Citation Nr: 21028209 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 16-29 672 DATE: May 10, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include schizotypal personality disorder, panic disorder and stimulant use disorder in sustained remission, is denied. FINDING OF FACT The Veteran's psychiatric disorders did not have onset during active service and are not otherwise related to active service. CONCLUSION OF LAW The criteria for an entitlement to service connection for acquired psychiatric disorder, to include schizotypal personality disorder, panic disorder and stimulant use disorder in sustained remission, have not been met. 38 U.S.C. §§ 1110, 5107 (West 2014); 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from February 1978 to February 1982. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2015 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. The Veteran testified before the undersigned Veterans Law Judge during a March 2019 video conference hearing, a transcript of which is associated with the claims file. Having reviewed the record, the Board finds that there has been substantial compliance with the previous Board remand directives as requested VA treatment records and an adequate medical addendum opinion have been obtained. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In a July 2020 statement, the Veteran's representative disputed the adequacy of the December 2019 VA examination. Specifically, the representative pointed out that the examiner failed to address VA treatment records, which document diagnosis of only depression and anxiety disorder with agoraphobia, not a personality disorder, as well as July 2015 VA treatment records showing the onset of the Veteran's psychiatric disorder as 1981 (when the Veteran was on active duty). The representative also stated that the examiner failed to consider the Veteran's in-service stabbing event in furnishing a negative medical nexus opinion. However, as an adequate medical addendum opinion/VA examination was subsequently obtained, which took into consideration all pertinent records, to include VA treatment records and service treatment records, the Board finds that another remand is not required. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist, or with the conduct of his Board hearing. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Thus, the Board need not discuss any potential issues in this regard. The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant, when rendering a decision on appeal. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board has thoroughly reviewed all the evidence in the Veteran's VA files. In every decision, the Board must provide a statement of the reasons or bases for its determination, adequate to enable the Veteran to understand the precise basis for the Board's decision, as well as to facilitate review by the United States Court of Appeals for Veterans Claims (Court). 38 U.S.C. § 7104 (d)(1) (2012); see Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (rejecting the notion that the Veterans Claims Assistance Act mandates that the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. 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; 38 C.F.R. § 3.102; 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 to the claimant. See Gilbert, 1 Vet. App. at 53. Service connection may be granted for disability arising 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 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Direct service connection may be granted only when a disability was incurred or aggravated in the line of duty, and not the result of the veteran's abuse of alcohol or drugs. An injury or disease incurred during active military, naval, or air service is not considered to have been incurred in the line of duty if such injury or disease was a result of the abuse of alcohol or drugs. Drug abuse means the use of illegal drugs (including prescription drugs that are illegally or illicitly obtained), the intentional use of prescription or non-prescription drugs for a purpose other than the medically intended use, or the use of substances other than alcohol to enjoy their intoxicating effects. 38 C.F.R. § 3.301 (d). See also, 38 U.S.C. § 105; 38 C.F.R. § 3.1 (m). The Veteran contends he has an acquired psychiatric disorder as a result of an in-service incident in which he and his friend were both stabbed. It is not in question that the Veteran has a current psychiatric disability, as he has been diagnosed with various conditions, to include cocaine use in remission, antisocial personality disorder, alcohol use disorder in remission, schizotypal personality disorder, panic disorder and stimulant use disorder (cocaine) in sustained use, depression and anxiety disorder with panic attacks and agoraphobia. Personality disorders are specifically excluded from the definition of disease or injury within the meaning of VA statutes and regulations. See 38 C.F.R. §§ 3.303(c); 4.9, 4.127; Winn v. Brown, 8 Vet. App. 510 (1996). While a claimant cannot be compensated for a personality disorder, which is considered to be a congenital or developmental abnormality, disability resulting from a mental disorder that is superimposed upon a personality disorder may be service-connected. See 38 C.F.R. § 4.127; VAOPGCPREC 82-1990 (July 18, 1990). Therefore, while 38 C.F.R. §§ 3.303(c), 4.9, and 4.127 prohibit any grant of service connection for a personality disorder, even if aggravated in service, a diagnosed psychiatric disorder may provide a basis for service connection if the evidence demonstrates the psychiatric disorder was superimposed upon a veteran's diagnosed personality disorder. Thus, in this case, the Veteran's schizotypal personality disorder cannot be service-connected, but a disability resulting from a mental disorder that is superimposed upon his schizotypal personality disorder may be service-connected. Turning to the Veteran's service treatment records, while the Veteran waived his separation examination, his January 1981 service treatment records document treatment received for a stab wound in the left side of the chest. There was no in-service treatment for a mental health condition. Thus, the question at issue is a medical etiology between the Veteran's acquired psychiatric conditions and his in-service stabbing incident or any other in-service disease or injury. There were multiple VA examinations obtained throughout the appeal period. First, the Veteran underwent a VA examination in March 2015, during which time he was diagnosed with schizotypal personality disorder, panic disorder and stimulant use disorder (cocaine) in sustained use. After reviewing all pertinent records, the examiner provided a negative medical etiology opinion for all of these diagnosed conditions, pointing out that the onset of his panic disorder and stimulant use disorder were years after separation from service (2013 and 2008, respectively), and associated them with his post-service events unrelated to his service (after brother's death (in 2013) per the Veteran's report, and after his mother's death in 2008). As for his schizotypal personality disorder, the examiner clarified that this is a congenial abnormality. There was no evidence of any mental disorder superimposed upon his schizotypal personality disorder. Although the opinion itself was adequateas it was provided after reviewing all relevant records and was substantiated by concrete factual findingsconsidering that the Veteran reported thereafter that he has