Source: https://va-claim.com/2019/04/10/entitlement-to-service-connection-for-an-acquired-psychiatric-disorder-to-include-posttraumatic-stress-disorder-ptsd-denied-citation-nr-18160573/?shared=email&msg=fail
Timestamp: 2019-04-23 22:48:55+00:00

Document:
Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied.
The weight of the evidence is against a finding that the Veteran has a diagnosis of an acquired psychiatric disorder, to include PTSD, in accordance with VA regulations.
The criteria to establish service connection for an acquired disorder, to include PTSD, are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 4.125 (2017).
The Veteran had active service from November 2002 until August 2008.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).
Service connection may be granted for a disability resulting from injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. § 1110; 38 C.F.R.         § 3.303. In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).
In order to prevail on the issue of entitlement to service connection, there must be (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247 (1999).
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).
The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value.
The Veteran contends that he suffers from PTSD and anxiety and that his claimed psychiatric disorders were incurred during military service. See November 2016 Substantive Appeal.
After thorough consideration of the evidence of record, the Board finds that service connection for an acquired psychiatric disability, to include PTSD and anxiety, is not warranted.
Turning to the evidence of record, the Veteran’s physical examination at discharge showed no report of a psychiatric disorder.  A May 2008 Chapter 14 separation for misconduct report, however, reflects that the Veteran complained of anxiety, depression and anger and was diagnosed with adjustment disorder with disturbance of emotions and conduct, probable PTSD and cocaine abuse. The examiner noted that the Veteran may meet the criteria for PTSD and believed that PTSD contributed to the Veteran’s drug and alcohol abuse but concluded that the Veteran was mentally responsible for his actions.
The Veteran was afforded a VA examination for PTSD in December 2015. The Veteran provided his social, marital, family, occupational and educational history. The Veteran reported that while he was deployed in Southwest Asia, he was mortared on and it hit their tank.  The Veteran reported that he had a daydream about his family member being killed.  He has anxiety and difficulty with driving but he sleeps well most of the time.  He also reported that his thoughts back to deployment do not bother him and he does not find them traumatic. The psychologist observed that the Veteran had good hygiene and grooming, was fully cooperative, oriented to time, place, person and purpose of the interview, thoughts were organized and goal directed, did not harbor hallucinations, denied suicide ideations, and appeared to have attention, concentration and memory within normal limits.
The psychologist noted that he reviewed the Veteran’s virtual claims file.  The psychologist provided a detailed summary of the Veteran’s service treatment records: the Veteran did not report any emotional difficulties after he returned from Kuwait and Iraq in 2004; the PTSD screening was negative at that time; and he was not on any psychotropic medications.  Moreover, the psychologist pointed out that the Veteran was not receiving treatment at any VA or private facility for his claimed psychiatric disabilities.
After a full examination, the VA psychologist concluded that the Veteran does not have PTSD that conforms to DSM-5 criteria. The psychologist noted that the Veteran’s symptoms do not meet the diagnostic criteria for PTSD and that the Veteran does not have a mental disorder that conforms with DSM-5. There was no diagnosis of a mental disorder. The psychologist clarified that a review of DSM-5 criteria would not support a diagnosis for a mood disorder, anxiety disorder, trauma disorder, current substance use disorder or other mental condition.  It was noted that the Veteran has some symptoms but none would rise to the level of a psychiatric disorder.
The psychologist provided a detailed rationale for his conclusion: reported symptoms are minor and infrequent and the Veteran endorsed that they do not cause impairment in his functioning; the Veteran has never been diagnosed with PTSD; the Veteran has no documentation of any mental health care since service over 7 years ago; and the examination suggested that the Veteran has some vague symptoms but are infrequent and lack severity of a psychiatric diagnosis.  Therefore, combined with the fact that there was no ongoing mental treatment, the VA psychologist opined that he does not meet the criteria for a mental health disorder.
The VA psychologist noted that the Veteran was seen for a mental status examination in May 2008 for a chapter separation due to misconduct for cocaine use and was diagnosed with adjustment disorder and possibly PTSD; however, the psychologist pointed out that there was no supporting documentation for PTSD in the service treatment records and the in-service examiner had a rule out of PTSD.  Moreover, the psychologist noted that adjustment disorders are conditions that are short in nature or can develop into a chronic condition; and there was no evidence of a chronic condition by the Veteran’s report and his medical records.
The probative value of a medical opinion is based on the medical expert’s knowledge and skill in analyzing the data and the examiner’s medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician’s access to the claims folder and the thoroughness and detail of the opinion. See Nieves-Rodriguez, 22 Vet. App. 295 (2008).
Here, the Board accords great probative weight to the medical opinion by the VA psychologist. In this regard, the Board notes that the medical opinion and conclusion were based on a thorough and detailed review of the Veteran’s medical history, as well as, a physical examination of the Veteran.  Furthermore, the psychologist provided a clear rationale as to why the Veteran does not manifest a mental disorder, including PTSD. As delineated above, the psychologist provided numerous explanations as to why the Veteran does not exhibit a mental disability that conforms to the DSM-5, including the facts that the Veteran did not have any mental treatment since he left service, his symptoms are infrequent and lack severity of a psychiatric disorder, the Veteran’s diagnosis of adjustment disorder for Chapter evaluation is not chronic, and that there was no actual diagnosis of PTSD.  See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (holding when assessing the probative value of a medical opinion, the access to claims files and the thoroughness and detail of the opinion must be considered and the opinion is considered probative if it is definitive and supported by detailed rationale). Therefore, the Board gives significant probative value and weight to the opinion and conclusion of the VA psychologist.
The Board acknowledges that the examiner for the Chapter evaluation diagnosed the Veteran with adjustment disorder and probable PTSD.  However, the VA psychologist in December 2015 provided a thorough rationale as to why the prior diagnosis of an adjustment disorder is not a mental disorder that conforms to DSM-5.  Moreover, the in-service examiner stated that the Veteran “may” have PTSD; there was no diagnosis of PTSD as the VA psychologist stated in the December 2015 examination.  Moreover, since the in-service examiner did not provide a rationale for any of the diagnoses, the Board finds that his opinion has little probative weight. See Obert v. Brown, 5 Vet. App. 30, 33 (1993) (medical opinions that are speculative, general, or inconclusive in nature cannot support a claim); see also Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (holding that medical opinions are speculative and of little probative value when a physician provides an opinion using qualitative language such as “may”).
The Board notes the Veteran’s assertions in his claim, notice of disagreement and substantive appeal.  Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness 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 (1994); see also Young v. McDonald, 766 F.3d 1348, 1353) (Fed. Cir. 2014) (holding that “PTSD is not the type of medical condition that lay evidence … is competent and sufficient to identify”); see also Clemons v. Shinseki, 23 Veteran. App. 1, 4-5 (2009) (holding that a claimant without medical expertise cannot be expected to precisely delineate the diagnosis of his mental illness). As such, the Veteran’s conclusory statements have little probative weight.
The Board notes the Veteran mentioned during his December 2015 VA examination that he was treated by a primary care doctor since military service. Thereafter, in August 2016, the Veteran submitted a VA 21-4142, Authorization to Disclose Information to the VA. In the form, the Veteran did not list any provider or facility from which the VA could obtain records.  Despite any request for obtaining records, the RO attempted to obtain medical records from VA’s Private Medical Records Retrieval Center.  In September 2016, the request was rejected because of incomplete PHP information. The RO, then, attempted to contact the Veteran without avail. See October 2016 Report of General Information. The Board notes that the duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Moreover, it is the Veteran’s responsibility to present and support a claim for benefits. See 38 U.S.C. § 5107 (a); Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).
Additionally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with regards to this claim. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).
In summary, while the lay contentions that the Veteran exhibits an acquired psychiatric disorder have been considered, the Board accords greater weight to the probative medical evidence of record. Accordingly, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for an acquired psychiatric disability. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

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