Citation Nr: 21073469 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 16-50 037 DATE: December 8, 2021 ORDER Entitlement to service connection for an acquired psychiatric condition is granted. FINDING OF FACT The Veteran's depression with alcohol abuse was proximately due to his service-connected cervical spine disability and cervicogenic headaches. CONCLUSION OF LAW The criteria for service connection for depression with alcohol abuse are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who served on active duty in the United States Coast Guard from June 1993 to July 2010, died in September 2018. The appellant is his surviving spouse and has been properly substituted as the claimant for purposes of processing the claim to completion. See 38 U.S.C. § 5121A. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran, before his passing, requested a hearing before the Board when he perfected his claim in October 2016 by filing a VA Form 9. However, the record is unclear as to whether or not the appellant would like a hearing before the Board. As the instant decision awards a full grant of benefits, the Board finds that the appellant is not prejudiced by lack of clarification of her request for a Board hearing. The Board notes that the Veteran was denied service connection for a personality disorder in an August 2014 rating decision, which was not appealed by the Veteran and is not before the Board. During his lifetime, the Veteran asserted that his depression was related to his cervical spine and cervicogenic headaches. See April 2014 VA 21-4138; May 2015 VA Form 21-4138. The Board agrees. Service connection may be established on a secondary basis for a disability which is proximately due to or aggravated by a service-connected disability. 38 C.F.R. § 3.310. Establishing secondary service connection requires (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). July 2014 and July 2016 VA examination reports show that the Veteran was diagnosed with major depressive disorder and alcohol use disorder. Moreover, the record is replete with all of his hospitalizations indicating the same. The Veteran was also service-connected for degenerative arthritis of the cervical spine and cervicogenic headaches. Accordingly, the first two elements of secondary service connection are established. After a full review of the record, and resolving reasonable doubt in his favor, the Board finds that the evidence is at least in equipoise that his depression with alcohol abuse is related to his service-connected cervical spine disability and cervicogenic headaches. Against the claim are the VA examiner opinions. The July 2014 VA examiner who submitted an addendum opinion in July 2016 essentially found that the Veteran was likely to develop an alcohol use disorder regardless of headaches given his ineffective coping strategies from which to handle stress and related the Veteran's alcohol use and depression to other factors such as family and financial stressors. The examiner emphasized that the Veteran's depression, and likely alcohol use, is in perceived life failures and those stressors were as much a cause of the headaches as they were the effect of them. And finally, he opined that aggravation was not shown to occur in direct relation to cervicogenic headaches, reasoning that they were part of the constellation of factors which maintained the Veteran's alcohol usage and depression but was not the sole cause of it. The September 2016 VA examiner largely agreed with the previous examiner noting the Veteran's depression was in response to psychological stressors which were both perpetuated by and ineffectively managed by his alcohol usage. Although both VA examiners opined negatively, they also, albeit circuitously, indicated that there was proximate causation between the Veteran's cervicogenic headaches and his depression with alcohol use disorder. Upon closer inspection of the VA examinations, the examiners conceded that the depression and alcoholism began during service, together they interact to reinforce and sustain each other (indicating a causal connection), his headaches were seen as a stressor, and alcohol was used for self-medication purposes for headaches. These factors indicate, and the Board finds, that the VA examiners found that there was at least some level of proximate causation with the cervicogenic headaches in relation to the Veteran's depression with alcohol use. See Bastien v. Shinseki, 599 F.3d 1301, 1306 (Fed. Cir. 2010) ("The evaluation and weighing of evidence and the drawing of appropriate inferences from it are factual determinations committed to the discretion of the fact finder.") In May 2015, the Veteran indicated he did not believe the VA examiners adequately addressed his lay statements or the other evidence of record. The Board agrees. In April 2014, the Veteran stated that he does not function the same anymore and that essentially, he is in an incredible amount of pain and wakes up every day with headaches, which are constant and cannot be alleviated, emphasizing how every facet of his life is controlled by his pain; due to this, he does not want to get out of bed. He noted how the pain consumed his life and how he began to self-medicate and eventually he noticed that he was on a "dark path". Additionally, VA treatment records further support the Veteran's contentions. A January 2015 VA treatment note shows the Veteran's worsening depression, and his coinciding increasing issues related to headaches, which suggests a connection. An April 2015 VA treatment record noted the Veteran's frustrations in that he did not think that his physician understood that he got headaches every day and that his headaches were directly linked to his mood and overall mental health, and when he got bad headaches it was hard for him to do anything and he would start to get "stupid ideas." May 2015 and July 2016 VA treatment records noted that he attributed his drinking to self-medication due to his severe chronic headaches. A July 2016 VA treatment record noted his suicidal thoughts were "an on and off thing" and that he has had headaches for the past 15 years, and when his head hurts "it gets to [him]." A September 2017 VA treatment record noted he drank about a quart of vodka per day and took multiple Tylenol pills with the vodka in an attempt to "stop the pain in [his] head." An October 2017 VA treatment record noted his headaches were a "major stressor". In affording the Veteran the benefit of the doubt, the Board finds that all elements needed to establish secondary service connection are shown. At the very least, the evidence in this case is in equipoise regarding whether the Veteran's depression with alcohol abuse was is proximately due to the pain associated with his service-connected cervical spine and headache disorders. The Board, therefore, finds that service connection is warranted for the Veteran's acquired psychiatric disorder. 38 U.S.C. § 5107; 38 C.F.R. § 3.310(a); see also Gilbert, 1 Vet. App. at 54. A. ADAMSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. J. Rogers, 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.