomyopathy was not related to herbicide exposure. In this case, the Board first finds that the preponderance of the evidence does not show ischemic heart disease. While coronary artery disease is listed in several VA treatment records, there is no explanation provided for this apparent diagnosis. By contrast, the subsequent VA examinations and opinions consistently reflect the view that the diagnosis was instead cardiomyopathy, and, given the record reviewed by these examiners and the rationales provided, the Board finds that the preponderance of the evidence strongly supports the determination that cardiomyopathy – not among the heart disorders classified as ischemic heart disease – is the correct diagnosis. There is also no competent evidence of record relating the cardiomyopathy diagnosis back to service on a direct basis. The only seemingly supportive evidence in this regard is the Veteran’s own contentions. However, the Veteran lacks the training and credentials needed to provide a diagnosis or a competent medical opinion, and his contentions thus do not constitute competent medical evidence. See Jandreau, 492 F.3d. at 1376. In the absence of competent medical evidence, the Board finds no basis for a remand for a more detailed medical opinion, as there exists no reasonable possibility that such opinion could contain findings favorable to the Veteran in the context of this claim. Therefore, the preponderance of the evidence is against finding that the Veteran’s heart disorder is related to an in-service injury, event, or disease. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 55. Thus, the claim is denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.