Citation Nr: 0914078 Decision Date: 04/15/09 Archive Date: 04/24/09 DOCKET NO. 03-08 622 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUE Entitlement to an effective date earlier than July 1, 2002, for the award of service connection for post traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. P. Simpson, Counsel INTRODUCTION The Veteran served on active duty from October 1967 to May 1969. He served in Vietnam and received a Purple Heart and Combat Infantryman Badge. This case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2003 Decision Review Officer decision of the Phoenix, Arizona, Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for post traumatic stress disorder and assigned an effective date of July 1, 2002. In an August 2006 decision, the Board denied the claim for entitlement to an effective date earlier than July 1, 2002, for the award of service connection for post traumatic stress disorder. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2008 decision, the Court vacated the Board's August 2006 and remanded it for further proceedings consistent with the decision. The substance of the Veteran's arguments before the Court and the Court's determinations will be addressed in more detail below. The case has been returned to the Board for further appellate review. FINDINGS OF FACT 1. On May 25, 2001, VA received VA Form 21-526, Veteran's Application for Compensation or Pension, wherein the Veteran requested compensation benefits for post traumatic stress disorder. 2. On June 15, 2001, the Veteran underwent a VA post traumatic stress disorder examination, wherein the examiner determined there was no mental disorder to diagnose, and that there was insufficient current clinical symptomatology to establish a diagnosis of post traumatic stress disorder. This examination report met the requirements under the VA Adjudication Procedure Manual M21-1, which was in effect at that time. 3. Veterans Benefits Administration (VBA) fast letter, dated March 15, 2006 (VBA Fast Letter 06-03 (Mar. 15, 2006)) and Fast Letter 05-01 (Feb. 9, 2005) do not apply to the June 2001 VA examination report. 4. A July 1, 2002, VA outpatient treatment report shows that a VA psychiatrist examined the Veteran and provided an assessment of rule out post traumatic stress disorder. 5. On August 5, 2002, the same VA psychiatrist diagnosed post traumatic stress disorder. This is the first time in the record showing a diagnosis by a competent professional of post traumatic stress disorder in accordance with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (1994) (DSM-IV). 6. The preponderance of the evidence is against a finding that the Veteran met the three criteria necessary to establish service connection for post traumatic stress disorder prior to July 1, 2002. CONCLUSION OF LAW The criteria for an effective date earlier than July 1, 2002, for the award of service connection for post traumatic stress disorder have not been met. 38 U.S.C.A. §§ 5103, 5103A, 5107, 5110 (West 2002 & Supp. 2008); 38 C.F.R. § 3.400 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2008) defines VA's duty to notify and assist the claimant in the development of a claim. See also 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2008). The notice requirements require VA to notify the claimant of any evidence that is necessary to substantiate the claim, as well as the evidence VA will attempt to obtain and which evidence he is responsible for providing. Quartuccio v. Principi, 16 Vet. App. 183 (2002). The U.S. Court of Appeals for the Federal Circuit and the U.S. Court of Appeals for Veterans Claims (Court) have held that once a claim is granted, the claim is substantiated and additional VCAA notice is not required. See Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Therefore, VCAA notice requirements are satisfied in the matter of an effective date claim flowing downstream from the appeal of a decision awarding compensation benefits for post traumatic stress disorder. VA provided the Veteran with adequate notice of how effective dates are assigned, and it is clear from the Veteran's arguments throughout the record that he has actual knowledge of how effective dates are assigned and what type of evidence would be necessary to establish an earlier effective date. As to the duty to assist, in its decision, the Court found that "the Board did not provide an adequate statement of reasons or bases to support its finding that VA satisfied the duty to assist." The Court stated the following, in part: Specifically, the Board erred by failing to consider two "potentially applicable" regulatory provisions when it rendered its determination as to the adequacy of the June 2001 examination report. First, VA's internal procedures, as set forth in the VA Adjudication Procedure Manual M21- 1 (M21-1), provide: Although Veterans Service Center employees are not expected to review the credentials of clinical personnel to determine the acceptability of their reports, all examination reports must be signed by physicians or clinical or counseling psychologists. Copies transmitted by CAPRI without signatures are acceptable, since signed copies will be maintained by the VHA examining facility. If an unsigned examination report is otherwise received, return the report as insufficient for rating purposes. M21-1, pt. VI, para. 1.07(d), change 107 (Dec. 5, 2003) (rescinded by M21-1MR, pt. III, subpt. iv, dated Dec. 13, 2005) (now found in VA Adjudication Procedure Manual M21-1MR, pt. III, subpt. iv, ch. 3, sec. D (2007)). In certain circumstances, M21- 1 provisions may be construed as "the equivalent of Department regulations." See Hamilton v. Derwinski, 2 Vet. App. 671, 675 (1992) (holding that substantive rules in the M21-1 Manual are binding on VA). As such, the Board in this case erred when it failed to consider the applicability of M21-1, change 107, and the provision's possible relevance with respect to VA's compliance with the duty to assist. See 38 U.S.C. § 7104(a); Weaver[ v. Principi, 14 Vet. App. 301 (2001) (per curiam order)]. Likewise, in a Veterans Benefits Administration (VBA) fast letter dated March 15, 2006 (VBA Fast Letter 06-03 (Mar. 15, 2006)), the Director of the Compensation of Pension Service states that a mental disorder examination report must be returned as inadequate when it "does not include the examiner's credentials and signature" or "does not include the signature of a board- certified or board-eligible psychiatrist or licensed doctorate-level psychologist." VBA Fast Letter, at 4. The Board should have considered the applicability of this fast letter or its predecessors, see, e.g., Fast Letter 05-01 (Feb. 9, 2005), and whether it affected the adequacy of the June 2001 examination report based on the absence of a signature or the examiner's credentials. See 38 U.S.C. § 7104(a); Weaver, supra. Because the Board did not provide an adequate statement of reasons or bases for its finding that VA satisfied the duty to assist, the Court will vacate the Board decision and remand the matter for the Board to address the potentially applicable M21-1 and VBA fast letter provisions. See Tucker[ v. West, 11 Vet. App. 369 (1998)]. Initially, the Board notes that the Veteran made no arguments to the Board prior to its August 2006 decision as to the adequacy of the June 2001 examination report. The only argument he made regarding that examination report was that it was likely the Veteran had masked his post traumatic stress disorder symptoms, which was why the examiner did not diagnose post traumatic stress disorder. The Board had no doubt, and continues to have no doubt, about the adequacy or sufficiency of the June 2001 examination report, which is why it did not consider addressing the adequacy/sufficiency of such report in its August 2006 decision. Because the Court has directed the Board to consider the M21- 1 and VBA Fast Letter(s), the Board will do so, which should help the Veteran understand why the Board had no reason to question the adequacy/sufficiency of the June 2001 examination report when it considered his claim previously. The M21-1 in effect in June 2001 stated the following, in part: d. Medical Examiner's Signature. VA medical facilities are responsible for ensuring that examiners are adequately qualified. Although Adjudication employees are not expected to review the credentials of clinical personnel to determine the acceptability of their reports, all examination reports must be signed by physicians or clinical or counseling psychologists. Copies transmitted by AMIE without signatures are acceptable, since signed copies will be maintained by the VHA examining facility. If an unsigned examination report is otherwise received, return the report as insufficient for rating purposes. M21-1, pt. VI, para. 1.07(d) (underline and italics added). (The Court's decision quoted the M21-1 that was in effect in 2003, which had changed the wording from "AMIE" to "CAPRI.") The June 2001 VA post traumatic stress disorder examination report in the claims file was transmitted by AMIE to the RO. Thus, the fact that there was no signature on the examination report did not make it "insufficient for rating purposes" on that basis. See id. The Board understands that based upon the appearance of the document, it would be unclear to the Veteran that such examination report had been transmitted by AMIE. Under the CAPRI system, the format is more recognizable. Compare June 2001 VA post traumatic stress disorder examination report with June 2003 post traumatic stress disorder examination report (which report was printed out via the CAPRI system and which also contains no signature). Nevertheless, the Board finds as a matter of fact that the June 2001 examination report met the requirements of the M21-1 in effect at the time of that examination report since it had been transmitted by AMIE to the RO. As to the competence of the June 2001 examiner, it must be noted that at the bottom of the June 2001 examination report are the initials, "FO." Those same initials appear on the June 2003 examination report, which the Board notes was an examination that the RO considered when it awarded the Veteran a 100 percent schedular evaluation for post traumatic stress disorder. At the very top of the first page of the June 2003 examination report, it shows the full last name of the "Examining Physician." The Board looked up that VA employee, and he is a psychologist with a PhD in clinical psychology at the VA Medical Center in Phoenix, Arizona. Thus, he was qualified to examine the Veteran to determine whether he had post traumatic stress disorder, which is consistent with the M21-1 cited above. See id. (stating "VA medical facilities are responsible for ensuring that examiners are adequately qualified."). The Board will now address the VBA Fast Letters the Court cited to in its decision. Sees VBA Fast Letter 06-03 (Mar. 15, 2006)) and Fast Letter 05-01 (Feb. 9, 2005). Both of those Fast Letters are entitled, "Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations." The Board finds that neither of these letters are applicable to the June 2001 VA examination report. Specifically, neither were in existence at the time of the examination, and neither of these letters use any wording that would indicate that they had retroactive effect. It is not logical that VA would create guidance on "Qualifications for Examiners Performing C&P Mental Disorder Examinations" for examinations that have been conducted in the past. Normally, this type of letter is created to correct and prevent past problems/errors. The wording in the 2006 Fast Letter states, "This letter . . . provides field stations with additional guidance concerning the mental health professionals who are qualified to conduct C&P mental disorder examination." The wording in the 2005 Fast Letter states, "The purpose of this letter is to provide all field stations with the qualifications necessary for those who perform C&P examinations for mental disorders." The wording in both Fast Letters would indicate the guidance is for current and future examinations-not ones that occurred five years earlier. The Board will not apply letters created in 2005 and 2006 to a 2001 examination report when there is nothing in these letters to indicate an intent to apply them retroactively. See Durr v. Nicholson, 400 F.3d 1375, 1380 (Fed. Cir. 2005) stating, "Absent clearly expressed intent to the contrary, statutes and regulations are presumed not to have retroactive effect." Thus, the Board concludes that the VBA Fast Letters are not applicable to the June 2001 VA examination report. The Veteran, in his March 2008 reply brief to the Court, in arguing that there are instances where a law has retroactive effect, cited to VAOPGCREC 3-2000 (April 10, 2000), which he stated "regard[ed] the retroactive effect of liberalizing VA regulations." The Board finds that it would be hard pressed to make an argument that a VBA Fast Letter providing "guidance" concerning what mental health professionals are qualified to conduct C&P mental disorder examination can be equated to a liberalizing VA law or regulation. Thus, it will not do so in the decision. Even if either or both letters applied to the June 2001 examination report, the Board finds that they have no effect on the adequacy or sufficiency of the examination report. The point of the VBA Fast Letters (the 2006 Fast Letter rescinded the 2005 letter) was to establish what individuals had the capacity to conduct C&P mental disorder examinations, and VA wanted to ensure that only these individuals would examine the claimant by having their credentials put on the examination report. A clinical psychologist is one of the individuals that is qualified to perform a mental disorder examination. The person who conducted the June 2001 VA examination was and is a clinical psychologist. Thus, applying the spirit of the VBA Fast Letters, the Veteran was, in fact, examined by the appropriate competent professional. If the Board remanded this claim because the June 2001 examination report failed to provide the examiner's credentials, it would ask only that the VA Medical Center confirm the examiner's credentials. There would be no need to have the Veteran re-examined since he was, in fact, examined by a competent professional as contemplated by VA and who provided an examination report that addressed the necessary clinical findings to make the determination that he did. See M21-1, pt. VI, para. 1.07(a) (stating that a sufficient examination must include a brief medical and industrial history from the date of discharge, or last examination, to the current date. It should also record subjective complaints and a complete description of objective findings, stated in concrete terms). Thus, a remand to conduct such development would not serve any purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (remand not warranted when it "would result in this Court's unnecessarily imposing additional burdens on the [Board and the Secretary] with no benefit flowing to the veteran"). Additionally, as to the June 2001 VA examination, the Veteran had noted in his October 2007 brief to the Court that the examiner did not review the Veteran's claims file. The Board understands that in claims for service connection, a review of the claims file can be necessary in order for the examiner to provide a valid and informed opinion. However, in this case, what happened in service was not at issue. The Veteran had received a Purple Heart and Combat Infantryman Badge from his service in Vietnam. Thus, an in- service stressor was conceded. In the June 2001 examination report, the examiner noted that the Veteran had engaged in combat and had received combat medals, and there was nothing in the report to indicate that the examiner found the Veteran did not engage in combat or did not otherwise believe the Veteran's report of history. The examiner stated he did not diagnose post traumatic stress disorder because he found the Veteran did not exhibit or meet the specific symptomatology necessary for that diagnosis. Thus, his determination was not based upon what happened in service; rather, it was based upon the symptoms or lack of symptoms the Veteran demonstrated during the examination. Therefore, based on the facts in this case, the Board finds that the Veteran was not harmed by the examiner not having reviewed his claims file before providing the medical opinion. For all the above reasons, the Board finds no valid or logical reason to question the sufficiency or adequacy of the June 2001 examination on any basis-whether it be because the report was not signed or because the examiner's credentials were not provided on the report itself. In sum, VA met its duty to assist by providing the Veteran with a VA examination in connection with his claim that met the VA requirements that existed at that time. M21-1, pt. VI, para. 1.07(d) (2001). The Board is aware that in his briefs before the Court, the Veteran argued that VA should remand the claim for a retrospective medical opinion and cited to Chotta v. Peake, 22 Vet. App. 80 (2008), for this proposition. In that case, VA essentially determined that it had committed clear and unmistakable error in a 1947 rating decision that denied service connection for a psychiatric disorder, and a rating needed to be assigned between 1947 and 1997 (the date the veteran filed his claim to reopen). The Court did not order that an examination be provided; rather, it suggested that possibility. The facts in this case are entirely different. Here, the Veteran was provided an adequate and, in the Board's opinion, rather thorough examination in June 2001. It finds no basis to remand for a retrospective opinion, which should not be construed as a rebuke of the pro- claimant VA system. Additionally, the Veteran made arguments before the Court about the Veteran's claims file being "rebuilt" based upon a September 2001 VA e-mail and noted that "pertinent information may be unavailable[] through no fault of [the Veteran]." The Board has reviewed that e-mail and cannot explain why there was a finding that the Veteran's claims file was "rebuilt." Of record is the original copy of the VA Form 21-526 and the original copies of the Veteran's service treatment records. Also of record are private medical records that VA had requested (in connection with a claim for service connection for diabetes mellitus) that had been received at VA in June 2001. The Veteran has admitted that prior to his May 2001 claim for service connection for post traumatic stress disorder, he did not receive any mental health treatment. Of record are VA treatment records beginning in 2000. The e-mail was drafted within four months of receipt of the Veteran's claim for service connection for post traumatic stress disorder. Thus, the Board finds it difficult to believe that pertinent information is missing. Additionally, while the Veteran made a comment that records may be missing, he did not identify anything specific that was missing, and he would be in the best position to state what records, if any, were missing. The Board finds no basis to determine that pertinent information may be unavailable. The Veteran has been afforded a meaningful opportunity to participate in the adjudication of the claim for an earlier effective date. He has provided argument as to why he warrants an earlier effective date, and the Board finds that it has addressed the deficiencies the Court found in its decision regarding the Board's August 2006 conclusion that the duty to assist had been met in this case. The Board stands by that finding, and the claim is ready for adjudication. II. Earlier effective date The Veteran asserts he warrants an earlier effective date for the award of service connection for post traumatic stress disorder. He believes it should go back to the date of his claim, which was received in May 2001. Service connection for post traumatic stress disorder was awarded in the March 2003 Decision Review Officer decision currently on appeal. The Decision Review Officer assigned an effective date of July 1, 2002, stating that such was the date the Veteran "first sought psychiatric treatment." He noted that a June 2001 examination "clearly found you did not have post traumatic stress disorder or any psychiatric disability at that time. You had not been receiving any mental health treatment. There is no basis to show you[] had post traumatic stress disorder when you filed your claim on May 25, 2001." The assignment of effective dates of awards is generally governed by 38 U.S.C.A. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on an original claim "shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor." 38 U.S.C.A. § 5110(a). The implementing regulation clarifies this to mean that the effective date of service connection based on an original claim will be the "[d]ate of receipt of claim or date entitlement arose, whichever is later." 38 C.F.R. § 3.400. Service connection for post traumatic stress disorder "requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) of this chapter;" 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 provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (1994) (DSM-IV). Id. The Board has carefully reviewed the evidence of record, which includes the Veteran's arguments and the Court's September 2008 decision, and finds that the preponderance of the evidence is against an effective date earlier than July 1, 2002, for the award of service connection for post traumatic stress disorder. The reasons follow. These facts are not in dispute. The Veteran's original claim for service connection was received on May 25, 2001. (The Veteran noted in his September 2007 brief to the Court that there was no date stamp on the copy of the original claim in the Record on Appeal. There is, in fact, a date stamp, but it is very light and would likely not show up on a photocopy. Nevertheless, it unquestionably shows that the Veteran's VA Form 21-526 was received on May 25, 2001.) On June 15, 2001, the Veteran underwent a VA examination, wherein the psychologist determined that the Veteran did not warrant any psychiatric diagnosis and stated specifically that there was not sufficient clinical symptomatology to establish a diagnosis of post traumatic stress disorder. On July 1, 2002, he was seen at VA with psychiatric complaints of depression by a registered nurse, who took rather detailed notes about the Veteran's past medical history, including the fact that he denied any past mental health treatment. The Veteran was referred for further evaluation. A VA psychiatrist found no evidence of depression and under Axis I, he stated to rule out dysthymia and rule out post traumatic stress disorder. This same psychiatrist entered a diagnosis of post traumatic stress disorder in an August 5, 2002, VA treatment record. The Board concludes that entitlement to service connection for post traumatic stress disorder did not arise prior to July 1, 2002. Specifically, the Board finds that the preponderance of the evidence is against a finding that the Veteran had post traumatic stress disorder prior to July 1, 2002, and thus he did not meet all three requirements to establish entitlement to service connection for post traumatic stress disorder. See 38 C.F.R. § 3.304(f). Stated differently, because one of the requirements for entitlement to service connection for post traumatic stress disorder was not met prior to July 1, 2002, the benefit, in this case, will not be granted prior to that date. The Board is fully aware of the arguments the Veteran has made to the Court about how the law does not prevent granting an effective date earlier than the first date post traumatic stress disorder is diagnosed. In his October 2007 brief to the Court, he stated, "[T]he Board appears to believe that an effective date for a grant of service connection for [post traumatic stress disorder] is precluded prior to the date of the initial diagnosis." This is an inaccurate description of the Board's belief. Rather, based upon the "facts found" in this case, see 38 U.S.C.A. § 5110(a), the Board finds that the preponderance of the evidence is against a finding that the Veteran had post traumatic stress disorder prior to that date. This, in no way, means that it is impossible for the Veteran to have had post traumatic stress disorder prior to July 1, 2002. It means that the Board has accorded more probative value to the June 2001 VA psychologist's opinion that the Veteran did not have post traumatic stress disorder (or any psychiatric disorder), than to the Veteran's allegations that he had post traumatic stress disorder or symptoms of post traumatic stress disorder prior to July 1, 2002. Interestingly, when the VA psychiatrist first saw the Veteran on July 1, 2002, he was unable to diagnose post traumatic stress disorder. Instead, he noted to rule out such diagnosis. In reading through the detailed clinical findings provided by the registered nurse in the July 2002 treatment record, the Veteran was silent as to the typical symptoms associated with post traumatic stress disorder. See, e.g., DSM-IV on page 209 describing symptoms of post traumatic stress disorder. And, yes, the Veteran could have been masking his symptoms of post traumatic stress disorder at that time, but that is not a fact the Board is willing to accept in this case. It would seem logical that a psychologist would be able to sense the masking of symptoms. The VA psychiatrist was also unable to diagnose post traumatic stress disorder at the time the Veteran was seen on July 1, 2002. Thus, two competent professionals examined the Veteran and were unable to diagnose post traumatic stress disorder. This is evidence against a finding that the effective date for the award of service connection for post traumatic stress disorder should be prior to July 1, 2002. There is no competent evidence of a DSM-IV diagnosis of post traumatic stress disorder prior to July 1, 2002, to refute the competent opinion provided in the June 2001 VA examination report. See 38 C.F.R. § 3.304(f) stating that one of the requirements for entitlement to post traumatic stress disorder is a diagnosis of post traumatic stress disorder that conforms to the DSM-IV. In sum, prior to July 1, 2002, the Board finds that the preponderance of the evidence is against a finding that the Veteran had post traumatic stress disorder to warrant an earlier effective date for the award of service connection. Here, in the Board's opinion, entitlement to the benefit arose after the current effective date assigned, as the first diagnosis of post traumatic stress disorder that met the DSM IV criteria was on August 5, 2002. However, the issue before the Board is whether an effective date earlier than July 1, 2002, is warranted. The Veteran has argued that it is not logical that post traumatic stress disorder miraculously appeared on July 1, 2002, and that it likely existed prior to that date, which establishes a basis to award the Veteran an earlier effective date. The statute states that the effective date will be determined based upon "facts found" but will not be earlier than the date of claim. 38 U.S.C.A. § 5110(a). The statute does not allow only one date to control the effective date. Rather, Congress recognized that there would be circumstances where the effective date for the award of a benefit should be after the date of claim. See id. The facts in this case is one of those circumstances for all the reasons stated above. The result in this case may have been different had the record been silent between the date of claim and July 1, 2002. However, here, there is a competent opinion on June 15, 2001, wherein the VA psychologist determined the Veteran did not have post traumatic stress disorder or any psychiatric disorder. This is evidence that is against a finding that the Veteran had post traumatic stress disorder prior to July 1, 2002. Even if his own disability caused him to mask his psychiatric symptoms, that is something the Veteran chose to do, whether consciously or unconsciously, in connection with a claim for compensation benefits for post traumatic stress disorder. As stated in its prior decision, the Board is not free to substitute its own judgment for that of a competent professional. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). It must be noted that when the case was before the Court, the Veteran had argued that the Court should reverse the Board's August 2006 decision. In its September 2008 decision, the Court noted that "a finding that reversal is appropriate amounts to a finding that the Board made a clearly erroneous factual determination." Citing Johnson v. Brown, 9 Vet. App. 7, 10 (1996); Hicks v. Brown, 8 Vet. App. 417, 422 (1995); Karnas v. Derwinski, 1 Vet. App. 308, 311 (1991)). The Court concluded that, "The evidence does not suggest as much in this case." It added: An award of service connection for [post traumatic stress disorder] requires both "medical evidence diagnosing the condition in accordance with [38 C.F.R.] § 4.125(a) [ (2008) ] . . . [and] a link, established by medical evidence, between current symptoms and an in-service stressor." 38 C.F.R. § 3.304(f) (2008). The appellant recognizes that he did not receive a diagnosis of [post traumatic stress disorder] until August 2002. Appellant's Br. at 7. In the absence of such evidence, the Court cannot conclude that the Board clearly erred when it found that the appellant was not entitled to an award of service connection prior to July 1, 2002. See Johnson, supra; 38 C.F.R. § 3.304(f). Moreover, although a lay person may "provide an eye-witness account of [his] visible symptoms," as the appellant did here, he is not competent to render a medical diagnosis of [post traumatic stress disorder]. See Espiritu, supra. (Emphasis added.) For the reasons described above, an effective date earlier than July 1, 2002, for the award of service connection for post traumatic stress disorder is denied. Hence, the evidence is not so evenly balanced as to allow for the application of reasonable doubt. 38 U.S.C.A. § 5107(b). ORDER An effective date earlier than July 1, 2002, for the award of service connection for post traumatic stress disorder is denied. _______________________________________ CHERYL L. MASON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs