Citation Nr: 18140730 Decision Date: 10/05/18 Archive Date: 10/05/18 DOCKET NO. 16-03 370 DATE: October 5, 2018 ORDER The petition to reopen the claim for depression associated with lumbar strain based on the submission of new and material evidence is reopened, and to that limited extent, the claim is granted. Entitlement to an increased disability rating of 40 percent for gastritis claimed as stomach condition and reflux associated with lumbar strain is granted from May 21, 2014. Entitlement to a disability rating in excess of 10 percent for gastritis claimed as stomach condition and reflux associated with lumbar strain is denied for the period from February 20, 2013 to May 21, 2014. Entitlement to an initial disability rating of 10 percent for gastritis, but no greater, is granted for the period prior to February 20, 2014. Entitlement to an earlier effective date prior to April 15, 2011 for the claim of increased rating in excess of 40 percent for lumbar strain previously shown as chronic low back strain is denied. REMANDED Entitlement to an effective date for the grant of service connection for gastritis, claimed as stomach condition, is remanded. En entitlement to a rating in excess of 40 percent for lumbar spine disability is remanded. Entitlement to service connection for an acquired psychiatric disorder claimed as depression associated with lumbar strain is remanded. Entitlement to a grant of total disability based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. In a June 2012 decision, the Board denied entitlement to service connection for acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability. 2. The Veteran’s medical records show a diagnosis of gastritis in 2007; that the condition manifested as “mild gastritis” in an August 2012 medical report; moderate symptoms of gastritis are not show prior to May 21, 2014. 3. Symptoms consistent with intercurrent episodes of abdominal pain at least once a month partially or completely relieved by ulcer therapy, mild and transient episodes of vomiting or melena are show since May 21, 2014; however, manifestations of a severe disability, same as pronounced with less pronounced and less continuous symptoms with definite impairment of health are not shown 4. A November 2005 rating decision denied the Veteran a rating in excess of 20 percent for lumbar spine disability and the Veteran did not appeal that decision. The Veteran filed a new claim for an increased disability rating for his lumbar spine disability on April 15, 2011. CONCLUSIONS OF LAW 1. The June 2012 Board decision, which denied the claim for entitlement to service connection for acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability, is final. 38 U.S.C. § 7104(b), 7105; 38 C.F.R. § 3.105, 20.302. 2. The evidence received subsequent to the final June 2012 Board decision for the claims for acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability is new and material, and the issue of service connection for that condition is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to a disability rating of 40 percent, but no higher, for gastritis have been satisfied from May 21, 2014. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.21, 4.114, DC 7306. 4. The criteria for entitlement to a disability rating in excess of 10 percent for gastritis for the period from February 20, 2013, to May 21, 2014, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.21, 4.114, DC 7306. 5. The criteria for entitlement to an initial disability rating of 10 percent, but no greater, for gastritis for the period prior to February 20, 2013, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.21, 4.114, DC 7306. 6. The criteria for entitlement to an earlier effective date prior to April 15, 2011 for the rating of 40 percent for lumbar strain previously shown as chronic low back strain have not been met. 38 U.S.C. §§ 5110; 38 C.F.R. §§ 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1968 to February 1970.   Petition to Reopen based on New and Material Evidence 1. Entitlement to service connection for acquired psychiatric disorder claimed as depression associated with lumbar strain is reopened. The Veteran seeks to reopen a denied claim for entitlement to service connection for acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability. After a review of the evidence, the Board finds that reopening the claim is warranted and will remand the claim for further development to the agency of original jurisdiction (AOJ). In a June 2012 decision, the Board denied entitlement to service connection for acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability. The Veteran did not appeal to the Court of Appeals for Veterans Claims. The June 2012 Board decision is final. 38 U.S.C. § 7104(b). The prior rating decisions by the AOJ were subsumed by the Board decision. The Veteran submitted a request to reopen the claim for entitlement to service connection for acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability in February 2014. The RO declined to reopen the claim in a June 2014 rating decision due to lack of new and material evidence. The Veteran timely appealed that decision and in a January 2016 statement of the case and December 2016 supplemental statement of the case, the RO denied reopening the claim for entitlement to service connection for acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability because the evidence presented was not new and material. The Veteran perfected a timely appeal of the claim to the Board by filing a Form VA 9 in February 2016. In reviewing the June 2014 decision and statement of the case and supplemental statement of the case, the Board has determined that a new and material evidence analysis is proper for the psychiatric disorder issue on appeal, as it was clearly adjudicated by the June 2012 Board decision. See Velez v. Shinseki, 23 Vet. App. 199, 204 (2009) (when determining whether a new and material evidence analysis is required, the focus of VA’s analysis must be on whether the evidence presented truly amounts to a new claim “based upon distinctly diagnosed diseases or injuries,” or whether it is evidence tending to substantiate an element of the previously adjudicated matter). Regardless of the RO’s actions, the Board has jurisdictional responsibility to determine whether a claim previously denied by the RO is properly reopened. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001) (citing 38 U.S.C. §§ 5108, 7105(c)). See also Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996) and VAOPGCPREC 05-92 (March 4, 1992). Accordingly, the Board must initially determine whether there is new and material evidence to reopen the depression issue before proceeding to adjudicate the underlying merits of the claim. If the Board finds that no new and material evidence has been provided, that is where the analysis must end. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The question of whether new and material evidence has been received sufficient to reopen the matter is a threshold question in any case involving a previously denied claim. Wakeford v. Brown, 8 Vet. App. 237, 239-40 (1995). The United States Court of Appeals for Veterans Claims (Court) has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold, and viewed the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” Shade v. Shinseki, 24 Vet. App. 110 (2010). See also Evans v. Brown, 9 Vet. App. 273, 284 (1996) (the newly presented evidence need not be probative of all the elements required to award the claim, but only need to be probative in regard to each element that was a specified basis for the last disallowance). That is, a finally decided claim must be reopened where the claimant submits new and material evidence relative to a fact that was unestablished at the time of the prior final decision on the claim. Shade, 24 Vet. App. at 119. For the purpose of reopening a claim, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). Here, the Board finds that new and material evidence within the meaning of 38 C.F.R. § 3.156(a) has been received since the final June 2012 Board decision. Specifically, the Veteran’s claim was previously denied for lack of evidence showing that the Veteran’s depression was secondary to service-connected disabilities. The Veteran continues to contend that his depression is related to his service-connected disabilities. The Veteran has submitted a letter dated July 2014 from Dr. A.M.T., that opines that the Veteran’s depression is aggravated by his service-connected disabilities. This evidence is neither cumulative nor redundant as it is new, meaning not previously considered, and relates to the reason for which the claim was originally denied in 2012. The Board finds that the additional evidence of record constitutes new and material evidence to reopen the claim for entitlement to service connection for acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability. In short, this evidence, if presumed credible, relates to an unestablished fact necessary to substantiate the depression claim, i.e. whether the condition relates to service-connected disabilities, and raises a reasonable possibility of substantiating the claim. Accordingly, the Board finds that new and material evidence has been presented to reopen the Veteran’s previously denied claim for entitlement to service connection for an acquired psychiatric disorder, claimed as depression secondary to service-connected lumbar disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. If there is a question as to which evaluation to apply to the Veteran’s disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings are sufficiently characteristic to identify the disease and the resulting disability and coordination of rating with impairment of function. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of his disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). “The relevant temporal focus for adjudicating an increased-rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim.” Hart v. Mansfield, 21 Vet. App. 505, 509 (2007). The relevant time period for consideration in a claim for an increased initial disability rating is the period beginning on the date that the claim for service connection was filed. Moore v. Nicholson, 21 Vet. App. 211, 216-17 (2007). The Board must also assess the competence and credibility of lay statements and testimony. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). In increased rating claims, a Veteran’s lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010), rev’d on other grounds by Vazquez-Flores v. Shinseki, 580 F.3d 1270, 1277 (Fed. Cir. 2009). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. However, pyramiding, or evaluating the same manifestation of a disability under different diagnostic codes, is to be avoided. See 38 C.F.R. § 4.14. Thus, separate ratings under different diagnostic codes are only permitted if, for example, those separate ratings are assigned based on manifestations of the Veteran’s disability that are separate and apart from manifestations for which the Veteran has already been rated. Esteban v. Brown, 6 Vet. App. 259, 261 (1994). In determining the propriety of the initial rating assigned after a grant of service connection, the evidence since the effective date of the grant of service connection must be evaluated and staged ratings must be considered. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999). Staged ratings are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the course of the appeal. Id. 2. Entitlement to a compensable rating prior to February 20, 2013, and in excess of 10 percent from that date, for gastritis claimed as stomach condition and reflux associated with lumbar strain The Veteran contends that his service-connected gastritis is more severe than contemplated by the noncompensable rating prior to February 20, 2013, and more than severe than the 10 percent rating from that date. After a thorough review of the evidence, the Board finds that the Veteran’s gastritis is productive of symptoms most closely resembling the 10 percent rating for the entire period on appeal prior to February 20, 2013, and a 40 percent rating from May 21, 2014. The Veteran is currently rated at 10 percent for gastritis, claimed as stomach condition and reflux associated with lumbar strain under diagnostic code 7306, identified as gastritis, hypertrophic. The record shows that he had been diagnosed with gastritis at least as early as 2007. The August 2, 2012 medical report noted the Veteran’s gastritis was “mild.” The Veteran was afforded a VA examination in February 2013. The examiner reviewed the Veteran’s medical history, but did not examine the Veteran in person. The examiner concluded that the Veteran had no diagnosable stomach condition. As documented in other evidence, there had been medical findings of esophageal, duodenal, and stomach conditions prior to the Veteran’s claim, as such the February 2013 VA examination is inadequate as it does not refer to any of this evidence. The Veteran was afforded another VA examination on May 21, 2014. The examiner confirmed a diagnosis of gastritis dating back to 2007 noted in the relevant report as “erosive GERD with esophagitis, acute gastritis.” The examiner noted that the Veteran was taking prescription medication to control the gastritis symptoms. The symptoms noted regarding the Veteran’s stomach condition include recurring episodes of severe symptoms at least 4 times per year, that last less than one day, and include abdominal pain that occurred at least monthly and was only partially relived by standard ulcer therapy. The Board finds that since May 21, 2014, a higher rating of 40 percent may be assigned under DC 7306, the code for ulcer, marginal (gastrojejunal), the currently assigned diagnostic code. Under this code, a 40 percent rating is warranted for a moderately severe condition, manifested by intercurrent episodes of abdominal pain at least once a month partially or completely relieved by ulcer therapy, mild and transient episodes of vomiting or melena. As the May 2014 VA examination report documented intercurrent episodes of abdominal pain at least monthly, partially relieved by standard ulcer therapy, the Board finds that a 40 percent rating may be assigned from the date of the May 2014 examination. Although the Veteran’s symptoms did not include reported mild and transient episodes of vomiting or melena, the symptoms documented more closely resemble those of the 40 percent rating as opposed to the lower 20 percent rating. 38 C.F.R. § 4.7. A 60 percent rating requires manifestations of a severe disability, same as pronounced with less pronounced and less continuous symptoms with definite impairment of health. As the May 2014 VA examination report does not document a definite impairment of health, weight loss, or total incapacitation, higher ratings under DC 7306 since May 21, 2014 are not warranted. The preponderance of the evidence is against a rating in excess of 10 percent under DC 7306 prior to May 21, 2014. Under DC 7306, a 10 percent rating is assigned with mild disability, manifested by brief episodes of recurring. A rating of 20 percent under DC 7306 requires moderate symptoms, and the Board does not find that the medical evidence of record reflects this. The Board notes that the Veteran manifested symptoms of gastritis and was diagnosed with gastritis prior to the February 2013, accordingly, the minimum disability rating of 10 percent at least must apply under 38 C.F.R. § 4.31 from for the period prior to February 20, 2013, as opposed to the noncompensable rating currently in effect. The available August 2012 report notes a “mild gastritis.” However, as the record prior to the May 21, 2014 examination does not show that the Veteran’s gastritis was manifested by moderate gastritis, a disability rating in excess of 10 percent prior to May 21, 2014 is denied. The Board considered all other diagnostic codes pertaining to the digestive system but none provide the basis for any higher rating during any portion of the appeal period. For a higher rating under DC 7307, a 60 percent rating requires chronic disability of gastritis with severe hemorrhages, or large, ulcerated areas, and the medical evidence of record does not support that the Veteran’s gastritis manifests as such. The Board has additionally considered the Veteran’s various written statements regarding his stomach symptoms, for example “severe stomach pain and reflux” (September 2014 NOD), but finds that his symptomatology since has been considered by the newly-assigned 40 percent rating effective from May 21, 2014. He does not allege symptoms indicative of an even higher rating, nor is the evidence indicative of such a rating. The Board does not find that remand is necessary to adjudicate the claim. For all the foregoing reasons, the Board finds that a 40 percent, but no higher, rating is warranted for the Veteran’s gastritis since May 21, 2014, but finds no basis for the assignment of an even higher rating since that date, or a rating in excess of 10 percent prior to that date. In reaching this decision the Board considered the doctrine of reasonable doubt, however, the doctrine is not for application. Effective Date Generally, the effective date of an evaluation and award of compensation for an increased rating claim is the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(o)(1). A claim is “a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit.” 38 C.F.R. § 3.1(p). An informal claim is “[a]ny communication or action indicating intent to apply for one or more benefits.” 38 C.F.R. § 3.155(a). VA must look to all communications from a claimant that may be interpreted as applications or claims - formal and informal - for benefits and is required to identify and act on informal claims for benefits. Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). In some cases, a report of examination or hospitalization may be accepted as an informal claim for benefits. 38 C.F.R. § 3.157(b). The date of outpatient or hospital examination or date of admission to a VA hospital will be accepted as the date of receipt of a claim when such reports relate to examination or treatment of a disability for which service-connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission. 38 C.F.R. § 3.157(b). A report of examination implies that the medical record describes the results of a specific, particular examination and reflects a worsening of the condition. Massie v. Shinseki, 25 Vet. App. 123, 133-34 (2011) (noting that a letter from a VA physician generated for a pending Social Security claim was not a report of examination). 3. Entitlement to an earlier effective date prior to April 15, 2011 for the rating of 40 percent for lumbar strain previously shown as chronic low back strain The Veteran contends that the most recent assignment of 40 percent for lumbar spine disability with an effective date of April 15, 2011 should be earlier, as he references his claim for increased rating dated in 2003 in his February 2014 notice of disagreement. After a review of the evidence, the Board finds that April 15, 2011 is the appropriate effective date for the most recent grant of increased rating for lumbar spine disability. The Veteran had a previous claim for increased rating for his lumbar spine disability that was continued at 20 percent in a November 2005 rating decision. The evidence does not show that the Veteran appealed that decision or made another claim for an increased rating for his lumbar spine disability until April 15, 2011. The claim was considered in a February 2013 rating decision wherein the disability rating for the Veteran’s lumbar spine was increased to 40 percent from April 15, 2011, the date that the claim was received. Accordingly, the Board finds that the proper effective date for the Veteran’s current claim for increased rating for lumbar spine disability is April 15, 2011, and the claim for an earlier effective date is denied. REASONS FOR REMAND 1. Entitlement to an earlier effective date prior to August 2, 2012 for the issue of service connected gastritis, claimed as stomach condition The Veteran was initially granted service connection for gastritis with an effective date of February 20, 2013 in a June 2014 rating decision. The Veteran submitted a notice of disagreement dated September 2014 in which he states the medical evidence showed he had been having stomach problems since 2001 and the RO accepted this as a disagreement with the assigned effective date. The RO subsequently issued a rating decision in January 2016 that awarded an earlier effective date of August 2, 2012, for the grant of service connection for gastritis. The rating decision incorrectly notes that this action is a full grant for the issue of earlier effective date for the gastritis. The Board disagrees. The Veteran has consistently expressed his desire to establish an effective date from 2001. To date, a statement of the case has not been issued with respect to the claim for an earlier effective date for the grant of service connection for gastritis. As such, the Board must remand that claim for the issuance of a statement of the case. See Manlincon v. West, 12 Vet. App. 238 (1999). 2. Entitlement to a rating in excess of 40 percent for lumbar spine disability is remanded. The Veteran continues to maintain that his lower back disability is worsening. The most recent examination is from May 2014. The Veteran is rated at 40 percent for his lumbar spine disability and thus, the next rating of 50 percent requires the presence of ankylosis in the thoracolumbar spine. The May 2014 examination showed a forward flexion of 10 degrees. The Board requires a new examination to determine if the Veteran’s lumbar spine disability has devolved into ankylosis in the past 4 years. The Board notes that a VA examination was requested by the RO in September 2017, but it is unclear from the record if the examination was completed, and if so, the results have not been loaded in to the Veteran’s claims file. The Board also notes that the Veteran disagrees with the assignment of the diagnostic codes for his lumbar spine disability as one disability with related separately rated lower extremity radiculopathy as opposed to two separate disabilities of lumbar spine and intervertebral disc syndrome. The Board notes that a VA examination is necessary to determine the extent of severity of these conditions as the more severe condition is used as the basis for disability rating to avoid pyramiding under 38 C.F.R. § 4.14. 3. Entitlement to service connection for an acquired psychiatric disorder claimed as depression is remanded. The Veteran submitted a treatment report from a private provider dated July 2014 indicating that the Veteran’s service connected disabilities aggravate his diagnosed depressive disorder. The Veteran should be afforded a VA psychiatric examination to determine if the Veteran’s service-connected disabilities aggravate his depression. 4. Entitlement to a grant of total disability based on individual unemployability (TDIU) is remanded. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of TDIU, lumbar spine disability, and depression. The Board notes that the July 2014 psychiatric report from Dr. A.M.T. opines that the Veteran is unable to work. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. The matters are REMANDED for the following action: 1. Send the Veteran and his representative a statement of the case that addresses the issues of an earlier effective date for the grant of service connection for gastritis. Only if the Veteran perfects an appeal by submitting a timely VA Form 9 should the issues be returned to the Board for further appellate consideration. 2. Determine the status of the September 2017 request for a VA spinal examination. If the examination was completed, upload the results to the Veteran’s claims file. If the lumbar spine examination scheduled in September 2017 was completed, a new VA examination is not necessary. 3. If the September 2017 VA lumbar spine examination was not completed, then schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected lumbar spine disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the lumbar spine disability alone and discuss the effect of the Veteran’s lumbar spine disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Schedule the Veteran for a VA psychiatric examination with a qualified examiner. The examiner should consider the following: (a.) Does the Veteran have a diagnosis or diagnoses of any psychiatric disorder? (b.) Is the Veteran’s diagnosed psychiatric disorder at least as likely as not (50% probability) incurred in or a result of active service? (c.) Is the Veteran’s diagnosed psychiatric disorder at least as likely as not (50% probability) caused or aggravated by the Veteran’s service-connected   disabilities? The examiner should reference the July 2014 psychiatrist report from Dr. A.M.T. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Miller, Erin (BVA)