Citation Nr: 20051085 Decision Date: 07/31/20 Archive Date: 07/31/20 DOCKET NO. 14-38 186 DATE: July 31, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder to include stress, posttraumatic stress disorder (PTSD), and acute adjustment disorder is denied. Entitlement to service connection for a sleep disorder, to include as secondary to an acquired psychiatric disorder is denied. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric condition is denied. FINDINGS OF FACT 1. The Veteran’s acquired psychiatric disorder was not incurred in or is not otherwise related to active service. 2. The Veteran does not have a diagnosis of a sleep disorder. 3. The Veteran’s hypertension is not related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder to include stress, posttraumatic stress disorder (PTSD), and acute adjustment disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a sleep disorder, to include as secondary to an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a). 3. The criteria for service connection for hypertension, to include as secondary to an acquired psychiatric condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1959 to September 1961. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified at a hearing before the undersigned Veterans Law Judge in April 2018. A transcript of the hearing has been associated with the record. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the claimed in-service disease or injury and the present disability. See, e.g., Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also 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) that a current disability exists and (2) that the current disability was 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). 1. Entitlement to service connection for an acquired psychiatric disorder to include stress, posttraumatic stress disorder (PTSD), and acute adjustment disorder The Veteran contends that he suffers from a psychiatric disorder that is related to active service. He has contended that he suffered a nervous breakdown in 1960 during service. The Veteran’s enlistment examination, service treatment records (STRs), and separation examination are silent as to any complaints, treatment, or diagnosis of any psychiatric disorder. The Veteran was afforded a VA Examination in December 2017. The examiner found that the Veteran did not suffer from any mental disorder that conforms with DSM-V criteria. The examiner noted symptoms which included difficulty with memory and trouble sleeping. The examiner considered the Veteran’s purported mental breakdown in 1960; however, the examiner indicated that the Veteran complained of no mental disorders during service and could not remember his military experience. When this matter was before the Board in July 2018, it was remanded for further development. The Board noted a June 2018 private medical statement which noted a complaint of memory impairment and trouble sleeping and the diagnoses included mild dementia. Based on this evidence, the Board determined that another VA examination was needed to address whether the Veteran had a current psychiatric disorder that was related to service. The Veteran was afforded a new VA examination in February 2019. The examiner indicated that the Veteran had a current diagnosis of adjustment disorder with mixed anxiety and depressed mood, but opined that it was less likely than not incurred in or related to active service. The examiner noted that the Veteran and his daughter both attributed his current symptoms to the recent death of his wife in May 2018. The examiner added that when asked if he had any other stressors from the military, the Veteran denied having any mental health problems during military service. Finally, the examiner added that the Veteran's records did not suggest that he had any previous diagnosis or treatments for mental health disorders prior or during his military service. The Board finds that the February 2019 examiner’s opinion is highly probative, 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). The Board also finds probative the Veteran and his daughter’s reports of his current symptoms being related to the recent death of his wife. While the Board has considered the Veteran’s contention that he has a psychiatric condition that is related to service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, and falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Moreover, there is no medical opinion of record to refute the findings of the February 2019 examiner. For the reasons stated above, the Board finds that the Veteran’s acquired psychiatric condition was not incurred in, or is not otherwise related to active service. Thus, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for an acquired psychiatric disorder must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Entitlement to service connection for a sleep disorder, to include as secondary to an acquired psychiatric disorder The Veteran contends that he suffers from a sleep disorder that is related to service, or alternatively, that it was caused or aggravated by his psychiatric condition. In this case, the Board concludes that the Veteran does not have a diagnosis of a sleep disorder due to disease or injury and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran’s STRs are silent as to any complaints, diagnosis, or treatment for a sleep disorder. The only medical evidence of record of a diagnosis of any sleep-related disorder is a January 2015 mental health consult note that shows a diagnosis of insomnia. The record further indicates that the Veteran was prescribed a trial of Trazodone to treat his sleep disturbance. The remainder of the Veteran’s VA treatment records show complaints of nightmares and sleep disturbance, but are silent as to any diagnosis of a sleep-related disorder. On several occasions during the appellate period, the Veteran reported sleeping 7-8 hours a night, with no disturbances. The Veteran was afforded a VA examination in February 2019. The examiner indicated that the Veteran did not have a diagnosis of any sleep-related disorder. The examiner noted the Veteran’s report that he sleeps a lot with no major problems aside from sadness from the death of his wife. Even in the absence of a diagnosis, the examiner opined that the Veteran’s symptoms were less likely than not incurred in or caused by service. In this case, the Board finds the February 2019 examiner’s opinion is highly probative as it considered the Veteran’s medical history, his reports of no issues sleeping, and concludes that he does not have a sleep-related disorder, to include a diagnosis of insomnia that meets the DSM-V criteria. Additionally, the Board finds credible the Veteran’s reports in the VA treatment records of sleeping 7-8 hours a night, with no disturbances. This evidence is weighed against the January 2015 mental health consult, which is the only medical evidence of record showing any diagnosis of a sleep disorder. Consequently, the Board gives more probative weight to the February 2019 examination, the Veteran’s own statements, and the totality of the VA evidence of record. Moreover, the Board also notes that February 2019 examiner’s finding that the Veteran’s symptoms were less likely than not incurred in or caused by service, but instead are related to the recent passing of his wife. Additionally, even assuming the Veteran had a current diagnosis of a sleep disorder, as the Veteran’s claim for service connection for a psychiatric condition has been denied herein, there can be no service connection for any disease or injury as secondary to a psychiatric condition. See 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995). Therefore, service connection for any sleep disorder, as secondary to a psychiatric condition would be denied as a matter of law. Absent a showing of a diagnosis due to disease or injury, service connection for a sleep disorder cannot be granted. Thus, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for a sleep disorder must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 3. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric condition The Veteran contends that he suffers from hypertension that is related to service, or alternatively, that it was caused or aggravated by his psychiatric condition. At the onset, the Board notes that while the Veteran has a diagnosis of hypertension, as his claim for service connection for an acquired psychiatric condition has been denied herein, there can be no service connection for any disease or injury as secondary to a psychiatric condition. See 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995). Therefore, service connection for hypertension as secondary to a psychiatric condition must be denied as a matter of law. As to the Veteran’s theory of direct service connection, the remaining inquiry for the Board is whether the Veteran’s hypertension was incurred in or is otherwise related to active service. The Veteran’s STRs are silent as to a diagnosis of hypertension. Likewise, the Veteran has not contended that his hypertension had its onset in service. The Veteran reports, and the medical evidence of record also shows, that the Veteran was first diagnosed with hypertension many years following his separation from active service. The Veteran was afforded a VA examination in February 2019. The examiner opined that the Veteran’s hypertension was less likely than not related to active service. The examiner reasoned that the Veteran’s STRs, enlistment, and separation examinations did not show a diagnosis or treatment of hypertension, or blood pressure consistent with a diagnosis of hypertension. The examiner added that there is no evidence of diagnosis of hypertension proximal to military service. While the Board has considered the Veteran’s contention that his hypertension is related to service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, and falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Moreover, there is no medical opinion of record to refute the findings of the February 2019 examiner. (Continued on the next page)   The Board finds that the preponderance of the evidence is against a finding that the Veteran's hypertension is related to service, and therefore, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the competent, probative evidence is against the claim, the doctrine is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Marsh II, 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.