Citation Nr: 21004224 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 17-16 847 DATE: January 26, 2021 ORDER Entitlement to service connection for a psychiatric disability is denied. FINDINGS OF FACT 1. The Veteran’s psychiatric disability did not manifest during active service and there is no indication that the disability is causally related to active service. 2. The Veteran’s psychiatric disability is not causally related to or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a psychiatric disability are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active air service from March 2002 to April 2002. This case initially came before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). In February 2020, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In April 2020, the Board remanded the claim for additional development. The case has since been returned to the Board for further appellate review. Service Connection – Psychiatric Disability The Veteran maintains that his current psychiatric disability is caused or aggravated by his service-connected right and left shoulder disabilities. During the February 2020 hearing, he testified that he had depression and anxiety related to his service-connected left shoulder disability because of pain and lack of sleep. He stated that he could not do certain things with his son, participate in sports, and do certain things around the house. The Veteran’s service treatment records are unremarkable for any complaints, treatment, or diagnoses related to a psychiatric disability. His records indicated that he had a pre-existing injury to his left shoulder when he entered service and that he re-injured his shoulder during basic training and was discharged after only 26 days with an entry level separation. He is service connected for a left shoulder disability and a right shoulder disability secondary to his left shoulder disability. An August 2006 VA treatment record indicated that the Veteran was experiencing situational anxiety related to work stress and the premature birth of his son. The Veteran’s vocational rehabilitation records indicated that he was referred for a neuropsychological evaluation in June 2007. During the evaluation, the Veteran denied any significant level of depression but indicated that he felt discouraged about his future and was disappointed in himself. It was noted that he had attention deficit hyperactivity disorder and an anxiety disorder with specific phobias and performance anxiety. There was no mention of any relationship to his shoulders. An August 2007 VA treatment indicated that prior to having surgery for his left shoulder, the Veteran had anxiety and one episode of a panic attack. In March 2008, a depression screen was negative. In May 2008, he was seen for a follow up from shoulder surgery and reports of increased anxiety. Treatment records from the Vet Center dated from July 2008 to October 2008 indicated that the Veteran was seen for supportive therapy during a stressful time. He stated that he was living with is parents who still treated him like a child and wanted surgery to replace his shoulder. The report of an October 2008 VA examination indicated that the Veteran described some symptoms related to depression but did not describe any impairment in occupational or social functioning. The examiner noted that he had a history of polysubstance abuse in long-term remission but did ot meet the diagnostic criteria for any mood-related disorder. A February 2009 private treatment record indicated that the Veteran denied experiencing anxiety and depression. An April 2010 VA treatment record noted that the Veteran had a history of situational anxiety. His depression screen was negative. During a September 2010 VA examination, the Veteran reported that he was not depressed and was in a good mood most of the time. The examiner indicated that the Veteran did not meet the criteria for the diagnosis of a psychiatric disorder. The examiner noted that the Veteran reported transient symptoms of anxiety related to situational concerns, including financial status, his son’s disability, and his claim status with VA. The examiner opined that his reported transient symptoms appeared to be related to situational stress over his claim for an increased disability rating rather than directly related to the service-connected disability. The examiner also noted that there was no impairment in occupational or psychosocial functioning related to anxiety. In a November 2013 letter, a private physician’s assistant, M.S., noted that the Veteran had been suffering from depression and had been improving with the use of Wellbutrin. In June 2014 and July 2016 letters, a private physician, Dr. L.L., noted that he had been treating the Veteran for right shoulder pain. He also noted that the Veteran had been suffering from depression and had been improving with the use of Wellbutrin. He noted that depression was a very commons side effect of chronic uncontrolled pain. A December 2014 VA treatment record indicated that the Veteran’s depression screen was negative. It was noted that he had a history of anxiety disorder and had been prescribed bupropion (Wellbutrin) by a non-VA physician. It was noted that he would continue to be followed for anxiety by his community primary care physician. In June 2015, he was seen for a myriad of neurological symptoms and severe anxiety. It was noted that his neurological symptoms seemed to be most consistent with radiculopathy in the cervical region but could be related to musculoskeletal disease in the shoulders. In April 2015, a depression screen was negative. Private treatment records from Hope Orthopedics of Oregon indicated that his problem list noted onset of anxiety and depression in April 2016. In November 2016, he denied anxiety and depression. In July 2017, he reported experiencing depression and the assessment was major depressive disorder, single episode, unspecified. Private treatment records from TriWest Healthcare Alliance indicated that in June 2016, the Veteran complained of fits of rage and struggling to express his anger appropriately. He also reported having anxiety with panic attacks, which were worse at night, interrupted his sleep, and were due to posttraumatic stress disorder (PTSD) and a custody situation with his son. He also reported having a negative outlook on most things and relationship conflicts with is significant other regarding her sons. The diagnoses were PTSD and intermittent explosive disorder. It was noted that he and had an injured shoulder, which was relevant to treatment, but no explanation was given. In February 2019, similar symptoms were reported and the diagnoses were intermittent explosive disorder and PTSD. Private treatment records dated in October 2017 from New Perspectives Center indicated that the Veteran reported experiencing severe anxiety that was easily triggered. It was noted that he was recently separated and going through a divorce, had recently been released from jail for strangling his wife, and now had a restraining order. It was noted that he met the criteria for PTSD from a history of trauma, including sexual abuse as a child and physical and emotional as an adult. In July 2017 and February 2020, a VA examiner reviewed the claims file and opined that the Veteran’s claimed psychiatric disability was less likely than not proximately due to or aggravated by his service-connected shoulder disabilities, including chronic pain. The examiner noted that his treatment records did not support a causal link between his current psychiatric disability and his shoulder disabilities with chronic pain nor did his records demonstrate an aggravated level of psychiatric severity directly caused by his shoulder disabilities. The examiner noted that he appeared to have been diagnosed with PTSD and intermittent explosive disorder, which were unrelated to his shoulder disabilities. The examiner noted that although the Veteran had physical limitations related to his shoulder disabilities, his records did not support an aggravation of a psychiatric disability caused by the shoulder conditions. In this case, the Board finds the most probative evidence weighs against the claim. The evidence indicates that the Veteran first started reporting symptoms of situational anxiety in August 2006, over four years after he separated from service. At that time, he attributed his symptoms to his financial situation and the premature birth of his son. A June 2007 private neuropsychologist indicated that the Veteran had an anxiety disorder; however, there was no indication in that report that his anxiety was related to his shoulder disabilities. August 2007 and May 2008 VA treatment records noted that he experienced anxiety coinciding with his left shoulder surgery and follow-up treatment; however, the October 2008 and September 2010 VA examiners indicated that he did not meet the criteria for a psychiatric disorder, noting that although he described some psychiatric symptoms, there was no impact on occupational or social functioning. Dr. L.L. indicated that he was treating the Veteran for a shoulder disability and depression, noting that depression was a common side effect of chronic pain. However, the physician did not expressly attribute the Veteran’s depression to his right and left shoulder disabilities. Furthermore, the underlying private treatment records, while noting depression and a major depressive disorder, did not attribute those symptoms to his shoulder disabilities. More recently, private treatment records indicated that the Veteran was diagnosed with PTSD and explosive disorder. There is no indication from those records that his shoulder disabilities either caused or aggravated those psychiatric disorders. Furthermore, the July 2020 VA examiner’s opinion weighs against the claim. As noted above, the examiner indicated that it was less likely than not that the Veteran’s psychiatric disability was caused or aggravated by his service-connected shoulder disabilities. The examiner considered and addressed the relevant evidence of record, the Veteran’s contentions, and provided rationale for her opinion. For those reasons, the Board finds the VA examiner’s opinion significantly probative. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board has also considered the lay evidence. The Veteran is competent to describe what he has personally observed or experienced; however, to the extent his reports conflict with the contemporaneous medical evidence, the Board does not find his statements credible. Furthermore, the ultimate questions of diagnosis and etiology in this case extends beyond the immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. For these reasons, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a psychiatric disability is not warranted. 38 U.S.C. § 5107(b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Mishalanie, 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.