Citation Nr: 21073909 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 13-09 455A DATE: December 13, 2021 ORDER Entitlement to service connection for an acquired psychiatric disability to include posttraumatic stress disorder (PTSD), depressive disorder, anxiety disorder and adjustment disorder, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's current acquired psychiatric disability began during active service or is otherwise related to an in-service injury or disease or is secondary to service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for acquired psychiatric disability due to service or service-connected disabilities are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1984 to August 1984, from June 1985 to August 1985, from December 1990 to June 1991, and from August 2011 to May 2012. The claim was most recently before the Board in June 2021 when it was remanded for additional development. The Board finds there has been substantial compliance with the remand directives for the claim decided herein. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran testified at a March 2015 Board hearing before a different Veterans Law Judge. In a March 2021 letter, VA advised the Veteran that the Veterans Law Judge who conducted the March 2015 hearing was no longer with the Board. The Veteran was also advised of the right to testify at a hearing before a different Veterans Law Judge who would decide the claim. 38C.F.R. §20.717. The March 2021 letter stated that, if there was no response within 30 days from the date of the letter, the Board would assume that the Veteran did not want another hearing and would proceed accordingly. The Veteran and the Veteran's representative did not respond to the March 2021 letter. 1. Entitlement to service connection for an acquired psychiatric disability to include PTSD, depressive disorder, anxiety disorder and adjustment disorder. The Veteran contends that he has an acquired psychiatric disability that is due to his active service, including an in-service assault. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F. 3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The questions for the Board are 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, and whether the Veteran's current disability is proximately due to or aggravated by a service-connected disability. The Board concludes that, while the Veteran has a current diagnosis of acquired psychiatric disability, and evidence shows that the Veteran was seen for mental health treatment while in service and for treatment after being assaulted, the preponderance of the evidence weighs against finding that the Veteran's current diagnoses of acquired psychiatric disability began during service or is otherwise related to an in-service injury, event, or disease. The Veteran reported that he was assaulted in service. Service treatment records indicate that in August 1984 the Veteran was treated after being assaulted. January 1999, February 1999 and April 1999 treatment notes indicates that the Veteran was diagnosed with anxiety disorder. In a statement dated in December 2008 a sister of the Veteran indicated that the Veteran was different after he returned from service in the Gulf War. She reported that the Veteran may be going through depression. The Veteran was reported to be drinking a lot more than usual. Before service the Veteran was very responsible, hard-working, had a good job, etc. After service he cannot seem to get his life together. In a statement dated in December 2008 the Veteran's mother indicated that the Veteran was more nervous since he was in the Gulf War. A friend of the Veteran reported in a statement that when the Veteran returned home from active-duty service he seemed fine but as time went on changes were noticed. He drank more, had trouble getting a job and when he got a job had trouble keeping the job. He had difficulty dealing with relationships. In June 2005 treatment records the Veteran was diagnosed with adjustment disorder, rule out PTSD, and depression. A service treatment record in November 2009 Report of Medical History, the Veteran denied all nervous trouble. In February 2010 the Veteran denied mental health concerns. The Veteran reported for a VA examination in December 2009. The Veteran's employment history and ability as well as his prior medical history were discussed. The Veteran's use of alcohol was considered. The examiner reported that that the Veteran stated that his experiences in Iraq were not extremely upsetting or stressful and the Veteran denied combat. The Veteran reported that he was assaulted while in basic training. The examiner diagnosed the Veteran with adjustment disorder, with mixed emotional features and alcohol abuse. No opinion was rendered regarding the etiology of the disability. In March 2012 the Veteran was diagnosed with adjustment disorder with anxiety. Subsequent treatment notes disclosed a diagnosis of adjustment disorder with mixed disturbance of emotions and conduct, and sleep difficulties. A private treatment note dated in June 2012 the Veteran was diagnosed with PTSD, alcohol abuse, partner relational problems, and adjustment disorder with disturbance of emotions and conduct. In July 2012, August 2012, and September 2012 the Veteran was diagnosed with depressive disorder, anxiety disorder, rule out PTSD, with alcohol abuse ruled out. The Veteran reported for a VA examination in August 2012. The Veteran was diagnosed with adjustment disorder with mixed disturbance of emotions and conduct and alcohol abuse. The Veteran was noted to have been recently deployed to Kuwait from August 2011 to May 2012. He described experiencing family stress with his wife and stepson during his deployment, but he did not experience criteria A stressors. He experienced multiple problems since his return from deployment, many of them alcohol related. The Veteran's history as well as stressors were discussed. However, an opinion regarding the etiology of the Veteran's disability was not provided. An addendum opinion was obtained in November 2012. The examiner noted that the Veteran's adjustment disorder was acute, given duration of less than six months from the end of his deployment. Given the nature of an adjustment disorder, it is more likely than not that symptoms would have remitted between the examination in December 2009 and the Veteran's period of active duty in August 2011. Therefore, it was opined that it is less likely than not that the Veteran's adjustment disorder was aggravated beyond its natural progression by his active duty. In a December 2013 VA treatment note, a clinician reported a diagnosis of adjustment disorder with mixed disturbance of emotions and conduct, rule out alcohol use disorder, rule out unspecified depressive disorder, rule out unspecified anxiety disorder, and rule out mild neurocognitive disorder. A December 2013 VA treatment note indicates that the Veteran was followed by a private provider until April or May of that year. Treatment records to 2012 from this provider have been associated with the claims file. Thereafter, the Veteran has been asked to identify and provide authorization for all relevant records, including in January 2017 and August 2017 letters. The Veteran has not identified or provided these records. Therefore, the Board will continue with adjudication. The Veteran reported for VA examinations in January 2014, October 2015, and August 2019. However, these examinations were found inadequate by the Board in May 2015, October 2018, and July 2020. In March 2018 the Veteran reported that he had ongoing anxiety, depression, and PTSD since returning from a tour of duty in the Gulf War in 1991. He presented to the emergency department for mental health. However, he was discharged with a finding of no current psychiatric treatment or medications. The Veteran reported for a VA examination in December 2020. The Veteran was diagnosed with unspecified anxiety disorder. The examiner identified the Veteran's reports of treatment for anxiety while in service. The examiner rendered the opinion that the claimed condition to include PTSD, depressive disorder, anxiety disorder and adjustment disorder was less likely than not incurred in or caused by service including but not limited to having been attacked with shovels during basic training in 1984 by several other soldiers, and suffering a concussion as a result of this incident. The examiner reported that the Veteran did not have a diagnosis of PTSD, depressive disorder, or adjustment disorder. He met the criteria for unspecified anxiety disorder due to his current report of symptoms. The examiner reported that service treatment records showed the Veteran being treated for an adjustment disorder in March 2012. They also show that in April 2012, the Veteran was placed on physical profile for anxiety. The examiner found that the service treatment records reflect treatment for adjustment disorder in 2005 and 2012 due to situational stresses at the time. The examiner explained that the nature of an adjustment disorder is that it occurs in response to an identifiable stressor and the symptoms resolve soon after the stressor resolves. His current diagnosis of unspecified anxiety disorder appears unrelated to having been attacked with shovels during basic training in 1984 by several other soldiers and a subsequent concussion. His anxious symptoms are not reported to have anything to do with the above-mentioned incident and he stated that he felt anxious about work or when he is overwhelmed with too many tasks. The examiner reported that the remand indicated that the remand letter stated that the Veteran claimed that his alcoholism did not manifest until after his most recent deployment in 2011. His VA treatment records note "Alcohol Abuse" and the VA examination in 2012 listed Alcohol Abuse. There are records as recent as January 2019 noting possible Alcohol Use Disorder and a provider in 2013 indicated possible alcohol abuse in 2013 during his intake. Upon this examination, the Veteran reported drinking 2 to 3 beers each day. He denied problematic use or concern about his alcohol use. No substance use disorder was indicated at the time. The examiner found that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Veteran reported for a VA examination in July 2021. The Veteran was diagnosed with unspecified anxiety disorder. The examiner found that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Veteran was noted to report that he was not the same after military service. He was not in combat and he could not identify an event that meets the definition of trauma that was still affecting him. The PTSD evaluations in 2009 and 2012 included the diagnosis of Alcohol Abuse. The examiner found that the diagnosis is not relevant since the Veteran reported that currently he does not experience any problems because of his use of alcohol. He does not report current behavior that would be considered a disturbance of emotions and conduct as listed in PTSD Initial 2012. The examiner found that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness, in response to a request for an opinion regarding whether his psychiatric disability is at least as likely as not a psychiatric disability was caused by the service connected disabilities. The examiner noted that when asked directly if he had any medical conditions, service connected or not, that had any impact on his current mental health, the Veteran stated he did not. Furthermore, when discussing his current situation, the Veteran did not refer in any way to any medical disabilities or conditions that troubled him. The examiner found that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that the Veteran has a mental health diagnosis, but there is no evidence that it is the result of his military service. The Veteran was seen three times for mental health services prior to leaving the military. However, the diagnosis of Adjustment Disorder with Anxiety is no longer relevant since at the time the Veteran was adjusting to issues related to his relationship with his wife. He was no longer married to her and had not been for many years. The diagnosis of an Adjustment Disorder indicates that the person giving that diagnosis believes that once the situation that is disturbing to the patient is removed the patient will return to normal functioning. The examiner found that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The claimed conditions were identified as PTSD, depressive disorder, and anxiety disorder, and the in-service injury was identified as being in the military. The examiner noted that the examiner, and those before, did not find evidence that the Veteran's mental health was affected by his military service. The Veteran's various diagnoses appeared to be a reaction to his living situation at the time, and not a continuation of a mental disorder from his service. There was no evidence of PTSD. The examiner found that the Veteran's in-service mental health did not, and does not, cause, contribute or aggravate his current condition. The examiner found that it was less likely than not, in response to a request for an opinion as to whether it is at least as likely as not that a psychiatric disability was present during active service or a psychosis manifested within one year following separation from active service. The examiner explained that neither the Veteran nor any of the numerous examiners over the years, have indicated that the Veteran suffered from a psychosis during or after his service. Over the years the Veteran has been diagnosed with various disorders. However, a connection to his military service has not been made. Instead, situations in his life at the time appeared to be the cause of his symptoms. Furthermore, the level of symptoms that the Veteran reported to the examiner were suspect in that he did not exhibit any of them while in the examiner's presence and were reported to be at the extreme level, yet the Veteran stated that he was only somewhat disturbed by them. In addition, the Veteran stated he was not interested in medications or therapy to reduce his symptoms. The examiner found this unusual. Entitlement to service connection for an acquired psychiatric disability is not warranted. It is acknowledged that the Veteran is diagnosed with acquired psychiatric disabilities. It is further acknowledged that service treatment records and records dated during a period of service show treatment after an assault and mental health treatment. However, the Veteran's current psychiatric disabilities are not related to or aggravated by his active service or any service-connected disability. Although the Veteran has reported that he first had problems following his active service and statements submitted indicate that the Veteran was different following his service, the issue is medically complex that go beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F. 3d 1372, 1377, 1377 (Fed. Cir. 2007). VA medical examiners have found that the Veteran's disabilities are not related to his active service, that the Veteran did not have psychosis within one year of service, and that the Veteran has denied that his disabilities are due to or aggravated by his service-connected disabilities. The examiner found that the Veteran did not have a diagnosis of PTSD and that the Veteran's alcohol use disorder either was not present. Moreover, the Veteran denied such. The examiners have identified that the Veteran's disability was related to his situation at the time of the treatment and that his current disabilities were not related. The Veteran's service-connected disabilities were noted to have no impact on his psychiatric disability by referencing that when the Veteran was discussing his current situation the Veteran did not refer in any way to any medical disabilities or conditions that troubled him. The Board finds the VA examination to be most probative and, therefore, entitlement to service connection for an acquired psychiatric disorder is denied. B. J. KOMINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert J. Burriesci, 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.