Citation Nr: 0002780 Decision Date: 02/03/00 Archive Date: 02/10/00 DOCKET NO. 92-04 240 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Kenneth B. Mason, Esq. WITNESSES AT HEARING ON APPEAL Appellant and his wife ATTORNEY FOR THE BOARD Michael Martin, Counsel INTRODUCTION The veteran served on active duty from September 1966 to September 1969. This matter came before the Board of Veterans' Appeals (Board) on appeal from a decision of October 1990 by the Department of Veterans Affairs (VA) St. Petersburg, Florida, Regional Office (RO). In that decision, the RO denied a reopened claim for service connection for post-traumatic stress disorder. That decision was appealed to the Board and, in March 1993 and February 1995, the Board remanded the claim for further development of evidence. Subsequently, in July 1996, the Board denied the claim for service connection for post-traumatic stress disorder on the basis that the claim was not well-grounded. The veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In October 1998, the Court issued a memorandum decision which reversed the Board's decision and remanded the case for readjudication. The Court specifically held that the claim was well-grounded, and noted that the duty to assist may not have been satisfied. In January 1999, the Board remanded the case to the RO for additional development. The requested development has since been completed, and the case has been returned to the Board for further appellate review. FINDINGS OF FACT 1. All evidence necessary for resolution of the issue on appeal has been obtained. 2. The preponderance of the medical evidence shows that the veteran does not have post-traumatic stress disorder. CONCLUSION OF LAW Post-traumatic stress disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.304(f) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the regulation pertaining to claims for service connection for post-traumatic stress disorder was recently revised, effective March 7, 1997. See 64 Fed. Reg. 32807-32808 (1999). The revised version provides that service connection for post-traumatic stress disorder 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 the claimed in-service stressor; and credible evidence that the claimed in-service stressor actually occurred. See 38 C.F.R. § 3.304(f) (1999). If the diagnosis of a mental disorder does not conform to DSM-IV or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis. 38 C.F.R. § 4.125(a) (1999). A claim for service connection for post-traumatic stress disorder is well grounded if a claimant has submitted medical evidence of a current disability; lay evidence (presumed to be credible for these purposes) of an in-service stressor, which in a post-traumatic stress disorder case is the equivalent of in-service incurrence or aggravation; and medical evidence of a nexus between service and the current post-traumatic stress disorder disability. See Cohen v. Brown, 10 Vet. App. 128, 137 (1997). The veteran has presented an account of a stressor in service and competent medical evidence showing that he has a diagnosis of post-traumatic stress disorder based on the claimed stressor. Therefore, the Board finds that the claim for service connection for post-traumatic stress disorder is well-grounded. The Board also finds that all relevant evidence necessary for resolution of the issue has been obtained. The veteran's medical treatment records have been obtained, and he has been afforded a disability evaluation examination. He has also been afforded a personal hearing. The Board does not know of any additional relevant evidence which is available. Therefore, no further assistance to the veteran with the development of evidence is required. The Board notes that during the personal hearing the veteran presented his own opinion that he had post-traumatic stress disorder. Significantly, however, the Court has held that lay persons, such as the veteran, are not qualified to offer an opinion that requires medical knowledge, such as a diagnosis or an opinion as to the cause of a disability. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1992). See also Grottveit v. Brown, 5 Vet. App. 91, 93 (1993), in which the Court held that a veteran does not meet his burden of presenting evidence of a well-grounded claim where the determinative issue involves medical causation and the veteran presents only lay testimony by persons not competent to offer medical opinions. The medical evidence which is in favor of the claim includes the report of a psychiatric examination conducted by the VA in August 1993 which reflects a diagnosis of post-traumatic stress disorder. A letter dated in April 1996 from Tucker Childs, MS, LMHC, of the Orlando Health Care Group shows that he concluded that the veteran had chronic symptoms of depression and mild symptoms of post-traumatic stress disorder secondary to his involvement in the Vietnam war. A VA psychology treatment record dated in November 1998 includes diagnoses of (1) depressive disorder, not otherwise specified, and (2) history of post-traumatic stress disorder. Finally, a VA treatment record dated in June 1999 shows that an RN recorded diagnoses of major depressive disorder and post-traumatic stress disorder. Many other records, however, reflect that the veteran does not have post-traumatic stress disorder. A VA hospital discharge summary dated in January 1989 shows that the veteran was admitted with a history of depression and family problems. There were no references to the veteran's military service. The diagnosis was adjustment disorder with depressed mood. A VA medical treatment record dated in May 1990 shows that the only diagnosis was major depression with suicidal ideation. A VA hospital discharge summary dated later in May 1990 shows that the only diagnosis was major affective disorder. Again, the record contained no references to the veteran's period of service. A VA hospital discharge summary dated in June 1991 shows that the veteran was admitted for treatment of symptoms of depression. The diagnoses were dysthymic disorder and alcohol abuse, sporadic. There were no references to the veteran's period of service. A VA hospital discharge summary dated in December 1991 shows that the only diagnosis was major depression, recurrent, moderate, with psychotic features. A VA medical certificate dated in December 1992 shows that the veteran reported that he was not sleeping well and had a poor appetite. His affect was flat and he appeared sad. He talked about his house burning down. The diagnosis was major depression with suicidal ideation. A VA hospital discharge summary dated in January 1993 shows that the diagnosis was major depression, moderate at this time. A hospital summary from the West Lake Hospital dated in August 1993 shows that the veteran was diagnosed as having major depression with suicidal ideation, recurrent type. A VA outpatient medical record dated in June 1994 reflects a diagnosis of major affective disorder, depressed. A hospital discharge summary from the South Seminole Psychiatric Services dated in June 1994 includes diagnoses of major depression, recurrent type. A hospital record from South Seminole Psychiatric Services dated in December 1994 reflects a diagnosis of major depression, recurrent type, with suicidal ideation. A hospital summary from the South Seminole Psychiatric Services dated in March 1995 shows that the only diagnosis was psychotic disorder not otherwise specified. A hospital summary from the South Seminole Hospital dated in April 1995 reflects diagnoses of major depression, recurrent, with psychotic features, and mixed personality disorder. The report of a psychiatric examination conducted by two VA examiners in June 1995 shows that the veteran's chief complaint was of having recurring depression. He had a history of several psychiatric hospitalizations and had received various psychiatric diagnoses primarily related to a major depressive disorder. He had some difficulty in verbalizing his complaints in detail. He stated that his current complaints were difficulty with his sleep pattern manifested by oversleeping, changes in appetite which fluctuated from loss of appetite to increased appetite, and an inability to enjoy sexual relationships. He also said that he had panic attacks every three to four months. He said that these attacks were triggered by feeling depressed. He also complained of having difficulty relating to people, feeling easily frustrated, and being unable to cope. However, he stated that he had been able to function at a reasonable level in his job as a park technician for the last several years. Upon questioning, he admitted drinking alcoholic beverages for many years, although without major intoxications or withdrawal reactions. He said that he had about two double shots (in other words, four drinks) per day. He gave a history of being a cook in Vietnam and of being only indirectly exposed to combat. He said that prior to entering service he had symptoms of anxiety and depression, but did not require any psychiatric treatment. On mental status examination, the veteran was casually, but appropriately dressed. There was no abnormal behavior displayed during the interview. His sensorium was clear and he appeared to be cognitively intact. He showed no evidence of a thought disorder. He stated that he heard voices at night, but this appeared to be a sleep related perceptual phenomenon. He did not display any true delusional thinking. His mood was euthymic. His affect was generally appropriate and had a full range. His insight and judgment were adequate. The diagnoses were (1) alcohol abuse and (2) alcohol induced mood disorder with depressive features. The examiners specifically stated that: This veteran does not have any symptoms or signs and the history is incompatible with the diagnosis of PTSD. In our opinion, alcohol, which apparently has been overlooked during previous evaluations, plays a major if not the major role in his psychopathology at this time. A memorandum from the VA Medical center dated in January 1999 shows that the examiners who conducted the foregoing psychiatric examination are both psychiatrists, and that they reviewed the veteran's claims file prior to the examination. The report of a psychiatric evaluation and treatment plan prepared in December 1995 at the South Seminole Hospital shows that the veteran's chief complaint was that of having depression. He stated that it was brought on when his stepson got drunk and pressured his wife to buy him beer. The veteran had an argument with his wife because he believed that it was stupid to buy beer for an alcoholic. He also said that he owed $6000 for child support, and that his son had signed up for the Army. Following mental status examination, the diagnoses were major depression, recurrent type, moderately severe; and personality disorder. A record from the Seminole Hospital dated in March 1996 reflects a diagnosis of major depression with recurrent psychosis. A record from the Social Security Administration dated in July 1996 shows that the veteran was found to be disabled due to major depression and hypertension. There was no mention of post-traumatic stress disorder. A VA mental health clinic record dated in December 1996 includes diagnoses of dysthymic disorder and generalized anxiety disorder. Other treatment records contain similar information. The Board finds that the evidence which weighs against the claim is more credible than the evidence which supports the claim. In this regard, the Board notes that there are far more medical records which contain diagnoses of disorders other than post-traumatic stress disorder. Also, some of the diagnoses of post-traumatic stress disorder were rendered by health care providers other than psychiatrists, such as a nurse. Such opinions have relatively less probative value than an opinion by a psychiatrist. See Black v. Brown, 10 Vet. App. 279 (1997). Furthermore, the diagnoses of disorders other than post- traumatic stress disorder which are contained in the hospital discharge summaries are based on extended periods of observation, rather than on a relatively brief interview such as the one conducted by the VA examiner in August 1993 in which the examiner diagnosed post-traumatic stress disorder. Thus, the preponderance of the evidence shows that the veteran does not have post-traumatic stress disorder. Accordingly, the Board concludes that post-traumatic stress disorder was not incurred in or aggravated by service. In light of the conclusion that the veteran does not have post- traumatic stress disorder, no discussion of the veteran's claimed stressors is required. ORDER Service connection for post-traumatic stress disorder is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals