PERSONALITY DISORDERS

Summary

The Veteran, an Air Force Veteran who served honorably from March 2005 to October 2008, including service in Iraq, appeals the denial of service connection for an acquired psychiatric disorder, specifically personality disorder and/or body dysmorphic disorder. The Veteran claimed these conditions stemmed from in-service harassment and appearance-related trauma during basic training and throughout his military service, leading to multiple cosmetic procedures. The Board reviewed lay statements from the Veteran and a June 2016 VA PTSD examination which did not diagnose these specific conditions. A December 2018 VA PTSD examination noted diagnoses of PTSD, depressive disorder, and body dysmorphic disorder, suggesting a relationship to in-service harassment, but lacked a clear nexus opinion. The Veteran testified at a virtual hearing about the impact of remarks on his appearance during service. A June 2024 VA medical opinion concluded that any current personality disorder and/or body dysmorphic disorder is less likely than not related to service, finding the Veteran's lay statements and the 2018 examination's suggestions insufficient to establish service connection. The Board found the June 2024 opinion highly probative and adequately addressed the Veteran's claims, outweighing the lay evidence. The Board denied service connection for the acquired psychiatric disorder, finding the evidence persuasively against a grant.

Rationale

Evidence persuasively weighs against finding that personality disorder and/or body dysmorphic disorder began during active service or is otherwise related to an in-service injury or disease.; June 2024 VA opinion found claimed condition less likely than not incurred in or caused by service.; Veteran's lay statements and 2018 VA examination were insufficient to establish service connection.

Full Decision Text

Citation Nr: 26005109
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 20-30 530
DATE: April 30, 2026

ORDER

Service connection for an acquired psychiatric disorder, other than posttraumatic stress disorder (PTSD), to include a personality disorder and/or body dysmorphic disorder, is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that a personality disorder and/or body dysmorphic disorder began during active service or is otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for an acquired psychiatric disorder, other than PTSD, to include a personality disorder and/or body dysmorphic disorder, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably in the United States Air Force from March 2005 to October 2008, with service in Iraq. The Board of Veterans' Appeals (Board) thanks the Veteran for his service to our country. 

By way of procedural background, this matter comes before the Board on appeal from a February 2019 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). 

The Board remanded the issue in November 2019 for issuance of a Statement of the Case (SOC), which was subsequently completed in October 2020. 

In October 2021, the Veteran testified at a virtual hearing before the undersigned, and a transcript of that hearing is of record.

The claim was recently remanded in May 2024, for further development, including providing the Veteran with a VA medical opinion. The Veteran was afforded with a VA medical opinion in June 2024. For the reasons discussed below, the Board finds that there has been substantial compliance with the development sought as part of the May 2024 Remand. See Stegall v. West, 11 Vet. App. 268 (1998).

Service connection for an acquired psychiatric disorder, other than PTSD, to include a personality disorder and/or body dysmorphic 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(a). Service connection may be granted for any disease diagnosed after discharge when the evidence establishes the disease was incurred in service. 38 C.F.R. § 3.303(d).

Generally, to prevail on the issue of service connection, the evidence must show: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the persistent disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

In December 2018, the Veteran submitted a statement, contending that he suffers from narcissistic personality disorder "due to [his] general lack of empathy for people, and frequency of cosmetic procedures." Inappropriate statements from his sergeant towards the Veteran affected his personal life, as the Veteran stated he has "no value in the opinions of others and could care less." The Veteran also stated that he suffers from body dysmorphic disorder due to military service. He stated that he was picked on for "having ears that stick out, an overbite, misaligned teeth, and a fat stomach." Since separation, the Veteran had undergone many cosmetic procedures including multiple cosmetic dental procedures, rhino/septoplasty, otoplasty, braces and cold laser therapy, pectoral implants, abdominal etching and flank liposuction, and Botox. The Veteran also asserts he has an eating disorder. See December 2018 Correspondence. 

In a June 2016 VA PTSD examination, the Veteran was not diagnosed with anything other than PTSD, for which he is already in receipt of service connection.

In a December 2018 VA PTSD examination, the Veteran was noted to have diagnoses of PTSD, depressive disorder, other specified obsessive-compulsive and related disorder and body dysmorphic disorder without repetitive behaviors. The examiner noted that the diagnosis "is seen as related to the harassment he experienced in the military"; however, it appears the examiner was merely noting that the Veteran attributed the diagnosis to in-service harassment, and did not provide a medical opinion on the etiology of the diagnosis.

In October 2021, at the Board hearing before the undersigned, the
2018 Correspondence. 

In a June 2016 VA PTSD examination, the Veteran was not diagnosed with anything other than PTSD, for which he is already in receipt of service connection.

In a December 2018 VA PTSD examination, the Veteran was noted to have diagnoses of PTSD, depressive disorder, other specified obsessive-compulsive and related disorder and body dysmorphic disorder without repetitive behaviors. The examiner noted that the diagnosis "is seen as related to the harassment he experienced in the military"; however, it appears the examiner was merely noting that the Veteran attributed the diagnosis to in-service harassment, and did not provide a medical opinion on the etiology of the diagnosis.

In October 2021, at the Board hearing before the undersigned, the Veteran testified that during basic training there was a lot of trauma from what was said about his appearance. The Veteran stated that those remarks during service stuck with him over time and caused the Veteran to get plastic surgeries done. The Veteran testified that he believes he has body dysmorphic disorder due to what occurred in basic training and the experience throughout the entire time in the military.

In June 2024, the Veteran was provided with a VA medical opinion, which provided an opinion on the etiology of the Veteran's diagnosis. The VA examiner opined that the claimed condition is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reviewed the December 2018 VA examination, which noted that Veteran has obsessive-compulsive disorder with more body dysmorphic disorder without repeated behavior, unspecified depressive disorder. The VA examiner specifically noted that the Veteran is service-connected for PTSD and that the appeal from the May 2024 Remand is regarding narcissistic personality disorder and body dysphoric disorder. The VA examiner reviewed the Veteran's December 2018 statement, including the statements that his symptoms started during boot camp, and reviewed the Veteran's medical records. The VA examiner noted that the Veteran did not have a diagnosis of narcissistic personality disorder or obsessive-compulsive disorder with body dysphoric disorder by a treating physician. The VA examiner indicated that "narcissistic personality disorder is secondary to the experience person received in during childhood. It is developed in teenage group. But is diagnosed after the client turns eighteen-year-old. Body dysmorphic syndrome and obsessive-compulsive disorder also developed during the teenage group." In sum, the VA examiner opined that any current diagnosis of a personality disorder and/or body dysmorphic disorder is not related to service. 

The Board finds the June 2024 VA examiner's opinion highly probative, as it contains clear conclusions with supporting data and a reasoned medical explanation connecting the two. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight to be attached to medical opinions are within the province of the Board). Notably, the medical opinion adequately addressed the May 2024 Board Remand directives, including addressing the Veteran's statements that symptoms started in boot camp due to harassment about his body. See Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing the probative value of a medical opinion include the examiner's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion).

To the extent to which the 2018 examination notes a diagnosis of other specified obsessive compulsive and related disorder and body dysmorphic disorder and suggests a relationship to service, the examination did not provide any rationale to explain the opinion that purports to link it to service. Nieves-Rodriguez, 22 Vet. App. at 304. Rather, it appears the examiner merely transcribed the Veteran's report. Such history and complaints are not transformed into medical evidence just because the veteran tells them to a doctor who writes it down. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (ruling that "a bare transcription of a lay history is not transformed into 'competent medical evidence' merely because the transcriber happens to be a medical professional...."). Therefore, the Board finds the 2018 medical opinion to be inadequate. 

The Board has also considered the Veteran's lay statements that he suffers from a personality disorder and/or body dysmorphic disorder, due to events from service. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts or events that the lay witnesses observed and is within the realm of his personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay evidence may also be competent to establish medical etiology or nexus. See Davidson v. Shinseki, 581 F
 be a medical professional...."). Therefore, the Board finds the 2018 medical opinion to be inadequate. 

The Board has also considered the Veteran's lay statements that he suffers from a personality disorder and/or body dysmorphic disorder, due to events from service. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts or events that the lay witnesses observed and is within the realm of his personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay evidence may also be competent to establish medical etiology or nexus. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). However, "VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to." See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In this case, the Board considers the potential relationship between the Veteran's personality disorder and/or body dysmorphic disorder, and its connection to service to be complex in nature. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Therefore, while the Veteran is competent to describe the symptoms, he is not competent to provide a nexus opinion. Accordingly, his lay opinion in this matter has little probative value.

Given these facts, the Board finds that the Veteran's contention, that his personality disorder and/or body dysmorphic disorder is related to service, is inconsistent with, and outweighed by, the medical evidence of record. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not in and of itself, render the lay evidence not credible). Here, the competent, credible, and most probative evidence does not show that the Veteran had a personality disorder and/or body dysmorphic disorder that manifested in or as a result of service.

There can be no doubt that the Veteran rendered honorable and faithful service for which the Board is grateful, and that he is sincere in his belief that his disorder is related to service. However, the Board has carefully reviewed the record in depth and has been unable to identify a basis upon which service connection may be granted. Significantly, there is no conflicting medical evidence that states the personality disorder and/or body dysmorphic disorder is related to service. 

Based on the foregoing, the Board finds the Veteran's personality disorder and/or body dysmorphic disorder is not related service. As the evidence is persuasively against a grant of service connection, the benefit of the doubt doctrine under 38 U.S.C. §5107(b), is not for application. 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).

Therefore, entitlement to service connection for an acquired psychiatric disorder, other than PTSD, to include a personality disorder and/or body dysmorphic disorder, is denied. 

 

H. SEESEL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Dourmashkin, Mark W.

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.