POSTTRAUMATIC STRESS DISORDER (PTSD)

C. TRUEBA · 2022 · Case ID: 22062346

MIXED

Summary

The veteran, who served in the U.S. Army from August 1970 to August 1973, including service in Vietnam, appeals the denial of service connection for PTSD and the grant of service connection for an acquired psychiatric disorder. The Board found the evidence persuasively weighed against a diagnosis of PTSD, noting negative or inconclusive PTSD screens in VA treatment records and a lack of specific DSM-5 criteria met in private evaluations. While a private psychologist diagnosed subthreshold PTSD and noted the Veteran's combat stressors were undisputed, the Board found this opinion did not constitute a valid diagnosis for VA purposes. The Board also noted that the Veteran's VA examinations did not meet PTSD diagnostic criteria. The Board concluded that the benefit of the doubt doctrine was not applicable to the PTSD claim due to the evidence weighing against service connection. For the acquired psychiatric disorder, the Board found the evidence to be in equipoise. A private psychologist diagnosed Other Specified Trauma- and Stressor-Related Disorder (subthreshold PTSD) and opined it was more likely than not related to Vietnam service, providing a detailed rationale. This opinion was found to be significantly probative. Resolving all doubt in the Veteran's favor, service connection for the acquired psychiatric disorder was granted. The Board denied service connection for PTSD.

Rationale

Evidence persuasively weighs against PTSD diagnosis; Negative/inconclusive VA PTSD screens; Private evaluations did not meet DSM-5 criteria; Benefit of the doubt doctrine not applicable

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

05-12 706

Full Decision Text

Citation Nr: 22062346
Decision Date: 11/07/22 Archive Date: 11/07/22

DOCKET NO. 05-12 706
DATE: November 7, 2022

ORDER

Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied.

Entitlement to service connection for an acquired psychiatric disorder, to include persistent depressive disorder (dysthymia) is granted.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had a DSM-4 or DSM-5 diagnosis of PTSD at any time during or approximate to the pendency of the claim.

2. Resolving reasonable doubt in the Veteran's favor, his acquired psychiatric disorder, diagnosed as other specified trauma- and stressor-related disorder, is at least as likely as not related to the Veteran's Vietnam service.

CONCLUSIONS OF LAW

1. The criteria for service connection for PTSD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for an acquired psychiatric disorder, diagnosed as other specified trauma- and stressor-related disorder, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from August 1970 to August 1973, to include service in the Republic of Vietnam.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2004 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Commonwealth of Puerto Rico. The Veteran presented sworn testimony at a hearing before the undersigned in June 2007.

The Board remanded this matter in December 2017 for additional development.

1. Entitlement to service connection for PTSD.

The Veteran contends that he has PTSD as a result of his service in Vietnam.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 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).

Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f).

VA regulations require that a medical diagnosis be competent. See 38 C.F.R. § 3.159(a). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer the medical diagnosis. Id.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of PTSD and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Initially, the Board notes that the Veteran's DD Form 214 and service personnel records confirm the Veteran served in the Republic of Vietnam from March 1972 to September 1972. The Board further notes that VA has conceded the Veteran's claimed stressor. See, February 2021 SSOC.

The Board notes that VA treatment records reveal the Veteran had negative PTSD screens in March 2005, December 2005, June 2007, April 2015, March 2016, and February 2017, whereas positive VA PTSD screens were noted in August 2006 and May 2012. The Board further notes that VA treatment record do not contain a diagnosis of DSM-4 or DSM-5 diagnosis
, the Board notes that the Veteran's DD Form 214 and service personnel records confirm the Veteran served in the Republic of Vietnam from March 1972 to September 1972. The Board further notes that VA has conceded the Veteran's claimed stressor. See, February 2021 SSOC.

An April 2019 private psychological evaluation from Centro Terapeutico Genesis notes the Veteran experienced combat in Vietnam and witnessed multiple deaths. Diagnoses of recurrent chronic depression and PTSD were noted. The Board notes that, while PTSD criteria A, B, C, D, E, and F were noted, the psychologist did not specify how each criterion was met, nor were criteria G and H even listed. The psychologist did not specify whether DSM-4 or DSM-5 criteria were being used.

Under 38 C.F.R. §§ 4.125(a) and 4.130, psychiatric disorders must conform to a diagnosis pursuant to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 404 (2020), aff'd sub nom. Martinez-Bodon v. McDonough, 28 F.4th 1241, 1247 (Fed. Cir. 2022). Accordingly, the April 2019 private opinion does not constitute evidence of a valid diagnosis of PTSD for VA purposes.

The Veteran was afforded a VA PTSD examination in June 2019. It was noted that the Veteran's symptoms do not meet the DSM-5 diagnostic criteria for PTSD, but a diagnosis of persistent depressive disorder (dysthymia) was rendered. It was further noted that, regarding PTSD criterion B through I were not met.

The Veteran was afforded a VA PTSD examination in September 2019. It was noted that the Veteran's symptoms did not meet the diagnostic criteria for PTSD under DSM-5, with only criteria A met. However, a diagnosis of persistent depressive disorder (dysthymia) was noted.

A December 2019 private psychological evaluation from Dr. C. L. R., a psychologist, stated the Veteran has other specified trauma and stressor related disorder (subthreshold PTSD). The psychologist provided a thorough, detailed discussion of the evidence of record, and noted that the April 2016 private psychologist "included the diagnostic criteria for PTSD in her report without recounting [the Veteran's] symptoms and diagnosed him with PTSD and Major Depressive Disorder, Recurrent." Dr. C. L. R. then noted that the Veteran's stressors in Vietnam had not been disputed and further noted "the presence of trauma-related nightmares", chronic insomnia, difficulty speaking about his combat experiences. A diagnosis of Other Specified Trauma- and Stressor-Related Disorder was rendered.

While the Veteran believes he has a current diagnosis of PTSD, he is not competent to provide a diagnosis. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Thus, the Board gives more probative weight to the competent medical evidence.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for PTSD, is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

2. Entitlement to service connection for an acquired psychiatric disorder, to include other specified trauma- and stressor-related disorder and/or persistent depressive disorder (dysthymia).

The Board has recharacterized the claim for entitlement to service connection for an acquired psychiatric disorder, to include persistent depressive disorder (dysthymia) as one for entitlement to service connection for an acquired psychiatric disorder, to include other specified trauma- and stressor-related disorder and/or persistent depressive disorder (dysthymia). Clemons v. Shinseki, 23
Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

2. Entitlement to service connection for an acquired psychiatric disorder, to include other specified trauma- and stressor-related disorder and/or persistent depressive disorder (dysthymia).

The Veteran was afforded a VA psychiatric examination in August 1974. It was noted that the Veteran "showed a tendency to somatize psychic tension" and that he scratches himself. It was noted that the Veteran reported "mal-humor, insomnia, getting easily angered by his family and people", not trusting anyone, lacking in drive, and being depressed often. Anxiety neurosis, chronic with psychophysiologic features, was diagnosed.

The Veteran was afforded a VA psychiatric examination in September 1975. Anxiety neurosis with somatization features was diagnosed.

The Veteran was afforded a VA PTSD examination in June 2019. A diagnosis of persistent depressive disorder (dysthymia) was rendered. The VA examiner opined that the Veteran dysthymia "has no nexus to his military service", noting that the Veteran was able to obtain a bachelor's degree, successfully work at different jobs, and have a stable family and social life. The Board notes that this is not a rationale regarding nexus, as it is essentially a statement regarding the severity of the symptoms. As such, the Board finds this opinion is of no probative value.

An addendum VA opinion was obtained in September 2019 and the VA examiner found that "there is no evidence of psychiatric complaints, psychiatric, findings, nor psychiatric treatment" during military service and opined against service connection for the diagnosed dysthymia. Here, the examiner relies entirely on a lack of documentation in service. As such, the opinion is of no probative value.

As noted above, the Veteran underwent a private psychological evaluation in December 2021 with Dr. C. L. P., who stated that the Veteran has other specified trauma and stressor related disorder (subthreshold PTSD) that is more likely than not related to his service in Vietnam. The psychologist provided a thorough, detailed discussion of the evidence of record, citing relevant medical literature, and concluded that the Veteran "was exposed to traumatic stressors during his service in Vietnam, and the psychiatric records from 1974 1975 are evocative of post-traumatic symptomatology. More recently, 2012 2015 notes reflect the presence of trauma-related nightmares. He has also suffered from chronic insomnia and finds speaking of his combat experience difficult. These symptoms warrant a diagnosis of Other Specified Trauma- and Stressor-Related Disorder (specifically, subthreshold PTSD)." It was further noted that the Veteran's "experience is consistent with that of other older veterans, specifically that his family and work had provided a buffer and that his experience hews more closely to the model of LOSS than of LATR." The psychologist then opined that it is more likely than not that his Subthreshold PTSD is related to his military service during the Vietnam War. The Board finds this opinion to be significantly probative. A medical examination is "fully informed" when the examiner has sufficient facts upon which to base an opinion relevant to the issue at hand. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008).

(Continued on the next page)

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's acquired psychiatric disorder is due to his service in Vietnam. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for an acquired psychiatric disorder, diagnosed as other specified trauma- and stressor-related disorder, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102."

C. TRUEBA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Keeley, Brian

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.

in Vietnam. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for an acquired psychiatric disorder, diagnosed as other specified trauma- and stressor-related disorder, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102."

C. TRUEBA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Keeley, Brian

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