Entitlement to service connection for an acquired psychiatric disability is denied.

Citation Nr: 26001454 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 19-36 642 DATE: January 30, 2026 ORDER Entitlement to service connection for an acquired psychiatric disability is denied. FINDING OF FACT The Veteran's current acquired psychiatric disability did not have its inception in service, is not causally related to an in-service disease or injury, and is not caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disability have not been met. 38 U.S.C. § 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1970 to April 1972. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from a June 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which, in pertinent part, denied service connection for an acquired psychiatric disability. The Veteran submitted a Notice of Disagreement (NOD) in June 2018, and the RO issued a Statement of the Case (SOC) in October 2019. The Veteran perfected a timely appeal via submission of a VA Form 9 in November 2019. In June 2023, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In an April 2024 decision, the Board remanded the claim for additional development. Upon completion of the additional development, the RO issued a Supplemental Statement of the Case (SSOC) in February 2025, denying service connection for an acquired psychiatric disability. The claim was thereafter returned to the Board for further appellate review. In a July 2025 decision, the Board again remanded the claim for additional development. Upon completion of the additional development, the RO issued an SSOC in October 2025, denying service connection for an acquired psychiatric disability. The claim was thereafter returned to the Board for further appellate review. As will be discussed in further detail below, the Board finds that there has now been substantial compliance with the Board's remand directives, as VA has obtained an adequate examination and opinion. Neither the Veteran nor his representative has argued otherwise. Stegall v. West, 1 Vet. App. 268, 271 (1998). Entitlement to service connection for an acquired psychiatric disability. The Veteran asserts multiple theories of entitlement with respect to his claim of entitlement to service connection for an acquired psychiatric disability. In his original application for compensation, the Veteran contended that his acquired psychiatric disability is directly related to his active service and/or is secondary to pain from his service-connected back disability. See April 2017 VA Form 21-526EZ. During the June 2023 Board hearing, the Veteran claimed that his acquired psychiatric disability is due to his service-connected tinnitus and bilateral hearing loss. Most recently, the Veteran has denied that his mental health symptoms are related to any of his service-connected disabilities. See October 2025 VA examination report. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for direct service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310. The three element test for secondary service connection requires evidence of: (1) a current disability; (2) a separate disability already service-connected; and (3) a causal relationship, i.e., a nexus, establishing that the current disability is due to, or aggravated beyond its natural progression by, the service-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of observable symptoms that are in his or her personal knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77. When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Id. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran's service treatment records (STRs) are silent for any complaints, observation, or treatment for a psychiatric disability. At his November 1969 enlistment examination, his psychiatric condition was assessed and determined to be normal. The accompanying report of medical history reflects the Veteran's denial of having, or ever having had, frequent trouble sleeping, depression or excessive worry, nervous trouble of any sort, or an excessive drinking habit. At his February 1972 separation examination, his psychiatric condition was again assessed and again determined to be normal. The accompanying report of medical history reflects his denial of having, or ever having had, frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. The evidence of record reflects that in a May 1975 rating decision, the RO awarded service connection for a back disability, effective April 11, 1972. The post-service clinical evidence of record reflects that in September 2007, the Veteran established care with VA, at which time he reported right shoulder and lower back pain. The clinician conducted a depression screening at that time, which was negative. A December 2007 treatment note reflects the Veteran's report of continued back and neck pain. He denied feelings of anxiety, depression, or mood swings. Treatment notes dated February 2011 and December 2012 reflect the Veteran's request for pain medication for back pain. They also reflect negative depression screenings. In April 2017, more than 40 years after separation from service, the Veteran submitted a claim for service connection for an acquired psychiatric disability, contending it is due directly to his active service and/or secondary to his service-connected back disability. In May 2017, the Veteran was afforded a VA examination. He reported symptoms of depressed mood (usually brought on by thoughts of his children or thoughts that his wife does not appreciate him), ruminative thoughts about past mistakes, frequent anxiety/sadness about his son who abused drugs, difficulty falling asleep due to anxious/ruminative thoughts, decreased appetite, increased forgetfulness, decreased concentration, anhedonia, low motivation, and irritability. He reported that he began abusing alcohol in the 1980's and currently drank two to three glasses of wine, once a week. He also reported that he began abusing prescription pain medication while in service but did not continue to use after service. The Veteran reported experimenting with cocaine but that "[i]t wasn't me. I was getting violent at that time." He also reported that he smoked marijuana off and on since service and that he currently smoked one joint, two to three days per week, to relax and improve his mood. The examiner diagnosed the Veteran as having unspecified depressive disorder with anxious distress and alcohol use disorder, in reported sustained remission. She opined that the Veteran's mental health disabilities were less likely than not proximately due to or the result of his service-connected back disability. She reasoned that given the Veteran's reported symptoms and history, i.e. the Veteran attributing his mental health symptoms to situational stressors and family issues and not to his service-connected back symptoms, a nexus was less likely. A November 2019 VA treatment note reflects that the Veteran sought help from a social worker on a walk-in basis for increased anxiety and difficulty sleeping for the previous four days. He claimed that these problems were caused by an incident at work where he was escorted from the worksite. He denied any other medical problems. During a psychiatric evaluation conducted the same day, the Veteran again recalled the work incident in which he was escorted from the worksite and reported that he had not slept well since that time. He denied previous psychiatric symptoms as well as any current weakness, pain, stiffness, back pain, or joint pain. The psychiatrist diagnosed the Veteran as having acute anxiety with sleep disturbance related to the reported work issue. He prescribed Lexapro, Trazodone, and hydroxyzine. A January 2020 follow-up note reflects the Veteran's report that he had taken the Lexapro for a few days but then stopped because he did not need it anymore. He also reported that the work issue had been resolved, he returned to work, and that he was feeling better and less anxious. At the June 2023 Board hearing, the Veteran testified that he began experiencing depression about 35 to 40 years prior and it caused problems in his multiple marriages. He testified that the depression caused him to feel that he could not stay in one place and resulted in him moving back and forth from Florida to New York. The Veteran's sister testified that she started noticing a change in the Veteran's behavior, including confusion, lack of attention, and screaming and yelling, after his separation from service. The Veteran also testified that his feelings of anger are often "because of my hearing [...] I get angry, because they tell me things that I don't - I don't - I don't hear...." He testified that "people think you - you're stupid, or you're being - just stupid, you're stupid, you don't hear, you don't understand, you know?" In the April 2024 decision, the Board found the May 2017 opinion inadequate to the extent that it did not adequately address the Veteran's contention that his depression is caused by the chronic pain from his service-connected back disability. The Board found that the examiner discussed the cause of the Veteran's current symptoms (current situational stressors) rather than the cause of the underlying depressive disorder. Accordingly, the Board remanded the claim for a new examination. See April 2024 Board decision. In a subsequent April 2024 rating decision, the RO awarded service connection for tinnitus, effective April 4, 2017. Pursuant to the Board's April 2024 remand, the RO obtained additional VA examinations and opinions in May 2024. The VA examiner completed both a mental disorders disability benefits questionnaire (DBQ) and a posttraumatic stress disorder (PTSD) DBQ. At the mental disorders examination, the examiner recorded the Veteran's chief complaint as "I'm anxious, depressed, for more than 4 or 5 years. I went to Vietnam War on [sic] 1970." (The Board notes that the Veteran's service personnel records show that he did not serve in Vietnam, but rather at Fort Dix, Fort Polk, and Fort Bliss). The Veteran also reported generalized anxiety and worry about events and activities. The Veteran reported that the source of his anxiety varies but it is present most days and he finds it difficult to control worry. He also reported the recent death of his son due to a fentanyl overdose and related symptoms of grief, including anger, anxiety, frustration, preoccupation with loss, and loss of interest in previously enjoyed activities. The examiner diagnosed the Veteran as having PTSD, major depressive disorder, recurrent severe without psychotic features (MDD), and generalized anxiety disorder (GAD). He indicated that the symptoms of each disorder, and their resulting impairments, overlap and that it is not possible to determine their individual impact. In an accompanying opinion, the examiner determined that the Veteran's MDD and GAD are at least as likely as not proximately due to or the result of his service-connected back disability. The examiner's rationale, in its entirety, read, "[d]epressive symptoms were associated with poorer health outcomes in people with neck pain and neck pain with radiculopathy." At the PTSD examination, the examiner noted diagnoses of PTSD, MDD and GAD. The examiner recorded the Veteran's reported stressor as, "I went to Vietnam War on [sic] 1970. Also his son died with overdose of medication last year." In an accompanying opinion, the examiner checked the box indicating that the "claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of Veteran's service-connected condition." The examiner's rationale, in its entirety, read, "Veteran has a current mental health disorder, as described in the report that meets DSM criteria. The disorder began subsequent to the service-connected diagnosis and it is aggravated by the related to that condition [sic]." The examiner further opined that the Veteran's claimed condition is at least as likely as not aggravated beyond its natural progression by his service-connected back disability. He reasoned that, "[t]he thoracolumbar disability is an aggravating to the [V]eteran depressive and anxiety chronic conditions." In a November 2024 rating decision, the RO awarded service connection for bilateral hearing loss, effective April 4, 2017. Given the multiple deficiencies and contradictions in the May 2024 opinion, in February 2025, the RO requested an addendum opinion. In providing that opinion, the examiner noted that he did not conduct an in-person examination and that his opinion is based on a review of the Veteran's DBQ's completed by the original examiners and the evidence in the claims file. The examiner opined that it is less likely than not that the Veteran's depression was caused or aggravated by his service-connected back disability. The examiner reasoned as follows: [T]he [V]eteran's claims file shows that over the years, he has presented depression and/or anxiety episodes resulting from various situational stressors. However, no evidence was found in his records to support that his mental health symptoms have been continuous, and no evidence was found to support that these episodes were related to his back pain. In the July 2025 decision, the Board found both May 2024 VA opinions failed to substantially comply with the Board's April 2024 decision because they lacked an adequate rationale for the positive opinions offered. The Board also found that the mental disorders examiner offered his positive opinion based on the wrong primary service-connected disability. The Veteran is service connected for a low back disability, not a neck disability. Furthermore, the PTSD diagnosis appears to be based, at least in part, on the Veteran's report that he served in Vietnam. While the Veteran served during the Vietnam era, the evidence of record establishes that he did not serve in Vietnam. His DD Form 214 does not reflect any foreign or sea service during his active service. Additionally, military personnel records show his record of assignments do not include service in the Republic of Vietnam or anywhere outside of the United States. In the July 2025 decision, the Board also found the February 2025 VA addendum opinion inadequate because it failed to substantially comply with the reasons for remand contained in the Board's April 2024 decision. Specifically, the Board found that while the examiner opined that the Veteran's depression is not aggravated by his service-connected back disability, he did not offer any rationale to support this finding. The United States Court of Veterans Appeals (Court) has held that because there are two prongs to a secondary service connection claim -- causation and aggravation -- in order to be adequate, a medical opinion must provide explanations for both prongs. Atencio v. O'Rourke, 30 Vet. App. 74 (2018); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). The Board also found that, despite the Veteran's contention that his acquired psychiatric disability is a direct result of his active service, the examiner failed to offer an opinion on this theory of entitlement, to include addressing the testimony of the Veteran and his sister regarding the onset and progression of his mental health symptoms. Pursuant to the Board's July 2025 remand, the Veteran was afforded a VA examination in September 2025, at which time he reported anxiety and depression. He claimed that he began experiencing depressive symptoms, which he described as episodic rather than daily, approximately two to three years prior. He stated that he is generally a positive person but that his mood is affected by ongoing marital stress and concerns about his granddaughter, whom he fears may be mistreated due to her sexual orientation. With respect to his anxiety, the Veteran reported that it is often triggered by intrusive thoughts or worries, particularly related to his family and fears about what would happen to them if he passed away. He acknowledged previous thoughts of suicidal ideation, specifically following the death of his son, but denied any such thoughts currently. He also reported that the current political climate contributes to his feelings of sadness and emotional distress. The examiner noted that he became visibly emotional when discussing his family. He denied serving in Vietnam. He also "directly denied that any of his medical conditions contribute to his mental health concerns." In an accompanying opinion, the examiner determined that the Veteran's acquired psychiatric disability is less likely than not incurred in or caused by his active service. She reasoned that the Veteran's STRs were silent for mental health complaints and that he did not report mental health concerns to a treating physician until 2019, over 45 years after separation from service. She noted that when the Veteran reported these symptoms, he attributed them to work problems. She also noted that during subsequent psychiatric evaluations, his mental health symptoms were attributed to situational stress, including workplace issues, family stress, and the loss of his son. The examiner acknowledged the Veteran's lay statement that he abused prescription drugs in service as well as his sister's statement that she started noticing a gradual change in the Veteran's behavior, including confusion, lack of attention, and screaming and yelling, after his separation from service. She explained that "[w]hile these lay statements are noted and given consideration, the gradual delayed nature of symptom onset does not establish a clear temporal relationship to active duty service, and there is no contemporaneous medical evidence to corroborate the reported onset of symptoms in the years following discharge." The examiner also noted that multiple negative depression and PTSD screenings during routine VA visits support the absence of continuous symptoms since discharge. With respect to secondary service connection, the examiner determined that because the Veteran denied that his mental health symptoms are caused by any service-connected disabilities, "there is no established nexus to support a claim that his mental health issues were exacerbated by those conditions. For the [acquired psychiatric disability] an opinion was not rendered as there was no pathology to render a diagnosis." In October 2025, the examiner rendered an addendum opinion regarding secondary service connection. She explained that during her examination of the Veteran, he explicitly denied that his service-connected hearing loss, tinnitus, and/or back disabilities contributed to his psychiatric symptoms. She further explained that: According to the VA M21-1 Adjudication Procedures Manual (III.iv.3.D.2.e), a veteran's competent and credible lay denial of a relationship between two conditions may be considered probative evidence when forming a medical opinion. [The Veteran's] denial is consistent with the broader clinical picture, which repeatedly attributes his psychiatric symptoms to non-service-related psychosocial stressors rather than physical health conditions. The examiner also opined that the Veteran's acquired psychiatric disability is not aggravated by his service-connected disabilities. She explained that, across multiple psychiatric evaluations, there is no documentation of clinical worsening of psychiatric symptoms temporally or functionally associated with worsening of his physical conditions. She noted that the Veteran has consistently denied any connection between his mental health and his service-connected disabilities, and his mental health symptoms have continued to be attributed to psychosocial factors such as grief, marital conflict, and family concerns, rather than physical pain or sensory impairment. The examiner also considered medical literature discussing the relationship between hearing loss and mental health as well as chronic pain and mental health. She explained that: While some medical literature identifies a potential association between hearing loss and depression, the relationship is typically correlational, not causal, and is often mediated by social isolation or functional impairment. For example, a 2017 study published in JAMA Otolaryngology found a correlation between self-reported hearing difficulty and depressive symptoms, but this association was not consistently observed with clinical diagnoses of MDD, particularly in individuals without social withdrawal. Similarly, the 2020 Lancet Commission on Dementia Prevention emphasized that hearing loss contributes to mental health decline primarily when it leads to social disengagement, a factor not present in this case, as the Veteran remains socially active and emotionally connected. Likewise, although chronic pain can contribute to depression in some cases, the Veteran's own 2019 psychiatric evaluation specifically noted no back pain, and there is no documentation in the record linking any worsening of depression or anxiety symptoms to his lumbar spine condition. His back issues were not mentioned in psychiatric assessments that led to his current diagnoses of MDD and GAD. In summary, the Veteran has consistently denied that his service-connected lumbar spine condition, hearing loss, or tinnitus have caused or worsened his psychiatric symptoms. The available medical records, clinical evaluations, and timeline of symptom development all point to non-service-related life stressors, including the death of his son, marital issues, and family concerns, as the primary contributors to his mental health condition. There is no evidence of direct causation or aggravation by service-connected physical conditions. Therefore, a secondary service connection for MDD or GAD is not supported. Having considered the medical and lay evidence of record, the Board finds that service connection for an acquired psychiatric disability is not warranted on any basis. With respect to the first element of service connection, the clinical evidence reflects that the Veteran has a current diagnosis of an acquired psychiatric disability, most recently characterized as major depressive disorder and generalized anxiety disorder. See October 2025 VA examination report. With respect to the second element of a service connection claim, an in-service disease or injury, the Veteran's STRs are silent for any complaints, observation, or treatment for a psychiatric condition. Rather, these records affirmatively establish that such a disability was not present at service separation. The February 1972 separation examination report reflects that the Veteran's psychiatric condition was assessed and determined to be normal at that time. The accompanying report of medical history reflects his denial of having, or ever having had, frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. Additionally, while the Veteran has been somewhat inconsistent regarding the precise onset of his mental health symptoms (see, e.g., November 2019 VA treatment note; June 2023 Board hearing transcript, May 2024 VA examination report) none of his statements place the onset of these symptoms within his period of active service. In other words, the Veteran has not alleged that his mental health symptoms began in service. The Board acknowledges the Veteran's claim, made during the May 2017 VA examination that he began abusing prescription drugs in service and affords it probative weight only to the extent that it describes what he claims to have done in service, and not as an indication of the onset of a mental health disorder. The Veteran is competent to report what behaviors he engaged in during active service but is not shown by training or experience to be competent to diagnose mental health disorders. Similarly, the Board has considered the statement of the Veteran's sister but finds that it does not establish the presence of a psychiatric disability in service. In this regard, the Board notes that the September 2025 VA examiner considered the statements of the Veteran and his sister, noted that there was no corroborating evidence in the STRs or other clinical records to support it, and did not make a finding that such was indicative of the onset of a mental health condition in service. To the extent these statements are intended to provide evidence that symptoms of a psychiatric disability had their onset during active duty, the Board notes that they conflict with the contemporaneous evidence, to include the Veteran's statements at separation denying experiencing, or ever having experienced, psychiatric symptoms. The Board assigns more probative weight to the contemporaneous evidence than to statements made in the context of a claim for monetary benefits. The evidence of record is also persuasively against finding that the Veteran's current acquired psychiatric disability is related to his active service. As described above, the evidence demonstrates that the first time the Veteran reported mental health symptoms (during the May 2017 VA examination), he attributed them to situational stressors and family issues and not to his active service. Moreover, the first time he reported mental health symptoms in a clinical setting was not until 2019, when he told his VA clinician that his anxiety and sleep problems were related to an issue with his job that had occurred the week prior. See November 2019 VA treatment note. During the May 2024 VA examination, the Veteran again attributed his mental health symptoms to family issues, including the recent death of his son. During this examination, the Veteran also claimed that he served in Vietnam, presumably to relate his current mental health symptoms to an in-service stressor. As shown above, however, and admitted by the Veteran during his most recent examination, he did not serve in Vietnam. During the September 2025 VA examination, the Veteran stated that issues related to his family as well as the current political climate contributed to his mental health condition. None of the credible evidence reflects that the Veteran attributed his current mental health symptoms to his service. Rather, they consistently show that the Veteran has attributed his mental health symptoms to situational stressors and family issues. With respect to the VA medical opinions of record, the Board finds that, when taken as a whole, they sufficiently demonstrate a lack of medical nexus between the Veteran's current acquired psychiatric disability and his active service. These opinions were based largely on the Veteran's own statements during these examinations attributing his mental health symptoms to situational stressors and family issues rather than to his active service. Moreover, the opinions are consistent with the clinical evidence which also reflects the Veteran's consistent reports that his mental health symptoms were caused by situational stressors and family issues. With respect to the most recent VA opinion (September 2025) regarding direct service connection, the Board finds that it substantially complies with the Board's remand directives, as it considered both the Veteran's statement regarding in-service drug abuse and his sister's statement regarding the onset of his mental health symptoms. Additionally, the opinion is thorough, well-reasoned, and consistent with the other evidence of record, agreeing with VA treatment records showing that the Veteran's mental health symptoms have been attributed to non-service-related causes. As such, the Board affords the opinion significant probative weight. The Board acknowledges the Veteran's contentions that his current acquired psychiatric disability is caused by his service-connected tinnitus, hearing loss, and/or back disabilities. In this regard, although lay persons are competent to provide opinions on some medical issues, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the etiology of an acquired psychiatric disability falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicolson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). More importantly, however, the Veteran's contentions are at odds with the objective medical evidence which, as explained exhaustively above, demonstrates that the Veteran's mental health symptoms have been consistently attributed to non-service-related causes. In fact, during the most recent VA examination, the Veteran specifically denied that his mental health symptoms are caused by his service-connected disabilities. See September 2025 VA examination report. As the September 2025 VA examiner noted, this denial is credible because it is consistent with the broader clinical picture, "which repeatedly attributes his psychiatric symptoms to non-service-related psychosocial stressors rather than physical health conditions." The examiner also noted that while hearing trouble and chronic pain can cause mental health symptoms, such is not the case for the Veteran. She explained that "[n]one of the Veteran's mental health evaluations identify a connection between his emotional symptoms and physical impairment, and no provider has diagnosed or documented psychiatric symptoms exacerbation linked to his hearing loss, tinnitus, or lumbar spine condition." She summarized her findings by stating that "the available medical records, clinical evaluations, and timeline of symptom development all point to non-service-related life stressors, including the death of his son, marital issues, and family concerns, as the primary contributors to his mental health condition. There is no evidence of direct causation or aggravation by service-connected physical conditions." The Board finds that this secondary service connection opinion substantially complies with the Board's remand directives and is thorough and well-reasoned. As such, the Board affords the opinion significant probative weight. The Board is charged with weighing the positive and negative evidence; resolving reasonable doubt in the Veteran's favor when the evidence is in relative equipoise. Considering the record, including the STRs, post-service medical evidence, and lay evidence presented by the Veteran and his sister, the Board finds that the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule is not applicable, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Madison, Siobhan K. 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.