Citation Nr: 21023418 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-24 888 DATE: April 20, 2021 ORDER Service connection for an acquired psychiatric disorder other than posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. The Veteran served on active duty from August 1973 to August 1976. 2. An acquired psychiatric disorder other than PTSD that is productive of psychiatric symptoms or functional impairment separate and distinct from that for which he is currently service-connected has not been shown. CONCLUSION OF LAW An acquired psychiatric disorder other than PTSD was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION In November 2018, denied service connection for PTSD and remanded the service connection for a disorder other than PTSD issue for additional development. Subsequently, service connection was granted for PTSD in a September 2020 Board decision. In a February 2021, the Veteran’s attorney withdrew his representation and the Veteran remains unrepresented. 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). Historically, the Veteran filed a claim for service connection for PTSD in January 2014. Service connection was denied in December 2014. In November 2018, the Board denied PTSD due to an absence of a diagnosis but remanded the appeal as to a psychiatric disorder other than PTSD based on private treatment records reflecting diagnoses of depressive disorder NOS, and panic disorder with agoraphobia. The Veteran appealed the November 2018 Board decision to the Veterans Claims Court. In January 2020, the Court Clerk granted a joint motion for partial remand (JMPR) which vacated the November 2018 Board decision and remanded the matter back to the Board for compliance with the JMPR. In September 2020, the Board granted service connection for PTSD. In October 2020, the agency of original jurisdiction (AOJ) implemented the Board’s grant of service connection for PTSD and assigned a 50 percent rating for symptoms including depressed mood, difficulty adapting to stressful circumstances including work/worklike setting, suspiciousness, disturbances of motivation and mood, flattened affect, anxiety, difficulty in establishing and maintaining effective work and social relationships, chronic sleep impairment, and occupational and social impairment with reduced reliability and productivity. Turning to the medical evidence, a December 2013 private treatment record noted a diagnosis of PTSD. The private psychiatrist reported that the Veteran endorsed disturbing memories, thoughts, and images of the traumatic events during his service. He also endorsed repeated, disturbing dreams and nightmares. The diagnoses were PTSD, depressive disorder NOS, and panic disorder with agoraphobia. A December 2014 VA examiner found the Veteran did not have a diagnosis of PTSD in accordance with DSM-5 criteria. The examiner opined that the Veteran’s presentation during the evaluation indicated inaccurate self-report consistent with embellishment of symptoms. The examiner also noted that the Veteran reported social and occupational functioning that would be inconsistent with the extreme levels of psychopathology that he endorsed on psychological testing measures. The examiner also stated that individuals who present with inaccurate self-report of symptoms may very well have mental health symptoms that are clinically significant and distressing; however, the examiner concluded that based on the inaccuracy of the Veteran’s report at the examination, it was not possible to ascertain, without undue speculation, the type or severity of symptoms the Veteran was currently experiencing. A June 2018 private disability benefits questionnaire listed a diagnosis of PTSD in accordance with DSM-5 criteria. The private psychologist summarized the Veteran’s occupational and social impairment as reduced reliability and productivity and reported that the Veteran had no other diagnosed mental disorder. The symptoms were noted to include depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances and neglect of personal appearance and hygiene. A September 2019 VA examination report noted a single diagnosis of unspecified depressive disorder, with anxious distress. The symptoms were noted to include depressed mood, anxiety, chronic sleep impairment, flattened affect, and disturbances of motivation and mood. A May 2020 private psychological examination report noted a diagnosis of PTSD. Symptoms included depression, anxiety, memory loss, intrusive memories, avoidance, intrusive thoughts, nightmares, sleep disturbances, isolation, decreased interest in activities or interaction with others, irritability, and difficulty concentrating. A September 2020 VA examination report noted that the Veteran had a single mental health diagnosis, PTSD. His symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances including work or a work like setting. It was also noted that a September 2019 VA examination report noted a diagnosis of unspecified depressive disorder with anxious distress, a December 2014 VA examination report did not reflect any psychiatric diagnosis, and a July 2015 treatment record reflected complaints of anxiety, hypervigilance, depression, obsessional thoughts. The diagnoses were PTSD, depressive disorder NOS and panic disorder with agoraphobia. Although service connection for PTSD has been granted, the issue remains whether service connection is warranted for any additional psychiatric manifestations, separate and apart from those attributable to the service-connected PTSD. In this regard, the medical evidence does not reflect that the Veteran has separate psychiatric diagnoses productive of distinct symptoms. Rather, a review of the medical evidence, the various evaluating and treating clinicians have alternatively referred to the same symptoms as PTSD, depressive disorder, and panic/anxiety disorder. Further, although various manifestations of a single disability may be assigned separate disability evaluations, VA regulations preclude the practice of “pyramiding,” which is the evaluation of the same manifestation of a disability under different diagnoses. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259 (1994). Indeed, the Court has noted that 38 U.S.C. § 1155 implicitly contains the concept that “the rating schedule may not be employed as a vehicle for compensating a claimant twice or more for the same symptomology; such a result would overcompensate the claimant for the actual impairment of his earning capacity” and would constitute pyramiding. Esteban, 6 Vet. App. at 261, quoting Brady v. Brown, 4 Vet. App. 203 (1993). Here, the Veteran is already in receipt of service connection for PTSD, which has been assigned a 50 percent rating. With the exception of eating disorders, all mental health disorders, including PTSD, other specified anxiety disorder (DC 9410), major depressive disorder (DC 9434), and depressive disorder NOS (unspecified depressive disorder, DC 9435), are evaluated under the General Rating Formula for Mental Disorders (General Rating Formula), which assigns ratings based on particular symptoms and the resulting functional impairment. See 38 C.F.R. § 4.130, DCs 9201-9440. The symptoms attributed to the Veteran’s PTSD (including depression, anxiety, irritability, intrusive memories, distressing dreams, isolation, avoidance of thoughts or feelings, detachment, flattened affect, chronic sleep impairment, irritability, hypervigilance, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a work like setting, and disturbances of motivation and mood) encompass the symptoms attributed to the Veteran’s depressive disorder and panic/anxiety disorder with agoraphobia. The medical evidence does not identify any additional psychiatric pathology or functional impairment attributable to any psychiatric disorder for which service connection is not in effect. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (reflecting that the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability”). As such, because the criteria under the General Rating Formula contemplate the disabling effects of the Veteran’s psychiatric symptomatology, to the extent that he asserts that service connection is warranted for another acquired psychiatric disability other than PTSD, his symptoms were already taken into consideration in the assignment of a rating for his PTSD. Thus, because there is no objective evidence that the Veteran has an acquired psychiatric disorder other than the service-connected PTSD that is productive of a functional impairment in earning capacity beyond that contemplated by the 50 percent evaluation currently assigned his PTSD, awarding service connection (and hence, a separate disability rating) for an acquired psychiatric disability other than PTSD would constitute impermissible pyramiding. See 38 C.F.R. § 4.14. To the extent the Veteran contends that he has a psychiatric disorder other than PTSD which is related to service, the Board notes that 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 such 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, 369-370 (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 E. Redman, 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.