Citation Nr: 21067429 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 17-04 934 DATE: October 18, 2021 November 4, 2021 ORDER Service connection for an acquired psychiatric disorder, to include secondary to service-connected hiatal hernia and right knee disorders is denied. FINDING OF FACT The competent and credible evidence of record is against a finding that the Veteran's evidence of record of an acquired psychiatric disorder is from his active service including as secondary to hiatal hernia and right knee disorders. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric order to include secondary to service-connected disabilities have not been met. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1982 to October 1992. He also had additional National Guard service. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision. By way of background, the matter has been remanded multiple times by the Board for appropriate development, most recently in May 2021 for additional medical opinion. Substantial compliance with prior remands is now complete. See Stegall v. West, 11 Vet. App. 268; D'Aires v. Peake, 22 Vet. App. 97, 105 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). 1. Service connection for any acquired psychological disorder to include secondary to service-connected disabilities, is denied. The Veteran contends that his current psychiatric disorders, to include major depressive disorder (MDD), generalized anxiety disorder, insomnia disorder, and memory loss is a result of his active service or are secondary to his service-connected disabilities for hiatal hernia and right knee disabilities. 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, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may not be granted without medical evidence of a current disability and medical evidence of a nexus between the current disability and a service-connected disability. Wallin v. West, 11 Vet. App. 5099, 512-14 (1998). An increase in severity of a nonservice-connected disease or injury shall not be service-connected if it is due to the natural progression of the nonservice-connected condition. Allen v. Brown, 7 Vet. App. 439 (1995). The initial question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of MDD, generalized anxiety disorder and insomnia disorder, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The probative value attributed to a medical opinion issued by either VA or private treatment providers to support service connection depends on factors such as thoroughness, degree of detail, and whether there was a complete review of the veteran's claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The Board must consider whether the examining medical provider had a sufficiently clear and well-reasoned rationale, and a basis in supporting objective clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejects medical opinions that do not indicate whether the physicians examined the veteran, do not provide the extent of the examination, and do not provide supporting clinical data). The Court has held that a bare conclusion, even when reached by a health care professional, is not probative without an accurate factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). The Board notes that the Veteran's service treatment records reflect that on April 23, 1992, the Veteran was diagnosed with a viral infection and he also advised that he was feeling stressed due to his marital problems at the time. The Veteran was advised to follow up with mental health treatment if he continued to feel stressed. The Veteran never pursued any mental health treatment until he was hospitalized for depression over 17 years later in 2009. A December 30, 2019 VA examination correctly noted that the single incident of the Veteran complaining of marital stress in 1992 was "acute, transient and resulted in no residual disability" that did not continue after his service. The evidence reflects there were multiple exams and findings from the Regional Office in this matter. As noted previously, there were various Board remands in this matter to ensure full development of the issues. However, just because a medical opinion is inadequate to fully decide a claim does not mean that it is without any probative weight. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). Although the Veteran believes that his current psychiatric disability is related to service or a service-connected disability, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of a psychiatric disability are matters not capable of lay observation and require medical expertise to determine. See id. Moreover, whether the symptoms the Veteran claims to have experienced in service or following service are in any way related to his current disability is also a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("Although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). Thus, the Veteran's own opinion regarding the etiology of his current psychological disorders is not competent medical evidence. Despite multiple exams and different examiners, all concluded that there were no positive medical opinions that the Veteran's claimed condition was due to or aggravated by service-connected conditions. A persuasive Supplemental Statement of the Case (SSOC) was issued on March 3, 2019 which determined there was no direct service connection for an acquired psychiatric disorder absent an event, disease or injury during service. Moreover, the most recent August 18, 2021 SSOC fully considered whether any acquired psychological disorder was aggravated beyond its natural progression by a service-connected hiatal hernia or right knee disorder. The Board also agrees that evidence of record simply does not support that the Veteran's acquired psychological disorders were aggravated beyond natural progression by his service-connected disabilities. The Board finds that the medical opinion of record does not establish a nexus between a current diagnosis of current psychological disorder and an in-service event. The Board has reviewed the medical records relating to the Veteran's diagnosis of MDD, generalized anxiety disorder, insomnia disorder and memory loss. The Board has also reviewed the Veteran's assertions regarding his current diagnoses. None of the evidence presented establishes a medical nexus between a claimed in-service disease or injury and a present psychological disorder. The lack of a medical nexus is also fatal to the Veteran's claims of service connection for an acquired psychological disorder as secondary to hiatal hernia and right knee disorders. See Wallin, 11 Vet. App. at 512-14. Accordingly, because the evidence preponderates against the claim of service connection for a psychological disorder, the benefit-of-the-doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C. §§ 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). The examining medical providers, after a thorough review of the Veteran's claim file and personal examination, articulated a sufficiently clear and well-reasoned rationale explaining their diagnosis with a basis in supporting objective clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The probative value of their opinions is accordingly high. The Board finds the multiple opinions of the VA examiners to be significantly more probative than the Veteran's lay assertions. Accordingly, the Board denies service connection for an acquired psychological disorder to include as secondary to his service-connected hiatal hernia and right knee disorders. Christopher R. Seppanen Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Seppanen, Christopher R. 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.