Citation Nr: 1005558 Decision Date: 02/16/10 Archive Date: 02/25/10 DOCKET NO. 07-20 780 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cheyenne, Wyoming THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for bipolar disorder. REPRESENTATION Appellant represented by: Colorado Division of Veterans Affairs ATTORNEY FOR THE BOARD T. L. Anderson, Associate Counsel INTRODUCTION The Veteran had active service from February 1996 to February 2000. This matter comes before the Board of Veterans' Appeals (BVA or Board) from a June 2006 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. Jurisdiction over the Veteran's claims file was subsequently transferred to the Cheyenne RO. On her VA Form 9, the Veteran requested a hearing before the Board at a local RO. The hearing was scheduled for January 6, 2010, at Cheyenne. However, she did not report for the hearing, and no request for postponement was received prior to the hearing date. Under 38 C.F.R. § 20.704(d), when a veteran fails to appear for a scheduled hearing and no request for postponement is received, the claim is processed as though the request for hearing had been withdrawn. Therefore, this case will be processed as though the request for a hearing was withdrawn, and the Board can now proceed to appellate review. See 38 C.F.R. § 20.702(d). FINDINGS OF FACT 1. The claims file reflects a current diagnosis of PTSD. 2. There is no documented evidence that the Veteran was involved in combat, nor is there any independent evidence corroborating the occurrence of a specific in-service stressor which could serve as the basis for a diagnosis of PTSD. 3. The competent and probative medical evidence of record preponderates against a finding that the Veteran's bipolar disorder is related to active service; nor was a psychotic disorder manifested within one year after her separation from active service. CONCLUSIONS OF LAW 1. Posttraumatic stress disorder was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 3.307, 3.309(a), 3.384 (2009). 2. Bipolar disorder was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), 3.384 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating their claims for VA benefits, as codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2009). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and her representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide, in accordance with 38 C.F.R. § 3.159(b)(1) (2009). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the decision of the Court in Dingess v. Nicholson, 19 Vet. App. 473 (2006) requires more extensive notice in claims for compensation, e.g., as to potential downstream issues such as disability rating and effective date. If complete notice is not provided until after the initial adjudication, such a timing error can be cured by subsequent legally adequate VCAA notice, followed by readjudication of the claim, as in a Statement of the Case (SOC) or Supplemental SOC (SSOC). Moreover, where there is an uncured timing defect in the notice, subsequent action by the RO which provides the claimant a meaningful opportunity to participate in the processing of the claim can prevent any such defect from being prejudicial. Mayfield v. Nicholson, 499 F.3d 1317, 1323-24 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). The U.S. Supreme Court has held that an error in VCAA notice should not be presumed prejudicial, and that the burden of showing harmful error rests with the party raising the issue, to be determined on a case-by-case basis. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). In September 2005, VA sent the Veteran a letter informing her of the types of evidence needed to substantiate her claim and its duty to assist her in substantiating her claim under the VCAA. The letter informed her that VA would assist her in obtaining evidence necessary to support her claim, such as medical records, employment records, or records from other Federal agencies. She was advised that it is her responsibility to provide or identify, and furnish authorization where necessary for the RO to obtain, any supportive evidence pertinent to her claim. See 38 C.F.R. § 3.159(b)(1). Although no longer required, she was also asked to submit evidence and/or information in her possession to the RO. In addition, a March 2006 letter described how VA calculates disability ratings and effective dates. The Board finds that the contents of the September 2005 and March 2006 letters satisfied the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to notify and assist, including the requirements set forth by the Court in Dingess, supra. In addition, the June 2006 rating decision, May 2007 SOC, and September 2009 SSOC explained the basis for the RO's action, and the SOC and SSOC provided her with additional 60-day periods to submit more evidence. Thus, it appears that all obtainable evidence identified by the Veteran relative to her claim has been obtained and associated with the claims file, and that neither she nor her representative has identified any other pertinent evidence, not already of record, which would need to be obtained for a fair disposition of this appeal. It is the Board's conclusion that the Veteran has been provided with every opportunity to submit evidence and argument in support of her claim, and to respond to VA notices. Moreover, the claimant has not demonstrated any prejudicial or harmful error in VCAA notice. See Shinseki v. Sanders, supra. With regard to VA's duty to assist, VA obtained the Veteran's service personnel records, service treatment records (STRs), treatment records from the Denver and Cheyenne VA Medical Centers (VAMC), treatment records from private physicians, and the Veteran was afforded a VA examination in May 2006. As the veteran has contended that she experienced a sexual assault stressor during service, the Board has considered the decision in Patton v. West, 12 Vet. App. 272 (1999). There, the Court held that special consideration must be given to claims for PTSD based on sexual assault. In particular, the Court held that the provisions in the VA Adjudication Manual, M21-1MR, Part III, 5.14(c) (rescinded and replaced, in relevant part, by M21-1MR, Part III, Subpart iv, Chapter 4, Section H30), which address PTSD claims based on personal assault, are substantive rules which are the equivalent of VA regulations and must be considered. See also YR v. West, 11 Vet. App. 393, 398-99 (1998). Section H30, Paragraph (b), states that, in cases of sexual assault, development of alternate sources for information is critical. There is provided an extensive list of alternative sources competent to provide credible evidence which may support the conclusion that the event occurred, to include medical records, military or civilian police reports, reports from crisis intervention centers, testimonial statements from confidants, and copies of personal diaries or journals. See M21-1MR, Part III, Subpart iv, Chapter 4, Section H30, Paragraph (b). Also of particular pertinence is the provision of Paragraph (c) of Section H30, which states that behavioral changes which occurred around the time of the incident may indicate the occurrence of an in-service stressor. In this case, the veteran stated in her June 2007 VA Form 9 that she testified in a legal proceeding against the person who she alleges sexually assaulted her in service. Consequently, the RO requested and received a copy of the U.S. Army Criminal Investigation Command (USACIDC) Report of Investigation (ROI) regarding the investigation against the alleged perpetrator. The RO also requested records from the Department of the Army Office of the Inspector General, but received a response in December 2008 stating that a thorough database search was conducted and no records relating to the Veteran were found. Accordingly, we find that VA has satisfied its duty to assist the Veteran in apprising her as to the evidence needed, and in obtaining evidence pertinent to her claim under the VCAA. Therefore, no useful purpose would be served in remanding this matter for yet more development. Such a remand would result in unnecessarily imposing additional burdens on VA, with no additional benefits flowing to the Veteran. The Court of Appeals for Veteran Claims has held that such remands are to be avoided. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). II. Service Connection A. Applicable Law Service connection may be granted for disability which is the result of disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 2002 & Supp. 2009); 38 C.F.R. § 3.303(a) (2009). Where there is a chronic disease shown as such in service or within the presumptive period under 38 C.F.R. § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation in service will permit service connection. To show chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established, there is no requirement of evidentiary showing of continuity. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection may be granted for disease that is diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d). The Court of Appeals for Veterans Claims has held that, in order to prevail on the issue of service connection, there must be: (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in- service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). In addition, the law provides that, where a veteran served ninety days or more of active military service, and certain chronic diseases, such as psychoses (defined in 38 C.F.R. § 3.384), become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. In order to establish service connection for PTSD, the evidence of record must include a medical diagnosis of the condition in accordance with 38 C.F.R. § 4.125(a), a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform to the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders, 4th ed. (1994) (DSM-IV). Further relating to claims of service connection for PTSD, in Zarycki v. Brown, 6 Vet. App. 91 (1993), the Court set forth the analytical framework and line of reasoning for determining whether a veteran was exposed to a recognizable stressor during service, which, as discussed above, is an essential element in supporting a claim for service connection for PTSD. In Zarycki, it was noted that, under 38 U.S.C.A. 1154(b), 38 C.F.R. 3.304(d) and (f), and the applicable provisions contained in VA Manual M21-1, the evidence necessary to establish the incurrence of a recognizable stressor during service to support a claim of service connection for PTSD will vary depending on whether the veteran "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60 (1993). As noted above, the aforementioned provisions of M21-1 have been rescinded and reissued as amended in a manual rewrite (MR). See M21-1MR, Part IV, Subpart ii, Chap. 1, Sec. D, entitled "Claims for Service Connection for Post-Traumatic Stress Disorder" Where there is no combat experience, there must be independent evidence to corroborate the veteran's statement as to the occurrence of the claimed stressor. Doran v. Brown, 6 Vet. App. 283, 288-89 (1994). The veteran's testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor. Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). Further, an opinion by a mental health professional based upon a post-service examination of the veteran cannot be used to establish the occurrence of a stressor. Moreau v. Brown, 9 Vet. App. 389, 395-96 (1996); Cohen v. Brown, 10 Vet. App. 128 (1997). It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C.A. § 7104(a). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court of Appeals for Veterans Claims held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. The Court has also stated, "It is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. B. Facts and Analysis 1. Posttraumatic stress disorder First, the Veteran contends that she has PTSD as a result of a sexual assault that occurred during active service. The Board first considers whether there has been a medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a), which requires that the diagnosis conform to DSM-IV and be supported by the findings on an examination report. In June 2005, the Veteran was hospitalized for nearly two weeks at the Denver VAMC after using methamphetamines. In an inpatient discharge note, the attending psychiatrist observed that her initial presentation was likely related to her use of amphetamines, and he assessed amphetamine dependence, amphetamine induced delirium, and bipolar mood disorder per history on a DSM-IV diagnosis chart. No mention of PTSD was made. However, the Veteran was afforded a VA examination in May 2006 at which a VA psychiatrist assessed PTSD, among other disorders, on the DSM-IV diagnosis chart. The Veteran reported insomnia due to occasional nightmares and flashbacks of being raped while in active service. In addition, she reported panic attacks that had occurred frequently beginning after the rape, but began to taper in 2001 when she learned methods of preventing such attacks. She stated she had feelings of impending doom and was easily startled, particularly in crowded places. Based on her symptoms, the examiner found a history consistent with PTSD. Based upon the May 2006 VA examination, the Board finds that the criteria for a diagnosis of PTSD under 38 C.F.R. § 4.125(a) have been met. Before beginning its analysis regarding the existence of a stressor, the Board first notes that, since the first diagnosis of PTSD was made more than five years after separation from service, and there were no manifestations of any of the mental health disorders listed in 38 C.F.R. § 3.384 either during service or within one year after separation, the presumptive provisions of 38 C.F.R. §§ 3.307, 3.309(a) as to psychotic disorders do not apply here. Next, the Board will examine whether the veteran in this case was exposed to an in-service stressor event which could support a diagnosis of PTSD. There is no allegation or record of her participation in combat during the Veteran's military service. Therefore, the veteran's lay statements as to any in-service stressor cannot be accepted without further corroboration through independent evidence. Doran, 6 Vet. App. at 288-89. In the present case, the veteran's PTSD claim is based on a contention of rape. As she wrote in her October 2005 Statement in Support of Claim for Service Connection for PTSD, the claimed assaults occurred in November 1996 and February 1997 while she was stationed in Germany. She said J.D. was the perpetrator in both incidents. In the earlier (1996) incident, J.D. forced her to take off her clothes and pose in degrading positions. In February 1997, he came to an on-post club, Tradewinds, where the Veteran was with a friend, S.L.S. There, J.D. verbally harassed her throughout the evening and then accompanied her back to her room, where he raped her. She stated that S.L.S. witnessed him leading her to her room just prior to the attack. The Veteran wrote that she testified at the trial of J.D., when he was charged with multiple sexual assaults. She also submitted several articles about J.D. being charged with rape, indecent assault, attempted rape, and forcible sodomy, among other crimes. These articles do name J.D. and describe at least one of the attacks for which he was being charged, but the articles do not name any of the victims. As previously mentioned, the claims file includes the Report of Investigation (ROI) by the USACIDC. The ROI details the investigation and ultimate conviction of J.D. for numerous offenses, including attempted rape, conspiracy, cruelty, and maltreatment of a subordinate, rape, and sodomy. The reports lists the dates and places of the attacks, which include several in Babanhausen, where the Veteran was stationed, around the time she alleges her attack occurred. However, that list does not name the victims involved. The ROI does, however, list each of the victims and the crime of which they were found to be victims. The Veteran is listed as a victim of indecent exposure. The report goes on to describe that the investigation led to a finding that J.D. committed the offense of indecent exposure in January 1997, when he and another soldier were playing a game of "Spin the Bottle" that led to J.D. and an accompanying male soldier being fully unclothed, exposing themselves to the Veteran and another female, S.C.S. The report includes the February 1997 testimonies of both the Veteran and S.C.S. regarding this incident. The Veteran At her hearing before the undersigned, the Veteran testified that she had heard J.D. was "bad news" but did not know why, that she viewed him as being very professional in his duties, and that she was never approached and sexually harassed by the ITC cadre. She testified about an incident around New Year's when J.D. came to the Tradewinds club where she was with friends, and she talked to him a few times throughout the night. Another male invited her and her friends to their barracks, where she ended up playing "Spin the Bottle" with J.D. and another male soldier, along with her female friend, S.C.S. She stated that J.D. and the other male were completely naked by the end of the game, but that she was never completely unclothed. She further stated that J.D. did not make any sexual passes at her or her friend, that she played the game freely without pressure from J.D., and that she and her friend left the room together. The Veteran's friend, S.C.S. provided testimony consistent with that of the Veteran. The ROI also includes the testimony of S.L.S., whom the Veteran said had witnessed J.D. leading the Veteran to her room just prior to attacking the Veteran. However, although S.L.S. described several assaults by J.D., she did not mention the Veteran in her testimony. The Veteran's service personnel records, specifically DA Form 2-1, confirm that she had service in Germany from November 1996 to September 1998. Her STRs show that she sought treatment in February 1997 for pain in her right lower abdomen which seemed to be related to sex. The pain had started after she terminated a pregnancy the year before. The Veteran did not report her attack to the doctor, nor is there any other indication that she sought medical treatment relating to the attack in the months or years following. Moreover, there is no other documentation of the attack in the Veteran's personnel records. With regard to personal assault cases, the Court in the Patton case, supra, pointed out that "VA has provided special evidentiary development procedures, including the interpretation of behavior changes by a clinician and interpretation in relation to a medical diagnosis." Patton, 12 Vet. App. at 280 (citing VA Adjudication Procedure Manual M21-1 (M21-1), Part III, 5.14c(8), (9)). The Court has also held that these provisions of M21-1, which provide special evidentiary procedures for PTSD claims based on personal assault, are substantive rules that are the equivalent of VA regulations. See YR v. West, 11 Vet. App. 393 (1998); Cohen v. Brown, 10 Vet. App. 128 (1997). The Board reiterates that M21-1, Part III, Chapter 5, the section of the manual discussed in Patton, has been rescinded and replaced, in relevant part, by M21-1MR, Part III, Subpart iv, Chapter 4, Section H, Para. 30. Specifically, Para. 30(c) provides that: If the military records contain no documentation that personal trauma occurred, consider secondary evidence, such as . . . evidence of behavioral changes that occurred around the time of the incident, including: visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment; use of pregnancy tests or tests for sexually-transmitted diseases around the time of the incident; sudden requests that the veteran's military occupational series or duty assignment be changed without other justification; changes in performance and performance evaluations . . . evidence of substance abuse, such as alcohol or drugs . . . increased interest in tests for Human Immunodeficiency Virus (HIV) or sexually transmitted diseases. See also M21-1MR, Part IV, Subpart ii, Chap.1, Sec.D, Para. 17, as to development of evidence in personal trauma PTSD claims. The Court in Patton went on to note that the manual improperly appeared to require that the existence of the in- service stressor be shown by a preponderance of evidence. Any such requirement would be inconsistent with the so-called equipoise doctrine, where the benefit of the doubt is given to the claimant unless the evidence preponderates against the claim. Thus, Patton serves to expand the universe of evidence that can be used to corroborate a stressor based on in-service personal assault. For example, evidence of behavior changes around the time of the incident can corroborate the stressor. Moreover, under the provisions of M21-1MR, discussed above, changes in performance around the time of the alleged personal trauma can serve as evidence of a behavioral change to corroborate an in-service stressor. In this vein, the veteran's service personnel records have been reviewed for such indications. As previously mentioned, her personnel records confirm that she served in Germany from November 1996 to September 1998. Moreover, she received a Good Conduct Medal for her service from February 1996 to February 1999. Therefore, there is no indication that her behavior or performance in active service declined after the alleged 1996 and 1997 attacks. Indeed, her records show she performed well. Thus, there is no documentation in the evidence of record showing a behavioral change around the time of the claimed assault. There are no service treatment records indicating that the veteran sought medical attention after the assault. There is no indication she reported for pregnancy or STD tests. The Veteran provided detailed testimony regarding J.D. in February 1997 and specifically denied ever being sexually approached or assaulted by him. Although the May 2006 VA examiner attributed the Veteran's PTSD to the alleged military sexual assault, the doctor's opinion assumed the occurrence of the sexual assault in rendering his opinion. In summary, there is very little evidence in the record to corroborate the Veteran's statement that a personal assault occurred, and the weight of the probative evidence in favor of the claim does not approach an approximate balance with the evidence against it. The Board acknowledges the Veteran's belief that her PTSD was caused by a sexual assault in active service. However, the resolution of issues that involve medical knowledge, such as the diagnosis of a disability and the determination of medical causation and etiology, require professional evidence. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). It is true that the veteran's lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events, such as her description of an in-service assault, or the presence of disability or symptoms subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. §§ 3.303(a), 3.159(a); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, as discussed above, the claim herein requires corroboration of the undocumented in-service stressor to support a relationship with the current diagnosis, and that evidentiary requirement has not been met. In conclusion, the evidence of record does not rise to relative equipoise regarding the requirement of corroboration of an in-service stressor as claimed by the Veteran. Therefore, even with a current diagnosis of PTSD, the claim must fail. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 2. Bipolar Disorder Next, the Veteran contends her current bipolar disorder is related to active service. Her STRs are negative for any manifestation of any mental disorders or other mood problems. Following separation from service, the Veteran sought treatment at Pikes Peak Mental Health in May 2001 for panic attacks. She was diagnosed with bipolar mixed disorder. It was noted that her manic episodes were evidenced by gambling sprees, distractability, and grandiosity. The Veteran began treating with a private nurse practitioner, J.B., for bipolar disorder in February 2004. She reported that her medications were not working and that she was experiencing acute rage outbursts, extreme sadness, disrupted sleep patterns, and catastrophizing, among other symptoms. In an undated letter, J.B. noted that the Veteran was distraught over her impending divorce and her husband's alcoholism. She also admitted to having an addictive personality with a history of gambling, sexual acting-out, heavy alcohol and drug abuse, and prescription Percocet abuse between two physicians. After failed attempts to get the Veteran into a drug treatment program, J.B. last saw the Veteran in April 2005. In April 2004, the Veteran presented to the emergency room of Memorial Hospital with severe confusion. It was suspected that medication changes contributed to changes in her mental status, as there were no significant metabolic abnormalities found on workup in the emergency room. She was advised to follow up with J.B. In June 2005, the Veteran was admitted into a mental health inpatient facility at the Denver VAMC after using methamphetamines for an unknown amount of time. She said that the medications for her bipolar disorder had not worked in the past two years and that is why she took methamphetamines. At discharge, the attending psychiatrist diagnosed amphetamine dependence, amphetamine induced delirium, and bipolar mood disorder per history. Following this inpatient admission, the Veteran continued treatment at the Denver VAMC from 2005 to 2007. At the May 2006 VA examination, the Veteran reported that she had been diagnosed with bipolar disorder by a private physician in 1998 while she was still in active service. She said she was treated with Depakote, and was afraid to be treated through the military because she did not want to be labeled as having a psychological "issue". The examiner assessed bipolar disorder, Type I , and noted the Veteran's current mood was slightly depressed. The examiner did not make any opinion as to the etiology of the Veteran's bipolar disorder, although he related her PTSD to the alleged in- service sexual assault. Based on the foregoing, the Board finds the preponderance of the evidence is against a grant of service connection for bipolar disorder. First, the Board finds that the presumptive provisions of 38 C.F.R. §§ 3.307, 3.309(a) as to any psychotic disorder do not apply here. The first diagnosis of a bipolar disorder was documented more than a year after the Veteran's separation from service, and there is no record of complaints during the first post-service year. Moreover, bipolar disorder does not meet the definition of a psychotic disorder as defined in 38 C.F.R. § 3.384. Next, there is no evidence of bipolar disorder during active service, nor are there any competent medical opinions relating the Veteran's bipolar disorder to service. Indeed, the May 2006 VA examiner did not relate the Veteran's bipolar disorder to service, even though he attributed her PTSD to the alleged in-service assault. While she told the examiner she had been diagnosed with bipolar disorder by a private physician in 1998 while she was in the Army, she has neither submitted records of such treatment and diagnosis nor identified where VA might seek to obtain such records. Moreover, continuity of the disorder has not been established by the evidence. The Board acknowledges that the Veteran is competent to give evidence about what she experienced; for example, she is competent to discuss her current mood swings and other experienced symptoms. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). Moreover, the Federal Circuit Court has held that in certain situations, lay evidence can even be sufficient with respect to establishing medical matters such as a diagnosis. Specifically, in Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), the Federal Circuit commented that competence to establish a diagnosis of a condition can exist when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See also Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that a layperson may comment on lay- observable symptoms). Similarly, the Court of Appeals for Veterans Claims has held that, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Furthermore, lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, the resolution of issues which involve medical knowledge, such as the diagnosis of a disability and the determination of medical etiology, requires professional evidence. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). In the present case, the Veteran's mood swings, sleep disturbances, and other symptoms are found to be capable of lay observation, and thus her statements constitute competent evidence. The Board must now consider the credibility of such evidence. The STRs show no evidence of any mental disorder during her active service in the Army. Following service, there was no documentation of bipolar disorder until May 2001, more than a year after separation. While she is clearly sincere in her beliefs, in light of these factors, the Veteran's current statements to the effect that she has experienced continuous symptomatology since active service, while competent, are not deemed to be credible. Therefore, the absence of documented complaints or treatment for over a year following her military discharge is more probative than her current recollection as to symptoms experienced in the distant past. See Curry v. Brown, 7 Vet. App. 59 (1994). Moreover, there are no competent opinions relating the bipolar disorder to military service. Accordingly, continuity of symptomatology is not established by either the competent evidence or the Veteran's own statements. In conclusion, the evidence of record is against a grant of service connection for bipolar disorder. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ORDER Service connection for PTSD is denied. Service connection for bipolar disorder is denied. ___________________________ ANDREW J. MULLEN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs