Citation Nr: 22045704 Decision Date: 08/11/22 Archive Date: 08/11/22 DOCKET NO. 18-06 031A DATE: August 11, 2022 ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. FINDING OF FACT The probative evidence of record is persuasively against the finding that the Veteran's current psychiatric disorders began during active service, and/or otherwise related to an in-service injury, event, or disease, including the in-service adjustment disorder, depressed mood, and alcohol abuse. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.3. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from August 1986 to July 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at an August 2021 Board's hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In February 2022, the Board remanded this matter to schedule the Veteran for a new VA examination, and to obtain a new medical opinion and updated treatment records. Consequently, the RO obtained updated treatment records, and scheduled the Veteran for a VA examination and obtained a medical opinion in May 2022. Subsequently, the RO issued a June 2022 supplemental statement of the case denying entitlement to service connection for an acquired psychiatric disorder, and returned the matter to the Board for appellate adjudication. The Board is obligated by law to ensure that the RO complies with its directives; where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board finds that the RO substantially complied with the directives set forth in the February 2022 remand, and medical opinion obtained in May 2022 regarding the Veteran's acquired psychiatric disorder is adequate for deciding the issue on appeal. See Stegall, 11 Vet. App. at 271; see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only "substantial" rather than strict or exact compliance with the Board's remand directives is required under Stegall). Entitlement to service connection for an acquired psychiatric disorder. At the August 2021 Board's hearing, the Veteran asserted that he had depression, anxiety, and nightmares while he was in service. Furthermore, he stated that he received treatment for adjustment disorder during service. He also asserted that his alcohol abuse during service was a symptom of his psychiatric disorder. 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; 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). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt should be resolved in favor of the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Thus, the question for the Board is whether the Veteran has a current diagnosis of an acquired psychiatric disorder that began during service or is related to an in-service injury, event, or disease. The existence of a current psychiatric disorder is not in question because the February 2022 private treatment record reflects that the Veteran has severe alcohol disorder and depression, unspecified. The March 2022 private treatment record noted the diagnosis of depression since September 2013 and major depressive disorder since September 2018. Also, diagnosis of anxiety was noted in the private treatment records. During the August 2015 VA examination, the examiner noted the diagnosis of unspecified schizophrenia spectrum and other psychotic disorder. Additionally, during the May 2022 VA examination, the examiner noted the diagnosis of unspecified bipolar disorder. As far as in-service incurrence of a psychiatric disorder is concerned, the April 1987 service treatment record reflects that the Veteran was diagnosed with adjustment disorder, depressed mood, and alcohol abuse, episodic. Also, the Veteran had incidents of disorderly conducts during service due to excessive alcohol use, including his arrest when he was intoxicated. Hence, the second element of service connection, in-service injury, event, or disease, is met. To determine the nature and etiology of his current psychiatric disorder and any potential relationship with his active service, the Veteran was afforded a VA examination in August 2015, during which the examiner diagnosed the Veteran with unspecified schizophrenia spectrum and other psychotic disorder, and alcohol use disorder, severe, in early remission by history. The examiner opined that it is less than 50 percent probable that that the Veteran's current psychiatric disorder was incurred in or caused by adjustment problems during the service, based on reasonable medical certainty. As a rationale, the examiner stated that this conclusion is based on the absence of notation of psychiatric problems in the military, aside from personality and/or conduct problems; and on the Veteran's significant alcohol use and onset of psychotic symptoms only post-discharge. The examiner also stated that the Veteran needs further treatment, including further detailing and refinement of his primary diagnosis. In February 2022, the Board remanded the matter for a new VA examination and medical opinion because in the August 2015 VA opinion, the examiner stated that there is absence of notation of psychiatric problems in the military, without addressing the adjustment disorder, depressed mood, and alcohol abuse, which were noted during active service. The Board also instructed the RO to obtain updated private and VA treatment records before obtaining the VA medical opinion. Consequently, the RO obtained VA and private treatment records. Thereafter, the RO afforded the Veteran another VA examination for psychiatric disorder in May 2022, during which the examiner noted the diagnosis of unspecified bipolar disorder and alcohol use disorder, severe. After reviewing and listing relevant evidence of record, the examiner opined that the Veteran's claimed psychiatric disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or disease. As a rationale, the examiner stated that there was a diagnosis of adjustment disorder during the Veteran's service. The examiner explained that the nature of adjustment disorders, if diagnosed accurately, is transitory in nature. That is, an adjustment disorder is based on a situational stressor and the usual course/progression of an adjustment disorder is to resolve when the situational stressor is eliminated. The examiner further stated that the competing reasons for the Veteran's mental health have included significant low back pain and loss of his son due to COVID-19. The examiner noted the Veteran's report that the loss of his son has negatively impacted him. The examiner further explained that compensation and pension examination for the Veteran's with suspected psychotic processes or disorders like bipolar are difficult to conduct with an expectation that self-report and history can be accurately recalled and elucidated on. For context, the Veteran has clear signs of some cognitive impairment, etiology remains unknown for now. During his 2015 examination, he was not oriented to time (stating it was 1915), and exhibited paranoid ideation. He was a poor historian regarding why he was arrested for discharging a gun. When looking at the chronology of his treatment records in their totality, there is a significant gap from his discharge to 2000's. He was only treated for adjustment disorder while in the military. The examiner concluded that as a result of such a significant gap in records, it is not possible to establish a clear nexus that the Veteran's diagnosed unspecified bipolar disorder was in any proximately due to his time in service. Bipolar disorder is mostly explained by heredity. The Board finds the May 2022 VA medical opinion adequate. The examiner provided a detailed supporting rationale, which is based on an accurate medical history and relevant evidence of record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Additionally, the Board notes that there is no other private or VA medical record that suggests any relationship between the Veteran's currently diagnosed psychiatric disorders and his service. At the August 2021 Board's hearing, the Veteran asserted that a psychiatrist, Dr. L., had stated that his mental problems are related to his active service. However, the Board notes that there is no such medical opinion in the claims file. In a December 2021 correspondence, a private psychologist, R. N., stated, "At his request, this letter is to inform you that [the Veteran] is my patient, that he is receiving treatment, and has been under my care since October 21, 2021." Thus, the Board notes that there is no medical evidence in the claims file that suggests any relationship between the Veteran's current psychiatric disorders and his active service. The Board has reviewed the Veteran's statements, including his testimony at the August 2021 Board's hearing, in which he asserted that his current psychiatric disorders are related to his in-service depression, anxiety, adjustment disorder, and alcohol use disorder. The Board acknowledges that the Veteran might sincerely believe that his current psychiatric disorders are related to his service. Lay statements are competent evidence as to observable symptomatology. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The Veteran is competent to describe the observable symptoms, however, he is not competent to provide an opinion that his current psychiatric disorders are related to his active service. The issue is medically complex, and the Veteran has not demonstrated that he has the medical education, training, or expertise to render such an opinion. See Kahana v. Shinseki, 24. Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, the Board gives more probative weight to the medical evidence, including the May 2022 VA medical opinion, and finds that the probative evidence of record is persuasively against the finding that the Veteran's current psychiatric disorders began during his active service, and/or otherwise related to an in-service injury, event, or disease, including the in-service adjustment disorder, depressed mood, and alcohol abuse. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); 38 C.F.R. §§ 3.102, 4.3. Thus, entitlement to service connection for an acquired psychiatric disorder is denied. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Tariq, Nadeem, Associate 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.