Citation Nr: 22019131 Decision Date: 03/31/22 Archive Date: 03/31/22 DOCKET NO. 17-54 822 DATE: March 31, 2022 ORDER Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) and adjustment disorder, is denied. FINDING OF FACT The Veteran's acquired psychiatric disability did not manifest during service, or within one year after separation, and is not shown to be causally or etiologically related to an in-service event, injury or disease. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from August 1967 to June 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a hearing in September 2021. A transcript of the hearing has been associated with the claims file. In January 2022, the Board remanded the claim for further development. Entitlement to service connection for an acquired psychiatric disability, to include PTSD, is denied. Generally, to establish service connection a veteran 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." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, 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). After a review of the record, the Board finds that although the Veteran has a current diagnosis of a psychiatric disability, he does not meet the standards for service connection as the evidence supports a finding that there is no nexus between active service and the current disability. Regarding the first element of service connection (a current disability), the Veteran was afforded a VA examination in March 2017. The examiner diagnosed the Veteran with adjustment disorder with anxiety and depressed mood. Additionally, the examiner determined that the Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria. On the examination report, the examiner noted that the Veteran did not meet criterion B, C, D, F, and G. He noted that as a result of the stroke, the Veteran appears to have pseudobulbar affect, which can cause rapid mood changes, to include tearful crying or no crying and then immediately stop crying or laughing, crying or laughing that does not match a person's mood, and crying or laughing at unusual times or that lasts longer than seems appropriate. The examiner also noted that during the interview, the Veteran burst into crying about the traumatic events in Vietnam, however, it was perceived as situational and that the outburst of tears did not meet the criteria for PTSD. See March 2017 C&P Exam. Additionally, in a February 2021 VA treatment record, the Veteran was provided a psychiatric evaluation and the clinician determined that the Veteran did not have PTSD. See February 2022 CAPRI. During the September 2021 Board hearing, the Veteran testified that Dr. Bennett, a private physician, wrote a letter to Dr. Sun in which he diagnosed the Veteran with PTSD. The Board notes that Dr. Bennett sent a letter to Dr. Sun dated in August 2016 in which he stated that the Veteran had been having headaches and bad dreams for the past few years. See March 2020 Medical Treatment Record - Non-Government Facility. Dr. Bennett further wrote that "[the Veteran] also has what sounds like [PTSD], but this started months after returning from combat, which is a little unusual." The Board notes that Dr. Bennett did not diagnose the Veteran with PTSD. Subsequent examinations and treatment records noted above ruled out a diagnosis of PTSD and the medical evidence reflects that the Veteran's psychiatric disability is diagnosed as adjustment disorder. Concerning the second element of service connection, on the May 1969 separation examination, the Veteran denied frequent trouble sleeping, frequent or terrifying nightmares, depression or excessive worry, and any nervous trouble. See October 2014 Military Personnel Record. On a May 1969 clinical examination at separation, the physician marked "normal" for psychiatric. The medical record is otherwise silent for any psychiatric related symptoms during service. Concerning the third element of service connection, the Board finds that the evidence of record does not support a finding that the Veteran's current diagnosis of a psychiatric disability manifested or otherwise originated during his period of service or is otherwise related to his military service. Initially, the Board notes that the March 2017 VA examiner diagnosed the Veteran with adjustment disorder but did not provide an opinion of whether the Veteran's adjustment disorder was related to service. In the January 2022 VA addendum opinion, the examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran's reports of medical history from 1966 to 1969 were negative for mental health endorsements. The examiner then cited to March 2017 examination by Dr. Wang to note that the Veteran suffered a stroke a year earlier and that Dr. Sun related the Veteran's adjustment disorder to the stroke. The examiner further reasoned that the Veteran's symptoms for adjustment disorder began after the stroke and were adversely impacting his optimal functioning. The Board affords great probative value to the March 2017 and January 2022 examiners' assessments and opinion. The examiners' assessments are based on a complete review of the Veteran's claims file with consideration of his service treatment records. Moreover, the January 2022 opinion provider relied on the March 2017 examiner's findings to thoroughly explain why the Veteran's psychiatric disability is less likely than not related to service. As the January 2022 examiner's opinion is detailed and well supported by the records, the Board affords it great probative value. Furthermore, the Veteran is competent to report that he has suffered from headaches and had trouble sleeping since his combat experience during service. See January 2017 VA 21-0781, Statement in Support of Claim for PTSD. However, as noted above, the Veteran's STRs, to include May 1969 separation report of medical history and medical evaluation, document that the Veteran did not report or have headaches, sleep problems, or any other psychiatric symptoms. Additionally, a May 2014 VA treatment record documents that the Veteran denied headaches. Further, the letter from Dr. Bennett dated in August 2016 to Dr. Sun specifically notes that the Veteran was having headaches and bad dreams the past few years. The Board otherwise notes that the VA treatment records reflect that the earliest documentation for treatment of headaches was in January 2016. See January 2017 CAPRI. Thus, the Board does not find his reports that he has experienced symptoms since combat credible. The Board finds the absence of any indication of any psychiatric symptoms or psychiatric issues in the STRs and for many decades after service more probative than his more recent reports, made years later, that he has had a psychiatric disorder beginning in service to the present time. The Board otherwise acknowledges the Veteran's lay statement that his psychiatric disability manifested as a result of his military service. However, a nexus opinion requires technical and medical expertise beyond that of a lay person. See Layno v. Brown, 6 Vet. App. 465 (1994); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). There is no evidence of record reflecting that the Veteran has the specialized training necessary to offer an opinion as to nexus. Thus, the Board finds there is no competent evidence of a nexus between the Veteran's psychiatric disability and service. In conclusion, although the Veteran has established a current disability, the evidence does not establish that there is a link to his military service. The claim is denied. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Hammad Rasul, 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.