Citation Nr: 21010724 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 19-33 632 DATE: February 25, 2021 ORDER New and material evidence having been received, the previously denied claim of entitlement to service connection for claustrophobia is reopened. Entitlement to service connection for Post-Traumatic Stress Disorder (PTSD) is denied. Entitlement to service connection for claustrophobia is denied. Entitlement to service connection for an alcohol use disorder is denied. Entitlement to service connection for major depressive disorder is denied. Entitlement to service connection for social anxiety disorder is denied. REMANDED Entitlement to service connection for bipolar disorder is remanded. FINDINGS OF FACT 1. In an August 2011 rating decision, the Agency of Original Jurisdiction (AOJ) previously considered and denied a claim for service connection for claustrophobia. The AOJ did not consider service connection for any other psychiatric disorder in that rating decision. 2. The Veteran was notified of the August 2011 rating decision and of his appellate rights, but he did not appeal. There was also no evidence received within one year of the issuance of either rating decision. 3. Evidence received after the August 2011 rating decision, by itself or in conjunction with the evidence previously of record, relates to an unestablished fact necessary to substantiate the claim for service connection for claustrophobia. 4. The most probative evidence of record establishes that there is no current diagnosis of PTSD attributable to the Veteran’s verified in-service stressors, in accordance within the applicable VA regulation. 5. The preponderance of the evidence is against finding that the Veteran’s diagnosed claustrophobia began during active service or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence is against finding that the Veteran’s alcohol use disorder began during active service or is otherwise related to an in-service injury or disease. 7. The preponderance of the evidence is against finding that the Veteran’s major depressive disorder began during active service or is otherwise related to an in-service injury or disease. 8. The preponderance of the evidence is against finding that the Veteran’s social anxiety disorder began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. New and material evidence has been received after the final August 2011 rating decision, to reopen a claim for service connection for claustrophobia. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.160(d), 20.200, 20.201, 20.302, 20.1103. 2. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. 3. The criteria for service connection for claustrophobia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for an alcohol use disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for major depressive disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for service connection for social anxiety disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. The criteria for service connection for generalized anxiety disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Navy Reserves from November 1962 to March 1968 with active duty service from December 1964 to December 1966. He later served in the Navy Reserves from November 1972 to November 1973. These matters come to the Board of Veterans’ Appeals (Board) from a decision of the Agency of Original Jurisdiction (AOJ). In October 2018, The AOJ issued a rating decision that denied the Veteran’s claim for service connection for PTSD-agoraphobia; the AOJ had adjudicated the claim as a claim to reopen a previously denied claim for acquired psychiatric disorders, to include claustrophobia. The AOJ also expanded the claim to include service connection for an unspecified anxiety disorder and depressive disorder. In the decision, the AOJ reopened the claim for claustrophobia and continued its denial of all the psychiatric disorders. The Veteran timely disagreed in an October 2018 Notice of Disagreement (NOD) and perfected his appeal in a November 2019 VA Form 9. Then, in June 2020, the Veteran’s case was received at the Board. The Veteran was scheduled for a Board hearing in December 2020. Before the hearing, he expressed to the undersigned Veterans Law Judge that his diagnosed spasmodic dysphonia would make it difficult to provide that testimony verbally. So, he requested that his testimony be submitted in writing; the Veteran’s request was granted. On December 30, 2020, the Veteran’s written testimony was received an incorporated into the record. 1. New and material evidence having been received, the previously denied claim of entitlement to service connection for claustrophobia is reopened. The Board acknowledges the AOJ reopened the Veteran’s claustrophobia claim in its October 2018 rating decision. But the Board has a jurisdictional responsibility to consider whether it was proper for a claim to be reopened, regardless of whether the AOJ granted or denied an application to reopen. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). Entitlement to service connection for claustrophobia was denied in unappealed rating decisions dated in January 2011 and August 2011. As the Veteran did not perfect an appeal these decisions, they are final. To reopen a claim that has been denied by a final decision, the claimant must present new and material evidence with respect to the claim. 38 U.S.C. § 5108. “New evidence” means existing evidence not previously submitted to VA. 38 C.F.R. § 3.156 (a). “Material evidence” means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim, and it must raise a reasonable possibility of substantiating the claim. Id. For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The language of 38 C.F.R. § 3.156 (a) creates a low threshold for finding new and material evidence and views the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” Evidence “raises a reasonable possibility of substantiating the claim,” if it would trigger VA’s duty to provide an examination in adjudicating a non-final claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). The Veteran’s initial claustrophobia claim was received in August 2010. In that claim the Veteran specifically noted he was seeking service-connection for claustrophobia. Evidence submitted in support of that claim indicate his claim was for a mental condition related to working in the munitions handling room aboard the USS Rowan. See April 11, 2010, Statement at 1; January 10, 2011, Statement. At the time of the decision for that claim the information available to the AOJ included a confirmed diagnosis of claustrophobia. See June 21, 2011, Record by C.M.S., ANP. In that record, the Veteran denied observing symptoms associated with agoraphobia. Id. Other available records included the Veteran’s service treatment records (STRs), statements from the Veteran and his wife, as well as private treatment records. All those records were dated before 2012. In August 2011, the AOJ issued a rating decision denying the Veteran’s claustrophobia claim. The AOJ acknowledged found the record did not support a nexus between his diagnosed claustrophobia and service. The AOJ also mailed a copy of the decision to the address of record at that time. The record reflects the Veteran did not appeal that decision. Nor did he submit new and material evidence with one year after he was notified of that decision. In May 2018, the VA received a claim for service connection for “PTSD-agoraphobia.” He also submitted a VA Form 21-0781, Statement in support of claim for service connection for PTSD. The Veteran stated his PTSD stems from his service, while aboard the USS Rowan. See July 27, 2018, VA From 21-0781 at 1. The record reflects the Veteran did not submit statements or evidence discussing claustrophobia between the filing of his PTSD claim and the AOJ’s rating decision that notified him it reopened his claustrophobia claim. The period of time from the filing of his PTSD up to the issuance of the AOJs rating decision, the Veteran submitted a December 23, 2016, mental health assessment wherein the Veteran asserts he is seeking therapy to address challenges with anxiety, depression, and adjustment issues related to his time in service. See December 23, 2016, Treatment Plan by M.J., MSW, and P.E.C., PsyD. at 2. The record notes the diagnoses of major depressive disorder, social anxiety disorder, generalized anxiety disorder and rules out PTSD; claustrophobia is not mentioned. Id. at 1-2. Returning to the Veteran’s initial claustrophobia claim, the Board finds the AOJs August 2011 rating decision is final as the Veteran did not appeal nor submit new and material evidence concerning a psychiatric disorder within a year of being notified his claim was denied. 38 U.S.C. § 7105(c). On October 1, 2019, the VA received three lay statements pertaining to the Veteran’s diagnosed claustrophobia. The first statement, by the Veteran, reiterates that disorder is due to his working in the munitions room aboard the USS Rowan service and adds descriptions of symptoms he currently observes. See September 11, 2019, at 2. The second statement, by his wife, provides observations of the Veteran. See September 27, 2019, Statement from C.L.M. The third statement, by a friend, provides his observations of the Veteran and adds the Veteran indicated his diagnosed claustrophobia is due to an incident aboard the USS Rowan when he had to paint in a constricted area and blacked out. See September 12, 2019, Statement from J.H. The Board finds the evidence received on October 1, 2019, is new and material. The lay evidence describing the Veteran’s disorder post-dates the August 2011 rating decision. The lay evidence includes a description of an in-service event that was not previously considered; that is, an incident when the Veteran blacked out while painting inside the USS Rowan. See September 12, 2019 Statement from J.H. It is evidence that relates to a nexus between the Veteran’s service and diagnosed claustrophobia. And presuming its credibility, it raises a reasonable possibility of substantiating his claustrophobia claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Therefore, lay evidence submitted on October 1, 2019, is new and material evidence. And the Veteran’s claustrophobia claim is reopened. 2. Entitlement to service connection for PTSD The Veteran contends his diagnosed PTSD is due to his service on board the USS Rowan. See VA Form 21-0781. Generally, service connection claims require a Veteran to provide evidence of (1) a current disability, an (2) in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. 38 C.F.R. § 3.303. But PTSD claims have unique evidentiary requirements. In order to establish service connection for PTSD , a Veteran must satisfy three specific elements: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-5); (2) credible supporting evidence that the claimed in service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in service stressor. 38 C.F.R. § 3.304(f). As to the occurrence of the in-service stressor, if the claimed stressor is not combat related, a Veteran’s lay testimony regarding in-service stressors will not be sufficient to establish the occurrence of the stressor and must be corroborated by “credible supporting evidence.” Cohen v. Brown, 10 Vet. App. 128, 142-143 (1997). In order to prevail on a claim for benefits, the Veteran need only demonstrate there is an approximate balance of positive and negative evidence. Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). The Veteran is entitled to the “benefit of the doubt” when the evidence is approximately balanced. Id. at 53. Beginning with the Veteran’s service, his entrance exam for the Navy Reserves does not note any psychiatric disorders. See November 5, 1962, Report of Medical Exam. Nor did he report to the examiner that he had symptoms or diagnosis of a psychiatric disorder. See November 5, 1962, Report of Medical History. At entrance into active duty service the Veteran reported observing car, train, sea, or air sickness but denied depression or excessive worry. See December 7, 1964, Report of Medical History at 1. The doctor who evaluated his report noted the Veteran has “mild car sickness.” Id. at 2. That doctor did not note any psychiatric disorders during his clinical examination. See December 7, 1964, Report of Medical Exam. The record reflects the Veteran served aboard the USS Rowan as a boatswain’s mate, from December 1964 to December 1966. See DD214. The Veteran asserts that he had many duties, to include working as a helmsman (steering the ship) and painter. See April 11, 2010, Statement at 2, 5. And as a collateral duty, during general quarters (the ship’s call to battle stations) he worked as a projectile handler in the upper handling room of the ships five-inch gun; it was situated directly under the gun. Id. at 1. That duty was performed on two occasions: first, in 1965, for 44 days, working four hours on and four hours off; and the second occasion was in 1966, working 45 days. Id. He asserts the room was 15 feet in diameter. See August 30, 2010, Correspondence. He also asserts that, even though there are two guns aboard the ship, only one was used to fire rounds. See April 11, 2010, Statement at 1. The Veteran asserts that he took part in the sinking of, at least, one sampan (a small boat). Id. And some of the time, the ship was firing for target practice. Id. The ship’s newsletter dated June 17, 1966, states that in May and June 1966 the ship was in Southeast Asia to support U.S. forces ashore with its guns. That support included the firing of over 3,800 rounds of five-inch high explosives at enemy positions, to include bunkers, troops, structures, and six sampans. See WESTPAC 66 Edition No. 1, dated June 17, 1966. The Veteran returned to the Navy Reserves following his service aboard the USS Rowan. The medical exams following his active duty service do not note any psychiatric conditions. See February 20, 1967, and November 6, 1972, Report of Medical Exam. Nor did the Veteran report any mental health issues, to include excessive worry; he did continue to report car sickness. February 20, 1967, and November 6, 1972, Report of Medical History at 1. And in both reports, he noted “I am in good health.” Id. In December 2016, the Veteran sought therapy for challenges with anxiety, depression, and adjustment issues, associated with his time in service. The mental health professional, M.J., MSW, recorded the Veteran’s description of his service. The mental health professional noted the Veteran’s reports of intrusive memories, psychological reactivity, avoidance, poor concentration, and hypervigilance. See December 23, 2016, Mental Health Assessment by M.J., MSW, and P.E.C., PsyD. at 2. The mental health professional acknowledged the Veteran experienced in-service stressors, to include working in a shipboard munitions handling room during Vietnam, seeing 8-15 body bags offloaded from a ship, and observing a North Vietnamese prisoner-of-war get severely beaten. Even though the mental health professional listed those stressors, he indicated he endorse a diagnosis of PTSD at that time. But the mental health professional explained that a questionnaire he administered to identify PTSD (Posttraumatic Checklist-Modified) did not indicate a significant in-service stressor that validates a diagnosis of that disorder. Id. at 1. The Veteran was diagnosed with major depressive disorder, moderate, recurrent episode with anxious distress; generalized anxiety disorder; social anxiety disorder; and alcohol use disorder, mild. Id. at 2. The mental health professional indicated that he ruled out the diagnosis of PTSD. Id. The mental health counselor’s assessment was approved by a doctor, P.E.C., PsyD. Id. at 4. In March 2017, the same providers prepared a treatment plan that reiterated a lot of what was stated in their December 2016 mental health assessment but added a new diagnosis of bipolar spectrum disorder. The mental health professional noted the Veteran has a history if cyclic mood challenges that indicate the presence of bipolar spectrum disorder, but not bipolar II disorder. See March 1, 2017, Treatment Plan by M.J., MSW, and P.E.C., PsyD. at 1. Later, in June, October, and December 2017, the same mental health providers drafted other treatment plans that were identical to the one in March 2017. See June, October, and December 2017 Treatment Plans by M.J., MSW, and P.E.C., PsyD. at 1. And the one they completed in March 2018 reiterated the diagnosis of bipolar disorder, but not PTSD. See March 2018 Treatment Plan by M.J., MSW, and P.E.C., PsyD. at 1. In September 2018, the Veteran underwent a VA disability examination for PTSD. The Veteran reported that he did not have any mental health issues prior to service. Nor any treatment for a mental health issue during service. The examiner acknowledged the Veteran’s reports of claustrophobia following his discharge from service as well as his reports of nightmares about car crashes and persistent worry. See VA Disability Benefits Questionnaire (DBQ) at 6. As for current symptoms, the Veteran reported depression; anxiety, to include problems with elevators; sleep problems; irritability; decreased concentration; and decreased interest/engagement. The Veteran denied suicidal ideation, hallucinations, and problems maintaining interpersonal relationships. Id. at 7 The examiner acknowledged and considered the Veteran’s description of working in a munitions handling room aboard the USS Rowan, to include his presence in an enclosed room when the five-inch guns fired. The examiner also noted the Veteran’s fear of helplessness and anxiety attacks. But the examiner noted the stressors described do not meet the criteria for a PTSD diagnosis. Nor is it a stressor related to a fear of hostile military or terrorist activity. Nor a fear related to personal assault. Id. at 8. The examiner noted the Veteran symptoms do not meet the criteria for PSTD under the DSM-5. Id. at 8-9. But has other mental disorders, which are claustrophobia, unspecified anxiety disorder, and unspecified depressive disorder. Id. at 1. Then the examiner differentiated the symptoms attributable to each diagnosis. He noted the Veteran’s fears of confinement with active avoidance of perceived locations/situations of confinement is attributable to his diagnosed claustrophobia. Also, his pervasive nervousness/restlessness, social avoidance, irritability is associated with his diagnosed anxiety disorder. And his frequent feelings of sadness, decreased energy, and decreased interest, are attributable to his diagnosed depressive disorder. Id. at 2. The examiner also noted that the Veteran’s diagnoses cause social impairment with occasional decreases in work efficiency. But the examiner was unable to determine which of his diagnoses was responsible for his social and occupational functioning. Id. at 2-3. The examiner noted the Veteran has not been diagnosed with traumatic brain injury. Id. at 2. The examiner concluded PTSD was not incurred in or related to service. The examiner explained that the stressors the Veteran described do not meet the diagnostic criteria for PTSD. The examiner indicated there is no record of treatment or diagnosis of PTSD in service, when those stressors occurred. The examiner acknowledged the Veteran has exhibited symptoms associated with psychiatric disorders. But he attributed those symptoms to the diagnoses of claustrophobia, anxiety and depressive disorders. He also acknowledged the Veteran’s consumption of alcohol and associated that with a mild use disorder in the past and after service. Id. The examiner also opined that the Veteran’s diagnosed psychiatric disorders are not related to service. See September 2018 VA Medical Opinion at 2. The examiner acknowledged the Veteran’s reports of working in enclosed places but, after reviewing the evidence between service and his current diagnoses, did not see evidence that supports a nexus between them. The examiner found support for his conclusion in the Veteran’s reserves medical records, where the Veteran denied having any mental health issues. The record reflects that, in December 2019, the Veteran underwent another mental health assessment. The mental health professional, H.M., LPC, noted in her assessment that the Veteran described his service working in a munitions handling room was traumatic. See December 17, 2019, Assessment by H.M., LPC, at 2.In her clinical assessment she noted the Veteran has been diagnosed with PTSD and confirmed the diagnosis. She noted the stressor associated with his diagnosis is “learning of traumatic events to others” and “experiencing repeated exposure to details of traumatic events.” Id. at 3. She does not identify the experiences she identifies as those stressors. She added that the Veteran suffers from claustrophobia and anxiety. She also acknowledged a past diagnosis of bipolar disorder but did not endorse that diagnosis because the associated symptom is primarily impulsivity with money, which has been improving with his wife’s help. Id. at 3. She also found the Veteran suffers from anxiety. She noted he reports he was not claustrophobic before serving in the Navy and he has nightmares related to his time in service. She stated he is fidgety and is concerned with being trapped. Also, he must take medications for his anxiety to make their appointments. And she found that his anxiety interferes with his ability to live a normal life. Id. Treatment records related to the above assessment note the Veteran has communication problems that are due to spasmodic dysphonia. See January 6, 2020, Private Medical Record by H.M., LPC, at 2. Also, he is observing anxiety-provoking dreams, unexplained anger. See February 17 and March 9, 2020, Record by H.M., LPC, at 2. The Veteran was scheduled for a Board hearing in December 2020 but expressed to the undersigned Judge that his diagnosed spasmodic dysphonia would make it difficult to provide that testimony verbally and requested that his testimony be submitted in writing; the Veteran’s request was granted. On December 30, 2020, the Veteran’s written testimony was received. In it, he asserts he has been diagnosed with agoraphobia, claustrophobia, PTSD, Bipolar disorder. See December 30, 2020, Statement at 3. He also confirms he did not receive treatment for any psychiatric condition before service. Id. at 1. The Veteran explained that, even though his job specialty was as a boatswain’s mate, there were times he worked as part of the USS Rowan’s five-inch gun crew. Specifically, he worked as a projectile handler in the upper handling room, which was underneath the guns. Id. at 1-2. He also testified the operation of that gun led to instances where escape was not possible. He explained a carousel in the room tended to block the only hatch that allowed for escape. Id. at 2. He described occasions he was in the handling room when the guns were fired off the coast of Vietnam. The Veteran denied observing any psychological symptoms following his first week as part of the gun crew, except for sleep deprivation. But, after the third week, he observed a sense of anxiety when the five-inch gun fired. Id. The Veteran testified that, following service, he observed anxiety. And he started avoiding people and parties. As well as rooms where it appeared it would be difficult to escape, such as an obstructed exit door. The type of places he avoided included theaters, stairwells, and stating in other people’s homes. Id. The Veteran reports P.E.C., PsyD, and H.M., LPC, related his psychiatric disorders to service. Id. at 4. The Veteran also believes it is related to his service. He added that within a week of discharge, he observed a need to eject himself from his friend’s car while it was on the freeway. He explained that he observed he was feeling warm and had to get out of the car. Id. Turning to the Veteran’s claim for disability compensation, the first issue is whether there is medical evidence establishing a clear diagnosis of PTSD. Following the December 2019 mental health assessment by H.M., LPC, the Veteran was diagnosed with the PTSD according to the criteria set forth in the DSM-5. Thus, the record reflects a clear diagnosis of PSTD. 38 C.F.R. § 4.125(a). The next issue is whether the Veteran’s lay testimony, alone, can be sufficient to support an in-service stressor. The Board finds the Veteran must provide corroborating evidence for the asserted in-service stressor. The Veteran’s service treatment records do not reflect a diagnosis of PTSD while in service. Nor has the Veteran asserted he was diagnosed during service or sought medical attention for its symptoms during service. So, he has not established he is exempt of the requirement of corroborating evidence of an in-service stressor under 38 C.F.R. §§ 3.304(f)(1). Similarly, the record does not reflect nor does the Veteran assert he was a prisoner of war. So, he has not established he is exempt of the requirement of corroborating evidence of an in-service stressor under 38 C.F.R. §§ 3.304(f)(4). The Board notes the Veteran has submitted evidence suggesting he is a combat Veteran; however, the Board finds he has not asserted his diagnosed PTSD is related to combat with the enemy. Throughout the appeal period, he has asserted his PTSD is due to working in an enclosed space without an avenue for escape. See December 23, 2016, Mental Health assessment at 1; May 6, 2018, Statement in Support of Claim; August 2018 VA DBQ for PTSD at 8; December 12, 2019, Mental Health Assessment at 2. As a result, the Board does not address whether he is a combat Veteran under 38 U.S.C. § 1154. And also finds consideration of 38 C.F.R. § 3.304(f)(2) is not warranted. The Board acknowledges that some of the shelling conducted by the USS Rowan in Southeast Asia was directed at enemy forces; however, the Board finds he has not asserted any in-service stressor that is related to combat. The Veteran has confirmed that, to his knowledge, the guns were not always being fired at enemy forces. See April 11, 2010, Statement at 1. He has not asserted, nor indicated, that his PTSD is due to the firing of those guns on a particular day. Nor at any specific targets. Instead, he has indicated his PTSD is related to his general presence in the munitions room, described as an enclosed space with little chance for escape. See August 2018 VA DBQ for PTSD; December 12, 2019, Mental Health Assessment at 2. So, it is not apparent to the Board he is asserting his PTSD is associated with the intended targets of the five-inch rounds. Nor has the Veteran claimed any in-service stress that is related to fear of hostile military forces. He has consistently maintained that the fear he observed was due to his inability to escape the munitions room, generally. And that fear was due to machinery that tended to obstruct his avenue of escape. See Transcript dated December 2020 at 2. The record does not reflect assertions of fear due to enemy actions that would have affected the ship. So, consideration of 38 C.F.R. § 3.304(f)(3) is not warranted. In this case the Veteran has not established his in-service stressor is combat related; therefore, his lay testimony of its occurrence must by corroborated by credible supporting evidence. Cohen, 10 Vet. App. at 142-143. The Board recognizes the Veteran’s experience working inside the USS Rowan’s the munitions handling room is the claimed in-service stressor. See May 6, 2018 Statement in Support of Claim; August 2018 VA DBQ for PTSD; December 12, 2019, Mental Health Assessment at 2. The Board also recognizes the Veteran’s lay statements may be found competent and credible to support an in-service injury in non-PTSD claims. And opinions by mental health professionals cannot be used to establish the occurrence of a stressor. Moreau, 9 Vet. App. at 394-96 (1996). The Veteran’s service personnel records provide credible evidence weighing in favor of finding the stressor occurred. See DD214; Record of Naval Reserve Service; WESTPAC 66 Edition No. 1, dated June 17, 1966. These documents cumulatively support the Veteran claims that he was aboard the USS Rowan during periods of time the ship fired its weapon. Those documents add plausibility to his participation in the operation of the ship’s five-inch guns. In this PTSD claim, the evidence is approximately balanced on whether he participated in the firing of the USS Rowan’s five-inch guns. His service personnel records place him on the ship when it fired those weapons. And even though his military specialty is not one that normally performs those duties, it is consistent with a sailor’s service to be assigned collateral duties like the one described. Considering there is no affirmative evidence that affirmatively suggests otherwise, doubt was resolved in the Veteran’s favor. Gilbert, 1 Vet. App. at 54. The last issue is whether there is medical evidence that links current symptoms of PTSD to the Veteran’s experience working as a projectile handler in the USS Rowan’s munitions handling room. The Board finds the medical evidence weighs against finding there is a link. The December 2019 mental health assessment weighs in favor of finding a nexus. As a Licensed Professional Counselor (LPC), H.M., is competent to asses and diagnose mental and emotional disorders. In her assessment, she investigated his social, emotional, and medical history, to include his experiences aboard the USS Rowan; thus, the Board finds she was cognizant of the relevant aspects of his medical history. Nievez-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2006). Although the counselor notes the Veteran’s experience aboard the USS Rowan was traumatic, she indicates his diagnosis of PTSD is based on trauma(s) that may be unrelated to his service aboard that ship. See December 17, 2019, Assessment by H.M., LPC, at 2, 3. The Board recognizes she noted the Veteran’s report of fear of an inability to escape a small room aboard a ship. Id. at 2. But she indicates the stressors that led to her diagnosis of PTSD have to do with learning of trauma experienced by others, which could have occurred on or off the ship. Id. at 3. The counselor’s rationale does not help the Board evaluate her conclusion. It discusses the Veteran’s PTSD symptoms as well as symptoms of other psychiatric disorders. It does not relate particular stressors to his diagnosed PTSD. Id. Because she does not discuss or identify the traumatic events that are linked to his PTSD in her assessment, the Board is unable to evaluation how she came to her conclusion. As a result, the probative value of her opinion is diminished. Nievez, 22 Vet. App. at 301. So, the Board assigned it some, but not significant probative weight. The August 2018 VA medical opinion weighs against a nexus. As a psychologist, the examiner is competent and credible to evaluate and diagnose a psychiatric disorder. The examiner reviewed the Veteran’s file and acknowledged the Veteran’s lay statements. The examiner also acknowledged the mental health assessments that pre-dated his examination: He listed the medical records noting the psychiatric conditions other than PTSD. See August 2018 VA DBQ at 3. He also indicated he reviewed the November 23, 2016, assessment. Id. Thus, the Board finds the examiner was cognizant of the Veteran’s past medical history. Nievez, 22 Vet. App. at 301. The examiner explained his reasons for concluding the Veteran does not have PTSD from his experience in the USS Rowan’s munitions upper handling room. Id. at 11. The examiner attributed the symptoms found in the record to other psychiatric disorders. He also associated those symptoms to other disorders. Then, the examiner found that the criteria for PTSD was not met. The examiner found the Veteran’s experience in the munitions handling room is not adequate to support of diagnosis of PTSD. He also indicated that the Veteran’s reports of good health following service supports his conclusion. The Board finds the examiner’s explanation sufficient to evaluate whether the data he relied on connects to his conclusion. Nievez, 22 Vet. App. at 301. So, the Board assigned it significant weight. The December 23, 2016, mental health assessment by M.J., MSW, and P.E.C., PsyD, also weigh against finding there is a nexus. Although it is not clear if M.J. possesses the necessary license and qualifications to diagnose a mental disorder, Dr. P.E.C. is qualified to do so. In their assessment, they investigated his social, emotional, and medical history; so, the Board finds Dr. P.E.C. was cognizant of the relevant aspects of the Veteran’s medical history. Nievez, 22 Vet. App. at 301. Dr. P.E.C. considered the Veteran’s in-service stressors and explained why they do not support a diagnosis of PTSD. Dr. P.E.C. asserts that diagnostic testing indicates the stressor described was not severe enough to diagnose that disorder. See December 23, 2016, Mental Health Assessment by M.J., MSW, and P.E.C., PsyD. at 1. Although the rationale is brief, it is sufficient for the Board to evaluate whether the data Dr. P.E.C. relied on connects to his conclusion. Nievez, 22 Vet. App. at 301. And because it is brief, the Board assigned it some, but not significant weight. The Board favors the December 23, 2016, mental health assessment and August 2018 VA disability examination over December 2019 assessment that weighed in favor of a nexus. The Board may favor one medical opinion over another if it offers an adequate statement of reasons or bases. D’Aries v. Peake, 22. Vet. App. 97, 107 (2008). In this case, it is not clear to the Board that the counselor who prepared the December 2019 assessment diagnosed PTSD based on the same in-service stressor the Veteran has described during the appeal period; that is, working as a projectile handler in a munitions handling room. But, the VA disability examination and December 23, 2016, assessment clearly express they assessed whether the Veteran’s experience in the munitions handling supports a diagnosis of PTSD; they concluded it does not. In this case, the evidence is not evenly balanced on the issue of a nexus. The December 23, 2016, assessment and August 2018 VA disability examinations that weighed against a nexus outweighed the less probative December 2019 assessment. Thus, doubt could not be resolved in the Veteran’s favor. Gilbert, 1 Vet. App. at 54. As a result, he has not established a link between his claimed in-service stressor and diagnosed PTSD. In sum, doubt was resolved in the Veteran’s favor as to his actually working in the munitions handing room of the USS Rowan, but the medical evidence weighs against finding there is a link between that stressor and his diagnosed PTSD. Thus, he has not established entitlement to service connection for PTSD under 38 C.F.R. § 3.304(f). 3. Entitlement to service connection for claustrophobia. The Veteran contends his diagnosed claustrophobia is related to his experience working in the munitions handling room aboard the USS Rowan. See October 2018 NOD at 2. He asserts that it would have been difficult to escape his workspace, which caused a sense of fear, helplessness. He also reported observing panic or anxiety attacks, often. Id. Entitlement to service connection requires a Veteran to provide evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (2007). Also, a Veteran may establish service connection 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). Or for any increase in the severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progression of the nonservice-connected disease. 38 C.F.R. § 3.310(b) Entitlement to service connection under 38 C.F.R. § 3.310(a) or (b) requires evidence of three elements: (1) evidence of a current disability that is not service-connected; (2) evidence of a service-connected disability; and, (3) evidence of nexus establishing a connection between the service-connected disability and the current disability. 38 C.F.R. § 3.310. Lay evidence, such as a claimant’s statement, can be competent and sufficient to establish a diagnosis of a condition when (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing the symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007). A lay person’s statement is competent if he or she has personal knowledge which is gained through the senses, to include what is heard, felt, seen, smelled, and tasted. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran asserts that he did not observe symptoms of claustrophobia before service. See September 11, 2019, at 2. And his first observation of that disorder occurred a week after service, in 1966. Id. He added that since his discharge, he has observed symptoms of claustrophobia. Id. at 1. The Veteran described his observations of claustrophobia. He reports he has nightmares of being in claustrophobic situations, at a frequency of three per week. Id. He needs to take medication for claustrophobia to go up stairwells. Id. at 2. He avoids halls without windows, to include halls leading to or inside medical offices. Id. He also indicates that he associates his diagnosed claustrophobia with working in a munitions room aboard the USS Rowan. Id. at 2-3. The VA also received a statement from the Veteran’s wife, C.L.M., wherein she provides observations of the Veteran’s claustrophobia. She states she has known the Veteran for over 10 years and his symptoms have worsened through that time. She states the Veteran’s anxiety and claustrophobia interferes with their life: when traveling by car, the Veteran has to be in the front seat and have the window down; he will not travel by train or plane; when in a room, the door needs to stay open; as for public places, it needs to be a large open place; and, due to the stress of traveling, being in places, he isolates. See September 27, 2019, Statement from C.L.M. In addition, the VA received a statement from the Veteran’s friend, J.H. He indicates he has known the Veteran for over 20 years, has observed the Veteran’s symptoms of claustrophobia, and has no doubt the Veteran is afraid of enclosed spaces. Without indicating an approximate date, J.H. states he first observed symptoms of the Veteran’s claustrophobia when the Veteran was in his care: J.H. observed the Veteran was adamant about sitting in the front seat by the door. See September 12, 2019, Statement from J.H. J.H. also asserts the Veteran’s symptoms worsened over time. J.H. described instances when the Veteran had to cancel or reschedule a medical appointment because the Veteran could not use the elevator or stairwells. And he reported his personal observation of some of those instances: one on occasion, he time he took the Veteran to a medical appointment but they had to reschedule because the Veteran could not use the elevator nor could he make it all the way up to the floor where the medical office is located. And when J.H. took him to the rescheduled appointment, the doctor had to see the Veteran on the first floor. Id. J.H. indicated that medication was of some help. J.H. stated that, even though the Veteran had taken medication, he exhibited distress and sweated profusely. Also, the Veteran continued to be unable to use elevators. And he could not stay in the treatment room without the door being open. Id. J.H. reports the Veteran said his service in Vietnam may have caused his fear of enclosed spaces. And the Veteran described an incident aboard a ship when he had to paint in a constricted area, and he blacked out. Id. In July 2020, the VA received a statement from the Veteran wherein he asserts his fear of being in enclosed spaces prevented him from reenlisting because his training would have included SCUBA diving into small spaces. Also, the Veteran observes nightmares about being stuck in places. See July 2020 Statement. A. Entitlement to service connection under 38 C.F.R. § 3.303. Turning to the Veteran’s claim for disability compensation, the first issue is whether the Veteran has a current disability. The August 2018 VA DBQ confirmed the diagnosis of claustrophobia; thus, there is a medical diagnosis of a that disorder. See August 2018 VA DBQ for PTSD at 1. Resolving doubt in the Veteran’s favor, the Board finds the evidence supports a finding of an in-service incurrence. The lay evidence of record indicates there are two different in-service events, both aboard the USS Rowan sometime between December 1964 and December 1966: the first, his service as a projectile handler in the munitions handling room; and the second, an occasion where he was painting in a confined area on a lower level of the ship and blacked out. See September 11, 2019, Statement at 2; September 12, 2019, Statement from J.H. at 2. The Board finds the Veteran’s observations of working as a projectile handler credible. The Veteran is competent to report what he did, saw, heard, and sensed, while working aboard the USS Rowan. Layno, 6 Vet. App. at 469. Even though his job specialty was working as part of a general deck crew he has consistently described having the collateral duty of working as part of a gun crew during general quarters. And since his initial claim, in 2010, he has consistently maintained that while working in that enclosed space, he observed that he would be unable to escape. See August 30, 2010, Correspondence; April 11, 2011, Statement at 1; September 11, 2019 Statement at 2. Considering the consistency of his reports over the last 10 years—the Board finds his statements credible and assigned them significant weight towards finding his experience as a projectile handler is an in-service incurrence. The Board also finds the Veteran’s report of blacking out while painting in a confining area of the ship credible. The Veteran is competent to report an incident working in an area of the USS Rowan that he found confining. Layno, 6 Vet. App. at 469. And his friend, J.H., is competent to report that is what he heard the Veteran tell him. Id. As to the incident itself, the peculiarities of the event are significant enough that the Veteran is likely to have an accurate recollection of the event, even over the passage of time. As to the accuracy of J.H.’s report, he is likely to remember when his close friend disclosed what he believed to be the cause of his disability; also, the details of the event the Veteran described to him. Even though the Veteran has not corroborated the event, he has conceivably read it before submitting it. And by submitting his friend’s statement, he has endorsed it. So, So, the Board finds the statement by J.H. credible and assigned it significant weight towards finding the Veteran’s experience painting aboard the ship an in-service injury. The Veteran’s service medical records do not note any injuries or events of the kind described by the Veteran. But the Veteran has explained that he did not seek medical attention while in service for the incidents described above. Considering the incidents described above are not of a kind he would have required that he get medical care, the Board finds his explanation credible. So, the lack of medical evidence corroborating those events were weighed against him. As to the issue of an in-service incurrence, the Board finds the evidence is, at least, approximately balanced. Although the Veteran’s service medical records do not indicate he was injured by working in the munitions handling room and painting inside the ship, he has not asserted he sought medical attention for those events. And the probative lay evidence in the record is sufficient to support an in-service injury. Any doubt was resolved in the Veteran’s favor. Gilbert, 1 Vet. App. at 54. The next issue is whether there is a nexus between the Veteran’s diagnosed claustrophobia and service. The Board acknowledges the Veteran’s lay statements and observations of symptoms consistent with claustrophobia, but finds he is not competent to diagnose the disorder nor opine on its onset. Medical disorders such as claustrophobia are complex and a lay diagnosis, to include assertions of its presence within a year from service, is not competent. Jandreau, 492 F.3d at 1377. For the same reasons, the Board is not qualified to make those medical conclusions. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). So, the Board did not consider his lay statements and observations. The Veteran’s service medical records weigh against a nexus. He denied observing symptoms of any psychiatric disorder to medical professionals who were competent to determine whether a disorder was present. The Veteran denied observing symptoms of psychiatric disorders during several service medical exams following his tours on the USS Rowan. See February 20, 1967, and November 6, 1972, Report of Medical History. Considering he had reported some conditions, like car sickness, throughout several of those examinations—the Board presumes he would have reported observations of psychiatric conditions as well. See December 7, 1964, Report of Medical History at 1; November 6, 1972, Report of Medical History at 1. Also, his reports were made to medical providers who evaluated him at the time he made those statements and confirmed he did not have psychiatric disorders. So, his reports to those examiners and their evaluations were found credible. Since the exams were conducted not too long after his service aboard the USS Rowan, they were assigned significant probative weight against a finding of a nexus. The December 2019 mental health assessment weighs in favor of a nexus. The Board notes it has already found this assessment competent and determined the counselor, H.M. was cognizant of the relevant aspects of the Veteran’s medical history. Nievez, 22 Vet. App. at 301. Although the counselor discussed the Veteran’s work in an enclosed space and developing claustrophobia, it is not apparent that she has opined on the likelihood of a nexus. She does not render her own diagnosis of this disorder. See December 17, 2019, Assessment by H.M., LPC, at 3. Instead, she acknowledges the presence of the condition while primarily discussing his diagnosis of PTSD. Id. Nor does she explain a link between his service and claustrophobia in her rationale. So, the Board is unable to evaluate whether she has opined on the condition or recognized the presence of the disorder. And as a result, the probative value of her opinion is diminished. Nievez, 22 Vet. App. at 301. So, the Board assigned it some, but not significant weight. Even if the Veteran contends the counselor’s note that working on a ship developed claustrophobia constitutes a rationale, that statement would not enhance the probative value of the assessment. See December 17, 2019, Assessment by H.M., LPC, at 2. The probative value of the counselor’s assessment is, in part, based on explanation for her conclusion. Nievez, 22 Vet. App. at 301. And, if accepted as a rationale, it would be too conclusory for the Board to be able to evaluate it. The Board recognizes the counselor may have tacitly endorsed another medical professional’s association of claustrophobia and the Veteran’s service, but without a rationale for doing so, such an endorsement does not enhance the probative value already assigned to it. The probative value of the counselor’s assessment is, in part, based on her own medical conclusions and explanation for that conclusion. Nievez, 22 Vet. App. at 301. And a tacit endorsement does not clearly provide either. The September 2018 VA medical opinion weighs against a nexus. The Board notes it has already found the disability examination that is associated with this opinion competent. And even though the examiner did not note and record every lay observation of claustrophobia since service, the examiner acknowledged the Veteran had been observing symptoms of that disorder since his discharge from the service. See August 2018 VA DBQ at 6. So, the Board finds the examiner was cognizant of the relevant aspects of the Veteran’s medical history. Nievez, 22 Vet. App. at 301. The examiner identified the symptoms attributable to claustrophobia and distinguished them from other psychiatric disorders. See August 2018 VA DBQ at 2. Then, after viewing the disorder on its own, opined that the Veteran’s experience working in enclosed spaces did not cause his claustrophobia. See September 2018 VA Medical Opinion at 4. The examiner found indicated Veteran’s denial of observing psychiatric symptoms during his service medical exams support his conclusion. Id. The Board finds the examiner’s rationale sufficient to evaluate whether the data he relied on connects to his conclusion. Nievez, 22 Vet. App. at 301. Since the examiner evaluated this disorder apart from the Veteran’s other diagnosed disorders, the Board assigned it great weight against a nexus. In this case, the evidence is not evenly balanced on the issue of a nexus. The December 2019 assessment that weighed in favor of the claim was of little probative value. Weighing against the claim is the more probative September 2018 VA medical opinion that concluded there is no nexus. And that examiner’s conclusion was supporting by the Veteran’s service medical records, which do not note or find the presence of psychiatric conditions. So, doubt could not be resolved in the Veteran’s favor. Gilbert, 1 Vet. App. at 54. As a result, he is not entitled to service connection for claustrophobia under 38 C.F.R. § 3.303(a). B. Entitlement to service connection under 38 C.F.R. § 3.310. The next question is whether there is evidence that any of his service-connected disabilities proximately caused or aggravated his diagnosed claustrophobia. The Veteran has not alleged any of his service-connected disabilities, to include diabetes mellitus type II, left ear hearing loss, caused or aggravated his diagnosed claustrophobia. And the record does not raise the inference that any of them did. So, the Board finds there is no evidence of entitlement to service connection on a secondary basis at this time. As a result, the Veteran has not established entitlement to service connection under 38 C.F.R. § 3.310(a) or (b). 4. Entitlement to service connection for an alcohol use disorder. The Veteran contend his alcohol use disorder is related to service. See December 2020 Statement at 4. Alternatively, the Veteran contends his alcohol use disorder is secondary to anger and depression. Id. To the extent that the Veteran may be claiming that an alcohol abuse disorder began during service, entitlement to service connection for alcohol abuse which began during service must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426 (1994). VA compensation shall not be paid if the claimed disability or death was the result of the person’s own willful misconduct or abuse of alcohol or drugs. 38 U.S.C.A. §§ 105, 1110; 38 C.F.R. §§ 3.1 (n), 3.301(c). Compensation is precluded for (1) primary alcohol abuse disabilities, and (2) secondary disabilities (such as cirrhosis of the liver) that result from primary alcohol abuse. The United States Court of Appeals for the Federal Circuit defined “primary” as meaning an alcohol abuse disability arising during service from voluntary and willful drinking to excess. See Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). Therefore, entitlement to service connection for the Veteran’s alcohol abuse disability which began during active duty service cannot be established as a matter of law. Nevertheless, a veteran may receive compensation for an alcohol or drug abuse disability acquired as secondary to, or as a symptom of, a veteran’s service-connected disability. In other words, 38 U.S.C.A. §§ 1110, 1131 do not preclude compensation for an alcohol or drug abuse disability secondary to a service-connected disability or use of an alcohol or drug abuse disability as evidence of the increased severity of a service-connected disability. Beginning with the December 23, 2016, assessment, the Veteran reported he began consuming alcohol after entering service. See December 23, 2016, Mental Health Assessment by M.J., MSW, and P.E.C., PsyD. at 1. And he drank heavily from the ages of 25 to 53. Then, at 62, he stopped drinking on a daily basis. Id. at 2. The assessment notes the diagnosis of alcohol use disorder, mild. Id. There is no explanation for the diagnosis. The treatment plans associated with the December 2016 assessment continue to note the diagnosis of alcohol use disorder, mild. But there is no additional discussion about the disorder. See Treatment Plans by M.J., MSW, and P.E.C., PsyD. dated March, October, and December 2017; March 21, 2018. The August 2018 VA disability examination acknowledged and addressed the Veteran’s diagnosed alcohol use disorder. See August 2018 VA DBQ at 3, 11. The examiner noted the Veteran had been diagnosed in the past; the examiner did not diagnose the Veteran with an alcohol use disorder. Id. at 1. The examiner noted the Veteran use of alcohol as a way to deal with nerves. Id. at 6. And the Veteran has not consumed alcohol excessively since 2007. Id. at 7. Currently, he consumes alcohol, occasionally. Id. The Veteran’s December 2020 statement included the Veteran’s report of alcohol consumption. The Veteran confirms he started drinking in the military. And he reports he drank because of anger and depression. See December 30, 2020, Statement at 4. After a review of the record, the Board concludes that service connection for an alcohol abuse disorder is not warranted. The Veteran has not alleged any of his service-connected disabilities, to include diabetes mellitus type II, left ear hearing loss, caused or aggravated his diagnosed claustrophobia. The Board acknowledges the Veteran has asserted his alcohol use disorder is due to anxiety and depression, but those disorders are not service connected. See December 2020 Statement at 4. So, consideration of service-connection due to those disorders is not warranted. Also, the record does not raise the inference that any of his service-connected disabilities caused or aggravated his diagnosed alcohol use disorder. So, the Board finds there is no evidence of entitlement to service connection on a secondary basis at this time. As a result, the Veteran has not established entitlement to service connection under 38 C.F.R. § 3.310(a) or (b). 5. Entitlement to service connection for an acquired psychiatric disorder (major depressive disorder, social and generalized anxiety disorder). Even though the Veteran has not asserted his diagnosed major depressive disorder, social anxiety disorder, and alcohol use disorder is related to his service, the VA must consider it a claim for any mental disability reasonably encompassed by factors, to include the information the claimant submits. Clemons, 23 Vet. App. at 4. The questions for the Board are whether there is sufficient evidence to find the Veteran’s diagnosed major depressive disorder as well as social and generalized anxiety disorders are related to his service or secondary to any other service-connected disability. For the reasons discussed below, the Board concludes that the evidence does not supports a grant of service connection on a direct or secondary basis. A. Entitlement to Service Connection for major depressive disorder. The first issue is whether the Veteran has a current disability. A December 23, 2016, assessment diagnosed the Veteran with major depressive disorder, which was confirmed in the August 2018 VA disability examination; thus, there is a current medical diagnosis of that disorder. The next issue is whether the Veteran has an in-service incurrence or aggravation of a disease or injury. For the reasons explained above, the Board has resolved doubt in the Veteran’s favor and found the Veteran’s service as a projectile handler is an in-service incurrence or injury. Also, the incident when he blacked out while painting inside the USS Rowan. The next issue is whether there is a nexus between the Veteran’s diagnosed major depressive disorder and service. The Board finds the medical evidence of record does not support a finding of a nexus. The Board notes it has already found the Veteran’s service medical records weigh against a nexus. As explained, he denied observing symptoms of any psychiatric disorder to medical professionals who were competent to determine whether a disorder was present. And because those exams were conducted not too long after his service aboard the USS Rowan, they were assigned significant probative weight against a finding of a nexus. The December 2019 assessment does not address whether the Veteran’s diagnosed major depressive is related to his service. See December 17, 2019, Assessment by H.M., LPC, at 3. So, it was not considered. The December 23, 2016, assessment by Dr. P.E.D. weighs in favor of a nexus. The Board notes it has already found this assessment competent and determined Dr. P.E.C. was cognizant of the relevant aspects of the Veteran’s medical history. Nievez, 22 Vet. App. at 301. Although Dr. P.E.C. has diagnosed the Veteran with major depressive disorder, he did not explain his reasons for doing so. The assessment provides a lengthy and informative history but does not indicate the factors that led to the diagnosis of this disorder. More importantly, Dr. P.E.C. does not indicate which experience during service led to the diagnoses of the disorder. Without more, the Board is unable to determine what information Dr. P.E.C. relied on to render his conclusion. Nievez, 22 Vet. App. at 301. So, the opinion was assigned little probative weight. Dr. P.E.C.’s March 2018 treatment plan provides some more information, but not enough to determine if he decided the listed stressors are related to his depressive disorder. See March 21, 2018, Treatment Plan by M.J., MSW, and P.E.C., PsyD. at 1. So, even if these medical letters are read together, the Board remains unable to determine what information Dr. P.E.C. relied on to render his conclusion. Nievez, 22 Vet. App. at 301. So, even if Dr. P.E.C.’s assessment and treatment plans were read together, the probative weight assigned to them all would not be any greater. The September 2018 VA medical opinion weighed against a nexus. The Board notes the disability examination that is associated with this opinion has already found this assessment competent and determined the examiner was cognizant of the relevant aspects of the Veteran’s medical history. Nievez, 22 Vet. App. at 301. The examiner identified the symptoms attributable to this disorder and distinguished them from other psychiatric disorders. See August 2018 VA DBQ at 2. Then after viewing the disorder on its own, opined that the Veteran’s experience working in enclosed spaces did not cause his diagnosed major depressive disorder. See September 2018 VA Medical Opinion at 4. The examiner indicated Veteran’s denial of observing psychiatric symptoms during service medical exams after his tours aboard the USS Rowan support his conclusion. Id. The Board finds the examiner’s rationale sufficient to evaluate whether the data he relied on connects to his conclusion. Nievez, 22 Vet. App. at 301. Considering the examiner was able to evaluate this disorder apart from the Veteran’s other diagnosed disorders, the Board assigned it great weight against finding a nexus. In this case, the evidence is not evenly balanced on the issue of a nexus. The December 23, 2016, assessment weighing in favor of a nexus did not specify whether it stems from events in service; so, it was of little probative value. Weighing against the claim is the more probative September 2018 VA Medical Opinion that concluded there is no nexus. Also, the Veteran’s service medical records, during and after service, do not report observations of psychiatric conditions. So, doubt could not be resolved in the Veteran’s favor. Gilbert, 1 Vet. App. at 54. As a result, he is not entitled to service connection for major depressive disorder under 38 C.F.R. § 3.303. The next question is whether there is evidence that any of his service-connected disabilities proximately caused or aggravated his diagnosed major depressive disorder. The Board finds there is not. The Veteran has not alleged any of his service-connected disabilities, to include diabetes mellitus type II, left ear hearing loss, caused or aggravated his major depressive disorder. And the record does not raise the inference that any of them did. So, the Board finds there is no evidence of entitlement to service connection on a secondary basis at this time. As a result, the Veteran has not established entitlement to service connection under 38 C.F.R. § 3.310(a) or (b). B. Entitlement to service connection for social and generalized anxiety disorder. The first issue is whether the Veteran has a current disability. A December 23, 2016, assessment diagnosed the Veteran with social and generalized anxiety disorder, and the presence of an anxiety disorder was confirmed in the August 2018 VA disability examination; thus, there is a current medical diagnosis of an anxiety disorder. The next issue is whether the Veteran has an in-service incurrence or aggravation of a disease or injury. For the reasons explained, the Board has resolved doubt in the Veteran’s favor and found the Veteran’s service as a projectile handler is an in-service incurrence or injury. Also, the incident when he blacked out while painting inside the USS Rowan. The next issue is whether there is a nexus between the Veteran’s diagnosed social anxiety disorder and service. The Board finds the medical evidence of record does not support a finding of a nexus. The Board notes it has already found the Veteran’s service medical records weigh against a nexus. As explained, he denied observing symptoms of any psychiatric disorder to medical professionals who were competent to determine whether such a disorder was present. And because those exams were conducted not too long after his service aboard the USS Rowan, they were assigned significant probative weight against a finding of a nexus. The December 2019 assessment does not address whether the Veteran’s diagnosed social anxiety disorder is related to his service. So, it was not considered. See December 17, 2019, Assessment by H.M., LPC, at 3. The December 23, 2016, assessment by Dr. P.E.D. weighs in favor of a nexus. The Board notes it has already found this assessment competent and determined Dr. P.E.C. was cognizant of the relevant aspects of the Veteran’s medical history. Nievez, 22 Vet. App. at 301. Although Dr. P.E.C. has diagnosed the Veteran with social and generalized anxiety disorders, he did not explain his reasons for doing so. See December 23, 2016, Mental Health Assessment by M.J., MSW, and P.E.C., PsyD. at 2. Dr. P.E.C. does not indicate which experience during service led to the diagnoses of those disorders. Without more, the Board is unable to determine what information Dr. P.E.C. relied on to render his conclusion. Nievez, 22 Vet. App. at 301. So, the opinion was assigned little probative weight. Dr. P.E.C.’s March 2018 treatment plan provides some more information, but not enough to determine if he decided the listed stressors are related to his anxiety disorders. See March 21, 2018, Treatment Plan by M.J., MSW, and P.E.C., PsyD. at 1. So, even if these medical letters are read together, the Board remains unable to determine what information Dr. P.E.C. relied on to render his conclusion. Nievez, 22 Vet. App. at 301. So, even if Dr. P.E.C.’s assessment and treatment plans were read together, the probative weight assigned to them all would not be any greater. The September 2018 VA medical opinion weighed against a nexus. The Board notes the disability examination that is associated with this opinion has already found this assessment competent and determined the examiner was cognizant of the relevant aspects of the Veteran’s medical history. Nievez, 22 Vet. App. at 301. The examiner identified the symptoms attributable to his diagnosed anxiety disorder and distinguished them from other psychiatric disorders. See August 2018 VA DBQ at 2. Then, after viewing the disorder on its own, he opined that the Veteran’s experience working in enclosed spaces did not cause his anxiety disorder. See September 2018 VA Medical Opinion at 4. The examiner indicated Veteran’s service medical records, noting his denials of observing psychiatric symptoms following his service aboard the USS Rowan, supports his conclusion. Id. The Board finds the examiner’s rationale sufficient to evaluate whether the data he relied on connects to his conclusion. Nievez, 22 Vet. App. at 301. Considering the examiner was able to evaluate this disorder apart from the others, the Board assigned it great weight against a nexus. In this case, the evidence is not evenly balanced on the issue of a nexus. The December 23, 2016, assessment that diagnosed major depressive disorder weighed in favor of a nexus but did not clearly specify whether it stems from events during service. Weighing against the claim is the more probative September 2018 VA Medical Opinion that concluded there is no nexus. Also, the Veteran’s service medical records, during and after service, do not report observations of psychiatric conditions. Thus, the doubt could not be resolved in the Veteran’s favor. Gilbert, 1 Vet. App. at 54. As a result, he is not entitled to service connection for social and generalized anxiety disorders under 38 C.F.R. § 3.303(a). The next question is whether there is evidence that any of his service-connected disabilities proximately caused or aggravated his diagnosed social anxiety disorder. The Board finds there is not. The Veteran has not alleged any of his service-connected disabilities, to include diabetes mellitus type II, left ear hearing loss, caused or aggravated his anxiety disorder. And the record does not raise the inference that any of them did. So, the Board finds there is no evidence of entitlement to service connection on a secondary basis at this time. As a result, the Veteran has not established entitlement to service connection under 38 C.F.R. § 3.310(a) or (b). In sum, the Veteran has not established entitlement to service connection for an acquired psychiatric disorder, including PTSD, claustrophobia, alcohol use disorder, major depressive disorder, and social anxiety disorder. Also, the Veteran has not raised any other issues nor have any other issues been reasonably raised by the record. Robinson v. Peake, 21 Vet. App. 545, 552-54 (2008) (holding the Board is not required to address issues unless specifically raised by the claimant or reasonably raised by the record). The Board regrets a more favorable decision could not be reached in the Veteran’s case. REASONS FOR REMAND 1. Entitlement to service connection for bipolar disorder is remanded. Even though the Veteran has not asserted his diagnosed major bipolar disorder is related to his service, the VA must consider it a claim for any mental disability reasonably encompassed by factors, to include the information the claimant submits. Clemons, 23 Vet. App. at 4. Although the Board regrets the delay, the Veteran’s claim must be remanded for a new medical opinion before the Board is able to decide on the merits. There is no medical opinion in the record that addresses the likelihood of a nexus between that disorder and his service. The Board acknowledges the Veteran has a diagnosed bipolar disorder which was not addressed in the August 2018 VA medical examination; therefore, the Veteran’s claim must be remanded before the Board is able to decide on the merits. The VA has a duty to assist claimants and must make “reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claimant’s claim for benefits.” 38 U.S.C. § 5103A(a)(1). And part of that duty to assist includes obtaining a medical opinion when an “opinion is necessary to make a decision on the claim.” 38 U.S.C. § 5103A(d)(1). The VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease, occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability; but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. 38 U.S.C. § 5103A(d)(2); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Beginning with the evidence of record, a March 21, 2018, mental health treatment plan notes the diagnosis of bipolar II disorder, most recent episode depressed with anxious distress. See March 2018 Treatment Plan by M.J., MSW, and P.E.C., PsyD. at 1. The August 2018 VA disability examination did not address whether that disorder. But later, in a December 2019 mental health assessment, a mental health professional noted she does not endorse the presence of that disorder. See December 17, 2019, Assessment by H.M., LPC, at 2. A new VA disability examination is warranted for the Veteran’s diagnosed bipolar disorder. McLendon, 20 Vet. App. at 81. There is a medical diagnosis of that disorder. As to an in-service injury, the Board has resolved doubt in his favor. And there is not enough information for the Board to make a fully informed evaluation of whether service connection is warranted. So, a remand is required for a medical opinion that addresses entitlement to service connection for his diagnosed bipolar disorder. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his diagnosed bipolar disorder. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: a. Is it at least as likely as not (i.e. a 50 percent probability or greater) that the Veteran’s bipolar disorder was incurred in or is otherwise related to an active duty service period or an injury incurred during a period of inactive service? The Veteran’s active duty service periods are December 1964 to December 1966. The examiner, in coming to his or her conclusion, is asked to comment on the following: i. The Veteran’s claims that his experience working in the USS Rowan’s munitions handling room led to his psychological condition. The munitions handling room is a small enclosed space situated below shipboard cannons. Also, the small hatch to get in and out of the room tended to get obstructed, making escape appear unavailable. ii. The Veteran’s claim that his experience painting inside an enclosed area of the USS Rowan led to his psychological condition. On one occasion, he blacked out while painting. iii. Discuss the March 21, 2018, mental health treatment plan by P.E.C., PsyD, that diagnosed the Veteran with bipolar II disorder. iv. Discuss the December 17, 2019, mental health assessment by H.M., LPC, that does not endorse the diagnosis of bipolar disorder. Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Dean, Michael S. 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.