Citation Nr: 21032766 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 14-20 395 DATE: May 27, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, is denied. FINDINGS OF FACT 1. The record does not contain competent medical evidence establishing a diagnosis of posttraumatic stress disorder (PTSD) based on an in-service traumatic event or stressor. 2. An acquired psychiatric disorder, to include PTSD, was not documented during service, nor was a psychosis shown within one year of separation from service, and the weight of the probative evidence is against finding a nexus between any diagnosed acquired psychiatric disorder and the Veteran's period of active service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 4.125(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from December 1963 to December 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during an October 2017 videoconference hearing. A transcript of that hearing is associated with the claims file. In a May 2019 decision, the Board denied the issue on appeal. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In an April 2020 Order, the Court remanded the claim to the Board for actions consistent with an April 2020 Joint Motion for Remand (JMR) filed by the parties. This case was most recently before the Board in September 2020 when it was remanded for additional development. It has returned for adjudication. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder The Veteran seeks service connection for an acquired psychiatric disorder. Under the relevant laws and regulations, 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, 1131. Generally, 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); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Certain chronic diseases, such as psychoses, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). An alternative method of establishing the second and third Shedden elements for disabilities identified as chronic diseases in 38 C.F.R. § 3.309(a) is through a demonstration of continuity of symptomatology. 38 C.F.R. § 3.303(b). Continuity of symptomatology may be shown if "the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology." Savage v. Gober, 10 Vet. App. 488, 498 (1997). Service connection for posttraumatic stress disorder (PTSD) requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is consistent with the circumstances, conditions, and hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 C.F.R. § 3.304(f). The Veteran's service treatment records are absent of complaint or treatment for an acquired psychiatric disorder. Indeed, on his September 1965 separation report of medical examination, the Veteran's psychiatric clinical evaluation was noted to be normal. On the accompanying report of medical history, the Veteran denied frequent trouble sleeping, frequent or terrifying nightmares, depression or excessive worry, nervous trouble of any sort, and a drug or drinking habit. VA treatment records dated in September 2009 reveal that a depression screening and a PTSD screening were both negative. A mental health note from later that month revealed that the Veteran reported a chronic history of sleep disturbance and nightmares. He stated that he had at least one dream per week related to a past experience in the military. He reported some anxiety and ruminating thoughts during the evening as he was anxious about going to sleep and having dreams. He denied depressive symptoms at that time. He was diagnosed with anxiety disorder not otherwise specified and rule out PTSD. In November 2009, the VA psychiatrist added PTSD to the Veteran's list of diagnoses. During the October 2017 Board hearing, the Veteran reported the onset of stress when he felt unable to financially support his family after he was drafted into the military. He stated that he became depressed and started having nightmares about not being able to provide for his family. After discharge, he said he was able to work and help his family again, but his dreams persisted. The Veteran indicated that a VA psychiatrist prescribed him medication to help him sleep. During an October 2018 VA examination, the Veteran was diagnosed with major depressive disorder with anxious distress and alcohol use disorder. The examiner specifically stated that the Veteran did not have a diagnosis of PTSD that conformed to the DSM-5 criteria based on the examination. Notably, the Veteran's reported stressors were related to having dreams about his rifle jamming during combat, an experience counting people from a fox hole, being stressed about not being able to help his family financially, and being called a "baby killer" when he returned from service. The examiner did not find any of these stressors adequate to support the diagnosis of PTSD and none of them were related to combat, the threat of hostile military or terrorist activity, or an in-service personal assault. The examiner went through the remaining PTSD criteria and found criteria C, D, F, G, H, and I were similarly not satisfied. However, the October 2018 examiner noted that the Veteran's depression and alcohol-use disorder are co-morbid disorders that likely exacerbate each other and cause a synergistic effect, making their resulting impairments indistinguishable. The examiner reviewed the Veteran's medical history, including the mental health consultation dated in 2009 noting a diagnosis of "anxiety NOS R/O PTSD". Records thereafter, dated in January 2010, March 2010, and September 2011, contain diagnoses of anxiety and PTSD. The examiner also noted review of the Veteran's statements regarding recurrent dreams of his rifle jamming but during his interview, the Veteran reported that the dreams were infrequent and failed to result in clinically significant distress. The Veteran denied mental health symptoms or treatment prior to or during service and stated that he first sought mental health treatment in 2009 when he went to a consultation at a VA mental health outpatient clinic. He indicated that he stopped seeking treatment for his anxiety from the VA in 2010 or 2011. The Veteran reported that his alcohol consumption increased after his second marriage and that the marriage was depressing at the end related to infidelity. Pursuant to the September 2020 Board remand, the RO obtained a VA opinion in March 2021. The VA psychiatrist indicated that the Veteran's service treatment records were silent for a mental illness and that his separation examination psychiatric clinical evaluation was normal. After a review of the pertinent treatment records, the VA psychiatrist opined that it was less likely than not that the Veteran's major depressive disorder and alcohol use disorder had their onset during service or are otherwise etiologically related to the Veteran's period of active service. The rationale was that the Veteran indicated his depressive symptoms were related to marital problems and he began drinking more heavily around that time. The examiner further pointed out that the Veteran's September 2009 PTSD screen was negative. Based on the available evidence, the examiner concluded that the Veteran was erroneously diagnosed with PTSD without the examiner showing the diagnostic criteria being met and instead relying solely on the Veteran's report, which was inconsistent with the report he provided during the September 2009 PTSD screen. The examiner explained that VA clinical providers, as contrasted with VA examiners, are under no obligation to review records or corroborate claimed stressors. As such, their reports must be viewed with caution, especially when they conflict with historical records. Alternatively, the VA examinations require the examiners to find objective, valid evidence in the record to support their conclusions. Here, the examiner concluded, there is no evidence that the Veteran's claimed psychiatric disorders, to include major depressive disorder, alcohol use disorder, anxiety disorder, and PTSD, have any nexus to his time in service. At the outset, the Board points out that the weight of the evidence is against a finding that the Veteran meets the criteria for a DSM-5 diagnosis of PTSD. See 38 C.F.R. § 4.125. As noted by the March 2021 VA psychiatrist, the VA treatment records reflect a diagnosis of PTSD without indicating the criteria used to assess such. The Board finds that the post-service treatment records are outweighed by the VA opinions finding against a PTSD diagnosis, as the October 2018 VA examiner included clinical testing results and addressed the pertinent DSM criteria explaining why these were not met for a diagnosis of PTSD and both VA examiners provided detailed rationale for the conclusions reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). To the extent that the Veteran asserts that he has a PTSD diagnosis, the Board finds that he is not competent to establish such a diagnosis. Although the Veteran is competent to report symptoms of his psychiatric disorder, determining the actual diagnosis based on those symptoms requires medical knowledge and training that the Veteran does not have. Moreover, VA requires a PTSD diagnosis to be in accordance with the applicable version of the DSM, which again requires knowledge and training that the Veteran does not possess. 38 C.F.R. § 4.125. Therefore, he is not competent to establish a diagnosis of PTSD. In the absence of a valid diagnosis of PTSD, service connection for PTSD must be denied. With regard to service connection for a psychiatric disorder other than PTSD, the Board finds that a preponderance of the evidence weighs against finding a nexus between either depressive disorder or alcohol use disorder and the Veteran's period of active service. Specifically, the VA examiner in March 2021 opined that the Veteran's diagnosed major depressive disorder and alcohol use disorder less likely than not had their onset in service or are etiologically related to the Veteran's period of active service. The Veteran's mental health symptoms are instead associated with situational stressors, such as being in a distressing marriage. The Board also finds it compelling that a diagnosis of a psychiatric disorder was first recorded in 2009, over 40 years after discharge from service, and there is no indication that psychosis had its onset during or within one year of separation from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. Based on the foregoing, the Board finds the preponderance of the probative and persuasive evidence is against a finding that an acquired psychiatric disability, to include PTSD, began in service or is otherwise etiologically related to service or any incidents therein. Moreover, as psychosis was not shown within one year following discharge from service, and the provisions regarding continuity of symptomatology of a chronic condition are not for application. In sum, as the Board finds that there is no competent medical evidence of a diagnosis of PTSD that meets the DSM requirements, and given the weight of the objective, persuasive evidence against a finding that any other psychiatric disorder is causally related to service, the Board finds that the preponderance of the evidence is against the claim that the Veteran has an acquired psychiatric disorder that was incurred in or caused by his period of active service. As such, the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.