Citation Nr: 21009829 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 12-06 850 DATE: February 23, 2021 ORDER Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) due to military sexual trauma (MST), unspecified anxiety disorder, adjustment disorder, and depressive disorder, is denied. FINDING OF FACT The Veteran does not have an acquired psychiatric disorder, to include PTSD, as due to MST, unspecified anxiety disorder, adjustment disability, or depressive disorder that was incurred in or caused by active service, and a psychosis did not manifest to a compensable degree within one year of separation from active service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disability, to include PTSD as due to MST, unspecified anxiety disorder, adjustment disorder, or depressive disorder, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.304(f), 3.307, 3.309, 4.125(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from October 1977 to March 1980. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office. The Veteran filed a timely Notice of Disagreement (NOD), received in October 2010. A Statement of the Case (SOC) was issued in January 2012. A timely substantive appeal was received in February 2012. By way of background, in August 2016, the Board remanded the claim for further development, to include obtaining additional records and a VA examination. In September 2017, the Board denied service connection for a personality disorder and remanded service connection for an acquired psychiatric disorder. In February 2018, the Board remanded the claim of service connection for an acquired psychiatric disorder for an DSM-V examination that adequately discussed the Veteran’s in-service complaints regarding sexual harassment. Finally, in June 2019, the Board remanded the claim for further development and to schedule the Veteran for a VA examination pertaining to her claim of PTSD, as due to MST. In June 2020 the RO issued a supplemental statement of the case (SSOC). The matter now comes back before the Board for further adjudication. Entitlement to service connection for an acquired psychiatric disability, to include PTSD as due to MST, adjustment disorder, unspecified anxiety disorder, and depressive disorder. The Veteran contends that she developed PTSD due to ongoing sexual harassment by her supervisor while on active duty service. See e.g., November 2009 Claim, February and July 2010 Statements in Support of Claim; October 2010 Notice of Disagreement; January 2012 VA Form 9, August 2017 Informal Hearing Presentation. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. “To establish a right to compensation for a present disability, a Veteran 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’—the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing 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 which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a presumptive basis for certain chronic disabilities, including psychosis, when manifested to a compensable degree within the initial post-service year. See 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a), i.e., a diagnosis conforming to specified diagnostic criteria (currently the DSM-5, previously the DSM-IV); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link, or causal nexus, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). Generally, corroboration of an in-service stressor cannot consist solely of after-the-fact medical nexus evidence. See Moreau v. Brown, 9 Vet. App. 389, 396 (1996). However, in Patton v. West, 12 Vet. App. 272 (1999), the United States Court of Appeals for Veterans Claims (CAVC) held that special consideration must be given to claims for service connection for PTSD based on personal assault. In particular, the Court held that the provisions in VA's Adjudication Manual which address PTSD claims based on personal assault are substantive rules which are the equivalent of VA regulations and must be considered. See also YR v. West, 11 Vet. App. 393, 398-99 (1998). Moreover, VA has amended the PTSD regulations to provide that evidence other than the Veteran's service records can corroborate the occurrence of a claimed in-service stressor based on personal assault. See 38 C.F.R. § 3.304(f)(5). Section 3.304(f)(5) provides that PTSD based on a personal assault in service permits evidence from sources other than a Veteran’s service records which may corroborate his or her account of the stressor incident. Examples of such evidence include, but are not limited to, records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Examples of such evidence include evidence of behavior changes following the claimed assault. Examples of behavior changes that may constitute credible evidence of a stressor include deterioration in work performance and episodes of depression, panic attacks, or anxiety without an identifiable cause, or unexplained economic or social behavioral changes. 38 C.F.R. § 3.304(f)(5). Significantly, 38 C.F.R. § 3.304(f)(5) also provides that VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. A medical opinion based on a post-service examination of a Veteran can be used to establish the occurrence of a stressor; however, the Board may consider and weigh this evidence in the context of the entire record. Menegassi v. Shinseki, 638 F.3d. 1379 (Fed. Cir. 2011). Turning to the evidence of record, review of the Veteran’s service treatment records contain a December 1976 report of medical history at the time of entrance onto active duty. The Veteran reported that she was in good health and takes birth control pills. She denied attempted suicide, frequent trouble sleeping, depression or excessive worry, and nervous trouble of any sort. An accompanying report of medical examination noted clinical evaluation on all systems as normal. At the time of separation from active duty, in a report of medical history, the Veteran reported that she was “presently in good health.” She denied experiencing nervous trouble of any sort or frequent trouble sleeping. However, she indicated that she had been hospitalized for a suicide attempt in December 1979 and that she suffered from “depression or excessive worry.” In addition, it was noted that the Veteran suffered from a “passive aggressive personality disorder.” An accompanying Report of Medical Examination showed the Veteran’s psychiatric system to be abnormal, and it was noted that the Veteran had a passive aggressive personality disorder. See e.g., December 1976 Reports of Medical History and Examination and March 1980 Reports of Medical History and Examination. The Veteran’s military personnel records indicate that the Veteran underwent a psychiatric consultation in November 1979. The record indicates that the Veteran was reportedly involved in a physical fight in the barracks. During the examination, the clinician noted that the patient was evaluated by a psychiatrist at the National Naval Medical Center (NNMC) following an overdose of aspirin in May 1979. Upon interviewing the Veteran, the clinician noted that the Veteran consistently received evaluations in the 3.5 to 3.8 range, until her most recent evaluation in July 1979 when her ratings dropped to 3.2 and 2.8 respectively. The Veteran attributed this drop in rating to sexual harassment from her supervisor. The Veteran stated that “the Navy is tearing me down mentally.” She alleged that it was necessary to go to bed with petty officers to escape harassment at work and was adamant that she be discharged from the Navy. The clinician noted that the Veteran initially presented in a hostile manner but became more cooperative during the course of the interview. It was noted that the Veteran demonstrated a mild impairment in attention, suggesting a degree of anxiety. She was diagnosed with passive-aggressive personality disorder and recommended for administrative separation. See e.g., November 1979 Psychiatric Consultation Sheet/Report. In February 1980, the Veteran filed a response to the psychiatric consultation of November 1979. At that time, the Veteran requested that she be honorably discharged from the U.S. Navy. In addition, she indicated that the psychiatric examination that she underwent in November 1979 was not thorough enough and that it was based on the “psychiatrist’s subjective interpretation of her self-reporting.” The Veteran felt that it was ridiculous for the U.S. Navy to make a decision about her naval career based on such a superficial examination. See e.g., February 1980 Veteran’s Statement. The Veteran’s personnel file contains a February 1980 letter from her commanding officer sent to the Commander, Naval Military Personnel Command, in which the Veteran was recommended for discharge by reason of unsuitability. The Commander stated that in December 1979, the Veteran was charged with a violation of the UCMJ and received a paygrade reduction along with forfeiture of two months of pay. In discussing the Veteran’s general attitude, the commander indicated that the Veteran “does not respond favorably toward authority and often times questions orders given by a superior.” Some days she is easy to get along with while on other days she is not. When she is given an assignment she doesn’t like, she exhibits poor performance. It was noted that she has been counseled repeatedly with no improvement in her attitude. The Commander noted a suicide attempt in which she was admitted to the hospital and diagnosed with a severe personality disorder, “which existed prior to service.” The Veteran was subsequently counseled with regard to seeking professional help and an appointment was made for her at the psychiatry unit in Bethesda, however she refused to go. Based upon this history, as well as her refusal to seek help or any desire to improve her behavior, the command recommended that the Veteran be administratively discharged under honorable conditions (as warranted by her performance marks). See e.g., February 1980 NNDC Commanding Officer Memorandum. Post-service treatment records indicate that in February 2009 the Veteran scored negative on a PTSD screening test. In a VA psychiatric evaluation dated March 2009, the physician noted that in primary care, the Veteran scored positive on questioning regarding military sexual trauma. The physician noted that the Veteran had some residual anger regarding her treatment in service, but no overt psychological dysfunction was evident. The physician indicated that the Veteran appeared to be functioning adequately in the present. No diagnosis was rendered. The Veteran was afforded a VA examination in September 2010. By way of history, the Veteran indicated that she lost her mother in a car accident when she was 15 years old, her father survived the accident, and raised her and her siblings as a single parent. The Veteran stated that her childhood was stressful because she felt responsible for everyone after her mother’s death. It was noted that the Veteran was “unaware of any family psychiatric history but she commented that “everybody in [the] family got issues and is dysfunctional.” The Veteran reported that she had many friends and boyfriends during her teenage years because “I wanted somebody to love me” and denied ever being suspended or expelled from school. Upon review of the claims file, the VA examiner indicated that the Veteran was often truant and was suspended from school during her senior year. She was involved in a fight during her senior year of high school. In addition, at the age of 19, she was reportedly involved in a domestic dispute with her father and the police were called to intervene, but no charges resulted. The examiner noted that the Veteran stated that she recalls having a fight at school but has no recollection of the other problems. Upon a review of her military history, the VA examiner noted that the Veteran was involved in an altercation with another service member, was reduced in rank, and forfeited two months’ pay. In addition, the Veteran reported that her supervisor sexually harassed her and began giving her bad evaluations when she refused him. She reported that she attempted suicide by taking two handfuls of aspirin and explained the reason for her suicide attempt as being involved in a car accident and fearing they would sue her, and she would lose her car. The VA examiner noted that the Veteran was smiling and laughing when she told the account of her suicide attempt. In addition, the Veteran reported being in a physically abusive marriage for eighteen years until they divorced in 1997. The VA examiner noted that the Veteran has been to treatment for cocaine abuse three times. It was noted that the Veteran had one visit with psychology in March 2009, but no diagnosis was received, and no additional treatment was recommended. She was hospitalized in 1995, 1996, and 1998 for cocaine dependence. The Veteran reported symptoms of sadness, loneliness, and neglect since the death of her common-law husband two years ago. The VA examiner noted that the Veteran was cooperative, friendly and attentive. Her affect was euthymic, except when talking about the death of her husband, then she was tearful. Her mood was depressed. It was noted that she has good judgment and understands the outcome of her behavior. The patient partially understands that she has a problem. The Veteran reported that since her husband passed away, she has slept during the day and stays up all night. Last reported use of alcohol was “1 beer 3 days ago.” Last reported use of drugs was “cocaine 4 months ago.” The Veteran was diagnosed with bereavement, cocaine abuse, and a personality disorder NOS (DSM IV). The examiner opined that the Veteran’s depressive symptoms appeared to be related to ongoing bereavement over the death of her common-law husband two years ago and stated that the Veteran continues to use cocaine occasionally despite problems with dependence in the past. In addition, it was noted that the Veteran has “exhibited difficulty in relationships since prior to the military and continues to feel lonely and neglected when not in an intimate relationship.” The examiner opined that according to her history and current presentation, the Veteran exhibits both passive-aggressive and borderline personality traits and at the present time, these traits are causing mild difficulty in her interpersonal relationships, but are not so severe that they require medication management. See e.g., September 2010 VA Examination. VA treatment records indicate that the Veteran was seen for a psychiatric consultation in October 2011. The Veteran complained of loneliness and sadness. She stated that both of her parents are deceased and a male friend, with whom she was together for eight years, died from pancreatic cancer shortly after becoming ill. She indicated that she is appealing her Navy discharge as she thinks that they made up the personality disorder to protect the chief who was harassing her. She indicated that she saw a physician who prescribed her medication for depression, but she quit taking it because it made her “feel crazy.” At that time, she was diagnosed with a depressive disorder and bereavement and placed on medication to help with depression, insomnia, and anxiety. See e.g., October 2011 Psychiatric Consultation. In a VA examination dated November 2011, the psychiatrist indicated that the Veteran’s symptoms did not meet the diagnostic criteria for PTSD under the DSM-IV criteria. The examiner instead rendered an Axis I diagnosis of chronic adjustment disorder with mixed anxiety, depressed mood, and cocaine dependence, in full remission. Upon examination the Veteran indicated that she is sad and can’t sleep at night. The Veteran indicated that she has occasional panic attacks “when the bills come in and I don’t have any money coming in.” The examiner rendered an Axis II diagnosis of personality disorder NOS. The examiner opined that it is less likely than not that the Veteran has PTSD from claimed sexual harassment while serving in the U.S. Navy. The examiner indicated that the Veteran does not meet DSM IV diagnostic criteria for PTSD (Lacking criteria A, C, D, and F). In a VA examination dated September 2012, the psychologist indicated that the Veteran’s symptoms did not meet the diagnostic criteria for PTSD or adjustment disorder with mixed anxiety and depressed mood under the DSM-IV criteria. The examiner instead rendered an Axis I diagnosis of cannabis abuse and an Axis II diagnosis of personality disorder NOS. The examiner noted that the Veteran’s personality disorder was first diagnosed during service and she was discharged because of it. Under Axis IV the examiner noted that the Veteran suffered from psychosocial and environmental factors of inadequate income. The examiner indicated further that the Veteran’s reported symptoms were related to her personality disorder and not her service. The examiner opined that the Veteran did not meet the diagnostic criteria for PTSD based on objective test results and diagnostic clinical interview from this examination. She did not report symptoms that would be consistent with the diagnoses of any anxiety, depressive, adjustment disorder, or any other Axis I mood disorders at this time. However, she does meet DSM-IV-TR criteria for a diagnosis of personality disorder NOS. The RO requested and obtained the Veteran’s records related to her disability SSA disability claim. In an SSA decision dated July 2015, the Veteran was noted to have several severe impairments, to include a personality disorder, adjustment disorder, and depression. PTSD was not noted. The decision indicated that “the specific mental status evaluation findings described in the VA records do not support the claimant’s allegations.” The decision noted that “the claimant does receive treatment through the VA for her mental problems, and the mental status evaluation findings show that her treatment is successful.” As examples, the decision cited an October 2014 treatment record which indicated that the “Veteran remains emotionally stable despite her numerous life stressors.” In January 2015, the claimant reported a “stable mood with no anger outbursts or depressive episodes since her last session.” A March 2015 record noted that the claimant “remains mentally/emotionally stable.” In addition, “the claimant stated I am blessed and had decided to attempt to manage her mood naturally without medication. She had been focusing on self-care such as exercise and diet.” See e.g., July 2015 Social Security Disability Decision. The Veteran was seen for a psychiatric initial evaluation in September 2015. It was noted that the patient was seen for restarting clonazepam. The psychiatrist informed the patient that her previous history of cocaine dependency and her use of alcohol currently precluded her from obtaining controlled substances. The psychiatrist noted that after a back-and-forth negotiation the patient relented and agreed to take Lexapro on a trial basis because she considers herself to be anxious and depressed; “though on examination she certainly did not have signs or symptoms of a major depressive disorder, or mania, or psychosis, and did not seem particularly anxious but rather more drug-seeking.” It was noted that the patient did not present with symptoms of depression and exhibited no symptoms of PTSD. The psychiatrist indicated that the Veteran presented with concerning symptoms which have caused her pain and dysfunction and are now in need of treatment for mild anxiety and depression. The Veteran was diagnosed with unspecified anxiety disorder and cocaine dependence, in remission. A VA treatment record dated December 2015 noted that the Veteran was seen in consultation to address issues related to a depressed mood. It was noted that the Veteran had a suicide attempt “once while in the military, by overdose.” She indicated that she “was stressed over the continuous harassment” and “I wouldn’t do it again. I believe it is a sin.” The Veteran was diagnosed with depression and a personality disorder. See e.g., December 2015 SWS Mental Health Progress Note. A VA treatment record dated May 2016 noted that the Veteran was seen to address issues related to a depressed mood. It was noted that the Veteran “remains mentally/emotionally stable without mental health medication.” The Veteran indicated that she has not had any emotional outbreaks, partly because she keeps to herself. She reported that her uncle is supportive, and she just interacts with family. The patient was diagnosed with depression and anxiety. See e.g., May 2016 SWS Mental Health Progress Note. In November 2016 the Veteran was seen in follow-up for treatment related to a depressed mood. Again, it was noted that the Veteran remains mentally and emotionally stable without mental health medication. The provider noted that the Veteran faces anxiety, depression, agitation, impulsive behavior and isolation on a daily basis. The Veteran stated that she is focused on staying mentally and emotionally healthy in order to provide a stable home environment for her daughter and granddaughter. The Veteran was diagnosed with adjustment disorder, mixed and MST. See e.g., November 2016 SWS Mental Health Progress Note. The Veteran was afforded another VA examination in November 2016 in which the psychologist opined that the Veteran did not meet DSM-5 diagnostic criteria for PTSD based on objective test results and diagnostic clinical interview from this examination. The examiner indicated that PTSD related to MST was specifically ruled out in 2009 clinical records. The examiner also noted that the events in service reported by the Veteran do not rise to the level of MST as she stated there was no overt behavior that could be described as harassing or sexual in nature. “She definitely denied any type of assault in service.” The examiner opined that there are no clear markers of potential MST as her suicide attempt was related to stress over wrecking her new car, per her report, and was in no way related to potential MST. The examiner noted that the Veteran reported that she first sought mental health treatment at the Pensacola VA in 2009 after she ran her truck into a boyfriend’s van because he was seeing another woman. She reported she threatened to kill this boyfriend because he owed her money and tracked him down while she had two knives to carry out her threat. When asked about stressors, she reported she was harassed by a chief in the Navy and he would find things to criticize her for after she told him she would not go to lunch with him. She reported he never directly asked her for sex or insinuated quid pro quo. She reported he never made overtly sexual remarks and she was never sexually assaulted by anyone in service. She reported a perception of sexual harassment by a chief and the feeling that it was unfair that this individual continued their career. It was determined that this stressor did not meet criterion A. The examiner opined that the Veteran’s reported symptoms and life history do meet the DSM-5 diagnostic criteria for the diagnosis of unspecified personality disorder, and this is the new terminology of her previous diagnosis of personality disorder NOS. In a September 2017 primary care office visit the Veteran returned for an annual physical. A past medical history active problems list showed depressive disorder since December 2015. In August 2019, A VA treatment note indicates that the Veteran underwent a screening for PTSD. At that time, she scored a 0, which indicates a negative screen for PTSD in the past month. The Veteran underwent a VA examination in September 2017 in which the psychologist noted that the Veteran herself stated that the chief never made a sexual request or asked her to go to bed with him. The psychologist opined that there was no evidence to support that the chief criticized her work because she rebuffed a sexual request. The examiner stated that there is a long history of behavior both during and after service that would support why the chief supervising her may have found her work below acceptable standards. In addition, the examiner noted that there is no evidence in either independent C&P Initial PTSD evaluation or the records reviewed of a separate psychiatric diagnosis or disability superimposed on the Veteran’s personality disorder other than the Veteran’s co-morbid cannabis use disorder. The examiner noted that in the PTSD evaluation dated November 2016, the Veteran was carefully questioned regarding any possible MST event and she clearly reported that she was never sexually assaulted in service or subjected to what a reasonable person would consider sexual harassment. She clearly reported that the worst thing that happened to her was that the chief would criticize her work and once asked her to go to lunch with no overt sexual comments ever made. The examiner noted that based on her own self-report, there is no evidence of an MST event. In addition, in all of her VA treatment records reviewed that referred to possible MST or sexual harassment, the providers do not describe any detail of the supposed event or appear to question the Veteran for any details, suggesting that her VA providers did a poor job of actually qualifying the Veteran’s statements. In January 2019, the Veteran underwent another VA examination in which the psychologist opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. Upon a complete review of the file and interview of the Veteran, the examiner opined that the Veteran does not have a diagnosis of PTSD. The examiner noted that the Veteran’s current diagnosis of unspecified personality disorder is less likely than not related to her military service. The examiner rationalized that the Veteran’s medical records do not support the claim that her currently diagnosed condition is related to an in-service stressor. Specifically, the Veteran’s reported stressor was sexual harassment by her supervisor, but no physical contact was reported. The examiner stated that this would not be considered a stressor that constitutes a military sexual trauma. The examiner noted that there are records that could indicate markers of military sexual trauma, such as: (1) a decline in military performance, (2) in-service complaints that the “Navy is tearing me down mentally,” (3) an in-service complaint that “it is necessary for me to go to bed with petty officers to escape sexual harassment at work,” (4) a medical separation report that notes the Veteran attributed low performance marks to “difficulties” with her supervisor, (5) an alleged sexual harassment/seeking legal assistance, (6) a statement in support of claim by the Veteran alleging sexual harassment, and (7) Veteran’s indication that her supervisor tried to force her into having sexual relations, however, based on the Veteran’s own reports during the examination, the reported stressor cannot be considered significantly traumatizing or a military sexual trauma. In addition, the examiner opined that “these records may indicate magnification or exaggeration of the events that actually occurred, possibly due to her diagnosed unspecified personality disorder.” The examiner opined that the Veteran does not meet criteria for a mental disorder other than the unspecified personality disorder. It was noted that she has been treated in the past for depression, cocaine abuse and cannabis abuse, but those disorders appear to be in remission, and she is not currently receiving medication or treatment for a mental disorder. The examiner noted that the Veteran’s medical records dating back to the 1970’s indicate a history of interpersonal conflict prior to being discharged from the Navy due to a personality disorder. The examiner rationalized that these behaviors suggest the presence of a personality disorder. In addition, the examiner stated that the Veteran’s tragic upbringing following her mother’s untimely death and her feeling the need to care for her younger siblings would be consistent with the development of a personality disorder. The examiner noted that the Veteran’s medical records also describe examples of impulsive and extreme behavior, to include a suicide attempt in 1979 (related to a car accident). The examiner stated that personality disorders do not form in adulthood as the reaction to a stressful life event and therefore, “the Veteran’s diagnosed personality disorder is less likely than not a result of an in-service stressor related event.” See e.g., January 2019 Compensation and Pension Examination. In a July 2019 VA examination the psychologist opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner diagnosed the patient with persistent depressive disorder and cannabis use disorder. In addition, he noted that “she has been persistently diagnosed with personality disorder, depression, and some type of substance use disorder in the past by all providers for evaluations and her treatment providers.” The examiner noted that the Veteran has never been diagnosed with PTSD nor have there been positive PTSD screenings. Although the examiner provided a diagnosis of persistent depressive disorder, the noted that much of the Veteran’s difficulty has been due to interpersonal problems, an abusive post-military marriage, and personality disordered behavior. The examiner further opined that what the patient states happened while in the military, is not considered MST and there is no potential evidence marker in the medical record. The examiner concluded that it is less likely MST occurred. After a careful review of the Veteran’s claims file, the Board finds that the weight of the evidence is against a finding that the Veteran has or has had a diagnosis of PTSD as due to MST, at any time during the period on appeal, or that any other diagnosed acquired psychiatric disorders are related to service. As an initial matter, the Board will not address the issue of entitlement to service connection for a personality disorder in this decision. As noted in the Introduction, the issue of service connection for a personality disorder was previously decided in September 2017 and is not currently before the Board. The Board reiterates that personality disorders are not considered diseases or injury for which service connection may be granted, even if symptoms increased in severity in service. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. However, service connection may be granted for additional disability superimposed on top of a personality disorder resulting from a disease or injury during service. See VAOPGCPREC 82-90 (July 18, 1990). Here, the probative evidence of record does not establish that any diagnosed superimposed psychiatric disorders are related to service. In addition, the record does not reflect, nor does the Veteran contend, that any subsequently diagnosed acquired psychiatric disorder was due to aggravation during service of her diagnosed personality disorder by a superimposed disease or injury. Despite numerous VA examinations, the Veteran has not met the criteria for a diagnosis of PTSD, and after consideration of the Veteran’s service treatment records, post service treatment records, lay statements, and personnel record, the competent evidence of record reflects that the symptoms experienced by the Veteran during service were attributable to her personality disorder and that various psychiatric diagnoses after service were attributable to her personality disorder or to situational and/or life stressors, rather than to her active service. Of note, the July 2019 VA examiner stressed that the Veteran’s problems of depression, anxiety and impaired relationships since she was discharged were due to interpersonal problems, an abusive post-military marriage, and personality disordered behavior. The examiner specifically stated that a review of all case notes and workups are consistent in providing data that the Veteran’s personality disorder, substance abuse, and post military abuse relationships and marital problems were not related to service, but were the cause of her current depression, which did not begin until 2012. The Board finds the VA examiner’s opinions, taken together, are highly probative as the examiners conducted in-person examinations, thoroughly reviewed the Veteran’s claims file, including STRs and post-service medical treatment records, and considered the Veteran’s lay statements in finding that the Veteran did not have a diagnosis of PTSD and that any other acquired psychiatric disorder, currently diagnosed or in remission, was not related to service. Nieves-Rodriguez, 22 Vet. App. 295 (2008). The Veteran is competent to report her symptoms; however, to the extent that such assertions purport to establish a current disability or the etiology of any such disability, such assertions do not provide persuasive support for the claim, as the Veteran is not shown to possess the medical training to render competent opinions about such complex medical matters. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). This is particularly true with respect to mental disorders, which are not directly observable, and which tend to alter the claimant’s perceptions. In this regard, as it pertains to the Veteran’s lay statements that she was sexually harassed in service, examiners have found that what she perceived as sexual harassment were exaggerated and did not amount to a personal assault once she was questioned further. Therefore, the Board gives more probative weight to the competent medical evidence as described above. To the extent that it is claimed that the Veteran has a separate psychiatric disorder characterized by substance abuse, to include cannabis use, the Board notes that statutes and VA regulations provide that no compensation shall be paid if a disability is the result of a Veteran’s own willful misconduct, including the abuse of alcohol and drugs. See 38 U.S.C. §§ 105, 1110; 38 C.F.R. §§ 3.1(n), 3.301; see also VAOPGPREC 2-97 (January 16, 1997). The law also precludes compensation for primary substance abuse disabilities, and secondary disabilities that result from primary substance abuse. Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). Thus, in order for service connection to be granted for alcohol or drug dependence, it must be established as secondary to, or a component of, a service-connected disability. However, the evidence does not reflect, nor does the Veteran claim, that she has substance dependence as a result of a service-connected disability, and a direct service connection theory is legally precluded. As such, service-connection for substance abuse must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426 (1994). Based on the reasons and bases discussed, the Board finds the Veteran’s claim for entitlement to service connection for an acquired psychiatric disorder, to include PTSD due to MST, adjustment disorder, unspecified anxiety disorder, and depressive disorder must be denied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Stephanie M. Owen Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.D. Hobbs, Associate 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.