Citation Nr: 21028265 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 17-06 138 DATE: May 10, 2021 ORDER Entitlement to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), other specified depressive disorder, and other specified personality disorder is denied. FINDING OF FACT The preponderance of the evidence is against finding that an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), other specified depressive disorder, and other specified personality disorder, began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), other specified depressive disorder, and other specified personality disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125, 4.127. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from September 1972 to December 1978. The Veteran was initially denied service connection in a July 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The claim was denied by the RO again in March 2016 and the Veteran subsequently filed an appeal to the Board of Veterans' Appeals (Board). In September 2019, the Veteran had a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. The Board then denied the Veteran's claim for an acquired psychiatric disorder, to include PTSD, other specified depressive disorder, and other specified personality disorder, in a December 2019 decision. In September 2020, the United States Court of Appeals for Veterans Claims (Court) vacated the December 2019 Board decision and remanded the Veteran's claim for action consistent with the directives of the Joint Motion for Remand (JMR). In the September 2020 JMR, the parties agreed that the Board's statement of reasons and bases was inadequate due to the fact that it omitted any discussion of the July 2019 PTSD diagnosis made by a psychiatrist. Therefore, the issue has been remanded back to the Board to address the July 2019 medical evidence in determining the Veteran's claim. See Tucker v. West, 11 Vet. App. 369, 374 (1998). 1. Entitlement to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), other specified depressive disorder, and other specified personality disorder The Veteran contends that he is entitled to service connection for an acquired psychiatric disorder, to include PTSD, other specified depressive disorder, and other specified personality disorder. Specifically, the Veteran claims that he was injured during a training exercise when a fellow soldier tripped a mine that exploded near the Veteran, lifting him in the air, throwing him against a tree and knocking him unconscious. Under the relevant laws and regulations, service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (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). Additionally, under 38 C.F.R. § 4.125, the diagnosis of a mental disorder must conform to the requirements found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). To prevail on a direct service connection claim, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Board, after fully and thoroughly reviewing the recordspecifically to include the July 2019 medical evidence that was omitted in the December 2019 Board decisionfinds that the evidence weighs against finding the Veteran service connected for an acquired psychiatric disorder to include PTSD, other specified depressive disorder, and other specified personality disorder. There is simply no evidence establishing a medical nexus between the Veteran's service and his acquired psychiatric disability, however diagnosed. The Veteran's service treatment records (STRs) do not reflect complaints, diagnosis, or treatment for any acquired psychiatric disorder. The November 1978 exit report of medical examination also shows that the Veteran had a normal psychiatric exam with no defects or diagnosis noted. Additionally, the STRs do not contain any reference to an in-service stressor. VA treatment records from the Louisville VA Medical Center (VAMC) show that the Veteran had a negative screening for depression in July 2004, a negative screening for PTSD in January 2005, a negative screening for depression in August 2008, and negative screenings for PTSD again in March 2009 and December 2009. However, in January 2011, a note from the mental health clinic stated that the Veteran "was abused as a child by his father both physically and verbally. He exhibits symptoms consistent with PTSD due to childhood trauma. [The Veteran] endorses symptoms as irritability/anger outbursts, social withdrawal, sleep disturbance, nightmares, avoidance of trauma triggers, and difficulty expressing emotion." In September 2014, the Veteran was seen at the Louisville VAMC where he reported that his trauma stemmed from getting "blown up" during a training exercise in-service and that he has no memory of the incident other than hitting the tree. He was diagnosed at that point with unspecified somatoform disorder, unspecified trauma, and stressor related disorder. The examiner specifically noted that PTSD was ruled out. However, the Veteran presented again to the Louisville VAMC in September 2014. On this second examination the Veteran was found to have adjustment disorder, depressed mood, and chronic PTSD. Specifically, the examiner stated that the Veteran met criteria for PTSD from his military service. In July 2015, the VA made a Formal Finding Regarding Lack of Information to Verify Stressors in Connection with a Claim for PTSD. It was determined that the information regarding the stressors described by the Veteran was insufficient to send to JSRRC or to research for service records. The VA found that all procedures to obtain information from the Veteran had been properly followed, evidence of written and telephonic efforts to obtain the information were on file, and all efforts to obtain the information had been exhausted, rendering further attempts futile. In December 2016, the Veteran was afforded a VA examination. The examiner specifically weighed the September 2014 VA treatment note diagnosing the Veteran with PTSD due to his military service. However, the examiner found the Veteran to not have any diagnosis of PTSD or other trauma-related disorder. The examiner reported that the Veteran's report of his symptoms was vague and not clearly associated with any specific stressor that occurred during service. The Veteran did claim involvement in a training accident during his service. But the examiner noted that the Veteran did not report any mental health difficulties specifically associated with the purported in-service event until years after he separated from service, despite being in contact with a VA mental health provider for several years before reporting the military trauma. The VA examiner also reported it was significant that the Veteran had an invalid performance on a test of response bias that is specifically related to PTSD symptoms and administered to assess the credibility of a Veteran's self-report. The December 2016 VA examiner diagnosed the Veteran with other specified depressive disorder, noting that the record is consistent in reporting the Veteran's depressive symptoms and life stressors (poor family relationships, grief issues, chronic pain, financial distress) that have contributed to the Veteran's depression. The examiner opined that the depressive symptoms were less likely than not incurred in or caused by service due to the fact that the Veteran did not seek mental health treatment in service and did not show any mental health symptoms at the time of his discharge. The examiner also diagnosed the Veteran with other specified personality disorder. Under 38 C.F.R. § 4.127, personality disorders are not diseases or injuries for compensation purposes. In March 2019, in a mental outpatient note, the Veteran continues to complain of nightmares and sleep disturbances. The nurse practitioner T.R.R. diagnoses the Veteran with depressive disorder due to another medical condition, chronic pain, COPD, and an unspecified trauma and stressor related disorder. NP T.R.R. specifically rules out PTSD. In July 2019, the Veteran was seen by Dr. S.B.B. who reported on a psychiatry inpatient progress note that the Veteran had a history of persistent depressive disorder, major depressive disorder, PTSD, and somatic symptom disorder with predominant pain. The note states that the Veteran self-presented to the ER earlier that month with complaints of his back and suicidal ideation. It is also reported that the Veteran called the VA Crisis Line while driving to the ER reporting depression, suicidal thinking, and thoughts of running his car into a telephone pole. At the ER the Veteran became agitated, demanded to leave, and attempted to hit one of the nurses, following which he was admitted. Dr. S.B.B. met with the Veteran before discharge and diagnosed the Veteran with major depressive disorder, persistent depressive disorder, somatic symptom disorder, and PTSD. The Veteran was seen again in July 2019 at mental outpatient clinic. The Veteran reported he has dealt with anger issues since 1998. He stated that he was injured in training by an explosion which injured his back, caused him to lose hearing in one ear, obtain a traumatic brain injury (TBI), and develop PTSD. The Veteran reports he still has nightmares, sleep disturbance, flashbacks when exposed to loud noise, and a lack of trust. The treatment provider at that time diagnosed the Veteran with unspecified depressive disorder and an unspecified trauma and stressor-related disorder. The examiner assigned only a "rule-out" diagnosis of both major depressive disorder and PTSD. Upon a full review of the record, to include the July 2019 medical treatment notes, the Board finds that the weight of the competent and credible evidence does not support a finding that the Veteran's acquired psychiatric disorder, however diagnosed, was manifested in service or within a compensable degree in the first year following service. The Board also notes that the weight of the competent and credible evidence does not establish that he has suffered from an acquired psychiatric disorder since service, with the first evidence of treatment and diagnosis occurring in 2011. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Despite the Veteran's September 2014 diagnosis of PTSD related to military service, the Board finds that the December 2016 examination holds more probative weight due to the fact that it reviewed the September 2014 diagnosis and found it to be inaccurate due to extensive investigation into the Veteran's symptomatology, self-reported symptoms, current life stressors, and past traumatic experiences that predated service. The Board also finds the July 2019 medical treatment note to have less probative weight than the remaining evidence of record. While Dr. S.B.B. states that the Veteran has a history of PTSD and assigns a current diagnosis of PTSD, he makes no mention of PTSD related to military service. The Veteran had been previously diagnosed with PTSD in 2011 due to his childhood trauma. Additionally, the July 2019 medical treatment note finding PTSD is surrounded by treatment records in August 2018, March 2019, later in July 2019, and August 2019 where the examiners and treatment providers all specifically ruled out PTSD in their final diagnosis and assessment. The Board finds compelling the consistent findings, both prior to and after the single instance in July 2019, that the Veteran does not have a clear diagnosis of PTSD. The Board considered the Veteran's lay statements in the record as well. The Veteran testified at his Board hearing in September 2019 that he was initially diagnosed with PTSD about eight to nine months ago. The Veteran also testified that he was in sniper training when a fellow soldier set a trip mine that exploded, throwing the Veteran against a tree, and causing him to lose consciousness. The Veteran also testified that he has been suffering from psychiatric symptoms since he left the service. While the Veteran is competent to report symptoms of a psychiatric disorder, he is not competent to provide a diagnosis of a specific psychiatric disability. Lay evidence that is submitted in the record must be competent and credible. Competent lay evidence is any evidence not requiring that the proponent have any specialized education, training, or experience. 38 C.F.R. § 3.159(a)(2). The issue here is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Due to the evidence reviewed above, the Board finds that the preponderance of the evidence is against a finding that the Veteran has an acquired psychiatric disorder, to include PTSD, other specified depressive disorder, and others specified personality disorder, due to service. As discussed above, the weight of the competent and probative evidence does not establish that any acquired psychiatric disorder, however diagnosed, is linked to his service. Since service connection requires competent evidence of a nexus between the current disability and service, service connection must be denied. In so finding, the Board has considered the benefit of the doubt doctrine. Because the preponderance of the evidence stands against the Veteran's claim, the doctrine is not helpful to the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.L. Aumiller, 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.