Citation Nr: 21068495 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 15-30 962A DATE: November 10, 2021 ORDER Entitlement to service connection for acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), is denied. FINDING OF FACT The objective medical evidence does not show acquired psychiatric disorder, to include PTSD, was incurred during active service, nor is it caused by an event, injury or illness occurring in active service. CONCLUSION OF LAW The criteria for service connection for acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from January 1968 to January 1970, to include service in Vietnam. He was awarded the Bronze Star Medal and Air Medal, among other decorations. Entitlement to service connection for acquired psychiatric disorder, to include PTSD. Service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in active service or that a preexisting injury or disease was aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2020). Establishing service connection generally requires: (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 in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran's service treatment records (STRs) show in both the January 1968 induction examination and the January 1970 separation examination, the examiners found a normal psychiatric evaluation of the Veteran. Additionally, the Veteran denied past or current frequent trouble sleeping, frequent or terrifying nightmares, depression or excessive worry, loss of memory or amnesia, and nervous trouble of any sort. The STRs overall show no reports, complaints, treatment, or diagnoses of any mental health symptoms or psychiatric disorders. The post-service record shows in March 2013, the Veteran presented for counseling at the Knoxville Veterans Center, during which the counselor identified PTSD symptoms of nightmares, night sweats, sleep difficulty, anger, difficulty concentrating and remembering, hypervigilant behavior, and exaggerated startled response, based on which she began an assessment. Counseling continued, during which the Veteran recounted stressor events, based on which in October 2013 the counselor concluded the Veteran endorses symptoms consistent with the required criteria at that time for PTSD under the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th Edition (DSM IV). She further identified symptoms of depression, sleep difficulty, fatigue, and "slowed thinking," as well as noting evidence of delusions and disorganized thinking. The Veteran was afforded a VA examination for PTSD in April 2014, in which the examiner at the outset stated the Veteran does not have a diagnosis of PTSD which conforms to the current diagnostic criteria under DSM-5 (5th Edition, which supplanted DSM-IV in August 2013). Consequently, she rendered no mental disorder diagnosis. The examiner noted the Veteran's reports of sleeping soundly, but not longer than 5 hours, sometimes waking sweating profusely, and overall waking not feeling refreshed. He further reported exhibiting excessive anger when impatient but assuring his wife it is not directed at her. He has startled responses, he denied hypervigilance, but admitted being somewhat over-careful in checking his door locks, he has experienced greater memory loss, but he denied any symptoms of depressed or anxious affect, psychotic symptoms or thoughts of self or other-directed violence, and he denied alcohol or other substance abuse. When presenting to VA in March 2017 and March 2018, the Veteran's PTSD screenings showed negative scores. VA depression screenings in September 2016, March 2018, March 2019, and August 2020 also showed negative scores. Similarly, an August 2019 VA cardiology consult noted the Veteran's denial of depression and anxiety. In its February 2019 Remand, the Board noted, although the April 2014 VA examiner found the Veteran did not meet the criteria for a PTSD diagnosis under DSM-5, she did not issue an opinion addressing DSM-IV, as the Board had directed. Moreover, the representative cited treatment notes from the Veteran's 2013 Veterans Center counselor, which indicate the Veteran may have met the criteria for a diagnosis of PTSD under the DSM-IV during the period at issue when it was still in effect. Therefore, the Board directed the Veteran be afforded an opportunity for an in-person mental health examination, in which the VA examiner identifies all current mental health disabilities under both the DSM-IV and the DSM-5, based on an examination of the Veteran and a review of the claims file. In August 2021, the Veteran underwent an VA examination for PTSD, after which the examiner stated the Veteran does not have a diagnosis of PTSD which conforms to DSM-5 criteria based on that day's evaluation and she did not diagnose a mental health disability. Other than some occasional anger directed at himself, the Veteran reported no irritability, depression or anxiety. The examiner found no symptoms which might be associated with any diagnosis. Accordingly, she found "[n]o mental disorder diagnosis" affecting occupational and social impairment. The examiner opined that claimed PTSD was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. She explained Veteran "does not have a current mental disorder diagnosis that meets DSM criteria." She further explained in her medical opinion summary that the Veteran reported he used to wake up with night sweats, but this rarely happens anymore. He denied anxiety or depressive symptoms. He does avoid some things, such as war movies and anything to do with the film actress, Jane Fonda. He reported recently he went to "the Wall" [presumably the Vietnam War Memorial in Washington DC] and some symptoms began, such as tearfulness when he watches something sad on television. The examiner added that it appears directly after Vietnam, the Veteran had symptoms, but he recovered from these as time went on. As stated, when he visited the wall, he started having feelings about this again. The Veteran denied recurrent images or thoughts of Vietnam. When asked about stressful events, he did not report anything about which he has nightmares or recurrent thoughts. However, the examiner added, she was "[u]nsure why the delusions/disorganized thinking was marked on the 2013 exam, because this was not seen during the interview." The Board has carefully considered the Veteran's reports to treatment providers and VA examiners as they appear throughout the record. The Board recognizes that laypersons are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. This evidence is discussed in detail in the following paragraphs. In the October 2021 Brief, the Veteran's representative argued the August 2021 VA examiner concluded the Veteran did not have a current diagnosis that met the DSM-IV criteria, but does not discuss or elaborate if the Veteran suffers from any other mental disorder and if that disorder could be due to his military service. The Board disagrees. First, regarding PTSD, the Veteran does not have and has never had a diagnosis of that disorder under DSM-5 or DSM-IV. The Vet Center record, specifically a Veteran Information Form, noted that PTSD was assessed March 26, 2013. This assessment was completed by a mental health provider that was not a psychiatrist or psychologist, and was not made following the specific criteria and evaluation protocol under DSM-IV or DSM-5. Even then, these records were considered when the VA examination directed by the Board in its February 2019 Remand was completed. At that time, the examiner was directed to consider both editions of the DSM, the August 2021 examiner explained that the Veteran "does not have a current mental disorder diagnosis that meets DSM criteria." The examiner found no such disorder and all medical evidence is negative as to such findings. Additionally, the August 2021 examiner, in considering the findings of the October 2013 Veterans Center counselor, specifically questions how it is the counselor could have arrived at findings of delusions and disorganized thinking, because, either there was no indication of those symptoms during the 2013 counselor's "interview" or, taking the August 2021 examiner's observation another way, such symptoms certainly were not found during her own interview of the Veteran. Although there is no dispute that an in-service stressor occurred, there is no current diagnosis of PTSD or medical evidence of a link or nexus between reported symptoms and the in-service stressor. More pertinent to the October 2021 Brief's argument, the August 2021 examiner specifically found "[n]o mental disorder diagnosis" affecting occupational and social impairment. The Board notes that all mental disorders are identified and evaluated in VA psychiatric examinations, whether for PTSD or any other mental disorder, as to its effect on occupational and social impairment. Here, the examiner did not identify any mental disorder whatsoever. Moreover, as set forth above, in her medical opinion summary remarks accompanying her opinion, the examiner in fact addressed the Veteran's prior reports during Vet Center counseling in 2013 and noted the comparison to what he presently reports. For example, he used to wake up with night sweats, but now reports this rarely happens. He presently denies anxiety and depressive symptoms. Although he was emotionally moved when visiting the Vietnam War Memorial, the Board notes from his reports in the remarks at the end of the examination that he was particularly affected by the cheers of "kids," as he and other veterans arrived, the very signs of appreciation he further reported had been denied him and other veterans when returning from active service in 1970 and which affects him to this day. Most significantly, he denies recurrent images or thoughts of Vietnam and he offered no report of stressful events about which he experiences recurrent thoughts or nightmares. Thus, the August 2021 examiner adequately reconciled prior conflicting evidence with current findings and reports. See Shoemaker v. Derwinski, 3 Vet. App. 248, 253 (1992). The Board further notes from the April 2014 examiner's behavioral observations that the Veteran "gave little indication of any concerns about his reactivity to combat traumas, and indicated he had no memory for his Viet Nam [sic] service. Examiner can only conjecture as to the etiology of his lack of memory for his service." Nonetheless, she concluded the Veteran "does not indicate symptoms consistent with any mental disorder at this time (emphasis added)." The August 2021 VA examination and accompanying opinion are adequate to decide the issue, as they are predicated on an interview with the Veteran, a review of the record, to include available service treatment records, and following an in-person examination. The opinion rendered considered all pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). As the record overall contains sufficient competent medical evidence to decide the claim, there is no necessity and no outstanding duty of VA to assist the Veteran further in his claim with an additional VA examination. See 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). For the foregoing reasons and based on the objective medical evidence, the Board finds the preponderance of the evidence is against the claim for service connection for any acquired psychiatric disorder, to include PTSD. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. As the preponderance of the evidence is against the claim, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. J. M. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Franke, 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.