Citation Nr: 0810740 Decision Date: 04/01/08 Archive Date: 04/14/08 DOCKET NO. 96-51 431 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania THE ISSUE Entitlement to service connection for claimed post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD G. Jackson, Associate Counsel INTRODUCTION The veteran served on active duty from May 1966 to April 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 1994 rating decision issued by the RO. The Board remanded this case to the RO for additional development in June 1999, June 2003 and March 2005. FINDING OF FACT The veteran is not shown to have a medically supported diagnosis of PTSD that can be linked to a verified or a potentially verifiable stressor during his active service. CONCLUSION OF LAW The veteran does not have a disability manifested by PTSD due to disease or injury that was incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.125 (2007). REASONS AND BASES FOR FINDING AND CONCLUSION On November 9, 2000, the Veterans Claims Assistance Act of 2000 (VCAA), (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107) became law. Regulations implementing the VCAA provisions have since been published. 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). In this case, the Board finds that all relevant facts have been properly developed in regard to the veteran's claim, and no further assistance is required in order to comply with VA's statutory duty to assist him with the development of facts pertinent to his claim. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. Specifically, the RO has obtained records of treatment reported by the veteran and has afforded him comprehensive VA examinations addressing his claimed disorder. There is no indication from the record of additional medical treatment for which the RO has not obtained, or made sufficient efforts to obtain, corresponding records. The Board is also satisfied that the RO met VA's duty to notify the veteran of the evidence necessary to substantiate his claim in September 2002 and April 2005 letters. By these letters, the RO also notified the veteran of exactly which portion of that evidence was to be provided by him and which portion VA would attempt to obtain on his behalf. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). In these letters, the veteran was also advised to submit additional evidence to the RO, and the Board finds that this instruction is consistent with the requirement of 38 C.F.R. § 3.159(b)(1) that VA request that a claimant provide any evidence in his or her possession that pertains to a claim. In Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007), the United States Court of Appeals for the Federal Circuit (Federal Circuit) reaffirmed principles set forth in earlier Federal Circuit and United States Court of Appeals for Veterans Claims (Court) cases in regard to the necessity of both a specific VCAA notification letter and an adjudication of the claim following that letter. See also Mayfield v. Nicholson, 19 Vet. App. 103, 121 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006); Mayfield v. Nicholson, 20 Vet. App. 537 (2006). The Mayfield line of decisions reflects that a comprehensive VCAA letter, as opposed to a patchwork of other post- decisional documents (e.g., Statements or Supplemental Statements of the Case), is required to meet VA's notification requirements. At the same time, VCAA notification does not require an analysis of the evidence already contained in the record and any inadequacies of such evidence, as that would constitute a preadjudication inconsistent with applicable law. The VCAA letter should be sent prior to the appealed rating decision or, if sent after the rating decision, before a readjudication of the appeal. A Supplemental Statement of the Case, when issued following a VCAA notification letter, satisfies the due process and notification requirements for an adjudicative decision for these purposes. Here, the noted VCAA letters were issued subsequent to the appealed August 1994 rating decision. However, the RO readjudicated the case in an August 2007 Supplemental Statement of the Case (SSOC). The Board is also aware of the considerations of the United States Court of Appeals for Veterans Claims (Court) in Dingess v. Nicholson, 19 Vet. App. 473 (2006), regarding the need for notification that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. However, the absence of such notification is not prejudicial in this case, involving only a service connection claim. With service connection cases, no disability rating or effective date is assigned when service connection is denied. Also, in cases where service connection is granted, it is the responsibility of the agency of original jurisdiction (here, the RO) to address any notice defect with respect to the rating and effective date elements when effectuating the award. Id. Accordingly, the Board finds that no prejudice to the veteran will result from an adjudication of his claim in this Board decision. Rather, remanding this case back to the RO for further VCAA development would be an essentially redundant exercise and would result only in additional delay with no benefit to the veteran. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993); see also Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), a link established by medical evidence between current symptoms and an in-service stressor, and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) (2005). The evidence necessary to establish the occurrence of a stressor during service to support a claim for PTSD will vary depending on whether the veteran was "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60, 66 (1993). If the evidence establishes that the veteran was engaged in combat with the enemy or was a prisoner of war (POW), and the claimed stressor is related to combat or POW experiences (in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service), the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. Where, however, the VA determines that the veteran did not engage in combat with the enemy and was not a POW, or the claimed stressor is not related to combat or POW experiences, the veteran's lay statements, by themselves, will not be enough to establish the occurrence of the alleged stressor. Instead, the record must contain service records or other credible evidence corroborating the stressor. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d), (f); Gaines v. West, 11 Vet. App. 353, 357-58 (1998). Such corroborating evidence cannot consist solely of after- the-fact medical evidence containing an opinion as to a causal relationship between PTSD and service. See Moreau v. Brown, 9 Vet. App. 389, 396 (1996). As noted, however, the diagnosis of PTSD is required before a grant of service connection can be made. Here, the veteran's active duty from May 1966 to April 1968, included service in the Republic of Vietnam from April 1967 to April 1968. His awards include the National Defense Service Medal and the Vietnam Campaign Medal with device. His military occupational specialty was that of baker. The service treatment records are negative for any complaints or findings referable to PTSD or any other innocently acquired psychiatric disorder. Subsequent to service, private facility records from April 1994 document treatment for diagnosed major depression with psychotic features. During a VA hospitalization from January to February 1995, the veteran complained of having depression, increasing anger and irritability. He reported having stopped his medication and becoming very withdrawn. He had noted sleep disturbance and loss of appetite. He also reported intrusive thoughts about Vietnam, but no flashbacks were elicited. The veteran had a known history of cocaine, heroin, marijuana and amphetamine dependence, but denied any drug abuse since April 1994. The discharge diagnosis included that of polysubstance dependence in remission and notation to rule out PTSD. He was assigned a Global Assessment of Functioning (GAF) score of 45. A report of hospital stay from April to May 1995 contained discharge diagnosis of adjustment disorder with depressed mood, polysubstance abuse and rule out PTSD. He was assigned a GAF score of 45. During a VA hospitalization from September to October 1995, the veteran complained of nightmares and flashbacks and having paranoid thoughts that people wanted to take him back to Vietnam. The record noted that the veteran was under house arrest until December 1995. The record observed that the veteran had been diagnosed with PTSD in August 1995 at VA. The veteran reported a 25 year history of alcohol and cannabis use. He had not used cannabis in the past year; but had used crack cocaine 1-2 times per week, with last use being on September 16, 1995. Psychological evaluation revealed his affect to be restricted and his mood stable. He reported the hospital was a place he felt safe. He denied any current suicidal or homicidal ideations. He had no signs of formal thought disorder and gross cognitive screening was unremarkable. Attention, concentration, recent and remote memory were all within normal limits. Insight and judgment were fair. The veteran was enrolled in fourteen day inpatient program. He completed the program without incident. The veteran was diagnosed with cocaine dependence, alcohol abuse and PTSD, delayed onset. The psychological evaluations for parole purposes from August 2002 to October 2003 document a history of complaints, treatment and medication for diagnosed PTSD. In the October 2003 record, he was assigned a GAF score of 65. During a June 2004 VA examination, the examiner indicated that the claim folder was reviewed. The veteran reported his military history that led to the development of his claimed PTSD. He reported that his unit was assigned to a base in Tay Ninh and his duties included guarding the ammo dump. In performing this guard duty, his unit reportedly took a lot of sniper fire. He reported his most stressful event was his base receiving mortar and rocket attacks at night. No one in his unit was injured, and his area did not take any direct hits. He added that the Tet offensive was a scary time when he could not sleep at night. During the Tet, he reported running convoys from Cu Chi back to Tay Ninh. During one missions, he witnessed a Vietnam national get trapped under a truck. The veteran also described an incident where he ran to an unfinished bunker during a mortar attack. Following discharge, the veteran returned to work in the mill, but quit after a year because the noise upset him. He later worked as a custodian at the Post Office, but quit also. After that, he entered a program for ironworker trainees, but he had problems with his back and began having nightmares. He self medicated with cocaine. At some point in 1993, the veteran reported hearing a voice tell him to jump out of his high rise apartment window. His drug problem worsened, and he began having legal problems. His present complaints included social isolation, angering easily, a feeling of not belonging and "a lot of issues that I [could not] sort out and [could not] put [his] finger on." On examination, the veteran's grooming, hygiene and dress were all fair. His speech was rather vague and guarded and at times clearly evasive. Most of his complaints were listed in generalities without specifics or details. His speech was somewhat tangential at times, but generally coherent. His mood was somewhat withdrawn and sullen with poor eye contact and flattened affect. The veteran's mood was described as "bleak." He reported that medication was helping psychologically. He had sleep impairments and had nightmares approximately 2-3 times per week. His nightmares were about that time where he had to tell Private Woods about his friend being in a body bag. He had dreams about people not making it back home and sometimes had dreams about faces of people calling him back. The veteran reported that he had been alcohol and drug free for the past year, but had previously had a history of alcohol and drug abuse. With regards to suicidal ideation, the veteran reported "that [was] with me all the time." However, he stated, "it [was] not like [he] want[ed] to go and get a gun and stick it in my mouth, but if something happen[ed] [he] would just let it happen." He denied any homicidal ideation, but would defend himself if someone tried to harm him. The veteran reported occasional experiences where he heard voices. He gave no other information or details concerning the voices and the examiner indicated they did not appear to be actual auditory hallucinations. There were no delusions reported. Insight and judgment were somewhat limited. The veteran's daily routine consisted of waking at 6 or 7 in the morning, fixing breakfast, watching TV and then going to the plaza to meet with his lady friend. He stayed with her until she went to work. Occasionally, he went to the library to read. He would like to go fishing, but did not have any motivation. He currently lived with his cousin. He handled his own finances and activities of daily living without assistance. He had no other interests, socialization or hobbies and described himself as a loner. The veteran was administered the Mississippi Scale for Combat-Related PTSD, the SCL-90-R, the Beck Depression Inventory and the Impact of Events Scale. He scored a 142 on the Mississippi Scale for Combat-Related PTSD which was well above the cutoff for diagnosis of PTSD. The veteran's score was considered extremely excessive in light of the complete lack of combat exposure and trauma and appeared to represent deliberate exaggeration and symptom over reporting. The veteran scored a 70 out of the possible 88 on the Impact of Events Scale which again seemed to represent rather extreme exaggeration of symptomatology given his absence of direct combat exposure in service. On the Beck Depression Inventory, the veteran scored a 34, which suggested moderate to severe depression. On the SCL- 90-R, the veteran reported some level of distress for 71 out of 90 symptoms across a wide range of categories. 51 were rated at the severe level. The examiner noted again the responses appeared to be grossly exaggerated and overall the veteran's psychological testing results suggested deliberate symptom fabrication and over reporting for secondary gain. The veteran was diagnosed with dysthymic disorder, mixed substance dependence currently in remission and malingering PTSD symptomatology. He was assigned a GAF score of 60. The examiner stated the results of the evaluation clearly indicated that the veteran did not meet criterion A for exposure to a traumatic stressor according to DSM-IV criteria for diagnosis of PTSD. The examiner noted that the veteran reported never being in direct combat, nor was he or any of his fellow soldiers wounded or injured during his tour. In this regard, the examiner noted that the veteran worked mostly in supply and was detailed to guard duty, but engaged in no direct combat or confrontation with the enemy. Further, the VA examiner opined that the veteran did not report a full range of symptomatology consistent with PTSD despite his deliberate attempt to exaggerate such symptomatology on psychological testing. The veteran did report vague nightmares, about which he could provide little detail. He did not show symptoms of hyperarousal or alertness or dissociative symptomatology associated with PTSD. He did show symptoms of irritability and poor socialization that appeared to be a result of characterological problems and history of substance dependence rather than a service-related disorder. The examiner concluded that psychological testing clearly indicated that the veteran was exaggerating or fabricating symptomatology across almost all areas of symptom dimensions, clearly indicating an attempt to portray himself as disabled for compensation purposes. To that end, the examiner noted that recent VA treatment records failed to diagnose the veteran with PTSD. During a November 2004 private hospital stay, the veteran reported his history of polysubstance abuse and recent relapse. He reported feeling increasingly depressed since March. He reported having poor sleep, nightmares, poor appetite, anhedonia, anergia, amotivation and poor concentration. He was becoming very hopeless and had tried to overdose on crack cocaine prior to coming to the facility. He reported feeling suicidal and could not guarantee his safety outside of the facility. The veteran also reported having auditory hallucinations. He reported the hallucinations were becoming increasingly louder over time. He heard multiple voices, though he could not recognize them. The voices were carrying on a conversation and not commanding in nature. The hallucinations were causing him much distress. He reported such PTSD symptoms as nightmares, cold sweats, hyperarousability, and avoidance behavior. He stated he had received past treatment for these symptoms at VA, but they had gotten worse recently. Specifically they worsened beginning in March when he started reading about the war in Iraq. He denied symptoms of mania, obsessive compulsive disorder, panic, paranoia or visual hallucinations. He denied alcohol withdrawal symptoms and denied any history of blackouts and withdrawal seizures. His living situation was stable. He denied use of drugs, other than crack cocaine and marijuana. Over the course of the hospital stay, the veteran's depression lessened. His appetite improved, and his sleep improved with few to no nightmares. He had more energy and was better able to concentrate. He felt more hopeful and did not have further suicidal or homicidal ideation. Further, the veteran did not experience any additional auditory hallucinations. He continued to report having some symptoms of PTSD including looking over his shoulder and not wanting to have his back on a room of people. The anxiety associated with these feelings was diminished. At the time of discharge the veteran was cooperative, made good eye contact and had no abnormal movements. His mood was better and his affect was euthymic. His speech was normal and thoughts were linear and organized. He denied suicidal and homicidal ideation and showed no evidence of delusions. He denied auditory and visual hallucinations. Attention, concentration, recent and short-term memory were intact. His judgment and insight were fair to good. He was diagnosed with recurrent severe major depression with psychotic features, PTSD and drug and alcohol dependence. His GAF score on entrance was 28 and at discharge 50. During a July 2007 VA examination, the examiner indicated that the claims file and all available medical records were thoroughly reviewed. The examiner reported the Beck Depression Inventory II, SCL-90-R Impact of Event Scale, and Mississippi Scale for Combat-Related PTSD were all administered in conjunction with the examination. The VA examiner noted the conclusion reached in the June 2004 VA examination, that the veteran's testing results suggested deliberate symptom fabrication and over reporting for secondary gain. The examiner recorded the veteran's military history. When questioned about his stressful or traumatic events, the veteran stated that he experienced stressful events "every day." Specifically, while stationed at Tay Ninh, a fellow soldier threatened to commit suicide. He reported being able to talk the soldier out of doing that. The veteran also reported that, while on convoy duty he witnessed Vietnamese locals stealing lumber out of the back of a truck. The veteran stated that he snapped and began firing his weapon over the heads of the locals. The veteran also reported that, while riding in a jeep past a Vietnamese man working on his truck, the jack slipped and the truck fell down on the Vietnamese man. The veteran did not know his fate, but assumed the man was killed instantly The veteran also reported that, on one occasion, their base received incoming mortar fire. He unknowingly ran into a bunker that was not completed. He added that there were many other stressors, but he self-medicated and put them out of his head. During service, he drank 3-4 times per week and smoked marijuana on a daily basis. The veteran's post service work history remained unchanged from previous reports. He was never terminated from a job, but always left for a better paying job. He denied having any problems with productivity or getting along with supervisors or peers. He had no lost time or decreased productivity due to psychiatric symptoms. Socially, the veteran was married from 1966 to approximately 1974 and had one adult son from this marriage. The veteran and his son had limited contact. He denied being in any other significant romantic relationships since his marriage. His source of income was Social Security Disability benefits. He rented an apartment and lived alone. The veteran reported his past history of substance abuse and stated his last use of crack cocaine was in 1994. However, the examiner noted drug and alcohol screen one week previous was positive for cocaine as was a drug and alcohol screen from January 2007. The examiner observed the November 2004 private hospital stay record and noted the evaluation did not include a description of valid criterion A stressors or a full constellation of symptoms of PTSD. The examiner also observed that the veteran had received treatment from the private facility in approximately 1992. The veteran complained of avoidance behavior of people and crowds. He also complained of memory difficulty and indicated that he had been diagnosed with a form of Alzheimer's. The examiner noted that there was no diagnosis of Alzheimer's, but a treating doctor did note the possibility of a TIA, which the veteran was encouraged to get evaluated. The veteran had no post-military traumatic stressors. The veteran scored a 34 on Beck Depression Inventory, indicating severe depression. On the SCL-90-R, the veteran endorsed 76 out of 90 possible symptoms, which covered a wide range of diagnostic categories, including mood disorders, anxiety disorders, somatic complaints and psychotic processes. On the Impact of Event Scale, the veteran scored a 25 indicating his experiences have moderately impacted his functioning. The VA examiner noted that the veteran endorsed all the items on this measure, but did not spontaneously endorse any of the items in clinical interview. On the Mississippi Scale for Combat-Related PTSD, the veteran scored a 110, which was above the cutoff score for a diagnosis of PTSD, but was significantly inconsistent with the vague stressors reported by the veteran. The examiner concluded the veteran's scores reflected an over reporting of symptomatology which was inconsistent with his current level of functioning. The examiner noted the veteran's report of stressors did not meet criterion A for a diagnosis of PTSD. Further, the veteran did not present with a full constellation of symptoms for this diagnosis. Additionally, the examiner noted that the veteran's reported stressors were not consistent with the reported stressors from the 2004 examination. The veteran's hygiene and grooming were adequate. His mood was dysphoric and affect was congruent with mood. The veteran did brighten spontaneously a few times throughout the examination. He had difficulty remembering specific dates and details of his employment history. His speech was slowed; he did not exhibit any impairment of thought process or communication. He denied any auditory or visual hallucinations and no delusions were elicited. The veteran maintained appropriate eye contact and did not exhibit any inappropriate behavior. He denied current suicidal or homicidal ideation, plan, or intent. He was able to maintain all aspects of activities of daily living without assistance. Short-term memory was intact, although the veteran had some difficulty with long-term memory. He denied any obsessive or ritualistic behavior that would interfere with routine activities. He did not endorse symptoms consistent with panic disorder. The veteran described his mood as not great and stated he always felt depressed. He reported his current health problems were a precipitant of his depression. Reported symptoms of depression included decreased appetite, low energy, and irritability. He reported that he felt nervous and the trigger for this nervousness was his ill health. He described his sleep as erratic. Although, he reported that he averaged approximately 8 hours of sleep per night. He reported he had difficulty breathing, associated with his congestive heart failure, which interfered with the quality of his sleep. The examiner also noted that cocaine abuse increases mood instability, irritability, and sleep disruption. The veteran reported that he typically got out of the bed at 7 am, attended to his personal hygiene, made breakfast and then read the newspaper. He reported that he spent most of his day resting or on the phone. He had 2 people living with him who assisted with the household chores; however, he was going to ask them to leave so he would be doing the chores by himself in the future. He did not have any current hobbies or recreational activities. He did not have many friends and his physical health limited his activities. His health continued to be a source of stress for him. He denied current alcohol or drug use; but, the examiner noted that it appeared that the veteran had used crack cocaine in the past week. The veteran was diagnosed with depression not otherwise specified (unrelated to military service) and cocaine abuse. He was assigned a GAF score of 70 due to depression and 65 due to impact of cocaine abuse. The examiner summarized that the veteran did not meet the DSM-IV criteria for a diagnosis of PTSD, either in terms of a valid criterion A stressor or presenting with a full constellation of symptoms for the diagnosis. The examiner again noted the reported stressors were significantly different from reported stressors in the veteran's 2004 examination as well as his various written statements contained in the claims file. The examiner indicated that the discrepancies brought into question the veracity of the veteran's report. The results from psychometric testing, in their totality, appeared inflated and inconsistent with his present functioning. The veteran appeared to continue to abuse crack cocaine, and the examiner observed that this substance use and chronic medical problems appeared to exacerbate current mood disorder symptoms. In this case, as indicated, there exists competent medical evidence both supporting and contradicting the veteran's contentions. It is therefore the responsibility of the Board to weigh this evidence so as to reach a determination on the veteran's claim. See Hayes v. Brown, 5 Vet. App. 60, 69 (1993); Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992) (it is the responsibility of the Board to assess the credibility and weight to be given the evidence). Several considerations must be addressed in cases where there are competent but conflicting medical opinions. First, the Board may only consider independent medical evidence to support its findings and may not provide its own medical judgment in the guise of a Board opinion. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1990). 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) Second, the probative value of a medical opinion largely depends upon the extent to which such an opinion was based on a thorough review of a veteran's medical history, as contained in his claims file. In cases where an examiner who has rendered a medical opinion had not had an opportunity to review the veteran's medical records, the medical opinion's probative value was substantially limited. See Miller v. West, 11 Vet. App. 345, 348 (1998) (bare conclusions without a factual predicate in the record are not considered probative); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994). Third, the fact that an opinion is relatively speculative in nature also limits its probative value. For example, an examiner's opinion that a current disorder "could be" related to, or that there "may be" some relationship with, symptomatology in service makes the opinion of the examiner too speculative in nature. See Bostain v. West, 11 Vet. App. 124, 127-28, quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993) (a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a causal relationship). See also Warren v. Brown, 6 Vet. App. 4, 6 (1993) (a doctor's statement framed in terms such as "could have been" is not probative). Fourth, the fact that a veteran has received regular treatment from a physician or other doctor is certainly a consideration in determining the credibility of that doctor's opinions and conclusions. That notwithstanding, the United States Court of Appeals for Veterans Claims (Court) has declined to adapt a "treating physician rule" under which a treating physician's opinion would presumptively be given greater weight than that of a VA examiner or another doctor. See Winsett v. West, 11 Vet. App. 420, 424-25 (1998); Guerrieri v. Brown, 4 Vet. App. 467-471-3 (1993). Finally, evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Given its review of the record, the Board finds the June 2004 and July 2007 VA examination reports to have greater probative value than the medical opinions offered in the psychological evaluations for parole purposes in 2002 and 2003 and the November 2004 hospital stay record. See Owens v. Brown, 7 Vet. App. at 433. The psychological evaluations from August 2002 to October 2003 and the November 2004 hospital stay record are of limited probative value in deciding this matter because they give no indication that they were based on a review of the claims file or other appropriate medical records. See Miller v. West, 11 Vet. App. at 348; Gabrielson v. Brown, 7 Vet. App. at 40. The basis for the medical diagnoses in this regard was not adequately explained. By contrast, the record shows that the June 2004 and July 2007 VA examinations included a thorough review of the entire claims file, including the private psychological evaluations from August 2002 to October 2003 and the November 2004 private hospital stay record, in conjunction with the opinion offered. In this regard, in the July 2007 VA examination, the examiner explained that, although the November 2004 private record diagnosed the veteran with PTSD, the evaluation did not include a description of valid criterion A stressors or a full constellation of symptoms of PTSD. The VA examiners further explained that while objectively the veteran's psychometric test results showed scores above the cutoff score for a diagnosis of PTSD, these scores reflected an over reporting of symptomatology which was inconsistent with the veteran's current level of functioning. The other evidence supportive of the claim are the veteran's own lay statements. The veteran is not shown to possess the requisite medical training or credentials needed to render a diagnosis or a competent opinion as to medical causation. As such, his lay statements in this regard cannot constitute medical evidence. Routen v. Brown, 10 Vet. App. 183, 186 (1997), aff'd, 142 F.3d 1434 (Fed Cir. 1988); YT v. Brown, 9 Vet. App. 195, 201 (1996); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). As the veteran has not been shown to have a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a), further discussion of the verification of any alleged in-service stressors is not necessary. Thus, the Board finds the preponderance of the evidence is against the veteran's claim of service connection for PTSD. In reaching this determination, the Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. That doctrine, however, is not applicable in this case because the preponderance of the evidence is against the veteran's claim. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); 38 U.S.C.A. § 5107(b). ORDER Service connection for claimed PTSD is denied. ____________________________________________ STEPHEN L. WILKINS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs