Citation Nr: 1004335 Decision Date: 01/28/10 Archive Date: 02/16/10 DOCKET NO. 07-17 342A ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder (PTSD), to include a psychiatric disability other than PTSD. 2. Entitlement to a compensable rating for a left knee disability. REPRESENTATION Veteran represented by: Albert Bacharach, Jr., Esq. WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Matthew W. Blackwelder, Associate Counsel INTRODUCTION The Veteran had active military service from May 1979 to June 1981. This appeal comes to the Board of Veterans' Appeals (Board) from an October 2005 rating decision. It is noted that the Court of Appeals for Veterans Claims (Court) has held that claims for service connection for PTSD encompass claims for service connection for all psychiatric disabilities. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Here, while the Veteran filed a claim for PTSD, psychiatric treatment records show that the Veteran has been diagnosed with several psychiatric disabilities, including anxiety and depression. Thus, the Board has redefined the Veteran's psychiatric appeal, as is listed on the title page of this decision. FINDINGS OF FACT 1. No in-service stressor has been corroborated to support a diagnosis of PTSD. 2. The medical evidence does not link a psychiatric disability to the Veteran's military service. 3. Objective medical evidence does not show any instability in the Veteran's left knee. 4. Even accounting for functional limitation, the Veteran has not demonstrated range of motion in her left knee that was limited to less than 0-100 degrees. 5. X-rays confirm the presence of arthritis in the Veteran's left knee that is accompanied by painful motion. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disability, to include PTSD, have not been met. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.304(f) (2009). 2. The criteria for a 10 percent rating for a left knee disability have been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.71a, Diagnostic Codes (DCs) 5003, 5257, 5260, 5261 (2009) REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. To establish entitlement to service connection for PTSD a Veteran must provide: 1) medical evidence of PTSD; 2) a link, established by medical evidence, between current symptoms of PTSD and an in-service stressor; and 3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The Veteran contends that she has PTSD as a result of being raped while stationed in Germany in May 1981. There is some indication in the medical records that the Veteran meets the criteria for PTSD (for example, a PTSD screening was positive in July 2009, and the Veteran testified that she had been diagnosed with PTSD by a VA medical professional based on her account of being allegedly sexually assaulted in service); as such, the pivotal issue is whether any evidence has been presented that corroborates the Veteran's reported stressor, namely her assertion that she was sexually assaulted during service. The regulations recognize that sexual assaults are often unreported. As such, when a post-traumatic stress disorder claim is based on an in-service personal assault, the regulations authorize the use of evidence from sources other than a Veteran's service records to corroborate a Veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(4). In this case, the Veteran denies having told more than a handful of people that she was sexually assaulted in service. She testified that the only people she told about the alleged assault while she was in Germany were her first sergeant and her company commander. She denied speaking to the military police or to any doctors about the alleged incident, indicating that her superior officers wanted to handle the matter internally and effectively quarantined her until she was transferred out of Germany several weeks later. The Veteran indicated that in the years following service she told her mother about the alleged incident, and discussed it with several friends through the years. Unfortunately, the Veteran's mother is now deceased, and no buddy statements have been received describing any conversation with the Veteran about her reportedly being assaulted while stationed in Germany. The Veteran testified that she eventually told a doctor in approximately 2004, but this conversation occurred several decades after service and therefore adds no probative value to the Veteran's assertion that she was sexually assaulted in service. Given that the Veteran did not seek any medical treatment or speak to many people shortly after the alleged assault, many of the alterative types of evidence cited by 38 C.F.R. § 3.304(f)(4) are not present in this case, as, for example no pregnancy test would be available given the lack of medical treatment. The Veteran has submitted a written statement describing the alleged rape and she has testified about it at a hearing before the Board in November 2009. The record reflects that the Veteran was transferred to Germany in April 1981 for what was intended to be a two year assignment. The Veteran testified that she did not like life on the base in Germany, explaining that she perceived a bias against having a woman in the motor pool; and, she recalled being given whatever menial tasks could be found for her such as picking up trash around the base. The Veteran testified that she went out with two male soldiers and another female soldier one Saturday night. The Veteran stated that they went back to the apartment of one of the soldiers where she alleged she was sexually assaulted by her date. She stated that she would have been sexually assaulted by the other soldier, but she was able to escape. The Veteran could not remember any of the names of the soldiers that were involved, and she provided little detail about the alleged incident, only describing generically that she was raped or sexually assaulted. She did not explain how she escaped or what happened to the other woman, and she provided no detail how the alleged assault transpired. The Veteran testified that there were 3 other people involved (with the third being the other woman); but in a phone conversation with the RO in January 2005, she sated that she was attacked by two men from her unit in Germany, failing to even mention the other woman. While the Board is sympathetic to the sensitive nature of cases involving sexual assault, and is aware that recalling memories of these events can be traumatic, the fact remains that detail has the potential to either add credibility to a victim's account or to undermine the credibility of such an account. The Veteran testified that following the alleged incident she went to see her first sergeant who told her to return to her barracks. She indicated that the next day she met with her first sergeant and the company commander where she reiterated her account of the alleged incident and was offered an honorable discharge. Service treatment records show that the Veteran underwent a separation physical on May 19, 1981, was transferred out of Germany on June 16, 1981, and was discharged from service the following day. While the Veteran has not deviated from her basic contention that she was sexually assaulted while in Germany; there are many inconsistencies in her claims file. For example, the Veteran testified at her hearing that the alleged incident occurred on a Saturday night, whereas in her written statement in November 2004, the Veteran indicated that on or about May 19, 1981 (a Tuesday) she was raped. While this is a small detail, service treatment records show that the Veteran was given a separation physical on May 19, 1981, which would make it appear that her discharge was already in the works at that point. Additionally, the difference between an incident occurring on a weekend versus a weeknight is a significant distinction. The Veteran also testified that she was not provided with a physical examination prior to leaving Germany. However, the Veteran's separation physical clearly took place while she was in Germany as the location of the examination was listed as the 225th Station Hospital (which is a military hospital located in Germany); and the examination occurred on May 19, 1981, nearly a month before she was transferred out of Germany. As such, despite her testimony to the contrary, it is clear that the Veteran was in fact given a physical examination while in Germany; and presumably following when she alleged being assaulted. In her November 2004 statement the Veteran indicated that she was so traumatized by the incident that she began throwing up blood and she reported being treated at the base hospital. However, no such treatment is shown by the service treatment records; as the only treatment the Veteran received at the 225th Station Hospital aside from her separation physical on May 19, 1981 was treatment of a foot problem a week earlier. It is noted that the Veteran reported a number of symptoms on her medical history survey that was completed at the time of the physical, and the medical officer did in fact indicate that the Veteran had multiple somatic complaints at that time. However, somatic complaints alone are not necessarily indicative of a rape having occurred; and given the multiple inconsistencies in the Veteran's accounts, the Board concludes that the Veteran's somatic complaints alone are insufficient to establish that it is at least as likely as not that the Veteran's reported stressor occurred. The Veteran's representative has attempted to show that the Veteran underwent a change in character following the alleged assault, arguing that her discharge from service should establish reasonable doubt that her reported stressor actually occurred consistent with 38 C.F.R. § 3.304(f)(4). The essence of this argument was that the Veteran had established a record as an achiever prior to being stationed in Germany and that her personality only changed after she was allegedly assaulted. However, a review of the Veteran's personnel file does not mandate such a conclusion. Rather, the evidence shows that the Veteran had problems with authority prior to being stationed in Germany, as approximately one year earlier in May 1980, the Veteran was punished under Article 15 of the UCMJ for using disrespectful language towards a superior officer. The Veteran was reduced in rank and fined following that incident. Then, once she was transferred to Germany, it is clear from the Veteran's own testimony that she was disgruntled with the authority figures there, as she stated at her hearing that they did not want women in the motor pool in Germany and she complained that her jobs included walking around and picking up cigarette butts, painting things, or doing any other menial job they could find for her. Given this professed lack of commitment to the overall mission, it is not surprising that the Veteran's commanding officer in Germany explained (in a personnel record dated May 27, 1981) that the Veteran was being discharged for lack of self-discipline and an inability to get along with her peers. The commanding officer added that the Veteran was a constant source of friction both for the people who worked with her as well as for her roommates, and it was noted that she had a total disregard for authority. While the representative argued that this document was evidence of a personality change; the Veteran had evidenced a lack of appreciation for authority prior to arriving in Germany. As such, the Board does not agree that the evidence shows an attitude change towards the end of the Veteran's time in Germany. Additionally, while the Veteran has stated that she was emotionally devastated at the time she was separated from the military (she specifically stated in November 2004 that she was traumatized by the incident to the point that she was throwing up blood and in an altered mental state) the evidence shows that despite being in this alleged state, the Veteran was nevertheless able to file a claim for VA benefits in August 1981, only two months after separating from service, and more importantly less than three months after the alleged rape took place. Yet, this initial claim for benefits made no mention of any rape, seeking service connection only for a back disability and for a respiratory condition which she alleged occurred in May 1981 while she was in Germany. Furthermore, she made no allegation of sexual assault for more than two decades after she was discharged from service. While minor inconsistencies in the Veteran's account might be attributed to the significant passage of time since she was in service; in this case, the Veteran failed to provide any real detail about the incident and her claims file is full of inconsistencies that when taken together render her assertion that she was sexually assaulted debatable and insufficient for purposes of constituting a stressor that would permit the grant of service connection for PTSD. As such, the Board concludes that the Veteran's statements are not sufficient to establish that she was a victim of a sexual assault while in service; and her service treatment records and service personnel records only serve to further undermine her account. Therefore, because an in-service stressor has not been corroborated, the criteria for service connection for PTSD have not been met. Accordingly, the Veteran's claim of entitlement to service connection for PTSD is denied. However, the analysis does not end here. As noted in the introduction, the Board must also consider whether the Veteran's diagnosed psychiatric disabilities, other than PTSD, were caused by her time in service. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In this case, VA treatment records show that the Veteran has been treated for several psychiatric disorders including major depressive disorder, general anxiety disorder, and social anxiety disorder. As such, while it was concluded that the criteria for service connection for PTSD were not met, the Board must also consider whether the evidence links any additional diagnosed psychiatric disability to the Veteran's time in service. However, for the reasons discussed below, the Board concludes that the evidence does not. Service treatment records do not show any psychiatric treatment while the Veteran was in service. On a medical history survey completed in conjunction with her separation physical the Veteran's indicated that she had difficulty sleeping, depression/excessive worry, and nervous trouble, and the medical officer noted that the Veteran had presented multiple somatic complaints. However, the Veteran was found to be psychiatrically normal at her service separation physical examination; and a mental status evaluation specifically found that the Veteran's behavior was normal; that she was fully alert and oriented with an unremarkable mood/affect; and that her thought content was normal. The Veteran was found to be mentally responsible, and no psychiatric disability was diagnosed. Following service, there is no evidence of any psychiatric complaints or treatment for several decades. In December 2004, the Veteran was diagnosed with anxiety disorder, major depressive disorder, alcohol abuse in remission, and cannabis abuse in remission. The doctor noted the Veteran's allegation that she was raped in service, but he also observed that the Veteran had been sexually and physically abused by her two adopted brothers prior to enlisting, and that she had been traumatized by being abandoned by her mother at age 3. He further noted that the molestation by her brothers still affected the Veteran to the point that she was unable to trust men other than her deceased husband and her father; and further noted that the Veteran's depression was related to her husband's sudden death in approximately 1998 from a pulmonary embolism. The Veteran has not argued that she had psychiatric problems in service aside from the impact of the alleged sexual assault, and in fact she was found to be psychiatrically normal at separation. Following service, there is no evidence of the Veteran receiving any psychiatric complaints or treatment for more than two decades, and even when she did begin receiving treatment, her diagnoses were based on her difficulty dealing with the unexpected death of her husband and possibly the molestation by her adopted brothers. As such, the evidence does not suggest that any of the Veteran's diagnosed psychiatric conditions are the result of her time in service, with the exception of the diagnosis of PTSD, which, as discussed above, is not based on a credible in-service event. Given the fact that the Veteran was found to be psychiatrically normal at separation from service and did not receive any psychiatric treatment for more than two decades after service, combined with the fact that the medical evidence does not suggest that any of the Veteran's diagnosed psychiatric conditions are related to her time in service, the criteria for service connection have not been met, and the Veteran's claim for an acquired psychiatric disability, other than PTSD, is therefore denied. II. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. In Fenderson v. West, 12 Vet. App. 119, 126 (1999), the Court noted a distinction between an appeal involving the Veteran's disagreement with the initial rating assigned at the time a disability is service connected. Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where, as here, the question for consideration is propriety of the initial evaluations assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. See Fenderson, 12 Vet. App. at 126. The Veteran is service connected for chondromalacia of her left knee which is assigned a noncompensable rating under 38 C.F.R. § 4.71a, DC 5260. Under this rating code, a noncompensable rating will be assigned for limitation of flexion of the leg to 60 degrees; a 10 percent rating will be assigned for limitation of flexion of the leg to 45 degrees; a 20 percent rating will be assigned for limitation of flexion of the leg to 30 degrees; and a 30 percent rating will be assigned for limitation of flexion of the leg to 15 degrees. Under Diagnostic Code 5261, a noncompensable rating will be assigned for limitation of extension of the leg to 5 degrees; a 10 percent rating will be assigned for limitation of extension of the leg to 10 degrees; a 20 percent rating will be assigned for limitation of extension of the leg to 15 degrees; a 30 percent rating will be assigned for limitation of extension of the leg to 20 degrees; a 40 percent rating will be assigned for limitation of extension of the leg to 30 degrees; and a 50 percent rating will be assigned for limitation of extension of the leg to 45 degrees. Normal range of motion of the knee is to zero degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. In October 2005, the Veteran underwent a VA examination to evaluate the range of motion in her left knee. The Veteran demonstrated active and passive range of motion from -1 to 141 degrees. The examiner had the Veteran perform 10 knee bends, which she did slowly, and which the examiner noted caused knee pain. However, the knee bends did not cause any additional loss of strength nor did they cause any limitation of motion. Additionally, the examiner opined that the Veteran did not have any functional limitation in her knee. Treatment records were reviewed, but they do not show that any additional range of motion testing was ever conducted during the course of the Veteran's appeal. Additionally, it is noted that while the Veteran testified that motion in her left knee was painful, she did not specifically allege that the range of motion that she demonstrated at her VA examination in October 2005 was inaccurate. As such, because the Veteran has shown range of motion in her left knee from at least 0-100 degrees, she fails to meet the criteria for a compensable rating based on limitation of motion. In reaching the decision, the Board has considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance, and must be manifested by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. In this case, while the range of motion in the Veteran's knees was clearly limited by pain, she was able to do 10 knee bends and the examiner specifically found that the Veteran did not have any functional limitation as a result of her left knee disability. The Veteran's complaints of pain have therefore been considered, but they are outweighed by the objective medical findings which do not show sufficient functional loss to merit a compensable rating for the Veteran's left knee disability. Therefore, a compensable rating is not warranted for the Veteran's left knee based on limitation of motion. While the Veteran has not demonstrated compensable limitation of motion in her knee, even when limitation of motion is not itself compensable, a compensable rating may still be assigned when arthritis is established by x-ray findings. The regulations provide that when degenerative (meaning either osteoarthritis or hypertrophic) arthritis is established by x-ray findings, it is to be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. If, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, DC 5003. For purpose of rating disability from arthritis, the knee is considered a major joint. 38 C.F.R. § 4.45(f). In this case, x-rays of the Veteran's left knee in April 2009 showed slight narrowing of the knee joint that was compatible with degenerative changes, and the Veteran was diagnosed with degenerative joint disease of the left knee. It is also noted that at her VA examination, the Veteran walked with an antalgic gait and the examiner found that she had left knee pain based on the knee bends he asked her to perform. As noted above, the Veteran has not demonstrated limitation of motion significant enough for a 10 percent rating to be assigned for her left knee; however, as x-rays show degenerative joint disease in her left knee, and the Veteran has credibly testified that she has painful motion when using her knee (which was substantiated by objective evidence of pain during knee bends at her VA examination in October 2005), a 10 percent rating is assigned for the Veteran's left knee; and to this extent the Veteran's claim is granted. In addition to ratings based on limitation of motion, a rating may also be provided based on either recurrent subluxation or lateral instability under 38 C.F.R. § 4.71a, DC 5257; which assigns 10, 20, or 30 percent ratings, depending on whether the instability or subluxation is slight, moderate or severe respectively. The words "slight," "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. The Veteran testified at a hearing before the Board that she had to use crutches or a walker to get around. However, at a VA psychiatric treatment session in December 2004, the Veteran indicated that she used the crutches for balance. There was no indication that she needed then on account of knee instability. Additionally, at the VA examination in October 2005, the examiner specifically found no instability, explaining that the Veteran's left knee was ligamentously stable with the exception of mild crepitus behind the kneecap, and reporting that there was no laxity to varus and valgus stress. Furthermore, anterior and posterior drawer tests were negative, as were Lachman's and McMurray's tests. VA treatment records have also been reviewed, but they similarly fail to show any objective evidence of instability or subluxation in the Veteran's left knee. As such, the objective medical evidence has repeatedly failed to find any indication of instability or subluxation; and a compensable rating is therefore not warranted based on either instability or subluxation in the left knee. The Board notes that if an exceptional case arises where ratings based on the statutory schedules are found to be inadequate, consideration of an "extra-schedular" evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities will be made. 38 C.F.R. § 3.321(b)(1). The Court has held that the determination of whether a claimant is entitled to an extraschedular rating under § 3.321(b) is a three-step inquiry, the responsibility for which may be shared among the RO, the Board, and the Under Secretary for Benefits or the Director, Compensation and Pension Service. Thune v. Peake, 22 Vet. App. 111. The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service- connected disability are inadequate. This means that initially there must be a comparison between the level of severity and symptomatology of the claimant's service- connected disability with the established criteria found in the rating schedule for that disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is adequate, and no referral is required. If the criteria do not reasonably describe the claimant's disability level and symptomatology, a determination must be made whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." 38 C.F.R. § 3.321(b)(1) (related factors include "marked interference with employment" and "frequent periods of hospitalization"). See id. In this case, the medical evidence fails to show anything unique or unusual about the Veteran's left knee disability that would render the schedular criteria inadequate. The Veteran has not been hospitalized for her left knee and her main knee symptom is arthritic pain on motion, which is specifically accounted for in the rating criteria. Additionally, the examiner in October 2005 opined that the Veteran had excellent range of motion and was ligamentously stable in her left knee, and he opined that most of the Veteran's difficulties stemmed from her back disability and opioid therapy. Accordingly, an extraschedular rating for the Veteran's left knee is not warranted. III. Duties to Notify and Assist Under applicable criteria, VA has certain notice and assistance obligations to claimants. See 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Notice must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits and must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). With respect to service connection claims, a section 5103(a) notice should also advise a claimant of the criteria for establishing a disability rating and effective date of award. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 486 (2006). In this case, the Veteran's claim service connection for a left knee disability was granted. She then appealed the downstream issue of the rating that had been assigned. Under these circumstances, since the original claim was granted, there are no further notice requirements under the aforementioned law with regard to that issue. With regard to the Veteran's claim of entitlement to service connection for PTSD, required notice was provided by a letters dated in January 2005 and December 2006, which informed the Veteran of all the elements described above. The Veteran's representative has argued that VA has not sufficiently assisted the Veteran in obtaining evidence. However, the duty to assist is not boundless in its scope, and VA's duty is only to make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claimant's claim; VA is not required to assist a claimant in obtaining identified records if no reasonable possibility exists that such assistance would aid in substantiating the claim. 38 U.S.C. § 5103A; Golz v. Shinseki, No. 2009-7039, 2010 WL 6160 (Fed. Cir. Jan. 4, 2010). In this case, VA has obtained VA treatment records, service treatment records and service personnel records; and there is no allegation that the Veteran has received any private treatment. To the extent that additional records would assist the Veteran's claim, such records have not specifically been identified. The Veteran was also provided with a VA examination of her left knee (the report of which has been associated with the claims file). At her hearing, the Veteran spent considerable time explaining that she felt the examiner at the October 2005 examination was inadequate. However, there is no evidence in the examination report that would suggest that the findings were in any way inadequate. It is also noted that the Veteran often complains about the care she receives, as she stated at her hearing that she was disgusted with her therapist in addition to being dissatisfied with the VA examiner. Regardless, the Veteran has not alleged that her left knee has worsened since her VA examination; and, the Board therefore sees no reason to order a new examination of the Veteran's left knee. While a VA examination was not obtained with regard to the Veteran's claim of entitlement to service connection for PTSD; the evidence does not corroborate the Veteran's reported in-service stressor and therefore an examination is not warranted, as even were the examiner to diagnose the Veteran with PTSD, the stressor would not have been corroborated. Similarly, there is no suggestion that the Veteran's acquired psychiatric disabilities (aside from PTSD) are related to her time in service; and an examination is therefore not warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Additionally, the Veteran testified at a hearing before the Board. As such, VA has satisfied its duties to notify and assist, and additional development efforts would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Because VA's duties to notify and assist have been met, there is no prejudice to the Veteran in adjudicating this appeal. ORDER Service connection for an acquired psychiatric disability, to include PTSD, is denied. A 10 percent rating for a left knee disability is granted, subject to the laws and regulations governing the award of monetary benefits. ____________________________________________ JOAQUIN AGUAYO-PERELES Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs