Citation Nr: 20039916 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 17-28 016 DATE: June 11, 2020 ORDER 1. The claim of entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. 2. The claim of entitlement to service connection for an acquired psychiatric disability, to include mood disorder, anxiety disorder, other specified trauma and stressor-related disorder, and adjustment-like disorders, is denied. FINDINGS OF FACT 1. The Veteran does not meet the criteria for a diagnosis of PTSD during the appeal period. 2. The Veteran's acquired psychiatric disability, characterized variously as mood disorder, anxiety disorder, other specified trauma and stressor-related disorder, and adjustment-like disorder, did not have its onset during active service, and is not otherwise related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304 (f). 2. The criteria for service connection for an acquired psychiatric disability, to include mood disorder, anxiety disorder, psychotic disorder, other specified trauma and stressor-related disorder, and adjustment-like disorder, have not been 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 from September 1975 to February 1976 and from February 1991 to June 1991 with additional service in the U.S. Marine Corps Reserve. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that although the Veteran submitted a claim solely for PTSD, the record reflects additional psychiatric diagnoses to include mood disorder, anxiety disorder, other specified trauma and stressor related disorder and adjustment-like disorder. Thus, a claim for service connection for a psychiatric disability is deemed to encompass all psychiatric diagnoses reasonably presented in the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, the Veteran’s psychiatric disability claim has been properly characterized to include mood disorder, anxiety disorder, other specified trauma and stressor related disorder, adjustment-like disorder and PTSD. In February 2019, the Board remanded the case to afford the Veteran a psychiatric examination and in December 2019, the Veteran underwent a VA examination. Additional VA treatment records were associated with the claims file and the RO issued a Supplemental Statement of the Case (SSOC) in April 2020. Therefore, the Board finds that the remand directives from the July 2018 Board decision were substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection The Veteran contends that he is entitled to service connection for an acquired psychiatric disability, to include PTSD, as a result of stressors experienced while in service. Service connection may be granted for a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C. § 1110,1131. 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." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Holton v. Shinseki, 557 F.3d 1362 (2009). 1. PTSD To establish entitlement to service connection for PTSD, the record must contain the following: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304 (f). The Veteran has not alleged nor does the evidence show that the Veteran was diagnosed with PTSD during service; that he engaged in combat with the enemy and his claimed stressors are related to that combat; that his claimed stressors are the result of fear of hostile military or terrorist activity; or that he was a prisoner-of-war and his claimed stressors are a result of that experience. 38 C.F.R. § 3.304(f). The Board notes that the December 2019 VA examiner indicated that the Veteran’s claimed stressors were primarily related to his time in bootcamp and that when he was activated in support of Operation Desert Shield/Storm, he reported that he was stationed in northern Europe and was not involved in combat. Thus, because the Veteran did not engage in combat with the enemy nor did he allege any stressors related to combat, the Veteran's lay testimony by itself is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain service records or other evidence to corroborate the veteran's testimony or statements. See Moreau v. Brown, 9 Vet. App. 389, 394 (1996). If a PTSD claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. 38 C.F.R. § 3.304 (f)(5). Effective August 4, 2014, the VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to Diagnostic and Statistical Manual, 4th Edition (DSM-IV) and replacing them with references to the DSM-V. Here, the Veteran submitted his claim of service connection for PTSD in October 2012, and the case was certified to the Board in June 2018. Therefore, the DSM-V applies. See 38 C.F.R. § 3.304 (f)(2); Molitor v. Shulkin, 28 Vet. App. 397, 410-11 (2017). The Veteran has claimed to have experienced several in-service stressors that he believes caused his PTSD. In his December 2012 Statement in Support of Claim for PTSD (VA Form 21-0781), the Veteran stated that he had foot problems in service and had to wear sneakers because he could not wear boots. In a December 2012 statement, he reported that during bootcamp in 1975, he saved a fellow soldier from committing suicide and in 1988 prevented another soldier’s death from an adverse drug reaction by getting him medical attention. During the appeal period, the Veteran has provided various statements related to the mental and physical rigors of being a Marine. For example, he reported weight fluctuations due to stress, the pressure of being the best, and difficulty keeping up with physical requirements. (See e.g. Veteran’s June 2013 statement; June 2013 21-0781). In a February 2014 letter to his congressman, the Veteran also stated that it was physically draining to be in the Marine Corps and stressful trying to keep up with tactics and exercises. In a February 2014 statement, he claimed that he almost drowned in the Pacific Ocean when his vessel flipped over but with the help of other soldiers, they managed to flip it back. He also reported that he was afraid of live ammo such as grenades, feared failure, and the drill instructor punched him in the stomach for no reason. In an April 2017 VA Form 21-0781, he reported that a drill instructor named Sergeant Hough punched him in the back during bootcamp on Parris Island between October and December 1975. In addition, he was made to jump into a pool despite his fear of going in the water and almost drowned; he stated that he was saved by three instructors. In his written correspondence during the appeal period, the Veteran has reported psychiatric symptoms such as night sweats, nightmares, an inability to sleep in the dark because of having to live in fox holes, constantly talking about his military experiences, seeing dead Marines, discomfort when people yell, marital issues, suicidal ideation, depression, problems with memory and cognitive ability, social isolation, and he avoided crowds, guns, and knives. The Veteran was afforded a VA examination in December 2019 at which time the examiner determined that the Veteran did not have a diagnosis of PTSD related to his alleged military stressors. Rather, the examiner assessed the Veteran with “other specified trauma-and stressor-related disorder and adjustment-like disorders with prolonged duration of more than 6 months without prolonged duration of a stressor”; the examiner opined that these psychiatric disabilities were at least as likely as not related to his stressful, though non-traumatic experiences in boot camp. With regard to PTSD, the examiner determined that the Veteran did not satisfy the clinical criteria for a diagnosis of PTSD. The examiner reasoned that the Veteran's description of his in-service stressors did not qualify as traumatic stressors because although he was frightened at the time, his life was not in actual danger and he was not seriously harmed (e.g. jumping into the deep end of a pool for anti-drowning training with other Marines in the pool and preventing another soldier from cutting his wrists in a suicide attempt). Likewise, the claimed personal assault by a drill instructor caused no serious injury and did not pose a threat to his life. The examiner stated that aside from the Veteran's lay statement about these events, there is no documentation in his claims file to support his allegations. In addition to these claimed stressors not qualifying as traumatic stressors, the examiner determined that the Veteran did not meet the criteria for PTSD because he did not exhibit negative alterations of cognition and mood. The examiner indicated that the Veteran’s non-military adverse life events, such as his brother’s attempted suicide, his father’s death from significant health issues, and a serious spider bite in 2003 which led to his hospitalization, could have also contributed to his fixation on death or near-death experiences. To the extent that the Veteran has argued that he has been diagnosed with PTSD by VA clinicians during the appeal period, a review of the Veteran’s VA treatment reports indicate that various mental health evaluations resulted in conflicting psychiatric diagnostic impressions. For example, a September 2012 mental health evaluation conducted by a VA staff psychologist assessed the Veteran with a mood disorder due to his general medical condition and anxiety disorder, NOS; the psychologist determined that the Veteran did not meet the criteria for military-related PTSD. In July 2013, however, a mental health consult, which was also conducted by a staff psychologist, noted a diagnostic impression of PTSD and indicated that the Veteran did meet the criteria for military-related PTSD. In December 2016, a PTSD screen was negative. The Board recognizes that VA treatment reports contain a diagnosis of PTSD rendered by a VA psychologist during the appeal period. However, the Board places greater probative weight on the December 2019 VA examiner's findings that supported his conclusion that the Veteran did not have PTSD. The VA examiner’s diagnosis and extensive rationale were predicated on a review of the Veteran’s claims file, including his service records and VA treatment reports, as well as consideration of his reported history and alleged in-service stressors. Furthermore, the examiner directly referenced the stressor criteria and symptomatology for a DSM-V diagnosis of PTSD and discussed why the Veteran did not meet the criteria. Specifically, the examiner did not find that any of the Veteran’s enumerated stressors contributed to a PTSD diagnosis, and also found that other PTSD criteria were not met, such as alterations of cognition and mood. In contrast, the VA provider who diagnosed PTSD in July 2013 did not provide any rationale for the diagnosis, did not review the Veteran’s claims file prior to rendering a diagnosis, and notably, made no reference to the criteria required for a diagnosis of PTSD under DSM-IV (in effect at the time the diagnosis was rendered). Essentially, the VA psychologist provided a generalized “diagnostic impression” for VA treatment purposes whereas the VA examiner provided current diagnoses as well as a detailed PTSD diagnostic summary based on DSM-V PTSD criteria. In so doing, the VA examiner reviewed the Veteran’s history, symptoms, pertinent evidence of record, and reported stressors. Accordingly, the Board finds the December 2019 VA examination report to be the most probative evidence of record as to whether the Veteran has been diagnosed with PTSD during the appeal period. The Board also notes that a diagnosis of PTSD alone does not constitute sufficient evidence for the grant of service connection. Here, in order to establish that the Veteran’s alleged stressors occurred, the record must contain service records or other corroborative evidence substantiating or verifying his statements. However, no such evidence exists in this case. Regardless of the credibility of the Veteran's statements, his statements alone are not sufficient to establish the occurrence of the alleged stressors. Moreau v. Brown, 9 Vet. App. 389 (1996); Dizoglio v. Brown, 9 Vet. App. 163 (1996). Furthermore, with regard to his claims of having been hit in the stomach and back by drill sergeants during boot camp, the Veteran’s generalized descriptions of these alleged assaults do not lend themselves to meaningful verification efforts by the VA. The Board acknowledges the Veteran's contention that he currently has PTSD that is related to his military service. However, whether the Veteran meets the required diagnostic criteria for PTSD is a complex medical question and is not within the realm of knowledge of a lay person or determinable by observation with one's senses. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Therefore, the Veteran's statement is not competent evidence and not probative. For the foregoing reasons, the Board concludes that the Veteran does not have a diagnosis of PTSD related to a verified in-service stressor. As the preponderance of the evidence is against the claim, entitlement to service connection for PTSD is denied. 2. Acquired Psychiatric Disability The next consideration is whether the Veteran’s currently diagnosed psychiatric disability had its onset during active service or is otherwise related to his active service. As previously discussed, the December 2019 VA examiner diagnosed the Veteran with “other specified trauma-and stressor-related disorder and adjustment-like disorders with prolonged duration of more than 6 months without prolonged duration of a stressor”; and opined that these psychiatric disabilities were at least as likely as not related to his stressful, though non-traumatic experiences in boot camp. The Veteran’s service treatment records show that no psychiatric disabilities were noted upon enlistment. However, a notation dated August 18, 1984, while the Veteran was on active duty for training, indicates that he had passed out in the bathroom and was found lying on the floor; he was reported to be alert, lucid, and clear and religiosity was noted. The Veteran had denied experiencing any hallucinations or delusions. The examiner stated that the Veteran appeared to have had a hysterical dissociation but was not psychotic, suicidal or homicidal; however, the Veteran was not assessed with a psychiatric disability at the time. The Veteran indicated that he was fine, and it was determined that he was fit for unrestricted duty. One month later, in a September 1984 Report of Medical History conducted in connection with a routine physical, the Veteran denied any symptoms such as periods of unconsciousness, loss of memory, trouble sleeping, or nervous trouble. Subsequent service treatment records, including Reports of Medical History and Reports of Medical Examination, are silent for any psychiatric complaints, treatment, or diagnosis. Following separation from active service, the record shows that the Veteran was treated at the VA Medical Center in September 2012 for complaints of nightmares, night sweats, and mood problems due to his physical ailments. The record also reflects the first report of visual hallucinations was noted in a January 2013 VA treatment report; the Veteran was later diagnosed with psychosis, NOS in June 2013 and prescribed antipsychotic medication. A March 2014 VA mental status examination reveals that the Veteran exhibited thought blocking and tangentiality at times and had also reported visual hallucinations. The Board notes that certain chronic diseases, including psychoses, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101,1112; 38 C.F.R. §§ 3.307, 3.309(a). However, the Board finds that a psychotic disorder is not considered part of the Veteran's current psychiatric disability at this time. In this regard, based on his examination of the Veteran and a review of relevant VA treatment reports, the December 2019 VA examiner concluded that the Veteran did not currently meet the criteria for a psychotic disorder. The examiner explained that the Veteran’s potentially psychotic symptom (visual hallucination) of seeing dead people in 2013 occurred in the absence of any other psychotic symptoms and was not currently occurring. Finally, the Veteran has not asserted that he suffered from psychosis in service, within one year of separation from active service, or that he currently has psychosis. Furthermore, during his December 2019 VA examination, the Veteran denied that he had any psychiatric symptoms or disabilities prior to or during active service. Therefore, the Board finds that an acquired psychiatric disability was not incurred during active service. The December 2019 VA examiner’s medical opinion relating the Veteran’s diagnosis of “other specified trauma-and stressor-related disorder and adjustment-like disorders” to his stressful experiences in boot camp is the only positive nexus opinion of record. However, the Board does not find that the opinion is highly probative on the matter of nexus because it is based on the Veteran’s lay statements regarding his bootcamp experiences and is not consistent with the contemporaneous record. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (holding that contemporaneous evidence has greater probative value than history as reported by a claimant). Indeed, the examiner stated in his rationale that aside from the Veteran’s lay statement about these events, there is no documentation in his claims file to support his allegations that these events occurred. The examiner further indicated that the Veteran’s significant non-military life events could have contributed to his fixation on death or near-death experience. Thus, the Board finds that the VA examiner’s positive opinion is outweighed by the competent evidence of record and the Veteran’s lay assertions are not credible evidence to establish a link between his current psychiatric diagnoses and events he has claimed occurred during active service. The Veteran lacks the adequate medical expertise in this case to render a medical opinion as to the etiology or cause of his diagnosed disabilities. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). As such, the Veteran's assertions are not competent or probative evidence to determine whether the Veteran's current psychiatric disability was incurred in or aggravated by service. In conclusion, the Board finds that service connection for an acquired psychiatric disability is not warranted in this case. As the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. 38 C.F.R. §§ 3.102. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Krunic, 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.