Citation Nr: 21041342 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-58 820 DATE: July 8, 2021 ORDER Service connection for an acquired psychiatric disorder, including posttraumatic stress disorder (PTSD), is denied. FINDINGS OF FACT 1. There is no competent medical evidence of a psychiatric disorder, except for personality disorder; and there are no other psychiatric disabilities superimposed upon the personality disorder as a result of service. 2. A personality disorder may not be service-connected as a matter of law CONCLUSIONS OF LAW 1. A personality disorder is not a disease or injury within the meaning of the law providing compensation. 38 C.F.R. §§ 3.303, 4.9. 2. An acquired psychiatric disorder was not incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from March 1979 to June 1980. The case was remanded by the Board in December 2018 for further development of the evidence. This has been accomplished and the case has been returned for further appellate consideration. Entitlement to service connection for an acquired psychiatric disorder, including PTSD The Veteran contends that service connection should be established for his psychiatric disorder, which he claims has been diagnosed as PTSD. He has claimed several different stressors, including having been covered with a significant amount of jet fuel, which he reported during an informal hearing in August 2016, or having been subject of a personal assault, which he reported during a September 2016 psychiatric examination. Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection requires: (1) medical evidence of a current disability; (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease; and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999). For entitlement to service connection for PTSD, it is noted that this requires precise findings. These findings are: (1) a current medical diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor occurred; and, (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. See 38 C.F.R. § 3.304(f). The diagnosis of PTSD must comply with the criteria set forth in the DSM-5. Id.; see 38 C.F.R. §§ 4.125(a), 4.130. With respect to the third element of service connection for PTSD, if the evidence shows that a veteran engaged in combat and the veteran is claiming a combat-related stressor, no credible supporting evidence is required. 38 C.F.R. § 3.304(f); See Doran v. Brown, 6 Vet. App. 283 (1994). The Board finds that the Veteran did not engage in combat with the enemy. Therefore, his lay statements alone are not sufficient to establish the occurrence of a recognizable stressor upon which the diagnosis of PTSD may be based. West v. Brown, 7 Vet. App. 70 (1994). For the reasons expressed below, the Board finds that the service connection for an acquired psychiatric disorder is not warranted. Review of the record shows that service treatment records (STRs) are silent for any complaint or manifestation of an acquired psychiatric disorder at the time of enlistment into service. It was reported that in February 1980 the Veteran was "temporarily decertified" for emotional stress reaction. In March 1980, he was referred for counseling. He underwent a mental health evaluation in April 1980 at the request of his unit commander. The results of the evaluation revealed no evidence of any psychiatric disorder and were not sufficient to warrant a character or behavior disorder. The Veteran was noted to manifest a certain level of emotional immaturity in addition to adolescent conflicts in relation to authority, but was found to be fully fit for military duties. Service personnel records show that in May 1980 the Veteran was noted to have a "less than acceptable" military record having been referred to counselling on two occasions and violated other rules. The Veteran was found to be not suitable for further military service due to his attitude, an inability to correct a progressive downward trend, a failure to meet and maintain prescribed standards of military deportment, and his expressed desire to separate from service. His discharge was recommended. On examination for separation from service, the Veteran had no complaints or manifestations of depression or nervous trouble of any sort. At that time, psychiatric clinical evaluation was normal. Post-service VA treatment records dated in October 2002 include a report that a psychological evaluation conducted in September 2002 was not sufficient to meet the criteria for a diagnosis of PTSD. Rather, the Veteran was assessed with an anxiety disorder, not otherwise specified (NOS), dysthymia, and a personality disorder NOS. In December 2002, it was again noted that the Veteran did not meet the criteria for PTSD. The assessment at that time was personality disorder NOS and anxiety disorder NOS. VA treatment records include a physical examination in March 2004. At that time, the assessments included PTSD, stable. No basis for this assessment was provided among the treatment records. A September 2009 VA treatment record included a negative screening for depression. September 2011 treatment records include diagnoses of depressive disorder NOS, rule out PTSD, and personality disorder NOS. A June 2015 screening for depression was considered to be positive, but a screening for PTSD conducted at that time was negative. An examination was conducted by VA in September 2016. After psychological testing, records review, and a clinical interview with the Veteran, the examiner rendered a diagnosis of other specified personality disorder. The examiner noted that the Veteran had been evaluated for PTSD and a variety of other mental diagnoses. The psychological testing showed a somewhat exaggerated self-report style so that the profile was to be interpreted with caution. The profile showed significant distress in a variety of areas and did not help to clarify a specific diagnosis other than to suggest general mental distress. During the evaluation for PTSD, the Veteran reported a personal assault-type stressor that he reported he perceived as life threatening. While this could meet the criteria for PTSD, the examiner found the descriptions of experienced symptoms to be somewhat vague and did not clearly support a link to this incident, nor did they invalidate a link to the incident. The examiner went on to note that the service personnel records did not document a change in the Veteran's behavior and emotional state after a visit home around January or February 1980. Prior to this, he had shown a positive attitude and work performance, but showed a significant decline after this visit. The examiner then went on to describe the psychological evaluation documented in the Veteran's STRs and the Veteran's eventual separation from service due to "Unsuitable-Apathy, Defective Attitude." During the current interview, the Veteran reported nothing about problems at home, but blamed all of his behavior problems over the years on treatment by his superior officers during one shift. The examiner went on to state that no mental health treatment records were found prior to 2002, at which time the Veteran sought treatment for trauma-related symptoms related to an accident wherein he was hit by a vehicle and sustained significant physical injuries while a pedestrian; a trauma that was not reported to the examiner. The examiner ultimately diagnosed a personality disorder with the possibility of adjustment disorder and to rule out dysthymia or cyclothymia. No military stressor was documented during this treatment. The examiner went on to evaluate the Veteran's 2011 psychiatric treatment wherein the Veteran had described "PTSD symptoms from the Iranian Crisis during that time." He refused to talk about a stressor at the time and did not want to return for follow-up treatment; the working diagnoses were depressive disorder NOS and personality disorder NOS. The examiner stated, "Based on all available information, it is likely that the Veteran is experiencing some distress. However, he seems to be selectively reporting information at the current time as there are significant inconsistencies when compared to past documentation." The most likely mental health diagnosis was then stated to be Other Specified Personality Disorder with prominent cluster B traits. The examiner then explained that no medical opinion would be offered, because in the field of mental disorders personality disorders were characterized by developmental defects or pathological trends in the personality structure manifested by a lifelong pattern of action or behavior. The examiner cited the VA regulations to support this statement. Another examination was conducted by VA in January 2020. The diagnosis was other specified personality disorder. The examiner noted the findings of the 2016 VA examination and stated that repeating that information would be redundant. The examiner then stated that in light of findings of the current examination, which were drawn from a review of the records, the Veteran's presentation and manner of self-report, and the presumed (from testing) invalidity of his self-report in the examination, the examiner concurred with the 2016 PTSD examiner that only a diagnosis of "Other Specified Personality Disorder" could be offered at this time. The examiner also opined that it was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the only diagnosis offered was that of the personality disorder, which was a developmental defect. The examiner further stated that although the Veteran had received a working diagnosis of PTSD by several treatment providers in the past, this diagnosis represented a superior diagnostic product because of the availability of more sources of information, having more time to review the treatment records, the ability to conduct objective standardized testing, the ability to use structured diagnostic interviews, not having to worry about the impact of any diagnosis on a therapeutic alliance, an extensive scrutiny of the self-reported symptoms and etiological assumptions, and the ability to comprehensively assess for potential dissimulation. Finally, the examiner stated that the Veteran had been given a diagnosis that was not subject to direct service connection and there had been no research to support the theory that adverse inservice events could cause permanent aggravation of any of the personality disorders. At the outset, the Board notes that, while the Veteran was evaluated for possible emotional difficulties while he was on active duty, a psychiatric evaluation at that time found no basis for a diagnosis. Moreover, clinical evaluation at the time of separation from service was normal. Psychiatric treatment was not noted until 2002 at which time various diagnoses were made; these included a personality disorder and anxiety disorder. A diagnosis of PTSD is noted in the treatment records, but no basis for this diagnosis was provided. After several psychiatric evaluations by VA, it has been determined that the Veteran may only be diagnosed with a personality disorder, with no superimposed acquired psychiatric disorder, including PTSD. Those examination reports make specific findings regarding the inconsistencies in the Veteran's claimed stressors. The Board too finds the Veteran's non-combat stressor descriptions to be inconsistent, including claims of a personal assault, mistreatment by superior officers, and being covered in jet fuel. None of these claims have been verified and, in a June 2011 memorandum it was determined that there was insufficient information provided to enable corroboration of the claimed in-service stressors. As such, the Board finds that there is no basis for a diagnosis of PTSD. It is further noted that a personality disorder is not a disability for which service connection may be granted; rather, it is considered a congenital or developmental abnormality. See 38 C.F.R. § 3.303(c). As VA regulations specifically prohibit service connection for congenital or developmental defects, the Veteran's diagnosed other specified personality disorder is, therefore, not a disability for which VA compensation benefits may be awarded. A superimposed acquired psychiatric disorder resulting from such personality disorder or representing an aggravation of the disorder may, however, be service connected. See 38 C.F.R. § 4.127; VAOPGCPREC 82-90 (1990) (cited at 55 Fed. Reg. 45,711) (Oct. 30, 1990); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995). VA examinations were ordered in 2016 and 2020 to determine if there is such a superimposed acquired psychiatric disorder. Both failed to find such a disability. The Board assigns the greatest probative value in the 2016 and 2020 medical opinions to support the finding that the there is no competent medical evidence of a psychiatric disorder, except for personality disorder. The examiners provided well-grounded conclusions supported by thorough rationale and the medical evidence of record. Notably, the Board finds significant probative value in the examiners' detailed discussion of the Veteran's credibility, in which she highlights numerous discrepancies between the Veteran's histories reported as compared to the evidence of record. As noted, the Board observes that the Veteran's statements have varied wildly and are inconsistent during reports in treatment or recollections made in connection with a claim for VA benefits. Accordingly, the Board finds that the Veteran's reports of symptoms not credible for this purpose. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Thus, such previous psychiatric diagnosis of PTSD, depression, and anxiety based on the Veteran's inconsistent statements are therefore not viewed as credible, and accorded significantly less probative weight. (Continued on the next page) In the absence of any other psychiatric disability superimposed upon the personality disorder, the Board finds that service connection for the Veteran's personality disorder is precluded by law, and therefore not warranted. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Accordingly, the claim must be denied. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph P. Gervasio 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.