Citation Nr: 21063894 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 14-27 358 DATE: October 18, 2021 ORDER Service connection for an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has a current diagnosis of an acquired psychiatric disorder, to include PTSD, including as related to a fear of hostile military activity. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder to include PTSD are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 2002 to February 2007. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2017, a hearing was held before the undersigned. A transcript of the hearing is of record. The case was previously before the Board in February 2018 and January 2020 when it was remanded for further development. Entitlement to Service Connection for PTSD Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 C.F.R. § 3.303(a). Service connection generally requires credible and competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may only be granted for a current disability. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Establishing service connection for PTSD claims requires: (1) a PTSD diagnosis conforming to the criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5); (2) a link, established by medical evidence, between a Veteran's present symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. 38 C.F.R. § 3.304; Cohen v. Brown, 10 Vet. App. 128, 139 (1997). Under 38 C.F.R. § 3.304(f)(3), 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. Id. For these purposes, "fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Id. The Veteran is seeking service connection for an acquired psychiatric disorder, including PTSD. At her hearing before the Board in August 2017, the Veteran stated that while serving in Iraq, for almost six months they were under constant mortar and rocket attacks for two weeks in a row, then it would stop for a week and then it would start back up again. The building she was in was hit and she had to retreat to a bunker. The Veteran also was part of units that cleaned up after attacks. She stated that things such as movies would cause her to reexperience the events and she would get depressed and go hide. She would also avoid social situations. Buddy statements submitted also indicated that the Veteran had experienced mortar fire and rocket fire. The Veteran's service treatment records note that in an April 2003 pre-deployment questionnaire, the Veteran stated that she had not sought counseling or care for her mental health. In a December 2006 post-deployment health assessment, the Veteran stated that she did not see anyone wounded, killed, or dead during deployment, was not engaged in direct combat, did not feel that she was in great danger of being killed, and was not interested in receiving help for stress, emotional, alcohol, or family problems. She stated she had some feelings of feeling down, depressed, or hopeless over the past two weeks, and some feelings of little interest in doing things. She also indicated over the past month that she was on guard and felt numb or detached. She stated that she had thoughts of serious conflict with spouse, family members, or close friends. A January 2013 VA examiner reviewed the claims file and found that the Veteran did not have a mental disorder that conformed to the DSM-IV criteria. The examiner noted on the Veteran's post-deployment health assessment in December 2006 that she indicated that she denied seeing anyone wounded, killed, or dead during deployment, and that she denied engaging in direct combat or feeling that she was in great danger of being killed. She was not interested in receiving help for stress, emotional, alcohol, or family problems. The examiner found that the Veteran's stressor of experiencing mortar attacks in Iraq was adequate to support a diagnosis of PTSD and was related to fear of hostile military or terrorist activity, but the Veteran did not persistently re-experience traumatic events and did not experience persistent avoidance of stimuli associated with trauma, so she did not meet the criteria for PTSD. VA treatment records include a July 2014 PTSD assessment. The Veteran also recently resubmitted these records in August 2021. The Veteran identified difficulties with sleep and relationship concerns. She indicated that within the last four months she had destroyed property, threatened physical violence, and had been verbally abusive to others. The VA psychologist indicated that the Veteran did not provide any military records, so any military history was based upon self-report only. The psychologist indicated that the Veteran appeared to presently meet the DSM-5 criteria for PTSD, and reported intrusive and repeated memories of her service, reexperiencing events, avoidance, negative cognitions/moods, and hyperarousal symptoms associated with traumatic military experiences over the last month. However, she described variations in the frequency and intensity of her symptoms and the assessment took place just before the 4th of July, when many triggers such as unexpected loud noises, flashes, and burning spells were present in her environment. A buddy statement submitted in September 2017 by S.M., a fellow servicemember, indicated that he was deployed with the Veteran to Iraq, and that she was involved in several indirect fire incidents ranging from mortar fire to rocket fire. She worked in the tactical operations center and performed guard duty, as well as her duties as a cook. The Veteran underwent a VA examination in May 2018. The examiner indicated that the Veteran did not meet DSM-5 criteria for PTSD or any other psychiatric disorder. Regarding PTSD, the Veteran only met criterion A for the diagnostic criteria for PTSD, and did not meet any other criterion. The examiner stated that a review of the record showed a lack of delineation of symptoms sufficient to support the diagnosis of PTSD and other diagnoses. The examiner did concede that the Veteran was likely exposed to traumatic stressors in service and they were related to her fear of hostile military or terrorist activity. The examiner also noted that the Veteran had recently completed four counseling sessions with the Vet Center, but that it was not necessarily suggestive of the presence of a mental illness. The Veteran did not describe a clinically significant level of distress or functional impairment required for PTSD or any other diagnosis. Vet Center treatment records from April 2018 to February 2020 indicate that the Veteran suffered from episodes of hypervigilance, difficulty sleeping, difficulty with intimate relationships, job instability, isolation, startle responses, irritability, nightmares, occasional flashbacks and intense memories, and anger. She was noted to have sub-clinical PTSD and suffered from guilt and sleep problems. Notations were also made that the Veteran appeared to be struggling with symptoms related to PTSD. A VA addendum medical opinion was obtained in March 2020 from the May 2018 VA examiner. The VA psychologist reviewed the Veteran's claims file. Following a review of the claims file, including recent Vet Center records, the psychologist stated that it was quite clear that the Veteran continued to have an absence of a valid psychiatric diagnosis. She did not meet the DSM-5 criteria for any condition. Her Vet Center treatment records indicated a lack of delineation of symptoms sufficient to support a diagnosis of PTSD or any other DSM-5 diagnosis. The treatment records suggest that the topics of the treatment were essentially improving her coping with the average psychosocial stressors of life. The psychologist also noted that engagement in psychotherapy is not necessarily suggestive of the presence of a mental illness. The Vet Center records do not indicate that the Veteran was experiencing a clinically significant level of distress or functional impairment in any domain of functioning as a result of mental health symptoms. The Veteran has no history of psychotropic medication use or psychiatric hospitalization. The psychologist also noted the July 2014 assessment of PTSD but stated that it was unclear as to how the evaluator came to such a diagnostic conclusion. The evaluator submitted a lack of delineation of symptoms sufficient to support a diagnosis of PTSD or any other disorder. The psychologist also noted that in the May 2018 VA examination, the Veteran's statements regarding her traumatic events that were corroborated by her fellow servicemember S.M., were considered, but the question is not whether she was exposed to traumatic events, the question is whether the Veteran currently or historically carried a psychiatric diagnosis. The psychologist conceded that the Veteran was likely exposed to traumatic stressors, but did not meet the criteria for any psychiatric diagnosis. The Board notes that while the July 2014 VA treatment record includes an assessment of PTSD, the Board finds that the preponderance of the evidence is against a finding that the Veteran has been diagnosed with PTSD in accordance with the DSM for the period on appeal. Significantly, the July 2014 assessment of PTSD was made by the VA psychologist without a review of the claims file and discussed the Veteran's symptoms within the past month only, and indicated that the Veteran may have had heightened symptoms at that time due to having recently experienced the Fourth of July that year. As such, the Board finds that the July 2014 assessment is of low probative weight. The Board also notes that VA treatment records do show some positive PTSD screens; however, the Board notes that these screening tests are essentially a mere recording of the Veteran's subjective medical history based upon a four-question inquiry. The Veteran's lay reports that form the basis of the positive PTSD screens are insufficient to establish a formal diagnosis of PTSD, as the Veteran lacks the expertise to diagnose a complex psychiatric disorder such as PTSD, which has very specific requirements. Similarly, the four-question screening test underlying the positive PTSD screens of record is inadequate to support a formal diagnosis of PTSD under the full DSM criteria as required for service connection. 38 C.F.R. §§ 3.304(f), 4.125(a). As such, the Board finds that positive PTSD screens are of less probative value as to whether the Veteran has been diagnosed with PTSD in accordance with the DSM. The Board affords the greatest weight of probative value to the January 2013 VA examination and the combined May 2018 VA examination and March 2020 addendum opinion. These examinations and opinions document that the Veteran's symptoms did not meet the diagnostic criteria for a DSM-IV or DSM-5 diagnosis of PTSD or any other psychiatric disorder. The examiners performed in-person examinations, listened to the Veteran's history and current psychiatric complaints, reviewed the claims file, and provided a rationale that was based on an accurate description of the facts and medical principles. While the Veteran believes she has PTSD due to her service, the Board finds that the Veteran is not competent to render an opinion on this matter. While she is competent to report symptoms she has experienced, she does not have the medical training or experience to opine as to diagnosis of a mental health disability. See Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) (holding that "PTSD is not the type of medical condition that lay evidence . . . is competent and sufficient to identify"); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Such diagnosis requires medical expertise and falls outside the realm of common knowledge of a lay person. As such, the Board affords greater probative weight to the VA medical opinions which found the Veteran did not meet the diagnostic criteria for PTSD in relation to her in-service stressors. The Board finds that the preponderance of the evidence is against a finding that that the Veteran has been diagnosed with a psychiatric disability. Therefore, service connection cannot be granted. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). As the preponderance of the evidence is against the claim for service connection, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claim for service connection for an acquired psychiatric disorder to include PTSD is denied. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bonnie Yoon, 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.