Citation Nr: 21024611 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 17-48 256A DATE: April 23, 2021 ORDER Entitlement to an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD), depression, and anxiety is denied. FINDING OF FACT The Veteran’s acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) and depression were not shown in service or for many years thereafter, and is not otherwise etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD), depression, and anxiety have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Air Force from December 1967 to November 1971. This matter was previously remanded by the Board in July 2020 for additional development, including a VA examination. As there has been substantial compliance with prior remand directives, this matter is properly before the Board for adjudication. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may 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). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection for PTSD requires (1) medical evidence diagnosing the condition; (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f). The applicable regulation requires that the in-service stressor or traumatic event involve actual or threatened death, serious injury, or a threat to the physical integrity of self or others and the person's response involve intense fear, helplessness, or horror. Typically, if a Veteran did not engage in combat with the enemy, the Veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. Instead, the record must contain evidence that corroborates the Veteran's testimony as to the occurrence of the claimed stressor. 38 U.S.C. § 1154 (b); 38 C.F.R. § 3.304 (d), (f); West v. Brown, 7 Vet. App. 70 (1994). However, if a stressor claimed by a veteran is related to a fear of hostile military or terrorist activity that is consistent with the places, types, and circumstances of a veteran's service, and a VA psychiatrist or psychologist (or a psychiatrist or psychologist with whom VA has contracted) confirms that the claimed stressor is adequate to support a diagnosis of PTSD that is related to the claimed stressor, then the requirement for corroborating the stressor is eliminated. "Fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304 (f)(3). Additionally, a service connection claim that describes only one particular psychiatric disorder should not necessarily be limited to that disorder. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Rather, as reflected in the title page, VA should consider the claim as one for any psychiatric disability that may reasonably be encompassed by evidence of record. Therefore, the Board will consider service connection for any acquired psychiatric disorder shown by the record. 1. Entitlement to an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD), depression, and anxiety The Veteran is seeking service connection for PTSD, depression, and anxiety. After a review of the evidence the Board finds that service connection is not warranted for an acquired psychiatric disorder. As an initial matter, the Veteran was diagnosed with PTSD and recurrent major depression in 2007. However, the evidence of record does not indicate that these disorders are related to service. PTSD In this case, the Board finds that the Veteran's service connection claim for PTSD should not be granted as the evidence cannot confirm his reported stressor event. As an initial matter, the Veteran has been diagnosed with PTSD under the DSM-V, as such the Board concedes a current disability of PTSD. Specifically, in order to clarify the nature of the Veteran's psychiatric symptoms, the Veteran underwent a VA psychiatric examination in November 2020. After a thorough psychiatric evaluation, the examiner determined that a diagnosis for PTSD was warranted based upon the identified stressors that were incurred in service, to include learning about the deaths of service members aboard a C-130 that he had routed, which was shot down. In addition to his PTSD diagnosis, the Veteran diagnosed the Veteran with unspecified depressive disorder, and alcohol use disorder, which was currently in sustained remission. Next, the Board has heard the Veteran's recitation of a stressor, specifically that the crew members on the planes that he scheduled lost their lives in Vietnam which caused his PTSD. However, there is insufficient evidence to corroborate this stressor, given its general nature. While the Board recognizes that the Veteran's statements regarding his service, there is no evidence to corroborate what he has said actually occurred. Notably, several formal findings were conducted in April 2008, December 2012, September 2013, and February 2014 which determined that the information required to verify the stressful events described by the Veteran is insufficient to send to JSRRC and/or insufficient to research the case for an Air Force record. Additionally, the Veteran was sent a letter on November 7, 2012 requesting the Veteran to provide additional information regarding the loss of his friends, however no additional information has been provided. In the Board’s view, non-specific assertions of incidents that did not directly occur to the Veteran are insufficient to constitute a “stressor” event for purposes of 38 C.F.R. § 3.304(f). Moreover, since the Veteran was not actually on the C-130s that he discussed, there was no reasonable fear of hostile activity. Moreover, lay testimony alone, is not sufficient to establish that a stressor occurred; it must be corroborated by "credible supporting evidence." See Cohen v. Brown, 10 Vet. App. 128, 142 (1997); see also Moreau v. Brown, 9 Vet. App. 389. The evidence does not indicate that the Veteran is a "combat veteran" under § 3.304(f)(2). Finally, the Veteran does not assert that he was a prisoner of war under 38 C.F.R. § 3.304 (f)(4). As such, neither the Veteran's own testimony, nor any medical evidence obtained after service, is enough to corroborate his claimed stressor. The Board notes the opinion provided by the November 2020 VA examiner who found that the Veterans current PTSD was at least as likely as note incurred in or caused by the claimed in-service injury, event, or illness. To support this opinion, the examiner stated that the Veterans symptoms were the direct result of the identified stressors that were incurred in service. However, the fact that the VA examiner referred to this as a “stressor” does not make it so under the regulation. Cf. 38 C.F.R. § 3.304(f)(5). Rather, as discussed above, stressor events such as the ones the Veteran describes require verification, and this has not been shown here. Thus, the third element, credible supporting evidence that the claimed in-service stressor occurred, for service connection for PTSD has not been met. Despite following all required procedures to assist the Veteran in corroborating his claimed stressor, VA was not able to corroborate it. Given the insufficient information of record required to corroborate the Veteran's claimed stressor, the preponderance of the evidence is against the claim. Accordingly, service connection for PTSD is not warranted. Acquired Psychiatric Disorders other than PTSD As for whether service connection is warranted an acquired psychiatric disorder, to include depression and/or anxiety, the Board determines that service connection is also not warranted on this basis. While the Board notes that the Veteran has current diagnosis of unspecified depressive disorder and alcohol use disorder, they were not shown in service or related to service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). The Veteran's in-service medical records are silent for any signs, symptoms, treatment, or diagnoses of an acquired psychiatric disorder. In fact, there are no indications in his July 1971 separation examination of any psychiatric disorder or symptoms. In fact, the post-service evidence does not reflect a diagnosis of any acquired psychiatric disorder until 2007, approximately 36 years following the Veteran's last period of active duty service, as such, a continuity of symptoms is not shown based on the clinical evidence. Additionally, the large gap in treatment for the asserted conditions weighs against the Veteran's claims. See Kahana v. Shinseki, 24 Vet. App. 428, at 439-40 (2014) (The Board may weigh silence in a medical record against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated). As part of this claim, the Board recognizes the statements from the Veteran, regarding his history of psychiatric symptoms. In this regard, while the Veteran is a nurse and has some authority to speak to medical subjects, there is no indication that he is trained in psychiatry. Furthermore, the lack of supporting clinical evidence of record weighs against such claims. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, for the same reasons stated above, the Board determines that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless inconsistent, given the large gap between the Veteran's discharge and when he first received a diagnosis and sought medical treatment for PTSD, depression, and anxiety. See Walker, 708 F.3d at 1331. Further, the Veteran filed claims for VA benefits prior to filing the claims on appeal. Therefore, the fact that the Veteran was aware of the VA benefits system and sought out a claim for other benefits, but made no reference to the disorders he now claims, weighs heavily against his credibility. Therefore, continuity of symptoms has not been shown based on the clinical evidence, including for purposes of the chronic disease presumption under 38 C.F.R. § 3.307 (a)(3). Next, service connection may nonetheless be established if a relationship may be otherwise established by competent evidence, including medical evidence and opinions. In this case, however, the competent evidence fails to establish a relationship between active duty and the Veteran's current symptoms. As noted above, the Veteran underwent a VA examination in November 2020. The examiner diagnosed the Veteran with PTSD, unspecified depressive disorder, and alcohol use disorder. The examiner noted that the Veteran suffered from occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The examiner noted that the Veteran has had intermittent treatment through VA in Pueblo since 2009 and is prescribed antidepressants and anxiety medications. Additionally, the examiner noted that the Veteran suffers from symptoms of depressed mood, anxiety, panic attacks, disturbances motivation/mood, chronic sleep impairment, flattened affect, difficulty in establishing and maintaining effective work or worklike setting, and suicidal ideation. In this case, there is not sufficient evidence in the medical records to demonstrate a nexus between his active duty service and his presently diagnosed psychiatric disorders. Indeed, there is no objective medical evidence linking these disorders to his active duty service. Further, the Board notes that the Veteran has not provided sufficient evidence, including private opinions and/or medical evidence, to establish a nexus between his active service and his current psychiatric disorders. As part of this claim, the Board recognizes the statements from the Veteran regarding the relationship between his disorders and active service. Nevertheless, while he is competent to provide testimony regarding observable symptomatology such as psychiatric symptoms, he is not competent to provide a nexus opinion in this case as he has not been shown to have been trained in psychiatry. These issues are also medically complex, as they require knowledge of the interaction between multiple systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Therefore, the unsubstantiated statements regarding the claimed diagnosis and etiology of the Veteran's psychiatric disorder are found to lack competency. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claims for service connection for an acquired psychiatric disorder, to include PTSD and unspecified depressive disorder and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the appeal is denied.   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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Vample, Erica