Citation Nr: 21030779 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-01 355 DATE: May 19, 2021 ORDER Service connection for a psychiatric disability, to include posttraumatic stress disorder (PTSD), unspecified depressive disorder, and dysthymic disorder, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has a diagnosis of PTSD in accordance with DSM. 2. The preponderance of the evidence is against finding that a psychiatric disability began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a psychiatric disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from October 1976 to November 1996, including service in Southwest Asia from August 1990 to April 1991. This matter comes before the Board of Veteran's Appeals (Board) on appeal from a July 2015 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018 and November 2020, the Board remanded this issue for additional development. Entitlement to service connection for a psychiatric disability to include PTSD The Veteran asserts that stressors he experienced during active service caused his current psychiatric disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). A review of the Veteran's service treatment records shows not complaints or reports of psychiatric disabilities during active service. A November 2014 private psychiatric examination report shows that the Veteran was diagnosed with chronic PTSD and dysthymic disorder. The examiner noted that Veteran's reported history of stressors of being fired upon and returning fire while in Granada which caused him to fear for his life. The Veteran reported nightmares occurring in 1997 which caused waking in panic and sweats. The examiner provided a treatment plan which included mediation and cognitive behavior psychotherapy. An April 2015 statement submitted by the Veteran reported stressors for his PTSD of being deployed to Kuwait and Iraq from Fall 1990 to Spring 1991 in support of Desert Shield/Desert Storm. He reported that he worked as a Fire Support Infantryman and during deployment lived under life threatening conditions, with constant threat of enemy mortars, sniper fire, IEDs and land mines and his work as in Fire Support was inherently dangerous. A June 2015 VA PTSD examination report shows that the examiner did not diagnosis a mental disorder and a diagnosis of PTSD that conformed to DSM-5 criteria was present. The examiner noted that the Veteran was receiving mental health treatment in 2014 and that he was prescribed Trazadone and Bupropion. The examiner noted that the Veteran had not been hospitalized for any psychiatric reasons. The examiner opined that the Veteran endorsed suicidal and homicidal ideations without any plan but denied any current plans of suicidal or homicidal ideations. The examiner did note that the Veteran did experience a stressor during active service but a mental diagnosis was not assessed. After a review of the evidence of record, the examiner opined that the Veteran did not have a diagnosis that met the full criteria for PTSD. The examiner reported that while he was exposed to traumatic situation during his time in the military, at the present time, his scores on the PCL-5 confirm that the symptoms do not meet the criteria for PTSD diagnosis. The examiner noted that the Veteran also had endorsed problems with sleep and but that was more likely due to his diagnosis of sleep apnea. While the examiner noted that the Veteran was receiving mental health treatment for PTSD, the presenting symptoms at present time did not support a current diagnosis. A November 2019 VA psychiatric examination report shows that after a review of the evidence of record and an in-person examination, the examiner opined that it was less likely than not that any psychiatric disability was related to or incurred during active service. The examiner reported that the Veteran did not the DSM-5 criteria for a diagnosis of PTSD or Persistent Depressive Disorder (Dysthymic Disorder per DSM-IV-TR nomenclature). The examiner did report that the Veteran's current diagnosis of Unspecified Depressive Disorder met the DSM-5 criteria, but there was no evidence that it was related to the Veteran's military service. The examiner noted that the Veteran's depressive disorder began approximately 15 years following his retirement from the Army and was not related to any injury, illness, or event incurred during service. The examiner noted that there was no report of mental health issues during the Veteran's service, as evidenced by his denial of any current or historical mental health symptoms during his July 1996 retirement exam, and no consistent report of ongoing mental health problems since military service. The examiner referenced that VA medical records contained numerous negative depression screenings and the Veteran himself endorsed an initial onset of recurrent depressed mood within the last 7-8 years in the context of marital stressors. Therefore, the examiner reported there was no nexus between military service and current symptoms. Regarding the Veteran's claim for PTSD specifically, the examiner remarked that the after a review of the evidence of record which included numerous negative VA PTSD screenings, that the Veteran did not meet the DSM-5 criteria for PTSD. The examiner noted that while the Veteran endorsed combat-related trauma exposure that meets DSM-5 Criterion A for PTSD, he did not endorse persistent symptoms of intrusion, persistent avoidance symptoms, negative alterations in cognition and mood directly associated with these combat-related stressors, or marked alterations in arousal and reactivity directly associated with these combat-related stressors. While the Veteran was noted to experience recurrent distressing memories, the examiner noted that he did not describe these memories as intrusive. The Veteran was also noted to have denied nightmares/distressing dreams related to any combat stressor, but did note rare and random distressing dreams unrelated to any actual experiences. The examiner remarked that the Veteran denied clinically significant sleep disturbance related to mood or anxiety, reporting that he falls asleep easily and while he awakened 2-3 times per night and he is able to easily return to sleep and wake feeling rested. While the Veteran reported intermittent, transient episodes of irritability resulting in him taking a certain "tone" with others (but without angry outbursts), he attributed this behavior to leadership role during the latter part of his military service & his frustration at times w/ employees not following orders. The examiner also reported that the Veteran denied a marked change in behavior due to avoidance or hyperarousal, but did note increased vigilance in larger crowds. The November 2019 examiner also noted that the findings from the October 2014 private examination report represented an outlier and based on statements within the evaluation that were exaggerated (e.g.,"prefrontal cortex is dysfunctional", GAF=40) and was remarkably inconsistent with the Veteran presentation and occupational history. Regarding the claim for PTSD, the Board finds that the weight of the evidence is against a finding that the Veteran meets the criteria for a DSM-5 diagnosis of PTSD. 38 C.F.R. § 4.125(a). The Board finds that the November 2019 VA examiner's findings and conclusions outweigh the October 2014 private examiner's diagnosis of PTSD. In this regard, the VA examiner reviewed the entirety of the Veteran's claims file, to include the Veteran's service treatment records, service personnel records, VA treatment records, and private medical records. The 2019 VA report indicates that relevant facts were considered, such as the 1996 report of medical history at separation, VA treatment records with PTSD screens from the early 2000s, and prior psychiatric assessments. In addition, the 2019 examiner conducted psychologic testing and a diagnostic interview. The examiner determined that the Veteran's symptoms only met the Criterion A for the diagnosis of PTSD under the DSM-5. The Board finds that the November 2019 examination is adequate and highly probative, as it is based upon a review of the medical records, examination of the Veteran, and provided a supporting explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that the central issue in determining probative value of a medical opinion is whether the examiner was informed of the relevant facts). Regarding the October 2014 private examiner which endorsed a diagnosis of PTSD, it is not clear whether or not the diagnosis was made in conformance with the DSM-5. See Cohen v. Brown, 10 Vet. App. 128, 140 (1997) (stating that mental health professionals are experts and are presumed to know the DSM requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis). Even assuming the PTSD diagnosis was in accordance with the applicable DSM, there is no indication that the private examiner did any psychological testing or reviewed any of the Veteran's records. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (stating that the physician's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion, are important factors for assessing the probative value of a medical opinion). Other than the Veteran's service dates, a review of the Veteran's service treatment records, to include the 1996 report of medical history were not noted. Finally, the private examiner did not provide a detailed rationale explain how this PTSD diagnosis was supported via in-service events, to include discussing the criterion for PTSD, such as the presence of (one or more) of the intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s). Accordingly, the Board finds that the private diagnosis of PTSD is of less probative value with regard to whether the Veteran has had PTSD diagnosed in accordance with 38 C.F.R. § 4.125 at any time during the pendency of his claim. In sum, the preponderance of the competent and probative evidence does not tend to support a diagnosis of PTSD in accordance with DSM, service connection for PTSD is denied. 38 C.F.R. § 3.304(f); 38 C.F.R. § 4.125(a). Concerning a psychiatric disability other than PTSD, as noted above, the Veteran's has a diagnosis of unspecified depressive disorder as noted on the 2019 VA examination report and dysthymic disorder as reflected by the 2014 private report by Dr. E.H. However, after a review of the evidence of record, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a psychiatric disability, other than PTSD, to include a depressive disorder. The competent medical opinions of record that addresses the probability of a medical relationship between any psychiatric disability and service weigh against the claim. The Board finds that the November 2019 VA examiner's opinion constitute competent, probative, and persuasive evidence that is based on review of the Veteran's documented medical history and assertions and examination. The examiner provided a rationale based on an accurate discussion of the evidence of record, to include his 1996 report of medical history as separation and VA treatment records from the early 2000s. Prejean v. West, 13 Vet. App. 444 (2000); Guerrieri v. Brown, 4 Vet. App. 467 (1993). The Board finds that the most persuasive, competent medical evidence of record shows that the Veteran's diagnosed psychiatric disability is not related to service to active service to include his reported stressors. The VA examination report also shows that the Veteran did not show symptoms of a psychiatric disability until more than 15 years after separation from service. As noted above, the examiners opinion is supported by a thorough review of the evidence of record. Additionally, the 2014 private report did not provide a nexus statement or rationale concerning any relationship to the diagnosed dysthymic disorder. Cf. Savage v. Shinseki, 24 Vet. App. 259, 270 (2011) (recognizing that the Court has set for a duty for VA to clarify private examination reports, in limited instances, in which the missing information is relevant, factual, and objective and where the missing evidence bears greatly on the probative value of the private examination report). The Veteran is a lay person and is not competent to relate psychiatric disabilities to service which requires expertise that is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiological opinion as to these issues, which require specialized knowledge and training to diagnose and determine etiology of psychiatric disorder. Therefore, the Veteran's statements in this regard lack weight. Accordingly, as the preponderance of the competent and probative evidence is against a nexus, service connection is also denied for a psychiatric disorder, other than PTSD. 38 U.S.C. § 5107(b). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dworkin, 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.