Citation Nr: 18156772 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 14-07 369 DATE: December 11, 2018 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), anxiety disorder, and depressive disorder, is denied. FINDING OF FACT The preponderance of the competent and credible evidence indicates that the Veteran’s acquired psychiatric disorder, to include PTSD, anxiety disorder, and depressive disorder, was not caused by or aggravated by his service-connected type II diabetes mellitus; and is not otherwise etiologically related to service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, to include PTSD, anxiety disorder, and depressive disorder, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1971 to March 1973. This matter was remanded in September 2015 and December 2017 and has been returned to the Board for appellate review. Service Connection A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. §§ 1110, 1131. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). Under section 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Acquired psychiatric disorder, to include PTSD, anxiety disorder, and depressive disorder The Veteran filed a January 2011 claim for service connection for PTSD and/or anxiety due to fear of dying while in the Vietnam War. See January 2011 Statement in Support of Claim. He asserted that during his service in Vietnam he felt anxious and nervous due to the rocket and mortar attacks there. See May 2013 notice of disagreement (NOD). In a July 2012 Statement in Support of Claim, the Veteran asserted that he had depression, secondary to his service-connected type II diabetes mellitus. Regarding the first Shedden and Wallin elements, the Veteran has a currently diagnosed anxiety disorder. However, the Veteran does not have diagnosed depressive disorder or PTSD. The December 2011 and November 2015 VA examination reports indicated that the Veteran has diagnosed anxiety disorder, but does not have more than one diagnosed mental disorder. Significantly, the December 2011 VA examiner opined that the Veteran does not have a diagnosis of PTSD and further indicated that the Veteran presents with symptoms consistent with anxiety disorder. The April 2012 reviewing clinician stated, upon December 2011 VA examination, the Veteran did not meet the criteria to warrant a PTSD diagnosis. The May 2018 reviewing clinician acknowledged the psychiatric examination from 1974 where the Veteran was diagnosed with neurosis, phobic reaction, and fear of syphilis and cardiac ailment; however, the May 2018 reviewing clinician identified the Veteran’s psychiatric disorders that have been present since January 2011 as anxiety disorder. In determining the Veteran has only diagnosed anxiety disorder since January 2011, the May 2018 reviewing clinician stated that the Veteran requested service connection for a nervous condition and venereal disease in April 2014 and the rating decision stated, “there were no complaints of NP symptomology during service or following separation” and it was determined “NSC VE: neurosis, phobic reaction, fear of syphilis and cardiac ailment.” Accordingly, the Board finds that the Veteran has currently diagnosed anxiety disorder and further analysis will be limited to his anxiety disability. Turning to the second Shedden and Wallin elements, regarding the second Shedden element, the Veteran contends that during his service in Vietnam, he felt anxious and nervous due to the rocket and mortar attack there. See May 2013 notice of disagreement (NOD). Service treatment records (STRs) include the Veteran’s March 1973 separation examination which indicated normal psychiatric findings. Further, the Veteran was noted as being in good health. Regarding the second Wallin element, the Veteran is service-connected for type II diabetes mellitus. Finally, with regard to the third Shedden and Wallin elements, the April 2012 reviewing clinician opined that there was no basis to establish a relationship between the Veteran’s mental disorder and his reported stressor or military service. The reviewing clinician stated that review of the medical record does not show any evidence of psychiatric treatment. The Veteran first came to VA for diabetes mellitus medication refill and there are no psychiatric complaints, treatment, or medications within VA. Further, he did not provide any evidence of private treatment other than his treatment for diabetes mellitus. The examiner stated that the diagnosis of anxiety disorder reported in the December 2011 VA examination is not related to his claimed stressor or military service. The reviewing clinician explained that although, not clearly expressed, it is implied in the statement made in the December 2011 medical opinion that the Veteran’s symptoms are compatible with the anxiety diagnosis. The November 2015 VA examiner opined that the Veteran’s psychiatric disorder less likely than not (less than 50 percent probability) was occurred in or caused by the claimed in-service injury, event, or illness. The Veteran’s psychiatric disorder is less likely than not (less than 50 percent probability) proximately due to or the result of service-connected type II diabetes mellitus. The Veteran’s psychiatric disorder is less likely than not (less than 50 percent probability) permanently worsened beyond the normal progression by service-connected type II diabetes mellitus. In support of his opinions, the examiner stated that the Veteran’s service treatment records were silent for behavioral health referrals, personal requests, findings, diagnoses, or treatment for a mental disorder. The Veteran has never been seen for psychiatric/psychological/mental health treatment. He was prescribed Clonazepam by his primary care physician after the Veteran claimed to be anxious, but he has not requested mental health evaluation nor has he been referred to psychiatry/mental health. The examiner reiterated that the December 2011 and April 2012 VA clinicians were clear in that, there is no basis to establish a relationship between the Veteran’s mental disorder and the stressor of the Veteran’s Vietnam service. The May 2018 reviewing clinician reiterated the April 2012 reviewing clinician’s opinion that there is no relationship between the Veteran’s mental disorder and the reported stressor or military service. Further, the May 2018 reviewing clinician opined that the Veteran’s diagnosed anxiety disorder is not secondary to his service-connected diabetes mellitus. In support of his opinions, the reviewing clinician considered the April 1974 VA psychiatric examination, but noted there were no complaints of NP symptomology during service or following separation and service connection for neurosis, phobic reaction, and fear of syphilis and a cardiac ailment was denied in a July 1974 rating decision. Moreover, the reviewing clinician stated there is no evidence to suggest the Veteran’s anxiety disorder (diagnosed in 2011, 37 years post-service) has been worsened by service-connected diabetes mellitus. Further, the reviewing clinician stated that studies have shown that individuals with diabetes were not more likely to meet the diagnostic and statistical manual of psychiatric disorders for at least one mental disorder that were those without diabetes. Together, the Board finds that the VA examination reports and VA addendum opinions of record are competent and highly probative. The Board has considered the Veteran’s contentions. However, as a lay witness, the Veteran is only competent to report on factors such as observable symptomatology. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Determining the possible cause of his diagnosed anxiety disorder is beyond the scope of lay observation. Thus, a determination as to the etiology of his anxiety disorder requires specialized training. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno, 6 Vet. App. at 469-70. As such, the Veteran’s lay assertions do not constitute competent evidence concerning the etiology of his currently diagnosed anxiety disorder. Moreover, as detailed above, there is no competent evidence of record indicating that the Veteran’s anxiety disorder is etiologically related to his active military service or service-connected type II diabetes mellitus. In summary, the competent medical evidence of record weighs against the claim, the Board finds that entitlement to service connection for an acquired psychiatric disorder, to include PTSD, anxiety disorder, and depressive disorder, is not warranted on a direct or secondary basis. As the preponderance of evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107(b). DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Schick, Associate Counsel