Citation Nr: 21001271 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 17-33 595 DATE: January 7, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder, is denied. FINDING OF FACT The Veteran’s acquired psychiatric disorder did not have its onset during service and is not is not related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1983 to May 1986 and from March 2003 to May 2004, with additional service in the Reserves. This matter originally came to the Board of Veterans’ Appeals (Board) on appeal from a December 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2018 and June 2020, the Board remanded the claim for additional evidentiary development; the remand directives have been substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The appeal has been returned to the Board for adjudication. As a final initial matter, the Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Entitlement to service connection for an acquired psychiatric disorder 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. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). “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)). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Veteran seeks service connection for an acquired psychiatric disorder that he maintains is caused by his active military service. At the outset, the Board notes that the Veteran’s service treatment records from his second period of service are not available. The RO attempted to obtain those reports and by letters dated in October 2014 the Veteran was advised of the unavailability of the records and provided with an opportunity to submit any reports he may have. The duty to assist in this regard has been met. The acknowledges that it has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of- the-doubt rule. See O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). Nonetheless, after reviewing the probative and persuasive evidence of record, the Board finds that the preponderance of the evidence weighs against the Veteran’s claim and that the evidence is not in equipoise. Here, the Veteran has been diagnosed with an acquired psychiatric disorder as noted on the May 2019 (date correction from previously referenced July 2019 date) and June 2020 VA examination reports. As such, the Board has recharacterized the Veteran’s claim to include all psychiatric disorders that have been diagnosed, to particularly include major depressive disorder, unspecified depressive disorder, and unspecified anxiety disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Veteran contends that while at war in Iraq, he suffered several incidents that caused him emotional problems. See November 2012 statement. The Veteran’s DD Form 214 notes that the Veteran served in Iraq from May 2003 to April 2004, and that he received hazard pay. It also shows that the Veteran’s military occupation specialty was a senior laundry and textile non-commissioned officer. Regarding the Veteran’s claimed in-service fear of being attacked and difficulty with adjusting to his surrounding environment, after resolving doubt in the Veteran’s favor, the Board finds that in-service occurrence is present. However, the Board finds that the probative and persuasive evidence fails to show that the Veteran’s current major depressive and anxiety disorders, unspecified, had onset in service or are in any way related to service or any event of service. It is initially noted that the Veteran’s available service treatment records from his first period of service do not show a diagnosis for an acquired psychiatric disorder or treatment for psychiatric symptoms. It is also noted that based on review of the record, the Veteran did not begin treatment for a psychiatric disorder until 2012, and he reported that it took time to recognize that he needed help. See May 2019 VA examination report. In May 2019, the Veteran underwent a VA examination, during which he was diagnosed with major depressive disorder. During the examination, the Veteran reported that everything changed when he went to Iraq, that he currently lives in “difficult situations”, and quit his job because he can’t work. Additionally, the examiner noted that the Veteran was unable to identify a specific stressor but indicated that only thinking of a mission could present symptoms of anxiety or depression. After examining and interviewing the Veteran and reviewing the claims file, the VA examiner concluded that the Veteran’s acquired psychiatric disorder is likely than not a result of his military service. The examiner noted that the Veteran’s military record does not document a stressor and that he first sought psychiatric treatment in 2012, several years after discharge. Additionally, the examiner noted that when the Veteran first sought treatment, he reported that he was feeling stressed in his job and resigned after working for the last 12 years as an accountant. The examiner concluded that not working lead to the Veteran’s psychiatric problems, to include his symptoms of depression and that while his acquired psychotic disorder may pose difficulty in everyday situations, they are not related to his military service. Following the June 2020 Board remand, additional private treatment records were associated with the claims file and the RO obtained an addendum opinion addressing the additional evidence in October 2020. While the Veteran reported traumatic experiences (i.e., war/abuse, etc.) as one of his psychosocial stressors in a progress note from December 2017, the October 2020 examiner reached the same conclusion as the May 2019 VA examiner. The examiner concluded, based on a review of the Veteran’s claims file, to include private and VA treatment records, that the Veteran’s main psychosocial stressors are his job, financial wellbeing, health care, and concerns about the well-being of his brother. In addition, the Veteran also reported stressors of medical problems, chronic pain, and hurricane Maria. The Board acknowledges that the Veteran submitted a statement from a private examiner in September 2012. While the examiner did not provide a diagnosis in accordance with the DSM IV or V criteria, she reiterated the Veteran’s accounts of his psychiatric problems and concluded that the Veteran’s “nervous problems” are at least as likely as not related to the Veteran’s stress of war, duties, and training. However, it does not appear the private examiner reviewed the Veteran’s claims file and she did not provide a complete rationale for her conclusion. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weight against contrary opinions.”). Additionally, the VA examiners reviewed the Veteran’s medical records, including the May 2012 opinion, and examination findings and found that the Veteran’s psychiatric disorder is not service related. For these reasons, the May 2012 private examiner’s opinion, submitted September 2012, is of minimum probative value and entitled to less weight than the May 2019 and June 2020 VA medical opinions. Additionally, in November 2012, the Veteran underwent a VA examination. However, as the VA examiner simply concluded that the Veteran does not suffer from PTSD or a sleep disorder, such opinion is provided no probative weight. Furthermore, to the extent that the Veteran asserts his acquired psychiatric disorder incurred in active duty, the Board finds that he is competent to report experiencing mental health symptoms, but not competent to determine the nature and etiology of such a disability, as it is a complex medical question beyond the ability of a layperson. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In conclusion, the probative evidence of record does not support a finding that the Veteran’s acquired psychiatric disorder was incurred in or aggravated by his active service. Even after reviewing the claims file and considering the Veteran’s military service in Iraq, the VA examiners found the Veteran’s psychiatric disorder due to post-military life stressors, such as being unemployed, financial hardships, medical concerns, environmental problems, and concern for his family members and not the result of his active military service. As noted, the Board has considered the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, the claim is not in equipoise. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, entitlement to service connection for an acquired psychiatric disorder is denied. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. B. Smith, 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.