Citation Nr: 21022498 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 13-32 536 DATE: April 16, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder other than posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The preponderance of the evidence is against finding that an acquired psychiatric disorder other than PTSD pre-existed service, began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder other than PTSD are not met. 38 U.S.C. §§ 1110, 1111, 1112, 1113, 1131, 1132, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1966 to November 1970 and from September 1980 to May 1996. The Board remanded this claim in May 2015, December 2019, and September 2020 for further development. The matter has now returned to the Board for appellate review. As noted below, service connection for PTSD was previously denied by the Board, leaving the instant issue as the one in need of appellate review. Entitlement to service connection for an acquired psychiatric disorder other than PTSD. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). For claims, as here, filed after October 31, 1990, service connection may not be granted for substance abuse on the basis of service incurrence or aggravation. 38 U.S.C. §§ 105, 1110; 38 C.F.R. § 3.301(a); VAOPGCPREC 2-98. However, the law does not preclude a veteran from receiving compensation for an alcohol or drug abuse disability acquired as secondary to, or as a symptom of, a service-connected disability. Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). The Veteran contends he has a psychiatric disorder (originally claimed as PTSD) that is etiologically related to his active duty service. Alternatively, he contends that his psychiatric disorder, which includes a substance abuse disorder, pre-existed service and was aggravated by his service. The Veteran was provided a VA examination in April 2013. The examiner found that the Veteran did not have a diagnosis of PTSD but noted diagnoses of severe alcohol dependence and depression. In May 2015, the Board denied service connection for PTSD but recharacterized his claim to also include acquired psychiatric disorders other than PTSD and remanded his claim for further development. Pursuant to the Board remand, an addendum opinion was obtained in September 2015. The examiner concluded, “within a reasonable degree of scientific-professional certainty, that the Veteran has exhibited alcohol dependence for years and that he demonstrated anxiety and depression over all the negative effects of his drinking in various areas of his life.” In other words, the examiner opined that the Veteran had been experiencing anxiety and depression secondary to his alcohol dependence. Further, the examiner also found that, “with the same degree of certainty, that [the Veteran’s] alcoholism and his Adjustment Disorder were not caused by, aggravated by or related to his military service.” The examiner did not specify whether these conditions clearly and unmistakably had preexisted the Veteran’s service. Therefore, in the December 2019 remand, the Board concluded that the September 2015 addendum opinion did not substantially comply with the May 2015 remand directive in that the examiner failed to address whether any psychiatric disability began during the Veteran’s active duty service. Specifically, the Board asked the examiner to address the Veteran’s prescription of Valium, which was noted in a 1987 service treatment record (STR). Consequently, the claim was again remanded for consideration of this relevant information. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Dalton v. Nicholson, 21 Vet. App.23 (2007). The Veteran was thus afforded an additional VA examination in January 2020 during which the examiner noted the Veteran’s alcohol abuse disorder was then currently in remission and that he reported that his alcohol abuse pre-dated his military service. The examiner noted that while his STRs noted that he was prescribed Valium in service in relation to situational stress of a divorce, he denied actually taking the medication. Therefore, the examiner opined that it was less likely than not that his alcohol dependence is related to his military service. However, the examiner also indicated that the Veteran’s alcohol dependence may have been exacerbated by his service. Claimants are presumed to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that the injury or disease in question existed prior to service and was not aggravated by such service. 38 U.S.C. §§ 1111, 1137. Only such conditions as are recorded in entrance examination reports are to be considered as "noted." Crowe v. Brown, 7 Vet. App. 238, 245 (1994). See also Quirin v. Shinseki, 22 Vet. App. 390, 394-396 (2009). To this end, the Board observes that the report of the Veteran’s military entrance examination does not mention any pre-existing psychiatric condition. However, treatment records indicate that the Veteran reported that he began drinking at an early age–prior to his military service. The Board notes that the Veteran attended a VA substance abuse treatment facility on three occasions, most recently in October 2011. Treatment notes from this time indicate depression as being a “trigger” for his substance abuse and that he was, at the time, diagnosed with depressive disorder, not otherwise specified (NOS). This diagnosis also appears to be reflected in the report of his 2013 VA examination, although it was attributed as secondary to his substance abuse disorder. Therefore, in September 2020 the Board again remanded the claim in order to obtain an addendum opinion to clarify the nature and etiology of any acquired psychiatric disorder, to include whether the Veteran had a pre-existing psychiatric condition prior to military service. The examiner opined that any acquired psychiatric disability is less likely than not etiologically related to the Veteran’s military service. He indicated that there was no clear and unmistakable evidence to indicate that the Veteran had a pre-existing mental disorder to include alcohol dependence prior to enlistment to military service. He explained that there is no record in the Veteran’s claims file aside from the Veteran’s own statement that he began drinking at age 14 (though one exam had a conflicting start date at much later age of 39). The examiner also opined that the Veteran does not have any other mental health diagnosis other than alcohol use disorder, which is now considered in sustained remission. The examiner noted no medical report of any mental health disorder during service and no consistent report of mental health problems since military service other than for alcohol abuse. The examiner noted that the Veteran’s first alcohol treatment was recorded in 2002, which is six years after discharge from military service. Therefore, the examiner found no indication of a nexus between the Veteran’s military service and any current mental health symptoms (though he found no current mental health diagnosis other than alcohol dependence in remission), nor any medical indication of aggravation of any pre-existing mental disability during service. The Board finds that the evidence of record preponderates against the claim. There is no medical evidence to support that the Veteran had a pre-existing mental health condition prior to active duty service. Further, there is no medical evidence or opinion in support of the Veteran's claim of a nexus between military service and any acquired psychiatric disorder. The Board acknowledges the competent and credible lay statements from the Veteran regarding symptomatology. Nevertheless, to the extent that the Veteran attributes his disability to service, he is not competent to opine on the etiology of a complex medical condition, and his statements are therefore afforded no weight. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board affords more probative weight to the September 2020 examiner's opinion, for it is provided by a medical practitioner, reached based on medical principles and methods and sufficient facts consistent with the evidence in the claims file. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). Further, the Board emphasizes that pursuant to VA regulation, alcoholism as a primary disability is not a basis from which disability compensation may be granted. The evidence of record in this case does not indicate any other acquired psychiatric disorder that is eligible for service connection to support an award of service connection for alcohol use disorder on a secondary basis. Accordingly, the claims must be denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the claims, the doctrine is not for application. 38 U.S.C. § 5107. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Sneeringer, 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.