Citation Nr: 21028173 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 16-27 912 DATE: May 10, 2021 ORDER Service connection for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The Veteran does not have a current diagnosis of PTSD. CONCLUSION OF LAW The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from August 1968 to August 1970. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019 and December 2020, the Board remanded the Veteran's appeal to the RO for further evidentiary development. A January 2021 rating decision granted service connection for bilateral hearing loss and service connection for an acquired psychiatric disorder, to include anxiety disorder and depressive disorder. As this constitutes full grants of the benefits sought on appeal in regard to bilateral hearing loss and acquired psychiatric disorder disabilities, there remain no issues of controversy for adjudication by the Board on those claims. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). Entitlement to service connection for PTSD The Veteran contends that he has PTSD which warrants service connection. As indicated above, a January 2021 rating decision awarded the Veteran service connection for an acquired psychiatric disorder, to include anxiety disorder and depressive disorder, effective January 15, 2013. Thus, the only question remaining is whether service connection for PTSD is warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing entitlement to direct service connection generally requires: (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 - which is the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Turning to the evidence, the Veteran underwent a VA psychiatric consultation in March 2009. He reported irritability, particularly when he was in the car when his wife was driving, and nightmares two to four times a month. He said that in the past he had physically struck out in his sleep, seemingly due to nightmares of combat. The Veteran reported feeling depressed most of the time and nervous frequently, including worries about the economy. He also said that he was disturbed by movies about war and that they gave him nightmares and that he is startled by loud noises. The examiner diagnosed anxiety disorder not otherwise specified, and major depressive disorder. VA treatment records include negative screening tests for PTSD and depression through June 2013. One 2005 screen indicated that the Veteran had PTSD. In January 2013, the Veteran provided a written statement about a stressor incident during his service. He said that his unit was attacked by enemies who were located in a civilian area, making it impossible for U.S. air support to attack them. The Veteran reported that one of his men lost both legs to a mortar attack. He also described separate incidents including sniper attacks, temporary loss of hearing due to an explosion, and firefights against the enemy. The Veteran's wife provided a January 2013 statement that his personality changed during his military service. She said that the Veteran had nightmares and ducked at loud noises on returning from service. She said that the Veteran's nightmares worsened and that he had little patience with their children. The Veteran underwent a VA examination for PTSD in November 2013. The examiner noted the Veteran's reported stressor events during service. The examiner concluded that the Veteran did not meet the diagnostic criteria under DSM-IV for PTSD because, although the Veteran had traumatic events in service (Criterion A) and persistently reexperienced them (Criterion B) and two or more persistent symptoms of increased arousal (Criterion D), he did not show persistent avoidance of stimuli associated with the trauma (Criterion C). The examiner did not diagnose a mental health disorder but noted that the Veteran had the following symptoms: chronic sleep impairment and difficulty in adapting to stressful circumstances at work. On January 2020 VA examination, the examiner also found that the Veteran did not meet the diagnostic criteria for PTSD. This examination used rating criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Specifically, the Veteran had exposure to actual or threatened death or serious injury (Criterion A) and marked alterations in arousal and reactivity associated with the traumatic event (Criterion E), but did not have the presence of one or more listed intrusion symptoms (Criterion B), persistent avoidance of stimuli associated with the event (Criterion C), or negative alterations in cognitions or mood (Criterion D). The examiner diagnosed unspecified anxiety disorder, unspecified depressive disorder, and alcohol use disorder. In January 2021, a VA examiner also found that the Veteran did not meet the rating criteria for PTSD under DSM-5. Specifically, the examiner found that the Veteran had exposure to actual or threatened death or serious injury in service (Criterion A), presence of one or more listed intrusion symptoms associated with the traumatic event (Criterion B), persistent avoidance of stimuli associated with the traumatic event (Criterion C), and marked alteration in arousal and reactivity associated with the traumatic event (Criterion E), but he did not have negative alterations in cognitions and mood associated with the traumatic event (Criterion D). The examiner diagnosed unspecified anxiety disorder, unspecified depressive disorder, and alcohol use disorder. The preponderance of the evidence is against a finding that the Veteran has a diagnosis of PTSD under DSM-5 criteria. Specifically, the psychologists completing the examinations in January 2020 and January 2021 concluded that the Veteran did not show negative alterations in cognition or mood associated with the traumatic event (Criterion D under DSM-5). The Board places great weight of probative value on these opinions as they reflect full consideration of the Veteran's history and lay and medical evidence and provide clear rationales for their conclusions. As discussed in the Board's July 2019 remand order, the 2013 VA examination report relied on factual inaccuracies and was internally inconsistent, and these failures render the opinion inadequate and not entitled to weight of probative value. Although a 2005 screening was positive for PTSD, the January 2020 and January 2021 VA examinations each found that the Veteran did not meet the criteria for a diagnosis of PTSD according to the criteria of DSM-5. In the March 2021 brief, the Veteran's representative contended that the Veteran met the diagnostic criteria for PTSD because of the 2005 positive screen and because the Veteran's spouse said that he was nervous and relived his Vietnam experiences when watching war movies. A screen for PTSD is based on answers to several yes-or-no questions; it is not a diagnosis, is not based on DSM criteria, and it does not include a rationale for its conclusion, and as a result holds little weight of probative value. Miller v. West, 11 Vet. App. 345 (1998) (finding that a mere conclusion without an underlying rationale is of no probative value). Therefore, the Board finds that the VA examination reports hold more probative value than the June 2005 PTSD screen. Although the Veteran's spouse is competent to describe the Veteran's observable symptoms, she is not competent to make a diagnosis of PTSD. Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) (holding that "PTSD is not the type of medical condition that lay evidence... is competent and sufficient to identify"). The March 2021 brief also argued that the Veteran has PTSD because, in March 2009, a VA treatment record stated that the Veteran had a past medical history of PTSD. The VA note indicating that a Veteran has a history of PTSD does not reflect a diagnosis of PTSD during the appeal period and does not contain a rationale; therefore, the VA treatment record holds little weight of probative as to whether the Veteran has had a diagnosis of PTSD during the period on appeal. The March 2021 brief also contended that the Veteran's failure to meet DSM criteria for a diagnosis of PTSD may be because his symptoms may be masked by his medications or alcohol. However, the Veteran's representative has not cited to any evidence supporting this argument, and the record does not contain any such evidence. The Board places greater weight of probative value on the medical examiners' opinions in this regard as they have considered the Veteran's full medical history in determining the most appropriate diagnosis, including his medication and alcohol use. The Veteran's representative argues that he is not required to meet every diagnostic requirement in order to have a diagnosis of PTSD. The representative cites Drosky v. Brown, 10 Vet. App. 251, 255 (1997), and Johnson v. Brown, 7 Vet. App. 95, 97 (1994), but those cases addressed diagnostic codes for increased ratings claims, not diagnoses under DSM-5. Pertinent regulations require that medical evidence must diagnose PTSD in accordance with 38 C.F.R. § 4.125, which provides that psychiatric diagnoses must be made in accordance with DSM-5. 38 C.F.R. §§ 3.304(f), 4.125. Lay persons are not competent to provide diagnoses of PTSD. Young, 766 F.3d at 1353. In the absence of proof of a current disability, there can be no service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. Brammer, 3 Vet. App. at 225. As the preponderance of the evidence is against a finding that the Veteran has a diagnosis of PTSD during the appeal period, the Veteran's claim for service connection for PTSD is denied. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Dean 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.