Citation Nr: 21000400 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-16 316 DATE: January 5, 2021 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD), claimed as PTSD secondary to military personal trauma, is denied. Entitlement to service connection for an acquired psychiatric disorder, to include depression, is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran has an acquired psychiatric disorder, to include PTSD and depression, that began during active service, or is otherwise related to an in-service injury, event or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). 2. The criteria for service connection for an acquired psychiatric disorder, to include depression, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from February 1984 to June 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision of a VA Regional Office (RO). This matter was last before the Board in October 2019, when it was remanded for further development. The Veteran testified before the undersigned during a hearing in June 2019. The Board notes that the Veteran filed a claim for entitlement to service connection for PTSD and chronic depression in September 2014. The Board has broadened the Veteran’s claims here, to include psychiatric disorders broadly. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires evidence showing: (1) the existence of a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). There are particular requirements for establishing service connection for PTSD in 38 C.F.R. § 3.304(f) that are separate from those for establishing service connection for other acquired psychiatric disorders. Service connection for PTSD requires medical evidence diagnosing the condition; 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). Alternatively, the regulations provide that if a stressor claimed by a Veteran is related to the Veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3). 1. Entitlement to service connection for PTSD, claimed as PTSD secondary to military personal trauma. In this case, the Veteran asserts that ever since he served a two-week detail in Germany that involved “tagging” and categorizing dead bodies, he has had a difficult time and was saddened by the experience. The Veteran states he experiences depression, distressing dreams, and sleep disturbances as a result. The medical evidence shows a diagnosis of PTSD, with an onset of symptoms in 1997, several years after the Veteran left service. In regards to the Veteran’s statement regarding an in-service stressor of “tagging” and loading dead bodies in Germany, an October 2020 VA medical opinion states that the Veteran’s PTSD diagnosis does not relate to the Veteran’s fear of hostile military or terrorist activity as the Veteran was not involved in combat, as confirmed by the record, or other hostile military or terrorist activity while stationed in Germany. The examiner explained that the stressor alleged by the Veteran is “related to the exposure to the aftermath of combat.” As the Veteran did not engage in combat, and his claimed stressor is not based on combat or fear of hostile military or terrorist activity while stationed in Germany, the Veteran’s statements alone are not sufficient to establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f). Thus, the claimed in-service stressor must be independently corroborated. The Agency of Original Jurisdiction (AOJ) notified the Veteran that additional information was needed from him in order to verify the claimed in-service stressor. The Veteran was asked in October 2014 correspondence to provide details regarding the stressful incidents he experienced in service. However, the Veteran did not provide any additional details that would assist in verification of the claimed stressor. As such, a November 2014 VA formal finding memorandum indicated that the AOJ was unable to verify the stressor because the Veteran failed to provide enough information and specificity when describing the stressor he claimed as the basis of his PTSD. The Board notes that although a December 2012 VA search revealed that Operation Desert Storm casualties were transported to Germany, VA was not able to verify that personnel assigned to the 3rd Battalion, 44th Air Defense Artillery, as stated by the Veteran, participated in those operations. A review of the Veteran’s service personnel records also does not verify that the Veteran participated in those operations. Furthermore, although the Veteran’s service treatment records (STRs) indicate that the Veteran was dealing with stress while in service, it was within the context of a parent-child problem as the Veteran requested a hardship discharge in order to attend to his child who had been diagnosed with a serious mental illness. It was deemed that the Veteran needed to be present in his child’s life. However, the STRs do not show any reports or complaints of a psychiatric-related condition, such as depression or PTSD, related to his time or experiences in service. Moreover, the October 2020 VA medical opinion by a VA psychologist states that the Veteran’s PTSD is not service-related and is due to the effects of ongoing non- service-related stressors, including caring for a young child with a serious mental illness. The Board acknowledges the February 2020 VA opinion that provided a positive nexus regarding the Veteran’s PTSD. However, as explained in the October 2020 addendum opinion, which was requested in order to clarify and explain the basis of the positive nexus opinion, the positive opinion did not contain an adequate rationale and was not consistent or supported by the evidence of record. The Board agrees with this finding, as the February 2020 positive opinion merely stated that the Veteran did not have mental health issues prior to service but now has “clear symptoms of PTSD and major depressive disorder which began post service discharge but have been ongoing for many years hereafter.” Although the examiner did comment on the Veteran’s post-service mental health treatment records, she did not explain how the claimed stressor amounted to fear of hostile military or terrorist activity while the Veteran was stationed in Germany and not engaging in combat, or how the claimed in-service stressor regarding handling dead bodies in Germany was related to his post-service mental health symptoms based on the facts in the record when providing the positive nexus opinion. In addition, this same examiner provided a negative nexus opinion on the same day that the positive nexus opinion was provided, stating that although the Veteran does have PTSD, “there is no evidence that it is related to the Veteran’s military service.” The examiner explained by stating that there was nothing more than the Veteran’s lay statements regarding his Veteran’s job assignment and duty of handling dead bodies while in Germany and that without a confirmed in-service stressor, the examiner would not be able to determine whether his PTSD was caused by his time in service. The Board finds that the February 2020 positive nexus opinion’s probative value is limited as the examiner did not provide an adequate rationale for the opinion and on the same day provided a negative nexus opinion regarding the Veteran’s PTSD, which had a more adequate explanation supported by the evidence of record. As such, the Board assigns greater probative weight to the October 2020 addendum opinion, which reconciled the inconsistent opinions provided by the February 2020 examiner. The October 2020 examiner explained that the Veteran’s STRs did not show reports of symptoms, diagnosis, or treatment for any psychiatric condition; the stress noted in service was within the context of a parent-child problem, as the Veteran’s son had been diagnosed with a serious mental illness, and it was deemed in the best interest of the child for the Veteran to be discharged from service based on hardship. The record does not verify the Veteran’s claimed in-service stressor, nor does it show the Veteran engaged in combat or that there was a valid basis for fear of hostile military or terrorist activity while stationed in Germany. Moreover, the Veteran did not seek treatment for his symptoms until several years after service in 1996 or 1997, and these symptoms were found to be attributable to the personal stressors in his family life, which led to his discharge from service based on hardship. Additionally, the Board acknowledges the lay statements of record provided by the Veteran’s family members regarding there being no family history of mental health issues. However, these lay statements are not probative in establishing or verifying that an in-service stressor occurred or that the Veteran’s claimed stressor is sufficient to cause PTSD. In addition, the Board acknowledges the Veteran’s lay statements; however, the Veteran and his family members have not been shown to have the training or credentials to provide a competent medical opinion on the etiology of his PTSD, as that requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The October 2020 examiner has training, knowledge, and expertise upon which he relied to reach the above determinations, and the opinion reflects a comprehensive, accurate, and reasoned review of the entire evidentiary record, as well as the Veteran’s lay statements. The Board finds that the October 2020 VA opinion is the most probative evidence with respect to the Veteran’s PTSD claim; it outweighs the other evidence of record, including the lay statements, as it contained a well-reasoned and thorough rationale supported by the evidence, is based upon a claims file review, and is presented by a medical professional with training and credentials. In sum, the Board concludes that the preponderance of the evidence is against a finding of a nexus between the Veteran’s PTSD and his service, as his in-service stressor could not be verified, and the weight of the evidence is against linking the diagnosis to the claimed in-service stressor. Therefore, the benefit of the doubt doctrine does not apply, and service connection for PTSD is not warranted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for an acquired psychiatric disorder, to include depression. The Veteran further claims that his chronic depression is also related to his experiences of handling dead bodies while stationed in Germany. The record confirms the Veteran has a diagnosis of depression. Thus, a current disability has been shown. However, as noted above, the in-service event is not supported by the record. In addition, the stress noted in service was within the context of the Veteran’s personal and family-related issues regarding the care of his son, which led to his discharge from service based on hardship. The Veteran’s STRs do not show any treatment or reports of psychiatric or depression symptoms that could be related to his time in service. In regard to nexus, October and February 2020 VA opinions state that the Veteran’s depression is less likely than not related to his active service, as the examiners found that there was a lack of evidence regarding the Veteran’s claimed in-service event (same as the stressor noted above for PTSD) that he states caused his depression, no diagnosis or reports of depression symptoms in his STRs that could be related to an in-service event or injury, and that his reports of mental health problems in and post-service were attributable to his ongoing non-service-related life stressors. The Board acknowledges the February 2020 VA opinion that provided a positive nexus regarding the Veteran’s depressive disorder. However, as noted above and explained in the October 2020 addendum opinion, which was requested in order to clarify and explain the basis of the positive nexus opinion, the positive opinion did not contain an adequate rationale and was not consistent with or supported by the evidence of record. The Board agrees with this finding as the February 2020 positive opinion merely stated that the Veteran did not have mental health issues prior to service but now has “clear symptoms of PTSD and major depressive disorder which began post service discharge but have been ongoing for many years hereafter.” Although the examiner did comment on the Veteran’s post-service mental health treatment records, she did not explain how the Veteran’s depressive disorder was related to his experiences in service, including handling dead bodies in Germany. This opinion also did not explain how his post-service mental health symptoms showed that depression was related to service based on the facts and circumstances in the record when providing the positive nexus opinion. In addition, this same examiner provided a negative nexus opinion on the same day the positive nexus opinion was provided, stating that although the Veteran does have a diagnosis of depression, there is no evidence it is related to his active service, as the Veteran did not report symptoms in service nor was the in-service event claimed by the Veteran supported by evidence other than the Veteran’s own lay statements. The Board finds that the February 2020 positive nexus opinion’s probative value is limited for the same reasons indicated above - the examiner did not provide an adequate rationale for the opinion and on the same day provided a negative nexus opinion regarding the Veteran’s depressive disorder that had a more adequate explanation supported by the evidence of record. As such, the Board assigns greater probative weight to the October 2020 opinion, which reconciled the inconsistent opinions provided by the February 2020 examiner. The October 2020 examiner explained that the Veteran’s STRs did not show reports of symptoms, diagnosis, or treatment for any psychiatric condition; the stress noted in service was within the context of a parent-child problem as the Veteran’s son had been diagnosed with a serious mental illness, and it was deemed in the best interest of the child for the Veteran to be discharged from service based on hardship; the record does not verify the Veteran’s claimed in-service event; and the Veteran did not seek treatment for his symptoms until several years after service in 1996 or 1997, and these symptoms were found to be attributable to the personal stressors in his family life, which led to his discharge from service based on hardship. Moreover, the Board acknowledges the lay statements of record provided by the Veteran’s family members regarding there being no family history of mental health issues. However, these lay statements are not probative in showing the Veteran’s depression had its onset in service, that the claimed in-service event occurred, or that there is a nexus between the Veteran’s depression and his active service. In addition, the Board acknowledges the Veteran’s lay statements; however, the Veteran, and the Veteran’s family members, have not been shown to have the training or credentials to provide a competent medical opinion on the etiology of his depression, as that requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The October 2020 examiner has training, knowledge, and expertise upon which he relied to reach the above determinations, and the opinion reflects a comprehensive, accurate, and reasoned review of the entire evidentiary record, as well as the Veteran’s lay statements. The Board finds that the October 2020 VA opinion is the most probative evidence with respect to the Veteran’s depression claim; it outweighs the other evidence of record, including the lay statements, as it contains a well-reasoned and thorough rationale supported by the evidence, is based upon a claims file review, and is presented by a medical professional with training and credentials. Therefore, the benefit of the doubt doctrine does not apply, and service connection for an acquired psychiatric disorder, to include depression, is not warranted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ariasaif, 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.