Citation Nr: 20011977 Decision Date: 02/12/20 Archive Date: 02/12/20 DOCKET NO. 19-05 940A DATE: February 12, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. FINDING OF FACT The Veteran does not have an acquired psychiatric disorder. CONCLUSION OF LAW A psychiatric disorder was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. §§ 3.303, 3.304(f) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1959 to January 1961. The Veteran appeared at a Board hearing September 2019; a transcript is of record. With respect to the Board hearing, the undersigned VLJ clarified the issues on appeal, identified potential evidentiary deficits, and clarified the type of evidence that would support the Veteran’s claim. These actions complied with any duties owed during a hearing. 38 C.F.R. § 3.103. 1. Acquired psychiatric disorder The Veteran contends a psychiatric disorder is due to service, specifically a motor vehicle accident in October 1959. Service connection may be established for disability resulting from personal injury or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. § 1131 (2012). To establish a right to compensation for a present disability, a Veteran must show: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303(a); see also Davidson v. Shinseki, 581 F.3d 1313, 1315–16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (providing that a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis if (1) the medical issue is within the competence of a layperson, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511–12 (1995). For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) the product of reliable principles and methods; and (3) the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 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 U.S.C. § 3.304(f). The Veteran submitted a news article reporting a car accident that occurred while he was in service. A car he was driving with three fellow soldiers as passengers was involved in an accident while escorting a tractor-trailer loaded with explosives. Two other soldiers were injured. VA treatment records show active medical problems and assessment/diagnostic impressions of PTSD, depression, and anxiety as well as mental health treatment. A mental health treatment record dated in July 2015 indicated that the Veteran had been depressed for the last couple of years. The Veteran was depressed and anxious due to his health problems and aging. The Veteran denied any prior outpatient or inpatient treatment. The Veteran did mention the motor vehicle accident during service and that he had nightmares regarding the accident. An August 2015 VA treatment records show findings, per the DSM-V, of unspecified depressive disorder and unspecified anxiety vs adjustment disorder with mixed anxiety and depression. Assessment was based on PTSD self-reported checklist. The Veteran reported being depressed and anxious secondary to a car accident while in the military. He reported he believed he had a nodule on his forehead as a result of this accident. Medical records indicate nodule is a stable osteoma. The Veteran reported that he has thought about the motor vehicle accident ever since, and he is still very upset about it. He reported anxiety while driving and depressed mood. He also reported anxiety and worrying about his health. Psychosocial and contextual factors were reported as chronic medical illnesses. The VA psychologist noted that it was unclear if the Veteran met the criteria of the DSM-V for a traumatic event (Criterion A). While the car accident was distressing for him, he denied experiencing actual or threatened death or serious injury. His injuries were reported as minor and the accident’s severity was not clear. The Veteran had further VA mental health treatment in October, November, and December 2015, as well as in February 2017. A diagnostic impression dated in February 2017 noted adjustment disorder with depression and anxiety. The Veteran submitted a VA treatment record dated in November 2019, which lists assessment/impression as PTSD, depression, and anxiety. The Veteran also submitted a blank (excepting name and social security number) PTSD Disability Benefits Question (DBQ). A VA examiner provided an opinion on the matter in September 2017. The examiner reported that the Veteran did not have a diagnosis of PTSD or any other acquired psychiatric disorder that conforms to the DSM-5 criteria. The examiner reported that the Veteran had treatment for depression, anxiety, and nightmares since 2015. Regarding the diagnoses in VA treatment, the basis of successful clinical care is a trusting relationship between treatment provider and the Veteran. Since an attempt by a provider to assess the Veteran’s response style would probably diminish or destroy this trust, treatment providers rarely if ever do so. In other words, the Veteran’s mental health treatment providers accept the Veteran’s self-reported symptom history and decline in functioning without any attempt to verify the veracity of those claims. The examiner noted that treatment for depression and anxiety is not a DSM-V diagnostic criterion, nor is there evidence in the published empirical literature that a diagnosis of depression/anxiety is at least as likely as not to be valid because one receives treatment associated with it. The examiner was unable to corroborate that the Veteran indeed suffers from a mental disorder. The results of a symptom validity screening measure suggest that the Veteran was highly likely to be exaggerating his symptoms. The examiner was unable to accept the self-report of symptomatology or impairment at face value. Individuals who present with such a response bias may very well have mental health symptoms that are clinically significant and distressing. While it is recognized that the Veteran is currently in treatment, the examiner simply cannot determine within a reasonable degree of confidence the nature of his mental disorder and the severity of his functional impairment. Thus, no diagnosis was provided. Due to significant concerns regarding the credibility of the Veteran’s self-reported psychological symptoms, the examiner stated she could not ethically provide a diagnosis. The provision of any diagnosis within the current context would be unethical. A diagnosis of posttraumatic stress disorder (PTSD) must meet all diagnostic criteria as stated in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. The evidence does not show a confirmed diagnosis of PTSD. The examiner noted that while the car accident was distressing for him, he denied experiencing actual or threatened death or serious injury. Service treatment records do not even indicate that he required or received medical care after the motor vehicle accident, and it would seem unlikely that level of the accident would continue to cause such distress as the Veteran is reporting 58 years after the incident. The examiner noted many years of negative screens of mental health issues, specifically PTSD, from October 2007 to June 2015. The examiner reported the Veteran’s claimed stressor and noted that he purposefully left the criterion section blank, because she could not ascertain what, if any, symptoms the Veteran currently experiences due to evidence of significant amplification of symptoms. The examiner reported that the Veteran’s validity screening measures showed likely feigning (total score of 34 with cut-off of over 14). The Veteran endorsed a high frequency of symptoms and impairment that are highly atypical of individuals who have genuine psychiatric or cognitive disorders. This suggests a high likelihood of potential feigning. He demonstrated elevations on all scales. He endorsed unusual psychotic symptoms that are not typically present in actual psychiatric patients. The examiner then explained at length that the symptoms endorsed were atypical, infrequent, illogical, inconsistent, or incorrect. Altogether, the Veteran’s protocol suggests a high likelihood of feigning or symptom exaggeration, there remains the possibility that he may be experiencing a very atypical psychotic disturbance or atypical neurologic or cognitive impairment. The VA examiner reviewed the entire record, considered the reported stressor, and found that she could not corroborate that a mental disorder existed. There was specifically no PTSD and no mental disorder that conforms with the DSM-5 criteria. The opinion was supported by a detailed assessment and rationale by the examiner. The results of the interview and psychological testing suggested the Veteran did not meet the criteria for PTSD or any other acquired psychiatric disorder according to the DSM-5. Although the Veteran identified a potentially traumatic stressor, his primary stressor does not satisfy criterion A for PTSD. While depression and anxiety disorders have been diagnosed by VA treatment providers, the VA examiner explained that he could not determine whether the Veteran currently had an anxiety or depressive disorder, as the Veteran was found to be likely feigning on a symptom validity screening measure. The Board finds the VA medical opinion is well-supported and thorough. Further, evidence elsewhere suggests that any mental health symptoms are related to post-service events, specifically health issues and aging. The VA examiner noted the distance in time between the accident and the current symptoms of distress as well as the multiple negative screenings many years after service. For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) be the product of reliable principles and methods; and (3) be the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). The Board finds the VA opinion persuasive. Therefore, there is no diagnosis of PTSD or any other psychiatric disorder. To the extent VA treating medical professionals found a disorder, the Board gives more weight to the VA examiner’s opinion, which is far more detailed and explained why symptoms were likely feigned and why VA treating professionals diagnosis of a mental health disorder may be less reliable – that successful clinical care requires a trusting relationship and the veracity of the Veteran’s statements would not be analyzed in such an environment. This rationale is consistent with the record and based on the facts of the case. Therefore, the VA opinion has more probative weight, as it is well-supported, relied upon a diagnostic testing (including a validity screening measure), and is based on a review of the record. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332(1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The more probative evidence supports a finding of no reliable diagnosis of PTSD or other psychiatric disorder. Here, we have weighed the evidence and finds the more thorough VA opinion to be the most probative evidence. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Yoffe, 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.