Citation Nr: 21061506 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 15-15 248 DATE: October 4, 2021 ORDER Entitlement service connection for an acquired psychiatric disorder other than posttraumatic stress disorder (PTSD), to include major depressive disorder, panic disorder, or alcohol use disorder, is denied. FINDING OF FACT An acquired psychiatric disorder other than PTSD, to include major depressive disorder, panic disorder, or alcohol use disorder, did not develop in service and is not causally related to an event, injury, or disease in service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder other than PTSD, to include major depressive disorder, panic disorder, or alcohol use disorder, have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 2, 1981 to April 28, 1981. The Department of Veterans Affairs (VA) is grateful for service. The Veteran testified before the undersigned Veterans Law Judge of the Board of Veterans' Appeals (Board) at a Travel Board hearing in March 2018, a transcript of which is of record. In January 2019, the Board reopened and remanded the claim for service connection for an acquired psychiatric disorder. The Board remanded the claim again in July 2019 and July 2020. In December 2020, the Board trifurcated the claim, denied service connection for other specified personality disorder, mixed narcissistic and antisocial features; denied service connection for PTSD; and remand the appealed claim now before the Board of entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include major depressive disorder, panic disorder, or alcohol use disorder. The Board remanded the appealed claim again in May 2021, and it now returns to the Board for further review. Claim of entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include major depressive disorder, panic disorder, or alcohol use disorder Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §1131; 38 C.F.R. § 3.303. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303 (d). The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 433-34. In determining the weight to be assigned to evidence, credibility can be affected by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self- interest, malingering, desire for monetary gain, and witness demeanor. Caluza v. Brown, 7 Vet. App. 498, 511, 512 (1995), aff'd per curiam, 78 F.3d. 604 (Fed. Cir. 1996). The Veteran essentially contends that his current psychiatric disability is the direct result of his perception that the U.S. Navy breached his enlistment contract. The Veteran served on active duty from April 2, 1981 to April 28, 1981, with separation based on voluntary separation following the Veteran's disqualification from OS Class "A" School. The record does not reflect any medical finding of psychiatric disability for decades following service. The Veteran's February 1981, Four Year Obligor School Guarantee Program contract shows that he had been guaranteed assignment to the OS Class "A" School, and he signed indicating that he understood that his eligibility would be rechecked during recruitment training and subsequent schooling. It was stated that if he became ineligible that he had the option of being reassigned or honorably discharged from the Navy. The Veteran's service treatment records show that on his February 1981 entrance examination report it was indicated that he passed the FALANT (Farnsworth Lantern Test), with "RYG-Passed" handwritten. However, in the summary of defects it was noted: "Defective Color Vision." He was found qualified for service. April 1981 eye examination reports show that he failed the FALANT twice. The Veteran's military personnel records show that he signed a statement acknowledging that he enlisted in the Navy under the school guarantee program, OS (Operation Specialist); that he had been found disqualified due to defective color perception; that he had been fully counseled as to his options for continuation in service under other fields of guaranteed training or his option for separation from the Naval service; and that he elected separation from service. Service personnel records show that it was determined that enlistment was erroneous, and the Veteran was separated from service. The records show that he was eligible for reenlistment except for the disqualifying factor of erroneous enlistment, which would require prior approval of the Chief of Naval Personnel. The Veteran signed a statement that he had been informed of the authority and reason for his separation and of his reenlistment code, and he indicated that he did not desire a written statement containing the reason and authority for his separation and his reenlistment code. The Veteran presented several lay statements in support of his claim. In October 2012, his cousin wrote: "I can honestly say that [the Veteran's] life was severely impacted by his experience with the Navy." It was stated that his "emotional state was a mess when he came home from the Navy and even now he still struggles with it." In an October 2012 letter, D.T., a relative, stated that when the Veteran returned home "he was not the same person," and what happened in service "had a very negative effect on him and he brought it home to us." In an October 2012 letter, E.S.G., who had known the Veteran for 40 years, provided a very detailed description of the Veteran's situation upon returning from service and thereafter. In a March 2018 letter, the Veteran's son wrote about his knowledge of the Veteran's separation from service, which included the Veteran's decision to take an honorable discharge from the Navy so that he could then enlist in the Army, not knowing that he would receive a re-enlistment code that would prevent it. It was pointed out that the Navy knew at the time the Veteran was accepted that he had defective vision such that the Navy's conduct was perceived as intentional. In an October 2012 letter, T.B., a younger brother, stated: "I can say with authority that [the Veteran's] experience in the Navy had a negative effect on him mentally and emotionally.... When [the Veteran] came home he was clearly not the same. Emotionally he was a wreck. His anger, depression, stress, and even his confusion were all something that the rest of his family would have to deal with from that point on." It was stated that his anger stemmed from the Navy not honoring "their part of a contract" and giving the Veteran a re-enlistment code that prevented him from serving in any branch of service. It was stated that he "would talk about it for hours while drinking himself into a drunken state." It was stated that the Veteran would "pull out his contract and show it to us all the time saying, 'I had a contract.'" It was opined that his depression was "because he felt he was a failure." It was stated: "Even now many years later, he still carries his duffle bag around, worn and tattered with moth holes. Obviously, he is still attached to the Navy but it's not in a way that's pleasant to see." Additionally, throughout the adjudication of this claim, the Veteran has provided numerous, detailed statements of his own. Dr. R.S.'s treatment notes show that in December 2012 the Veteran expressed disappointment with his holiday, that he was, once again, unable to give gifts to his children, sharing that he related, in his mind, to his discharge from the military and his inability to pay child support as a result. He reported that he felt the experience "was the beginning of his life's downturn." In April 2013, it was recorded that the Veteran continued to vent about his short time in the military, changed job description, his subsequent discharge, and his breach of contract lawsuit. It was noted that when Dr. R.S. tried to bring the Veteran to the present, he became somewhat defensive, refusing to generate an alternative plan for success besides pursuing the lawsuit. It was noted: "He did state that he finds some benefit to venting about past injustices." In August 2013, it was noted that the Veteran "shared more about his narrative of being lied to by Navy recruiter and having that branch put out [sic] hold on his employment in the other branches. He shared about what he feels were repercussions, perseverating about loss of idealism." In November 2019, the Veteran was afforded a VA examination for PTSD, during which, in pertinent part, other specified personality disorder, mixed narcissistic and antisocial features, was diagnosed. In August 2020, the Veteran was afforded a VA examination for mental disorders, which was performed by the same examiner and, again, other specified personality disorder, mixed narcissistic and antisocial features, was diagnosed. The examiner indicated that it was possible to differentiate the symptoms of the Veteran's multiple psychiatric diagnoses, explaining that his personality disorder was manifested by "repeated acts that are grounds for arrest, failure to plan ahead, repeated physical fights, repeated failure to honor financial obligations (nonpayment of child support), a sense of entitlement, arrogant behavior, fury when not catered to, sensitivity to "injury" from any form of defeat, criticism or failure leads to rage." The examiner opined that the Veteran's personality disorder was at least as likely as not "aggravated by the in-service event of inability to enter OS Class 'A' and early discharge." It was explained: Individuals with Narcissistic Personality Disorder (part of the Claimant's current PD) are overly sensitive to injuries to self-esteem and that "criticism may haunt these individuals and may leave them feeling humiliated, degraded, hollow, and empty" (DSM-5, pg. 671). A perceived failure for an individual with this PD can lead to a lifelong obsession with righting the wrong done to him, as it has in this claimant, documented by Dr. R.S.'s notes. In November 2019 and August 2020, the Veteran was afforded VA examinations for PTSD and mental disorders, respectively, during which diagnoses of major depressive disorder, panic disorder, and alcohol use disorder were assigned. At the August 2020 VA examination, the examiner concluded that the limits of medical knowledge made it impossible to render an opinion without resort to speculation as to whether the Veteran's diagnosed major depressive disorder, alcohol use disorder, and panic disorder were causally related to service. The examiner attributed this impossibility in part to the absence of medical records for the interval from 1981 to 2008, and an associated impossibility of determining when his psychiatric disabilities began. While the examiner noted that many lay statements in 2012 were to the effect that the Veteran had depressive symptoms following his service discharge, depressive symptoms could be due to many diagnosed conditions, and hence it would be pure speculation to state what mental health condition the Veteran had prior to 2008. In December 2020, the Board found that the medical opinions provided by those examinations were inadequate for questions of etiology for claimed psychiatric disability other than PTSD. Accordingly, the Board remanded the claim for service connection for an acquired psychiatric disorder other than PTSD for an examiner to address the likelihood that the Veteran's psychiatric disorders other than PTSD were causally related to his brief period of service, since the August 2020 VA examiner failed to address those questions as previously posed. In December 2020, the Board also denied service connection for a personality disorder with mixed narcissistic and antisocial features because personality disorders are not recognized as disabilities subject to service connection, as a matter of law, pursuant to 38 C.F.R. § 3.303(c), and hence whatever role his personality disorder may have played in the Veteran's reaction, this is also not a basis of service connection for any psychiatric disability. In December 2020, a VA examiner provided separate addendum opinions addressing the Veteran's diagnosed major depressive disorder, panic disorder, and alcohol use disorder. The examiner carefully reviewed the record including the lay statements contained within the record and submitted on the Veteran's behalf to the effect that following service the Veteran had various symptoms of depression, panic, and alcohol use disorder. For each of these diagnosed mental disorders, the examiner separately opined that regardless of when the disorder began it was not at least as likely as not that the disorder was due to or aggravated by an in-service injury, event, or disease; and it was not at least as likely as not that the disorder was related to the Veteran being disqualified for his chosen in-service training program due to colorblindness. The examiner noted that the Veteran was in the Navy for 26 days in April 1981, he signed a contract that guaranteed OS Class "A" school but was found ineligible for that program due to colorblindness, and he opted for an honorable discharge instead of accepting a different qualification rating. The examiner then noted that upon a VA examination in November 2019 the Veteran was provided an initial diagnoses of PTSD, major depressive disorder, panic disorder, alcohol use disorder, and other specified personality disorder with mixed narcissistic and antisocial features; and that the November 2019 examiner found that none of these were not related to service. The December 2020 examiner then opined that the Veteran's major depressive disorder and panic disorder were secondary to his other specified personality disorder with mixed narcissistic and antisocial features, and that this mixed personality disorder clearly and unmistakable existed prior to service. To support this opinion, the examiner noted that antisocial personality disorder was associated with anxiety disorders including panic disorder, was also associated with depressive disorders including major depressive disorder, and was also associated with substance use disorders. The examiner further explained that narcissistic personality disorder was associated with "persistent depressive disorder (dysthymia)" and major depressive disorder. The examiner added that the Veteran's alcohol use disorder was in remission and in any case was not recognized as a diagnosis in DSM 5. In May 2021, the Board again remanded the claim for an examination addendum to address in the Veteran's specific case why it was believed that the Veteran's claimed psychiatric disorders were not caused or aggravated by an in-service injury, event, or disease. Addenda were obtained in June 2021. The claims file including submitted lay statements were reviewed. The examiner provided separate medical opinions against each of the claimed major depressive disorder, panic disorder, and alcohol use disorder. The examiner concluded that the Veteran's major depressive disorder, panic disorder, and alcohol use disorder were due to his mixed personality disorder with narcissistic and antisocial features; and that this personality disorder clearly and unmistakably existed prior to service and clearly and unmistakably was not aggravated by service. The examiner endorsed findings from the prior addendum in December 2020, and also noted that there were not "records from [any] professional over an extended period of time to confirm that there was emotional dysregulation in 1981 to have affected the Veteran's quality [of functioning], as there are no treatment records or medical notes to show a connection between time frames of 1981 to more recent mental health diagnosis and claimed emotional dysregulation." The examiner thereby concluded that each of the claimed psychiatric disorders were not caused or aggravated by an injury, event, or illness in service. The Board has carefully reviewed the record and finds that the weight of competent and credible evidence is consistent with and supportive of the findings and opinions of the VA examiner in the obtained addenda. While the Veteran's friends and family members have provided statements and opinions to the effect that the Veteran had psychiatric disorders after he returned from service, with statements to the effect that he was severely impacted or not the same person or that he could not get over the failure of the Navy to fulfill the contract that he had signed. However, these lay statements are lay impressions made may years after service, potentially influenced by a myriad of factors, not least by the Veteran's reported dwelling on the circumstances of his brief service for years, upon which presentation friends and family members relied. In short, the Board does not find that these lay statements provide convincing evidence of symptoms of psychiatric disorders manifesting immediately or shortly after service, and the Board also does not find that these lay statements tend to support a causal link between the brief experiences and interactions of the Veteran in service and his psychiatric disabilities present during the claim period. The Board finds that the weight of the evidence rather supports the addendum opinions of the VA examiner to the effect that the Veteran's psychiatric disabilities are unrelated to service but rather are due to his personality disorder. Medical knowledge about the nature of such psychiatric disorders as related to and caused by the type of mixed personality disorder possessed by the Veteran amply informs those medical opinions, as do the absence of medical evidence for decades following service to support any psychiatric disorder proximate in time to service or causally linked to service. The exceedingly brief interval of service amounting to simple disqualification over the course of less than a month due to the physical defect of colorblindness has been convincingly medically rejected as the cause of the Veteran's claimed psychiatric disorders, with the Veteran's lifelong personality disorder rather identified as the likely cause of the psychiatric disorders. The Board finds that the weight of competent and credible evidence supports this. Moreover, the examiner's opinions are probative because she is a medical professional, her opinions are based on an accurate medical history, after review of the record including extensive lay statements, and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). She cites to known medical principles in support of her opinions. Consequently, the Board gives significant probative weight to the VA examiner's opinions. Accordingly, the Board finds that the preponderance of the evidence is against the claim, based on absence of a medical nexus between an event, injury, or disease in service and claimed psychiatric disability, and service connection must be denied. 38 C.F.R. § 3.303. To arrive at this determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against entitlement to the service connection for an acquired psychiatric disorder to include major depressive disorder, panic disorder, and alcohol use disorder, that doctrine is not applicable. 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). L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Schechter 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.