Citation Nr: 1305876 Decision Date: 02/20/13 Archive Date: 02/27/13 DOCKET NO. 06-15 865 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico THE ISSUE Entitlement to service connection for an acquired psychiatric disability, including as secondary to service-connected residuals of a left fifth toe fracture. REPRESENTATION Appellant represented by: Florida Department of Veterans Affairs ATTORNEY FOR THE BOARD Andrew Mack, Counsel INTRODUCTION The Veteran served on active duty for training (ACDUTRA) from March 1983 to August 1983. Thereafter, he served for over 16 years in the Air National Guard of Puerto Rico. This matter comes before the Board of Veterans' Appeals (Board) from a March 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. The matter was before the Board in January 2010 and December 2011, and both times was remanded for further development. It has been returned to the Board for further appellate action. While this Veteran's claim has previously been characterized as one for depressive disorder, not otherwise specified, given the Veteran's description of his claim and the information of record, the Board finds that the claim encompasses any acquired psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that the scope of a Veteran's claim for service connection for PTSD may also include any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). Therefore, the Board has characterized that portion of the appeal involving service connection for a psychiatric disability as encompassing any acquired psychiatric disability, as reflected on the title page. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to ensure a total review of the evidence. The issue of entitlement to a total disability rating for individual unemployablity due to service-connected disabilities (TDIU) was raised by the Veteran in a September 2012 statement, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. The record does not reflect, and the Veteran has not contended, that an acquired psychiatric disability began during or is directly related to either the Veteran's period of ACDUTRA from March 1983 to August 1983 or any other service. 2. The weight of the competent, credible, and probative evidence shows that an acquired psychiatric disability was not caused or aggravated by the Veteran's service-connected residuals of a left fifth toe fracture. CONCLUSION OF LAW An acquired psychiatric disability was not incurred or aggravated in service and was not caused or aggravated by a service-connected disability. 38 U.S.C.A. §§ 101(22), (24), 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.6, 3.303, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for disability resulting from disease or injury incurred or aggravated while performing ACDUTRA or injury incurred or aggravated while performing inactive duty for training (INACDUTRA). See 38 U.S.C.A. § 101(22), (24); 38 C.F.R. § 3.6 (2012). Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (2012). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc) (additional disability resulting from aggravation of a nonservice-connected disorder by a service-connected disorder is also compensable under 38 C.F.R. § 3.310). With disability compensation claims, VA adjudicators are directed to assess both medical and lay evidence. As a general matter, a layperson is not capable of opining on matters requiring medical knowledge. See 38 C.F.R. § 3.159(a)(2); see also Routen v. Brown, 10 Vet. App. 183, 186 (1997). In certain circumstances, however, lay evidence may be sufficient to establish a medical diagnosis or nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In addressing lay evidence and determining its probative value, if any, attention is directed to both competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In terms of competency, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot). That notwithstanding, a Veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Routen, 10 Vet. App. 183. In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See generally Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006); but see Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. In this case, the record does not reflect, and the Veteran has not contended, that acquired psychiatric disability began during or is directly related to either the Veteran's period of ACDUTRA from March 1983 to August 1983 or any other service. Service treatment records indicate no findings or notes regarding mental health or psychiatric problems, and there is no assertion by the Veteran that any psychiatric disability existed until approximately 1999. Rather, as reflected in his October 2003 claim and September 2005 substantive appeal, the Veteran contends that an acquired psychiatric disability was caused or aggravated by his service-connected residuals of a left fifth toe fracture. Simply stated, the Veteran believes he has a psychiatric disability as the result of toe problem. In February 2004, a VA psychiatrist reviewed the claims file and examined the Veteran. The examiner noted that there was no evidence in the record of a past history of psychiatric treatment for depressive disorder or any type of mental disorder, but that the Veteran reported that he had been in ambulatory psychiatric treatment with a private psychiatrist, Dr. S., since about five years prior. The examiner also noted that there was no medical certificate to corroborate this information, and no evidence of VA psychiatric treatment over the last year, but that the Veteran reported that he was in psychiatric treatment in the last year due to major depression treated with Xanax, Paxil, and BuSpar in unknown concentrations. The Veteran further reported that his last job had been with a private company for eight years until the past year when he had stopped working due to his depressive disorder, precipitated by a stressful working environment, and that he was receiving Social Security Administration (SSA) disability benefits. The Veteran reported that in the last year had had been feeling sad and depressed with irritability, loss of interest for daily living activities, loss of energy, insomnia, inability to feel pleasure in daily tasks, loss of interest in sex, and inability to concentrate, and anxiety. On examination, the Veteran's mood was depressed and his affect was constricted and appropriate, and it was noted that there was no available psychological testing. The diagnosis was depressive disorder, not otherwise specified, and the VA examiner opined that such depressive disorder was not due to or aggravated by the Veteran's service-connected condition, as there was no objective evidence in the Veteran's clinical history of mental status examination indicating that the depressive disorder was precipitated or aggravated by his service-connected fracture of proximal phalanx of the left fifth toe. Following the February 2004 VA examination, private psychiatric evaluation reports in connection with SSA disability claims from Dr. T. and Dr. S. were associated with the claims file. The report of an October 2000 psychiatric evaluation by Dr. T. reflects that the Veteran had last been employed in February 2000, and that he was very depressed and did not cooperate very well during his interview so that it was necessary to get information from his sister. It was reported that in February 2000 the Veteran was fired from his job for apparently not functioning well in his job, and that since that time he had become very depressed with crying spells, reclusiveness at home, and refusing to see friends and relatives. It was further reported that he remained home all the time, sitting around, pacing the floor or lying down in bed, and that he had lost his appetite and weight, was receiving outpatient psychiatric treatment with Dr. S. every two weeks or every month, and had been treated with psychiatric drugs with no improvement. On mental status examination, the Veteran's mood was severely depressed with head bent down staring at the floor and no eye contact with the interviewer and mumbling. The Veteran's sister reported that the Veteran stated that he wanted to die, heard voices calling him, and saw shadows, and Dr. T. reported that the Veteran was disoriented as to time and place. The diagnosis was major depression with psychotic features, with being fired from his job as his stressor. A February 2003 psychiatric evaluation of the Veteran by Dr. S. reflects that Dr. S. had treated the Veteran monthly from January 1999 to January 2003, and that the Veteran had come presenting with some psychiatric symptoms for several years, which had gradually developed and become concomitantly exacerbated with his physical illnesses and stress. It was noted that the Veteran had began to isolate himself, abandoned his appearance, and lost all interest in social, physical, and sexual activities. It was also noted that the Veteran did not tolerate frustration and had a poor capacity to resolve problems inside and outside the home, did not participate in group activities, and became irritable and argued frequently. It was further reported that the Veteran was not involved in physical activities, and at the time did not tolerate stressful conditions since they would cause him a psychotic, depressive crisis and exacerbate his condition. It was noted that the Veteran wanted to continue to work, but that his illness would not allow him to do so, that he was not mentally competent to carry out any work, and that his ability to maintain a good personal appearance was severely limited. It was further reported that the Veteran was unable to maintain a stable emotional manner or behave appropriately in social situations, and did not have the capacity to manage his funds. A February 2003 SSA form reflects that the Veteran was considered disabled as of February 2000 with a primary diagnosis of affective disorder, and no secondary diagnosis established. A toe problem was not noted as the basis for the SSA finding. A March 2004 report from Dr. S., submitted in connection with the Veteran's November 2003 claim for VA benefits, reflects that the Veteran was a person who got anxious and nervous and was not capable of concentrating well, and had tried less demanding jobs but tended to get confused easily. He was confused, anxious and depressed, and asked to have several questions repeated. Dr. S. diagnosed severe major depression, and stated that the Veteran was showing psychiatric symptoms from years ago but that they had been accelerating constantly with his physical illness such as his "phalanx left fifth toe claimed as left two small toes" and stress, which had disabled the Veteran totally to perform any kind of labor. Dr. S. stated that the Veteran felt like a worthless human being due to the fact that he was unable to perform his labor as before due to his physical condition, did not like to socialize with others, did not sleep well, and got irritated easily. In his September 2005 substantive appeal, the Veteran asserted that he could not stay in the military as long as he wanted to due to his toe disability, and that he could not have a normal livelihood as a civilian because his foot problem kept getting worse and limited him from sustaining a normal job, which resulted in a mental disorder. The Veteran was afforded another VA examination in January 2012. The examiner noted that the Veteran had formally been diagnosed with major depressive disorder, but after examining the Veteran determined that he had no current psychiatric diagnosis. The Veteran reported that he was not currently receiving psychiatric treatment, but that he had received mental health treatment with a private psychiatrist from 2000 to 2008, had been diagnosed with major depression, and had been on Paxil and two other medications but was currently on no medications. The Veteran reported being occasionally depressed, every three weeks to once per month, and being anxious about once per week. It was noted by the examiner that the Veteran did not have a psychiatric diagnosis at present, but stated that he had a depression diagnosis in the past that began from foot pain from a broken toe in the military, that, due to the pain, he had to resign from the National Guard, and that he felt that this prompted his depression. Considering the pertinent evidence in light of the governing legal authority, the Board finds that the Veteran's service connection claim must be denied. The weight of the competent, credible, and probative evidence shows that a psychiatric disability was not caused or aggravated by the Veteran's service-connected residuals of a left fifth toe fracture. The medical evidence in this case is conflicting as to whether the Veteran has a current psychiatric disability at this time, and whether any such disability is related to the Veteran's left little toe fracture residuals. The private medical opinions of record, and in particular the March 2004 report from Dr. S., suggest that the Veteran has had major depression, and that such depression was aggravated by his left toe injury residuals. The February 2004 VA examiner opined that depressive disorder was not due to or aggravated by the Veteran's service-connected condition, and the January 2012 VA examiner concluded that the Veteran currently had no psychiatric diagnosis. The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). When reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). In assessing medical opinions, the failure of the physician to provide a basis for his 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 file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). The Board finds that the private opinions of Dr. T. and Dr. S. are of very little probative value regarding the question of whether the Veteran's service-connected residuals of a left fifth toe fracture caused or aggravated a psychiatric disability. The October 2000 report of Dr. T. suggests that the Veteran suffered such symptoms as wanting to die, hearing voices calling him, seeing shadows, and disorientation to time and place, that his diagnosis was major depression with psychotic features, and that such depression was the result of being fired in February 2000 for not functioning well in his job. There is no suggestion in this report that the Veteran's left little toe fracture residuals caused or aggravated any psychiatric disorder. The February 2003 report of Dr. S. also indicates severe symptomatology such as losing all interest in social and physical activities, not being mentally competent to carry out any work, being severely limited in ability to maintain a good personal appearance, being unable to behave appropriately in social situations, and not having the capacity to manage his funds. While the February 2003 report indicates that the Veteran had "psychiatric symptoms for several years that [had] gradually developed and [had] become concomitantly exacerbated with his physical illnesses and stress," the nature of such "physical illness" and how this included his little toe fracture residuals is not explained in the report. Moreover, the noted aggravating factors of "physical illnesses and stress" are very general and not explained in any detail, as are most of the assertions contained in this report, limiting the probative value on the critical issue in this case. The March 2004 report of Dr. S., submitted in connection with the Veteran's claim for VA service connection benefits rather than for SSA disability benefits, is the first examination report that mentions the Veteran's left little toe. The report suggests that the Veteran was showing psychiatric symptoms from years ago but that they had been "accelerating constantly with his physical illness such as his phalanx left fifth toe claimed as left two small toes and stress, which ha[d] disabled the [Veteran] totally in order to perform any kind of labor," and that the Veteran felt "like a worthless human being [due] to the fact that he [was] unable to perform his labors as before due to his physical condition." The Board notes with great interest that this description of the Veteran's aggravating disability is stated almost exactly as it is listed on the Veteran's rating code sheet and rating decisions sent to the Veteran from the RO, and there is no substantive explanation of how such toe disability aggravated a psychiatric disability except that it prevented him from working. However, the assertion that the Veteran's left fifth toe fracture residuals prevented him from working is contradicted by the findings of both Dr. T. and Dr. S. in their private opinions, which suggest that the Veteran originally stopped working due to not functioning well in his job, that his job loss led to his psychiatric problems, and that such psychiatric problems, and not any physical problem, prevented the Veteran from being able to work. In February 2000, Dr. T. stated that in February 2000 the Veteran was fired from his job for apparently not functioning well in his job, and that since that time he had become very depressed, and the February 2003 report of Dr. S. states that the Veteran wanted to continue to work but could not due to his psychiatric condition, that he was not mentally competent to carry out any work, and that his depression kept him from engaging in physical activities. Even in the March 2004 report, Dr. S. noted that the Veteran got anxious and nervous and was not capable of concentrating well and had tried less demanding jobs but tended to get confused easily. Also, the private reports of Dr. S. and Dr. T., including their diagnoses and opinions, appear to be significantly based on the reports of the Veteran himself. The Board finds that this fact further diminishes the probative value of the private examination reports, as the Board finds that the Veteran's statements regarding his psychiatric disability and any relationship of such disability to his service-connected little toe injury residuals are not accurate. For example, in his September 2005 substantive appeal, the Veteran asserted that he could not have a normal livelihood as a civilian because of his foot problem kept getting worse and limited him from sustaining a normal job, which resulted in a mental disorder. However, again, this statement is contradicted by the October 2000 report of Dr. T. and reports of Dr. S., which indicate, based on the Veteran's own statements, that the Veteran originally stopped working due to not functioning well in his job (with no reference to a little toe problem causing this loss of job), that his job loss led to his psychiatric problems, and that such psychiatric problems, and not any physical problem, prevented the Veteran from being able to work. The Veteran's assertion in April 2005 is also contradicted by his statements to the February 2004 VA examiner that his last job had been with a private company for eight years until the past year when he had stopped working due to his depressive disorder, precipitated by a stressful working environment, for which he was receiving SSA disability benefits. Further, the basis for a finding that a little toe disability could cause such substantial damage in the Veteran, notwithstanding the fact that treatment records make little reference to this "disability" is never clearly explained. The Board recognizes that while the February 2004 VA examiner reviewed the claims file, he did not have the opportunity to consider the private opinions of Dr. T. and Dr. S., which had not been associated with the claims file at the time of the examination, including the March 2004 opinion of Dr. S. which was dated in the month following the VA examination. However, the Board nonetheless finds this opinion to be more probative than the private opinions. As discussed above, the Board finds such private opinions, and particularly the March 2004 opinion of Dr. S., which is the only that discusses the Veteran's service-connected little toe fracture residuals, to be of very little probative value, which diminishes the relevance of the fact that they were not reviewed by the February 2004 VA examiner prior to providing an opinion. Also, the February 2004 VA examiner, prior to expressing his opinion, while stating that there was no corroborating medical evidence in the record of a past history of psychiatric treatment, acknowledged that the Veteran reported that he had been in psychiatric treatment with a private psychiatrist for about five years prior and had been treated with Xanax, Paxil, and BuSpar. Based on the above, the Board finds that the probative value of the February 2004 VA examiner's opinion that depressive disorder was not due to or aggravated by the Veteran's service-connected condition, and the January 2012 VA examiner's opinion that the Veteran currently had no psychiatric diagnosis, outweighs the probative value of the private opinions of Dr. T. and Dr. S., and that a preponderance of the competent, credible, and probative evidence is against the Veteran's claim for service connection. Accordingly, the Board finds that the claim for service connection for an acquired psychiatric disability, including as secondary to service-connected residuals of a left fifth toe fracture, must be denied. 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 claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 53-56. Duties to Notify and Assist Under applicable criteria, VA has certain notice and assistance obligations to claimants. See 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Notice must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits and must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). With respect to service connection claims, a section 5103(a) notice should also advise a claimant of the criteria for establishing a disability rating and effective date of award. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 486 (2006). In the present case, required notice was provided by letters dated in December 2003, August 2005, and January 2012, which informed the Veteran of all the elements required by the Pelegrini II Court as stated above. While the January 2012 notice letter, which advised the Veteran of the criteria for establishing service connection on a secondary basis and a disability rating and effective date, was provided subsequent to the initial RO determination in March 2004, after issuance of the letter and opportunity for the Veteran to respond, a February 2011 supplemental statement of the case (SSOC) reflects readjudication of the claim. Hence, the Veteran is not shown to be prejudiced by the timing of this notice. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as in an SSOC, is sufficient to cure a timing defect). As to VA's duty to assist, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The Veteran's service treatment records, VA medical treatment records, identified private medical records, private medical opinions, and SSA records have been obtained. Also, the Veteran was provided VA examinations and opinions in February 2004 and January 2012. These examinations were adequate because, along with the other evidence of record, they provided sufficient information to decide the appeal. The examination reports were based on examination of the Veteran and a review of the relevant medical records, and in February 2004 a review of the entire claims file, by examiners with appropriate expertise. The opinions provided they were thorough and adequate, and provided a sound basis for a decision on the Veteran's claim. 38 C.F.R. § 3.159(c)(4) (2012); Barr v Nicholson, 21 Vet. App. 303 (2007). In this regard, the Board must emphasis that it remanded this case twice in order to assist the Veteran with his claim. The Board notes that the January 2012 VA examiner did not acknowledge a review of the entire claims file or the March 2012 opinion of Dr. S. indicating that the Veteran's psychiatric disorder had been partly accelerated by his service-connected residuals of a left fifth toe fracture. However, the examiner did review pertinent medical records and acknowledged that the Veteran had formally been diagnosed with major depressive disorder, received mental health treatment with a private psychiatrist from 2000 to 2008, and had been on Paxil and two other medications, but after examining the Veteran determined that the Veteran had no current psychiatric diagnosis, noting that the Veteran reported that he was not currently receiving psychiatric treatment or currently on medication. Furthermore, as the VA examiner assessed that there was no current psychiatric diagnosis, no nexus opinion was considered or provided by the examiner, and thus the fact that he did not review Dr. S.'s nexus opinion is moot. Moreover, the RO has substantially complied with the Board's January 2010 and December 2011 remand instructions. The Veteran was provided the requisite notice regarding his claim, as discussed above, and available VA treatment and SSA records have been obtained and associated with the claims file. Also, as discussed above, the Veteran was provided an adequate VA examination in January 2012 that, together with the February 2004 VA examination report and other evidence of record, provided adequate information on which to base a decision with regard to the Veteran's claim. Under these circumstances, the Board finds that there has been substantial compliance with the December 2009 and October 2011 remand instructions, and an additional remand to comply with the Board's directives is not required. See D'Aries v. Peake, 22 Vet. App. 97, 104-106 (2008); Stegall v. West, 11 Vet. App. 268 (1998). Therefore, VA has satisfied its duties to notify and assist, and additional development efforts would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Because VA's duties to notify and assist have been met, there is no prejudice to the Veteran in adjudicating this appeal. ORDER Service connection for an acquired psychiatric disability, including as secondary to service-connected residuals of a left fifth toe fracture, is denied. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs