PSYCHOSIS

Summary

The Veteran, who served on active duty from January 1969 to January 1971, including service in the Republic of Vietnam, appeals the denial of service connection for an acquired psychiatric disorder, specifically PTSD and depression. The Board reviewed the evidence, noting the Veteran's assertion of PTSD due to in-service trauma. To establish service connection for PTSD, the Board requires a medical diagnosis, credible evidence of the stressor, and a medical link between the current symptoms and the stressor. The Veteran underwent multiple VA examinations in March 2013, February 2016, and a VA social worker assessment in June 2013. The VA examiners consistently opined that the Veteran did not meet the diagnostic criteria for PTSD or any other mental disorder, noting primarily sleep impairment without significant social or occupational dysfunction. A private physician in December 2012 stated, "I think he has PTSD," and a VA physician in June 2013 noted chronic PTSD and depression symptoms. However, the Board found the VA examinations more probative, deeming the private and conflicting VA diagnoses speculative or based on history. The Board concluded that the Veteran's lay assertions of having PTSD were not competent medical evidence, while the VA examinations were conducted to meet DSM criteria. The Board found the weight of the evidence against a current acquired psychiatric disorder diagnosis. The benefit of the doubt rule was considered but not applied as the evidence preponderated against the claim. Service connection for an acquired psychiatric disorder was denied.

Rationale

Weight of the evidence against current acquired psychiatric disorder.; VA examinations found Veteran did not meet DSM criteria for PTSD or other mental disorders.; Conflicting diagnoses from private physician and one VA physician deemed speculative or history-based.

Full Decision Text

Citation Nr: 18114711
Decision Date: 06/27/18	Archive Date: 06/27/18

DOCKET NO. 15-14 668
DATE:	June 27, 2018
ORDER
Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression, is denied.
FINDING OF FACT
The most probative evidence is against a finding that the Veteran has a current acquired psychiatric disorder.
CONCLUSION OF LAW
The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and depression, have not been met.  38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017).

 
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty from January 1969 to January 1971, to include service in the Republic of Vietnam.  
While the Veteran initially requested to testify before the Board of Veterans’ Appeals (Board) at a hearing, he withdrew that request in November 2015.
Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).
The Board has reviewed all the evidence in the record.  Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail.  Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim.  See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).  When there is an approximate balance of evidence for and against an issue, all reasonable doubt will be resolved in the Veteran’s favor.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
The Veteran asserts that he has an acquired psychiatric disorder, specifically PTSD, as a result of trauma experienced during his active duty service.  As the scope of a mental health disability claim generally includes any psychiatric disorder that may reasonably be encompassed by a veteran’s description of the claim, reported symptoms, and the other information of record, the Board will consider whether service connection for any acquired psychiatric disorder is warranted.  Clemons v. Shinseki, 23 Vet. App. 1 (2009). 
Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called “nexus” requirement.  See 38 U.S.C. § 1110; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).  Additionally, service connection for PTSD requires: (1) medical evidence diagnosing PTSD in accordance with criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor.  38 C.F.R. § 3.304(f); see also Cohen v. Brown, 10 Vet. App. 128 (1997). 
Upon review, the Board finds the weight of the evidence is against a finding that the Veteran has a current acquired psychiatric disorder.  
The Veteran first underwent Department of Veterans Affairs (VA) examination in connection with this claim in March 2013, at which time the examiner evaluated the Veteran and reviewed his medical history and lay statements.  The examiner op
 Statistical Manual of Mental Disorders (DSM); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor.  38 C.F.R. § 3.304(f); see also Cohen v. Brown, 10 Vet. App. 128 (1997). 
Upon review, the Board finds the weight of the evidence is against a finding that the Veteran has a current acquired psychiatric disorder.  
The Veteran first underwent Department of Veterans Affairs (VA) examination in connection with this claim in March 2013, at which time the examiner evaluated the Veteran and reviewed his medical history and lay statements.  The examiner opined that, based on the evaluation, the Veteran did not have a diagnosis of PTSD or of any other mental disorder.  In that regard, the examiner noted that the Veteran denied current or historic impairments due to depression or anxiety but did report nightmares about once per month.  While the Veteran was noted to have symptoms including anxiety and mild memory loss, the examiner concluded that he did not meet the diagnostic criteria for any mental disorder.
Conversely, in December 2012, the Veteran visited his private physician and asked him for a letter regarding a PTSD diagnosis.  The physician noted symptoms of night terrors and sleepwalking and made the statement “I think he has PTSD.”  In June 2013, a VA social worker completed a thorough mental health assessment of the Veteran and concluded that he did not present with symptoms that would suggest that he met the diagnostic criteria for PTSD.  Also in June 2013, however, the Veteran sought treatment from a VA physician who noted that the Veteran presented with chronic symptoms of PTSD and depression and continued to note such diagnoses in subsequent treatment.  
As a result of this evidence, the Veteran again underwent VA examination in February 2016.  The examiner again opined that the Veteran did not meet the diagnostic criteria for PTSD or for any other mental disorder.  In support of that opinion, the examiner stated that the Veteran’s symptom picture, which primarily included sleep impairment, did not appear to cause impairment in his social and occupational functioning.  
Upon review, the Board finds the evidence is against a finding that the Veteran has been diagnosed with a current acquired psychiatric disorder.  Although diagnoses of PTSD and depression were noted in the record, the diagnoses appeared to be by history or to be speculative in nature.  Furthermore, the evidence does not indicate that the diagnoses were made in accordance with the DSM, in contrast to the VA examinations which were conducted with the express purpose of determining whether the Veteran met the DSM criteria for any acquired psychiatric disorder diagnosis.  Accordingly, the Board finds the results of VA examination more probative than the medical records which are in conflict with the opinions provided by VA examiners.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (noting that the probative value of a medical opinion comes from whether it is factually accurate, fully articulated, and has sound reasoning for the conclusion).
The Board acknowledges that the Veteran has asserted that he has PTSD related to service.  While lay persons are competent to report on symptoms they have experienced, the diagnosis of PTSD or any other acquired psychiatric disorder requires medical testing and expertise to determine.  Thus, as a lay person, the opinion of the Veteran as to whether he has a diagnosable mental health condition is not competent medical evidence.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis).  As such, the Board finds the VA opinions to be of greater probative value than the lay contentions of record. 
Thus, for the foregoing reasons, the claim for service connection for an acquired psychiatric disorder is denied.  In reaching the decision to deny this claim, the Board has considered the applicability of the benefit of the doubt rule, but it is not for application because the most probative evidence of record is against the claim.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49.
 
Lana K. Jeng
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. D. Bruce, Associate Counsel