Citation Nr: 0814303 Decision Date: 04/30/08 Archive Date: 05/08/08 DOCKET NO. 00-12 990 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Entitlement to service connection for a psychiatric disability, to include post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for a skin disability, to include as secondary to Agent Orange exposure. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. M. Powell, Associate Counsel INTRODUCTION The veteran had active service from June 1968 to April 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 1999 rating decision of the San Juan, Puerto Rico Regional Office (RO) of the Department of Veterans Affairs (VA) that denied service connection for a depressive disorder and a skin disability. It also comes on appeal from a February 2005 decision that denied service connection for PTSD. The Board notes that the issue of entitlement to service connection for migraine headaches was also denied in the December 1999 decision. The veteran perfected an appeal as to the issue. However, the record demonstrates that in a January 2008 decision, the RO granted service connection for migraine headaches. Therefore, as the RO's grant of service connection is a full grant of the benefit sought, the Board finds that the issue of entitlement to service connection for migraine headaches is no longer available for appellate review and will not be addressed in this decision. As a preliminary matter, the Board notes that, in August 2006, the United States Court of Appeals for Veterans Claims (Court) issued a decision in Haas v. Nicholson, 20 Vet. App. 573 (2007), that reversed a decision of the Board that denied service connection for disabilities claimed as a result of exposure to herbicides. VA disagrees with the Court's decision in Haas and has appealed this decision to the United States Court of Appeals for the Federal Circuit. To avoid burdens on the adjudication system, delays in the adjudication of other claims, and unnecessary expenditure of resources through remand or final adjudication of claims based on court precedent that may ultimately be overturned on appeal, on September 21, 2006, the Secretary of Veterans Affairs imposed a stay at the Board on the adjudication of claims affected by Haas. The specific claims affected by the stay include those involving claims based on herbicide exposure in which the only evidence of exposure is the receipt of the Vietnam Service Medal or service on a vessel off the shore of Vietnam. In this case, the veteran's DD Form 214 specifically indicates that the veteran served in the Republic of Vietnam. As such, the claim on appeal is not affected by the holding in Haas and thus, is not the subject of any associated stay or proceedings. FINDINGS OF FACT 1. Psychiatric disability other than PTSD has not been shown by competent evidence to be causally related to the veteran's active service, and a psychosis was not demonstrated within one year after service. 2. The competent evidence of record establishes that the veteran engaged in combat activity with the enemy, and causally relates the veteran's PTSD diagnosis to his combat- related stressors in service. 3. A skin disability was initially demonstrated years after service and has not been shown by competent evidence to be causally related to the veteran's active service. CONCLUSIONS OF LAW 1. A psychiatric disability, other than PTSD, was not incurred in, or aggravated by, active service, nor may a psychosis be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2007). 2. PTSD was incurred in active service. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2007). 3. A skin disability was not incurred in, or aggravated by, active service and may not be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2007); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). On March 3, 2006, the United States Court of Appeals for Veterans Claims (Court) issued its decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Court in Dingess/Hartman holds that the VCAA notice requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a "service connection" claim. As previously defined by the courts, those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Upon receipt of an application for "service connection," therefore, the Department of Veterans Affairs (VA) is required to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. This includes notice that a disability rating and an effective date will be assigned in the event of the award of the benefits sought. In the present case, VA satisfied its duty to notify by means of April 2001, July 2004, June 2006, and July 2007 letters from the agency of original jurisdiction (AOJ) to the appellant that informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence, as well as requested that he submit any evidence in his possession that pertains to the claims. The veteran was also provided with notice of the type of evidence necessary to establish a disability rating or effective date in the event of award of the benefit sought. In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the U.S. Court of Appeals for Veterans Claims held, in part, that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. In the present case, additional VCAA notice was issued after the initial AOJ adjudication of the claims. Nevertheless, the Court in Pelegrini noted that such requirement did not render a rating decision promulgated prior to providing the veteran full VCAA notice void ab initio, which in turn would nullify the notice of disagreement and substantive appeal filed by the veteran. In other words, Pelegrini specifically noted that there was no requirement that the entire rating process be reinitiated from the very beginning. Rather, the claimant should be provided VCAA notice and an appropriate amount of time to respond and proper subsequent VA process. Here, the Board finds that any defect with respect to the timing of the VCAA notice letter was harmless error. Although the notice was provided to the appellant after the initial adjudication, the case was readjudicated thereafter, and the appellant has not been prejudiced thereby. The content of the notice provided to the appellant fully complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to notify. Not only has the appellant been provided with every opportunity to submit evidence and argument in support of his claims and to respond to VA notices, but