Citation Nr: 1105331 Decision Date: 02/09/11 Archive Date: 02/18/11 DOCKET NO. 08-08 452 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York 1. Whether new and material evidence has been received to reopen a previously denied claim for service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD. REPRESENTATION Appellant represented by: Vietnam Veterans of America WITNESSES AT HEARING ON APPEAL The appellant and her brother ATTORNEY FOR THE BOARD J. Murray, Associate Counsel INTRODUCTION The Veteran served on active duty in the United States Navy from October 1982 to October 1986 and from August 1990 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office in Buffalo, New York (RO). In that rating decision, the RO reopened the previously denied claim because new and material evidence had been received, but continued and confirmed the denial of the benefits sought. While the April 2007 RO decision addressed the service connection matter on a de novo basis, for purposes of establishing jurisdiction, the Board is required to make a decision in the first instance as to whether new and material evidence was received warranting the reopening of this matter. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir 1996). The Board has re- characterized the issue accordingly to reflect the procedural status of the previously denied claim. In the Court of Appeals for Veterans Claims (Court) decision, Clemons v. Shinseki, 23 Vet. App. 1 (2009), VA was instructed that it should consider alternative current conditions within the scope of the filed claim. Id. The Board has preliminarily reviewed the case at hand and finds that Clemons is applicable here. As such, other psychiatric diagnoses, as identified above, will be considered as part of the Veteran's claim. FINDINGS OF FACT 1. In an August 2004 rating decision, the RO denied a claim of service connection for PTSD. The Veteran was notified of the decision later that month, but she did not appeal. 2. Additional evidence that has been received since the August 2004 decision relates to an unestablished fact necessary to substantiate the Veteran's claim of service connection for PTSD, and raises a reasonable possibility of substantiating that claim. 3. The Veteran's service treatment records do not show any complaints, problems, or treatment for any acquired psychiatric disorder during service or at separation. 4. The first evidence of any acquired psychiatric disorder is not shown until seven years after service. 5. The preponderance of the medical evidence shows that any acquired psychiatric disorder to include PTSD is not related to service. 6. The record does not contain objective corroborating evidence to verify the actual occurrence of the Veteran's alleged in- service stressor. CONCLUSIONS OF LAW 1. The August 2004 rating decision that denied the claim of service connection for PTSD became a final decision. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2010). 2. New and material evidence sufficient to reopen the claim for service connection an acquired psychiatric disorder to include PTSD has been received since the last final decision in August 2004. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2010). 3. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS New and Material Evidence to Reopen the Claim VCAA As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). Here, in view of the Boards favorable decision to reopen the previously denied claim for service connection for PTSD, any further discussion as to any lapses in duties to assist and notify regarding the reopening of claim would serve no useful purpose. Law and Regulations - New and material A previously denied claim may be reopened, and its former disposition reviewed if new and material evidence is presented or secured with respect to a claim that has been disallowed. 38 U.S.C.A. § 5108. The Board has a jurisdictional responsibility to consider whether it is proper for a claim to be reopened prior to addressing the merits of the previously denied claim. See Barnett v. Brown, 83 F. 3d 1380 (Fed. Cir. 1996). In order to reopen the Veteran's claim, the Board must first determine whether the Veteran has submitted new and material evidence. 38 C.F.R. § 3.156. Under current VA law, "new" evidence means existing evidence not previously submitted to agency decision makers. 38 C.F.R. § 3.156. "Material" evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. Id. In order to establish whether new and material evidence has been submitted, the credibility of the evidence, although not its weight is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Factual Background and Analysis Evidence of record at the time of the August 2004 rating decision consisted of the Veteran's service treatment records, her service personnel records, and VA treatment records. The service treatment record did not show any complaints, treatment or diagnosis for chronic psychiatric disorders, and her service personnel records did not reveal any reports of abuse. The post- service VA treatment records showed that the Veteran had a current diagnosis of PTSD related to sexual trauma during her period of service. See June 2004 VA treatment record. The Veteran did not submit any other evidence, including statements, to corroborate any alleged in-service stressor event. The RO denied the claim on the basis that the record did not contain evidence of a verified in-service stressor event. Since the August 2004 rating decision, VA has received the following additional evidence: VA and private treatments records; Social Security Administration (SSA) disability benefits records; a June 2008 and a November 2008 medical statements from VA providers; statements from the Veteran in which she provides details about her alleged in-service stressor events; and statements from family members and friends attesting to the Veteran's emotional changes. The Board finds that the additional evidence received since the RO's August 2004 relates to the unestablished fact of whether the Veteran has a current diagnosis of PTSD related to a verified in- service stressor event that is necessary to substantiate the claim. In particular, the Veteran's statements in which she describes her alleged in-service stressor events provide additional evidence that may assist in substantiating her claim. The Board also finds that the additional evidence is neither cumulative nor redundant, and that it raises a reasonable possibility of substantiating the claim. Thus, new and material evidence has been received pursuant to 38 C.F.R. § 3.156(a), and thereby meets the requirements to reopen. On that basis, the claim for service connection for PTSD is reopened and the VA must consider the appeal on the merits of the underlying claim for service connection. 38 C.F.R. § 3.156. Service Connection for an Acquired Psychiatric Disorder to include PTSD VCAA In regard to the service connection claim, VA is required to notify the claimant of the information and evidence not of record that is necessary to substantiate the claim. VA will inform the Veteran of the type of information and evidence that VA will seek to provide, and of the type of information and evidence, the claimant is expected to provide. 38 C.F.R. § 3.159(b). VA must provide such notice to the claimant prior to an initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (AOJ), even if the adjudication occurred prior to the enactment of the VCAA. See Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004). These VCAA notice requirements apply to all elements of a claim for service connection, so VA must specifically provide notice that a disability rating and an effective date will be assigned if service connection is awarded. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The United States Court of Appeals for Veterans Claims (Court) held that in cases of alleged sexual assault the RO must first inform the claimant that she may submit alternative forms of evidence, that is, evidence other than service records, to corroborate his account of an in- service assault, and suggest potential sources for such evidence. Then, VA must assist her in the submission of alternative sources of evidence, by providing additional time for her to submit such evidence after receipt of the personal-assault letter and, where appropriate, by obtaining evidence on his behalf. See Gallegos v. Peake, 22 Vet. App. 329 (2008). Here, prior to the April 2007 RO decision in the matter, the Veteran was informed in a December 2006 of the notice elements concerning her PTSD claim. The letter informed the Veteran of what evidence is required to substantiate the claims, and apprised the Veteran as to her and VA's respective duties for obtaining evidence. VA informed the Veteran how it determines the disability rating and the effective date for the award of benefits if service connection is to be awarded. Dingess v. Nicholson, 19 Vet. App. 473 (2006). Additionally, in the December 2006 notice letter, VA notified the Veteran of additional evidentiary sources other than service records that she could submit or ask VA to obtain, in order to corroborate her statements regarding her alleged inservice personal assault. In light of the above, the Board finds that all notices required by VCAA and implementing regulations were furnished to the Veteran and that no useful purpose would be served by delaying appellate review to send out additional VCAA notice letters. In addition to its duty to notify, or inform, the Veteran with regard to her claim, VA also has a duty to assist the Veteran in the development of the claim. This duty includes assisting the Veteran in the procurement of service treatment records and records of pertinent medical treatment since service, and providing the Veteran a medical examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. In this case, VA has made reasonable efforts to obtain any available pertinent records as well as all relevant records adequately identified by the Veteran. As the claim was based, in part, on a personal assault, the Veteran was also provided a PTSD questionnaire asking for information or evidence other than service records or evidence of behavior changes that may constitute credible supporting evidence of an in-service stressor. While VA has not afforded the Veteran a comprehensive medical examination relating to her claim of service connection for psychiatric disorder, to include PTSD, the Board finds that such an examination is not necessary to render a decision under the circumstances of this case. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C.A. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i). The evidence of record does not show a verified inservice stressor or any evidence of inservice psychiatric complaints, treatment or diagnosis. The Board finds that any medical opinion linking a currently diagnosed psychiatric disorder, to include PTSD, to service would be speculative at best. Since providing the Veteran with an examination would not provide any reasonable possibility in assisting to substantiate the Veteran's claim, VA has no further duty to assist in this regard. 38 U.S.C.A. § 5103A(a)(2). The Veteran has not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. See Bernard v. Brown, 4 Vet. App. 384 (1993). For the foregoing reasons, the Board therefore finds that VA has satisfied its duty to notify and its duty to assist pursuant to the VCAA. See 38 U.S.C.A. §§ 5102 and 5103; 38 C.F.R. §§ 3.159(b), 20.1102; Pelegrini, supra; Quartuccio v. Principi, 16 Vet. App. 183 (2002). Law and Regulations - Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303(a). For the showing of 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. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. See 38 C.F.R. § 3.303(b). The chronicity provision of 38 U.S.C.A. § 3.303(b) is applicable where the evidence, regardless of its date, shows that the Veteran had a chronic condition in service or during an applicable presumption period and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. Savage v. Gober, 10 Vet. App. 488, 498 (1997). In addition, certain chronic diseases, including psychosis, may be presumed to have incurred during service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309; see also 67 Fed. Reg. 67792-67793 (Nov. 7, 2002). Service connection may also be granted 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). To prevail on the issue of service connection for PTSD requires: (1) medical evidence establishing a diagnosis of the condition; (2) credible supporting evidence that the claimed in-service stressors actually occurred; and (3) a link, established by medical evidence, between the current symptomatology and the claimed in-service stressors. 38 C.F.R. § 3.304(f). The evidence necessary to establish the occurrence of a recognizable stressor during service to support a diagnosis of PTSD will vary depending upon whether a veteran engaged in "combat with the enemy". See Gaines v. West, 11 Vet. App. 353, 359 (1998). If VA determines that a veteran engaged in combat with the enemy and the alleged stressor is combat-related, then her lay testimony or statement is accepted as conclusive evidence of the stressor's occurrence and no further development or corroborative evidence is required, provided that such testimony is found to be credible and "consistent with circumstances, conditions or hardships of service." See 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f)(1); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). If the Veteran did not engage in combat with the enemy, or if the claimed stressors are not related to combat, then the veteran's testimony alone is not sufficient to establish the occurrence of the claimed stressors, and that testimony must be corroborated by credible supporting evidence. Cohen v. Brown, 10 Vet. App. 128 (1997). Service department records must support, and not contradict, the veteran's testimony regarding non-combat stressors. Doran v. Brown, 6 Vet. App. 283 (1994). If the Veteran was not engaged in combat, corroborative evidence of her claimed in-service stressors must be introduced. Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. See Moreau v. Brown, 9 Vet. App. 389, 395 (1996); Cohen v. Brown, 10 Vet. App. 128, 142 (1997). Thus, one element necessary to establish entitlement to service connection for PTSD in this case, is determining whether there is competent evidence of record corroborating the Veteran's allegation that she was sexually assaulted in service,. In Patton v. West, 12 Vet. App. 272, 278 (1999), the Court specified that there are special evidentiary procedures for PTSD claims based on personal assault. VA ADJUDICATION MANUAL M21-1MR, Part IV, subpart ii.1.D.17. Since personal trauma is an extremely personal and sensitive issue, many incidents of personal trauma are not officially reported, and the victims of this type of in-service trauma may find it difficult to produce evidence to support the occurrence of the stressor. It is often necessary to seek alternative evidence. Id. Further, with respect to a claim of entitlement to service connection for PTSD based on an alleged personal assault, 38 C.F.R. § 3.304(f) (4) provides that: If a posttraumatic stress disorder claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. VA will not deny a post- traumatic stress disorder claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f) (4). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C.A. § 7104(a) (West 2002); Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). If there is at least an approximate balance of positive and negative evidence regarding any issue material to the claim, the claimant shall be given the benefit of the doubt in resolving each such issue. 38 U.S.C.A. § 5107 (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); 38 C.F.R. §§ 3.102. On the other hand, if the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule is not applicable. Ortiz, 274 F.3d at 1365. Factual Background and Analysis The Veteran claims that she has PTSD related to several traumatic incidents during her period of service. She first alleges that her PTSD resulted from multiple episodes of in-service personal assault by husband, who was also in the Navy. She maintains that while in service she was sexually assaulted and beaten by her husband. The Veteran also alleges that she was sexual assaulted by another serviceman on one occasion. She asserts that while she was walking to the softball field one day, she was grabbed by another serviceman, who held her close and made sexual gestures with his body against her. Lastly, the Veteran has alleged the following two non-combat, and non-personal, traumas associated with her duties as a nurse: observing the deaths of servicemen, and experiencing anguish associated with being stuck with a used needle. The Veteran maintains that as a result of these episodes of trauma she developed PTSD. A review of the service treatment records (STRs) does not show any treatment or diagnosis for any chronic psychiatric disorder or any reports of injuries from a personal assault during service. The record shows that the Veteran was pregnant two times during her first period of service, in 1984 and in 1986. An August 1985 service treatment records notes that the Veteran reported that she and her husband were trying to have another child. There was no indication in the service treatment records that either of her pregnancies resulted from a sexual assault. In fact, STRs include no evidence of trauma that could not be verified or explained as due to an event other than sexual trauma. For example, the Veteran stuck herself on a contaminated needle in January 1984, for which she received immediate treatment. In June 1985, she was involved in a motor vehicle accident, and was transported to the emergency room via shore patrol. The service treatment records only show one period where the Veteran sought treatment for psychology-related symptomatology. Two August 1986 service treatment records show that the Veteran twice sought treatment for complaints of insomnia. In the second August 1986 service treatment record it was noted that the Veteran wanted to request a reduced work schedule because she was "becoming less able to tolerate it emotionally." There was no chronic diagnosed psychiatric disorder observed, and none of the subsequent service treatment records shows any complaints or treatment for psychiatric symptoms. The Veteran was discharged two months later, when her term of service had been completed. It is noted that all five reports of physical examination during service, including the reports prior to her separation in June 1986 and June 1991, show that that the Veteran received a normal psychiatric evaluation, and on none of the five associated reports of medical did the Veteran mark any symptoms indicative of a psychiatric disorder. A review of the Veteran's service personnel records do not document the occurrence of a sexual assault, or suggest any behavior changes during service that support evidence of a stressor event as described above. The record shows that when Veteran sought voluntary transfers to other military duty assignments, it was so she could be stationed at the same location as her husband. None of the personnel records reflects deterioration in work performance. Instead, the service personnel records show that the Veteran was promoted during both periods of her service because of her outstanding performance of military duties. Her military occupational specialty was hospital corpsman (HM). Her ratings were consistently high, and mostly 4.0, the highest rating possible. In January 1985, she was promoted to a HM3, and in May 1991, she was promoted to a HM2. The earliest record showing that the Veteran sought any treatment for psychiatric problems is dated in September1998, as part of a worker's compensation claim. A September 1998 private psychological consultation report from Dr. G. L. W. shows the Veteran was diagnosed with major depressive disorder. Her psychological stressors were listed as the inability to work due to a traumatic injury to her left hand and chronic pain. The report showed that the Veteran reported that she had been experiencing symptoms of depression for the prior four years after a traumatic injury where her left hand was caught in machinery at work. The accident resulted in the loss of tactile sensation and of fine motor dexterity in the hand, and the injury prevented the Veteran from working. Private treatment records dated in 2001 show that the Veteran was hospitalized four times that year due to her depressive symptoms and some suicidal ideations. The hospital summary reports and other treatment records show she has been diagnosed with various psychiatric disorders, include depression, anxiety, and PTSD. Her diagnosed psychiatric disorders were associated with her inability to work due to left hand injury and with increased financial and familial stressors. A January 2001 private hospital summary report shows that the Veteran reported that she had become increasingly depressed, and feeling irritable and hopeless, with insomnia, because she was having marital problems and familial problems. The Veteran reported that her husband was having an affair, and she felt "betrayed". The Veteran also reported an increase in her depression symptoms coincide with the start of her taking prescription pain killers for chronic pain. She gave a history of sexually and physically abuse from her stepfather and her mother's inability to deal with it and prevent the abuse from happening. She felt "betrayed" by her step-father. She reported being "betrayed" by a man at work who was suppose to help her, and this eventually led to her occupational injury. The Veteran did not report any incident of sexual or physical assault or other traumas during her period of service. The Veteran was diagnosed with depression, and it was felt that her symptoms were related to her inability to work due to her left hand injury, chronic pain, and in part, due to recent consumption of prescription pain killers. A January 2001 private psychiatric evaluation by Dr. D. T. I. shows that he diagnosed the Veteran with depression and PTSD. Dr. I. reported that the Veteran had been experiencing symptoms of chronic recurring depression with a severe episode related to use of pain killers, familial stress and chronic pain. Dr. I. found that the Veteran met the criteria for PTSD, and that both her PTSD and depression were related to her childhood history of abuse and betrayal. It was felt that her chronic pain and disability secondary to left hand injury exacerbated her diagnosed disorders. She did not report a history of inservice sexual assault or other traumas. She was described by the physician as showing excellent grooming and hygiene. A March 2001 private psychiatric evaluation, made in conjunction with the Veteran's application for state disability benefits, contains similar findings to those recorded in the January 2001 reports. The Veteran again associated the increase symptoms of depression with the start of her taking prescription pain killers, and she reported a childhood history of sexual and physical abuse from childhood. She did not report a history of inservice sexual assault or other traumas. A May 2001 hospital summary report shows that the Veteran was diagnosed with depression and PTSD. It was noted that the Veteran reported she continued to have marital problems with her husband, and that her husband's girlfriend had been forthright in her wanting the Veteran's husband. The Veteran further reported that she had been "secretive with her physicians about her problems" and she had not wanted to "complain" about having stress flashbacks to her pervious injury. The Veteran did not report that she was experiencing symptoms that were related to any incident during her period of service. An August 2001 private treatment record from Dr. I. shows that the Veteran was hospitalized on a police hold after she threatened to kill herself with a gun. When her husband took the gun from her, she made suicidal gestures with a knife. Ongoing clinical noted from Dr. I., dated through October 2001 include notations that the Veteran's husband phoned the physician in September 2001 expressing concern that the Veteran might be suicidal after her support system (her brother) left the area to return to his home. An October 2001 hospital summary report shows that the Veteran was hospitalized for depression related to her left hand injury, and her recent stressors included separation from her husband, stress associated with co-parenting of her daughters, and financial stressors. It was noted that a restraining order against the Veteran by her husband had been recently lifted. The Veteran reported a history of mutual domestic violence between herself and her husband (slapping each other) in August 2001. The Veteran's childhood history of sexual and physical assault was again recorded. She did not report a history of inservice sexual assault or other traumas. The report of a December 2001 SSA psychiatric evaluation shows that the Veteran's depression was related to her disability associated with her left hand injury and her belief that she "has not been a good enough wife." An April 2002 psychological evaluation of the Veteran, her estranged husband, and their three children is of record. The evaluation, performed for the purpose of divorce proceedings included acknowledgements of domestic violence, and a somewhat dysfunctional family. However, no mention of sexual trauma/domestic violence during service was reported by any of the interviewees. Subsequent VA treatment records continue to show that the Veteran sought treatment for psychiatric disorders, to include depression and PTSD. In these treatment records, it is first recorded that the Veteran's PTSD was related to an in-service sexual trauma, to include domestic violence in her marriage. In a June 2004 VA treatment record, it was noted that the Veteran "continues to suffer chronic PTSD symptoms secondary to significant sexual trauma while in the United States Navy." The basis for that statement was not provided. Additional VA outpatient treatment records show treatment for PTSD. The records note the childhood sexual abuse by her step-father, as well as the physical and emotional abuse from other family members (April 2007) Letters dated July 2004, May 2005, August 2005, and November 2008 from the Veteran's treating VA psychiatrist, which appear to be the same letter, but have different date stamps, show that the Veteran's PTSD was related to "sexual trauma she sustained while on active duty." A June 2008 letter from the Veteran's VA license clinical social worker was to the effect that the Veteran's PTSD was related to events of sexual trauma that she experienced during her period of service, as described by the Veteran. In June 2008, the Veteran and her brother appeared and provided testimony before a VA decision review officer at the RO. The Veteran testified that during service, while married to her husband, he "gave" her to other servicemen to engage in sexual relations while he watched. She described other incidents of sexual trauma at the hands of her husband as well as her attempted suicides. The Veteran's brother testified that prior to service, the Veteran was not the person that she was after service. The record also contains statements from the Veteran's family members that were submitted in support of the Veteran's claim dated in 2008. These statements essentially contain observations regarding the deterioration of the Veteran's behavior and her husband's abusive behavior towards the Veteran since her separation from her second period of service. Each family member noted that after the Veteran was observed to become depressed and withdrawn since her last period of service. The record shows that the Veteran has been diagnosed with a variety of psychiatric disorders other than PTSD. These diagnoses include major depressive disorder, anxiety disorder, and dysthymia. See VA and private treatment records. While the Veteran has current diagnoses of psychiatric conditions, the preponderance of the medical evidence is against a finding that any psychiatric diagnosis (other than PTSD) is related to service. First and foremost, the service treatment records contain no evidence of psychiatric problems, complaints, or treatment during service. On her examination prior to separation from both periods of her service, the Veteran was evaluated as psychiatrically normal. While the service treatment records do document that the Veteran complained of insomnia and emotional stress in August 1986, a psychiatric problem was not shown in service, at separation, or for many years after separation. Second, seven years passed between the date of separation from service and the date the Veteran's psychiatric problems were first documented. The first medical evidence a psychiatric disorder is not shown until 1998, and at that time, her psychiatric symptoms were associated with her disability associated with her left hand injury. The Veteran's psychiatric problems were not associated with her periods of service until 2004, thirteen years after her separation from service. The evidentiary gap between the Veteran's active service and the earliest medical evidence of psychiatric disorders related to her service weighs heavily against the Veteran's claims on a direct basis. A lengthy period without treatment is evidence against a finding of continuity of symptomatology, and it weighs heavily against the claims. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd 230 F.3d 1330 (Fed. Cir. 2000) (service incurrence may be rebutted by the absence of medical treatment of the claimed condition for many years after service). It is noted that the record does show the Veteran reported that she was experiencing symptoms of depression since service. She is competent to comment on her symptoms, but she does not have the medical training to give an etiology for these symptoms. See Clemons v. Shinseki, 23 Vet. App. 1 (2009)(holding that a claimant generally is not competent to diagnose his mental condition; he is only competent to identify and explain the symptoms that he observes and experiences). The Veteran's statements are dated more than a decade after her discharge from service. There is no evidence that is contemporary with service, or comes shortly after service, which shows the occurrence of depression or any other psychiatric symptoms. Thus, although the Veteran's report of having a history of depression since service may be competent evidence, the persuasive value of this history is greatly reduced by the fact that there is no other indication of depression in service for over 10 years prior to the her recent statement that she has experienced symptoms since service. In addition to the lack of any finding of psychiatric problems during service, and the lack of any objective medical evidence of psychiatric problems for many years after service, the record also lacks medical evidence establishing a relationship between any currently diagnosed psychiatric disorder (besides the PTSD) and some documented aspect of the Veteran's period of active service. Conversely, several of the private treatment records and the SSA disability benefits record link the Veteran's diagnosed psychiatric disorders (other than PTSD) to non-service related problems, such as disability associated with left hand injury, marital problems, parental issues, financial stress, and unemployment. In short, there is no evidence of any psychiatric disorder in service, or until seven years after the Veteran's service. The preponderance of the evidence does not support a finding that any psychiatric disorder other than PTSD, is related to service. The claim for service connection is not warranted. PTSD Regarding the Veteran's main contention on appeal, entitlement to service connection for PTSD, to include due to personal assault, the Veteran has alleged four inservice stressor events: (1) sexual and physical assault by her husband; (2) sexual assault by another serviceman; (2) watching serviceman die in the hospital; and (4) being stuck with a used needle. To review, an award of service connection for PTSD requires: (1) medical evidence establishing a diagnosis of the condition; (2) credible supporting evidence that the claimed inservice stressors actually occurred; and (3) a link, established by medical evidence, between the current symptomatology and the claimed inservice stressors. 38 C.F.R. § 3.304(f). Here, the Veteran has a diagnosis of PTSD. Initially, the Board observes that the service records verify the occurrence of the Veteran's alleged inservice stressors pertaining to her duties as a nurse. Records show that the Veteran was assigned to work in a naval hospital as a HM, and a January 1984 service treatment records confirm that she was stuck with a used needle and received prompt treatment. There was no indication in the January 1984 medical report, or subsequent service treatment records, that the Veteran experienced any emotional anguish associated with the accidental needle stick. It is pertinent to note that there is no medical evidence that relates the Veteran's current diagnosis of PTSD with her alleged stressors involving her work as a HM. While there is evidence that corroborates the Veteran alleged inservice stressor regarding her work as a HM, there is, in fact, no competent medical evidence that shows a current diagnosis of PTSD related to that stressor. Rather, the medical evidence of record shows that the Veteran's diagnosis of PTSD has been related to other stressors. The Board now turns back to the Veteran's assertion of PTSD related to inservice personal assault. To review, service treatment records and the report of examination prior to separation show no complaints, treatment or diagnoses of a chronic psychiatric problem. Neither the service personnel records nor the service treatment records from service document any in-service personal assault. Records show that the Veteran was married and had children during her period of service. A review of the claims folder shows that the Veteran was first diagnosed with PTSD in January 2001 by Dr. T. At that time, the Veteran's diagnosis was related to her childhood history of sexual and physical/emotional abuse. Her diagnosis of PTSD was not related to her period of service until 2004. Subsequent VA treatment records continue to show a diagnosis of PTSD linked to the alleged inservice sexual assault and physical abuse as well as the Veteran's childhood history of sexual and physical abuse. The Board essentially notes that the PTSD diagnosis have been based solely on statements from the Veteran, and that it not supported by evidence of a confirmed in-service stressor. The Court has held that a bare transcription in a medical record of the Veteran's self-reported history, unenhanced by medical analysis, does not constitute competent medical evidence. LeShore v. Brown, 8 Vet. App. 405 (1995). It is noted that since the Veteran's claimed stressor is not related to combat, her lay testimony alone is not enough to establish the occurrence of the alleged stressor. See Moreau, 9 Vet. App. at 395. A medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed inservice stressors. Id.; Cohen, 10 Vet. App. at 142. Moreover, the record shows that the Veteran has provided inconsistent statements regarding the source of her stressors. When the Veteran first sought psychiatric treatment in the late 1990s to early 2000s, her diagnosis of PTSD was based on her reports of sexual and physical trauma from her childhood. The Board finds it pertinent that the Veteran never reported any incidents of inservice assault until after she originally filed a claim for entitlement to service connection in June 2004. In light of the inconsistent accounts of the history of sexual and physical, the Board, however, is unable to afford the Veteran's statements any probative value, and in this regard, her statements cannot be used to support a diagnosis of PTSD based on inservice personal trauma. Therefore, the crux of the issue before the Board is whether there is competent evidence of record corroborating the Veteran's allegation that she was personally assaulted in service. A corroborated inservice stressor event is an element which is necessary to establish entitlement to service connection for PTSD in this case. Here, the evidence of record does not corroborate the Veteran's account of her claimed inservice stressor. There is no documentation in the service records to indicate that the Veteran reported that she had been personally assaulted, or that she instigated proceedings against her alleged attacker. Moreover, the Veteran's service treatment records contain no evidence that the Veteran sought treatment for the alleged sexual or physical assault itself. There are also no private medical records identified by the Veteran, contemporaneous to her period of service that would provide corroboration of inservice personal assault. The Board has considered evidence from other sources. As noted above, records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases may also be used to corroborate stressors. The Veteran has stated that she did not report personal assault to military or civilian authorities. It is noted that a positive pregnancy test was reflected in the service treatment records; however, there is no notation that the pregnancy was a result of sexual assault. Rather, the only evidence from that same time period leans against a finding that Veteran was trying to become pregnant by her husband. This evidence does not support the assertion that she was sexually assaulted by the one who fathered the child (her husband). The record does contain statements from the Veteran's family members, which essentially reflect the Veteran's reports of physical abuse by her husband. The family members also gave statements indicating that the Veteran's behavior changed since she returned from second period of service. These individuals are certainly competent to report their observations. See Savage v. Gober, 10 Vet. App. 488, 496 (1997) (lay persons are competent to provide evidence of observable events). Regardless, none of these individuals has claimed to witness any personal assault that took place in service, and these statements were submitted seventeen years following the Veteran's separation from her second period of active duty. These recitations of the personal assault subjected on the Veteran are not as probative as the contemporaneous service treatment and personnel records that do not reflect that the Veteran was assaulted while on active duty, and they only account for physical abuse by her husband that occurred after the Veteran's separation from service. Another avenue by which the Veteran may corroborate her claimed inservice personal assault stressor is through the submission of evidence showing behavioral changes that may constitute credible evidence of the claimed stressor. Although the list of examples noted in 38 C.F.R. § 3.304(f) (4) is not exhaustive, the record does not show a decline, or radical change, in the Veteran's behavior at the time of the alleged assault and throughout her service. Rather, the record shows that the Veteran had outstanding military service throughout her periods of service, and that she was promoted twice. The record does show that the Veteran voluntarily transferred her assignment twice, and on both occasion, it was specifically noted that she requested to be transferred to the location where her husband was stationed. While the August 1986 service treatment record shows that the Veteran sought to reduce her work hours because she felt that she suffered from increased emotional stress at that time, there was no indication in the record of what was the cause of her stress, and it does not show that any work schedule changes resulted from her request. The record does show that the Veteran was discharged two months later, because her term of service had been completed. It is pertinent to noted that at the time of her discharge in 1986, the Veteran was recommended for re-enlistment because of her outstanding military performance. Additionally, the statements contained in the post-service medical treatment records do not corroborate the Veteran's assertion of her claimed inservice stressor. The fact that the Veteran's statements concerning the etiology of her PTSD were transcribed by health care providers as part of the history section of the medical reports does not turn such statements into competent medical evidence. As the Court has noted, "[e]vidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by that examiner, does not constitute 'competent medical evidence.'" Leshore v. Brown, 8 Vet. App. 406, 410 (1995). As noted previously, the Veteran's report and the diagnosis of PTSD does not verify the occurrence of a claimed in-service stressor. While the Veteran's account of this history was noted in other subsequent VA treatment records, there is no additional medical comment from the medical personnel who created these records and these records do not serve to support or verify the Veteran's contentions. In short, the Veteran's claimed stressor of an in-service personal assault is not verified by any of the records on file. The Board notes that the diagnoses of PTSD related to an inservice personal assault, are provided by VA medical providers who did not have access to the Veteran's claims folder prior to writing their reports. Even if they did have an opportunity to review the record, it is clear that the record does not contain evidence to verify that a personal assault occurred. Medical providers diagnosing PTSD due to inservice personal assault could only do so by relying on the Veteran's uncorroborated report of an in-service personal assault. Since the diagnoses of PTSD and all opinions supporting a relationship to service are not based on a confirmed inservice stressor, they are of little probative value. Swan v. Brown, 5 Vet. App. 229, 233 (1993). In effect, they are mere speculation. See Black v. Brown, 5 Vet. App. 177, 180 (1993). It is noted that an award for service connection cannot be based upon mere speculation. See 38 C.F.R. § 3.102. Moreover, the Veteran's reported history of personal assault has been inconsistent, and none of the subsequent VA medical providers have considered the Veteran's early reports of childhood sexual and physical abuse when determining the etiology of the Veteran's PTSD. Finally, the Board notes that a number of medical records show a diagnosis of PTSD related to stressor events that have nothing to do with her period of service. These post-service stressors include the following: inability to work because of 1994 left hand injury; marital problems; parenting issues; and financial stress. The fact that all these diagnoses relate PTSD to more recent stressor events, casts into doubt the diagnoses of PTSD with a recent onset due to unverified accounts of personal assault approximately 10 years earlier. In sum, in order to award service connection for PTSD the evidence must show that the diagnosis of PTSD is related to an actual inservice stressor event. 38 C.F.R. §3.304 (f). The Veteran's current diagnosis of PTSD has not been related to a verified inservice stressor event. Although the Veteran has a diagnosis of PTSD, which some of her treating physician relate to her claimed inservice stressor, the evidence of record is insufficient to confirm that the claimed stressor, on which the PTSD diagnosis is based, did occur. Without adequate evidence to corroborate the claimed noncombat stressor, service connection for PTSD is not warranted. For the reasons discussed above, the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER As new and material evidence sufficient to reopen a claim for service connection for psychiatric disorder, including PTSD, has been received, the Veteran's previously-denied claim is reopened. Entitlement to service connection for psychiatric disorder, to include PTSD, is denied. ____________________________________________ RENÉE M. PELLETIER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs