Citation Nr: A21020200 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 200715-97966 DATE: December 17, 2021 ORDER Entitlement to service connection for a subarachnoid hemorrhage is denied. REMANDED Entitlement to service connection for an acquired psychiatric disability, to include unspecified depressive disorder and/or an unspecified mild neurocognitive disorder, either on a direct basis or as secondary to a service-connected disability is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a subarachnoid hemorrhage or residuals of a subarachnoid hemorrhage at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for a subarachnoid hemorrhage are not 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 August 1966 to July 1972. In a September 2016 rating decision, the Agency of Original Jurisdiction (AOJ) denied service connection for 1) subarachnoid hemorrhage, resolved, without residuals to include memory loss and 2) a mood disorder due to general medical conditions status post head trauma. The Veteran disagreed with the decision and prior to the issuance of an Statement of the Case (SOC), in August 2018 the Veteran requested Higher Level Review of the September 2016 rating decision. In an August 2019 Higher Level Review decision, the AOJ denied the claim for service connection for subarachnoid hemorrhage, resolved, without residuals to include memory loss and for unspecified depressive disorder to include an unspecified mild neurocognitive disorder (previously claimed as mood disorder due to general medical conditions status post head trauma as secondary to ischemic heart disease. The Veteran timely appealed the August decision to the Board of Veterans' Appeals (Board) and chose the Direct docket. See July 2020 VA Form 10182. Therefore, the Board may only consider the evidence of record at the time of the August 2018 RAMP opt-in, when the "evidentiary window" closed. 38 C.F.R. § 20.301. The Veteran initially claimed entitlement to service connection for a mood disorder, but the record suggests additional psychiatric diagnoses. Thus, the Board has characterized the claim to include any acquired psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Documents were added to the claims file after the evidentiary window closed. As the Board is deciding the claims of service connection for subarachnoid hemorrhage, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. As the Board is remanding the claim of service connection for an acquired psychiatric disability for further development, this additional evidence will be considered by the RO in the adjudication of that claim. Entitlement to service connection for a subarachnoid hemorrhage is denied. The Veteran seeks service connection for residuals of a subarachnoid hemorrhage to include memory loss, which he contends is due to a fall as a result of his service-connected coronary artery disease. 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). The 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 the Veteran does not have a current diagnosis of subarachnoid hemorrhage or any residuals of a subarachnoid hemorrhage and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The August 2016 VA examiner evaluated the Veteran and determined that, while the Veteran had a subarachnoid hemorrhage following a fall in December 2014, the subarachnoid hemorrhage had resolved and there was no residuals. Additionally, the examiner noted that the Veteran's memory issues were related to his neurocognitive disorder and not explained by an isolated subarachnoid hemorrhage. Further, despite treatment records through August 2016 being of record, VA treatment records do not contain a diagnosis of subarachnoid hemorrhage or any residuals. While the Veteran believes has a current diagnosis of subarachnoid hemorrhage or any residuals, he is not competent to provide a diagnosis in this case. The issue involves complex medical issues that go beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Thus, to the extent that the Veteran experienced a subarachnoid hemorrhage, the probative evidence of record does not establish current residuals, or relate the subarachnoid hemorrhage to the Veteran's military service or a service-connected disability. Accordingly, service connection for subarachnoid hemorrhage is denied. as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application and the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to service connection for an acquired psychiatric disability, to include unspecified depressive disorder and/or an unspecified mild neurocognitive disorder, either on a direct basis or as secondary to a service-connected disability, is remanded. The issue of service connection for an acquired psychiatric disability is remanded to correct duty to assist errors that occurred prior to the August 2018 RAMP opt in; the August 2016 VA examination of record is inadequate. The Veteran asserted that he had a mood disorder that was due to a general medical condition status post head trauma. He also has asserted that his head trauma was due to his service-connected ischemic heart disease. While the August 2016 VA examiner opined that the Veteran's psychiatric conditions were not the result of his ischemic heart disease, the examiner did not address whether an acquired psychiatric disability was aggravated by his ischemic heart disease. The opinion also appears not to consider the premise that the Veteran's alcohol use disorder was caused by his acquired psychiatric disability (i.e., using alcohol to self-medicate), such that a neurocognitive disorder could be proximately related to the acquired psychiatric disability. On remand, consideration should be given to these asertions. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate provider (with examination or telehealth interview, review of the record, etc., if needed) on the likely etiology of the Veteran's acquired psychiatric disability. Copies of all pertinent records should be made available to the examiner for review. The examiner should answer the following: (a.) Identify all acquired psychiatric disabilities diagnosed since July 2015, to include an unspecified depressive disorder, and identify if the Veteran's unspecified mild neurocognitive disorder is a manifestation of his depressive disorder or a separately diagnosed psychiatric disorder. (b.) For each diagnosed acquired psychiatric disability, is it at least as likely as not either (1) caused or (2) aggravated (defined as any increase in disability) his service-connected disability? The Veteran is service connected for ischemic heart disease and bilateral hearing loss. Please explain why or why not. The examiner should consider and address the 2018 report from Dr. Kerri Bresnen, submitted by the Veteran's attorney, to include the idea that the Veteran's alcohol use disorder is due to his acquired psychiatric disability, and determine if the diagnosed alcohol use disorder plays a role in the Veteran's neurocognitive disorder. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. J. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Eric Struening 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.