Citation Nr: 20042840 Decision Date: 06/24/20 Archive Date: 06/24/20 DOCKET NO. 12-22 728 DATE: June 24, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected left ear hearing loss, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s acquired psychiatric disorder began during active service, is otherwise etiologically related to service, or is secondary to service-connected left ear hearing loss. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1972 to February 1975. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the electronic claims file. Subsequently, the Board remanded the matter in July 2018 and August 2019 for further development. The Veteran contends that his acquired psychiatric disorder is due to service. Specifically, he testified at the February 2018 hearing that his position on the honor guard made him anxious due to the precision required and depressed due to the number of funerals that were occurring per day during his service. Alternatively, he alleges that his acquired psychiatric disorder is secondary to his service-connected left ear hearing loss. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Secondary service connection is warranted where a claimed disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The threshold legal requirements for a successful secondary service connection claim are evidence of (1) a current disability for which secondary service connection is sought; (2) a disability already service-connected; and (3) competent evidence that the already service-connected disability caused or aggravated the disability for which service connection is sought. Id. After considering all of the evidence of record, the Board concludes that the preponderance of the evidence is against finding that the Veteran’s acquired psychiatric disorder is related to service or secondary to his service-connected left ear hearing loss. The Veteran’s service treatment records (STRs) indicate that the Veteran reported having depression or excessive worry and nervous trouble of any sort in December 1974. The remainder of his STRs are silent as to any treatment, report, or diagnosis of an acquired psychiatric disorder and his December 1974 separation examination noted no psychiatric abnormalities. A July 2010 VA examiner diagnosed the Veteran with anxiety disorder, not otherwise specified (NOS). The examiner opined that the condition was less likely than not caused by or a result of the Veteran’s hearing loss. Although the examiner addressed secondary service connection, she failed to address the issue of aggravation. Therefore, the Board finds that this opinion is inadequate and affords it no probative weight. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). A March 2011 VA examiner opined that the Veteran’s anxiety disorder NOS was less likely than not related to the Veteran’s depression, excessive worry, and nervous trouble reported during service. The examiner explained that while the Veteran checked off the aforementioned symptoms in his discharge paperwork, there is no evidence to confirm that the symptoms experienced during service would have been sufficient to constitute a mental disorder at that time. The examiner noted that even if they had, the symptoms would likely have been labeled an adjustment disorder in modern terminology and, by definition, the symptoms would be expected to go away a short time after the stressor, in this case service on honor guard, had ceased to be part of the Veteran’s life. The examiner further noted that there was no continuum of treatment connecting the Veteran’s symptoms at that time to the present, and that the Veteran’s description of his current anxiety suggests that it is related to a variety of current life stressors. Thus, the examiner concluded that the Veteran’s current anxiety was less likely than not caused by or related to service, to include mental health symptoms reported during service. A March 2011 private medical examination completed by Dr. J.A. diagnosed the Veteran with anxiety disorder NOS and dysthymic disorder, onset in service. Dr. J.A. opined that the Veteran had difficulty coping with requirements of honor guard, especially with knee pain. He noted that the Veteran started getting depressed and anxious at that point, to some extent, and grew more anxious the past few years. In a March 2018 private medical examination, Dr. J.A. diagnosed the Veteran with adjustment disorder with depressed mood, secondary to ongoing stress of having a service-connected general medical condition and residuals of acute stress reaction beginning while he was in service. Dr. J.A. further opined that the Veteran’s conditions were at least as likely as not incurred in or caused by service because his mental health problems were related to in-service stress connected with work assignments and were amplified by the onset of knee pain exacerbated by the same stressors. A March 2019 VA examiner diagnosed the Veteran with unspecified depressive disorder and anxiety disorder. The Board notes that the March 2019 VA medical opinion lacks probative value as the examiner provided an inadequate opinion concerning direct and secondary service connection. Specifically, the VA examiner’s opinion addressing direct service connection was largely based on the lack of documentation of a relationship, which is insufficient to deny service connection. Additionally, regarding secondary service connection, the examiner was explicitly advised that a permanent worsening was necessary to show aggravation of an acquired psychiatric disorder. This is incorrect as the aggravation standard for secondary service connection does not require that the nonservice-connected disability be permanently aggravated. A September 2019 VA examiner diagnosed the Veteran with unspecified anxiety disorder and depressive disorder. The examiner opined that the Veteran’s conditions were less likely than not incurred in or caused by service. The examiner acknowledged that while the Veteran self-reported nervousness on discharge, there is no indication that a mental health condition was ever formally diagnosed or treated. She reasoned that there is no indication that the symptoms present on active duty persisted beyond discharge to a functionally impairing degree. She further reasoned that the Veteran’s symptoms were noted many years after separation from service and were noted to be associated with family stressors; medical illnesses, to include hernia repair surgery and MRSA; physical limitations; and variety of current life stressors, to include marital conflict, his wife’s serious medical and mental health problems, as well as his daughter’s and granddaughter’s health issues. She further indicated that there is no indication that the Veteran’s symptoms are conceptually related to any symptoms that may have been present on active duty. The examiner stated that job stress on active duty would have been a finite stressor, and it is just not plausible that symptoms documented approximately 35 years later would be associated with the same. Regarding secondary service connection, the examiner opined that it was less likely than not that the Veteran’s current psychiatric symptoms are due to or aggravated by the Veteran’s service-connected left ear hearing loss. The examiner explained that the Veteran’s symptoms have been associated with various stressors, as discussed above. Additionally, the examiner reasoned that it was not plausible that the Veteran’s hearing loss would account for his mental health concerns. The examiner explained that the Veteran’s left ear hearing loss does not significantly contribute or aggravate his mood symptoms. Furthermore, the examiner noted that collateral treatment records do not suggest any kind of relationship between his current mental health symptoms and hearing loss. As mentioned above, the Board finds that service connection for an acquired psychiatric disorder is not warranted. The evidence of record does not indicate that the Veteran was diagnosed with an acquired psychiatric disorder during service or for many years after separation from service. Additionally, the September 2019 VA examiner concluded that while the Veteran self-reported psychiatric symptoms during service, the Veteran’s honor board stress was a finite stressor and that his current condition was associated with family stressors and medical issues. The Board notes that the March 2011 and March 2018 private opinions from Dr. J.A. are contrary to this conclusion. However, the Board has assigned greater probative weight to the September 2019 VA examiner. Here, Dr. J.A.’s March 2011 examination explicitly indicated the Veteran’s medical records were not reviewed. Additionally, the March 2018 examination report did not indicate whether the Veteran’s medical records or STRs were reviewed. While Dr. J.A. has opined that the Veteran’s acquired psychiatric disorder began in service, he has not provided any explanation or rationale about how or why he drew this conclusion. Accordingly, the two submitted examination reports and opinions cannot be considered probative evidence in this case. The Board notes that the September 2019 VA examiner’s medical opinion contains clear conclusions, supporting data, and a thorough analysis given the Veteran’s medical history provided in the claims file, to include the Veteran’s STRs. The Board finds that the September 2019 contemplates correct facts, to include facts not addressed by the private opinions (making this private opinions less probative). See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (noting that most of the probative value of a medical opinion comes from its reasoning). As a result, the Board finds that the VA examiner’s opinion is entitled to significant probative weight. As to secondary service connection, the September 2019 VA examiner opined that the Veteran’s acquired psychiatric disorder was less likely than not the result of, or aggravated beyond its natural progression, by his service-connected left ear hearing loss. As discussed above, the Board finds that the September 2019 VA examination and medical opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Id. Moreover, the Board notes that while Dr. J.A.’s March 2011 and March 2018 private medical examinations indicate that the Veteran’s acquired psychiatric disorder was aggravated by his knee pain, the Veteran is currently only service-connected for left ear hearing loss and thus secondary service connection is not warranted on this basis. The Board has considered the Veteran’s statements and other lay statements of record made in support of his claim. However, the evidence of record does not demonstrate that the Veteran has the requisite medical training, expertise, or credentials needed to provide a diagnosis or a competent opinion as to medical causation. The question of causation involves a complex medical question, and the Veteran does not have the medical expertise to provide such an opinion. Therefore, he is not competent to diagnose or provide an opinion as to the etiology of his current acquired psychiatric disorder. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). With respect to the other lay statements of record submitted by the Veteran’s son and R.P., as well as an unsigned October 2010 statement, the Board finds that they have not demonstrated any specialized knowledge or expertise to indicate they are capable of rendering a competent medical opinion. Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, the etiology of the Veteran’s acquired psychiatric disorder falls outside the realm of common knowledge of a lay person. Id.; Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Consequently, the Board gives more probative weight to the opinion of the September 2019 VA examiner. In sum, the Board finds that the evidence of record does not show that the Veteran’s acquired psychiatric disorder is related to service or is secondary to service-connected left ear hearing loss. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Robinson, Associate 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.