Citation Nr: 0842892 Decision Date: 12/12/08 Archive Date: 12/17/08 DOCKET NO. 07-20 143 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Honolulu, Hawaii THE ISSUES 1. Entitlement to service connection for a back disorder. 2. Entitlement to service connection for a bilateral knee disorder. 3. Entitlement to service connection for tinnitus. 4. Entitlement to service connection for a respiratory disorder, to include as due to asbestos. 5. Entitlement to service connection for erectile dysfunction, to include as due to exposure to herbicides. 6. Entitlement to service connection for post-traumatic stress disorder (PTSD). ATTORNEY FOR THE BOARD J. Fussell, Counsel INTRODUCTION The veteran had active service from January 1946 to April 1965. His military decorations include the Korean Service Medal but not the Vietnam Service Medal. This matter comes before the Board of Veterans' Appeals (Board) from a January 2006 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Honolulu, Hawaii. In February 2008, within 90 days after mailing the notification of certification of the appeal in January 2008, the veteran's son submitted additional evidence directly to the Board without a waiver by the veteran of initial consideration of that evidence by the RO. Under 38 C.F.R. § 20.800, and subject to the limitations in 38 C.F.R. § 20.1304, "an appellant may submit additional evidence, or information as to the availability of additional evidence, after initiating an appeal." 38 C.F.R. § 20.1304(c) provides that any pertinent evidence submitted without a waiver must be referred to the RO. 38 C.F.R. § 20.1304(c) specifically states that "[e]vidence is not pertinent it if does not relate to or have a bearing on the appellate issue or issues." In this case, the additional evidence merely confirms the veteran's prior statements and allegations. Accordingly, the additional evidence received in February 2008 is not pertinent and referral of the claims for readjudication in light of this evidence is not required. FINDINGS OF FACT 1. The competent evidence of record does not demonstrate a current back disorder. 2. The competent evidence of record does not demonstrate a current bilateral knee disorder. 3. The competent evidence of record does not demonstrate current tinnitus. 4. The competent evidence of record does not demonstrate a current respiratory disorder. 5. The competent evidence of record does not demonstrate current erectile dysfunction. 6. The competent evidence of record does not demonstrate a current PTSD disability. CONCLUSIONS OF LAW 1. A back disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2008). 2. A bilateral knee disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2008). 3. Tinnitus was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2008). 4. A respiratory was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2008). 5. Erectile dysfunction was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2008). 6. PTSD was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duties to notify and to assist claimants in substantiating VA claims. See 38 U.S.C.A. §§ 5103, 5103A and 38 C.F.R § 3.159. This notice is only required to be given in sufficient time to enable a claimant to submit relevant evidence. The notice may be generic without identifying evidence specific to the individual claim, although it must be tailored to the nature of the claim. It does not extend throughout the claim process. Wilson v. Mansifeld, 506 F.3d 1055, 1059-60 (Fed. Cir. 2007). Duty to Notify Under 38 U.S.C.A. § 5103(a) VA must notify a claimant of the information and evidence needed to substantiate a claim, which information and evidence VA will obtain, and which the claimant must provide. See 38 C.F.R. § 3.159. In service connection claims, the notice must also state what is needed to substantiate all five elements of a service connection claim, which are: 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. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The VCAA notice was intended to be provided before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). A review of the record shows the veteran was provided with pre-adjudication VCAA notice by letter, dated in September 2005, prior to the January 2006 rating decision being appealed. The veteran was notified of the evidence needed to substantiate a claim of service connection, namely, evidence of an injury, disease, or event causing an injury or disease during service; evidence of current disability; and evidence of a relationship between the current disability and the injury, disease, or event causing an injury or disease during service. The veteran was also notified that VA would obtain service records, VA records, and records from other Federal agencies, and that he could submit private medical records or authorize VA to obtaining private medical records on his behalf. Here, the claimant was notified of the law and regulations governing effective dates and rating service-connected disorders by letter of June 2006, prior to readjudication of the claims in the April 2007 statement of the case. An error in failing to afford a preadjudication notice (timing-of-notice error) can be cured by notification followed by readjudication. See Mayfield v. Nicholson, 444 F.3d at 1333-34; Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006); Pelegrini v. Principi, 18 Vet. App. 112, 122-24 (2004). The statement of the case constituted a readjudication of the claims. Mayfield v. Nicholson, 20 Vet. App. 537, 541-42 (2006); affm'd Mayfield v. Nicholson, No. 07-7130, slip op. (Fed. Cir. September 17, 2007); see also Prickett, 20 Vet. App. at 377-78. As for content of the VCAA notice, the documents substantially comply with the specificity requirements of Quartuccio v. Principi, 16 Vet. App. 183 (2002) (identifying evidence to substantiate a claim and the relative duties of VA and the claimant to obtain evidence), of Charles v. Principi, 16 Vet. App. 370 (2002) (identifying the document that satisfies VCAA notice); and, of Pelegrini, supra (38 C.F.R. § 3.159 notice); and of Dingess v. Nicholson, 19 Vet. App. 473 (2006) (notice of the five elements of a service connection claim), aff'd Hartman v. Nicholson, --- F.3d ----, 2007 WL 1016989 (C.A. Fed. 2007). Duty to Assist As required by 38 U.S.C.A. § 5103A, VA has made reasonable efforts to identify and obtain relevant records in support of the claims. The veteran's service treatment records have been obtained. Also on file are records of the veteran's post-service treatment in recent years at a military medical facility. The veteran was afforded the opportunity to testify at a personal hearing in support of his claims but he declined. The veteran has not sought VA treatment and has not indicated that any private clinical records exist or identified any additionally available evidence for consideration in his appeal. Under 38 U.S.C.A. § 5103A(d), a service connection claimant is entitled to a VA examination or opinion when (1) there is competent evidence of current disability or recurrent or persistent disability symptoms, and (2) evidence establishing that an in-service event, injury, or disease occurred or showing a chronic disease manifested in an applicable presumptive period for which the claimant qualifies, and (3) an indication that disability or recurrent or persistent disability symptoms may be associated with service or another service-connected disorder, but (4) insufficient competent medical evidence to render a decision. McLendon v. Nicholson, 20 Vet. App. 79, 81 - 85 (2006); see also Locklear v. Nicholson, 20 Vet. App. 410, 418 - 19 (2006) (emphasizing that the third prong has a "low threshold"). Here, the veteran has not been provided with VA nexus examinations because he had not provided evidence of the current existence of any of his claimed disabilities. As to the claims for service connection for a respiratory disorder due to asbestos exposure and service connection for PTSD, he has not provided the information requested by the RO which would have allowed for any further evidentiary development of those claims. In this regard, the duty to assist is not a one-way street. When necessary or requested the veteran must cooperate with the VA in obtaining evidence. If a veteran wishes help, he cannot passively wait for it in circumstances where he may or should have information that is essential in obtaining the putative evidence. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (reconsideration denied, 1 Vet. App. 406 (1991)). In Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) the Court noted that this was particularly true where "[t]he factual data required, i.e., names, dates and places, are straightforward facts and do not place an impossible or onerous task on appellant." In sum, there is no competent evidence of persistent or recurrent symptoms relative to the claimed disorders from the time of service to the present and, so, there is no indication that any of the claimed disabilities may be associated with service. Under these circumstances, a medical examination or medical opinion is not required for the service connection claims under 38 C.F.R. § 3.159(c)(4). As there is no indication that the veteran was unaware of what was needed, nor any indication of the existence of additional evidence for claim substantiation, the Board concludes that there has been full VCAA compliance. Principles of Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002)38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after discharge from service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Godfrey v. Brown, 7 Vet. App. 398, 406 (1995). Certain conditions, such as arthritis, will be presumed to have been incurred in service if manifested to a compensable degree within 1 year after service. 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection requires that there be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed inservice disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The absence of any one element will result in the denial of service connection. Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006). Service connection is limited to cases in which disease or injury have resulted in a disability and absence of proof of present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Degmetich v. Brown, 104 F.3d 1328 (1997) (interpreting 38 U.S.C. § 1131 as requiring the existence of a present disability for VA compensation) and Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). "A veteran seeking disability benefits must establish . . . the existence of a disability [and] a connection between the veteran's service and the disability." Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000)). Also found at Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000); Collaro v. West, 136 F.3d 1304, 1308 (Fed. Cir. 1998). The Board must weigh the evidence of record and assess its credibility and probative value. 38 U.S.C.A. § 7104(a) (West 2002); Baldwin v. West, 13 Vet. App. 1 (1999). If the preponderance of the evidence is against the claim, it is denied but if the preponderance of the evidence supports of the claim or is in equal balance, the claim is allowed. 38 U.S.C.A. § 5107 (West 2002 & Supp. 2008); Ortiz v. Principi, 274 F.3d 1361, 1365-66 (Fed.Cir. 2001); 38 C.F.R. § 3.102 (2007). Background The service treatment records are negative for the claimed disabilities. Reenlistment examinations in January 1956 and November 1961, as well as the April 1965 separation examination, found that the veteran had a 2 inch by 1 inch scar on the lower portion of his left tibia. All chest X- rays during service were normal. Service personnel records show that the veteran was stationed on ships off the coast of Korea during the Korean Conflict. Also, from May 1962 to April 1965 he was stationed on the USS McKean DD 784, USS Isbell DD 869, and USS Larson DD 830. His military decorations include the Korean Service Medal but do not include the Vietnam Service Medal. In the veteran's original claim, VA Form 21-526 received in May 2005, he reported that he had been treated from September 1964 to April 1965 for PTSD at the US Naval Base in Subic Bay; in September and October 1957 for back pain at the US Naval Station General Mann (TAP-112); from November 1964 to April 1965 for knee pain aboard the USS Everett F. Larson (DD-830); for ringing in his ears in February and March 1947 while with the Subic China Ship Group; and in September 1957 for difficulty breathing at the US Naval Station General Mann (TAP-112). He did not report having received in-service treatment for erectile dysfunction but reported that it had begun in January 1965. Post-service clinical records in 2005 from a military medical facility show that the veteran was seen in April 2005 for hypertension and vertigo. The latter was most likely secondary to benign positional vertigo. He denied having hearing loss or tinnitus. In a September 2005 statement the veteran reported that he had served aboard three destroyers, cruising the straits of Vietnam. These were the USS McKean (EE-784), the USS Arnold J. Isbell (DD-869), and the USS Everett F. Larson (DD-830). While patrolling, they had encountered an attack by a fast boat of the enemy making for his ship at full speed and zigzagging in the straits. Also while aboard the USS General W. A. Mann (T-HP-112) he started experiencing backaches while working in the galley. That ship was sent to the Oregon Naval Ship Yard to have asbestos ripped off and during this time the crew stayed on board the ship. He had been on the USS Helena (CA-75) when it was engaged in combat off the coast of Korea. Information from the service department indicates that there was no evidence in the veteran's file to substantiate any service in the Republic of Vietnam. In the veteran's June 2006 notice of disagreement he reported that he was suffering from all of the conditions set forth in his application. However, due to his cultural up-bringing he had not been regularly seeing a physician. He had taken home remedies and lots of Tylenol for pain. In August 2007 the RO sent the veteran a letter requesting detailed information concerning his exposure to asbestos and information about his claimed in-service stressors. In October 2007 the veteran reported that he was not able answer the questions that the RO had requested in the August 2007 letter. He requested that another such letter be sent to him. The RO did so in November 2007. However, the veteran never responded to the November 2007 request for information. In the statement from the veteran's son, received in February 2008, it was noted that there had been racial conflict aboard the USS Helena when the veteran was stationed on that ship. Others had made threatening gestures with a knife and on one occasion he had been nicked by a knife. He had been in constant fear for his life. During the bombardment of Inchon, Korea, he and other crew members would try to sleep "carrying bombs on their forearms whenever possible." He had dreamed about these incidents over and over. The dreams were so vivid that he would awake in a cold sweat. Also, for as long as the veteran's son could remember, the veteran had back and knee problems but was too proud to admit it. Just after he retired, he began using non-traditional therapy such as massages, back rubs with Vicks Medicated Vaporub, and pain relieving patches on his back and knees. In the Navy, personnel had been discouraged from seeking treatment for any illnesses. He had been assigned to numerous ships and been exposed to hazardous noise working in the galley and scullery areas. He had been very close to artillery guns during the bombardment of Inchon, Korea. He had complained countless times to his daughter, a registered nurse, about ringing in both ears and she had advised the veteran to have that checked. Analysis Back disorder, Bilateral Knee Disorder and Tinnitus Here, there is no clinical evidence that the veteran has ever had a chronic disability of the back or knees. Moreover, in light of this recent denial of having had tinnitus, that he ever had chronic tinnitus. In fact, neither tinnitus nor disabilities of the back or knees have ever been diagnosed. Moreover, as a lay person, the veteran is not competent to establish such diagnosis or causal relationship to service. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). A layperson is competent to provide evidence for the purpose of establishing continuity of symptomatology but cannot render a medical opinion as to the etiology of a disorder. Such lay evidence of continuous symptom cannot be found to lack credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 - 37 (Fed. Cir. 2006). To whatever extent the veteran's communications of record can be found to assert continuity of symptomatology relating to the claimed disabilities at issue, ultimately, there must be proof of a current disability for there to be a valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Given the lack of evidence demonstrating current disability, the back knee and tinnitus claims must be denied. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Respiratory Disorder, Including Due to Asbestos Regarding asbestos-related diseases, the Board notes there are no laws or regulations specifically dealing with service connect for asbestos exposure. However, the VA Adjudication Procedure Manual, M21-1 (M21-1), and opinions of the United States Court of Appeals for Veterans Claims (Court) and General Counsel provide guidance in adjudicating these claims. In 1988, VA issued a circular on asbestos-related diseases that provided guidelines for considering asbestos compensation claims. See Department of Veterans Benefits, Veterans' Administration, DVB Circular 21-88-8, Asbestos- Related Diseases (May 11, 1988). The information and instructions contained in the DVB Circular since have been included in VA Adjudication Procedure Manual, M21-1, part VI, paragraph 7.21 (October 3, 1997). VA must adjudicate the veteran's claim for service connection for a lung disorder, as a residual of exposure to asbestos, under these guidelines. See Ennis v. Brown, 4 Vet. App. 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). As to the M21-1, it provides that, when considering these types of claims, VA must determine whether military records demonstrate evidence of asbestos exposure in service (see M21-1, Part III, par. 5.13(b) (October 3, 1997); M21-1, Part VI, par. 7.21(d)(1) (October 3, 1997)); determine whether there was pre-service and/or post-service evidence of occupational or other asbestos exposure (Id.); and thereafter determine if there was a relationship between asbestos exposure and the currently claimed disease, keeping in mind the latency and exposure information found at M21-1, Part III, par. 5.13(a) (see M21-1, Part VI, par. 7.21(d)(1) (October 3, 1997)). In this regard, the M21-1 provides the following non- exclusive list of asbestos related diseases/abnormalities: asbestosis, interstitial pulmonary fibrosis, effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, lung cancer, bronchial cancer, cancer of the larynx, cancer of the pharynx, cancer of the urogenital system (except the prostate), and cancers of the gastrointestinal tract. See M21-1, Part VI, par. 7.21(a)(1) & (2). The M21-1 also provides the following non-exclusive list of occupations that have higher incidents of asbestos exposure: mining, milling, work in shipyards, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, and manufacture and installation of roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment. See M21-1, Part VI, par. 7.21(b)(1). In addition, the M21-1 notes that, during World War II, several million people employed in U.S. shipyards and U.S. Navy personnel were exposed to asbestos. See M21-1, Part VI, par. 7.21(b)(2). Next, the Board notes that the M21-1 provides the following medical guidance: in order for an appellant to have a clinical diagnosis of asbestosis the record must show a history of exposure and radiographic evidence of parenchymal lung disease (see M21-1, Part VI, par. 7.21(c)); the latent period for asbestosis varies from 10 to 45 or more years between first exposure and development of disease (see M21-1, Part VI, par. 7.21(b)(2)); and exposure to asbestos may cause disease later on even when the exposure was brief (as little as a month or two) or indirect (bystander disease) (Id.). As to the Court, it has held that the M21-1 did not create a presumption of in-service exposure to asbestos for claimants that worked in one of the occupations that the M21-1 listed as having higher incidents of asbestos exposure. See Dyment v. West, 13 Vet. App. 141, 145 (1999); Also see Ennis v. Brown, 4 Vet. App. 438, vacated at 4 Vet. App. 523, new decision issued at 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993); Ashford v. Brown, 10 Vet. App. 120 (1997). Therefore, in claims for service connection for disability due to asbestos exposure, the appellant must first establish that the disease that caused or contributed to his disability was caused by events in service or an injury or disease incurred therein. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). As to the General Counsel, in VAOPGCPREC 04-2000 (April 13, 2000), it was held, in relevant part, as follows: M21-1, Part VI, par. 7.21(a), (b), and (c) are not substantive in nature, but nonetheless need to be discussed by the Board in all decisions; the first three sentences of M21-1, Part VI, par. 7.21(d)(1) are substantive in nature and the development criteria it lays out must be followed by the agency of original jurisdiction; and M21-1, Part VI, par. 7.21 does not create a presumption of medical nexus between a current asbestos related disease and military service. In this case there is no competent evidence that the veteran now had or has ever had a respiratory disability. His statements, and that of his son, are not competent for the purpose of establishing a current diagnosis of a respiratory disability and there is no diagnosis of a respiratory disability at any time. In this regard, mere exposure to asbestos, to which the veteran was most likely exposed during service, is by itself not a disability. The Board also observes that the veteran failed to cooperate by providing requested information as to the detail of his potential exposure. Again, the first Hickson element is not established by competent evidence and, so, the claim must be denied. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Erectile Dysfunction, Including Due Herbicide Exposure A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era (beginning in January 1962 and ending in May 1975) shall be presumed to have been exposed during such service to herbicide agents, including an herbicide commonly referred to as Agent Orange. 38 U.S.C.A. § 1116(a)(3); 38 C.F.R. §§ 3.307, 3.309. Whenever VA's Secretary determines, on the basis of sound medical and scientific evidence, that a positive association exists between the exposure of humans to an herbicide agent and the occurrence of a disease in humans, the Secretary shall prescribe regulations providing that a presumption of service connection is warranted for that disease. 38 U.S.C.A. § 1116(b)(1). If a veteran was exposed to an herbicide agent during active military service, the following diseases will be presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service: chloracne or other acneform disease consistent with chloracne, Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin's disease, chronic lymphocytic leukemia, 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 sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 U.S.C.A. § 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6), 3.309(e). VA's Secretary has determined that a presumption of service connection based on exposure to herbicides to include Agent Orange used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See Notice, 72 Fed. Reg. 32,395 (2007). Notwithstanding the aforementioned provisions relating to presumptive service connection, which arose out of the Veteran's Dioxin and Radiation Exposure Compensation Standards Act, Pub. L. No. 98-542, § 5, 98 Stat. 2,725, 2,727-29 (1984), and the Agent Orange Act of 1991, Pub. L. No. 102-4, § 2, 105 Stat. 11 (1991), the Federal Circuit has determined that a claimant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); 38 C.F.R. § 3.303(d). In the present case, even if herbicide exposure were conceded, the competent evidence does not show that he has ever had the claimed erectile dysfunction. There has never been a diagnosis of erectile dysfunction and the statements of the veteran are not competent for that purpose. So, the first Hickson element is not established by competent evidence and, so, the claim must be denied. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Post-Traumatic Stress Disorder Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with § 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). The evidence necessary to establish the occurrence of any in-service stressor varies depending on whether or not the veteran engaged in combat with the enemy. Gaines v. West, 11 Vet. App. 353, 358 (1998). If it is determined through military citation or other supportive evidence that a veteran engaged in combat with the enemy, and the claimed stressor is related to combat, the veteran's lay testimony regarding the reported stressor must be accepted as conclusive evidence as to the actual occurrence and no further development or corroborative evidence will be necessary, provided that the testimony is found to be satisfactory and consistent with the circumstances, conditions or hardships of such service. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d), (f). Where a determination is made that the veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, the veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. Moreau v. Brown, 9 Vet. App. 389, 395 (1996); Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). In such a case, the record must contain service records or other corroborative evidence that substantiates or verifies the veteran's testimony or statements as to the occurrence of the alleged in-service stressor. Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). The veteran contends that his stressors are a mix of combat related stress and non-combat related stress from racial tension on board the ship upon which he served. The record does not show that the veteran served in combat. His mere presence onboard a ship off the coast of Korea, even if that ship did participate in the bombardment of Inchon, Korea, does not establish that the veteran participated in combat with the enemy. Where, as here, the determination is made that the veteran did not engage in combat with the enemy, the veteran's lay testimony alone is not sufficient to establish the occurrence of the alleged noncombat stressors. Moreau v. Brown, 9 Vet. App. 389, 395 (1996); Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). Here, there is no credible supporting evidence that the in-service stressors actually occurred. Moreover, there is no diagnosis of PTSD and the veteran has not related having had the signs or symptoms consistent with, nor having ever sought treatment for, PTSD. Lastly, the veteran did not comply with requests to provide details concerning his alleged stressors. So, here again, the first Hickson element is not established by competent evidence and, thus, the claim must be denied. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ORDER Service connection for a back disorder is denied. Service connection for a bilateral knee disorder is denied. Service connection for tinnitus is denied. Service connection for a respiratory disorder is denied. Service connection for erectile dysfunction is denied. Service connection for PTSD is denied. ____________________________________________ ERIC S. LEBOFF Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs