Citation Nr: 18131218
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 17-37 635
DATE:	August 31, 2018
ORDER
Entitlement to service connection for an acquired psychiatric disorder to include secondary to service-connected left testicle removal is denied.
FINDINGS OF FACT
1. An acquired psychiatric disorder was not manifest during active service and is not related to active service.
2. An acquired psychiatric disorder is not caused or aggravated by a service-connected disease or injury.
CONCLUSIONS OF LAW
1. An acquired psychiatric disorder was not incurred in or aggravated by service.  38 U.S.C. §§ 1131 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2017).
2. An acquired psychiatric disorder is not proximately due to, the result of, or aggravated by a service connected disease or injury.  38 C.F.R. § 3.310 (2017).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from October 1962 to September 1964.
1. Entitlement to service connection for an acquired psychiatric disorder to include secondary to service-connected left testicle removal
The Veteran’s sole assertion has been that his claimed psychiatric disorder (claimed as depression) is secondary to his service-connected left testicle disorder.  Regardless, the Board will address both direct and secondary theories of service connection.
Veterans are entitled to compensation if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.”  38 U.S.C. § 1110 (wartime service), 1131 (peacetime service).
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 -the so-called ‘nexus’ requirement.”  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service establishes that the disability was incurred in service.  38 C.F.R. § 3.303 (d).  The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value.  See Baldwin v. West, 13 Vet. App. 1, 8 (1999).
There is no medical evidence that the Veteran has been diagnosed with a psychosis.  The two diagnosed psychiatric disorders, generalized anxiety disorder and depressive disorder, are not identified as “chronic” diseases under 38 U.S.C. § 1101 and 38 C.F.R. § 3.309 (a). 
Service treatment records do not document any relevant complaints, symptoms, treatment, or diagnoses.  The Veteran’s July 1964 separation examination documented a normal psychiatric evaluation.  In an accompanying report of medical history, the Veteran specifically denied depression, excessive worry, nervous trouble of any sort or any relevant symptom.
As noted, the Veteran has not asserted that his claimed psychiatric disorder is directly related to service.  In fact, he has specifically claimed that it is secondary to his service-connected left testicle disorder.  To the extent that the Veteran has asserted any relationship to service, there is simply no competent evidence of an in-service incurrence or a nexus between the currently diagnosed psychiatric disorders and active service.  The Board finds that the probative value of any such assertions are outweighed by the clinical evidence of record. 
In sum, there is no reliable evidence linking the Veteran’s generalized anxiety disorder or depressive disorder to service.  The contemporaneous records establish that there were no objective manifestations in service and generalized anxiety disorder and depressive disorder were first manifest many years after separation.  The Board finds the contemporaneous records to be far more probative and credible than any suggestion of onset in service and continuity and treatment.  The evidence establishes that psychiatric evaluation was normal upon separation from service, the Veteran specifically denied any relevant symptoms upon separation and the onset of any relevant disorder occurred many years after service.  The Board finds that the preponderance of the evidence is against the claim and the claim must be denied on a direct basis.
Secondary Service Connection
Service connection is warranted on a secondary basis for “disability which is proximately due to or the result of a service-connected disease or injury.”  38 C.F.R. § 3.310 (a).  Secondary service connection is also warranted for “[a]ny increase in 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 progress of the nonservice-connected disease.”  38 C.F.R. § 3.310 (b).
The Board notes that 38 C.F.R. § 3.310 was amended, effective October 10, 2006. Under the revised § 3.310(b) (the existing provision at 38 C.F.R. § 3.310 (b) was moved to sub-section (c)), any increase in severity of a nonservice-connected disease or injury proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the disease, will be service connected.
As noted, the Veteran’s sole assertion is that his psychiatric disorder is secondary to his service-connected left testicle disorder.  He asserts that the deformity resulting from the removal of his left testicle and the related erectile dysfunction have caused or aggravated his psychiatric disorder.
A January 2015 VA examiner concluded that the Veteran’s psychiatric disorder was less likely than not due to or the result of his service-connected left testicle.  The examiner cited VA treatment records and a 2007 VA examination indicating that the Veteran’s erectile dysfunction was not related to his left testicle disorder.  The examiner considered the Veteran’s lay statements with respect to his disorder, to include his assertion regarding the deformity caused by the removal of his left testicle. 
In a February 2015 addendum medical opinion, another VA examiner clarified that the Veteran’s erectile dysfunction was not attributable in any way to his service-connected left testicle disorder.  This examiner also considered the Veteran’s lay statements and the entirety of the claims file.
In an additional September 2015 addendum medical opinion, a separate VA examiner concluded that the Veteran’s psychiatric disorder was less likely than not aggravated by the Veteran’s left testicle disorder.  The examiner cited VA treatment records indicating that the Veteran first sought treatment for anxiety in 2012 due to financial problems, and 2014 treatment records that made no mention of depression or emotional distress due to erectile dysfunction or the Veteran’s left testicle disorder.  The examiner concluded that there is no evidence that “would indicate an aggravation of his anxiety.”  
The Veteran submitted a January 2018 note from a VA psychiatrist reiterating a diagnosis of generalized anxiety disorder, as well as depressive disorder.  The statement indicates that the Veteran reports that his left testicular deformity affects his emotional well-being.  
The probative value of a medical opinion primarily comes from its reasoning; threshold considerations are whether a person opining is suitably qualified and sufficiently informed.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  In this case, the Board accepts the January, February and September 2015 VA examiners’ opinions that the Veteran’s psychiatric disorder is less likely than not caused or aggravated by his service-connected left testicle disorder as highly probative medical evidence on this point.  The Board notes that the examiners rendered their opinions after thoroughly reviewing the claims file and relevant medical records.  The examiners noted the Veteran’s pertinent history and provided a reasoned analysis of the case.  See Hernandez-Toyens v. West, 11 Vet. App. at 379, 383 (1998); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994) (the probative value of a physician’s opinion depends in part on the reasoning employed by the physician and whether or not (or the extent to which) he reviewed prior clinical records and other evidence).
The Board may favor the opinion of one competent medical professional over that of another so long as an adequate statement of reasons and bases is provided.  See Owens v. Brown, 7 Vet. App. 429, 433 (1995).  An evaluation of the probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the examiner’s knowledge and skill in analyzing the data, and the medical conclusion reached.  The credibility and weight to be attached to such opinions are within the province of the Board as adjudicators. Guerrieri v. Brown, 4 Vet. App. 467 (1993).
Greater weight may be placed on one physician’s opinion over another depending on factors such as reasoning employed by the physicians and whether or not and the extent to which they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994).  The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert’s qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion.  Sklar v. Brown, 5 Vet. App. 140 (1993). 
Here, the Board finds the January 2018 medical opinion by a VA psychiatrist to be of minimal probative value.  The psychiatrist indicates that the Veteran’s left testicle deformity affects the Veteran’s mood/depression, but provides no medical rationale for such an assertion.  Rather, the psychiatrist cites the Veteran’s report of the effect on his well-being.  These assertions were considered by the previously mentioned VA examiners, and were accounted for in their opinions supported by medical rationale.  
In this instance, the Board finds the January, February and September 2015 VA examiners opinions to be the most probative as they provided unequivocal and detailed medical opinions supported by pertinent rationales based upon a review of the Veteran’s claims file, when concluding that the Veteran’s psychiatric disorder was not caused or aggravated by his service-connected left testicle disorder.
The Board again acknowledges that the Veteran is competent, even as a layperson, to attest to factual matters of which he has first-hand knowledge.  See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Buchanan v Nicholson, 451 F.3d 1331 (Fed Cir. 2006); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, as a layperson, it is not shown that the Veteran possesses the medical expertise to provide a medical opinion linking his psychiatric disorder to his service-connected left testicle disorder.  The most probative medical opinions of record addressing the claimed relationship are negative.  The VA examiners considered the Veteran’s lay assertions, but ultimately found that the Veteran’s psychiatric disorder was not caused by or aggravated by his service-connected left testicle disorder.  The Board finds that the Veteran’s lay statements are outweighed by the VA examiners’ medical opinions as they were based on consideration of the Veteran’s contentions, reviews of medical records, and medical expertise.
The Board finds that the preponderance of the evidence is against a finding that the Veteran’s psychiatric disorder is directly related to service, or in the alternative, secondary to service-connected left testicle disorder, and the claim must be denied.

 
H. N. SCHWARTZ
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	W. R. Stephens, Counsel 

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