Citation Nr: 22001709 Decision Date: 01/12/22 Archive Date: 01/12/22 DOCKET NO. 17-61 023 DATE: January 12, 2022 ORDER The claim for entitlement to service connection for generalized anxiety disorder (GAD) as secondary to the service-connected tinnitus is granted. FINDING OF FACT GAD is the result of the service-connected tinnitus. CONCLUSION OF LAW The criteria for entitlement to service connection for GAD as the result of the service-connected tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from November 1967 to November 1968. In addition, he served in the U.S. Navy Reserves. The Veteran testified before the undersigned Veterans Law Judge virtually in August 2021. A transcript of the hearing is associated with the claims file. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for 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). In addition, a disability that is the etiological result of a service-connected disability shall also be service connected. 38 C.F.R. § 3.310. In the case of secondary service connection, the second element of Shedden is the service-connected disability; and medical evidence of a nexus, or causal link, between the service-connected disability and the claimed disability is required. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). The Veteran and his representative have provided sufficient evidence of all three Shedden/Holton elements. The Veteran initially argued and testified in August 2021 that he believed his anxiety disorder is the result of his back disability. However, medical evidence received within the 90-day period left open by the Veteran's Law Judge after the hearing shows the Veteran is diagnosed with GAD causally linked to his service-connected tinnitus. The medical evidence consists of the November 2021 private examination and medical opinion of Dr. BV, PhD and licensed clinical psychologist. Dr. BV examined the Veteran and diagnosed him with GAD, which the physician opined is the result of his long-standing service-connected tinnitus. In addition, VA treatment records show the Veteran is diagnosed with GAD and insomnia, and is treated with prescribed psychotropic medications escitalopram and trazodone. The record further shows the Veteran is service-connected for tinnitus, evaluated as 10 percent disabling, effective in November 2009. Thus, the first two criteria are met under Shedden/Holton. Concerning the third element, or that of a causal link between the diagnosed GAD and service-connected tinnitus, the Board turns to Dr. BV's opinion. Dr. BV explained the Veteran was service-connected for tinnitus as the result of being exposed to repeated blasts from a 5-inch gun while at sea on board a destroyer, where he was assigned to the forward gun mount. Over time and due to the continuous nature of the tinnitus and its loudness, the Veteran experienced inability to communicate with his co-workers, supervisors, and clientele adequately or effectively which caused impairment in his occupation in sales and restaurant management. In addition, the Veteran expressed difficulty in social gatherings, being unable to adequately hear and understand individual speaker and in groups. He described being overwhelmed by the noise in social settings and becoming anxious at the prospect of meeting people and socializing. He reported startling easily at loud noises. Unable to communicate effectively occupationally and socially; sleep; concentrate; and find relief in quiet places and reading, Dr. BV opined the Veteran developed anxiety. As further rationale, Dr. BV pointed to medical literature associating sleep disorders, slowed cognitive processing and difficulty concentrating, decreased speech discrimination, and higher incidence of anxiety and depression with tinnitus. Dr. BV's qualifications include his medical degree and license as a clinical psychologist; his completion of numerous VHA, VBA, and DMA courses; and his certification to conduct VA examinations from 2013-2019. There is no evidence that Dr. BV is not qualified to examine the Veteran, diagnose GAD, and provide a probative medical opinion that the diagnosed GAD is the result of the service-connected tinnitus. There is no evidence of record against a finding that the claimed GAD is the result of the service-connected tinnitus. The Board finds the third criteria under Shedden/Holton is met. Accordingly, service-connection for GAD as secondary to the service-connected tinnitus is warranted. The claim for entitlement to GAD as secondary to the service-connected tinnitus is granted. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bakke, Lila J. 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.