Citation Nr: 21008676 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 15-03 118 DATE: February 17, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), anxiety disorder, and depressive disorder, is denied. FINDINGS OF FACT 1. The preponderance of the evidence reflects that the Veteran does not have an acquired psychiatric disorder that was caused by, or incurred in, any incident of his active duty service. 2. Alcohol abuse disorders may not be service connected on a direct basis; the evidence does not show that the Veteran’s alcohol abuse disorder is proximately due to, caused by, or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD, anxiety disorder, and depressive disorder, have not been met. 38 U.S.C. §§ 105, 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102 3.301, 3.303, 3.304, 3.310, 4.125. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from December 1965 to December 1967. In April 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board videoconference hearing. A copy of the transcript is of record. In August 2018, the Board, in pertinent part, remanded the above referenced issues for additional development. Review of the completed development related to the Board’s remand reveals that, at the very least, substantial compliance with the remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). In light of the Veteran’s reported symptoms and reported diagnoses, the Board has characterized the claim of service connection for PTSD as a claim for service connection for an acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that, in determining the scope of a claim, the Board must consider the claimant’s description of the claim, the symptoms described, and the information submitted or developed in support of the claim). Entitlement to service connection for an acquired psychiatric disorder The Veteran contends that he suffers from a psychiatric disorder (variously diagnosed as alcohol use disorder, anxiety disorder, and depressive disorder) due to his period of active service. The Veteran has contended his condition is due to experiences the military, particularly his service in Vietnam. Unfortunately, the Board is unable to grant service connection for alcohol use disorder and any other diagnosed acquired psychiatric disorder as any diagnosed condition is either unrelated to the Veteran’s period of active service or ineligible for service connection on a direct basis. Generally, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. To establish service connection for a disability, the Veteran must show: (1) the existence of 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 disease or injury incurred in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may also be granted for disability, which is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310 (a). "When aggravation of a veteran's non-service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation." Allen v. Brown, 7 Vet. App. 439 (1995). The relevant statutes and regulations deem abuse of alcohol to be willful misconduct. As such, service connection may not be granted for an alcohol abuse disorder on the basis of service incurrence or aggravation. See 38 U.S.C. §§ 105, 1131; 38 C.F.R. § 3.301; see also VAOPGCPREC 2-98. However, service connection may be established for an alcohol abuse disorder on a secondary basis if the condition is proximately due to, caused by, or aggravated by a service-connected disability. See 38 C.F.R. § 3.310. The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entire record. A layperson is competent to report on the onset and continuity of current symptomatology based on personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if the layperson: (1) is competent to identify the medical condition, (2) is reporting a contemporaneous medical diagnosis, or (3) is describing symptoms that support a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, at 1376-77 (Fed. Cir. 2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See Caluza v. Brown, 7 Vet. App. 498 (1995). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. The Veteran has reported that he believes his psychiatric problems are caused by his service in Vietnam, to include his fear associated with hostile military and terrorist activity. He has stated that his symptoms such as daily stress, anxiety, panic attacks, mood changes, depression, pain in various parts of his body, headaches, and problems sleeping did not start until after he served in Vietnam. See September 2012 Statement in Support of Claim. The Veteran has reported that he began drinking in Vietnam (or shortly afterwards) to mask or try to get rid of his symptoms. See 2018 Hearing Testimony pp. 9-10;see November 2020 statement. The Veteran also provided statements from his three sisters and brother reporting changes in his behavior from prior to serving in the military and after his service in Vietnam. See lay statements received in October 2012; lay statements received in March 2017. A letter was also submitted from the Veteran’s daughter regarding the Veteran’s symptoms during her lifetime. The Veteran was provided multiple examination regarding the etiology of his psychiatric problems during the appeal period. In September 2012, the Veteran was diagnosed with alcohol dependence disorder and anxiety disorder. In April 2014, a private psychologist provided a diagnosis of PTSD, alcohol dependence secondary to PTSD, and Depressive disorder secondary to PTSD. In December 2014, he was diagnosed with alcohol use disorder, in remission. In February 2017, he was diagnosed with unspecified depressive disorder. In April 2019, he was diagnosed with alcohol use disorder, severe, in sustained remission. He was also diagnosed with alcohol dependence and anxiety disorder, not otherwise specified in September 2020. Unfortunately, the Board finds that the weight of the evidence indicates that the Veteran suffers from alcohol use disorder due to his period of military service, which cannot on its own be granted service connection. Further, the weight of the evidence does not provide a link between the Veteran’s other acquired psychiatric conditions diagnosed during the appeal period and his period of active service. Initially, the Board finds that service connection for PTSD is not warranted. Specifically, the record does not show a valid PTSD diagnosis conforming to the applicable DSM diagnosis criteria. 38 C.F.R. §§ 3.304 (f), 4.125(a). There are particular requirements for establishing PTSD in 38 C.F.R. § 3.304 (f) that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); 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). The current version of § 4.125(a) requires that the diagnosis conform to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013) (DSM-5). Prior to the publication of DSM-5, section 4.125(a) required that diagnoses conformed to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994) (DSM-IV). Both versions require that certain criterion be met to support a diagnosis of PTSD. Criterion A relates to exposure to a traumatic event, but the definition of Criterion A differs between the DSM-IV and DSM-5. In short, the DSM-IV required that an individual was exposed to an event and that he or she must have responded to that exposure. Effective August 4, 2014, VA issued a rule amending the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations to refer to certain mental disorders in accordance with DSM-V. The provisions of the final rule only apply, however, to all applications received at the Agency of Original Jurisdiction (AOJ) on or after August 4, 2014, but not to claims certified to or pending before the Board, the Court, or the United States Court of Appeals for the Federal Circuit (Federal Circuit). 79 Fed. Reg. 45,093, 45,094-096 (Aug. 4, 2014). The Veteran’s PTSD claim was received by the AOJ prior to that date. VA regulations require that a medical diagnosis be competent. See 38 C.F.R. § 3.159 (a). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer the medical diagnosis. Id. Unfortunately, while a diagnosis of PTSD appears in multiple instances in the Veteran’s treatment records through the Huntington VAMC, the Board finds that the evidence does not support that these records demonstrate a diagnosis that meets the criteria specified to warrant service connection for PTSD. 38 C.F.R. §§ 3.304 (f), 4.125(a). The evidence indicates that the diagnosis appears frequently in problem lists that are based upon prior records or the Veteran’s report of his prior history. In March 2013, a diagnosis of PTSD is provided in a mental health outpatient note, however, this diagnosis was provided by a staff nurse that is not competent to provide a diagnosis of PTSD. 38 C.F.R. §§ 3.304 (f), 4.125(a). The evidence also indicates that the Veteran was provided a diagnosis of PTSD in a private April 2014 evaluation provided by J.R.A., a licensed psychologist. Unfortunately, the Board does not find that this opinion provides a valid diagnosis of PTSD. The Board finds probative the opinion provided by the April 2019 examiner that the private psychologist failed to reconcile how chronic alcohol use is known to overlap with mood, sleep, anxiety, and various cognitive symptoms. The 2019 examiner also noted that the private psychologist opined that the Veteran’s alcohol use was “secondary” to PTSD without discussing research debunking the “self-medication” hypothesis (citing American Journal of Drug and Alcohol Abuse, 38, 524-529). As the evidence indicates that the private psychologist’s diagnosis was not made while considering valid medical principles, the diagnosis provided by the psychologist will not be afforded any probative weight to the extent that it provides a diagnosis of PTSD. The September 2020 VA psychologist provided a well-reasoned explanation for why a PTSD diagnosis was not appropriate for the Veteran’s symptoms throughout the period on appeal. The examiner explained how the Veteran failed to meet the criteria for a PTSD diagnosis under the DSM during each evaluation during the appeal period. The Board attaches high probative value to this determination. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Based upon the findings of the April 2019 and September 2020 VA examiners, the Board finds that the weight of the medical evidence does not support a diagnosis of PTSD during the appeal period. As to the Veteran’s assertions of a current PTSD diagnosis, the question of whether such symptoms warrant a PTSD diagnosis is a medical one for which lay statements are not competent. Young v. McDonald, 766 F.3d 1348 (Fed. Cir. 2014) (PTSD is not the type of medical condition that lay evidence, standing alone, is competent and sufficient to identify); Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). Regarding the anxiety disorder and depressive disorder diagnoses, the September 2020 examiner opined that these diagnoses were not related to service. The examiner provided a thorough rationale that is supported by the evidence of record, including consideration of the lay statements provided by the Veteran and his family members. The examiner explained it was less than at least as likely as not the anxiety disorder and depressive disorders diagnosed were due to military service due to the presence of Alcohol Dependence, which is known to cause and aggravate anxiety, depression, etc. in extant research. The examiner also noted the reports in the 2017 examination that the Veteran did not indicate any discernible relationship among the Veteran’s current depressive symptoms and any event of military service. As such, the Board finds the September 2020 VA medical opinion to be highly probative evidence weighing against a relationship to between any anxiety disorder or depressive disorder and the Veteran’s active service. See Nieves-Rodriguez, 22 Vet. App. at 304. The Board has considered whether there is any additional evidence supporting a nexus between the Veteran’s anxiety disorder or depressive disorder and his period of active service. The Veteran is competent to report about the circumstances of his military service, his current symptoms, and history of symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board in no way doubts the sincerity of the Veteran and his family in their reports of his symptoms and the hardships of service in Vietnam. However, the question of whether his current psychiatric disorder and symptoms are related to service is a complex medical issue of the type as to which lay evidence is not competent. See Clemons, 23 Vet. App. at 6 (2009). The lay statements of record in this regard are therefore not competent evidence. Specifically, the Board notes that the 2020 psychologist noted that the presence of alcohol dependence is known to cause and aggravate anxiety and depression; as such, the changes reported in the Veteran after his return from Vietnam could stem from his alcohol dependence and requires a medical opinion as to their etiology. Also, as the Veteran is not competent to differentiate between symptoms of alcohol dependence and anxiety, entitlement to service connection cannot be granted based upon continuous reports of anxiety since service or within a year of separation from service. 38 C.F.R. §§ 3.303(b), 3.307, 3.309. Finally, the Board notes that the September 2020 examiner opined that based upon the evidence of record that the Veteran’s alcohol dependence was at least as likely as not the result of his active service. Unfortunately, service connection for alcohol dependence cannot be granted based on in-service incurrence or aggravation. See 38 U.S.C. §§ 105, 1131; 38 C.F.R. § 3.301; see also VAOPGCPREC 2-98. Furthermore, the record does not show, and the Veteran has not contended, that the alcohol abuse disorder is proximately due to, caused by, or aggravated by any currently service-connected disability. Therefore, his alcohol abuse disorder also may not be service connected on a secondary basis. See 38 C.F.R. § 3.310. (Continued on the next page)   For the foregoing reasons, the preponderance of the evidence is against the claim for service connection for an acquired psychiatric disability, to include alcohol dependence, PTSD, depressive disorder, and anxiety disorder. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.M. Johnson, 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.