Citation Nr: 21024582 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 12-14 056 DATE: April 23, 2021 ORDER Service connection for an acquired psychiatric disorder, other than posttraumatic stress disorder (PTSD) is denied. REMANDED Service connection for uterine cancer. Service connection for a bilateral eye disorder. FINDINGS OF FACT 1. The Veteran served on active duty from November 1975 to May 1983. 2. The evidence does not show that the Veteran’s depression, anxiety, or any other psychiatric disorder, is separate and distinct from her already service-connected PTSD disability. CONCLUSION OF LAW An acquired psychiatric disorder, other than PTSD, was not incurred in service. 38 U.S.C. §§ 1113, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 4.14 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION In May 2018, the Board remanded the appeal for additional development. The case has now been returned to the Board for further appellate action. Service Connection for Acquired Psychiatric Disorder Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). As a procedural matter, the Veteran has been service connected for PTSD since December 2009, and rated at 30 percent disabling. Regarding the issue of service connection for depression, anxiety, or an acquired psychiatric disorder other than PTSD, the Board notes that PTSD, depressive disorders, and anxiety disorders are all rated under the same criteria. See General Rating Formula for Mental Disorders, 38 C.F.R. § 4.130. In this regard, the Veteran’s VA treatment notes show sporadic notations for depression and anxiety. However, it is unclear that the Veteran has ever received another chronic mental health diagnosis. In this regard, at her April 2012 VA examination, the examiner found only a diagnosis of PTSD. Nonetheless, since that examination is dated, and her treatment records are updated with notations of depression and anxiety, that will qualify as current diagnoses. Even so, these symptoms substantially overlap with her PTSD symptoms. Her PTSD was noted to induce symptoms of anxiety and depression, amongst other things. There is no indication that she has another mental health diagnosis with differentiable symptoms than those contemplated by her 30 percent disability rating for PTSD. Given that the Veteran’s depressive symptoms are being compensated through her service-connected PTSD, to rate the Veteran’s symptoms separately would be considered pyramiding. The evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Notwithstanding the above, VA is required to provide separate evaluations for separate manifestations of the same disability which are not duplicative or overlapping. See Esteban v. Brown, 6 Vet. App. 259, 261 (1994). If it is not possible to distinguish between the respective symptoms because they are so intertwined, then the symptoms will be attributed to the service-connected disability. See 38 C.F.R. §§ 3.102, 4.14; Mittleider v. West, 11 Vet. App. 181, 182 (1998). The Board has also considered the Veteran’s lay statements that her disorder was caused by service. She is competent to report symptoms because this requires only personal knowledge as it comes to her through her senses. However, she is not competent to offer an opinion as to the etiology of her current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to her statements. In this regard, the Veteran has been service-connected for PTSD since 2009, and assigned a 30 percent rating. This disability rating was based, at least in part, on consideration of the Veteran’s depression and anxiety. Therefore, the Board determines that separate service connection and evaluation for an additional psychiatric disorder is not warranted since it has been encompassed by the rating assigned for her service-connected PTSD. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND With regard to her claim for uterine cancer, the Veteran has asserted that her uterine symptoms began during service, and her treatment records show she was diagnosed in 2009. At an October 2017 VA examination, the examiner confirmed her diagnosis but opined it was less likely due to service since there was no evidence that her condition was present in service. However, at her January 1983 separation examination, the treating provider specifically noted that the Veteran was being followed for dysfunctional uterine bleeding. Thus, the October 2017 VA opinion is inadequate as the premise relied on no findings during service, and a new opinion must be obtained. With regard to her claim for a bilateral eye disorder, the Veteran has long asserted that it was due to her respiratory disorders of asthma and sarcoidosis. During the pendency of this appeal, she became service connected for a respiratory disorder, and a July 2019 VA respiratory examiner noted that she reported her eye was impacted by the medications taken for the condition. No secondary or aggravating opinion has been obtained; remand is necessary. The matters are REMANDED for the following actions: 1. Identify and obtain any outstanding, pertinent, VA and private treatment records and associate them with the claims file. 2. Obtain an addendum opinion to assess the etiology of the Veteran’s uterine cancer. The entire claims file, to include her STRs and post-service treatment records, should be made available to, and reviewed thoroughly by the examiner. After this review, the examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s uterine cancer is related to any incident of her active service, to include the dysfunctional uterine bleeding noted at her separation examination. Another examination should not be scheduled unless deemed necessary by the examiner. A thorough rationale is required for any opinion rendered. 3. Obtain an addendum opinion to assess the etiology of the Veteran’s bilateral eye disorder. The entire claims file, to include her STRs and post-service treatment records, should be made available to, and reviewed thoroughly by the examiner. (Continued on the next page)   After this review, the examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s eye disorders are proximately due to, or aggravated beyond their natural progression by, her service-connected respiratory disability of asthma and sarcoidosis. Another examination should not be scheduled unless deemed necessary by the examiner. A thorough rationale is required for any opinion rendered. Emily Tamlyn Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yacoub, 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.