Citation Nr: 1035481 Decision Date: 09/20/10 Archive Date: 09/28/10 DOCKET NO. 04-04 143 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUE Entitlement to service connection for a psychiatric disorder, to include as secondary to a history of right shoulder subluxation and laceration. REPRESENTATION Appellant represented by: David E. Boelzner, Attorney at Law WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD A. P. Simpson, Counsel INTRODUCTION The Appellant served on active duty from November 1979 to December 1982. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2003 rating decision of the San Diego, California, Department of Veterans Affairs (VA) Regional Office (RO), which denied the issue on appeal. At a July 2004 hearing, the Appellant presented testimony before the undersigned Veterans Law Judge. In March 2005, the Board remanded the claim for additional development and adjudicative action. In September 2008, the Board denied the claim. The Appellant appealed the denial to the United States Court of Appeals for Veterans Claims (Court). In November 2009, the Appellant and the Secretary of VA (parties) filed a joint motion to vacate the Board decision. The Court granted the motion that same month. The case has been returned to the Board for further appellate review. FINDINGS OF FACT 1. The Appellant is not a credible historian. 2. A psychiatric disorder was not shown in service or for many years after service. 3. The Appellant is service connected for a history of right shoulder subluxation. 4. In July 1997, a VA physician found the Appellant's right shoulder had no functional impairment. 5. In November 1998, a VA physician found that the Appellant's right shoulder had no functional impairment and did not cause the Appellant pain. 6. On August 14, 1999, the Appellant sustained a postservice industrial accident, where he fell backwards landing on his back and striking his head on the cement floor. He reported pain and tingling in the upper extremities. 7. In January 2001, Mark Rawlings, D.C., determined that while the Appellant had a prior right shoulder injury in service, it "did not result in any work restrictions or significant pain." He stated that the Appellant's right arm complaints were "a result of the thoracic outlet syndrome[,] which (was) a result of his industrial injury of August 14, 1999." 8. In March 2003, a VA physician concluded after reviewing the Appellant's records and examining him that the claimant's depression was not related to his service-connected right shoulder condition. 9. On May 26, 2004, the Appellant slipped, fell and landed on his backside and his right elbow in another industrial accident. He was diagnosed with a right wrist/right forearm sprain, right elbow contusion, and back sprain. 10. In November 2004, a private physician determined that 50 percent of the Appellant's current right upper extremity disability was attributable to the postservice May 2004 industrial accident. 11. In April 2006, a VA psychiatrist concluded that he was unable to link the Appellant's psychiatric disorder to his service-connected disability. 12. The preponderance of the evidence is against a finding that a psychiatric disorder had its onset in service, or is caused or aggravated by subluxation and laceration of the right shoulder. CONCLUSION OF LAW A psychiatric disorder was not incurred in or aggravated by service, it is not proximately due to, the result of, or aggravated by the service-connected right shoulder disability; and a psychosis may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act The requirements of the Veterans Claims Assistance Act of 2000 (VCAA) have been met. There is no issue as to providing an appropriate application form or completeness of the application. In a January 2003 letter the RO informed the Appellant of the information and evidence needed to substantiate and complete a claim, to include notice of what part of that evidence is to be provided by the claimant and notice of what part VA will attempt to obtain. VA failed to fully comply with the provisions of 38 U.S.C.A. § 5103 prior to the rating decision in question by failing to inform him of how disability evaluations and effective date are assigned. The record, however, shows that any prejudice that failure caused was cured by the fact that VA notified the Appellant in March 2006 correspondence of how disability evaluations and effective dates are assigned. The claim was readjudicated in May 2006, May 2007, and October 2007 supplemental statements of the case. VA fulfilled its duty to assist the claimant in obtaining identified and available evidence needed to substantiate a claim, to include VA medical records, Social Security Administration records, private medical records, lay statements, and as warranted by law, affording VA examinations. The Appellant has attacked the April 2006 VA examination that was prepared in response to the Board's March 2005 remand. The Board finds, however, that a new examination is not warranted in light of the reasons and bases provided below. VA also provided the Appellant with a personal hearing before the Board, which occurred in July 2004. The Board concludes the Appellant was provided the opportunity to meaningfully participate in the adjudication of his claims and did in fact participate. Washington v. Nicholson, 21 Vet. App. 191 (2007). Hence, there is no error or issue that precludes the Board from addressing the merits of this appeal. Analysis The Appellant claims that he developed depression as a result of the fall he sustained in service in April 1980. Specifically, he has alleged that he either developed depression in service as a result of the injury, or that right shoulder pain has, at a minimum, contributed to his depression. At the July 2004 hearing before the undersigned, the Appellant testified that he first had depression in 1982, when he could not hold a job because of severe right shoulder pain. See Hearing Transcript, pgs. 6-7. He stated he was first treated for depression between 1982 and 1985. Id. He complained about a March 2003 VA examination and argued that the examiner did not review the claims file because the Appellant did not see it when he was physically examined. Id. at pgs. 8-9. The Appellant noted that he was experiencing depression before he was diagnosed with diabetes. Id. at pg. 10. He testified that he would see Dr. Rawlings three times a week for depression. Id. at pgs 10- 11. The Appellant noted Dr. Rawlings was also treating him for his right shoulder as well. Id. at pgs. 12-13. The Appellant was awarded service connection for a history of subluxation and laceration of the right shoulder in a November 1985 rating decision and assigned a 10 percent evaluation. He was awarded a 20 percent evaluation for the right shoulder in a July 1999 Hearing Officer's decision. The Board has reviewed all the evidence in the Appellant's claims file, which includes his written contentions, his testimony, service treatment records, private and VA medical records, Social Security records, and statements submitted by multiple people. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Appellant or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Service connection may also be warranted for a psychosis if manifested to a compensable degree within one year following discharge from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Service connection may also be warranted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice- connected disability which is aggravated by a service connected disability. In such an instance, the veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). After having carefully reviewed the evidence of record, the Board finds that the preponderance of the evidence is against a finding that the Appellant has a psychiatric disorder, which has been variously diagnosed, that was incurred in service or is attributable to the service-connected right shoulder disability whether by incurrence or aggravation. The reasons follow. The Board will initially discuss the Appellant 's credibility given that the issue being decided is directly impacted by whether or not the Board finds him to be a credible historian. The Board concludes that the Appellant is not credible for the reasons follow. Throughout the record, the Appellant has reported inconsistent facts on a consistent basis. With the passage of time the appellant has changed the "facts" of his in-service injury. The service treatment records show that the Appellant sustained a right shoulder injury in a fall in April 1980. No other injury was reported in the service treatment records, to include any subsequent complaints of pain in other areas as a result of the injury. The service treatment records do not show any complaints of pain pertaining to the appellant's head, neck, or any portion of his spine. Rather, any complaint related only to the right shoulder. Additionally, the service treatment records are silent for how far the Appellant fell, and they do not document that the appellant sustained a head injury during that fall with a loss of consciousness. Indeed, in November 1982, when asked if he had "EVER HAD" a serious head injury, the Appellant circled, "No." (Capitals in original.) This is evidence against a finding of the Appellant sustaining a head injury during service with loss of consciousness. The Appellant attested to the truth of this statement by signing the document. In a VA Form 21-2545, Report of Medical Examination for Disability Evaluation, dated in August 1985, the Appellant stated he fell 20 to 25 feet. Based on the service treatment records and the August 1985 VA examination report, the Board finds that the Appellant fell no more than 20 to 25 feet; that he sustained a right shoulder injury; that he did not sustain an injury to either his head, neck, or low back; and that he did not suffer a loss of consciousness. However, the record shows that the Appellant has since reported to those from whom he has asked for medical opinions that he fell 40-50 feet in service. He also reported this distance to the April 2006 VA psychiatrist. In October 2002, he reported to a VA social worker that he fell 100 to 200 feet. The Board finds these allegations to be false, and finds the statement he made in close proximity to his service discharge to be far more probative than statements made over the 20 years since in connection with a claim for monetary benefits. Additionally, the Appellant had never claimed any loss of consciousness at the time of the 1980 fall and specifically denied any serious head injury right before service discharge. Moreover, in a February 1997 private medical record from Dr. Ford it was noted that the Appellant denied "any prior history of head []injury." See February 1997 private medical record (the Appellant was being examined in connection with a postservice motor vehicle accident wherein he claimed he sustained a head injury). The November 1982 and February 1997 records show that the Appellant did not suffer either a loss of consciousness or a head injury in-service. In contrast to these records, the appellant in October 2002 reported to a VA social worker that he had fallen head first 100 to 200 feet while in service. In August 2007 statements the Appellant's common-law wife and a registered nurse asserted that not only did the Appellant sustain a head injury but also suffered a loss of consciousness from the fall. In a December 2007 private medical record, the examiner recorded that the Appellant sustained a closed-head injury in service and was knocked unconscious. Such statements are inconsistent with prior statements the Appellant made in service and in February 1997. They have no independent corroboration, and they clearly are based on the appellant offering a self serving history. The Board rejects as not credible the assertion that the Veteran sustained a head injury in service and a loss of consciousness. Not only are these subsequent allegations inconsistent, but the Board finds it difficult to believe that more than 20 years after the fall, claims of a head injury and a loss of consciousness first appeared with respect to the 1980 fall. There are other reports of loss of consciousness in connection with other injuries, which will be addressed below. Nevertheless, the foregoing is evidence that the Veteran has presented inconsistent statements regarding what did or did not happen in service. As noted, in November 1982, the Appellant specifically denied having sustained a head injury. A postservice February 1993 VA treatment record shows that the Appellant reported that he had been hit in the head with a baseball bat during a fight in 1983 and was hospitalized for three days and had a loss of consciousness. During an April 1993 VA neuropsychiatric evaluation he reported the same facts, i.e., a 1983 head injury with loss of consciousness, and added he had "concussive sequelae." Yet when the Appellant was examined by Dr. Ford in February 1997, he specifically denied a prior history of a head injury. Thus, the November 1982, February 1993, April 1993 and February 1997 records are inconsistent based on the Appellant's inconsistencies. Interestingly, a September 1998 VA treatment record noted that the Appellant reported a history of a closed- head injury when he was hit in the head by a bat in 1983 but had no loss of consciousness. Thus, in February and April 1993, the Appellant reported a loss of consciousness associated with the 1983 head injury, but then denied any loss of consciousness in September 1998 based on the same injury. This is further evidence of Appellant offering inconsistent statements, and why the Board concludes that he is not remotely credible. Further evidence of the Appellant's lack of credibility is evident by the fact that he has been entirely inconsistent regarding any in-service neck or back injury. When the Appellant was hospitalized in February 1993, he reported a prior medical history pertaining to hypertension, cholelithiasis and meningitis. He also reported dislocating his right shoulder in the service He did not report any in-service neck or back injuries. However, a June 1996 private medical record by Dr. Vu indicates that the Appellant had been under his care since May 1996 for neck, midback, and right shoulder pain, which pain was a result of a 1980 injury in service. Dr. Vu entered diagnoses pertaining to the cervical and thoracic spine, indicating the Appellant had current neck and back disabilities. In February 1997, the Appellant was examined in connection with a disability claim he had filed following a January 1997 motor vehicle accident. Significantly, when discussing the past medical history, Dr. Ford in 1997 stated, "The patient denies any prior history of head, neck, or back injury or pain or dizziness." Id. on page 2. Thus, in February 1993, the Appellant reported an in-service injury to his right shoulder but no injuries to his neck or back at that time. In June 1996, the Appellant reported suffering injuries to his neck and back in-service. Yet in February 1997 he denied any past neck or back injuries. Five months later, at a July 1997 VA neurological examination, the Appellant claimed that he had developed neck and back pain due to an in-service fall, and that the January 1997 motor vehicle accident had aggravated these problems. An August 1998 VA treatment record indicates that the Appellant reported for the first time that he sustained a back injury in 1986. At a March 1999 RO hearing, the Appellant reported a history of neck and back pain in service. See Transcript on pages 16-17. A January 2001 letter from Dr. Rawlings indicates he had examined the Appellant in connection with an August 1999 slip-and-fall industrial injury. The Veteran then claimed that the industrial accident caused his neck and back pain. See January 2001 letter. When Dr. Rawlings noted the in-service injury, he stated the Appellant injured his left shoulder. The January 2001 letter did not address any prior neck and back pain or injuries, which would have been relevant in connection with this evaluation, as the Appellant was claiming neck and back pain as a result of the August 1999 accident. The Board finds the lack of a complete medical history highly damaging to the Appellant's credibility. A November 2004 letter from Dr. Wieseltier indicates he had examined the Appellant in connection with a May 26, 2004, slip- and-fall industrial injury wherein the Appellant claimed resulting neck and back pain. See November 2004 letter. When addressing the Appellant's past medical history, particularly the in-service accident, he stated the Appellant injured his right shoulder. There was no mention of any neck or back pain or injuries in 1980. There was no mention of the January 1997 motor vehicle accident that allegedly caused the Appellant to be unable to work until July 1997. See April 1997 letter ("I've treated [the Appellant] since January 31, 1997 for injuries sustained in an automobile accident dated above. He is currently on State Disability because of neck and low-back pain.") See also May and July 1997 "Claimant's Certifications" (wherein the Appellant attested to the fact that he was unable to work). Lastly, the Appellant was evaluated by Dr. Greenwald in December 2007. There, he noted the Appellant sustained injuries to his shoulder, neck, and back while in service. When addressing the Appellant's past medical history, there was no mention whatsoever of the 1997, 1999, and 2004 accidents. As noted above, the Appellant alleged neck and back injuries at each of those times. That medical history would have been entirely relevant to the evaluation conducted in December 2007 since it involved the same body parts. The foregoing is evidence that the Appellant changed from reporting that his neck and back pain began in service, to reporting that it began following a January 1997 motor vehicle accident, to reporting that it began following an August 1999 slip-and-fall industrial accident, to reporting that it began following a May 2004 following the slip-and-fall industrial accident. (The Board acknowledges that in 2004, the Appellant admitted to prior history back pain, but did not report any prior neck pain). Simply put, the record is replete with instances where the Appellant's self reported medical history is consistently inconsistent. The evidence shows that the Appellant fails to report facts when it is convenient for him and reports facts when it is. This is most evident when he is seeking monetary benefits. For example, in November 2004, when discussing his past medical history, the Appellant did not report either that he had sustained neck and back injuries in the January 1997 motor vehicle accident or that he had injured his neck in the August 1999 industrial accident. When the Appellant filed his claim involving the January 1997 automobile accident, he specifically denied any past neck or back pain and injuries, while at the same time was telling VA that he sustained neck and back pain/injuries in service in 1980. The Appellant's stories as to the onset of his neck and back pain or prior medical history involving those areas show inconsistencies that fully support the Board's conclusion that the Appellant is not a credible historian. Following the May 2004 slip-and-fall accident, the Appellant denied sustaining any direct head trauma from that accident. See June 2004 private medical record from Dr. Besser. However, in May 2005, the Appellant reported sustaining head in the May 2004 accident. See May 2005 VA treatment record. This is yet another example of the Appellant's inconsistent statements. In a May 2010 letter, the representative requested that the Board review the claims file with a "less exacting expectation of precision." Alas, the truth is a stubborn thing. Whatever may be the appellant's wishes, inclinations, or passions they cannot alter the state of the truth. In going through the six volumes of evidence the truth leads the Board to be amazed by the shifting history presented by the Appellant. Had the Appellant been truthful and consistent with his report of the facts, the Board would not need to point out the multiple inconsistencies throughout the record, and his lack of credibility. It is not just the undersigned who has found that the Appellant is not credible. Multiple examiners throughout the years who have examined the Appellant in multiple medical settings note his inconsistent behavior and/or inconsistent statements during physical or psychiatric examinations, or during review of the records. For example, in a November 1992 VA treatment record, the examiner noted the Appellant told a confused story and concluded the Appellant was a poor historian. The Appellant was hospitalized in February 1993, and multiple examiners made findings that the Appellant was a "very poor historian," tended to give different stories to different staff members," and had a liability of lacking honesty in giving facts of history. The Appellant underwent neuropsychological testing in April 1993, and the evaluator stated, "The validity indices of his MMPI-2 profile suggest an inconsistent response set, which calls into serious question the validity of his clinical profile." In an April 1993 VA examination report, the examiner noted the Appellant told two, different stories as to how his shoulder was injured. When the Appellant was examined in November 1998, the examiner stated, "The physical examination is most interesting in this patient. Everything I did to the patient produced a great deal of pain and he tried to convince me how painful it was . . . ." He did not find the Appellant's complaints of pain convincing because of the completely normal findings. He made the following conclusion, in part: I can simply say that the patient's physical findings do not correspond at all with his stated expressions of pain in the various parts of his body and, as I mentioned, every part of his body seemed to be painful as we examined it. He was very vocal in all of this and yet, as I mentioned, he did not cringe or resist any of the movements. He did everything that I asked him to do very quickly and without hesitation. See November 1998 VA examination report. In November 2004, the Appellant was being evaluated following a May 2004 industrial accident. Dr. Wieseltier noted that the chief complaints of pain involved the low back, neck, right elbow, right forearm, and right wrist. He stated the following, in part: Initially, I asked [the Veteran] if he had sustained any previous injuries to any of the body parts involved in his claim. He did indicate that he had a prior low back injury (See Past Medical History). However, he did not indicate that in 1980 he sustained a dislocation of his right shoulder (probably acromioclavicular joint). When I informed him that his x-rays were consistent with a chronic shoulder injury, he did tell me that he had dislocated his shoulder while in the Army and had received a 10% service-connected disability. See November 2004 private medical record on page 10. The Board notes that the Appellant reported only the 1999 low back injury at the time of the November 2004 evaluation (again, the examiner stated this occurred in August "1998") and failed to report that he also injured his neck in 1999, and injured both his neck and back in January 1997. Indeed, the incident in 1997 was serious enough for the state to place the appellant on state disability. Again the Appellant has shown a pattern of reporting only those facts which support his particular wishes, inclinations, and passions at that particular time. In July 2005, a VA examiner noted that the Appellant gave conflicting history and dates for psychiatric issues. When the Appellant underwent a VA psychiatric evaluation in April 2006, the psychiatrist made multiple findings that the Appellant's history could not be trusted. He found the Appellant's behavior during the examination to be "manipulative." The Appellant reported that he was depressed because of his inability to work, which had caused him to have a reduction in sex drive. However, during the examination, the Appellant asked for Viagra because he would meet girls in bars and wanted to be able to perform for them. The Appellant reported that he was clean and sober for 15 years, but admitted to the VA psychiatrist that he had two beers two weeks ago. The VA psychiatrist noted that he had examined the record and evaluated the Appellant. The examiner's overwhelming sense was that the Appellant was not a credible historian and the examiner provided rather detailed reasons for why he did not believe the Appellant. When multiple clinical professionals from all areas of medicine question the credibility of the Appellant's history and symptom presentation during the various examinations, the Board cannot help but find that its conclusion that the Appellant is not credible has been validated by professionals who have had an opportunity to see the Appellant, hear his complaints, and make informed clinical findings based upon the face-to-face examination. The number and type of complaints by professionals is remarkably consistent throughout the record covering a period of more than 14 years. In September 2008, the Board found that it was possible that the Appellant's inconsistent statements were not intentional in light the multiple psychiatric diagnoses he has been given over the years. Yet, on further review, the Board finds that the evidence clearly and unmistakably shows that the Appellant has said exactly what he meant to say. It is the Veteran who has reported to VA examiners that his neck and back pain began in- service, and it was the Veteran who when filing a claim for injuries allegedly sustained in a January 1997 motor vehicle accident, who reported that he had never had a prior neck or back injury. Likewise, it was the Veteran who when filing a claim for disability benefits in connection with an August 1999 slip-and-fall accident, failed to reveal his prior January 1997 injuries that led to his receipt of State Disability benefits until July 1997. See April 1997 letter from Dr. Libs (stating, "He is currently on State Disability because of neck and low- back pain") and May 1997 and July 1997 "Claimant's Certifications." The Veteran's pattern of selective disclosure is clearly intentional, and severely damaging to his credibility. When filing a claim for disability benefits in connection with a May 2004 slip-and-fall industrial accident, wherein he was claiming neck, back and right upper extremity pain, the Appellant "neglected" to report the January 1997 motor vehicle accident, the fact that he had injured his neck in the August 1999 accident, as well as post accident right upper extremity pain. Dr. Rawlings entered a diagnosis pertaining to the Appellant's upper extremities and determined in January 2001 that all the Appellant's upper extremity symptoms were attributable to the August 1999 industrial accident. This is yet another incident showing the Appellant's behavior pattern of omitting pertinent facts. Lastly, when examined in December 2007 in connection with neck, back, and right shoulder pain (which Dr. Greenwald contributed to the in-service injury), in reporting his prior medical history the Appellant neglected to report the January 1997 motor vehicle accident, the August 1999 industrial accident, and the May 2004 industrial accident, all involving injuries to his neck and back. The Board is hard pressed NOT to find such a repeated failure to report a complete medical history to be intentional. Accordingly, the Board concludes that the Appellant's word cannot be trusted. His statements are contradictory throughout the record, and he is entirely unreliable. The Board does not come to this conclusion lightly; rather, it is based upon a thorough review of all six volumes of evidence in the Appellant's claims file. In going through the claims files, the Board found it difficult to keep track of the shifting sands of facts reported by the Appellant. For example, he sustained a 1989 low back injury. See August and September 1989 private medical records. At a VA clinic in April 1993, he reported a head injury when he was hit in the head with a baseball bat and lost consciousness. In June 1996, a private physician stated he was treating the Appellant for neck, midback, and right shoulder pain from a 1980 injury in service. Following a January 1997 motor vehicle accident, the Appellant was reported as denying any prior history of head, neck, or back injury or pain or dizziness in a February 1997 private medical record. In August 1998, the Appellant reported to VA a history of a 1986 back injury which had not been reported previously. In September 1998, the Appellant reported the 1983 closed-head injury but denied a loss of consciousness. The Appellant had an industrial accident in August 1999 and when he was evaluated in January 2001, the past medical history did not include any in- service neck and back injuries or any neck and back injuries following a January 1997 motor vehicle accident. In September 2003, the Appellant reported an on-the-job injury in February 2003 and he was debating whether to file for unemployment and/or workman's compensation involving his back. However, a September 2003 private medical record shows that the Appellant reported sustaining a right hand injury in February 2003. There was no mention of a back injury. The Appellant sustained injuries in a May 2004 industrial accident, but then he also reported a July 2004 re-injury to his back when cleaning shelves at work. See July 2004 private medical record and November 2005 VA treatment record. These are only some of the inconsistent allegations offered by the Appellant in the record. The Board is fully aware that a couple of examiners have found the Appellant credible. See, e.g., January 2005 private medical record from Dr. Engelhorn and December 2007 private medical record from Dr. Greenwald. Interestingly, the Appellant did not provide Dr. Greenwald an accurate and complete medical history since he failed to report a past medical history involving injuries to his neck and back in January 1997, August 1999, and May 2004. At that time, a Social Security Administrative Law Judge had found the Appellant was disabled due to neck and back disabilities from the May 2004 fall (the Social Security decision was issued in February 2006). Dr. Greenwald had no reason to question the Appellant's credibility since he did not have all of the facts, to particularly include those that contradicted the self serving history provided by the Appellant. Concerning Dr. Engelhorn, he specifically stated, "There were no medical records to review prior to this examination." Thus, without seeing other medical record, he would not have any need to question the Appellant's honesty. For example, Dr. Engelhorn stated the Appellant had been clean and sober from alcohol for at least 15 years. Had he reviewed other records, he would have seen that in January 2001 Dr. Rawlings reported that the Appellant was an occasional drinker, which would have refuted the claimant's own statements. See January 2001 under Social History (stating, "He is a smoker and uses alcohol occasionally."), and a March 2003 VA examination report (stating, "[H]e was sober for 13 to 14 years, however, he recently drank over the past few months."). When an examiner does not have an opportunity to see that the patient has made inconsistent statements, he would have no reason to question the credibility of the patient's facts. Nevertheless, the Board makes its own credibility determinations. Even if every doctor who has examined the Appellant found him to be a credible historian, the Board must make its own determination based upon its review of the claims file. In this particular case, however, the Board finds that its conclusion that the Appellant is not a credible historian is completely supported by the entire record. The statements written by RH (buddy), the Appellant's common-law wife, and PS, a registered nurse, are all rejected because they contain facts that the Board finds are entirely incredible. RH states that the Appellant wrote him a letter telling him that he had injured his right shoulder, back, and neck from the fall. The Board finds as a fact that the Appellant did not sustain injuries to his back and neck in the in-service fall. The Board also finds as a fact that the Appellant did not sustain a head injury from that fall or had any loss of consciousness. Again, in November 1982, the Appellant specifically denied ever having a serious injury to his head. Thus, the Board does not find that the service treatment records are silent for a finding of head injury, but rather show that he did not have one in service. If one wants to argue that the Appellant stated "No" because at that time, he did not think he incurred a "serious" head injury, the Board rejects that allegation, as he clearly has reported to three people (common-law wife, registered nurse, and Dr. Greenwald) that he lost consciousness. A reasonable person would label a head injury causing a loss of consciousness as "serious." If the Appellant had truly sustained a head injury in service which caused a loss of consciousness, the Board finds he would have reported that fact on the November 1982 form. The Board accords the Appellant's November 1982 statement high probative value because it was created contemporaneously with service and is consistent with what the other service treatment records show, i.e., the absence of any complaints of head, neck, and/or back pain. The Appellant was seen throughout service for multiple complaints. He cannot argue that he was the type of person who never went to see a doctor. Besides being seen for the right shoulder, he was seen for multiple skin issues in various areas of his body (November 1978, December 1979, January 1980, July 1980, August 1980, November 1980, December 1980, July 1981, November 1982); knee pain (October 1981); residuals of cold injury (December 1980); gastrointestinal complaints (January 1981); a painful left thigh (March 1982); an injury to the left hand (June 1982); upper respiratory infections (January 1980, August 1982); cellulitis (March 1980); constipation (October 1982); and for other concerns. The Appellant was seen following the April 1980 injury on multiple occasions yet he never reported any head, neck, or back pain or related injuries. See April, May, June and July 1980 treatment records. It is difficult to believe that the assertion that the Appellant sustained head, neck, and low back injuries in-service when no residual was ever documented in the service treatment records and when he denied a history of any head injury in November 1982. The Appellant clearly was able to have multiple other medical complaints documented in the claims file, but he wants the Board to believe that somehow all of his purported complaints pertaining to his head, neck, and back were not documented. Such an allegation is facially incredible. Thus, to the extent that these three individuals claim the Appellant sustained a head injury and/or loss of consciousness, such facts are rejected and their inaccurate reports of the Appellant's medical history taint their statements. Thus, they are accorded no probative value. None of the lay authors witnessed the April 1980 injury. Hence, all must be relying on statements provided by the Appellant, which are neither credible nor supported by the objective evidence of record. As to RH's allegation that he had received a letter from the Appellant while he was still in service about falling from a tower and dislocating his right shoulder, back, neck, and even having dizziness prior to getting up from the ground, the Board find his report incredible for two reasons. First, his allegations are not supported by the service treatment records. Second, the statements are not supported by a copy of the actual letter itself. Third, the Board finds it incredible that RH would remember the intricate detail he describes more than 27 years after the incident in question. Somehow RH remembers the specific body parts the Appellant claimed that he injured in a letter written 27 years ago and how the claimant reported that his instructor made him run to the training medical center when there was an ambulance nearby. In light of the totality of the record, the Board does not accept as credible the statements offered by either RH or the Appellant's spouse because it is clear that their statements are based on "facts" provided by the Appellant which the Board has rejected as not credible. In sum, the three statements the Appellant submitted in August 2007 are unreliable and full of Appellant's self-reported exaggerations. The Board will now address the issue of entitlement to service connection for a psychiatric disorder on a direct basis and as secondary to the service-connected right shoulder disability. The Appellant has been diagnosed with various psychiatric disorders. Therefore, the issue of a current disability is not disputed. As to direct service connection, the service treatment records are silent for any complaints or diagnosis of a psychiatric disorder. The Appellant's allegations of having psychiatric symptoms in service are rejected as not credible. There is no competent evidence that a psychosis was manifested to a compensable degree within one year following discharge from active duty. The first documentation of psychiatric complaints was in 1988, when the Appellant was seen for marital distress. See April 1988 VA treatment record. Five months later, he was seen with complaints of increasing dysphoria in the face of job stress, financial indebtedness, and chronic conflicts with his common-law wife. See September 1988 VA treatment record. In April 1991, he reported being depressed due to relationship problems. See April 1991 VA treatment record. In December 1992, he reported depression due to custody issues. See December 1992 VA treatment record. In January 1993, the Appellant was described as anxious due to issues involving his family. See January 1993 VA treatment record. Thus, the first showing of psychiatric complaints is more than five years following service discharge. This is evidence against the claim of having psychiatric symptoms in service or soon after service discharge. See Maxson v. West, 12 Vet. App. 453 (1999) (service incurrence may be rebutted by the absence of medical treatment of the claimed condition for many years after service). In the April 1988 record, the Appellant reported he had undergone marital counseling with his wife's psychologist five years prior, which would have been in 1983 and which post dates the Appellant's service. Regardless, the Board finds that seeking marital counseling is not necessarily indicative of a psychiatric disorder. Indeed, the objective evidence shows the Appellant was first diagnosed with a psychiatric disorder in April 1991, when he was diagnosed with adjustment disorder with depressed mood. When he was seen in September 1988, the examiner listed psychiatric disabilities to rule out. Even if ruling out "adjustment disorder with depressed mood" and "evolving major depression" is evidence of a then present psychiatric disorder, it was not presented until six years following service discharge, and none of the medical professionals who then examined the Appellant attempted to attribute it to service, to include a fall he sustained in service. The Board is aware that Mark Rawlings, D.C., has essentially attributed the onset of the Appellant's depression to service, however, his medical opinion is rejected for three reasons. First, he is not competent to opine as to matters involving the etiology of a psychiatric disorder. Dr. Rawlings is a chiropractor, and there is no evidence that establishes chiropractic training is the same as psychiatric training to provide this opinion. In M21-1MR and in VBA Fast Letters, VA prepared a list of professionals who can provide VA psychiatric examinations. See VA Adjudication Procedure Manual M21-1MR, pt. III, subpt. iv, ch. 3, sec. D (listing (1) board-certified or board-eligible psychiatrists, (2) licensed doctorate-level psychologists, and (3) doctorate-level mental health providers, psychiatry residents and clinical or counseling psychologists under the close supervisions of a board-certified or Board-eligible psychiatrist; or licensed doctorate-level psychologist) and Appellants Benefits Administration (VBA) fast letter dated March 15, 2006 (VBA Fast Letter 06-03 (Mar. 15, 2006)) (providing the same list as the M21-1). Neither the M21-1MR (and its former versions) nor the VBA Fast Letter (and its former version) provide that a chiropractor can provide a VA psychiatric examination. The Board finds that such adherence should be applied to private examiners as well. In 2008, the Board made this same finding with respect to Dr. Rawlings' competency to offer psychiatric opinions and the Appellant has yet to provide any argument or evidence to the contrary. Second, it is clear that Dr. Rawlings has provided these opinions based on history reported by the Appellant. The Appellant's history of depression in service since the fall is rejected for all the reasons described above. See Black v. Brown, 5 Vet. App. 177 (1993) (Board is not bound to accept medical opinions based on history supplied by veteran, where history is unsupported or based on inaccurate factual premises). The Board finds that there is no objective evidence of in- service psychiatric complaints or diagnoses in service. It further finds that the Appellant's statements and testimony of depression while still in service are not credible because the Appellant is not credible for the reasons discussed above. As an aside, the Appellant testified at the July 2004 hearing before the undersigned that Dr. Rawlings was treating him three times a week for his psychiatric disorder. See Transcript on page 11. In March 2006, the RO specifically asked Dr. Rawlings to "send us any outstanding psychiatric treatment records or diagnostic records you have regarding the [V]eteran's depression." Dr. Rawlings submitted copies of October 2005 and March 2006 letters that were already in the claims file. The Board finds that the lack of treatment records pertaining to treatment for a psychiatric disorder is evidence that the Appellant provided false information to the undersigned about receiving psychiatric treatment from Dr. Rawlings three times a week for depression. Third, Dr. Rawlings has provided his own contradictory statements, which the Board finds negatively impacts his credibility. For example, in January 2001 Dr. Rawlings notified an insurance company that the Appellant had injured his back and neck in August 1999 in a work-related injury. Dr. Rawlings stated that the Appellant's history was remarkable for a right acromioclavicular joint dislocation that had occurred in 1980 while in the military. Dr. Rawlings noted, however, that the right shoulder had "not interfered with his work or activities." He further noted the Appellant had denied any other major illnesses. Following his review of medical records, which records he listed and all were dated after the August 1999 accident, Dr. Rawlings made the following conclusions, in part: CAUSATION: Based upon the available information presented to me at this time and with no evidence to the contrary, I believe that all of the patient's symptoms with regard[] to his neck and back are directly causally related to the industrial injury which occurred on August 14, 1999. APPORTIONMENT: The patient does have a history of a prior injury to his right shoulder, which was an acromioclavicular dislocation[,] which did not result in any work restrictions or significant pain. This is a separate body part. The patient's right arm complaints are a result of the thoracic outlet syndrome which is a result of his industrial injury of August 14, 1999. Id. on page 8 (Capitals and bold in original.) Thus, in January 2001, Dr. Rawlings reported that the Appellant sustained a right shoulder injury in service but he was completely silent as to any history of an in-service neck or back injury. Dr. Rawlings attributed all of the Appellant's neck and back and shoulder disabilities to the August 1999 industrial accident. In 2001, Dr. Rawlings, knowing that the Appellant sustained a right shoulder injury in 1980, attributed all of the Appellant's right upper extremity symptoms to the August 1999 industrial accident. Yet, in October 2005 and March 2006 letters, Dr. Rawlings attributed all three disabilities to service without any explanation for his change in opinion. Did he believe that the neck, back, and shoulder disabilities from the August 1999 industrial accident had resolved, leaving the only cause of these disabilities to the in-service fall? Did he discover that the Appellant had prior neck and back injuries in service after his January 2001 evaluation? The Board has no explanation for Dr. Rawlings's changed opinion. Such unexplained inconsistencies, however, negatively impact Dr. Rawlings's subsequent opinions of July 2004, October 2005, and March 2006. To the extent that Dr. Rawlings is competent to state the facts he made in the October 2005 and March 2006 letters, the Board accords no probative value to his subsequent opinions of 2005 and 2006. The Board finds no reason to question the opinions he provided in January 2001, as they are essentially statements against interest in connection with the current claim. Statements against interest tend to be highly reliable. Cf. generally Federal Rule of Evidence 804(b)(3). The January 2001 finding, at least pertaining to the right upper extremity, are consistent with July 1997 and November 1998 VA examination findings, which will be discussed in more detail below. The Board is aware that the parties addressed the Board's September 2008 finding that Dr. Rawlings's opinions were of no probative value. The parties alleged that at least part of Dr. Rawlings's opinions were based on an accurate history. The Board will address that below in discussing the evidence for and against a conclusion that a psychiatric disorder is attributable to the service-connected right shoulder disability. Thus, to sum up the direct service connection claim, there is no credible evidence of a psychiatric disorder or symptoms in service, there is no credible evidence of a psychosis within one year following discharge from service, and there is no credible evidence of a nexus between a psychiatric disorder and service for all the reasons described above. Again, the Appellant is not a credible historian, to include misrepresenting facts for the purposes of monetary gain. As to secondary service connection the Board finds that the preponderance of the evidence is against a finding that the Appellant has a psychiatric disorder that is attributable to the service-connected right shoulder disability. The Appellant is service connected for a right shoulder disability as a result of a fall he sustained in service. He has a 20 percent evaluation, which indicates his disability is severe enough to be compensable. Notably the 20 percent evaluation does not accurately reflect the severity of the Appellant's service- connected disability. At the time that the Hearing Officer granted the Appellant the 20 percent evaluation, there was a sustained showing of a lack of any impairment of the right shoulder. See July 1997 and November 1998 VA examination reports where a VA physician found no functional impairment. The Board finds that the 20 percent evaluation does not seem appropriate; however, the propriety of the current rating is not in appellate status. Rather, the current issue is whether the Appellant has developed a psychiatric disorder from pain associated with the service- connected right shoulder disability. To come to this conclusion, one must find that (1) the Appellant has a psychiatric disorder, and that (2) the psychiatric disorder is, in part, related to right shoulder pain from the service- connected right shoulder disability. Pain is an exceptionally subjective concept. Because it is difficult to objectively quantify or confirm any conclusion based on "pain" is heavily reliant upon statements from the Appellant. The evidence does not lead the Board to question whether the Appellant has a psychiatric disorder. Rather, the evidence leads the Board to question whether any psychiatric disorder is caused by pain reported by an Appellant who has problems with his credibility. VA examinations established that in July 1997 and November 1998 the Appellant had no residual functional right shoulder impairment. When the Appellant was examined in February 1997, the examiner stated the upper extremities had normal muscle contour without evidence of wasting. There was 5/5 strength. There was diminished left but not right upper extremity sensation. When the Appellant was examined in July 1997, the examiner stated he found no acromioclavicular separation or joint instability. The Appellant had full range of motion, including abduction. The examiner stated the complaints of pain were very mild and that the Appellant did not flinch or cringe as he went through the range of right shoulder motion. Muscle power was normal, as was sensation. The examiner concluded there was no functional impairment, no weakness, no limitation of motion, no painful motion, no fatigability and no incoordination. This same medical conclusion was reiterated in November 1998 with even more detailed findings. While the examiner noted that everything he did to the Appellant "produced a great deal of pain" and that the claimant "tried to convince me how painful it was," the examiner did not find the Appellant convincing based on his physical examination. The right shoulder had normal range of motion. The examiner stated that, "All the time we were doing these motions, both actively and passively, he was complaining of how painful it was, and yet there was no external sign that he had pain as he went through these motions." The neurological examination was "completely normal" and all upper extremity reflexes were active and symmetrical. There were no abnormal reflexes, and sensation was "completely normal." He concluded that the Appellant's physical findings did not at all correspond with his stated expressions of pain in various body parts. The examiner reiterated that the Appellant did not cringe or resist any of the movements, and that he did everything that the examiner had asked him to do "very quickly and without hesitation." The examiner found no right shoulder joint impairment at that time. Thus, in July 1997 and November 1998, a medical professional determined that the Appellant had no functional right shoulder disability. The Board assigns these medical opinions high probative value for several reasons. First, the examiner provided detailed physical examination findings. This includes the examiner's discussion of the lack of credible evidence that the Appellant was experiencing actual pain. The examiner described the Appellant's facial expressions as he conducted the ranges of motion and why he felt that such were not indicative of real pain. In other words, the examiner had a clear rationale for the opinion he expressed. Moreover, the examiner provided a detailed rationale for why he did not believe the Appellant was experiencing right shoulder pain during both examinations. Second, the VA physician's conclusions are entirely consistent with Dr. Rawlings' January 2001 detailed medical opinion as to the right upper extremity. In January 2001, when discussing the Appellant's past medical history, Dr. Rawlings noted the 1980 right shoulder injury and stated that any residual disability had not interfered with the claimant's work or activities. After examining the Appellant and reviewing multiple medical records, Dr. Rawlings provided the opinion on "Apportionment" quoted above, wherein in acknowledging the 1980 injury, but opined, "The patient's right arm complaints are a result of the thoracic outlet syndrome[,] which is a result of his industrial injury of August 14, 1999." Thus, accepting the July 1997 and November 1998 VA examiner's conclusions that the right shoulder disability had no functional impairment as late as November 1998, the Board can only conclude that the evidence shows that any right upper extremity pathology is most likely attributable to the 1999 injury and not the service-connected disability. It is possible that the Appellant's service-connected right shoulder disability could have been aggravated by the 1999 accident; however, Dr. Rawlings was clear in his opinion, that is, ALL of the Appellant's right upper extremity symptoms were attributable to the August 1999 industrial accident. Hence, it is reasonable to conclude that in addressing "apportionment," Dr. Rawlings took into consideration that the right shoulder disability could have been aggravated by the 1999 fall and found that such was not the case when he affirmatively determined that all the symptoms were due to the August 1999 accident, while at the same time acknowledging the 1980 injury. Apportionment implies that the examiner determines to what extent the current disability is attributable to one injury versus another injury, to include due to aggravation. Thus, aggravation was considered and rejected. As noted above, the VA physician's conclusions are entirely consistent with Dr. Rawlings' January 2001 medical opinion as to the right upper extremity." The undersigned italicizes the latter words, however, to explain that the Board limits the finding of consistency to the conclusion that Dr. Rawlings made regarding the right upper extremity only. The Board finds that other parts of Dr. Rawlings' January 2001 letter are inconsistent in that there is no report of prior neck and back injuries, when the Appellant had been on "State Disability because of neck and low-back pain" from the January 1997 motor vehicle accident. See April 1997 private medical record from Dr. Libs and May 1997 and July 1997 "Claimant's Certifications." It is within the Board's purview to find portions of evidence to be credible and portions to be not credible, as long as it provides a rationale for its conclusions. The Board finds that the January 2001 medical opinion is credible as to Dr. Rawlings's conclusions regarding the right upper extremity and how the current symptoms were related to an August 1999 industrial accident because they are entirely consistent with the July 1997 and November 1998 opinions from a VA physician, whose clinical findings the Board has found credible. The Board will now separately address each of Dr. Rawlings other opinions. In July 2004, Dr. Rawlings stated that the Appellant had been experiencing chronic right shoulder pain since his 1980 service injury and had been experiencing associated depression since 1982. He stated that chronic pain was understood to be a cause for depression and that the Appellant's right shoulder pain was a contributing cause of his depression. To the extent that Dr. Rawlings alleges that the Appellant's right shoulder pain is a contributing cause to the Appellant's depression, the Board rejects his opinion as not competent in light of his professional background as a chiropractor, and not in psychiatry. This same finding applies to Dr. Rawlings' October 2005 and March 2006 letters, wherein he alleges depression had its onset in service or is associated with his right shoulder disability. The Board acknowledges that in the April 2006 VA examination report, the psychiatrist stated the following, in part: Regarding Dr. Rawlings' statements, I can only say that it is as least likely as not that any right shoulder pain would contribute to depression, if indeed it existed. This would seem to provide positive opinion between the Appellant's right shoulder pain and a psychiatric disorder. In order to find that this is a positive opinion, one must accept that the Appellant has right shoulder pain due in part to his service-connected disability and that this pain caused or aggravated depression. Notably, however, the VA psychiatrist conditioned his statement by stating, "[I]f it indeed existed." Such conditional statement was offered because the psychiatrist found the Appellant not credible. The psychiatrist found allegations of shoulder pain contributing to depression to be of questionable veracity. The Board agrees that it is difficult to conclude that the Appellant has depression due to the service- connected right shoulder disability for the following reasons. First, as detailed above, the Appellant is not a credible historian. He has shown throughout the record that when seeking monetary benefits for disabilities, he knows when to report pain and/or injury in connection with that disability or disabilities, and he will deny a history of prior pain and injuries if it suits his objective for that claim. For example, in June 1996, the Appellant reported to a chiropractor that he had injured his neck and back in the 1980 injury, yet in February 1997, he denied any prior neck and back injuries prior to the January 1997 motor vehicle accident. Such omissions of relevant facts are indicative of someone who manipulate the facts in order to obtain monetary benefits. Thus, any allegation the Appellant made that he has chronic right shoulder pain from the service-connected disability, as opposed to, e.g., the August 1999 superimposed industrial injury, is not credible. The Appellant has reported too many inconsistent facts throughout the record for the Board to conclude that this fact is true. Simply put, the Appellant's lack of credibility forces the Board to conclude that it cannot rely on statements he provided, particularly when they were made in connection with a claim for monetary benefits involving his service-connected disability. Second, Dr. Rawlings determined in January 2001, approximately one year and seven months prior to the Appellant's claim for secondary service connection for depression, that all of the Appellant's right upper extremity symptoms were attributable to an August 1999 industrial injury. Thus, it reasonable to conclude that the right shoulder pain the Appellant was experiencing at the time he claimed he had depression was due to the August 1999 accident and not the service-connected disability. Third, a VA examiner had examined the Appellant and found his complaints of pain not credible and concluded the Appellant had no functional impairment associated with his service-connected right shoulder disability as late as November 1998. This is entirely consistent with Dr. Rawlings' January 2001 findings. Fourth, the Appellant sustained yet another industrial injury in May 2004, which impacted his right upper extremity. In a November 2004 letter, Dr. Wieseltier found that the current symptoms associated with his right upper extremity were 50 percent related to the May 2004 accident. The Board is aware that Dr. Wieseltier also concluded that 50 percent of the current right upper extremity symptoms were attributable to service; however, such opinion was based upon an inaccurate factual premise. Specifically, Dr. W. was not informed of all the facts related to the August 1999 industrial injury that, according to Dr. Rawlings in January 2001, resulted in all of his then current right upper extremity symptoms. Dr. Wieseltier was under the impression the Appellant injured only his low back in the 1999 injury. See November 2004 private medical record on page 4. Nevertheless, Dr. Wieseltier found that the right upper extremity disability was, in part, due to the May 2004 injury, which is evidence against the Appellant's claim. In other words, Dr. W. was acknowledging that at least half of the current right upper extremity symptoms were not due to the service-connected disability. Two medical professionals have determined that the Appellant has right upper extremity pain due to post service injuries. Due to the Board's finding that the Appellant is not credible, the Board is unwilling to conclude that any alleged right shoulder pain is due to the service-connected right shoulder disability, particularly when there is evidence that he had no symptoms from his service-connected disability from July 1997 to as late as January 2001. To whatever extent that Dr. Rawlings is competent to make the conclusions he made in the July 2004, October 2005, and March 2006 statements, the Board finds that his opinions are outweighed by the March 2003 and April 2006 VA examination reports. In March 2003, a VA psychiatrist noted that the Appellant reported pancreatitis, diabetes mellitus, as well as pain in his neck, back, shoulders, and knees. The psychiatrist noted he had reviewed the record and reported clinical findings shown in some of the medical records. He noted the Appellant had been homeless since October and unemployed for the last two years. Following the physical examination, he concluded the following: In this case, I have been asked to review his records and opine as to whether his depression is at least as likely as not related to his service[-]connected right shoulder condition or whether it is more likely than not unrelated. This is a [V]eteran, who has become depressed over being jobless and now homeless. His records clearly state that he has been depressed over his physical conditions of pancreatitis and diabetes. I see no evidence that his depression is related to his service connected right shoulder condition. This is evidence against the Appellant's claim. The March 2003 VA examiner found that the service-connected right shoulder disability was not the cause of the Appellant's depression. This opinion has high probative value as it was provided by a physician and he provided a rationale for his opinion, which was based upon a review of the records and his medical expertise. In September 2008 the Board determined that the April 2006 VA medical opinion provided by the psychiatrist was evidence against the Appellant's claim. In the joint motion, the parties stated that the Board's finding was "contrary to th[e] Court's holdings that medical opinions are speculative and of little or no probative value when a physician makes equivocal findings." See Joint Motion on page 3. If one reads the entire examination report, however, a reasonable person cannot conclude that the examiner's findings are equivocal. Indeed, they show that the examiner did not believe the Appellant's story. As a result, the April 2006 examiner was unable to find a relationship between the psychiatric disorder and the service-connected disability. For example, in the examination report, the examiner stated the following, in part: The overwhelming sense, based on the tone of the data in the C-file at all levels, particularly post-military, tends to make me highly suspicious of this [V]eteran's credibility as a historian. Since I do not believe the timeline of the case as presented by the [V]eteran, that in the answer [] of the Regional Office as to the opinion regarding the etiology of his alleged mood disorder, which is currently being medicated, as noted above, my answer has to be paragraph F. Namely, his mood disorder cannot be resolved at this time without resorting to mere speculation. There are simply too many holes and too much drug, alcohol and other inconsistencies in the [V]eteran's history provided to me today to see any clear connection between his current problems and his military service. . . . See April 2006 VA examination report on page 5. The April 2006 examiner also stated, "This entire case is vague, most probably poorly founded and highly suspect, and I find it impossible to connect it to his alleged fall of 50 feet at Fort Benning in 1980." Id. on page 6. In addressing the Appellant's psychiatric status the examiner wrote the following, in part: Depressive disorder, not otherwise specified, mild-to-moderate in degree, of unknown onset and cause, most probably due to a traumatic childhood and many years of polysubstance abuse, including cocaine, methamphetamine and alcohol, plus 2 years of employment. . . . Id. (Italics added.) The examiner then made the following conclusion: In my final answer to the specific opinion request by the Regional Office[], after reviewing the entire medical record packet and interviewing the patient for 90 minutes, it would be my opinion that the [V]eteran's current psychiatric difficulties, including depressive disorder, not otherwise specified, cannot be resolved with[out] a result to mere speculation, due to the complexity of the case, the vagueness of the [V]eteran's presentation, and the diagnosis of severe antisocial and borderline traits, which in my judgment renders the [V]eteran's history not credible and, therefore, I cannot link it to his service-connected injuries of 1980. Id. on page 7. This opinion is not speculative. The mere use of the word "speculation" does not make a medical opinion speculative. Indeed, in the paragraph beginning, "The overwhelming sense," the examiner concludes that he cannot see a connection between the current psychiatric problems and the Appellant's service. That is a negative opinion. The examiner reiterates this negative finding on the following page when he states he cannot connect the Appellant's case to the fall in service. Next, the psychiatrist diagnosed a depressive disorder. While the examiner initially stated it was of unknown onset, he provided a probable cause, i.e., the Appellant's traumatic childhood and many years of polysubstance abuse, and two years of employment. Thus, the examiner specifically excluded the Appellant's service-connected right shoulder disability as being part of the cause. Finally, the examiner reiterated yet again the negative finding when he stated that he could not link a psychiatric to the Appellant's service-connected disability. Reviewed in its entirety, and not simply selectively, it difficult to conclude that a reasonable person could read the VA opinion as speculative and/or that the psychiatrist made equivocal findings. Indeed, this medical opinion has high probative value for several reasons. The psychiatrist had an opportunity to review the claims file, he provided relevant medical history in the evaluation report, and he provided a rationale for his opinion. To the extent that the Appellant has argued that this is a speculative opinion, the psychiatrist provided the bases for why he could not establish a relationship between the a current psychiatric disorder and service. That rationale was not based upon an incomplete record and it was not provided by an uninformed examiner. See Jones v. Shinseki, 23 Vet. App. 382, 389 (2010) ("In general, it must be clear on the record that the inability to opine on questions of diagnosis and etiology is not the first impression of an uninformed examiner."). In the evaluation report, the psychiatrist noted that the facts in this case were complicated. The examiner noted that the Appellant had sustained a right shoulder injury in-service, as well as an industrial injury to the right upper extremity in August 1999. The Appellant suffered yet another industrial injury to the right upper extremity in May 2004. Finally, the examiner concluded Appellant was not a reliable historian, a finding that is consistent with the Board's finding for the reasons discussed earlier. The Court has acknowledged that an inconclusive opinion is valid when the application of current medical knowledge could yield multiple possible etiologies with none more likely than not the cause of a veteran's disability that a physician could only speculate as to the cause of a claimant's disability or condition. Id. at 390. In this case, any medical opinion addressing whether the Appellant has a psychiatric disorder due to a right shoulder disability is based, at least in part, on a reliance upon the Appellant's own words. Because the psychiatrist did not find the Appellant credible, and because there are multiple, possible etiologies of the Appellant's right upper extremity pain, the examiner was incapable of attributing it to the service-connected disability. Such a conclusion is entirely reasonable and understandable based upon the facts in this case. There are multiple VA treatment and private medical records wherein examiners diagnosed a psychiatric disorder and included "shoulder pain" under Axis III of the psychiatric diagnosis. One could argue that this evidence supports the Appellant's claim. However, the only way that evidence could be supportive of the Appellant's claim is if the examiner relied upon statements provided by the Appellant, or relied upon medical records where an examiner previously relied upon statements from the Appellant. As the Board assigns no probative value to the Appellant's statements made in support of his claim, the Board cannot assign any probative value to any medical opinion that relies upon the Appellant's statements either directly or derivatively . See Black, 5 Vet. App. 177. To the extent that one would argue that the Appellant's common- law wife is competent to provide a nexus opinion, her August 2007 opinion is outweighed by the March 2003 and April 2006 VA medical opinions, as these examinations were conducted by medical doctors. A physician's opinion is more probative than a person with a psychology major/degree, as they have had more training involving psychiatric issues. The Appellant's common- law wife's credentials do not meet the VA requirements of who can provide psychiatric evaluations. See M21-1MR, pt. III, subpt. iv, ch. 3, sec. D and VBA Fast Letter 06-03. The Board has reviewed the lay statements provided by the Appellant's son and sister. His sister is competent to describe the changes in the Appellant's behavior when returning from service. His son is competent to describe the Appellant's disabilities as he perceives them. As lay persons, however, neither is competent to offer a medical opinion finding a nexus between a current psychiatric disorder and service or a service- connected disability. To the extent that one would argue that their opinions are competent, their opinions are outweighed by the March 2003 and April 2006 opinions prepared by medical doctors for the reasons described above. Turning to the contentions the Appellant made in a May 2010 letter. He first alleges that the Board relied on a medical opinion that did not state an actual opinion. See May 2010 letter pg. 1. The Board has already explained why it believes that the VA psychiatrist provided a probative opinion, and why the opinion meets the Jones criteria when an inconclusive opinion will be accepted. The Appellant argued that the April 2006 evaluation report was "troubling" because of inaccurate findings the psychiatrist made. For example, he stated that the psychiatrist labeled the Appellant as divorced with a later reference to his wife, when the claims file contained ample evidence that the Appellant never married the mother of his child. It is clear from the record, however, that the Appellant and the mother of his child had a common-law marriage. See February 1993 VA hospitalization summary report on page 2 (stating, "The patient is separated from his common-law wife.") and April 1993 VA neuropsychological Evaluation (stating, "He has a 7-year-old son and considers his 10[-]year relationship with his son's mother a common[-]law marriage."). These quotes establish that the Appellant publically held out the mother of his child as his "wife." The February 1993 quote also establishes that at some point, the Appellant and his common-law wife were no longer living together and were no longer together as a couple. Additionally, in January 1993, the Appellant reported going out drinking with his "ex-wife and her friends." See January 1993 VA treatment record. The VA psychiatrist's statement that the Appellant was divorced was a reasonably-deduced fact based on the Appellant's own statements to examiners. The Appellant had labeled the mother of his child his "common-law wife," subsequently reported he was separated and single, and held her out as his "ex-wife." Hence, a reasonable person would conclude that in order for a person to label himself as "single" or refer to his wife as an "ex-wife," the person would have needed to have obtained a divorce. Significantly, however, regardless whether the Appellant is married, single, or divorced that fact had no impact on the psychiatrist's opinion, as that was not part of any rationale he provided when discussing whether any psychiatric disorder was related to the right shoulder disability or the Appellant's lack of credibility. Any controversy pertaining to the appellant's marital status in April 2006 does not lessen the probative value of the April 2006 opinion. This same finding applies to the psychiatrist's statement that, "A recent Medical Board gave him an honorable discharge with a 20% rating for fracture of the scapula." The Board is unable to determine where the examiner obtained that information, but it did not appear to have any impact on the psychiatrist's opinion and conclusions. The Appellant argues that more troubling was the April 2006 VA psychiatrist's attitude towards him and the accusations he made that the Appellant was unreliable. As discussed above, the Appellant is not a credible historian. He reports untrue facts to assist him when seeking monetary benefits. The Appellant has made multiple inconsistent statements throughout the record. The Board has not reported ALL of these inconsistent statements because it does not need to do so to establish that the Appellant's word cannot be trusted. The April 2006 psychiatrist was unwilling to have the Appellant undergo testing because he found that the Appellant was unreliable. The psychiatrist explained why, and the Board agrees with that professional assessment. Testing relies upon statements the patient provides, and if one cannot rely on the statements a patient provides, there is no need to provide testing. Additionally, prior testing had revealed exaggerated responses. It seems entirely reasonable that a psychiatrist would not conduct additional testing where that patient had exaggerated previously and provided inconsistent facts to the psychiatrist when being evaluated. Next, the Appellant complains that while the psychiatrist found much of the Appellant's history unreliable, he was "perfectly willing to accept certain statements from the patient as wholly reliable," such as the Appellant having a traumatic childhood, when "[t]here is no other source of information in the claims file regarding the [V]eteran's childhood." That latter statement is untrue. The Appellant reported child abuse back in April 1991 and February 1993. See April 1991 ("[I]ndicates possible abuse as a child. Family life appeared chaotic.") and February 1993 VA treatment records ("Abused by natural father until 9-10 years old." "He states that he was physically abused by his biological father, who bruised him and knocked him down and used a belt."). Since such statements were reported at a time when the Appellant was not seeking monetary benefits for a psychiatric disability, the Board has no reason to question the truthfulness of those statements. The VA psychiatrist apparently reached the same conclusion, i.e., that the particular statement was credible. Additionally, it is completely reasonable for an examiner to believe some facts and discount others that are not supported by medical principles or the facts. In noting that the psychiatrist attributes part of the Appellant's psychiatric disorder to polysubstance abuse, the Appellant states the doctor contradicted himself when he stated he had "no real feeling for what happened to this man in terms of substance abuse since 1982." The Board cannot discern what the examiner meant by that phrase; however, the VA psychiatrist accurately discussed what substances the Appellant had abused. Cf. April 2006 VA psychiatric evaluation report, pg. 3, with February 1993 VA hospitalization summary report. The Appellant attacked the VA psychiatrist's finding that the Appellant could not remember any presidents before Reagan or name the current president or vice president. He explained that many people are deficient in current affairs. However, in the January 2005 private psychiatric evaluation of the Appellant, Dr. Engelhorn stated, "He could name the current president of the United States as well as three of the four living ex- presidents." See January 2005 private medical record on page 3. The president in 2006 was also the president in 2005. It is no wonder the VA psychiatrist was dubious of the Appellant's "inability" to name the current president or remember any presidents before Reagan since he was able to do so approximately one year prior. The Appellant argued that the April 2006 examination was deficient and should be returned for clarification and completion of a proper evaluation or re-evaluation in light of the VA psychiatrist's hostility towards the Appellant. The Board finds that no clarification is needed nor is a re- evaluation warranted. The April 2006 VA psychiatric evaluation is entirely adequate for the reasons described above. Additionally, as mentioned above, a medical opinion in this case must, in part, rely on statements provided by the Appellant, which statements the Board would find unreliable because of the multiple inconsistent statements he had made over the years. Thus, a re-evaluation would be a waste of limited government resources because even if the examiner provided a positive medical opinion, the Board would reject it because the Appellant's word cannot be trusted. The Appellant argued that his exaggeration of the distance he fell in service is a common human trait. Even assuming that to be true, it does not excuse the Appellant's lack of credibility. What is an uncommon human trait is the degree of repeated exaggeration and falsehoods that have been presented in this case by the Appellant's pursuit of monetary benefits. The Board has explained above that its finding regarding the Appellant's lack of credibility is based on multiple factors, which factors were laid out in detail above. This was just one small factor. The Appellant argues that one he has repeatedly testified that he was "being depressed since service because of his injury." See May 2010 statement on page 4 (italics added). The Board has reviewed the evidence very carefully and it cannot find how the Appellant would have come to this conclusion. The Appellant has consistently reported feelings of depression over the years, but the causes of his complaints have been numerous: (1) family issues; (2) financial issues; (3) homelessness, (4) being unable to obtain a job; (5) diabetes; (6) erectile dysfunction, (7) pancreatitis, and other causes. It was only close in time to the Appellant's August 2002 claim for service connection for depression that he began reporting his depression was related to the April 1980 fall and/or the service-connected right shoulder disability. The Appellant made arguments regarding the Board's September 2008 decision in addressing Dr. Rawlings's opinion and the Appellant's common-law wife's statement. He argued that the January 2001 opinion from Dr. Rawlings did not preclude two other possibilities: "(1) the [V]eteran's problems in the neck and back in 2001 were in fact related to the industrial accident but the in-service shoulder injury caused later problems in [the] neck and back; or (2) he injured the neck and back at the same time as the shoulder in service, and the 1999 injury aggravated the same body parts." If the Appellant wanted to establish either of these possibilities, he had at least ten months during which he could have submitted competent evidence of such since the joint motion for remand was granted. Regardless, the Board finds neither of these two possibilities credible based on the current evidence of record. As to the second possibility, the Board finds as fact that the Appellant never injured his neck and back in service. No matter who makes that allegation, the Appellant or a medical professional, the Board will reject it because (1) there are no objective records to support this allegation, and (2) the Appellant's allegations of in-service injuries to the neck and back are incredible. The Board finds that the other arguments presented in the May 2010 letter are addressed above in the discussions regarding Dr. Rawlings's and the common-law wife's statements and opinions. Lastly, the Appellant stated if the Board contemplated relying on any case law, regulations, statutes, General Counsel opinions, or other authority not previously addressed by the regional office in a notification to the Appellant, he requested that the Board provide notice of such, via his representative, along with a reasonable opportunity to respond. The Board has considered the holding in the Jones case. The RO did not consider this decision since it was decided in 2010; however, the Appellant specifically addressed the holding in Jones in his May 2010 letter to the Board. Thus, the Appellant has had a reasonable opportunity to address that case law and therefore the Board need to send a notice to the Appellant. The preponderance of the evidence is against the Appellant's claim for service connection for depression, both on a direct basis and as secondary to the service-connected right shoulder disability. The claim is denied. In reaching this decision, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the appellant's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to service connection for a psychiatric disorder, to include as secondary to a history of right shoulder subluxation and laceration is denied. ______________________________________ DEREK R. BROWN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs