Citation Nr: 20040147 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 18-03 840 DATE: June 11, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. FINDING OF FACT The preponderance of evidence is against finding that the Veteran has a current psychiatric disorder that was incurred in or is otherwise etiologically related to her active military service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty for training (ACDUTRA) in the United States Army from August 2006 to March 2007 and on active duty in the United States Army from April 2008 to July 2008. She received the National Defense Service Medal. The Board of Veteran’s Appeals (Board) expresses its gratitude to the Veteran for her honorable service to the country. This matter comes before the Board on appeal from a November 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The issue was previously before the Board in March 2019, at which time the Board reopened the Veteran’s claim for entitlement to service connection for an acquired psychiatric disorder, based on the submission of new and material evidence into the record, and remanded the issue itself for further development. The claim was returned to the Board in December 2019, at which time the Board remanded the claim again because it did not find substantial compliance with its March 2019 remand directives. The Board now finds that there has been substantial compliance with its December 2019 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for an acquired psychiatric disorder Service connection is warranted if it is shown that a veteran has a disability resulting from an injury incurred or a disease contracted in active duty service or for aggravation of a preexisting injury or disease in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) an 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. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In addition to the general criteria for service connection, service connection for PTSD requires: (1) medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a), i.e., a diagnosis conforming to specified diagnostic criteria (currently the DSM-5); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link, or causal nexus, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). Congenital or developmental defects such as personality disorders and mental deficiency are not “diseases” or “injuries” within the meaning of applicable legislation. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. Generally, the degree of probative value that may be attributed to a medical opinion issued by a VA or private treatment provider accounts for such factors as the opinion’s thoroughness, degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians physically examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). 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; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss every piece of evidence of record in detail. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Thus, the Board will summarize the relevant evidence as appropriate; and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. Here, the Veteran asserts that her psychiatric disorder was incurred in or is otherwise etiologically related to her military service. Specifically, she reports in-service stressor incidents of engagement in an unexpected nighttime mission in Iraq that resulted in her helicopter coming under fire, as well as the death of a friend in a fatal car accident. See VA Form 21-4138, Statement in Support of Claim, dated April 1, 2011; see also VA Form 9, dated October 9, 2017. She further relays that she was sexually harassed by a Sergeant during her military career. See VA Form 21-4138, Statement in Support of Claim, dated April 3, 2016. She contends that she experiences myriad psychological and behavioral repercussions from her claimed PTSD. See VA Form 21-4138, Statement in Support of Claim, dated May 10, 2016; see also VA Form 21-0958, Notice of Disagreement, dated February 22, 2017. At the outset, the Board observes that the medical evidence of record is conflicting in regard to the nature of the Veteran’s psychiatric disorder. Medical notes from 2008 onward reference a personal medical history of PTSD or depression. See, e.g., medical treatment records dated March 2, 2011; see also medical treatment records received by VA on April 5, 2011. Indeed, outpatient files from VA medical facilities document a diagnosis of PTSD. See, e.g., medical treatment records received by VA on April 5, 2011; see also medical treatment records dated May 31, 2016 and June 6, 2016. The record also contains multiple mentions of failure of the Veteran’s symptoms to satisfy the diagnostic criteria for PTSD or depression. See, e.g., medical treatment records dated February 20, 2009 and October 8, 2010; see medical treatment records dated September 28, 2016; see also medical treatment records dated July 12, 2019. Significantly, the VA psychological examinations the Veteran has undergone were performed by examiners who personally evaluated the Veteran and her in-service and post-service medical history before finding that the Veteran does not have a current diagnosis of PTSD or depression. In determining that the Veteran’s symptoms do not satisfy the criteria for a diagnosis of PTSD, the February 2020 clinician opined, after a review of the Veteran’s claims file and all pertinent medical evidence of record, that the Veteran more likely than not had borderline personality disorder prior to enlisting in the Army and that the disorder more likely than not contributed to the Veteran’s symptoms of anxiousness and depressed mood. See VA examination dated February 5, 2020. Indeed, other examiners have also concluded that the Veteran’s borderline personality disorder accounts for the totality of her symptomatology. See, e.g., addendum medical opinion dated August 2, 2019. Concerning diagnoses other than PTSD and depression, in a mental health evaluation from July 2008, the Veteran was diagnosed with borderline personality disorder and was noted not to experience a severe mental defect or other any psychiatric disorder. See service treatment records dated July 1, 2008. The examining physician recommended expeditious administrative separation due to the disorder’s impairment on the Veteran’s ability to function affectively in the Army environment. See id. Pursuant to the Board’s March 2019 remand directives, the February 2020 examiner determined that no additional psychiatric disorder existed, and an opinion addressing whether a psychiatric diagnosis resulted from a superimposed disease or injury was therefore not warranted. See VAOPGCPREC 82-90. Viewing the record in the light most favorable to the Veteran, she has at times during the appeal period carried a psychiatric diagnosis other than personality disorder, including PTSD and major depressive disorder. See Cohen v. Brown, 10 Vet. App. 128, 140 (1997) (holding that mental health professionals making diagnoses ‘are presumed to know the DSM requirements applicable to their practice and to have taken them into account.’). However, the Board finds that the preponderance of the evidence fails to establish that the Veteran has had at any time during the appeal a psychiatric diagnosis that was incurred in or is otherwise related to her military service, to include PTSD and major depression. As an initial matter, the Veteran’s borderline personality disorder is not considered a “disease” or “defect” for VA disability compensation purposes. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. To the extent that at times the record reflects other diagnoses, the preponderance of the medical evidence, including the opinions of VA clinicians in 2019 and 2020 have concluded that any other diagnoses, including PTSD and depression, are unrelated to service. The August 2019 medical opinion provided by a VA clinical psychologist recognized the diagnosis of PTSD in the VA treatment records and opined that “any potential PTSD diagnosis would relate to the primary trauma, which was a pre-military [personal assault].” The clinician explained that symptoms related to the Veteran’s reported service stressors “do not meet the criteria for PTSD.” The opinion concluded that no disorders were superimposed on the Veteran’s Borderline Personality Disorder which had clearly and unmistakably preexisted service and was clearly and unmistakably not aggravated by service. The examiner provided a detailed rationale for these conclusions. The February 2020 VA psychologist concurred with the conclusions of the 2019 VA psychologist and noted PTSD assessments and a diagnosis of major depressive disorder in the record. The 2020 examiner concluded that the life disruptions that result in symptoms like periods of depressed mood are “not a function of any disorder caused by or proximal to her military service.” The clinician explained that “[f]rom the [V]eteran’s own report, she has experienced periods of depressed mood subsequent to many life disruptions.” The examiner noted the 2019 initial PTSD Disability Benefits Questionnaire and noted that “the [V]eteran experiences many major life disruptions as a function of her Borderline Personality Disorder.” The examiner also identified the Veteran’s “symptoms of anxiety or depression as precipitants of the Borderline Personality Disorder and best accounted for that that diagnosis.” The Board finds this opinion highly probative as the conclusions are adequately explained and based on a full review of the record. As a result, the preponderance of the evidence is against a finding that the Veteran has had at any time during the appeal a psychiatric disability related to service. The Board greatly appreciates the Veteran’s honorable service and her sacrifices. This decision is in no way meant to diminish her service to our country. However, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable; and the claim must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Tolbert, 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.