been diagnosed with other non-personality disorder acquired psychiatric conditions, the Board remanded in October 2019 for another VA examination to address etiology for all acquired psychiatric diagnoses present during the pendency of the appeal. A new VA psychiatric examination was obtained in December 2019, but as noted in the November 2020 Board remand, this opinion was internally inconsistent (the examiner checked the box that the claimed condition is not related to service, but also stated that "the Veteran's medical records support that any currently diagnosed condition(s) related to the veteran's claimed acquired psychiatric disorder to include schizotypal personality disorder, panic disorder, stimulant use disorder in sustained remission, depression, and anxiety disorder with panic attacks and agoraphobia, is/are at least as likely as not etiologically-related to the veteran's service"), failed to provide any rationales in support of its finding (which is unclear as to whether it is a favorable or unfavorable conclusion), and also failed to address the in-service stabbing incident that the Board expressly requested the examiner to discuss. Therefore, this report is not persuasive evidence, and the Board has not considered it either for or against the claim. Thus, another VA examination/medical nexus opinion was obtained in January 2020. The examiner diagnosed the Veteran with cocaine use in remission, antisocial personality disorder, alcohol use disorder in remission, and opined that all of his symptoms are due to the Veteran's personality disorder, considering that the substance abuse disorders are in remission and do not affect the current clinical picture. After reviewing all pertinent records, the examiner concluded that the Veteran's diagnosed psychiatric disorders, to include schizotypal personality disorder, panic disorder, stimulant use disorder in sustained remission, depression, and anxiety disorder with panic attacks and agoraphobia, are not at least as likely as not etiologically related to his service. The examiner emphasized that the Veteran's diagnosis is a personality disorder. As for various non-personality psychiatric disorders diagnosed during the appeal period, to include any issues with mood/emotions, the examiner opined that all of the Veteran's symptoms are due to the Veteran's personality disorder, and further attributed his non-personality disabilities to alternative factors not related to service (long history of substance abuse; likely character logic in nature), considering that substance abuse disorders are in remission. A medical addendum opinion was again obtained in November 2020 for the examiner to further address the inconsistent findings in the 2019 VA examination and to address the 2015 VA treatment records showing the onset in 1981. First, regarding the discrepancy of the 2019 VA examination, the examiner indicated that she meant "less likely than not" and checked the correct box, but erroneously used the wrong language. With regards to the 2015 VA treatment records documenting the onset of psychiatric illness as 1981, the examiner opined, even after acknowledging this record, that there is no link between his psychiatric disorder and his service, to include the in-service stabbing incident. The examiner underlined that his treatment records from an earlier period (ie. 2000, closer to the time that the in-service incident occurred) provide an extensive history of alcohol and cocaine use (since 1985 and for 25 years) and related his conditions to his alcohol/substance abuse, and that he was not diagnosed with any mood disorder outside of periods of substance use. The examiner also emphasized that the Veteran was malingering on the exam. The recently obtained medical treatment recordsfurnished by social security administration (SSA), which document that the Veteran has panic disorder without agoraphobia, unspecified depressive disorder, history of cocaine use disorder (reportedly in remission 4.5 years)further corroborate the aforementioned VA opinions that his non-personality psychiatric disability (ie. panic disorder) is not related to service, as they include a private psychological assessment from July 2014 indicating that its onset was after the Veteran's brother passed away. The Board acknowledges the June 2015 VA treatment records, documenting the Veteran's report of the onset of his psychiatric conditions as post-in-service stabbing incident, and a notation stating, "onset of psychiatric illness [diagnosed as panic disorder and depressive disorder nos]: 1981." While this appears to be favorable to the claim, it is not persuasive evidence of a nexus to service. This notation of onset in 1981 is not a medical opinion, per se, as the VA medical provider at the time failed to provide any rationale in support of finding that the onset of his psychiatric illness was 1981. In fact, it does not appear that the medical provider reviewed all pertinent records, to include his earlier mental health treatment records, which is crucial here considering his documented substance abuse history. Instead, it seems that the note regarding the onset was based solely on the Veteran's report made during that visit, which the Board finds not credible, given its inconsistency with the overall medical history/his own statements and reports made at other times (see July 2014 VA treatment records, the Veteran reporting that he began having anxiety after his younger brother passed away; see June 2015 VA treatment records, the Veteran had a traumatic experience while in Germany in 1981, but his anxiety/shyness was present before the incident; see March 2015 VA examination, the Veteran reporting the onset of his psychiatric condition as after his mother and brother passed away). Thus, the Board does not assign any probative value to this evidence. Accordingly, the Board finds that the preponderance of the evidence is against the finding that the Veteran's acquired psychiatric conditions are related to his military service, to include his in-service incident. The Board assigns most probative value to the March 2015, January 2020, and November 2020 VA examinations/medical addendum opinions, in their totality. The 2020 opinions, in particular, were obtained after reviewing all pertinent records, to include VA treatment records and service treatment records, and were corroborated by concrete factual findings. The Board also points out that there is no evidence of any mental disorder that is superimposed upon a personality disorder that may be service-connected. The Veteran's lay statements have been considered in this decision. However, as a layperson, the Veteran is without the appropriate medical training and expertise to offer an opinion on a medical matter, including the diagnosis or etiology of a specific mental health disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also 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"). Moreover, as discussed above, his statements as to the onset of his symptoms are not entirely credible, given inconsistency with other evidence of record. [Continued on Next Page] As the preponderance of the evidence is against the claim of entitlement to service connection for acquired psychiatric disorder, to include schizotypal personality disorder, panic disorder and stimulant use disorder in sustained remission, the benefit-of-the-doubt doctrine has no application. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Lee 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.