Citation Nr: 21003403 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 14-16 203 DATE: January 21, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), is denied. FINDING OF FACT The preponderance of the evidence is against finding that an acquired psychiatric disorder, to include PTSD and MDD began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and MDD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1980 to March 1982. This matter is before the Board of Veterans’ Appeal (Board) on appeal from a May 2012 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). The Board previously remanded the appeal in August 2014, October 2015 and April 2020, and the matter has been returned for appellate consideration. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and a major depressive disorder (MDD) The Veteran is seeking 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). With respect to the matter of service connection for a personality disorder, the Board observes that, congenital or developmental defects such as personality disorders are not “diseases” or “injuries” within the meaning of applicable legislation. 38 C.F.R. §§ 3.303 (c), 4.9, 4.127. In essence, as a matter of law, they are not disabilities for VA purposes. As such, service connection cannot be granted for the Veteran’s personality disorder. Sabonis v. Brown, 6 Vet. App. 426 (1994). However, service connection may be granted if the evidence shows that an acquired psychiatric disorder was incurred or aggravated in service and superimposed upon a personality disorder. 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). 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 his military service, to include PTSD and major depressive disorder. Additionally, the Veteran’s 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. Here, the Veteran asserts that he was diagnosed with PTSD at a VA hospital. The Veteran reported as an in-service stressor that while in basic training during live fire in the sawdust pit, he saw a soldier raise his head and be decapitated. He also stated that a terrorist organization during the Carter administration set street bombs that contributed to his PTSD and he was enrolled in the trauma program at VAMC. He also stated that he saw a tank run over two cars, killing families inside and that in Frankfurt, Germany he say people being blown up from explosions from bombs that were in trash cans. Additionally, the evidence in this case does not include any evidence corroborating the Veteran’s account of his claimed in-service stressors such as in-service treatment records or lay statements from other servicemembers. A response from the service department with respect to his claimed stressor regarding the soldier who was killed in a training exercise stated “[w]e researched the US Army historical records that are available to this office and were unable to document the incident described by [the Veteran] pertaining to the death of an unnamed soldier at Fort Knox, Kentucky during a live fire exercise.” In addition, the response noted that research with the US Army Combat Readiness/Safety Center resulted in negative results. Documentation in the file also indicates that there was insufficient information provided to corroborate the stressor regarding terrorists. The Veteran has not contended, and the evidence does not suggest, that there are any outstanding records that would corroborate this incident. Furthermore, to the extent the Veteran claims he engaged in combat, the preponderance of the evidence, including the Veteran’s service records, is against a finding that the Veteran engaged in combat. As the Veteran’s claimed stressor is unrelated to combat and has not been corroborated, the second element required under section 3.304(f) is not met. While the May 2020 and the August 2020 VA clinician’s opinions explained the Veteran did not meet the diagnostic criteria for PTSD, with the August 2020 examiner noting inconsistencies in the record/history, the Board acknowledges that treatment records show a diagnosis of PTSD. See January 23, 2015 VA treatment record. However, the question of whether the Veteran was exposed to a stressor in-service is a factual determination. In the circumstances of this case VA adjudicators are not bound to accept the Veteran’s statements simply because treating medical providers have done so. Wood v. Derwinski, 1 Vet. App. 190 at 193. The statements from the Veteran upon which the diagnosis of PTSD was made are unsupported. The medical evidence of record includes diagnoses of psychosis, cocaine abuse in remission, major depressive disorder, stimulant use disorder and personality disorder. The August 2020 VA examiner opined that there is no nexus between military service and the current psychiatric disorders. MDD manifested years after service. The Veteran first sought mental health treatment in 2010, almost thirty years after he left service. The October 2014 and March 2016 VA examiners found the Veteran to be experiencing an Unspecified Personality Disorder, but opined that it was not incurred in, aggravated by, and/or treated during his service. [While the 2015 Board remand found the 2014 opinion inadequate in that it did not address other diagnoses of record, it did not make any other findings with respect to the opinion obtained]. The August 2020 VA opinion provider reviewed the Veteran’s medical history, including his service medical and personnel records, and noted his difficulty in adapting to the requirements of military service. The examiner opined that no psychiatric disorder was incurred in service. Therefore, no psychiatric disorder could have been superimposed on a personality disorder in service. To the extent that the opinion provider suggests that a psychiatric disability preexisted service, the Board finds that the Veteran was presumed sound at entrance and the presumption of soundness has not been rebutted. Whether the presumption of soundness has been rebutted is an adjudicatory determination, not a medical one. Further, the opinion provider concluded that no psychiatric disorder began in service, was caused by service, or is otherwise related to service. The Board notes that the Veteran has a recorded history of drug and alcohol use. To the extent that he seeks to service-connection for either, 38 U.S.C. §§ 105(a) and 1131 states that compensation is precluded on a direct basis when the “disability is a result of the veteran’s own willful misconduct or abuse of alcohol or drugs.” The evidence does not suggest that his alcohol, and substance abuse can somehow otherwise be service-connected (i.e., on a secondary basis). The August 2020 VA clinician stated that substance use disorders are comorbid with personality disorders and opined that it is at lease more likely than not that substance abuse disorder is secondary to the Veteran’s Unspecified Personality Disorder. However, the Veteran’s Unspecified Personality disorder cannot be service connected. Consequently, service connection for alcohol and/or substance abuse is not warranted. The preponderance of the medical evidence, is against a finding that a psychiatric disorder other than PTSD is related to service. Additionally, the record shows no disorders were superimposed on the Veteran's Unspecified Personality Disorder. The VA examiners provided detailed rationale for these conclusions. These opinions are highly probative. 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. 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 C. Sowden, 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.