Citation Nr: A24068614 Decision Date: 10/24/24 Archive Date: 10/24/24 DOCKET NO. 220615-251190 DATE: October 24, 2024 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran has had PTSD at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty with the United States Army from March 1986 to June 1991. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2022 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). The rating decision on appeal was issued in May 2022 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the June 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the May 2022 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the claimed in-service disease or injury and the present disability. See, e.g., Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104 (a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant; however, if the evidence of record is either persuasively for or persuasively against the claim, then the benefit-of-the-doubt rule no longer applies and the claim is instead adjudicated in accordance with the evidence. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Factual Background The March 2022 Veteran's statement states, during his active duty, he was sexually assaulted on several occasions by a senior NCO. The Veteran states the abuse occurred over several months. The abuse ended when the abuser was relieved from duty for sexual assault of other service members. The Veteran states the abuse effected his performance and was so devastating he tried to commit suicide. The Veteran states he did not tell anyone. The May 2022 VA medical exam included an in-person interview with the Veteran and reviewed the Veteran's record. The examiner confirmed the Veteran's diagnoses of unspecified bipolar and related disorder and unspecified personality disorder. The examiner states the Veteran does not meet the diagnostic criteria for PTSD under DSM-5. The examiner states it is not possible to differentiate the Veteran's symptoms as they are over lapping. The examiner records the Veteran denies any abuse as a child. However, the examiner notes there is a history of childhood abuse in medical records. The examiner notes the Veteran reported relating well to others in the military but having some fights, which includes an Article 15 for fighting. The examiner notes the Veteran was administratively discharged from active-duty service due to a personality disorder. The examiner notes the Veteran reported a suicide attempt in 1990. The examiner states the Veteran's stressor of sexual abuse is adequate to support the diagnosis of PTSD. The examiner recorded the Veteran directly experienced a traumatic event, and experiences recurrent, involuntary, and intrusive distressing memories. The examiner records the Veteran engages in avoidance of distressing memories, thoughts, or feelings closely associated with the traumatic event. However, the examiner found no criteria in section D regarding negative alterations in cognitions and mood were met. The examiner recorded the Veteran experienced hypervigilance and sleep disturbance. The examiner recorded the Veteran's symptoms do not meet the full criteria for PTSD. The examiner noted the Veteran denied a history of suicide attempts. The examiner opined the Veteran's statement of intrusive thoughts as continuous seemed exaggerated and contradictory as the Veteran had also stated he thinks about the traumatic event occasionally. The examiner noted the Veteran was an unreliable informant providing inconsistent accounts throughout medical records: denying alcohol abuse, while describing a long history of alcohol abuse; denying cocaine use, while describing a history of cocaine dependence; denying childhood abuse, when medical records have a history of childhood abuse. The examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service event, injury, or illness. The examiner stated the Veteran presents as a questionable informant providing inconsistent information, given the inconsistent personal history it would be difficult to say with any certainty if mental health symptoms noted on active duty are markers of military sexual trauma (MST) or related to a history of childhood trauma, alcohol abuse, or bipolar disorder. The examiner opined that-most importantly-the Veteran does not meet the full criteria for PTSD. Analysis The Veteran claims entitlement to service connection for PTSD. For the reasons set out below, the Board finds that the Veteran does not have a current disability of PTSD. The Board finds there is no additional acquired psychiatric disorder that should be considered as part of the Veteran's current claim for service connection of PTSD. The Board notes the Veteran is currently already service connected for unspecified bipolar and related disorder, rated 70 percent disabling, effective November 2015. The Board notes the Veteran was previously service connected for major depressive disorder, rated 70 percent disabling, effective January 2011 to November 2015. The Board finds there is no evidence of record suggesting the Veteran has additional psychiatric symptoms that are not already service connected and compensated. The Board finds the May 2022 VA medical exam competent and credible. The May 2022 VA medical exam was completed by an appropriately qualified medical professional, following a full review of the Veteran's medical record, and in person examination of the Veteran. The Board affords the May 2022 VA medical exam full probative weight. The Board notes the Veteran is competent to report his observable symptoms. Davidson v. Shinseki, 581 F.3d. 1313 (Fed. Cir. 2009); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). However, the Board finds the diagnosis of a psychiatric disorder is medically complex, it requires specialized medical knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board finds the probative medical evidence of record persuasively weighs against finding the Veteran has the current disability of PTSD. The May 2022 VA medical exam found the Veteran did not meet the diagnostic criteria for PTSD under the DSM-5. As noted above, the May 2022 VA medical exam confirmed the Veteran's diagnoses of unspecified bipolar and related disorder and unspecified personality disorder. The Board has noted the Veteran has been service connected for an acquired psychiatric disorder from January 2011 at a rating of 70 percent disabling. The Board has considered the Veteran's March 2022 statement and the Veteran's continued distress. However, as set out above the Board finds the diagnosis of a psychiatric disorder medically complex requiring specialized medical knowledge. As the persuasive weight of evidence does not reflect a current diagnosis of PTSD, and as the persuasive weight of evidence denies any such diagnoses at any time in service or since service, the cornerstone element of service connection has not been met, and service connection is not warranted. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the absence of proof of a present disability of PTSD there can be no valid claim for service connection. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, supra. Therefore, as the evidence of record persuasively shows that the Veteran did not have PTSD at any time during the appellate period, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service."); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial-of-service connection). The Board emphasizes that nothing in this decision impacts the Veteran's existing grant of service connection for unspecified bipolar and related disorder, rated 70 percent disabling, effective November 2015. Accordingly, the persuasive evidence of record demonstrates that the Veteran did not have any current disability of PTSD at any time during the appeal period, and therefore, the Board must deny the service connection claim and need not reach any further discussion related to either the "in-service incurrence" or "nexus" elements in this case. See 38 C.F.R. § 3.303; Brammer, supra. The Board finds that the evidence of record persuasively weighs against the claim. As a result, the benefit-of-the-doubt rule does not apply, and the Veteran's claim is adjudicated in accordance with the evidence. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). The Veteran's claim for service connection for PTSD is not warranted by the evidence and the Veteran's appeal must hereby be DENIED. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. J.P. Norman Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Shepherd DeRosa, 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.