Citation Nr: 21029283 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-35 280 DATE: May 13, 2021 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The most probative evidence is against a finding that the Veteran has PTSD. CONCLUSION OF LAW The criteria for entitlement to service connection for PTSD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.125. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1990 to June 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision by a Department of Veterans Affairs (VA) regional office. The Board remanded the claim for further development in November 2018. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). With respect to PTSD, service connection requires: (1) medical evidence establishing a diagnosis of the condition in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM); (2) credible supporting evidence that the claimed inservice stressor occurred; and, (3) a link established by medical evidence, between current symptoms and an in-service stressor. 38 C.F.R. §§ 3.304(f), 4.125. Lay testimony alone can establish the occurrence of the claimed in-service stressor in certain circumstances, but generally the claimed stressor must be corroborated by credible supporting evidence. Id. The evidence of record establishes that the Veteran has an in-service stressor related to a fear of hostile military or terrorist activity. Specifically, he reported that he was shot at during service. Additionally, he was awarded the Air Force Outstanding Unit Award with Valor, with reflects combat service. As such, the issue at hand is whether the Veteran has a current disability of PTSD related to his in-service stressor. The Veteran underwent a VA PTSD examination in connection with this claim in September 2019. The examiner diagnosed persistent depressive disorder, and opined that the condition was a progression of the Veteran's service-connected major depressive disorder. After providing a thorough review of the Veteran's medical history and symptoms, the examiner opined that the diagnostic criteria for PTSD were not met. In that regard, while the Veteran's stressor was adequate to support a diagnosis of PTSD, he did not meet the diagnostic criteria with respect to intrusion symptoms, persistent avoidance of stimuli associated with the traumatic event, negative alterations in cognitions and mood associated with the traumatic events, and marked alterations in arousal and reactivity associated with the traumatic event. The Veteran experienced symptoms which could be associated with these criteria, but the examiner found they were not clinically significant enough to support a PTSD diagnosis. The examiner instead opined that the Veteran's symptoms, including depressed mood, anxiety suspiciousness, chronic sleep impairment, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, are best represented by his service-connected diagnosis of major depressive disorder which, as noted above, has progressed to persistent depressive disorder. With respect to treatment records throughout the period on appeal, a diagnosis of PTSD based on the DSM-5 was made by a VA social worker in October 2015. Additionally, in September 2015, the same social worker diagnosed unspecified trauma and stressor related disorder. While other references to PTSD can be found in the Veteran's treatment records, it is generally referred to as a diagnostic impression or as a possible, rather than a definitive, cause of the Veteran's psychiatric symptoms. The Veteran, as a lay person, is competent to describe observable symptoms. Although lay persons are competent to provide opinions on some medical issues, an opinion as to a psychiatric diagnosis in accordance with the DSM falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Psychiatric diagnoses require specialized training; as the Veteran has not been shown to have any medical or psychiatric expertise, his lay opinion as to his diagnosis is afforded very little weight. Upon review, the Board finds the September 2019 VA opinion should be afforded greater probative weight than the October 2015 diagnosis found in the Veteran's VA treatment records. The September 2019 opinion was based on a full overview of the entire record by a licensed psychologist, including the VA treatment records noting the PTSD diagnosis, and was provided by an examiner who was specifically tasked with determining whether the Veteran's symptoms are best explained by a diagnosis of PTSD or by his service-connected depressive disorder. The September 2019 examiner fully explained the diagnostic tests used and why they were not consistent with a diagnosis of PTSD or another trauma disorder. Conversely, the October 2015 PTSD diagnosis was made by a social worker, who is not a medical expert. Moreover, the references to PTSD in the Veteran's regular treatment records are in the course of ongoing treatment; that is, in an environment where the exact diagnosis is less important than the symptoms themselves. These records, such as an August 26, 2019, record indicate the Veteran has symptoms which "may be consistent with" PTSD and a January 3, 2017, Mental Health Note which indicate the presence of PTSD symptoms, but not a PTSD diagnosis, by a nurse practitioner. Similarly, the Veteran has positive screenings, such as August 12, 2019, which are merely screenings and not definitive diagnoses. The Veteran also appears to be telling his treatment providers that he has PTSD rather than his providers diagnosing him. See, e.g., Jan. 24, 2019, VA Mental Health Telephone Encounter; see also Feb. 19, 2018, VA Emergency Dept. note. As such, the evidence is against a finding that the Veteran has a diagnosis of PTSD or another trauma-related disorder related to service. The Veteran has already been awarded service connection for depressive disorder. As noted above, the VA examiner opined that the Veteran's symptoms, which the Veteran has asserted are related to PTSD, are instead related to his service-connected depressive disorder. If the Veteran feels that the currently-assigned rating for depressive disorder does not adequately account for his current symptoms, he may file an increased rating claim. As the most probative evidence is against a finding that the Veteran has PTSD, the criteria for service connection are not met and the claim is denied. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. D. Bruce, 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.