Citation Nr: 21074100 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 11-21 171 DATE: December 14, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD), is denied. FINDINGS OF FACT 1. A probative diagnosis of PTSD is not demonstrated by the evidence of record. 2. The evidence of record shows that an acquired psychiatric disorder, to include depression, was not manifested during service and was not caused by or related to any disease or injury that occurred during service. CONCLUSION OF LAW The criteria for establishing entitlement to service connection an acquired psychiatric disorder, to include PTSD and depression, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from April 1971 to January 1975. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. The Veteran provided testimony at a hearing before the undersigned Veterans Law Judge (VLJ) in June 2015 and a transcript of that proceeding has been associated with the record. In a September 2017 decision, following a January 2016 Remand for an additional VA psychiatric medical opinion, the Board denied the appeal, concluding that no current acquired psychiatric disorder, including depression, was etiologically related to service. The Veteran appealed the Board's September 2017 decision to the Court of Appeals for Veterans Claims (Court). A November 2018 order vacated the Board's decision and adopted a Joint Motion for Partial Remand (JMPR) for reconsideration of the Veteran's claim of service connection for an acquired psychiatric disorder, not disturbing the other issues adjudicated by the Board. The Veteran's claim was remanded in June 2019, November 2020, and June 2021 in order to conduct development in accordance with the directive of the JMPR. That development having been completed; this claim is once again before the Board. Generally, in order to prevail on the issue of service connection the evidence must show: (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. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). There are particular requirements for establishing PTSD in 38 C.F.R. § 3.304 (f), which take precedence over the general requirements for establishing service connection in 38 C.F.R. § 3.303. See Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Establishment of service connection for PTSD requires: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304 (f). (The Board notes that VA amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the required in-service stressor.) 1. PTSD The preponderance of the evidence is against a finding that the Veteran currently has PTSD. The Board notes that the medical evidence of record reflects only diagnoses of potential or probable PTSD, including treatment for symptoms, but no actual diagnosis of the disorder outside of the Veteran's own reported self-history. See i.e. April 2009 VAMC Nursing note ("PTSD screening test...was negative (score=0)"); January 2010 VAMC Patient Interdisciplinary Record ("PTSD screening test...was negative (score = 0)"); June 2011 VAMC Psychiatric Note ("Previous Diagnostic labels (from the patient and/or medical record)...PTSD...previous psychiatric hx of PTSD symptoms...Axis I...Depression NOS...R/O PTSD"); October 2011 VAMC Nursing note ("PTSD screening test...was negative (score = 0)"). Moreover, the Veteran has been afforded multiple VA mental health examinations throughout the appeal, to include recent addendum opinions in 2020 and 2021, and none of them have rendered a positive diagnosis for PTSD. Beginning with the April 2011 VA PTSD examination, the examiner cited a litany of failed PTSD/Depression screenings between 1996 and 2010 and concluded that despite the Veteran's alleged stressors, he did not meet the "stressor criterion" and exhibited no Axis I disorder other than polysubstance abuse in remission. The May 2014 VA examiner came to an identical conclusion following a review of the record and interview with the Veteran, concluding that "at the present time, [Veteran] provided little evidence of meeting diagnostic criteria for a mental health condition." However, as noted above the medical treatment record indicates a prior diagnosis of depression from 2011, therefore the Veteran was afforded an additional VA examination in June 2016 to address this medical history in light of the conclusions of the prior VA examiners. The June 2016 VA examiner also did not find that the Veteran met the criterion for PTSD, concluding that he was suffering from depression due to current, post-service stressors including a diagnosis of Hepatitis C which resulted in the termination of a daily alcohol regimen, his mother-in-law's recent death, and various familial problems regarding his wife, children, and grandchildren. An additional VA examination conducted post-JMPR in January 2020. The VA examiner determined that the Veteran did not have PTSD, but rather other depressive episodes and that this was solely related to stressors post-service. There was no specific discussion of prior medical records or the Veteran's in-service stressors. As such, an addendum opinion was provided in March 2021. This provided little further analysis, and an additional addendum opinion was, thus, provided in June 2021 in which the VA examiner referenced the records and specific stressors, but continued to find that, despite such contentions, the Veteran still did not meet the complete criteria for a diagnosis of PTSD. In addition, the service treatment records contain no complaint, symptoms, or diagnoses of a psychiatric disorder, including his December 1974 separation examination. Furthermore, his post-service records do not reveal any psychiatric abnormalities for many years. Hence, the record evidence shows that during the period of the claim, a diagnosis of PTSD was not rendered. While rule out PTSD was noted in 2015, this does not constitute a diagnosis of PTSD, and there is no probative evidence showing he has PTSD. The Board finds it significant that the April 2011, May 2014, June 2016, and January 2020 VA examination reports with addendums and post-service treatment records contains no diagnosis of PTSD, which further supports the finding that this disorder does not presently exist in this case. The VA examiners relied on a complete and thorough review of the Veteran's record, including the lay and medical evidence, as contained in the claims file, and the reports were the product of very thorough interviews and evaluations of the Veteran and review of the account of his experiences during service. While the June 2016 VA examiner provided an Axis I diagnosis of depressive disorder, the examiner ultimately determined that the Veteran does not have PTSD and no medical opinion to the contrary of this analysis exists. The Board has also considered the lay evidence indicating that the Veteran has PTSD. The Veteran is competent to testify as to his observations. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). In addition, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, unlike disorders that may be observable as to both their incurrence and their cause, the cause of a psychiatric disability is not readily apparent to lay observation, and the Court has held that psychiatric diagnoses are generally the province of medical professionals. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) ("It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant"). See also Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis). Moreover, even if credible and competent, the general lay assertions are outweighed by the specific and reasoned conclusion of the health care professional who diagnosed a psychiatric disability other than PTSD. As explained above, the most persuasive and probative evidence of record does not reflect that the Veteran has a diagnosis of PTSD. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993). The lay statements of the Veteran were considered, but are found to be less probative than the April 2011, May 2014, June 2016, and January 2020 VA examination reports with addendum opinions. Thus, given the lack of probative and persuasive value of evidence demonstrating a current disability of PTSD, the evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and regulation. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. Accordingly, for the reasons and bases discussed above, the Board concludes that the preponderance of the evidence is against finding a PTSD diagnosis is present in this case. See, e.g., Cohen v. Brown, 10 Vet. App. 128, 153 (1997) (Chief Judge Nebeker, concurring) (VA adjudicators may reject the claim upon a finding that the preponderance of the evidence is against a PTSD diagnosis). Therefore, the claim for service connection for PTSD fails on the basis that all three elements for a showing under 38 C.F.R. § 3.304 (f) have not been met. Accordingly, service connection for PTSD is denied. 2. Acquired Psychiatric Disorder The Board will now discuss whether the Veteran is entitled to service connection for any acquired psychiatric disorders, other than PTSD. The Veteran's service treatment records are silent regarding any psychiatric complaints or symptomatology. In fact, during the Veteran's separation Report of Medical History, he indicated that did not have frequent trouble sleeping; he had no depression or excessive worry, and had no nervous trouble of any sort. See December 1974 Report of Medical History ("Statement of Examinee's Present Health...Good"). As noted above, the Veteran has received a post-service psychiatric diagnosis of depression. Therefore, the Board finds that the first requirement, a current diagnosis, is met. However, the evidence must also demonstrate a nexus between the present disease and an in-service disease or injury. Here, the Board finds that the evidence does not indicate a nexus between his current depressive disorder and an in-service disease or injury. Specifically, no medical opinion exists which provides a nexus, or link between the Veteran's diagnoses and his activities during service. Rather, the multifactorial symptoms discussed within the VA treatment records and by the June 2016 and January 2020 VA examiners involve the Veteran's family and past history of substance abuse, rather than his military service. As such, service connection for an acquired psychiatric disorder, other than PTSD, is not established. As discussed above, the Veteran's lay statements and testimony have been given due consideration by the Board. However, unlike disorders that may be observable as to both their incurrence and their cause, the cause of a psychiatric disability is not readily apparent to lay observation, and the Court has held that psychiatric diagnoses are generally the province of medical professionals. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). Moreover, even if credible and competent, the general lay assertions are outweighed by the specific and reasoned conclusion of the June 2016 VA examiner who attributed the current diagnosis to non-military factors. See Nieves-Rodriguez, 22 Vet. App. at 304 (most of the probative value of a medical opinion comes from its reasoning; threshold considerations include the qualifications of the person opining). As a result, to date, there is no competent evidence that the Veteran's other psychiatric disorders are causally or etiologically due to service. As the preponderance of the evidence indicates that the Veteran's psychiatric disorders are not due to service, the claim for service connection for an acquired psychiatric disorder, other than PTSD, must therefore be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see also Ortiz v. Principi, 274 F.3d 1361, 1366 (Fed. Cir. 2001). M. E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dodd, Ryan 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.