Citation Nr: 1237604 Decision Date: 11/02/12 Archive Date: 11/09/12 DOCKET NO. 10-14 386 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUES 1. Whether new and material evidence has been received to reopen a claim for residuals of a right ankle injury. 2. Entitlement to service connection for an acquired psychiatric disorder, including post-traumatic stress disorder (PTSD). 3. Entitlement to service connection for a low back disorder. 4. Entitlement to service connection for a right foot disorder. REPRESENTATION Appellant represented by: Wisconsin Department of Veterans Affairs ATTORNEY FOR THE BOARD J Fussell INTRODUCTION The Veteran had active service May 1977 to March 1978. He was discharged under honorable conditions. This matter comes before the Board of Veterans' Appeals (Board) from a March 2009 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. A review of the Virtual VA paperless claims processing system does not reveal any additional documents pertinent to the present appeal other than VA treatment records, the relevant portions of which are reported herein. FINDINGS OF FACT 1. In June 1993 the RO denied service connection for a right ankle disorder. Although notified of the denial, the Veteran did not appeal this action and it became final. 2. Additional evidence received since the unappealed rating action of June 1993, taken together with evidence previously on file, does not relate to an unestablished fact necessary to substantiate the claim for service connection for a right ankle disorder. 3. An acquired psychiatric disorder, including schizophrenia, is first shown decades after military service and is unrelated to the Veteran's military service. 4. PTSD was not diagnosed during the Veteran's military service, he did not engage in combat with the enemy, he was not a POW and did not sustain a personal assault during service, and he had no fear of hostile military or terrorist activity, and the current existence of PTSD related to military service is not shown. 5. The Veteran sustained an acute low back injury during service but a chronic low back, including arthritis, is first shown decades after military service and after postservice low back injuries, and is unrelated to the Veteran's military service. 6. A chronic right foot, including arthritis, is first shown decades after military service and postservice injuries, and is unrelated to the Veteran's military service. CONCLUSIONS OF LAW 1. The unappealed rating action of June 1993 which denied service connection for a right ankle disorder is final. 38 U.S.C.A. § 7105(c) (West 2002); 38 C.F.R. §§ 3.104(a), 20.302(a) (2012). 2. The additional evidence, when considered with the old evidence, is not sufficient to reopen the claim for service connection for a right ankle disorder. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (2012). 3. An acquired psychiatric disorder, to include PTSD, was not incurred in or aggravated during active service; and a psychotic disorder may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1110 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 4. A low back disorder was not incurred in or aggravated by active service and arthritis may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1112, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 5. A right foot disorder was not incurred in or aggravated by active service, and arthritis may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1112, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Review of the record reveals compliance with the Veterans Claims Assistance Act of 2000 (VCAA) which imposes certain duties to notify and provide assistance in substantiating claims. 38 U.S.C.A. § 5100, et seq (effective November 9, 2000); see also 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). This notice was intended to be provided prior to an initial adjudication of a claim. Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004) (Pelegrini II). By letter dated in October 2008, prior to the initial adjudication of the claim, the RO advised the Veteran of the evidence needed for claim substantiation and explained what evidence VA would obtain or assist in obtaining and what information or evidence the claimant was responsible for providing. 38 U.S.C.A. § 5103(a). See Quartuccio v. Principi, 16 Vet. App. 183 (2002). That October 2008 letter also apprised the Veteran of the specific reasons the claim was previously denied, in addition to the requirements for establishing his underlying entitlement to service connection. See Kent v. Nicholson, 20 Vet. App. 1, 10 (2006) (in a new and material evidence claim, when there has been a prior final claim denial, the VCAA notice must include the reason(s) for that denial, and the evidence and information needed to reopen and to establish entitlement to the benefit sought). That letter also apprised the Veteran of the downstream disability rating and effective date elements for claims. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007). Thus, there has been full compliance with the duties to provide notice of what was needed for claim substantiation. Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004) (Pelegrini II); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Duty to Assist And as for the duty to assist, the RO obtained the Veteran's service treatment records (STRs), VA treatment records, private clinical records, and records from the Social Security Administration (SSA). The Veteran declined to testify in support of the claims. He also had VA examinations in February 2009 as to his claimed psychiatric disorder, in March 2009 as to his claimed low back disorder, and in May 2012 as to his claimed right foot and right ankle disorders. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C.A. § 5103A(d); and 38 C.F.R. § 3.159(c)(4). Therefore, as there is no indication or allegation that other relevant evidence remains outstanding, the Board finds that the duty to assist has been met. 38 U.S.C.A. § 5103A. Background The Veteran's May 1977 examination for service entrance was negative, as was an adjunct medical history questionnaire. In September 1977 the Veteran sprained his right ankle. Later that month he injured his lumbar area picking up a heavy object and on examination he had lumbar tenderness but no spasm. He had full range of motion and straight leg raising was negative. One week later he still complained of low back pain and on examination he had no muscle spasm but had full range of motion and negative straight leg raising. In October 1977 the Veteran sprained his right ankle playing basketball but on examination there was no evidence of bony or tissue disruption, and he had good range of motion. The assessment was a mild sprain. In November 1977 he was given a profile limited his duties for 6 weeks due to another the right ankle sprain in early November 1977. Subsequently, in December 1977 it was noted that his right ankle was casted and his was given another profile extending his limited duty. A December 12, 1977, right ankle X-ray, to rule out a fracture, revealed no apparent fracture. Another right ankle X-ray on December 22, 1977, found no demonstrable evidence of an acute injury of the bony structures of the ankle; and the tibia and talus were in good position and appeared normal. In January 1978 the Veteran complained of swelling of the right foot, which was already casted. On examination he had full range of motion and no instability or swelling. There was tenderness along the peroneal tendon sheath. The impression was mild peroneal tendonitis. The examination for service separation in February 1978 was negative and it was specifically noted that a mental status examination had found no significant mental illness. In an adjunct medical history questionnaire the Veteran reported having had broken bones, recurrent back pain, frequent trouble sleeping, and nervous trouble of some sort. The Veteran was notified by RO letter in May 1978 that his March 1978 claim for service connection for disabilities of the right leg, right ankle, and back was denied for failure to prosecute his claim by virtue of not attending a VA examination scheduled in May 1978. The Veteran underwent VA hospitalization in January 1993 upon requesting admission into a substance abuse treatment program. He had started using cocaine in 1979, originally by snorting it, but he switched to smoking cocaine in 1988 and his use had recently increased. He had also used heroin since 1973, off and on, and had used other drugs such as Valium, marijuana and other street drugs years ago. He had never had past psychiatric treatment or treatment for drug use. The pertinent discharge diagnosis was drug dependence, cocaine. VA outpatient treatment (VAOPT) records show that the Veteran was seen for a right ankle eversion injury which he sustained in May 1993. The ankle was casted and a fracture was suspected. The evidence received after the June 1993 rating decision, which denied service connection for a right ankle disability, includes private clinical records showing that the Veteran was seen in April 1975 for symptoms of confusion, anxiety, difficulty in relationships, and drug abuse. He was referred to a drug abuse clinic for evaluation prior to further treatment. Also in April 1975 he sustained an injury of his back while playing basketball. X-rays of his lumbosacral spine were normal. In December 1976 he complained of having had pain in both feet for the last few weeks. The assessment was that he had multiple calcium deposits of the plantar surface of both feet. In 1987 he fell down some stairs, spraining his right ankle. X-rays of his right ankle found that the soft tissues appeared normal and the bony structures were intact but there was a prominent os trigonum. No fracture of bony lesion was identified and the joint spaces were intact without evidence of subluxation or dislocation. In June 1992 he was a passenger on a bus that was hit by a vehicle and he complained of neck and back pain. In October 1997 it was reported that he had a history of foot surgery. Records obtained from the SSA include a May 2006 clinical record during the Veteran's incarceration which indicates that he had had a fracture of the right ankle. Right ankle X-rays in May 2006 revealed a non-displaced fracture of the distal fibula and there was also an impression of an old fracture versus an unfused secondary ossification center tip of the medial malleolus. X-rays of the right ankle in June 2006, compared to those of May 2006, noted that a distal fibular fracture remained in an unchanged position and alignment. The fracture fragments appeared in good position and alignment. The ankle mortise appeared intact. The fracture line appeared somewhat less distinct, consistent with mild interval healing. The SSA records also show that in August 2006 the Veteran had a lipoma removed from his back. In July 2007 the Veteran reported that he had been diagnosed with schizophrenia during his military service. A July 2007 Disability Report, in conjunction with his application for reinstatement of benefits in reference to "schizophrenia versus malingering versus personality disorder," reflects that the Veteran reported having had surgery on his feet which were injured when a car ran over him. During the course of taking the Veteran's history and performing a mental status examination it was noted, multiple times, that he was a poor historian and, for this reason, it was felt that he was not malingering. On file are voluminous VAOPT records. In March 2008 it was noted that the Veteran had slipped and sustained a head injury. The assessments were schizophrenia, most likely chronic, paranoid type; and a cognitive disorder, not otherwise specified, from a combination of cognitive decline due to psychotic illness, possible history of learning disability, and history of numerous head injuries; and alcohol and cocaine dependence, in full sustained remission. In October 2008 his complaints included back pain. A November 2008 neuropsychological assessment noted that he reported a lifelong history of problems with recent memory, attention, and concentration. He complained of chronic back pain. After testing, his presentation was consistent with a diagnosis of mild developmental disability from early childhood complicated by chronic mental illness, and polysubstance abuse history with reportedly repeated head injuries. On VA psychiatric examination in February 2009 it was noted that the Veteran had resided at a domiciliary for 1 1/2 years and prior to that he had been incarcerated for 4 years. Prior to service he had sustained work-related second degree burns of his back. During service he had had multiple disciplinary proceedings and had once been absent without leave, leading to his service discharge. Although a medical history questionnaire at service discharge reflected complaints of nervous trouble and trouble sleeping, a psychiatric evaluation at that time had been normal. VA treatment records noted that post-traumatic stress disorder (PTSD) was to be ruled out, on the basis of his having been assaulted after military service. He reported having been badly beaten and had perhaps been in a coma. He continued to have hallucinations and delusions. His past drug use included LSD and amphetamines but he had last used drugs in 1998. After a mental status examination the summary was that he had a chronic history of a schizophrenic disorder, paranoid type, which was not as likely as not related to his military service. He believed that his mental problems began at about the age of 40 and acknowledged use of a variety of drugs, with his preferred drug being heroin. He also had a cognitive disorder, not otherwise specified, which was also less likely as not related to military service but was likely due to multiple factors, including cognitive decline due to psychotic illness, possible history of learning disability, history of numerous head trauma, and a history of polysubstance abuse. Further, he demonstrated a history of an antisocial personality disorder. This personality disorder was not as likely as not directly related to his past military service and more likely than not a lifelong characterological disorder. The final diagnoses were paranoid schizophrenia; cognitive disorder, not otherwise specified; polysubstance dependence and abuse, in sustained remission; and a personality disorder, not otherwise specified with antisocial features. On VA examination of the Veteran's low back in March 2009 his claim file was reviewed. He reported that he was not sure when or how his low back discomfort occurred. He recalled pain in his youth, throughout his military service, and into his adult life. He indicated that his memory was poor because of concussions. He felt that he had arthritis of multiple joints, including his back, but it had not been formally diagnosed. He remembered having once slipped on snow or ice, injuring his back, but could not recall when, or what treatment was required. After a physical examination, X-rays revealed degenerative disc disease (DDD) and degenerative changes in the lower lumbar spine. The diagnosis was degenerative joint disease (DJD) and DDD of the lumbar spine. After reviewing STRs it was noted that the Veteran had had an inservice low back pain complaint but his history and clinical course did not support a continuous complaint from his military service in the late 1970s. Therefore, it was the examiner's opinion that the Veteran's complaint of low back pain and disability was less likely than not related to his military service. Additionally, he had significant mental health condition which was likely impacting his symptom perception and reporting. His degenerative changes in the lumbar spine were age-related and not the result of military service. Contained with the SSA records is an unfavorable November 2009 decision of an Administrative Law Judge as to the Veteran's eligibility for SSA disability benefits. It was stated, at page 6 of that decision, that there were numerous references in the record that the Veteran was not psychotic and that he might exaggerate symptoms or blame others for his behavior. VA treatment records in the CAPRI system reflect that in February 2010 the Veteran endorsed a history of distant low back strains. In June 2010 it was reported that the Veteran had a past history of having had psychotic symptoms since his childhood. In June 2011 he complained of having had right ankle pain for one week. Also in June 2010 it was noted that he was to continue treatment for somatic delusions and anxiety. X-rays of his right ankle in August 2010 revealed a lucent zone in the medial fibular tip which was of uncertain significance. X-rays of the right foot at that time revealed minor degenerative changes of the dorsal navicular margins and the first and second metatarsophalangeal joints. An April 2012 statement from a VA Staff Psychiatrist reflects that the Veteran had paranoid schizophrenia and a cognitive disorder, not otherwise specified. On VA examination in May 2012 of the Veteran's ankle his claim file and personal medical history were reviewed. He reported that he had injured his right ankle during service and that it had then been casted, although there was no fracture. After military service he had injured his ankle multiple times and currently had right ankle pain. It was noted that his schizophrenia caused him to be confused as to his symptoms and his right ankle condition. It was reported that he did not have shin splints, stress fractures, Achilles tendonitis or rupture, malunion of the calcaneus (os calcis) or talus (astragalus) or had a talectomy (astragalectomy). He had not had any ankle surgery. The examiner's opinion was that without any objective findings it was less likely as not that the Veteran had any permanent disability in regard to his right ankle. It was less likely than not that his right ankle symptoms were caused or aggravated by his military service or injury of the right ankle during military service. Also on that examination in May 2012 by the same VA examiner it was reported that the Veteran had a foot condition, specifically that he had DJD. The Veteran's claims file and personal medical history were reviewed. He reported having injured his right foot during service at the same time that he had injured his right ankle. Following military service he had had multiple foot injuries and now had right foot pain. His schizophrenia caused him to be confused as to his symptoms and his right foot condition. On examination he did not have Morton's neuroma, hammer toes, hallux valgus, hallux rigidus, acquired claw foot (pes cavus), malunion or nonunion of tarsal or metatarsal bones, or bilateral weak feet. He had no surgical scars. It was reported that X-rays revealed degenerative changes of the right foot. The examiner opined that the osteoarthritis of the right foot was less likely as not related to military service or was aggravated by his military service or any injury during service. It was reported that at the age of 57 the Veteran's current minor osteoarthritis of the right foot was part of the natural aging process and, so, was less likely as not related to military service or aggravated by military service. Principles of Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1131. A showing of inservice chronic disease requires evidence of (1) a sufficient combination of manifestations for disease identification, and (2) sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." A showing of continuity of symptoms is not required when disease identity is established but is required when inservice chronicity is not adequately supported or when an inservice diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). However, not every manifestation of joint pain during service will permit service connection of arthritis first shown as a clear-cut clinical entity at some later date. 38 C.F.R. § 3.303(b). However, certain conditions, such as arthritis and a psychosis, will be presumed to have been incurred in service if manifested to a compensable degree within 1 year after service. 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection requires that there be (1) medical evidence of a current disability, (2) medical or, in some circumstances, lay evidence of in-service incurrence or aggravation of an injury, and (3) medical evidence of a nexus between the claimed in-service injury and the present disability. Dalton v. Nicholson, 21 Vet. App. 23, 36 (2007). Under 38 C.F.R. § 3.303(b) the 2nd and 3rd elements may be established by demonstrating continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). If some of these elements cannot be established, a veteran can instead establish continuity of symptomatology. 38 C.F.R. § 3.303(b); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). To establish continuity of symptomatology requires a show "(1) that a condition was 'noted' during service, (2) evidence of postservice continuity of the same symptomatology, and (3) medical or lay evidence of a nexus between the present disability and the postservice symptomatology." Barr, 21 Vet. App. at 307. In original claims for service connection, the Board must find whether the preponderance of the evidence is against the claim. If so, it is denied, but if the preponderance supports the claim or the evidence is in equal balance, the claim is allowed. 38 U.S.C.A. § 5107 (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1365-66 (Fed. Cir. 2001); 38 C.F.R. § 3.102. 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. Application to Reopen: Right Ankle Disorder The RO had denied the claim for service connection for a right ankle disorder on the merits in a June 1993 rating decision and although notified of that decision by RO letter that same month, the Veteran did not appeal that decision. Under 38 U.S.C.A. §§ 5108, 7105(c) (West 2002) and 38 C.F.R. §§ 3.104, 20.302(a) (2012) a rating action which is not appealed is final and may not be reopened unless new and material evidence is presented. Regardless of how the RO ruled on the question of reopening, the Board must re-decide that matter on appeal, because reopening is jurisdictional. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001) (reopening after a prior unappealed RO denial). The application to reopen that claim was received August 2008. The claim was previously denied because the Veteran had had only an acute and transitory inservice right ankle injury during military service and his chronic right ankle disability after service was not related to his period of military service. For the purpose of establishing 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); see also Kutscherousky v. West, 12 Vet. App. 369, 371 (1999) (per curiam) (holding that the "presumption of credibility" doctrine, articulated in Evans v. Brown, 9 Vet. App. 273 (1996), was not altered by the ruling in Hodge v. West, 155 F.3d 1356 (Fed.Cir. (1998). The ultimate weight to be accorded evidence is a question of fact that must be determined based on all of the evidence on file but only after a claim is reopened. Justus, 3 Vet. App. at 513. New evidence means existing evidence not previously submitted to agency decision makers. 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. 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. 38 C.F.R. § 3.156(a). The doctrine of the favorable resolution of doubt is not applicable in the reopening analysis but applies only after new and material evidence has been submitted to reopen a claim and adjudication of the claim on the merits. Annoni v. Brown, 5 Vet. App. 463, 467 (1994). Evidence Previously Considered The evidence on file at the time of the 1993 rating decision denying service connection for a right ankle disability shows that the Veteran was seen during service for a right ankle sprain in 1997 but X-rays ruled out a possible fracture. The 1978 service separation examination found no abnormality. The Veteran did sustain a postservice right ankle eversion injury in May 1993. The claim was denied in June 1993 because the Veteran's having failed to attend a scheduled VA examination and, so, the evidence did not establish that any current right ankle disability was of service origin, as opposed to the postservice 1993 injury. Additional Evidence The additional evidence confirms that the Veteran sustained additional right ankle injuries in 1987 and only then did X-rays reveal any right ankle abnormality. Moreover, he sustained yet another postservice right ankle injury in 2006 which caused a fracture. In essence, the additional evidence received since the June 1993 RO denial consists of updated VA outpatient records, the Veteran's statements and the May 2012 VA examination. However, the updated VA outpatient records are not new and material. See Cornele v. Brown, 6 Vet. App. 59, 62 (1993); Mintz v. Brown, 6 Vet. App. 277, 280 (1994) (medical evidence that merely documents continued diagnosis and treatment of disease, without addressing the crucial matter of medical nexus, does not constitute new and material evidence). Additionally, his statements add nothing which would serve as new and material evidence to reopen the claim but merely restates the essence of his statements in support of his earlier claim. The Veteran's own contentions likewise cannot serve to reopen the previously denied claim. The Court has specifically held that lay assertions of medical causation cannot suffice to reopen a previously-denied claim. Marciniak v. Brown, 10 Vet. App. 198 (1997). Since he is not a medical expert, he is not competent to identify the cause of any right ankle disability, or to express an authoritative opinion regarding his current medical condition. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Likewise, the VA examination did not indicate that the Veteran's right ankle disability is due to an injury during service. This evidence, although new, is not material, since it is against the claim. See Villalobos v. Principi, 3 Vet. App. 450 (1992) (evidence that is unfavorable to a claimant is not new and material). The Board does not assess credibility of the Veteran's statements because a credibility assessment is done only after reopening. Rather, the Board concludes that such supporting statements are, essentially, an expression of a medical opinion as to which the Veteran is not competent to attest. See 38 C.F.R. § 3.159(a)(1) (competent medical evidence is that which is provided by one qualified by education, training, or experience to offer medical diagnoses, statements, or opinions but includes statements of sound medical principles found in medical treatises or authoritative writings). Indeed, in Moray v. Brown, 5 Vet. App. 211 (1993), the Court noted that laypersons are not competent to offer medical opinions and that such evidence does not provide a basis on which to reopen a claim for service connection. In Routen v. Brown, 10 Vet. App. 183, 186, (1997), the Court noted "[l]ay assertions of medical causation . . . cannot suffice to reopen a claim under 38 U.S.C.A. 5108." Thus, what is still missing, is evidence of a nexus between the inservice right ankle injury and current right ankle disability. Because the claim is not reopened, the benefit-of-the-doubt standard of proof does not apply. Annoni v. Brown, 5 Vet. App. 463, 467 (1993). Acquired Psychiatric Disorder Initially, in de novo or merit adjudications of claims (as opposed to reopening), the credibility of supporting lay statements is an adjudicative issue. A layperson is competent to describe visible or personally observable symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). However, where the determinative issue involves causation or a diagnosis, there must be competent evidence and, generally, lay statements are not competent evidence. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Lay evidence can be competent to establish a diagnosis when (1) a layperson is competent to identify the medical condition, (e.g., a broken leg), or (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. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). While competent to attest to symptoms personally experienced during or after military service, a layperson is generally not competent to testify that what was experienced inservice caused disability which was not clinically shown to have manifested until years after service, particularly in light the absence of contemporaneous and corroborating evidence of continuous symptomatology. See Clyburn v. West, 12 Vet. App. 296, 301 (1999). The Board notes that there is evidence that the Veteran has a personality disorder. Developmental defects, such as personality disorders that are characterized by developmental defects or pathological trends in the personality structure manifested by a lifelong pattern of action or behavior, are not diseases or injuries within the meaning of applicable legislation in the absence of superimposed disease or injury, which there is none in this particular instance. 38 C.F.R. § 3.303(c). See also Johnson v. Principi, 3 Vet. App. 448, 450 (1992). Thus, to the extent that the Veteran has a personality disorder it is not a disability for which service connection may be granted. Moreover, the recent VA psychiatric examination intimated that the Veteran's behavioral and disciplinary problems during service were consistent with having been due to his characterological problems, i.e., a personality disorder. As to PTSD, a claim is not limited only to a particular diagnosis; rather, the disability claimed must reasonably be construed in light of the claimant's description of the claim, the symptoms described, and information submitted in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 - 6 (2009) (holding that a claim for PTSD is a claim for any acquired psychiatric disorder because multiple diagnoses may represent subjective differences of opinion as to the nature of one condition, not necessarily multiple separate conditions). Accordingly, while the Veteran has focused upon the diagnosis of schizophrenia, the Board will address whether service connection is warranted for any acquired psychiatric disorder, including PTSD. Service connection for PTSD requires the presence of three elements: (1) a current medical diagnosis of PTSD; (2) medical evidence of a causal nexus between current symptomatology and a claimed in- service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. 38 C.F.R. § 3.304(f) (2012). Lay testimony alone may establish the occurrence of the claimed inservice stressor if (a) PTSD is diagnosed during service; or (b) the stressor is related to the Veteran's having engaged in combat with the enemy; or (c) the stressor relates to his fear of hostile military or terrorist activity and appropriate medical personnel confirms that the stressor is adequate to support a PTSD diagnosis; or (d) the stressor relates to being a prisoner-of-war (POW). 38 C.F.R. § 3.304(f)(1), (2), (3), and (4). However, in claims for PTSD based on an inservice personal assault, evidence from sources other than service records may corroborate the account of the stressor incident. 38 C.F.R. § 3.304(f)(5). Here is it undisputed that PTSD was not diagnosed during the Veteran's military service, he served in peace-time and did not engage in combat with the enemy, he has no stressor related to a fear of hostile military or terrorist activity, he was not a POW, and he has no stressor related to having been personally assaulted during service. 38 C.F.R. § 3.304(f)(5) provides that VA will not deny PTSD based on in-service personal assault without first advising the claimant that evidence from sources other than the service records or evidence of behavior changes may constitute credible supporting evidence of the stressor. Here, the Veteran was not provided such notice because he does not allege an inservice personal assault. Rather, the only evidence of a possible stressor is the postservice clinical notation which only suggests, but does not diagnosis, PTSD based on a postservice personal assault. Thus, while postservice clinical evidence merely suggests that the Veteran may have PTSD based on postservice stressors, there is simply no corroborating evidence of an inservice stressor which could cause PTSD nor any diagnosis of PTSD based upon any form of inservice stressor. Overall, the evidence indicates that the Veteran may have had some learning disability prior to his military service but there is no persuasive evidence that he had an acquired psychiatric disorder during military service. Although many years after service he reported that schizophrenia was diagnosed during military service, this is simply not true. Rather, the psychiatric evaluation at service discharge was normal, despite his complaints of some unspecified nervous trouble in an adjunct medical history questionnaire. Significantly, at the recent VA psychiatric examination the Veteran reported that his mental problems began at around the age of 40, long after his military service and this history contradicts other histories which he has provided. This, together with the varying histories he has related over time detracts from this credibility as to having continuously had postservice psychiatric symptoms. Overall, the opinion of the 2009 VA psychiatric examiner is more consistent with the evidence as a whole than the contention now asserted by the Veteran of the incurrence of schizophrenia during active service. That VA examiner's opinion, made after review of the evidence as well as interviewing and examining the Veteran, was that both the Veteran's current schizophrenia and cognitive disorder were unrelated to his military service but more likely due to years of substance abuse and multiple postservice head traumas. For the foregoing reasons, the Board finds the opinion of the VA examiner to be more persuasive than the Veteran's lay statements of continuous postservice psychiatric symptoms. Accordingly, there is no basis for granting service connection for an acquired psychiatric disorder, including schizophrenia and PTSD. Low Back Disorder The Veteran sustained an acute preservice low back injury in 1975 but X-rays were normal; and because no low back disability was found on the examination for entrance into active service he is presumed to have been in sound medical condition at entrance into active service. See 38 U.S.C.A. § 1111 and 38 C.F.R. § 3.304(b). The Veteran was seen briefly during service for an acute low back injury in 1977. Although he did complain of a history of recurrent back pain in the medical history questionnaire at service separation, because the remaining STRs are negative as was the service separation examination, the STRs fail to demonstrate the combination of manifestations sufficient to identify a chronic low back disability during active service. Thus, chronicity of low back disability inservice is not adequately supported by the STRs and the evidence as a whole. Accordingly, a showing of continuity of symptomatology after service or competent medical evidence of a nexus with service is required to support the claim when, as here, it is unquestioned that the Veteran now has chronic lumbosacral DJD and DDD. To the extent that the Veteran indicates that he has had continuous low back symptoms since service, this is not corroborated by contemporaneous clinical evidence. He has reported having had something removed from his back, but the evidence shows that this was no more than the removal of a lipoma in 2006, almost three decades after service. Rather, he sustained a postservice back injury in 1992 and at the time of the 2009 VA examination he suggested that he had had yet a second postservice back injury. The Veteran's vague assertion of continuous postservice back pain, related at the 2009 VA examination, is outweighed by the opinion of the 2009 VA examiner, who interviewed and examined the Veteran, and also reviewed the claim file. That examiner's opinion was that the Veteran's DJD and DDD were less likely as not related to military service and, moreover, the lumbar degenerative changes were simply due to the aging process. Accordingly, service connection for a low back disorder is not warranted. Since, for these reasons, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Right Foot Disorder The STRs show that the Veteran had peroneal tendonitis in 1978 which was described as being only mild. Because the remaining STRs are negative as was the service separation examination, the STRs fail to demonstrate the combination of manifestations sufficient to identify a chronic right foot disorder during active service. As to this, there were no relevant complaints relative to his right foot in the medical history questionnaire at service separation. "[T]he more contemporaneous the evidence, the greater [the] probative value and credibility than can be attached to that evidence, especially when later-dated testimony [] and statements were generated for pecuniary purposes ... 'memory hinges on recency', earlier statements are generally more trustworthy than later ones." Curry v. Brown, 7 Vet. App. 59, 64 (1994). Thus, chronicity of a right foot disorder inservice is not adequately supported by the STRs and the evidence as a whole and, so, a showing of continuity of symptomatology after service or competent medical evidence of a nexus with service is required to support the claim since the Veteran now has chronic osteoarthritis of the right foot which is degenerative in nature. To the extent that the Veteran indicates that he has had continuous symptoms of right foot disability since service, this is not corroborated by contemporaneous clinical evidence. Rather, he conceded at the 2012 VA examination that he had sustained multiple postservice right foot injuries. Despite these injuries, X-rays at the 2012 VA examination found only degenerative changes which the examiner concluded were part of the natural aging process. That examiner reviewed the claim file and also interviewed and examined the Veteran before concluding that the arthritis of the Veteran's right foot was unrelated to his period of military service. Accordingly, service connection for a right foot disorder is not warranted. Since, for these reasons, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. ORDER The application to reopen the claim for service connection for a right ankle disorder is denied. Service connection for an acquired psychiatric disorder, including PTSD, is denied. Service connection for a low back disorder is denied. Service connection for a right foot disorder is denied. ____________________________________________ MICHAEL MARTIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs