Citation Nr: 1329472 Decision Date: 09/13/13 Archive Date: 09/20/13 DOCKET NO. 06-12 442 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for a bilateral foot disorder, to include as secondary to service-connected disabilities. 2. Entitlement to service connection for an acquired psychiatric disorder, other than paranoid schizophrenia, to include as secondary to service-connected disabilities. REPRESENTATION Appellant represented by: Georgia Department of Veterans Services ATTORNEY FOR THE BOARD John Francis, Counsel INTRODUCTION The Veteran served on active duty from April 1979 to September 1979. This appeal comes before the Board of Veterans' Appeals (Board) from a December 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In an April 2006 substantive appeal, the Veteran requested a hearing before a member of the Board. The Veteran requested a postponement of a travel board hearing in February 2009. The Veteran failed to report to a rescheduled hearing in May 2009 with no good cause shown. Accordingly, his request for a hearing is deemed withdrawn. 38 C.F.R. § 20.704 (d) (2012). With respect to the Veteran's claim of entitlement to service connection for an acquired psychiatric disorder, the RO originally adjudicated the claim as entitlement to service connection for depression. However, the Board has recharacterized this issue as shown on the title page of this decision in light of the decision in Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). The RO separately denied service connection for paranoid schizophrenia in May 2012. As the Veteran has not appealed that rating decision, the Board has not included paranoid schizophrenia in the acquired psychiatric disorder that remains on appeal. In June 2009 and February 2013, the Board remanded the claims for further notice and development. The issues of entitlement to service connection for rhabdomyolysis of the back, knees, neck, wrist, and shoulders, and entitlement to an increased evaluation for rhabdomyolysis legs were also addressed in the July 2009 Board remand. In part, the Board directed that the RO issue a statement of the case for these issues. In February 2012, the RO issued statement of the case in compliance with the remand. As the Veteran did not file a timely substantive appeal, the issues are no longer before the Board. The Virtual VA paperless claims processing system contains additional evidence relevant to this appeal that has been considered. FINDINGS OF FACT 1. The Veteran's bilateral foot disorder, best diagnosed as pes planus, mild degenerative joint changes, and a left bunion, manifested greater than one year after service and is not caused or aggravated by service or secondary to service-connected disabilities. 2. The Veteran's acquired psychiatric disorder other than paranoid schizophrenia, best diagnosed as depressive disorder, not otherwise specified, and various substance abuse dependence disorders, first manifested years after service and is not caused or aggravated by any aspect of service or secondary to service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection on a direct or secondary basis for a bilateral foot disorder are not met. 38 C.F.R. §§ 1101, 1110, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2012). 2. The criteria for service connection on a direct or secondary basis for an acquired psychiatric disorder other than paranoid schizophrenia are not met. 38 C.F.R. §§ 1101, 1110, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309. 3.310, 3.655 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA must notify the claimant of the following: (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The notice requirements apply to all five elements of a service connection claim. The five elements are: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Where complete notice is not timely accomplished, an error may be cured by issuance of a fully compliant notice, followed by readjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). In May 2004, the RO provided notice that did not meet the requirements. The notice explained the Veteran's and VA's respective responsibilities to obtain relevant evidence but did not mention the claim for service connection for a bilateral foot disorder, did not provide the criteria for service connection on a secondary basis, and did not explain the method for assigning a rating and effective date. After the initial decision on the claim and in compliance with the Board's July 2009 remand, the RO provided a notice that met the requirements followed by readjudication in supplemental statements of the case in February 2012 and June 2013 with opportunities for the Veteran to respond. Therefore, the initial notice and timing errors were not prejudicial, and the notice requirements have been satisfied. The Board also concludes VA's duty to assist has been satisfied. The Veteran's service treatment records and relevant VA and indentified private medical records have been associated with the claims file. The duty to assist also includes providing a medical examination or obtaining a medical opinion when it is necessary to make a decision on a claim. The Veteran underwent VA examinations in April 1980, August 1981, January 2002, September 2005, and November 2010. The results have been included in the claims file. Not all disabilities on appeal were examined on each occasion. Notably, the Veteran did not appear for the most recent scheduled psychiatric examination in November 2010. The examinations involved summary of the history from a review of the record and from reports by the Veteran, a thorough clinical examination in compliance with regulations and protocols, and in at least one of the examinations, an opinion on the etiology of the foot disability. The Board concludes that the examinations were performed by a qualified physician or psychologist with appropriate consideration of the history and clinical observations. The Board will address the facts, rationale for the opinion, and compliance with remand instructions below. Therefore, the Board finds that the examinations are adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). The Board finds that the VA has substantially complied with the duty to obtain the requisite medical information necessary to make a decision on the Veteran's claim. Additionally, the Board issued a remands in July 2009 and February 2013. Following a review of all examination report addenda, the Board concludes that there has been substantial compliance. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The RO requested any additional evidence from the Veteran, provided additional and complete notice, provided a statement of the case, obtained VA treatment records, and a VA examination as directed for scheduled examinations attended by the Veteran. Following the examination, the RO issued a supplemental statement of the case in February 2012 and June 2013 with an appropriate opportunity to respond. The Board finds that there has been substantial compliance with the mandates of its remand. See Stegall v. West, 11 Vet. App. 268 (1998) (finding that a remand by the Board confers on the Veteran the right to compliance with its remand orders). Therefore, the Board will proceed to review and decide the claim based on the evidence that is of record. The Veteran served as a U.S. Army soldier in basic training. He contends that he experiences a bilateral foot disorder and an acquired psychiatric disorder secondary to the service-connected rhabdomyolysis of the lower legs and bilateral ankle strains. 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 may also 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). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C.A. § 1112; 38 C.F.R. § 3.304. See also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. The requirement of a current disability is satisfied when the claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim and that a claimant may be granted service connection even though the disability resolves prior to the Secretary's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Additionally, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, to include psychoses, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The designated chronic diseases include arthritis and psychoses but not pes planus. The definition of psychoses for this purpose does include schizophrenia but not any of the other mental health diagnoses of record. See 38 C.F.R. § 3.384 (2012). Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. However, absent a diagnosis of a chronic disease as defined in 38 C.F.R. § 3.309(a), service connection may not be awarded based on continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In this case, the Veteran's mild degenerative changes of the feet are a chronic disease, but the acquired psychiatric diagnoses of record other than schizophrenia are not recognized as chronic diseases. Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Secondary service connection is permitted based on aggravation; compensation is payable for the degree of aggravation of a non-service-connected disability caused by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). The provisions of 38 C.F.R. § 3.310 were amended during the pendency of the Veteran's appeal, effective October 10, 2006; however, the new provisions state that service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). Although the stated intent of the change was merely to implement the requirements of Allen, supra, the Board finds that the new provisions amount to a substantive change to the manner in which 38 C.F.R. § 3.310 has been applied by VA in Allen-type cases since 1995. Consequently, the Board will apply the older version of 38 C.F.R. § 3.310, which is more favorable to the Veteran as it does not require the establishment of a baseline level of disability before an award of service connection may granted. See generally, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); VAOPGCPREC 7-2003. A lay claimant is competent to provide testimony concerning factual matters of which he or she has firsthand knowledge (i.e., reporting something seen, sensed or experienced). Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Under certain circumstances, lay statements may serve to support a claim for service connection by supporting the occurrence of lay- observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In Barr, the Court emphasized that when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board may weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. However, there are clearly limitations regarding the competence of a lay claimant to speak to certain matters, such as those involving medical diagnosis and etiology. See Jandreau, 492 F.3d at 1377 (Fed. Cir. 2007) (noting that a layperson is not competent to diagnose a form of cancer). As reflected in Fed.R.Evid. 701, lay witness testimony is permissible in the form of opinions or inferences when (a) rationally based on the perception of the witness and (b) helpful to a clear understanding of the witness' testimony or the determination of a fact in issue. Otherwise, in matters involving scientific, technical or other specialized knowledge, Fed.R.Evid 702 requires that an opinion be provided by a witness qualified as an expert by knowledge, skill, experience, training or education. If the evidence for and against a claim is in equipoise, the claim will be granted. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Bilateral Foot Disorder Service personnel and treatment records do not contain a report of an enlistment physical examination. Within days of the start of recruit training in April 1979, the Veteran was admitted to an Army hospital with pain and weakness in his back and lower extremities. He underwent 51 days of treatment including a spinal tap. The attending physician diagnosed spina bifida occulta and intermittent leg weakness without evidence of an organic disease. The Veteran was returned to duty at the end of May 1979 but immediately departed on unauthorized absence until he was apprehended the first week in August 1979 and taken to a different Army base. After further investigation and a second period of hospitalization, a medical board concluded that the spina bifida existed prior to service and that the lower leg weakness was best diagnosed as rhabdomyolysis, resolving. Rhabdomyolysis is a disintegration or dissolution of muscle. Dorland's Illustrated Medical Dictionary, 1626 (30th Ed. 2003). In an August 1979 discharge physical examination, the Veteran did not report and the examiner did not note any foot or ankle abnormalities. In April 1980, a VA physician noted the Veteran's treatment for rhabdomyolysis in service. The physician noted that the disorder is uncommon and occurs when striated muscle tissue degenerates under stress and exercise and myoglobin is released and excreted in the urine. The disorder is seen long distance runners and military recruits when first exposed to strenuous use of the lower extremities. The physician noted the Veteran's report of continued lower leg muscle weakness and aching after extended periods of time standing or walking any distance. On examination, the physician noted equal leg lengths and no atrophy or observable weakness in leg muscles. There were no sensory or motor changes in the lower extremities and no loss of agility. Neither the Veteran nor the physician noted any symptoms of the feet. In July 1980, the RO granted service connection and a 10 percent rating for rhabdomyolysis of the legs. In August 1981 another VA physician examined the Veteran's lower extremities, noting a normal posture and gait with no limp. Muscle size was equal at all levels. The Veteran was able to squat without difficulty. The physician noted that there were no physical findings and made no mention of any abnormality of the feet. In June 1996, the Veteran was hospitalized and treated for fractures of the left tibia and fibula. Treatment reports are silent for any injuries of the ankles or feet. In January 2002, a VA contract physician performed an examination to assess the severity of the rhabdomyolysis. The Veteran reported that he now experienced muscle weakness throughout his body but all joints moved freely. On examination, the physician noted a slow but normal gait. The physician observed bilateral pes planus and reduced range of motion of both ankles. X-rays of the feet showed no degenerative changes or indications of injury, but X-rays of the ankles showed evidence of remote trauma with some ossification on the right. The physician concluded that the ankle deficits were likely related to the rhabdomyolysis but did not make a similar observation regarding the feet. In May 2002, the RO granted service connection and 10 percent ratings for right and left ankle strain secondary to rhabdomyolysis. The RO received the Veteran's claim for service connection for a bilateral foot disorder in March 2004. In his claim and in subsequent statements in October 2004, May 2006, July 2006, the Veteran reported that his symptoms of leg muscle pain and weakness were spreading to other parts of his body including numbness and an inability to move his feet, limiting his standing and walking endurance. In September 2005, another VA contract physician noted a history of right ankle sprain and ankylosis of a tarsal joint since an injury in 2000. The only medical evidence of record to support this history is the 2002 X-rays of the ankles that suggest an old trauma. The Veteran reported that the injuries were sustained in parachute jump training. There is no earlier evidence to support a previous foot injury. The Veteran continued to report lower extremity pain and weakness with lack of endurance in standing and walking. On examination, the physician noted a normal gait and no indication of abnormal weight bearing on the feet. There was no impairment of muscle tone. There was limitation of motion and pain on motion of both ankles. Bilateral pes planus was present, but there was no tenderness, weakness, edema, atrophy, or disturbed circulation. X-rays of both feet were normal with no indications of degenerative changes. The physician noted that there was no change to a VA established diagnosis of "ankylosis of the subastragalar or tarsal joint" without explanation of the source or date of this previous VA diagnosis or any supporting clinical observations of fused joints in his examination. In November 2005, the Veteran sustained another fracture of his left femur in a motor vehicle accident. Treatment reports are silent for any foot injuries. In October 2010, a VA contract physician examined the Veteran's service-connected bilateral ankle disabilities. The Veteran continued to report weakness, stiffness, swelling, and lack of standing and walking endurance imposed by his ankle and leg disabilities. The physician did not examine the feet but noted that the Veteran ambulated with a normal gait. In November 2010, a VA physician performed a foot examination and noted the Veteran's reports of the same symptoms to include severely painful flare-ups and numbness such that the Veteran could not feel his feet on the ground. The Veteran reported that the symptoms began five years earlier and that his Army airborne experiences likely contributed to the foot symptoms. The physician noted that the Veteran had been receiving VA podiatry treatment for numbness and swelling of the feet and was diagnosed with diabetes mellitus with neuropathy and pes planus. The Veteran used a cane for walking short distances and a wheelchair for longer distances. On examination, the physician noted pes planus, dry skin, decreased pinprick sensation, and a callus on the left first toe but no edema, warmth, or tenderness, and no limitation of toe motion. X- rays showed pes planus, mild arthritis of the first metatarsophalageal joint, and a mild left first toe bunion formation. In the examination report and in a May 2013 addendum, the physician concluded that the bilateral pes planus and neuropathy were not caused or aggravated by service connected rhabdomyolysis or the bilateral ankle disabilities. The physician noted that pes planus was first diagnosed many years after service and the first symptoms reported by the Veteran were only five years earlier. The physician cited unidentified medical literature to explain that rhabdomyolysis is an acute, transient condition involving muscle injury with a breakdown of muscle fibers and does not cause or aggravate pes planus or neuropathy. Pes planus can be congenital or acquired and if developed later in life can be the result of a traumatic injury or spinal disorders such as spina bifida. There is no lay or medical evidence of a direct injury to the feet, and spina bifida is not service-connected. He further explained that ankle strains with a healed tibial fracture did not cause or aggravate pes planus, mild degenerative disease, or a bunion because the ankles are not ankylosed and do not put extra stress on the feet. In January 2012, the Veteran sought treatment for a foot callus and was examined by a VA podiatrist who noted painful thickened toenails but no other complaints. The podiatrist noted the 2010 X-ray reports and debrided the toenails and callus. The podiatrist did not note any effect of the leg muscle or ankle disabilities on the feet and did not prescribe inserts or other treatment for pes planus. The Board concludes that service connection for a bilateral foot disorder on a direct basis and secondary to service- connected rhabdomyolysis and bilateral ankle strains is not warranted. The Veteran is competent and credible to report his observable symptoms of lower leg, ankle, and foot pain, weakness, numbness and lack of standing and walking endurance because they were accepted by examiners and clinicians without challenge and in part were consistent with clinical observations and imaging studies. The Veteran is not competent to determine that his current foot symptoms were caused or aggravated by the spread of rhabdomyolysis or by ankle sprains as this determination requires medical training. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet.App. 428, 435 (2011), these issues fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Service connection on a direct basis is not warranted because the foot disorders, diagnosed as pes planus, mild degenerative changes, and a bunion on the left, were not reported by the Veteran or noted by examiners in service or for many years after service. The first observation and diagnosis of pes planus was in 2002, and the Veteran reported to a clinician in 2010 that his foot symptoms first manifested five years earlier. The Veteran associated the symptoms in part to Army parachute training. This is not credible as he served in recruit training for only a few days with his remaining service time under medical care, and the medical records show no treat or complaints for his feet. Further, the Veteran's symptoms of foot numbness also manifested many years after service, and the VA examiner in 2010 found that the neuropathy was secondary to the Veteran's non-service-connected diabetes mellitus. The Board further concludes that service connection secondary to rhabdomyolysis of the legs and bilateral ankle sprain is not warranted. Although the former disorder occurred in service, it is defined as an acute reaction to muscle strain and was described as resolving by military examiners. Nevertheless the Veteran reported continued muscle and leg pain, and there have been clinical observations of increased myoglobin in urine but not muscle atrophy. The Board places greatest probative weight on the review and opinion of the VA physician in 2010 with the addendum in 2013 who concluded that the Veteran's pes planus, mild degenerative changes, and left bunion were not caused or aggravated by rhabdomyolysis or bilateral ankle strains. The physician noted a review of the history, cited medical literature, and provided reasons for his conclusions. There are no contrary competent opinions of record. As the preponderance of the evidence is against this claim, the "benefit of the doubt" rule is not for application, and the Board must deny the claim. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Acquired Psychiatric Disorder At the conclusion of the Veteran's second hospitalization in August 1979, an attending physician noted that the Veteran had experienced a conversion reaction at the base reception center and diagnosed psychoneurotic reaction, but there was no record of any mental health treatment at any time in service. In an August 1979 discharge physical examination, the Veteran reported symptoms of depression, but the examiner did not note any psychiatric abnormalities. In April 1980, the Veteran was examined by a neuropsychiatrist who noted the Veteran's report of leg and back pain causing difficulty with endurance on his job as a radio technician. The psychiatrist noted that the Veteran was under "a little tension" but otherwise presented nothing unusual with regular employment and a normal personal life. The psychiatrist diagnosed adult situational reaction but no psychoneurosis. In May 1993, the Veteran was admitted to a VA hospital for treatment following a series of seizures. A neurologist evaluated the Veteran's reports of lower leg weakness as a symptom of a conversion disorder. There is no record of follow-up or repeat diagnosis. Starting in 2002, the Veteran occasionally sought VA treatment for substance abuse. The Veteran did not pursue or complete any extended treatment programs and clinicians noted at least two periods of incarceration that interrupted treatment. In December 2004, the RO denied service connection for depression because there was no evidence of a diagnosis of any chronic mental health disorder. In July 2009, the Board remanded the claim in part to provide the Veteran with a VA examination. In February 2010, the Veteran sought VA treatment shortly after release from incarceration and was referred for an initial mental health examination. A psychologist noted the Veteran's report of concern over multiple medical problems including infectious diseases, diabetes, and muscular degeneration and pain. He also reported auditory and visual hallucinations. The psychologist diagnosed a psychotic disorder, not otherwise specified, possible schizophrenia, and possible substance abuse psychosis. Follow-up examiners noted similar symptoms and diagnosed cocaine dependence in remission, psychotic disorder, and possible bipolar disorder. The Veteran did not continue regular mental health treatment after April 2010. Clinicians did not provide opinions or comments on the causes for the Veteran's psychiatric disorders. In September 2010, the RO received the Veteran's separate claim for service connection for paranoid schizophrenia. The Veteran did not appear for a VA examination scheduled in November 2010. In May 2012, the RO denied service connection for paranoid schizophrenia because there was no evidence of the onset of the disorder in service and because the Veteran had not been clearly diagnosed with paranoid schizophrenia. The Veteran did not express timely disagreement, and this decision is not on appeal. In February 2013, the Board noted that additional VA outpatient mental health treatment records had been added to the electronic file after the most recent adjudication in a February 2012 supplemental statement of the case and remanded the claim in part for the RO to consider these records. In a June 2013 supplemental statement of the case, the RO reviewed the records and continued to deny service connection for an acquired psychiatric disorder other than schizophrenia because there was no competent medical evidence of a diagnosis of any other chronic psychiatric disorder. The Board reviewed VA outpatient treatment records from September 2010 to August 2012. The records showed that the Veteran received periodic primary care treatment and was accepted into a comprehensive case management and housing assistance program starting in September 2010. Primary care clinicians noted occasional and inconsistent reports by the Veteran of feelings of depression with both positive and negative screening interviews. The Veteran inconsistently reported that he had been unemployed and homeless on some occasions and self-employed and living with family on other occasions. The Veteran often misrepresented his military service. In September 2011, a clinician noted his reports of service from 1971 to 1991 as a paratrooper. Clinicians noted his reports of abstention from substance abuse on some occasions but in October 2011 diagnosed cocaine and alcohol abuse and possible prescription drug abuse. The Veteran's participation in the comprehensive case management program was erratic and he was disenrolled in November 2011 and not reenrolled to the program managers for failing to appear at appeal hearings. Although some VA primary care clinicians and social workers occasionally listed depression as an on- going symptom, they noted that he was receiving separate mental health treatment. The Veteran has not identified any private treatment. VA outpatient mental health treatment included several encounters in October and November 2011. In October 2011, a VA psychiatrist noted a review of the VA medical records and a long history of various forms of substance abuse and a diagnosis of an infectious disease in 1998 and a recent and very serious episode of pneumonia. The Veteran reported that he was a paratrooper, was injured in a bad landing, and was medically discharged. The Veteran reported that he became a church minister after a family and financial crisis in 1997 but relapsed on substance abuse in 2007. The Veteran reported that he was self-employed as an electronics technician and minister and in one encounter reported that he was looking forward to getting back to his entrepreneurial activities for a government agency. Following an examination, the psychiatrist diagnosed a stable depressive disorder, not otherwise specified, cocaine dependence, and other substance dependence in remission. The psychiatrist listed relevant Axis IV issues as unemployment, financial concerns, homelessness, unstable housing, and a lack of transportation. In November 2011, a VA clinic psychologist noted that the Veteran had received little service at the clinic for two or three years. The Veteran reported that the first time his depression became profound was when he was diagnosed with an infectious disease five years earlier and had been diagnosed with schizophrenia and depression. The psychologist noted no delusions, hallucinations, or thought disturbances and diagnosed depressive disorder, cocaine dependence, and rule out psychotic disorder. The Board concludes that service connection for an acquired psychiatric disorder other than paranoid schizophrenia including depression on a direct and secondary basis is not warranted. Duty to assist in the development and adjudication of a claim is not a one-way street. Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996). If a veteran wishes help, he cannot passively wait for it in circumstances where he may or should have evidence that is essential in obtaining the putative evidence. Wood v. Derwinski, 1 Vet. App. 190, 193, reconsideration denied, 1 Vet. App. 406 (1991) (per curiam). When a claimant fails without good cause to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655(a), (b). Except for a notation that the Veteran displayed a conversion reaction at a reception center after being apprehended from unauthorized absence, the remainder of the service treatment records including a discharge physical examination is silent for any chronic mental health symptoms or disorder. None were noted in a VA examination in 1980 shortly after discharge. Another conversion reaction may have occurred in 1996 but with no clear diagnosis, follow- up, or recurrence of the symptoms or a renewed diagnosis. The Veteran reported symptoms of depression since the late 1990s following family crises and the diagnosis of an infectious disease. He first sought treatment for depression in 2002 but did not continue any treatment program. The Veteran was diagnosed with a non-specific psychosis in 2010, but he did not pursue continued treatment and failed to appear at a VA examination that may have clearly identified his disorder and any possible relationship to service or to his service-connected disabilities. The symptoms of auditory and visual hallucinations were never again reported in subsequent VA outpatient treatment encounters. Although lay evidence of observable symptoms is generally competent, the erratic and inconsistent reporting of his military service and employment and housing status, and erratic participation in treatment programs and examinations suggests that even if competent, his symptom reporting warrants very low probative weight. The Veteran continues to be diagnosed with depression and substance abuse disorders, but treatment is erratic. VA clinics lost contact with the Veteran from January to August 2012. Even if the Veteran does experience depression, conversion disorder, or other mental health disorder other than paranoid schizophrenia, he has not cooperated with the treatment and examination opportunities available. The claim must be decided on the record. There is no competent medical evidence that a psychiatric disorder, if any, is caused or aggravated by service or secondary to service- connected disabilities. Instead, those clinicians who examined him at clinics associated his symptoms and mental health disorders with unemployment, financial difficulties, and other social factors but none concluded that the disorders were caused or aggravated by service or by his service-connected leg and ankle disabilities. The Veteran did not appear for an examination that could have provided additional opinions on his contention of a relationship to the service-connected disabilities. In view of the Veteran's inconsistent cooperation with treatment programs and failure to appear at examinations, the Board concludes based on the credible lay and medical evidence of record that service connection on a direct or secondary basis is not warranted. As the preponderance of the evidence is against this claim, the "benefit of the doubt" rule is not for application, and the Board must deny the claim. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for a bilateral foot disorder, to include as secondary to service-connected disabilities is denied. Service connection for an acquired psychiatric disorder, other than paranoid schizophrenia, to include as secondary to service-connected disabilities is denied. ____________________________________________ MARJORIE A. AUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs