Citation Nr: 1237772 Decision Date: 11/05/12 Archive Date: 11/09/12 DOCKET NO. 10-26 004 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for hypospadias. 2. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), to include as secondary to hypospadias. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and D.M. ATTORNEY FOR THE BOARD T. Wishard, Associate Counsel INTRODUCTION The Veteran had active military service from February 1974 to March 1974. These matters come before the Board of Veterans' Appeals (Board) from a September 2009 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in Nashville, Tennessee. In May 2012, the Veteran and a witness testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In Clemons v. Shinseki, 23 Vet. App (2009), the Court held that an appellant's diagnoses which arise from the same symptoms for which he is seeking benefits, do not relate to entirely separate claims not yet filed by the appellant. Rather, these diagnoses should be considered to determine the nature of the appellant's current condition relative to the claim he did submit. Thus, the Board has characterized the previously separate issues for mental disabilities as one issue for an acquired psychiatric disability, to include PTSD. FINDINGS OF FACT 1. In an unappealed June 1975 decision, the RO denied the Veteran's claim for entitlement to service connection for hypospadias . 2. Some of the evidence received since the June 1975 RO decision is new; however, none of it is material because it does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for hypospadias. 3. The Veteran is not service-connected for any disability. 4. The Veteran is less than credible with regard to any statements that his current acquired psychiatric disability began in service. 5. There has been no demonstration by competent medical, nor competent and credible lay evidence of record that the Veteran has an acquired psychiatric disability, casually related to, or aggravated by, service, or causally related to, or aggravated by, a service-connected disability. CONCLUSIONS OF LAW 1. Evidence received since the June 1975 RO decision which denied entitlement to service connection for hypospadias, which was the last final denial with respect to this issue, is not new and material; the claim is not reopened. 38 U.S.C.A. §§ 5108, 7105 (West 2002); 38 C.F.R. § 3.156, 20.302, 20.1103 (2012). 2. Acquired psychiatric disability was not incurred in, or aggravated by, active service, nor is it proximately due to, the result of, or aggravated by, service-connected disability. 38 U.S.C.A. §§ 1110, 1137 (West 2002);38 C.F.R. § 3.303, 3.304, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). Duty to Notify Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2011); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice 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. VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). In March 2006, the United States Court of Appeals for Veterans Claims (Court) issued its decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Court in Dingess/Hartman held that the VCAA notice requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a "service connection" claim. As previously defined by the courts, those five elements include: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Upon receipt of an application for "service connection," therefore, VA is required to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. This includes notice that a disability rating and/or an effective date will be assigned if service connection is awarded. In Kent v. Nicholson, 20 Vet. App. 1 (2006), the Court issued a decision that established new requirements with respect to the content of the VCAA notice for reopening claims. In the context of a claim to reopen, the Secretary must look at the bases for the denial in the prior decision and to respond by providing the appellant with a notice letter that describes what evidence would be necessary to substantiate that element or elements required to establish service connection that were found insufficient in the previous denial. In VA correspondence to the appellant in May and July 2009, the Veteran was informed of what evidence was required to substantiate his claims, of his and VA's respective duties for obtaining evidence, and of the law pertaining to the assignment of a disability rating and effective date as the Court required in Dingess/Hartman. The July 2009 also informed the Veteran of the reasons for the prior denial as required by the Court in Kent. The notices were deficient in that they did not provide the Veteran with the evidence required to substantiate a claim for entitlement to service connection on a secondary basis. Nevertheless, the Board finds that the Veteran has not been prejudiced by the deficiency. As the Board in the decision below, denies the Veteran's claim to reopen his previously denied claim of entitlement to service connection for hypospadias, service connection for disabilities secondary to hypospadias cannot be warranted; thus, the Veteran has not been prejudiced by any notice deficiency. See Shinseki v. Sanders/Simmons, No. 07-1209 (U.S. Sup. Ct. April 21, 2009); 556 U.S. ____ (2009); Fenstermacher v. Phila. Nat'L Bank, 493 F.2d 333, 337 (3d Cir. 1974) ("[N]o error can be predicated on insufficiency of notice since its purpose had been served."). In order for the court to be persuaded that no prejudice resulted from a notice error, "the record must demonstrate that, despite the error, the adjudication was nevertheless essentially fair." Dunlap v. Nicholson, 21 Vet. App. 112, 118 (2007). In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the Court held that compliance with 38 U.S.C.A. § 5103 required that VCAA notice be provided prior to an initial unfavorable agency of original jurisdiction decision. Because the VCAA notice, with the exception of the secondary basis elements, was completed prior to the initial AOJ adjudication denying the claims, the timing of the notice does comply with the express requirements of the law as found by the Court in Pelegrini. Duty to assist With regard to the duty to assist, the claims file contains the Veteran's service treatment records (STRs), VA and private medical records, Social Security Administration (SSA) records, a "buddy statement", and the statements of the Veteran and a witness in support of his claims. The Veteran submitted correspondence in September 2009 in which he indicated that records from at least five medical facilities were unavailable. The Board has carefully reviewed the statements and concludes that there has been no identification of further available evidence not already of record. The Board has also perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claims for which VA has a further duty to obtain. With regard to the issue of whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for a hypospadias, VA is not required to obtain a medical opinion for a claimant seeking to reopen a previously and finally disallowed claim prior to a determination that new and material evidence has been received. See Paralyzed Veteran's of Am. v. Sec'y of Veterans Affairs, 345 F.3d 1334 (Fed. Circ. 2003). The Board has considered whether a VA examination on the issue of entitlement to an acquired psychiatric disability is warranted, but finds that it is not. The Veteran is not service-connected for hypospadias or any other disability; thus, he is not entitled to service connection for a disability caused by a non-service connected disability. Moreover, as is discussed in further detail below, the competent credible evidence of record does not indicate that the Veteran may have an acquired psychiatric disability causally related to active service on a direct incurrence basis. Thus, the Board finds that a VA examination and opinion is not warranted. McLendon v. Nicholson, 20 Vet. App.79, 81 (2006) The Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to his claims. Legal criteria New and material evidence In general, RO decisions that are not timely appealed are final. See 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.200 (2012). An exception to this rule is 38 U.S.C.A. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. The Board must consider the question of whether new and material evidence has been received because it goes to the Board's jurisdiction to reach the underlying claim and adjudicate the claim de novo. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). If the Board finds that no such evidence has been offered, that is where the analysis must end, and what the RO may have determined in that regard is irrelevant. Barnett, supra. Further analysis, beyond consideration of whether the evidence received is new and material is neither required nor permitted. Id. at 1384. See also Butler v. Brown, 9 Vet. App. 167, 171 (1996). "New" evidence is existing evidence not previously submitted to agency decision makers. "Material" evidence is 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 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). In determining whether evidence is new and material, the "credibility of the evidence is to be presumed." Justus v. Principi, 3 Vet. App. 510, 513 (1992). However, lay assertions of medical causation cannot serve as the predicate to reopen a claim under § 5108. See Moray v. Brown, 5 Vet. App. 211, 214 (1993). In order for evidence to be sufficient to reopen a previously disallowed claim, it must be both new and material. If the evidence is new, but not material, the inquiry ends and the claim cannot be reopened. See Smith v. West, 12 Vet. App. 312, 314 (1999). If it is determined that new and material evidence has been submitted, the claim must be reopened. The VA may then proceed to evaluate the merits of the claim on the basis of all evidence of record, but only after ensuring that the duty to assist the appellant in developing the facts necessary for the claim has been satisfied. See Elkins v. West, 12 Vet. App. 209 (1999), but see 38 U.S.C.A. § 5103A (West 2002) (eliminating the concept of a well-grounded claim). Service Connection Service connection is warranted if it is shown that a Veteran has a disability resulting from an injury incurred or a disease contracted in active service or for aggravation of a pre-existing injury or disease in active military service. 38 U.S.C.A. §§ 1110, 1131(West 2002); 38 C.F.R. § 3.303 (2011). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). A congenital defect is not a disability for which service connection can be granted. 38 C.F.R. §§ 3.303(c); 4.9. If the defect is aggravated by service such that a superimposed disease or injury occurred during service, service connection may be established for the resultant disability. VAOPGCPREC 82-90. The presumption of soundness does not apply to congenital defects. Quirin v. Shinseki, 22 Vet. App 390 (2009). In each case where service connection for any disability is being sought, due consideration shall be given to the places, types, and circumstances of such Veteran's service as shown by such Veteran's service record, the official history of each organization in which such Veteran served, such Veteran's medical records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a) (West 2002). In Robinson v. Shinseki, 312 Fed. Appx. 336 (2009), the Court held that, in some cases, lay evidence will be competent and credible evidence of etiology. Whether lay evidence is competent in a particular case is a question of fact to be decided by the Board in the first instance. The Court set forth a two-step analysis to evaluate the competency of lay evidence. First, Board must first determine whether the disability is the type of injury for which lay evidence is competent evidence. If so, the Board must weigh that evidence against the other evidence of record - including, if the Board so chooses, the fact that the Veteran has not provided any in-service record documenting his claimed injury - to determine whether to grant service connection. The Board observes that this Federal Circuit decision is nonprecedential. However, see Bethea v. Derwinski, 2 Vet. App 252, 254 (1992) [a non-precedential Court decision may be cited "for any persuasiveness or reasoning it contains"]. The Board believes that if Bethea applies to the utility of Court decisions, it surely applies to the utility of decisions of a superior tribunal, the Federal Circuit. Analysis The Board has reviewed all of the evidence in the claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claims. New and Material Evidence Historically, in 1975, the Veteran filed a claim for entitlement to service connection for hypospadias. His claim was denied by the RO in June 1975 because the evidence reflected that the Veteran had a constitutional or developmental abnormality which was not aggravated by service. The appellant did not appeal the decision and it became final. In 2009, the appellant requested that his claim for entitlement to service connection be reopened. Initially, the Board finds that hypospadias is a congenital defect and not a disease. Hypospadias is a developmental anomaly in which the urethra opens inferior to its usual location; usually seen in males with the opening on the underside of the penis or on the perineum. DORLAND'S ILLUSTRATED MEDICAL DICTIONARY (31st Ed. 2007). The Board acknowledges that surgery can be performed on the urinary channel; however the defect itself, without surgery, is not capable of improving or deteriorating, but is more or less stationary in nature; thus, it is a defect and not a disease process. Service connection is not warranted for defects. 38 C.F.R. §§ 3.303(c); 4.9. In addition, the presumption of soundness does not apply to congenital defects; thus, it is not applicable to the present case. 38 C.F.R. § 3.303(c); see Terry v. Principi, 340 F.3d 1378, 1385-86 (Fed.Cir.2003) (holding that the presumption of soundness does not apply to congenital defects); see Winn v. Brown, 8 Vet. App. 510 (1996)(holding that a non-disease or non-injury entity such as a congenital defect is "not the type of disease- or injury-related defect to which the presumption of soundness can apply"). Evidence of record at time of last final denial The evidence of record at the time of the last final denial in 1975 consisted of the Veteran's STRs. A February 1974 STR reflects that the Veteran had a history of hypospadias repair at age six with numerous surgical procedures. It was noted that there was no complaints of pain but the Veteran had tenderness in the membranous urethra. It was further noted that the Veteran may have a large diverticulum accounting for persistent urine loss, or that he could have a hair inside with calculus formation. The examiner doubted that the Veteran would be able to complete training. The urinalysis was positive for white blood cells. A Medical Board Report Cover Sheet reflects that a Board was held on March 8, 1974. The sheet reflects the Veteran had one month of service. He was discharged due to "enlistment in error". The Veteran's primary diagnosis was repaired hypospadias, which existed prior to entrance into service. The narrative summary reflects that the Veteran reported that he was born with hypospadias and had undergone at least six surgical procedures between the ages of four and six, to include surgery in the membranous urethra area. While on active duty, he sought treatment for complaints of intermittent burning, dribbling, frequency, and burning and throbbing in the area of the membranous urethra. He did not respond to antibiotics in service. Upon physical examination, it was noted that the Veteran had multiple surgical scars in the area of the urethral meatus consistent with multiple hypospadias repairs. He also had surgical scars in the area of the membranous urethra. The Medical Evaluation Board opined that the Veteran "does not meet the minimum standards for enlistment or induction as set forth in AR 40-501, that he has no unfitting physical disability incurred in nor aggravated by active military service" and that he be discharged. It was further noted that the Veteran was informed of the contents of the Board's report and did not desire to submit a statement in rebuttal. Evidence of record since the last final denial The evidence received since the last final denial consists of VA records, private records, lay statements, SSA records, and the Veteran's statements in support of his claim. A private medical record, dated in October 2003, reflects that the Veteran had had urethra reconstruction in 1989. He presented with a long history of urethral stricture. Private records reflect that in February 2004, the Veteran reported hypospadias symptoms since age 5 with approximately 20 surgeries. His last surgery was 15 years earlier, or in approximately 1989. March 2004 private records reflect that the Veteran had previously underwent multiple reconstructions which had all failed and he was left with strictures. The Veteran reported that following all his surgeries, he never remembered voiding from the tip of his penis. The records further reflect that in March 2004, the Veteran had surgery for a urethral stricture complication of hypospadias. Volunteer Behavioral Health Care system records from 2005 through 2009 are associated with the claims file. They reflect that the Veteran reported that since age 5 he had up to 41 surgeries on his urogenital tract with an unsuccessful outcome. He reported that he had an open urethra, and cannot urinate normally or involve in sexual activity with his wife. He reported depression. He reported that he was unable to work, cannot concentrate, constantly worries about finances, and had sought treatment from a psychiatrist. He had symptoms of mild "depression - mainly situational", and a diagnosis of mood disorder due to general medical condition with mixed features, major depressive disorder, single episode, severe without psychotic features. He was prescribed medication. SSA records reflect that the Veteran was disabled with an onset date of March 2004 and a primary diagnosis of "other disorders of the urinary tract." They further reflect that the Veteran had a long history of treatment for complications of congenital hypospadias and that the "the records show that [the Veteran] underwent urethra reconstruction in 1989, which apparently improved his symptoms. However, this condition worsened and he required treatment by dilation in February 2004. These efforts failed and he underwent a penoscrotal urethrostomy in March 2004. The claimant eventually required repeat catheterization in April 2005; however, the records show the claimant has continued to experience complications." VA records reflect that the Veteran sought mental health treatment. He was diagnosed with mood disorder secondary to his general medical condition (See November 2004 record.) He was also diagnosed with PTSD. (See June 2009 record.) A May 2009 VA examination report is of record. The report reflects that the Veteran reported that he sustained trauma to the genitourinary system while lifting a duffle bag in basic training. Upon examination, he was noted to have a severely scarred urethra. VA records reflect a statement by the Veteran that he was born with hypospadias, had four surgeries as a child, and reported that he tore his urethra in a military accident with subsequent surgeries totally 20. The records also reflect that the Veteran had to catheterize himself to dilate the strictures. The Veteran submitted a statement (VA Form 21-526) in April 2009 in which he stated that his mother told him that when he had been a baby, he had had an operation. He further reported that in basic training, he was running with a duffel bag with a lot of weight in it , and started urinating blood. He reported that this was the start of his surgeries, and that he had had approximately 20 operations, or more, since 1974. In an October 2009 statement, he reported that he was 100 percent in excellent health prior to service and that running with a heavy sea bag aggravated his hypospadias. He also stated that at "the time I was needing surgery immediately however I didn't receive it." The Veteran testified at the May 2012 Board hearing that he had four or five operations for his hypospadias when he was approximately four or five years old. He said that he was then normal until he was 19 years old; however, he also indicated that it was "normal" for him to have the opening of the urethra on the underside, rather than at the end, of the penis. He stated that he had a very active life prior to joining the service in 1974. He reported that in service, he had a sea bag on his back and that "he strained, in the leg, it was burning, and I fell out and I had to just - had to urinate real bad and I did pass blood at that time." (See Board hearing transcript page 4.) He stated that he sought treatment approximately two days later. He further stated that a scar tissue had formed inside his urethra. He also testified as to the post-service operations for his hypospadias. D.M. testified that prior to service, he and the Veteran played ball together and the Veteran never had any problems. He testified that the Veteran was "in perfect health" up to service. (See Board hearing transcript page 12.) The clams file includes a statement from J.W., received by VA in February 2010. He stated that he has known the Veteran his "entire life" and he is one of his best friends. He further stated that the Veteran was in excellent physical and mental health when he joined the service. He stated, in pertinent part, that while in boot camp, the Veteran was running with sea bags when the Veteran "fell out of formation" and was complaining of pain in the abdomen and groin area. Old and new evidence of record considered as a whole The Board finds that none of the additional evidence raises a possibility of substantiating the claim for entitlement to service connection for hypospadias; therefore, the appellant's claim to reopen is denied. The evidence cited above (VA records, private records, SSA records, and statements) are new as they were not previously of record; however, they are not material as they do not raise a reasonable possibility of substantiating the Veteran's claim. The Board is mindful of the Court's decision in Shade v. Shinseki, 24 Vet. App. 110 (2010), in which the Court held that the phrase "raises a reasonable possibility of substantiating the claim" must be viewed as "enabling" reopening of a previously denied claim rather than "precluding" it. However, even given the low threshold, the Board finds that it has not been met. The Veteran's statements and witness statements indicate that the Veteran's hypospadias may have been aggravated in service due to carrying a heavy bag on his back during training. In determining whether evidence is new and material, the "credibility of the evidence is to be presumed." Justus v. Principi, 3 Vet. App. 510, 513 (1992). Moreover, the Veteran is considered competent to describe symptoms such as pain and difficulty urinating. However, the evidence of record at the time of the last final denial was clear that the Veteran had symptoms related to his hypospadias in service; thus, the fact that he had symptoms in service is not in dispute. Neither the Veteran nor the witnesses has been shown to possess the training or credential needed to render a diagnosis or a competent opinion as to medical causation or aggravation. Lay statements as to etiology cannot serve as a basis to reopen a previously denied claim. Moray v. Brown, 5 Vet. App. 211 (1993). Thus, the lay statements that the carrying of a bag may have caused an aggravation of the Veteran's congenital hypospadias are not sufficient to reopen a previously denied claim. In addition, the Veteran's statement that he needed surgery immediately in service and his indication that because he did not get surgery, he had additional problems, is, in essence a statement as to etiology of his current disability, for which he is not competent to make. The Veteran also asserts that he tore his urethra in service; however, the Veteran is not competent to state that he tore his urethra, as he would be unable to note such regarding an internal tube. The Board acknowledges that the Veteran now contends that he had an additional symptom of bleeding while in service; bleeding was not noted in the STRs, although several other symptoms were noted. The STRs reflect white blood cells in the urine, but do not reflect any red blood cells in the urinalysis or Gram stain. Regardless, symptoms were noted, and the pertinent missing element is not evidence of symptoms but whether the Veteran's congenital defect was aggravated by service such that a superimposed disease or injury occurred during service. The newly received evidence of record does not indicate that the Veteran had a superimposed disease or injury during service. The evidence reflects that the Veteran entered service with a congenital defect of hypospadias; the evidence also reflects that the Veteran was discharged with symptoms of his defect; however, the evidence does not indicate any additional defects or injuries occurred during service. While symptoms of the defect may have occurred during service, there is no additional evidence that a superimposed disease or injury during service may have been incurred in the five weeks of service. While the Veteran now contends that he has an acquired psychiatric disability due to his hypospadias in service; such contentions would be diseases secondary to hypospadias and not superimposed. Such contentions are insufficient to reopen the Veteran's claim. Accordingly, the Board concludes that evidence has not been received which is new and material, and the claim for service connection for hypospadias is not reopened. The Board has considered the doctrine of giving the benefit of the doubt to the appellant, under 38 U.S.C.A. § 5107 (West 2002), and 38 C.F.R. § 3.102 (2012), but does not find that the evidence is of such approximate balance as to warrant its application. Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Acquired Psychiatric Disability Clinical records reflect that the Veteran has diagnoses of mood disorder, depression, and PTSD. He contends that they are related to his hypospadias. As noted above, the record reflects that the Veteran had symptoms of his hypospadias defect while in service. The STRs are negative for any psychiatric symptoms due to the physical symptoms of hypospadias. An October 2003 "history and physical detailed" examination report reflects that the Veteran denied depression, suicide attempts/plans, and anxiety disorders. In March 2004, the Veteran had surgery for his hypospadias. A November 2004 private record reflects that the Veteran has a mood disorder due to general medical condition with mixed features, and major depressive disorder, single episode, severe without psychotic features. It was noted that the Veteran was unable to work due to multiple surgeries for congenital hypospadias. It was noted that he was progressively depressed, frustrated, and irritable, and that he was worse since the last surgery failed in March 2004. It was also noted that in 1993, he was in a motor vehicle accident, was depressed, sought treatment and was helped with medication for eight months. The report is negative for any indication that his military service is causally related to his psychiatric disability. The Veteran submitted a statement (VA Form 21-0781) in May 2009 in which he stated that his difficulty urinating started in basic training when he tore his urethra. He contends that he was "horrified" by his symptoms of passing blood and hardly being able to urinate. He further stated that a post-service surgery caused additional horror. The STRs do not support the Veteran's contention that he passed blood and "could hardly urinate". The STRs reflect the presence of white blood cells, but not red blood cells. They reflect "intermittent burning, dribbling and frequency." The claims file includes a May 2009 VA psychiatry outpatient note. It reflects that the Veteran had a main stressor of pain from catheterization due to hypospadias. He was diagnosed with mood disorder secondary to his general medical condition. The report is negative for discussion of military service. The Board notes that the Veterans catherizations are post-service. A June 1, 2009 VA mental health outpatient note reflects a diagnosis of mood disorder due to medical condition. The report is negative for discussion of military service. A June 12, 2009 VA report reflects that the Veteran reported that after service, he had surgery with a civilian doctor. He reported that after he woke up from the surgery, his skin "was busted" and there were "4-5 fistulas and the urine [was] coming out of them." He reported that he reacted with extreme shock and horror and he passed out for a few minutes. He further reported that after the surgery, he started experireicing recurring thoughts of that incident. He stated that when he uses a catheter he is reminded of that post surgery incident. He also reported that he has dreams of the incident, during which he breaks out in a sweat. He was diagnosed with PTSD. The claims folder includes an August 2009 VA record by a social worker. The report reflects that the Veteran reported that he had been "hurt" in the military and subsequently had 20 different surgeries. The social worker stated that the Veteran is likely suffering from trauma associated with his "accident" while in service. The social worker diagnosed the Veteran with PTSD secondary to chronic medical condition. The social worker also made a report in April 2011 in which he noted that the Veteran reported that he is constantly depressed about his marriage and his trauma from war. The Board notes that the Veteran was not in a war, and only served for approximately five weeks of basic training. An August 2011 VA social worker note by the same examiner reflects that the Veteran reported bad dreams, night sweats, intrusive thoughts, and anxiety/depression secondary to his combat experiences. Again, the Board notes that the evidence of record is against a finding that the Veteran was in war or combat. A December 2010 VA record reflects that the Veteran reported experiencing night sweats, anxiety, numerous surgeries, hyprevigilance, and frequent bad dreams of his training trauma which he perceives as causing his present problems. An April 2011 VA record reflects that the Veteran had a negative PTSD screen. Initially, the Board notes that the Veteran does not have a competent diagnosis of an acquired psychiatric disability causally related to active service. The records reflect that the Veteran was diagnosed with an acquired psychiatric disability due to his chronic medical condition. (See May 2009 VA and June 1, 2009 psychiatry outpatient notes), and his post-service surgery (See June 12, 2009 VA report.) As noted above, the Board finds that the social worker opinions with regard to trauma in service are not probative as they reflect that the examiner did not have an accurate history with regard to the Veteran's service. (In this regard, the Board also notes that in a statement dated in August 2011, the Veteran requested service connection for diabetes secondary to his military service in Vietnam. An October 2011 report of general information, VA Form 21-0820, reflects that the Veteran later informed VA that he was not in Vietnam, but that his doctor wrote the August 2011 statement and told him to sign it. Although, the Veteran did not indicate to which doctor he was referring, his statement that he requested compensation based on a fraudulent statement as to service in Vietnam, brings into question his other statements.) Regardless, the social worker found PTSD based on a chronic medical condition, for which the Veteran is not service-connected. The Veteran has not been shown to possess the requisite training or credentials needed to render a competent opinion as to medical diagnosis or causation. As such, his lay opinion does not constitute competent medical evidence and lacks probative value. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The Board notes that the STRs are negative for symptoms of an acquired psychiatric disability, to include secondary to the Veteran's hypospadias symptoms. There is no competent credible evidence of record that the Veteran had an acquired psychiatric disability for more than two decades after service. The lapse of time between service separation and the earliest documentation of current disability is a factor for consideration in deciding a service connection claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The competent credible evidence of record reflects that the Veteran has an acquired psychiatric disability causally related to a chronic congenital defect which has required more than 20 operations, none of which was during service. The Board finds that service connection for an acquired psychiatric disability is not warranted. The Veteran contends that he has an acquired psychiatric disability due to his hypospadias defect, for which he is not service-connected. As the Veteran is not service-connected for hypospadias, he cannot be service connected for any disability secondary to it. Regardless of the Veteran's assertion that his acquired psychiatric disability is due to his nonservice-connected defect symptoms in service or that his problems began in service, he is, in essence, contending that he has an acquired psychiatric disability secondary to his non-service connected defect. The Board acknowledges that diseases or injuries that are superimposed on a defect may warrant service connection; however, in the present case, the evidence does not reflect that a disease or injury has been "superimposed" on the Veteran's hypospadias. The term "superimposed" means to lay or place over something. In the present case, the competent credible evidence reflects that the Veteran has an acquired psychiatric disability due to his hypospadias. Service connection as secondary to a service-connected disability is not warranted as the Veteran does not have any service-connected disability. The Board has considered the doctrine of giving the benefit of the doubt to the appellant, under 38 U.S.C.A. § 5107 (West 2002), and 38 C.F.R. § 3.102 (2010), but does not find that the evidence is of such approximate balance as to warrant its application. Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ORDER As new and material evidence has not been received to reopen the claim of entitlement to service connection for hypospadias, the appeal is denied. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), to include as secondary to hypospadias, is denied. ______________________________________________ MILO H. HAWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs