Citation Nr: 20022431 Decision Date: 03/31/20 Archive Date: 03/31/20 DOCKET NO. 18-05 678 DATE: March 31, 2020 ORDER The previously denied claim for service connection for a left knee disability is reopened; to this extent only, the appeal is granted. The previously denied claim for service connection for a right knee disability is reopened; to this extent only, the appeal is granted. The previously denied claim for service connection for an acquired psychiatric disorder, to include PTSD, is reopened; to this extent only, the appeal is granted. Entitlement to service connection for an erectile dysfunction disability is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a low back disability is remanded. FINDINGS OF FACT 1. In a February 2015 rating decision, the RO denied service for a left knee disability. 2. Evidence associated with the claims file since the February 2015 denial of a left knee disability, relates to unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 3. In a February 2015 rating decision, the RO denied service for a right knee disability. 4. Evidence associated with the claims file since the February 2015 denial of a right knee disability, relates to unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 5. In a February 2015 rating decision, the RO denied service for an acquired psychiatric disorder. 6. Evidence associated with the claims file since the February 2015 denial of for an acquired psychiatric disorder, relates to unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim. 7. The Veteran does not have an erectile dysfunction disability which could be attributed to active service. CONCLUSIONS OF LAW 1. The February 2015 RO decision, which denied the Veteran’s claim of service connection for a left knee disability, is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 2. New and material evidence has been received to reopen the claim of service connection for a left knee disability. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156. 3. The February 2015 RO decision, which denied the Veteran’s claim of service connection for a right knee disability, is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 4. New and material evidence has been received to reopen the claim of service connection for a right knee disability. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156. 5. The February 2015 RO decision, which denied the Veteran’s claim of service connection for an acquired psychiatric disorder, to include PTSD, is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 6. New and material evidence has been received to reopen the claim of service connection for an acquired psychiatric disorder, to include PTSD. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156. 7. The criteria for service connection for an erectile dysfunction disability have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1976 to April 1979. This matter is before the Board of Veterans’ Appeals (Board) on appeal of April 2017 and June 2017 ratings decision of the Department of Veterans Affairs (VA). In April 2019 and November 2019, the Board remanded the issues for further development. Stegall v. West, 11 Vet. App. 268, 271 (1998). New and material evidence In this case, the Veteran did not submit a Notice of Disagreement (NOD) in response to the February 2015 rating decision denying service connection for a left knee disability, a right knee disability and for an acquired psychiatric disorder on the basis that the Veteran’s claimed disabilities did not occurred in nor was caused by service. 38 U.S.C. § 7105. Evidence received since that decision includes VA treatment records and VA examination reports, to include VA medical opinions regarding secondary service connection for the claimed disabilities. The evidence is new to the record, relates to unestablished facts necessary to substantiate the Veteran’s claims, and is neither duplicative nor cumulative of evidence previously received; the Board finds it to be new and material sufficient to warrant reopening the Veteran’s claims for service connection. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The reopened claims are further addressed in the REMAND section below. Entitlement to service connection for an erectile dysfunction disability is denied. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). ¬ The Veteran seeks service connection for erectile dysfunction. The Veteran’s service treatment records are silent for complaints, treatments, or diagnosis of the claimed condition. The Veteran has not identified or produced any evidence, medical or otherwise, that would tend to show that he currently has any clinical diagnosis referable to his claimed erectile dysfunction that is related to service. A review of the evidence, to include VA treatment records show that the Veteran has a history of an erectile disorder from August 2013. The VA treatment records do not show, however, that the Veteran has complained of or has been treated for the condition since that time. Further, the Veteran has not been medically diagnosed with the condition during the pendency of the appeal. Even assuming the presence of current erectile dysfunction, the claims file nevertheless is devoid of competent evidence relating such disability back to service. The Veteran is certainly competent, even as a layman, to report symptoms of which he has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 469 (1994). As a layperson, however, he is not competent to establish a medical diagnosis or to establish a medical etiology merely by his own assertions since this requires medical expertise. See 38 C.F.R. § 3.159(a)(1). Further, medical training and credentials are required to provide diagnoses that can be considered competent evidence. Here, the Veteran has not shown to have the requisite training and credentials to ascertain whether symptoms are indicative of a diagnosable disorder that developed in a specific time frame. This is a complex medical question requiring a greater degree of expertise than the Veteran has not been shown to possess. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). In the absence of such competent evidence, there is no basis for a remand for a VA examination and opinion because such would present no reasonable likelihood of resulting in favorable findings. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, service connection is not warranted. REASONS FOR REMAND Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is denied. The Veteran seeks service connection for an acquired psychiatric disorder, to include PTSD, related to service and/or secondary to his service-connected foot disabilities.¬ In an October 2013 statement regarding his stressors, the Veteran noted that his relationship with everyone, to include his wife, had been lost. He noted that he did not leave his apartment and had trust issues. He stated that he was losing his mind and that sometimes he could not function. In a January 2015 Formal Finding, it was found that the Veteran had not identified a specific incident to support sending a request to the to the Joint Services Records Research Center (JSRRC) to research and verify the Veteran’s stressful incidents. In a July 2015 correspondence, the Veteran contended that his service-connected foot disabilities had caused or aggravated his mental health symptoms. The Veteran was afforded a VA examination in December 2019. Diagnoses of PTSD and unspecified depressive disorder were rendered. The VA examiner opined that the Veteran’s psychiatric disability was at least as likely as not caused by or the result of the reported traumatic stressors during this military service. The Veteran had reported symptoms supporting a diagnosis and had reported the onset during service, as associated with three significant traumatic events during his military which were noted to be sufficient to cause PTSD. It was also noted that the PTSD had been continuous since onset. In addition, the VA examiner opined that it was less likely as not that any current psychiatric disability had been caused by or aggravated by any service-connected disability, to include his service-connected foot disability. In this case, the Board finds that a remand is necessary to fully and fairly adjudicate this issue. The Board notes that there is a diagnosis of PTSD; however, the July 2015 Formal Findings memorandum indicated that there was not enough information to verify a stressor. During the Veteran’s December 2019 VA examination, the Veteran reported three different stressors that had not been expressed prior to the VA examination. The VA examiner noted in the opinion that the Veteran’s PTSD was associated with three significant traumatic events during his military service. The alleged in-service PTSD stressors reported at the December 2019 VA examination have not been corroborated. The Board finds that a search by the JSRRC and/or any other appropriate entity to verify the Veteran’s claimed stressors should be undertaken due to the additional information received. Further, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, if the Veteran’s stressors are not corroborated, an addendum opinion is needed with regard to whether the unspecified depressive disorder is directly related to his active duty service. Entitlement to service connection for a left knee disability, for a right knee disability and for a low back disability, are denied. The Veteran seeks service connection for a left knee disability, for a right knee disability and for a low back disability, each to include as secondary to his service-connected foot disabilities.¬ In the November 2019 Board decision and remand, the issues were remanded to comply with the April 2019 remand directives. The RO was directed to obtain opinions regarding whether the Veteran’s bilateral knee and back disorders were aggravated by his service-connected bilateral foot disorders. Although there was a VA opinion provided in July 2019, an opinion regarding aggravation was not provided. In a November 2019 VA addendum, the VA examiner stated that as he had previously stated in the July 2019 assessment, particularly based on consistent, ongoing clinical evaluation and treatment, the predominance of the VA medical treatment records documenting a robust credible, well-grounded medical nexus objectively associating the Veteran’s lumbar spine and/or knee condition with his service-connected foot condition was lacking, thereby failing to substantiate his claims as contended. The Board finds that the November 2019 addendum to the examination report merely reiterated the conclusions from the July 2019 examination report. As such, the August 2019 VA examination opinion is inadequate, and correction is needed. Barr, supra. The matters are REMANDED for the following action: 1. The RO should ask the Veteran to provide additional detailed information regarding his alleged stressor incidents, as reported at his December 2019 VA examination, and information pertaining to the date of the incidents. 2. Then, the RO should take appropriate action either to verify the alleged stressor through JSRRC, or to provide a formal finding that further attempts at verification are not possible based on the information provided by the Veteran. If the RO determines that the Veteran has not provided enough information to make a request to the JSRRC, the RO must clearly make this finding in the record and explain what information is lacking that precludes making the request. 3. If, the Veteran’s stressors are not corroborated, then return the Veteran’s claim folder to the examiner that provided the December 2019 VA examination for an addendum opinion. If an additional examination is necessary, one should be scheduled. If the prior examiner is not available, the file must be forwarded to another examiner to obtain the requested opinion. For the diagnosed unspecified depressive disorder, based on the review of the record, the examiner is to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the disability had its onset during, or was otherwise related to, the Veteran’s active military service. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. 4. In addition, obtain an addendum opinion from an examiner, other than the July 2019 and November 2019 VA examiner, addressing whether any current disabilities of the bilateral knees and low back are at least as likely as not (a 50 percent or greater probability) aggravated by the service-connected foot disorders. A pre-aggravation baseline for the disabilities should be determined, if possible. All opinions must be based upon a claims file review and must be supported by a rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A-L Evans, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.