the actions taken by VA have essentially cured the error in the timing of notice. Further, the Board finds that the purpose behind the notice requirement has been satisfied because the appellant has been afforded a meaningful opportunity to participate effectively in the processing of his claims. For these reasons, it is not prejudicial to the appellant for the Board to proceed to finally decide this appeal. With regard to the duty to assist, the claims file contains the veteran's service medical and personnel records, VA and private treatment records, and VA examination reports. Additionally, the claims file contains the veteran's statements in support of his claims. The Board has carefully reviewed such statements and concludes that he has not identified further evidence not already of record. The Board has also perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the veteran's claims. Thus, based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the veteran in developing the facts pertinent to his claims. Essentially, all available evidence that could substantiate the claims has been obtained. Legal Criteria and Analysis According to the law, service connection is warranted if it is shown that a veteran has a disability resulting from an injury incurred or a disease contracted in the line of duty, or for aggravation of a preexisting injury or disease in active military service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2007). 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). "Generally, to prove service connection, a claimant must submit (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury." Pond v. West, 12 Vet. App. 341, 346 (1999). Where the determinative issue involves a medical diagnosis, competent medical evidence is required. This burden typically cannot be met by lay testimony because laypersons are not competent to offer medical opinions. Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). Where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946 and a psychosis becomes manifest to a degree of 10 percent or more within one year from the date of termination of such service, such disease shall be presumed to have been incurred in or aggravated by service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309 (2007). 1. Psychiatric Disability, Other than PTSD The Board will initially consider whether entitlement to service connection is warranted for a psychiatric disability, other than PTSD. With respect to a current disability, the record reflects that the veteran has been variously diagnosed with depression, depressive disorder, and dysthymic disorder. However, in terms of an in-service injury or disease, the veteran's service medical records do not demonstrate that the veteran complained of or sought treatment for any psychiatric disability in service. In fact, on an April 1970 Report of Medical History provided in conjunction with his separation examination, the veteran denied a history of depression or excessive worry, loss of memory or amnesia, or nervous trouble of any sort. Moreover, on the corresponding Report of Medical Examination, the examiner indicated that the veteran was psychiatrically normal. Further, the Board observes that there is no clinical opinion of record which relates the veteran's current depression, dysthymic disorder, and/or depressive disorder to service. Indeed, it is significant to point out that in October 2007, a VA examiner opined that "the origin or etiology of [the veteran's] depression was not in any way related to his military experience, but to other family and marital problems, that are still partially present, and now after all these years, with added situations in relation to [his] multiple health problems." As such, in the absence of any evidence to the contrary, the Board finds that the preponderance of the evidence is against a grant of direct service connection for a psychiatric disability, other than PTSD. The Board notes that the veteran could be entitled to service connection on a presumptive basis if there is evidence that a psychosis was demonstrated within one year of separation from service. However, the record does not demonstrate that the veteran has a current psychosis. Indeed, the October 2007 VA examiner opined that "there is no evidence in any of the psychiatric reports, past and present, that this veteran ever had any psychotic disorder within one year from his discharge from service, as he is not psychotic at present." Thus, the Board concludes that the veteran is also not entitled to a grant of service connection for psychiatric disability on a presumptive basis. In conclusion, although the veteran asserts that he has a psychiatric disability, other than PTSD, that is related to service, he is not competent to provide an opinion requiring medical knowledge, such as a question of medical causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). He is competent to give evidence about what he experienced; for example, he is competent to report that he experiences certain symptoms. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). Competency, however, must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Therefore, as the competent evidence of record fails to establish that the veteran has a current psychiatric disability, other than PTSD, that is related to his active military service, the Board finds that the preponderance of the evidence is against the veteran's claim for service connection for a psychiatric disability, other than PTSD. The Board has considered the doctrine of giving the benefit of the doubt to the veteran, under 38 U.S.C.A. § 5107 (West 2002), and 38 C.F.R. § 3.102 (2007), but does not find that the evidence is of such approximate balance as to warrant its application. 2. Service connection- PTSD 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)(2007). The provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform to the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994). Further relating to claims of service connection for PTSD, in Zarycki v. Brown, 6 Vet. App. 91 (1993), the United States Court of Appeals for Veterans Claims (Court) set forth the analytical framework and line of reasoning for determining whether a veteran was exposed to a recognizable stressor during service, which, as discussed above, is an essential element in solidifying a claim for service connection for PTSD. In Zarycki, it was noted that, under 38 U.S.C.A. 1154(b), 38 C.F.R. 3.304(d) and (f), and the applicable provisions contained in VA Manual 21-1, the evidence necessary to establish the incurrence of a recognizable stressor during service to support a claim of service connection for PTSD will vary depending on whether the veteran "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60 (1993). The determination as to whether the veteran "engaged in combat with the enemy" is made, in part, by considering military citations that expressly denote as much. Doran v. Brown, 6 Vet. App. 283, 289 (1994). However, the Court has held that the Board may not rely strictly on combat citations or the veteran's military occupational specialty to determine if he engaged in combat; rather, other supportive evidence of combat experience may also be accepted. See Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996); West v. Brown, 7 Vet. App. 70, 76 (1994). If combat is affirmatively indicated, then the veteran's lay testimony regarding claimed combat- related stressors must be accepted as conclusive as to their actual occurrence and no further development or corroborative evidence will be required, provided that the veteran's testimony is found to be "satisfactory," i.e., credible, and "consistent with the circumstances, conditions, or hardships of such service." Zarycki, 6 Vet. App. at 98. If there is no combat experience, or if there is a determination that the veteran engaged in combat but the claimed stressor is not related to such combat, there must be independent evidence to corroborate the veteran's statement as to the occurrence of the claimed stressor. Doran, 6 Vet. App. at 288-89 (1994). The veteran's testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor. Dizoglio, 9 Vet. App. at 166 (1996). Further, an opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of a stressor. Moreau v. Brown, 9 Vet. App. at 395-96 (1996); Cohen v. Brown, 10 Vet. App. 128 (1997). The veteran contends that service connection is warranted for PTSD. His reported stressors include: 1) being under strong enemy fire on his first night in Pleiku Oasis in April 1969; 2) being under heavy fire on May 11, 1969 (Mother's Day) at Firebase Oasis when assigned to the 4th Infantry Division, HQ 704 Maintenance Battalion, and the deaths of soldiers and a Vietnamese barber that had been a good friend in that attack; 3) an attack on the barrack with damage to the airfield at An Khe the day before his departure from Vietnam; and 4) witnessing the death of his close friend, Anselmo Santiago, on July 21, 1969, at the 704 Maintenance Battalion, 4th Infantry Division, during an ambush when the veteran was assigned to the Rangers. As previously noted, in order to establish a claim of entitlement to service connection for PTSD, it is necessary to show that an in-service stressor occurred. With respect to whether the veteran engaged in combat with the enemy, his service personnel records show that he served in Vietnam from May 2, 1969 to April 10, 1970 and that he received the Vietnam Service Medal, the Vietnam Campaign Medal with device, the Army Commendation Medal for meritorious service in the Republic of Vietnam, and the Republic of Vietnam Gallantry Cross with Palm Unit Citation Badge. Information provided by the National Personnel Records Center reflects that the veteran was assigned to the 4th Infantry Division which occupied two locations in Vietnam, including Camp Enari and Camp Oasis. Such information also indicated that on May 11, 1969, Camp Oasis received over 300 rounds of mixed mortar, rocket, and recoilless rifle fire, following by a ground attack. The information provided by the NPRC also shows that the 4th Infantry was exposed to enemy fire on May 21, 1969, as well as in June 1969. Information provided by the veteran reflects that while in Vietnam, the 4th Infantry, Division Headquarters was located in Pleiku from April 1968 to February 1970, An Khe and Pleiku in March 1970, and An Khe from April 1970 to December 1970. The veteran also provided information that documented that Anselmo Santiago-Arroyo was killed on July 21, 1969 in Pleiku, South Vietnam. In weighing the evidence as to whether the veteran was exposed to combat, the Board finds persuasive the fact that the record corroborates the veteran's contentions that he was exposed to enemy fire in Vietnam, including on Mother's Day 1969 while at Camp Oasis and elsewhere in Pleiku. Therefore, as the record reflects that the veteran was stationed at Camp Oasis and at other locations in Pleiku at the same time that the enemy attacked the 4th Infantry Division at such locations, the Board is unable to affirmatively rule out that he was not exposed to such enemy fire. Therefore, in resolving all reasonable doubt in the veteran's favor, the Board concedes that the veteran was exposed to combat activity with the enemy while serving in Vietnam. The Board notes that if combat activity with the enemy is affirmatively indicated, then the veteran's lay testimony regarding claimed combat- related stressors must be accepted as conclusive as to their actual occurrence and no further development or corroborative evidence will be required, provided that the veteran's testimony is found to be "satisfactory," i.e., credible, and "consistent with the circumstances, conditions, or hardships of such service." Zarycki, 6 Vet. App. at 98. Here, the Board finds that the veteran's statements in the record regarding his combat- related stressors to be credible and consistent with the circumstances of his military combat activity. Thus, the next inquiry is whether the veteran has a current PTSD diagnosis and whether such diagnosis is causally related to the veteran's service. The record reflects that in an October 2004 VA examination report, the examiner reported that the veteran did not meet the stressor criteria for PTSD because his claimed stressors had not been verified. In an October 2007 VA examination report, an examiner indicated that the veteran's symptoms did not meet the diagnostic criteria for a diagnosis for PTSD, but rather were attributed to depression. However, in August 2000, March 2003, and May 2005, a private psychologist, after an assessment of the veteran and a discussion of his Vietnam-related stressors, diagnosed the veteran with PTSD. In weighing the probative value of the medical evidence as to whether the veteran has PTSD, the Board finds that because both examiners provided well-substantiated rationales for their conclusions, that both reports are competent, probative medical evidence. As such, the Board finds that the evidence of record is in equipoise in this regard. Therefore, because the veteran has been diagnosed as having PTSD, which is linked to his in-service combat experiences in Vietnam, and resolving all benefit of doubt in the veteran's favor, the Board finds that the evidence for record is sufficient to support a finding of service connection for PTSD. Accordingly, the veteran's claim for service connection for PTSD is granted. 3. Skin Disability A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the Vietnam era. "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 U.S.C.A. § 1116(a) (3) (West 2002); 38 C.F.R. § 3.307(a) (6) (iii) (2007). The presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for any condition other than those for which the Secretary has specifically determined that a presumption of service connection is warranted. See National Academy of Sciences report, "Veterans and Agent Orange: Update 1996," dated March 14, 1996. The following diseases are deemed associated with herbicide exposure, under VA law: chloracne or other acneform diseases consistent with chloracne, Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). See 38 C.F.R. § 3.309(e). The foregoing diseases shall be service connected if a veteran was exposed to a herbicide agent during active military, naval, or air service, if the requirements of 38 U.S.C.A. § 1116, 38 C.F.R. § 3.307(a) (6) (iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. In order to establish service connection by presumption, based on herbicide exposure, the diseases listed above (see 38 C.F.R. § 3.309(e)) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne and porphyria cutanea tarda shall have become manifest to a degree of 10 percent or more within a year, and respiratory cancers within 30 years, after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. See 38 C.F.R. § 3.307(a)(6)(ii). Even if the statutory presumptions are inapplicable, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that such does not preclude a veteran from establishing service connection with proof of actual direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The veteran contends that service connection is warranted for a skin disability, to include as due to Agent Orange exposure. With respect to entitlement to service connection on direct basis, the clinical evidence of record establishes that on VA examination in September 2007, the veteran was diagnosed with vitiligo in the genital area and status post recurrent furunculosis by history. However, it is significant to point out that the contemporaneous service medical records do not indicate that the veteran ever complained of, or was treated for, a skin disability in service. Indeed, on a Report of Medical Examination, provided in conjunction with the veteran's April 1970 separation examination report, the examiner indicated that the veteran's skin was normal. Likewise, on the corresponding Report of Medical History, the veteran denied a history of skin diseases. Moreover, there is no competent medical opinion of record that etiologically relates the veteran's current skin disability to any incident of service. Also, as noted above, in order for a veteran to establish service connection on a presumptive basis for a disability that results from exposure to herbicides (Agent Orange) while serving in Vietnam, the disability must be one that is statutorily listed as a presumptive condition. With respect to the veteran's claim for service connection as a residual of exposure to Agent Orange, the Board acknowledges that the veteran served in Vietnam and, as such, his in-service exposure to herbicides is presumed. However, the Board notes that the disabilities that have been positively associated with Agent Orange do not include vitiligo or furunculosis. See 38 C.F.R. §§ 3.307, 3.309 (2006). Further, the veteran has not presented any competent medical evidence that causally links such conditions to exposure to Agent Orange in service. Combee v. Brown, 34 F. 3d 1039 (Fed Cir. 1994). Indeed, it is significant to point out that the September 2007 VA examiner opined that the veteran's "skin conditions are not related to exposure." Therefore, in the absence of any medical evidence to the contrary, the Board finds that the preponderance of the evidence is against a finding of a causal connection between the veteran's exposure to herbicides during service and his current skin disability, to include vitiligo and status post recurrent furunculosis. In conclusion, the only evidence of record is to the effect that the veteran's current skin disability is not attributable to his military service. Although he asserts that his current skin disability is related to service, he is not competent to provide an opinion requiring medical knowledge. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). He is competent to give evidence about what he experienced; for example, he is competent to report that he experiences certain symptoms. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). Competency, however, must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). However, the negative evidence of record is of greater probative value than the veteran's statements in support of his claim. The Board has considered the doctrine of giving the benefit of the doubt to the appellant, under 38 U.S.C.A. § 5107 (West 2002) and 38 C.F.R. § 3.102 (2006), but it does not find that the evidence is of such approximate balance as to warrant its application. Accordingly, the Board finds that the competent evidence of record fails to establish that the veteran's current skin disability is related to his active military service. Thus, the Board finds that the preponderance of the evidence is against the veteran's claim for service connection for a skin disability, to include as due to Agent Orange exposure. ORDER Entitlement to service connection for a psychiatric disability, other than PTSD, is denied. Entitlement to service connection for PTSD is granted. Entitlement to service connection for a skin disability, to include as due to Agent Orange exposure, is denied. ____________________________________________ U. R. POWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs