Citation Nr: 21004769 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-05 511 DATE: January 28, 2021 ORDER Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and anxiety, is denied. FINDINGS OF FACT 1. The Veteran was not diagnosed with an acquired psychiatric disorder, to include PTSD and anxiety, under the DSM-V criteria, at any time during the period on appeal. 2. The Veteran’s diagnosed personality disorder is a congenital or developmental defect and is not a disease or injury for the purposes of service connection. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include PTSD and anxiety, are not met. 38 U.S.C. §§ 1110, 1155; 38 C.F.R. §§ 3.303, 4.9, 4.127. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from May 1966 to March 1970. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2019, the Board remanded the issue of entitlement to service connection for an acquired psychiatric disorder, to include PTSD and anxiety, for further evidentiary development. The Board finds that there has been substantial compliance with the prior remand instructions and no further action is necessary. See D’Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)). Service Connection The Veteran contends that he has PTSD as a result of in-service stressors related to the fear of hostile military activity. He stated that he continues to have great emotional stress, nightmares, and disorientation. He reported that when he wakes up from the nightmares, he feels that he is back in the bunker with his M-16 about to be killed during a rocket attack and thinks he is going to die. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. § 1110. Service connection may also 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). To establish service connection for a disability resulting from a disease or injury incurred in service, or to establish service connection based on aggravation in service of a disease or injury which pre-existed service, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of incurrence or aggravation of a disease or injury in active service; and (3) competent evidence of a nexus or connection between the current disability and the disease or injury incurred or aggravated in service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). 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. See 38 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128, 139 (1997). The provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform to the American Psychiatric Associations DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 5th Edition (DSM-V). In determining whether the Veteran has a current diagnosis of PTSD, the Board acknowledges that mental health professionals are experts, are presumed to know the DSM requirements applicable to their practice, and to have taken the DSM requirements into account in rendering a PTSD diagnosis. As such, a PTSD diagnosis provided by a mental-health professional must be presumed to have been made in accordance with the applicable DSM criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor, unless there is evidence to the contrary. See Cohen, 10 Vet. App. at 140. In making all determinations, the Board must fully consider the lay assertions of record. As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). Turning to the relevant evidence, service treatment records document a normal March 1966 enlistment examination. The Veteran reported depression and excessive worry at a March 1970 separation examination but had a normal psychiatric evaluation. Post-service treatment records are absent treatment or diagnoses of an acquired psychiatric condition. Of note, the Veteran had a negative PTSD screen in July 2015. The Veteran underwent a VA PTSD examination in April 2016. During that examination, the Veteran described stressors that included exposure to wartime experiences with active fire, seeing injuries/death, and loud noises within camp. After reviewing the claims file and administering a variety of psychological tests to determine whether a diagnosis of PTSD could be rendered, the examiner acknowledged the Veteran was exposed to the horrors of war, but found that the signs and symptoms presented did not meet the criteria required to support a diagnosis of PTSD. The examiner indicated that the Veteran currently experienced recurrent, involuntary, and intrusive distressing memories of the traumatic events he experienced in service, and that he experienced sleep disturbance and a persistent negative emotional state (fear, horror, anger, guilt, or shame) associated with the traumatic events in service. The duration of these disturbances was indicated to have persisted for more than one month. The examiner explained that a PTSD diagnosis could not be made because there was an absence of any of the listed symptoms at a clinically significant level of impairment. The examiner concluded that the Veteran experienced anxiety but nonetheless found the criteria for any mental health diagnosis were not satisfied. In its February 2019 remand, the Board requested another VA examination and medical opinion addressing whether the suggested functional impairment shown on examination was related to service stressors. The Veteran was afforded another examination in December 2019. The Veteran reported that he was a Vietnam veteran and had nightmares of his experience during the Vietnam war. The examiner determined that the Veteran had symptoms of disturbance of motivation and mood and met PTSD diagnostic criteria A and B. The examiner also reported that the Veteran was irritable and belligerent and refused to cooperate with the examination. The Veteran did not answer any questions but provided a brief written narrative of his situation. The examiner noted that the Veteran complained about the VA system, refused to answer questions, and left the appointment after 15 minutes. The examiner opined that the Veteran exhibited symptoms of personality maladjustment supporting the hypothesis of a personality disorder with narcissistic and histrionic features. Under these circumstances, the Board finds that the Veteran did not complete the December 2019 VA PTSD examination without good cause. The Board notes that the duty to assist a claimant is not a one-way street, and in the instant case, the Veteran has failed to cooperate to the full extent in the development of his claim. Wood v. Derwinski, 1 Vet. App. 406 (1991). In view of the foregoing, the Board concludes that there is no duty to attempt to provide another examination or medical opinion. As VA has fulfilled the duty to notify and assist to the extent possible, the Board can consider the merits of this appeal without prejudice to the Veteran. Bernard v. Brown, 4 Vet. App. 384, 394 (1993); see also Kyhn v. Shinseki, 26 Vet. App. 371, 374 (2013) (noting that the “Secretary correctly states that Baxter ‘holds that the Board need not examine whether the presumption of regularity has been rebutted unless and until an appellant, at a minimum, alleges that he did not receive the document in question’”). Where entitlement to a benefit cannot be established or confirmed without a VA examination and the Veteran fails to report for an examination scheduled in conjunction with an original compensation claim or a reopened claim for a benefit which was previously disallowed, the claim shall be rated based on the evidence of record. 38 C.F.R. §§ 3.655(a)-(b). Due to the Veteran’s lack of cooperation in completing the scheduled VA examination, the Board was unable to obtain medical evidence that is relevant to the claim. Thus, the Board finds that all reasonable efforts were made by VA to obtain evidence necessary to substantiate the Veteran’s claims, and no further assistance to develop evidence is required. As such, the claim for service connection for an acquired psychiatric disorder must be decided based upon the evidence of record. After review of the record, the Board finds that the Veteran does not have a diagnosis for which service connection may be granted. Turning first to the Veteran’s statements, the Board acknowledges that laypersons are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, while the Veteran may be competent to report the manifestation of symptoms of PTSD and anxiety, he has not shown that he has specialized training sufficient to render such an opinion on the cause of his current psychiatric disorder. In this regard, the diagnosis and etiology of psychiatric disorders are matters not capable of lay observation and require medical expertise to determine. Accordingly, the Veteran’s opinion as to the diagnosis or etiology of his psychiatric disorder is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Bostain v. West, 11 Vet. App. 124, 127 (1998); Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Hence, his lay assertions in this regard have no probative value. Due to the Veteran’s lack of cooperation at the December 2019 VA examination, the Board was unable to obtain medical evidence that is relevant to the claim. There otherwise is no competent and persuasive evidence showing that the Veteran has a current disability of an acquired psychiatric disorder. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Here, the competent evidence of record fails to support a diagnosis for PTSD, anxiety, or any other acquired psychiatric disorder, under the required DSM-V criteria, at any time during the appeal period. Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). The Board notes that a diagnosis under DSM-V is required for compensation for psychiatric disabilities. Without a diagnosis that for PTSD or anxiety, under the DSM-V criteria, the Veteran fails to meet the requirements of service connection. Id. Furthermore, a personality disorder is not a disease or injury within the meaning of applicable legislation for disability compensation purposes. See 38 C.F.R. §§ 3.303(c), 4.9; Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). However, service connection may be granted in limited circumstances, for disability due to aggravation of a constitutional or developmental abnormality (to include personality disorder), by superimposed disease or injury. See VAOPGCPREC 82-90, 55 Fed. Reg. 45,711 (1990); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993); VAOPGCPREC 82-90. Here, the Board finds no evidence of additional disability due to in-service aggravation of any personality disorder by superimposed disease or injury during service. As such, service connection for a personality disorder must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). The Board is grateful to the Veteran for his honorable service, and regrets that a more favorable outcome could not be reached. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Bilstein, 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.