Citation Nr: 18149665 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 16 32-092 DATE: November 13, 2018 ORDER Entitlement to service connection for obesity is denied. Entitlement to an effective date prior to August 28, 2014, for service connection for tinnitus is denied. Entitlement to service connection for obstructive sleep apnea is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for mesenteric ischemia is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for plantar fascitis is denied. Entitlement to service connection for kidney condition is denied. Entitlement to service connection for depression is denied. REMANDED Entitlement to service connection for headaches is remanded. FINDINGS OF FACT 1. Obesity is not a disability for VA compensation purposes. 2. A February 2015, rating decision granted service connection for tinnitus, and assigned a 10 percent rating from August 28, 2014. 3. There was no formal claim, informal claim, or written intent to file a claim for service connection for tinnitus prior to August 28, 2014. 4. The preponderance of the evidence is against finding that the Veteran has obstructive sleep apnea due to a disease or injury in service, or secondary to a service-connected disability. 5. The preponderance of the evidence is against finding that the Veteran has hypertension due to a disease or injury in service, or secondary to a service-connected disability. 6. The preponderance of the evidence is against finding that the Veteran has mesenteric ischemia due to a disease or injury in service. 7. The preponderance of the evidence is against finding that the Veteran has erectile dysfunction due to a disease or injury in service, or secondary to a service-connected disability. 8. The preponderance of the evidence is against finding that the Veteran has a foot condition, claimed as plantar fascitis and pes planus, due to a disease or injury in service. 9. The preponderance of the evidence is against finding that the Veteran has a kidney condition due to a disease or injury in service, or secondary to a service-connected disability. 10. The preponderance of the evidence is against finding that the Veteran has depression due to a disease or injury in service, or secondary to a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for obesity have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 2. The criteria for entitlement to an effective date prior to August 28, 2014, for service connection for tinnitus have not been met. 38 U.S.C. § 5110, 5107 (2012); 38 C.F.R. § 3.400 (2017). 3. The criteria for service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2017). 4. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2017). 5. The criteria for service connection for mesenteric ischemia have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 6. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2017). 7. The criteria for service connection for a foot condition, claimed as plantar fascitis and pes planus, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 8. The criteria for service connection for a kidney condition have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2017). 9. The criteria for service connection for depression have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from November 1979 to October 1980. This matter is before the Board of Veterans’ Appeals (Board) on appeal from March 2014 and February 2015, rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection 1. Entitlement to service connection for obesity The Veteran has submitted a claim for service connection for obesity. Service treatment records are negative for any reports of obesity. The existence of a current disability is the cornerstone of a claim for VA disability compensation. To be present as a current disability, the claimed condition must be present at the time of the claim for benefits, as opposed to sometime in the distant past. Obesity may be an intermittent step between a service-connected disability and a current disability that may be service connected on a secondary basis. VAOPGCPREC 1-2017 (Jan 6, 2017). The VA General Counsel opinion states that obesity is not a disease for service connection purposes. VAOPGCPREC 1-2017 at 1. Nonetheless, obesity may be an intermittent step between a service-connected disability and a current disability that may be service connected on a secondary basis. Id. at 2. The Veteran filed a claim for service connection for obesity. The VA General Counsel opinion states that obesity per se is not a disease or injury for purposes of 38 U.S.C. § 1131 and that therefore service connection cannot be granted on a direct basis. VAOPGCPREC 1-2017 at 1. As for obesity being an intermittent step between a service-connected disability and a current disability that may be service connected on a secondary basis, neither the Veteran nor his counsel has contended that his service-connected tinnitus caused his obesity, which caused another disability. Accordingly, the Board cannot construe the Veteran’s claim of entitlement to service connection for obesity as a claim of service connection for another disability for which service connection can be granted. 2. Entitlement to an effective date prior to August 28, 2014, for service connection for tinnitus Unless specifically provided, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a) (2012). The Veteran is seeking an effective date earlier than August 28, 2014, for the grant of service connection for tinnitus. The Veteran has expressed disagreement with the effective date assigned. Neither the Veteran, nor his attorney, provided any argument for why an effective date prior to August 28, 2014, should be granted. Under VA regulations, a claim includes 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); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Any communication or action, indicating intent to apply for one or more benefits under laws administered by the VA from a claimant may be considered an informal claim. The Veteran filed an original claim for service connection for tinnitus August 28, 2014. Service connection for tinnitus was granted in a February 2015, rating decision with a 10 percent rating assigned, effective August 28, 2014. As such, the effective date of an award of compensation, is August 28, 2014—the date of claim. 38 U.S.C. § 5110(a) (2012); 38 C.F.R. § 3. 400 (2017). Again, the effective date of compensation will not be earlier than the date of receipt of the claimant’s application. The date of receipt is the date on which the claim was received by VA, in this case, August 28, 2014. As the preponderance of the evidence is against an effective date earlier than August 28, 2014, for the grant of service connection for tinnitus, the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for obstructive sleep apnea (OSA) The Veteran contends that he suffers from obstructive sleep apnea as a result of his time in service. The question for the Board is whether the Veteran has a current disability that began during service, or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s OSA is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The service treatment records are negative for any complaints or reports of sleep apnea. VA treatment records indicate he suffers from obstructive sleep apnea, with the first mention of sleep apnea in 2009. A sleep study from June 2009 diagnosed the Veteran with obstructive sleep apnea, with a more recent study from April 2015 documenting severe OSA. In January 2017, Dr. S. completed a disability benefits questionnaire. The Veteran reported that there are several times per month he is unable to wear the CPAP mask through the night due to his mental health problems. Dr. S. concluded it is at least as likely as not that the Veteran’s depression aided in the development of and permanently aggravated his OSA. The Veteran had reported he frequently was unable to use his CPAP through the night due to his depressive disorder, as the CPAP makes him feel claustrophobic and he pulls it off his face while sleeping. Dr. S. stated the Veteran’s inability to use the CPAP nightly aggravates his sleep apnea, and his tiredness then adversely affects his depression. The Veteran was not provided with a VA examination and opinion to assess the current nature and etiology of his claimed OSA. However, VA need not conduct an examination with respect to the claim on appeal, as information and evidence of record contains sufficient competent medical evidence to decide the claims. See 38 C.F.R. § 3.159(c)(4). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. The standards of McLendon are not met in this case as there is no credible lay evidence or competent medical evidence that the Veteran’s OSA is related to service. Although the Veteran believes his OSA is proximately due to service or secondary to another disability, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). He is not competent to relate his OSA to service or any service-connected disability. There is no probative evidence of record indicating the Veteran had sleep difficulty during service. The Veteran has submitted no evidence or further indication as to why he believes his OSA is related to service. The opinion of Dr. Skagg has been considered, however, he links the Veteran’s OSA to depression, a condition for which he is not service connected (denied below). The service treatment records do not show treatment for OSA, and the first indication of OSA was over 25 years post service. In other words, the most probative evidence of record does not show that the Veteran’s OSA is directly due to service or secondary to a service-connected disability. 4. Entitlement to service connection for hypertension The Veteran contends that he suffers from hypertension as a result of his time in service. The question for the Board is whether the Veteran has a current disability that began during service, or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s hypertension is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The service treatment records are negative for any complaints or reports of hypertension. VAMC treatment records document a history of hypertension at an October 2002 visit. At a March 2014 visit, it was noted he no longer needed anti-hypertensive medication as he had low blood pressure. In May 2016, Dr. S. reviewed the file, and concluded it is as likely as not that the Veteran’s depressive disorder aided in the development of and permanently aggravates his high blood pressure. The Veteran was not provided with a VA examination and opinion to assess the current nature and etiology of his claimed hypertension. However, as is explained above, VA need not conduct an examination with respect to the claim on appeal, as information and evidence of record contains sufficient competent medical evidence to decide the claim. See 38 C.F.R. § 3.159(c)(4). Although the Veteran believes his hypertension is proximately due to service or secondary to a service-connected disability, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. He is not competent to relate his hypertension to service or as secondary to a service-connected disability. There is no evidence of record indicating the Veteran had hypertension during service or within his first post-service year. The Veteran has submitted no competent evidence or further indication as to why he believes his hypertension is related to service. The opinion of Dr. Skagg has been considered, however, he links the Veteran’s hypertension to depression, a condition for which he is not service connected (denied below). The service treatment records do not show treatment for hypertension, and the first indication of hypertension was over 20 years post service. In other words, the most probative evidence of record does not show that the Veteran’s hypertension is directly due to service or secondary to any service-connected disability. 5. Entitlement to service connection for mesenteric ischemia The Veteran contends that he suffers from mesenteric ischemia, due to stress he experienced during service. The question for the Board is whether the Veteran has a current disability that began during service, or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s mesenteric ischemia is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The service treatment records are negative for any complaints or reports of mesenteric ischemia. At an August 2013, gastroenterology visit, the Veteran was noted to have a history of mesenteric ischemia, status-post small bowel and partial colon resection in 2012. No clinician at that time opined that his mesenteric ischemia was due to an event, injury, or disease in service. Further, at the time of treatment, the Veteran did not report the onset of such symptoms during service or his belief that the stress of service caused this disability. In March 2014, he underwent a VA examination. In 2012, he had abdominal pain, and was found to have mesenteric ischemia and a small bowel resection was done. In January 2013, he began having abdominal pain and was taken to the hospital. He had adhesions wrapped around the small bowel. Another surgery was done to release the bowel and remove adhesions. He reported that he believes the mesenteric ischemia is related to his time in service, brought on by stress. The examiner concluded it is less likely than not that mesenteric ischemia was incurred in or caused by an in-service injury, event or illness. The rationale was there is no indication in his service treatment records of this condition, and it was over 30 years post-discharge that this condition appeared. Although the Veteran believes his mesenteric ischemia is proximately due to service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. He is not competent to relate his mesenteric ischemia to service. Moreover, he has not provided any competent evidence showing a link between his current bilateral mesenteric ischemia and his military service—despite being afforded ample opportunity to do so. Consequently, the Board gives more probative weight to the VA examiner. Accordingly, the March 2014, examination and opinion, establishes that the Veteran’s mesenteric ischemia, is not at least as likely as not related to service. The rationale was the service treatment records do not show treatment for this condition, or for over 30 years following service. The examiners’ opinion is the most probative evidence as to the nexus to service, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In other words, the most probative evidence of record does not show that the Veteran’s claimed mesenteric ischemia is directly due to service—to include the alleged stress experienced in service. 6. Entitlement to service connection for erectile dysfunction The Veteran contends that he suffers from a right knee sprain that began during service. The question for the Board is whether the Veteran has a current disability that began during service, or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s erectile dysfunction is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The service treatment records are negative for any complaints or reports of erectile dysfunction. VAMC treatment records indicate a note a history of erectile dysfunction in April 2003. In March 2014, he underwent a VA examination. The examiner indicated the erectile dysfunction due to the Veteran’s end-stage renal dysfunction. The examiner concluded it is less likely than not that erectile dysfunction was incurred in or caused by an in-service injury, event, or illness. The rationale was there is no indication in his service treatment records of this condition, and it was over 30 years post-discharge that this condition appeared. Although the Veteran believes his erectile dysfunction is proximately due to service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. He is not competent to relate his erectile dysfunction to service. Moreover, he has not provided any competent evidence showing a link between his current erectile dysfunction and his military service—despite being afforded ample opportunity to do so. Consequently, the Board gives more probative weight to the VA examiner. Accordingly, the March 2014, examination and opinion, establishes that the Veteran’s erectile dysfunction, is not at least as likely as not related to an in-service injury, event, or disease. The rationale was the service treatment records do not show treatment for erectile dysfunction, or for many years following service. The examiners’ opinion is the most probative evidence as to the nexus to service, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. In other words, the most probative evidence of record does not show that the Veteran’s claimed erectile dysfunction is directly due to service. Moreover, as a kidney disability is denied in this decision, service connection for erectile dysfunction on a secondary basis is also denied. 7. Entitlement to service connection for a foot condition, claimed as plantar fascitis and pes planus The Veteran contends that he suffers from a bilateral foot disability, claimed as plantar fasciitis and pes planus, that began during service. The question for the Board is whether the Veteran has a current disability that began during service, or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s foot condition is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The service treatment records are negative for any complaints or reports of a foot condition. VA treatment records document plantar fasciitis. In March 2014, he underwent a VA examination. The Veteran reported having pain in the soles of his feet from the arch to the heel. He was found to have plantar fasciitis. He had been given special inserts, but found the inserts made his feet feel worse, so he bought Dr. Scholl’s inserts. He had no recollection of being seen in service for plantar fasciitis. The examiner concluded it is less likely than not that plantar fasciitis was incurred in or caused by an in-service injury, event or illness. The rationale was there is no indicated in his service treatment records of this condition, and it was over 30 years post-discharge that this condition appeared. In June 2016, he was afforded a VA examination. The examiner referenced a screening physical dated November 6, 1979, in which the Veteran denied fallen arches or flat feet. The enlistment exam from November 8, 1979, the Veteran denied any prior foot trouble. There is no episode of treatment or complaints of a foot condition. The examiner concluded the Veteran’s plantar fasciitis and pes planus less likely than not was incurred in or caused by an inservice injury, event, or illness. The rationale was the Veteran had no evidence of a pre-existing foot condition, upon entry in service. There is no indication of treatment for a foot condition during service. The first documentation of a foot complaint was in March 2006, when the Veteran was diagnosed with plantar fasciitis secondary to severe pes planus and obesity. This was 26 years post-separation. There was one report of “foot trouble,” in 1980, with no further explanation or evaluation of any foot condition. Although the Veteran believes his foot condition, variously claimed as pes planus and plantar fasciitis, is proximately due to service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. He is not competent to relate his current foot complaints to service. Moreover, he has not provided any competent evidence showing a link between his current bilateral foot complaints and his military service—despite being afforded ample opportunity to do so. Consequently, the Board gives more probative weight to the VA examiners who found that his current bilateral foot disabilities are unrelated to service. Accordingly, the March 2014 and June 2016, examination and opinion, establishes that the Veteran’s pes planus and plantar fasciitis, are not at least as likely as not related to an in-service injury, event, or disease. The rationale was the service treatment records do not show treatment for any foot condition, or for many years following service. Additionally, the examiner opined that the Veteran’s symptoms are likely due to his obesity. The examiners’ opinion is the most probative evidence as to the nexus to service, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. In other words, the most probative evidence of record does not show that the Veteran’s claimed foot condition is directly due to service. 8. Entitlement to service connection for kidney condition The Veteran contends that he suffers from a kidney condition that began during service or is secondary to his claimed hypertension (denied above). The question for the Board is whether the Veteran has a current disability that began during service, or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s end stage renal disease is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The service treatment records are negative for any complaints or reports of a kidney condition. VAMC treatment records document the Veteran has end stage renal disease, and is on hemodialysis since September 2009. A September 2011 treatment note indicates he has chronic kidney disease, secondary to hypertension, and has been on chronic dialysis since 2009. In March 2014, he underwent a VA examination. He was diagnosed with end stage renal disease in February 2009. He reported believing his kidney disease was brought on by stress related to his time in service. The examiner concluded it is less likely than not that end stage renal disease was incurred in or caused by an in-service injury, event, or illness. The rationale was there is no indication in his service treatment records of this condition, and it was over 30 years post-discharge that this condition appeared. The examiner further noted that the Veteran’s kidney disease was due to his hypertension. In May 2016, Dr. S. reviewed the file, and concluded it is as likely as not that the Veteran’s depressive disorder aided in the development of and permanently aggravated his high blood pressure. He went on to state that the Veteran’s high blood pressure permanently aggravated his end stage renal disease. Although the Veteran believes his end stage kidney disease is proximately due to service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). He is not competent to relate his current kidney condition to service. Consequently, the Board gives more probative weight to the VA examiner. Accordingly, the March 2014, examination and opinion, establishes that the Veteran’s end stage renal disease, is not at least as likely as not related to an in-service injury, event, or disease. The rationale was the service treatment records do not show treatment for any kidney related condition, or for many years following service. The examiners’ opinion is the most probative evidence as to the nexus to service, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. The Board has taken note of Dr. S. opinion that the Veteran’s renal disease is aggravated by his hypertension and/or depression, however, the Veteran is not service connected for either hypertension or depression (both denied in the instant decision). Therefore, service connection for kidney disease on a secondary basis is not warranted. In other words, the most probative evidence of record does not show that the Veteran’s claimed end stage renal disease is directly due to service. 9. Entitlement to service connection for depression is denied. The Veteran contends that he suffers from depression as a result of his time in service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease; or in the alternative, whether the Veteran has a current disability that is proximately due to or was aggravated by a service-connected disability. The service treatment records are negative for any complaints or reports of depression. VAMC treatment records document a visit in March 1999, at which time he was diagnosed with major depressive disorder versus dysthymic disorder. He has a history of cocaine and alcohol dependency. Buddy statements were received indicating the Veteran behaved differently post-service. In March 2014, the Veteran was afforded a VA examination. He was diagnosed with alcohol dependence and cocaine dependence in remission, and major depressive disorder. The Veteran reported difficulties in school, and reported he began abusing drugs at the age of 15. The examiner indicted his depressive disorder could be caused by the persistent substance abuse. He reported involvement in mental health services in 1987. He had been married for 4 months, though they had been together for 14 years. He reported physically abusing his wife twice, but caught himself before he harmed her. He reported being depressed and sad most days. He was diagnosed with sleep apnea in 2002. The examiner concluded the Veteran clearly had major depressive disorder. The examiner went on to opine that given the Veteran’s history of behavioral and drug problems, it is unlikely his depression occurred as a result of military service. In an April 2017 report from Dr. H., she opined that the Veteran suffered from unspecified depressive disorder more that more likely than not began in service, continues uninterrupted to present, and is aggravated by headache, tinnitus, and end stage renal failure. Dr. H., cited to literature that details mental health symptoms within active duty servicemen, citing to particular research that found active military service impacts depression, anxiety, and quality of life. Further she cited to research that concluded active duty personnel being disillusioned with personal and professional identities as a result of guilt and shame associated with service identities. She then cites to research that found a link between traumatic events and substance abuse. Importantly, she did not address any specific in-service event, injury, or illness that would have been indicative of depression. She relied on generalized articles noting that active military can have psychological impact on service members. It is worth noting, the Veteran has reported no instances of guilt or shame associated with his service identity in conjunction with his mental health treatment. The Veteran has provided no accounts of exposure to trauma during service, or to feeling disillusioned. Research studies that conclude traumatic events and substance abuse often go hand in hand, do not support the Veteran’s contention that he has a psychiatric condition related to service as he has not specifically identified any trauma other than the general stress of being in the military. The research articles Dr H. used to support her conclusion that the Veteran suffers from depression as a result of his time in service, are not specific to this Veteran, nor do they touch on the Veteran’s particular experiences, and do not provide persuasive support for the claim. Finally, in annual reenlistment reports, the Veteran specifically denied any mental health complaints, and he did not report any stress at that time. In July 2016, the Veteran underwent a VA examination. The examiner noted the Veteran was first diagnosed with depression in 1999, with reports of tinnitus first shown in 2015. At the 2015 audio examination, the Veteran reported the onset of tinnitus around 10 to 15 years prior. The examiner commented on Dr. H.’s report indicating depressive disorder was due to another medical condition (tinnitus). The examiner opined that Dr. H.’s assessment is a questionable diagnosis because one of the criteria for the diagnosis is “evidence from history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.” In this case, depression could not be the direct pathophysiological consequence of tinnitus and without meeting the criterion, her given diagnosis is questionable. After review of the Veteran’s mental health records, the examiner found no link between depression to tinnitus. Therefore, it was concluded it is less likely than not that the Veteran’s diagnosis of depression was secondary to tinnitus. The examiner rendered an addendum, highlighting that that the Veteran made no mention of tinnitus or ear pathology to his mental health providers. In the absence of any mention of problems with tinnitus in relation to his depression in his sessions, by the Veteran or his treating providers, it is likely tinnitus did not play a role in impacting or aggravating his depression. The April 2017 opinion of Dr. H., is speculative in nature as it relies on a questionable history, and research articles that are not specific to the Veteran or his experiences. Therefore, her opinion is given limited probative value as to whether the Veteran’s depression was either directly related to service or secondary to his service-connected tinnitus. The Board finds the 2014 and 2016 examinations are more probative as to the nature and etiology of the Veteran’s depression (likely due to his history of drug use), as they were based on an examination of the Veteran, and consideration of an accurate medical history, and followed a review of the service treatment records and post-service treatment records. In view of the foregoing, the Board finds that the preponderance of the competent medical and other evidence of record is against a finding the Veteran has depression as a result of his active service or secondary to his service-connected tinnitus. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application in the instant case. See generally Gilbert, supra; see also Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). No other basis for establishing service connection for the claimed disability is otherwise demonstrated by the evidence of record, to include as secondary to a service-connected disability, tinnitus in this case, pursuant to 38 C.F.R. § 3.310. Consequently, the benefit sought on appeal must be denied. In other words, the most probative evidence of record does not show that the Veteran’s claimed depression is directly due to service or secondary to a service-connected disability. REASONS FOR REMAND Entitlement to service connection for headaches VAMC treatment records document complaints of headaches. In December 2014, the Veteran underwent a VA examination. He reported the onset of headaches around 2008. The examiner concluded headaches are less likely than not incurred in or caused by an in-service injury, event or illness. His STRs document visits in April 1980 for viral syndrome, and he had complaints of headaches associated with viral syndrome. There was no evidence of treatment for chronic headaches in his STRs. The examiner opined that the Veteran’s headaches noted in April 1980 were acute and transitory and most likely resolved with the viral syndrome. There is no evidence of chronic or recurrent headaches in his VA problems list. He reported an onset of headaches around 2008. The examiner went on to state that the Veteran has ESRD, morbid obesity, chronic pain, and OSA, which are all risk factors for chronic headaches. Dr. S. rendered an opinion in January 2017. Dr. S. concluded it is as likely as not that the Veteran’s headaches are caused by a combination of tinnitus, depression, and sleep apnea. The December 2014 VA examination did not address secondary service connection, and the January 2017 private opinion did not adequately address secondary service connection. Therefore, another opinion is required. The matter is REMANDED for the following action: Forward the claims file to an appropriate examiner for an opinion as to the nature and etiology of the Veteran’s claimed headaches. It is left to the examiner’s discretion whether to examine the Veteran. The examiner should answer the following questions: (a.) Is it at least as likely as not that the Veteran’s headaches were caused OR aggravated (worsened beyond its natural progression) by the service-connected tinnitus? (b.) If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of the headaches, by the service-connected disability. The examiner is asked to address the Veteran’s contentions, and to provide a rationale for all opinions reached. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Skiouris, Associate Counsel