Citation Nr: 21006648 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 15-45 488 DATE: February 4, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. FINDING OF FACT An acquired psychiatric disorder, to include PTSD, was not manifest during active service, a psychosis was not manifest within one year of service; and, the preponderance of the evidence fails to establish that an acquired psychiatric disorder is etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. §§ 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from March 1966 to February 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision by the Phoenix, Arizona, Regional Office (RO) of the Department of Veterans Affairs (VA). The case was remanded for additional development in June 2019 and September 2020. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303(a). Generally, 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, 1166-67 (Fed. Cir. 2004). The term “disability” for VA compensation purposes refers to the functional impairment of earning capacity rather than the underlying cause of the impairment and it is noted that pain alone may be a functional impairment. See Saunders v. Wilkie, 887 F.3d 1356, 1364-68 (Fed. Cir. 2018). VA regulations provide that service connection for PTSD requires medical evidence diagnosing the condition; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). During the course of this appeal VA revised its regulations to reflect that mental disorder diagnoses are based upon the criteria provided in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association. 38 C.F.R. § 4.125(a). If a PTSD claim is based on in-service personal assault, evidence from sources other than a veteran’s service records may corroborate the veteran’s account of the stressor incident. 38 C.F.R. § 3.304(f)(5). Certain chronic diseases, including psychoses, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). Psychoses are qualifying chronic diseases. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). VA may favor one medical opinion over another, provided an adequate basis is provided. Owens v. Brown, 7 Vet. App. 429 (1995). In determining whether evidence submitted by a claimant is credible, VA may consider internal consistency, facial plausibility, and consistency with other evidence. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). A medical opinion based upon an inaccurate factual premise may be discounted entirely. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102. The Veteran contends that he has an acquired psychiatric disorder, to include PTSD, as a result of active service. In a February 2014 statement he reported that during service in Germany from August 1966 to February 1969 his duties as a military police officer required that he respond to incidents at local taverns and bars involving military personnel. He stated he had two visible scars from separate incidents from broken beer bottle and knife injuries as a result of his attempts to break up fights. He also stated that during his career he was involved in many blood/death situations involving military personnel due to domestic violence, traffic accidents, combative personnel, and communism incidents. In a February 2015 statement he reiterated his claim that he had two scars as a result of injuries sustained in separate incidents during service in Germany. In a June 2020 statement in response to a VA request for details regarding the stressful events that caused his PTSD he identified a July 4, 1967, incident at the Ebony Bar in Germany and an horrific traffic accident on January 10, 1968, in Germany. In an April 2013 statement the Veteran’s sister reported that after service she had observed his behavior and noticed feelings of depression and anxiety. It was noted that he had feelings of guilt because he had service in noncombat locations and many of his friends and acquaintances were sent to war zones, some of whom were injured or did not return home. In a January 2014 statement the Veteran’s spouse reported that over the past years she noticed his worrying about things had gotten much worse. She stated he had feelings of guilt over not serving in Vietnam as had many of his peers. Service treatment records are negative for complaints, treatment, or diagnosis of an acquired psychiatric disorder. The Veteran’s January 1969 separation examination revealed a normal clinical psychiatric evaluation. No identifying scars were noted. In his January 1969 report of medical history, he denied having or having ever had frequent trouble sleeping, frequent or terrifying nightmares, depression of excessive worry, and nervous trouble of any sort. He marked “no” in response to the question as to whether he had any other illnesses or injuries. Service records show the Veteran served as a military policeman, including in Germany from July 1966 to February 1969. In a report received by VA in October 2020 the service department reported that a search involving the January 1968 motor vehicle accident stressor could not be completed because the requisite information had not been provided. A September 2015 statement from B.A., M.D., noted the Veteran was currently a patient and was receiving treatment for depression and anxiety. No opinions as to etiology were provided. VA treatment records include reports dated in April 2018 and January 2019 noting a diagnosis of mood issues/PTSD. It was noted the Veteran’s symptoms included depression and anxiety. No opinions as to etiology were provided. A January 2020 VA examination found the Veteran did not meet the applicable diagnostic criteria for PTSD. The examiner provided diagnoses of unspecified anxiety disorder and major depressive disorder. The statements of the Veteran, his spouse, and his sister were summarized. It was noted the Veteran reported he had married in 1977 and that he had retired from his employment as an Illinois State Trooper in 1993 after 30 years of service. He also reported that during service he started having sleep disturbances and was so stressed and anxious that he had stressful and fearful dreams every night. He reported that he still had the dreams every night and that approximately five years earlier he sought treatment for his anxiety and sleep issues. He stated he had been arguing a lot with his spouse and that those issues had continued since military service. He reported he experienced significant guilt and shame that he did not go to combat in Vietnam. The examiner noted he reported stressors including having to “handle” a motor vehicle accident involving his best friend in service who had sustained significant injuries when he was ejected through the windshield. He also reported stressors involving having been hit over the head with beer bottles when responding to military police calls and having witnessed physical fights dealing with family disturbances. In an attached medical opinion, the examiner found that the Veteran’s medical records supported the conclusion that his unspecified anxiety disorder and unspecified depression at least as likely as not had their onset during active service or were otherwise related to such service. It was noted that he had served as a military policeman and that it was likely that the events as he reported had in fact happened and had contributed to his present symptoms. The examiner noted that the Veteran’s statements that he sustained scars from injuries he incurred as a military policeman could easily be verified. It was also noted that the statements of the Veteran’s spouse and sister indicated the veracity of his claim. Based upon the evidence of record, the Board finds that an acquired psychiatric disorder, to include PTSD, was not manifest during active service, that a psychosis was not manifest within one year of service, and that the preponderance of the evidence fails to establish that an acquired psychiatric disorder is etiologically related to service. The Veteran is shown to have served as a military police officer in Germany and he has denied having served in combat. The available service treatment records are found to be persuasive that an acquired psychiatric disorder, such as PTSD, an anxiety disorder, or a depressive disorder, was not manifest during or as a result of active service. There is also no evidence of a diagnosis of a psychosis at any time during or after service, nor does the Veteran contend that such a diagnosis exists. As such, presumptive service connection is not warranted in this case. Although the Veteran contends, in essence, that in his duties as a military policeman he was involved in traumatic events involving military personnel due to domestic violence, traffic accidents, combative personnel, and communism incidents, no specific stressor event is verified or verifiable based upon the available information. The Board finds the Veteran was adequately notified of the information necessary for VA assistance in verifying such matters and that further VA efforts would be futile. As to the Veteran’s claims that he sustained injuries in his duties in Germany that resulted in two scars and that during service he was so stressed and anxious that he had stressful and fearful dreams every night, the Board finds these specific matters to be not credible based upon inconsistency with the other evidence of record. In fact, his January 1969 separation examination revealed a normal clinical psychiatric evaluation and found no identifying scars. In his January 1969 report of medical history, the Veteran also stated that he had not had any other illnesses or injuries and he denied having or having ever had frequent trouble sleeping, frequent or terrifying nightmares, depression of excessive worry, or nervous trouble of any sort. The Board notes that the Veteran is shown to have had 30 years of service as an Illinois State Trooper, a position of authority that is presumed to require a high level of mental and physical acuity, and the fact that he was able to maintain such employment for 30 years without apparent difficulty is further evidence against his specific claims as to continuing symptoms of stress and anxiety. See Caluza, 7 Vet. App.  at 511. Although the January 2020 VA examiner noted that the Veteran had served as a military policeman and found that it was likely that the events as he reported had in fact happened and had contributed to his present symptoms, the Board finds that the opinion is based upon an inaccurate factual premise and, as to this matter, may be discounted entirely. See Monzingo, 26 Vet. App.  at 107. Specifically, the examiner is shown to have based the opinion, in large part, upon the Veteran’s statements that he had sustained scars from injuries he incurred as a military policeman which is found to be neither verified nor credible based upon the available evidence. Additionally, the January 2020 VA examiner’s notation that the statements of the Veteran’s spouse and sister indicated the veracity of his claim is found to be too vague to support the opinion provided. In fact, upon review of the April 2013 and January 2014 statements, the Board is unable to discern how they indicate the veracity of the claims. They do not appear to indicate observations of symptoms that were manifest during or soon after service and the Veteran and his spouse are shown to have married in 1977 without evidence that they began their relationship prior to her divorce in 1972. The Board acknowledges that the Veteran is competent to report observable symptoms, but there is no indication that he is competent to etiologically link any such symptoms to a diagnosis of an acquired psychiatric disorder. He is not shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in evaluating such disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. Consideration has also been given to the Veteran’s personal assertions that he has an acquired psychiatric disorder, to include PTSD, as a result of service. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disability at issue is not a matter that is readily amenable to lay diagnosis or probative comment regarding etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In conclusion, the Board finds that service connection for an acquired psychiatric disorder, to include PTSD, is not warranted. When all the evidence is assembled VA is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim in which case the claim is denied. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). The preponderance of the evidence is against the claim. MICHELLE P. KATZ Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Douglas 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.