Citation Nr: 21070943 Decision Date: 11/27/21 Archive Date: 11/27/21 DOCKET NO. 07-36 682 DATE: November 27, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and schizophrenia is denied. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of PTSD. 2. The Veteran's schizophrenia is not due to his military service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and schizophrenia have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from September 1963 to September 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2006 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter has a significantly long procedural history and was most recently before the Board in July 2021, when it was remanded for additional development, including issuance of a SSOC. The matter has been returned to the Board for further appellate proceedings. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may 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). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). 1. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and schizophrenia The Veteran contends that he is entitled to service connection for PTSD as a result of his military service. In adjudicating a claim for service connection for PTSD, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence. Hayes v. Brown, 5 Vet. App. 60, 66 (1993); see also 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.304 (f). The evidence necessary to establish the occurrence of an in-service stressor for PTSD will vary depending on whether or not the veteran "engaged in combat with the enemy." Id. If VA determines that a veteran engaged in combat with the enemy and that the alleged stressor is related to combat, then the veteran's lay testimony or statements are accepted as conclusive evidence of the occurrence of the claimed stressor. 38 U.S.C. § 1154 (b); 38 C.F.R. § 3.304 (f). If, however, VA determines that the veteran did not engage in combat with the enemy or that the alleged stressor is not related to combat, the veteran's lay testimony by itself is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain service records or other evidence to corroborate the veteran's testimony or statements. See Moreau v. Brown, 9 Vet. App. 389, 394 (1996). Initially, the Board concludes that the Veteran does not have a current diagnosis of PTSD now or at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303 (a), (d). Specifically, the Veteran's service treatment records, to include his April 1967 separation examination report, do not reflect treatment for or other evidence of PTSD during active duty. In regard to his post-service records, in May 2013, the Veteran underwent an initial PTSD examination. The examiner noted an extensive record of mental health treatment with diagnoses including bipolar disorder, depression, adjustment disorder, and personality disorder. However, the examiner noted the Veterans primary diagnosis has been schizophrenia over the past four decades and stated that the Veteran did not meet the criteria for a diagnosis of PTSD. In regard to the three specific incidents reported by the Veteran to the RO, the examiner noted that the Veteran only discussed one of these events during the examination and did not endorse any PTSD symptoms related to the event. The examiner found that the only diagnosis that appeared relevant since the Veteran filed his claim in March 2006 is schizophrenia and there is no indication based on the record review and the current examination that any other psychiatric disorder has been present since March 2006. Additionally, the examiner found no evidence of a psychotic disorder having manifested within one year of the Veteran's separation from active service in September 1967. The Veteran underwent a VA examination in August 2014. The examiner diagnosed the Veteran with schizophrenia. The examiner stated that the Veteran did not meet the criteria for PTSD, and he did not endorse any symptoms of PTSD during the examination which is consistent with past psychological evaluations. During his January 2016 initial PTSD VA examination, the examiner found that Veteran's symptoms did not meet the diagnostic criteria for PTSD under DSM-5 criteria. The examiner opined that it is unlikely that the Veteran has ever met the full criteria for PTSD as his records do not support a diagnosis based on reliable, thorough evaluation of symptoms. Further, the examiner stated that upon examination, the Veteran initially did not describe events that meet criteria for PTSD. He was asked directly about the stressors identified in this exam request and while he acknowledged those experiences, he denied all PTSD related symptoms. Thus, the Veteran experienced incidents that would satisfy Criterion A, but as observed by several treatment providers and examiners, the veteran denies all related PTSD symptoms. Therefore, the examiner concluded that the Veteran does not meet criteria for PTSD despite experiencing a Criterion A event. Consequently, the Board finds that service connection for PTSD is not warranted. Nevertheless, the Board recognizes that the Veteran has also claimed service connection for schizophrenia. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. However, the Board determines that service connection is also not warranted on this basis. First, while the Veteran's service treatment records reflect that he exhibited some mental health symptoms in service, it does not appear that these were chronic in nature, as the Veteran's separation examination in 1967 does not reflect any psychiatric symptoms. Indeed, there was not post-service evidence of psychiatric symptoms until a diagnosis of schizophrenia in 1971, and four years after he left service. The Veterans post-service treatment records dated November 1975 reveal that he has had several psychiatric hospitalizations with diagnosis with schizophrenia and chronic alcoholism. Further, medical treatment records from 1976 through 1987 show diagnosis of schizophrenia and VA hospitalizations. However, in 2006 during a visit to urgent care for an eye problem, the treating physician noted that it appeared that the Veteran has not had psychiatric treatment for many years, nor did he showed interest in receiving psychiatric treatment. As such, the medical evidence shows that the Veteran did not have symptoms/complaints, or a diagnosis related to a psychiatric disorder until approximately 1975. Therefore, a continuity of symptoms is not shown based on the medical evidence. Moreover, presumptive service connection pursuant to 38 C.F.R. § 3.309 (a) is not warranted because his psychiatric disorder did not manifest to a degree of 10 percent or more within a year of separation from active service. See 38 C.F.R. § 3.307 (a). As part of this claim, the Board recognizes the statements made by the Veteran regarding his history of symptoms. In this regard, while the Veteran is not competent to diagnose a psychiatric disorder, as it may not be diagnosed by its unique and readily identifiable features, and thus require a determination that is "medical in nature," he is nonetheless competent to testify about the presence of observable symptomatology, which may provide sufficient support for a claim of service connection, if credible, regardless of the lack of contemporaneous medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, the Board is unable to grant service connection based on the Veteran's own statements. Specifically, the Veteran's separation physical was silent for any mental health condition. Moreover, the Board notes that the Veteran submitted a claim for service connection for non-psychiatric disorders. It is intuitive that, had the Veteran been experiencing symptoms since service, he would have claimed service connection at that time. Next, service connection may nonetheless be established if a relationship may be otherwise established by competent evidence, including medical evidence and opinions. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's psychiatric disorder to active duty service. The Veteran was diagnosed with schizophrenia during his May 2013 and August 2014 VA examinations. The 2014 examiner noted that the Veteran presented with symptoms of delusional beliefs, tangential speech, loose associations, and disorganized thoughts and speech. Additionally, the examiner noted that there seem to be some cognitive limitations, particularly with respect to remembering dates of significant events, and judging the passage of time more generally. The Veteran underwent a new VA examination in January 2016. The examiner diagnosed the Veteran with schizophrenia. The examiner noted that the extent and severity of the veteran's schizophrenia is such that he is an unreliable historian which is common for individuals with similar disorders. Though schizophrenia can take various forms, disordered thinking is the common, unifying symptom across varying presentations. In the Veteran's case, the examiner stated that his presentation was marked with unusual statements demonstrating disordered thinking, problem solving, and limited ability to accurately form cause/effect relationships. The examiner opined that it is less likely as not that the veteran's schizophrenia was incurred in or is otherwise etiologically related to the veteran's active military service. In support, the examiner noted that there is no reliable medical evidence to link his schizophrenia with his military service. The examiner further opined that it is less likely as not that the Veteran's schizophrenia manifested within one year of his separation from active service. In support, the examiner stated that the veteran's reported level of functioning during the military does not reflect the presence of symptoms consistent with schizophrenia. Additionally, the examiner found that the earliest records of mental health treatment are from the early 1970's. Further, the veteran's lay statement regarding treatment for "nerves" and developing hypochondriasis in service, despite being unreliable, is not reflected in the STR's and there is no indication of treatment for" nerves" found in the military records. Even affording the veteran the benefit of the doubt regarding treatment for "nerves", there is insufficient evidence available to comment on its prevalence, severity, or relation to his schizophrenia. The Board finds that the examiners opinions are well-reasoned and is supported by the medical evidence rather than based on the Veteran's report of symptoms. The Board has also considered the statements made by the Veteran relating his psychiatric disorder to his active service. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007)). In this case, however, the Veteran is not competent to provide testimony regarding a diagnosis and/or etiology of a psychiatric disorder. See Jandreau, 492 F.3d at 1377, n.4. Because a psychiatric disorder is not diagnosed by unique and readily identifiable features, it does not involve a simple identification that a layperson is competent to make. Therefore, the Veterans statements, by themselves, are insufficient to establish service connection. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Vample, Erica