Citation Nr: 21007484 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 17-12 662 DATE: February 9, 2021 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD), including as secondary to a service-connected right knee disability, is denied. REMANDED Entitlement to service connection for depressive disorder, including as secondary to a service-connected right knee disability, is remanded. FINDING OF FACT The Veteran does not have a diagnosis for PTSD that conforms with the DSM-V criteria. CONCLUSION OF LAW The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1984 to April 1988 with additional service in the Army National Guard. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. The issue of whether new and material evidence had been received to reopen the claim of entitlement to service connection for depressive disorder was previously before the Board in October 2018 when it was reopened; recharacterized as service connection for an acquired psychiatric disorder, to include PTSD and depressive disorder; and remanded for further development. As explained below, the Veteran does not have a diagnosis for PTSD that conforms with DSM-V criteria, and the Board has recharacterized the issues in order to reflect this finding. 1. Entitlement to service connection for PTSD, including as secondary to service-connected right knee disability The Veteran contends that he suffers from PTSD as a result of his service. In the alternative, the Veteran contends that his PTSD is secondary to his service-connected right knee disability. See February 2020 correspondence submitted by Veteran. As such, the Board finds that a secondary theory of entitlement has been raised by the record and the issues have been amended accordingly. The Veteran was provided with a VA PTSD examination in December 2019 where the VA examiner found that the Veteran did not have a diagnosis for PTSD that conforms to DSM-V criteria. The examiner noted that although the Veteran “met the DSM-V stressor criteria for PTSD,” he did “not meet the DSM-V symptoms criteria for persistent re-experiencing the traumatic event, avoiding reminders of the trauma or symptoms criteria for increased anxiety and emotional arousal.” The examiner noted that the Veteran has major depressive disorder and opined that this was less likely than not due to his service. The evidence of record includes private treatment records from January 2016 through June 2016 indicating that the Veteran’s current psychiatric symptomatology is attributable to his active duty service. The Board notes that this private medical evidence also indicates that the Veteran has a diagnosis for PTSD. However, the Board finds the December 2019 VA opinion concluding that the Veteran does not have a diagnosis for PTSD to be more probative than the private medical evidence indicating a diagnosis for PTSD. The December 2019 VA examiner thoroughly reviewed the evidence of record and provided a rationale supporting his conclusion, which described the reasons the Veteran did not meet the DSM-V criteria for PTSD. The examination report addresses the diagnostic criteria for PTSD under the DSM-5. On the other hand, the private medical evidence indicating a diagnosis for PTSD was not supported by any rationale and did not address the individual criteria. In the absence of a current diagnosis for PTSD, service connection cannot be granted on a direct or secondary basis and an explanation of the Veteran’s secondary theory of entitlement is not necessary in this case. While the Board is sympathetic to the Veteran’s claim, considering all of the relevant evidence of record, the preponderance of the evidence is against his claim. Accordingly, the Board finds that the claim of entitlement to service connection for PTSD, including as secondary to a right knee disability must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). REASONS FOR REMAND 1. Entitlement to service connection for depressive disorder, including as secondary to service-connected right knee disability. The Veteran contends that he suffers from depressive disorder as a result of service. In the alternative, the Veteran contends that his depressive disorder is secondary to his service-connected right knee disability. See February 2020 correspondence submitted by Veteran. The Veteran was provided with a June 2020 mental disorders VA examination where he was noted to have a diagnosis for major depressive disorder. The examiner opined that the Veteran’s disability was less likely than not due to his service-connected right knee disability because “there is no medical evidence that suggests a Veteran’s major depression is related to the pain in his knee.” However, the examiner noted that “the struggles related to his physical pain are part of his complaints and it is my personal opinion that they contribute to his depression.” The examiner added that “to state that it causes his depression would be mere speculation.” She noted that the Veteran’s file included notations addressing “the impact of physical pain on Veteran’s emotional state.” The notations referenced the Veteran’s pain in his left shoulder, right knee, and lower back. In an accompanying September 2020 VA addendum opinion, a VA examiner checked “No” regarding whether the Veteran’s major depressive disorder was aggravated beyond its natural progression by his service-connected right knee disability. The examiner explained that “the nexus of the Veteran’s depression, as shown in previous evaluations (see other C&P exams), is his injuries and how it relates to current functioning and pessimism for the future.” The examiner added that “it is impossible to untangle the injury and the depression as they are inter-related.” The Board notes that the Veteran is currently service connected for tinnitus, a right knee disability, and a right middle finger disability. Although, the VA medical opinions referenced above suggest that the Veteran’s pain from injuries contribute to his depressive disorder, it is not clear whether the Veteran’s service-connected disabilities alone contribute to his depressive disorder. As such, the Board finds that an addendum opinion is required prior to adjudication of this issue. Additionally, the Board notes that a portion of the June 2020 VA medical opinion requires translation from Spanish to English. On remand, the RO must translate this document, as well as any additional documents that require translation from Spanish to English and associate all English translations with their respective Spanish originals, in the claims file. The matters are REMANDED for the following action: 1. Obtain English language translations of all documents in the claims file that are in Spanish, to include a portion of the June 2020 VA medical opinion. All English translations must be associated with their respective Spanish originals in the claims file. 2. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s depressive disorder. It is up to the discretion of the clinician as to whether a new examination is necessary to provide an adequate opinion. After a review of the claims file, and examination of the Veteran if deemed necessary by the clinician, the clinician is asked to respond to the following inquiries: a) Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s depressive disorder was caused by his service-connected disabilities, alone or in combination? The clinician should specifically address the June 2019 examination report and accompanying September 2020 addendum opinion suggesting that the Veteran’s physical pain from his injuries have contributed to his depressive disorder. c) Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s depressive disorder is aggravated by his service-connected disabilities, alone or in combination? Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran’s medical history and the relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morrad, 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.