Citation Nr: 21008317 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 11-18 017 DATE: February 16, 2021 ORDER Service connection for an acquired psychiatric disorder is denied. FINDINGS OF FACT 1. The Veteran had active duty service in the Navy from June 1991 to March 1993. 2. A personality disorder was noted during service; an acquired psychiatric disorder, currently diagnosed as depression, was not shown in service and is not causally or etiologically related to any incident of service. CONCLUSION OF LAW An acquired psychiatric disorder was not incurred in service. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The claim for a psychiatric disorder was originally denied in April 1994 and again in February 2010. In April 2014, the Board reopened and remanded the issue for further development. The Board undertook subsequent remands in May 2016, August 2017, and October 2019. The case has now been returned to the Board for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. § 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). As to a current disorder, in December 2019, a VA examiner diagnosed the Veteran with a depressive disorder, not otherwise specified (NOS). Clinical records have noted a diagnosis of a depressive disorder as early as a January 2010 VA examination. As such, the first element of service connection is met. As to an in-service incurrence, the Veteran’s service treatment records (STRs) reflected that, in March 1993, a provisional diagnosis of an organic personality disorder was noted. While he reported depression and excessive worry at the separation examination, he was not diagnosed with depression while on active duty. A psychiatric evaluation found no psychosis or affective disease and noted antisocial personality traits. He was found unsuitable for service based on a personality disorder. Nevertheless, as psychiatric symptoms were noted during service, the second element of service connection is met. As to a medical nexus, the medical evidence is overwhelming that there is no connection between the Veteran’s in service complaints and diagnosis of a personality disorder and his current diagnosis of depression. The Veteran was hospitalized in April 2009 after an alcohol-related seizure. He was diagnosed with alcohol abuse, anemia, hypertension, seizures, and sinusitis. In a December 2009 VA, he reported that he had felt depressed for the past 10-to-15 years. After a mental status examination, the examiner diagnosed depression NOS (not otherwise specified). On the issue of nexus, the examiner opined that it was less likely as not that the current depression was caused by or a result of the personality disorder diagnosed in service. The examiner reasoned that the STRs did not indicate a diagnosis of depression but of a personality disorder with antisocial traits. This evidence weighs against the appeal. In a July 2010 psychiatric clinic note, the Veteran was seen in the emergency room for chest pain and daily alcohol use. At that time, he reported depression but was not on any anti-depressants. In an April 2011 psychiatric note for alcohol dependence, he reported that he was diagnosed with a personality disorder in service, saw a psychiatrist, but never received medication. He reported that he was seeking disability for mental illness based on his diagnosis of a personality disorder and had been depressed since losing his job two years before. In an August 2014 medical opinion, the December 2009 clinician reviewed the available medical records, including the STRs and post-service records, and reiterated that depression NOS was not linked to the in-service personality disorder with antisocial traits. The clinician noted that there were only the Veteran’s subjective statements that he had been depressed for 10-to-15 years but there had been no diagnosis of depression and the Veteran had reported that his depressed mood was due to losing a job. This evidence weighs against the appeal. In a December 2019 VA examination, the Veteran ascribed his current symptomatology to a history of childhood abuse, unhappiness with his family dynamics and lack of social relationships, particularly during the holidays, an admitted history of alcohol dependence (e.g., he smelled of alcohol as he walked into the examination), and current employment issues and financial difficulties. After a review of the records and a mental status examination of the Veteran, the examiner diagnosed alcohol abuse disorder and unspecified depression with no demonstrated link to service. Specifically, the examiner found that the Veteran’s psychiatric disorder was less likely than not (less than 50 percent probability) incurred in or caused by events in service. The examiner reasoned that he has reviewed the mental health records, including the Veteran’s complaints of feeling depressed as a child and comment in 2009 of being depressed for 10-to-15 years, and noted that he was having problems at work, home, and socially. The examiner noted that at the time of the 2009 evaluation, the Veteran was depressed because it was the holiday and he had no money. The examiner concluded that depression was less likely than not incurred in or caused by service and that an alcohol abuse disorder was less likely than not caused by or related to service and the Veteran started drinking prior to service and had a strong family history of substance abuse. The Board finds that the examination was adequate for evaluation purposes. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a mental status examination. There is no indication that the VA examiner was not fully aware of the Veteran’s past medical history or that he misstated any relevant fact. Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. Further, there is no contradicting medical evidence of record. Therefore, the Board finds the VA examiner’s opinion to be of great probative value. Based on the above, the evidence does not support a medical nexus between the in-service diagnosis of a personality disorder and current diagnosis of depression and alcohol abuse disorder and the third element of service connection has not been met. To the extent that the Veteran contends that he was depressed in childhood, the March 1991 enlistment examination reflected a normal psychiatric evaluation. Therefore, absent clear and unmistakable evidence, he entered service sound in this regard. Further, the STRs do not support a finding of clear and unmistakable evidence of a preexisting diagnosis of depression. Therefore, service connection based on aggravation of a preexisting disorder is not warranted and the issue is one for direct service connection as discussed above. The Board has considered the Veteran’s lay statements that his current diagnosis of depression was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses; however, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Associate Counsel Edward P. Vrtis 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.