Citation Nr: 20036726 Decision Date: 05/28/20 Archive Date: 05/28/20 DOCKET NO. 18-42 402 DATE: May 28, 2020 ORDER 1. Entitlement to service connection for a psychiatric disorder, including posttraumatic stress disorder (PTSD), is denied. 2. Entitlement to service connection for an umbilical hernia is denied. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of PTSD. 2. The most probative evidence of record establishes a lack of a current umbilical hernia disability or that the Veteran has abdominal pain that causes functional impairment in earning capacity. CONCLUSIONS OF LAW 1. The criteria for service connection for a psychiatric disorder, to include PTSD, is not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.301, 3.303, 3.304. 2. The criteria for service connection for umbilical hernia, to include abdominal pain, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for the United States Air Force from January 1983 to January 2005. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) 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. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, regarding the Veteran’s claims on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. 1. Entitlement to service connection for a psychiatric disorder, including PTSD Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. The Veteran believes his PTSD had its onset in service due to events that occurred during service. The first incident that the Veteran described was working at the Pentagon during the September 11th terrorist attacks. He stated that he was inside the Pentagon and they were told to evacuate. When he went into the main hallway to get to the parking lot, the hallway was filled with a sea of people. On the way out, a police officer said another plane was coming. The Veteran said that it was dark as night because of the smoke and fire. The second incident occurred while the Veteran was deployed between August and November 2002. The Veteran stated while he was overseas, he did not know when a bomb would go off or when the war would start. He had to gear up and remain on alert, and at the same time, act like nothing was happing. He said that he became emotionally numb and hardly slept. See December 2016 Statement in Support of Claim for PTSD. After a careful review of the evidence of record, the Board finds that the preponderance of the evidence is against the claim for service connection for a psychiatric disorder, including PTSD. The reasons follow. As to evidence of a current disability, the preponderance of the evidence is against a showing that the Veteran has a diagnosis of PTSD or any mental health disorder under Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is required for entitlement to service connection for PTSD. For example, the medical records show that the Veteran was seen in December 2011 and noted to have a reaction to chronic stress. At that time, the Veteran had symptoms of avoidance, hyperarousal, and numbness in the past during deployment and after the Pentagon attack. Since then, the document reports that the Veteran’s symptoms have been mitigated somewhat. He was educated on physiological reactions during trauma and told to watch for any increase or decrease in trauma symptoms. The Veteran was afforded a VA examination in November 2016, where the examiner found that the Veteran did not have a mental disorder that conformed to DSM-5. The examiner noted that Veteran has some sad and angry feelings about the experience at the Pentagon, but these feelings are within the range of ordinary and not a sign of any psychiatric disability more likely than not. The examiner noted that the sleep difficulties appeared to be from obstructive sleep apnea. Therefore, the Board finds there is no competent evidence from a medical professional that the Veteran has PTSD. Thus, without a diagnosis of PTSD from a medical professional, service connection for PTSD is not warranted. The Veteran asserts that he has PTSD, however, lay assertions do not constitute a competent clinical diagnosis of PTSD. See 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). A VA psychologist in November 2016 has made specific findings that the Veteran did not have a diagnosis of PTSD or any other psychiatric disorder, which conformed to DSM-5 criteria after thorough examination. The Veteran has not offered other competent medical evidence in support of his assertion that he had a diagnosis of PTSD. In the absence of a qualifying current diagnosis for PTSD, which conforms to DSM-5, service connection for PTSD cannot be established. See 38 C.F.R. §§ 3.304 (f), 4.125(a). For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the claim for service connection for a psychiatric disorder, to include PTSD. As the preponderance of the evidence is against the claim for service connection, the benefit-of-the-doubt doctrine does not apply, and the claim for service connection is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for umbilical hernia The Veteran believes that his umbilical hernia had its onset in service. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for umbilical hernia. The reasons follow. As to evidence of a current disability, the preponderance of the evidence of record is against a finding that the Veteran has an umbilical hernia, to include symptoms that cause functional impairment that affects earning capacity. For example, there is no competent evidence that shows the Veteran has a current umbilical hernia, to include abdominal pain, or that he has been treated for an umbilical hernia and/or abdominal pain during the appeal period. The Board notes that the Veteran was diagnosed with an umbilical hernia and underwent surgery in August 2008; approximately eight years before the Veteran filed an application for compensation benefits. Additionally, there is no documentation that the Veteran had complications from the surgery or a reoccurring umbilical hernia. The Veteran has not established that he has chronic stomach pains since service or stomach pains that causes functional impairment affecting earning capacity. A December 2011 medical treatment record shows that the Veteran did not have any abdominal pain or pain in the flank. Additionally, a review of the Veteran’s claims file shows no evidence of impairment, or functional pain that impacts his ability to work. Thus, there is no evidence of a current disability and the first element of a service-connection claim is not met. Furthermore, the Board considered Saunders v. Wilkie, 886 F. 3d 1356, 1368 (Fed. Cir. 2018) which held that the U.S. Court of Appeals for Veterans Claims erred as matter of law in finding the veteran’s pain alone, absent specific diagnosis or otherwise identified disease or injury, could not constitute a disability under 38 U.S.C. § 1110 and other relevant authorities. These authorities do not support a finding that the Veteran currently has an umbilical hernia. Pain alone resulting in functional impairment is, in fact, a disability, and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis. The Board notes that the Veteran has not reported pain. There is no evidence of functional loss in the Veteran’s claims file. Therefore, the Board finds the preponderance of the evidence is against a finding that the Veteran has current symptoms that result in functional impairment in earning capacity to establish evidence of a current disability. As to evidence of an in-service disease or injury, the service treatment records do not show that the Veteran complained of or was treated for an umbilical hernia in service. The service treatment records show that the Veteran complained of abdominal pain and it was related to a suspected appendicitis. An October 1985 radiology report shows that the Veteran had loop of air distended small intestine. A Foodhandlers’ Questionnaire from June 1988 shows that the Veteran denied having or ever having stomach, liver, or intestinal disorder. A February 2004 Adult Preventative and Chronic Care Flowsheet states that the Veteran reported that he had a hernia repair in 1969. Additionally, a November 2004 Report of Medical History shows that the Veteran denied ever having or having a rupture or hernia. The rest of the Veteran’s service treatment records are silent for other complaints or treatment of hernias. Thus, the preponderance of the evidence does not show that the Veteran complained of or was treated for a hernia during service and the Veteran does not meet the second element of a service-connection claim. While the Veteran is competent to provide evidence of observable manifestations or symptoms and report that which he has been told, the more probative and competent evidence establishes that the Veteran does not have a current diagnosis of an umbilical hernia. Additionally, the Veteran is not competent to attribute the 2008 umbilical hernia to service. The Veteran was not afforded a VA examination in connection with the claim for service connection for an umbilical hernia. The Board finds that the facts do not establish entitlement to VA examination or medical opinion. For example, VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The preponderance of the evidence is against the Veteran having a current disability or persistent or recurrent symptoms of a disability, it does not show an event, injury, or disease occurred in service, and it does not show an indication that the disability or persistent symptoms may be associated with the Veteran’s service, all of which has been explained above. For a VA examination to be warranted, all the criteria have to be met, and more than one criteria is not met. Therefore, entitlement to a VA examination is not warranted. Hence, the preponderance of the evidence is against a finding that that the Veteran has a current disability of an umbilical hernia or that is related to service. As the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim for service connection for an umbilical hernia is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Griffin, 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.