Citation Nr: 1304454 Decision Date: 02/07/13 Archive Date: 02/19/13 DOCKET NO. 12-13 864 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and anxiety disorder. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD R. Casadei, Associate Counsel INTRODUCTION The Veteran, who is the Appellant in this case, served on active duty from January 1972 to January 1976. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) Waco, Texas, which denied service connection for PTSD. Although the Veteran's July 2010 claim specifically claimed only service connection for PTSD, other psychiatric disorders have been raised by the record. In Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) held that the scope of a mental health disability claim includes any mental disorder that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record. In consideration of this holding and the other diagnosis of record (anxiety disorder), the Board has recharacterized the claim as reflected on the title page. The the issue of entitlement to an increased evaluation in excess of 10 percent for degenerative joint disease of the right elbow has been raised by the record, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. The Veteran did not engage in combat with the enemy during service. 2. The Veteran did not sustain a psychiatric injury or disease during service, including no superimposed injury on a personality disorder. 3. The Veteran does not have PTSD. 4. The Veteran has currently diagnosed anxiety disorder NOS. 5. Symptoms of an anxiety disorder were not chronic in service. 6. Symptoms of an anxiety disorder have not been continuous since service separation. 7. The Veteran's current anxiety disorder is not related to active service. 8. Cannabis dependence and alcohol dependence have not been acquired as secondary to a service-connected disability. 9. The Veteran has an avoidant personality disorder. CONCLUSION OF LAW The criteria for service connection for a psychiatric disorder, to include PTSD and an anxiety disorder, have not been met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.9 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.326(a) (2012). The notice requirements of VCAA require VA to notify the claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. The United States Court of Appeals for Veterans Claims (Court) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. In a timely letter dated September 2010, the RO provided notice to the Veteran regarding what information and evidence is needed to substantiate a claim for service connection, as well as what information and evidence must be submitted by the Veteran and what evidence VA would obtain. The notice included provisions for disability ratings and for the effective date of the claim. VA medical examinations were provided in September 2010 and March 2011. To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA opinions and findings obtained in this case are adequate. The VA nexus opinions provided consider all of the pertinent evidence of record, to include the statements of the Veteran, and provide a complete rationale for the opinions stated. The Board is also satisfied VA has made reasonable efforts to obtain relevant records and evidence. Specifically, the information and evidence that has been associated with the claims file includes the Veteran's service treatment records, VA examinations, post-service VA treatment records, and the Veteran's statements. For these reasons, the Board finds that VA has fulfilled the duties to notify and assist the Veteran. Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 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. 38 C.F.R. § 3.303(b). 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). Service connection for PTSD requires: medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (2012) (conforming to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) (2012). The applicable regulation requires that the in-service stressor or traumatic event involve actual or threatened death, serious injury, or a threat to the physical integrity of self or others and the person's response involve intense fear, helplessness, or horror. See DSM-IV § 309.81 (4th ed. 1994). In adjudicating a claim for service connection for PTSD, the evidence necessary to establish the incurrence of a stressor during service to support a claim of entitlement to service connection for PTSD will vary depending on whether or not the Veteran was "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60, 66 (1993). If it is determined through military citation or other supportive evidence that a veteran engaged in combat with the enemy, and the claimed stressors are related to combat, a veteran's lay testimony regarding the reported stressor must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary, provided that the testimony is found to be satisfactory, that is, not contradicted by service records, and "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C.A. § 1154(b) (West 2002); 38 C.F.R. § 3.304(d),(f); Doran v. Brown, 6 Vet. App. 283, 289 (1994). To gain the benefit of a relaxed standard for proof of service incurrence of an injury or disease, 38 U.S.C.A. § 1154(b) requires that a veteran have actually participated in combat with the enemy. See VAOPGCPREC 12-99. If it is determined that a veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, a veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. In such cases, the record must contain service records or other corroborative evidence which substantiates or verifies a veteran's testimony or statements as to the occurrence of the claimed stressor. See Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." See Layno, 6 Vet. App. at 469; 38 C.F.R. § 3.159(a)(2). The Court has emphasized that when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr, 21 Vet. App. 303; Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of a veteran's claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. VA's General Counsel has interpreted that direct service connection for disability resulting from a claimant's own drug or alcohol abuse is precluded for all VA benefit claims filed after October 31, 1990. See VAOPGCPREC 7-99; VAOPGCPREC 2-98. Compensation cannot be awarded pursuant to 38 U.S.C.A. §§ 1110, 1131 and 38 C.F.R. § 105(a) either for a primary drug abuse disability incurred during service or for any secondary disability that resulted from primary drug abuse during service. Allen v. Principi, 237 F.3d 1368, 1376 (Fed. Cir. 2001). However, service connection may be granted for an alcohol or drug abuse disability acquired secondary to or as a symptom of a service-connected disability. However, such compensation may be awarded only "where there is clear medical evidence establishing that alcohol or drug abuse is caused by a veteran's primary service-connected disability, and where the alcohol or drug abuse disability is not due to willful wrongdoing." See Allen, 237 F.3d at 1376. VA's General Counsel, after studying 38 C.F.R. § 3.303(c), issued the interpretation, binding on the Board, that service connection may be granted for diseases of congenital, developmental, or familial origin if the evidence as a whole shows that manifestations of the disease in service constituted "aggravation" of the disease within the meaning of applicable VA regulations. The VA General Counsel also has interpreted that a congenital defect can be subject to superimposed disease or injury, and if superimposed disease or injury occurs during military service, service-connection may be warranted for the resultant disability. VAOPGCPREC 82-90. The Board notes all the evidence in the Veteran's claims file, with an emphasis on the evidence relevant to this appeal, has been reviewed. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate, and the analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Service Connection for PTSD The Veteran contends that he has PTSD that is due to his military service in the Republic of Vietnam. Specifically, the Veteran states that he pulled an injured servicemember out of a plane that had crashed, and that he now suffers from PTSD symptoms due to the in-service incident. In this case, the evidence does not show, nor does the Veteran allege, that he engaged in combat with the enemy during active service. The Board also finds that there is no objective evidence that the Veteran engaged in combat with the enemy. For this reason, the combat presumptions of 38 U.S.C.A. § 1154(b) are not applicable in this case. With regard to competent evidence of a diagnosis of PTSD, the Board finds that the weight of the evidence demonstrates the Veteran does not have a diagnosed disability of PTSD. The evidence suggesting a diagnosis of PTSD is reflected in VA treatment records dated November 2010 to June 2012. In a December 2010 progress note, the chief medical officer noted PTSD as one of the Veteran's "active problems." The medical officer reported the Veteran's account of his in-service stressor, which involved assisting an injured pilot out of an airplane that had crashed. The medical officer reported that the Veteran suffered from nightmares, irritability, anger, lack of concentration and tiredness. The doctor noted that, upon examination, the Veteran was tired, depressed, and demoralized. The Veteran was alert, reported no hallucinations or delusions. The Veteran admitted using marijuana "to relax." The doctor assessed the Veteran with PTSD, nightmares, followed by dysthymia from horror of the experience in combat. The Board finds that the December 2010 VA treatment note does not establish a diagnosis of PTSD in accordance with the DSM-IV criteria. The Board acknowledges that if a veteran has received a diagnosis of PTSD from a competent medical professional, VA must assume that the diagnosis was made in accordance with the appropriate psychiatric criteria in regard to the adequacy of the symptomatology and the sufficiency of the stressor. Cohen v. Brown, 10 Vet. App. 128, 153 (1997). VA can only reject such a diagnosis on a finding that the preponderance of the evidence is against (1) the PTSD diagnosis, (2) the occurrence of the in-service stressor, or (3) the connection of the current condition to the in-service stressor. The adequacy of a stressor, sufficiency of symptomatology, and diagnosis are all medical determinations. Cohen, 10 Vet. App. at 143-44. Although the Board acknowledges that the December 2010 PTSD diagnosis was rendered by a VA medical professional, the Board finds that the VA doctor's PTSD assessment was not in accordance with the DSM-IV criteria, and therefore, is of little probative value. First, the VA doctor's diagnosis was based upon vague and general reference to symptoms without a specific discussion of the DSM-IV criteria and without discussion of the Veteran's pre-military history, family psychiatric history, post-military psychological history, marital and familiar relationships, history of drug and alcohol abuse, and history of violence or criminal activity. The mental status examination was brief and incomplete as it did not include a discussion relating to the Veteran's thought process, communication, behavior, suicidal or homicidal ideations, obsessive or ritualistic behaviors, rate and flow of speech, panic attacks, sleep impairment, and impaired impulse control. Importantly, the doctor did not perform any quantitative psychometric assessments prior to rendering his PTSD assessment. Ultimately, the December 2010 assessment of PTSD fails to explain how each of the diagnostic criteria were satisfied prior to rendering the PTSD assessment. Accordingly, the Board does not presume that the PTSD diagnosis was made in accordance with DSM-IV. Cohen at 140. Thus, the Board assigns minimal probative weight to this diagnosis. In a later VA treatment note dated May 2011, the medical officer noted that the Veteran reported continuing nightmares, irritability, panic attacks, anger, difficulty concentrating, and tiredness. The medical officer assessed the Veteran with PTSD, dysthymia, personality disorder NOS with avoidant traits, and substance abuse (marijuana addiction for calming anxiety). As in the December 2010 progress note, the medical officer in the May 2011 VA treatment note did not report on the Veteran's history, and did not discuss the March 2011 VA examination, conducted only two months prior, and which conflicted with the PTSD assessment. The May 2011 medical officer also did not perform a complete and thorough mental status examination and did not render any quantitative psychometric assessments prior to rendering his PTSD assessment; therefore, the Board also finds that this PTSD assessment was not in accordance with the DSM-IV criteria. Weighing against a diagnosis of PTSD includes two VA examination reports. In the September 2010 VA examination, the Veteran's history was reported and the Veteran noted symptoms of insomnia, nightmares, weight loss, attention problems, depression, and intrusive thoughts. Upon mental status examination, the doctor noted that the Veteran did not have impaired thought process or communication. Hallucinations and delusions were not reported. The Veteran reported past suicidal ideation, but denied any current thoughts or intent. The doctor noted that the Veteran reported alcohol and marijuana use. Specifically, the Veteran stated that while in service he drank 8 to 10 beers a day; however, during the examination he stated he only drank 8 to 10 beers twice a month. The Veteran further stated that he used marijuana while in service, but denied using any since 1974. Further, the doctor noted that the Veteran attended drug rehabilitation in 1974. The doctor diagnosed the Veteran with episodic alcohol abuse and stated that the Veteran did not have a diagnosis of PTSD. In a subsequent March 2011 VA PTSD examination, the Veteran reported symptoms of intrusive thoughts, irritability, difficulty sleeping, outbursts of anger, concentration problems, and an exaggerated startle response. Upon physical examination, the Veteran was oriented as to person and place, but was not able to recall what month it was. His attitude toward the examiner was noted as being contentious, irritable, and sarcastic. His thought process was noted as rambling, racing, and paucity of ideas. The Veteran denied hallucination, suicidal or homicidal ideation. The Veteran did report experiencing panic attacks at least once a week. Although psychometric testing was conducted, the VA examiner found that the MMPI2 scores were invalid as they indicated "extreme exaggeration" which, according to the examiner, would result in "a description which does not reflect the veteran's current status." The VA examiner noted an Axis I diagnosis of cannabis dependence, cannabis induced mood disorder, pain disorder associated with both psychiatric factors and a general medical condition, and anxiety disorder NOS. The examiner also provided an Axis II diagnosis of avoidant personality disorder. The examiner concurred with the September 2010 examiner that the Veteran did not have a diagnosis of PTSD due to the absence of objective clinical evidence to support such a diagnosis. The examiner further opined that the Veteran's cannabis dependence, cannabis induced mood disorder, and anxiety disorder were not caused by or a result of his exposure to traumatic events in service. Also weighing against a PTSD diagnosis are VA treatment records dated February 2012 and June 2012. Although the VA doctor continued to list PTSD as one of the Veteran's "active problems," these more recent VA treatment notes did not include a PTSD assessment and diagnosed the Veteran with Axis I: marijuana abuse, SIMD (substance induced mood disorder) vs. anxiety, and Axis II: personality disorder. In review of all the medical evidence, the Board finds the reports of the September 2010 and March 2011 VA examiners to be the most probative evidence of record as to whether the Veteran has a diagnosis of PTSD. The September 2010 and March 2011 VA opinions were thorough and took into account the Veteran's history, results of both a mental status examination and clinical testing, and a complete review of the claims folder, medical records, and documented medical history. The Board further finds that the VA treatment records dated November 2010 to June 2012 are of little probative value as they are based, in large part, on the Veteran's own inaccurate statements, including reports of combat in service, history or symptoms, and inconsistent reports of substance usage, which the Board finds inconsistent and, therefore, not credible. The Board is not bound to accept medical opinions that are based on history supplied by a veteran, where that history is unsupported by the medical evidence or based upon an inaccurate factual background. Black v. Brown, 5 Vet. App. 177 (1993); Swann v. Brown, 5 Vet. App. 229 (1993); Reonal v. Brown, 5 Vet. App. 458, 460- 61 (1993). The Board may reject a medical opinion that is based on facts provided by an appellant that have been found to be inaccurate or because other facts present in the record contradict the facts provided by the appellant that formed the basis for the opinion. See Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005). Importantly, the Board does not reject the factual histories provided in the VA treatment records dated November 2010 to June 2012 because they were supplied by the Veteran, but rejects the histories because they are inconsistent with the Veteran's other statements in the record and other objective evidence of record. For example, during the September 2010 evaluation, the Veteran reported drinking 8 to 10 beers twice a month; however, in the March 2011 VA examination, he stated that "I don't hardly drink any, I don't keep it in my icebox." The March 2011 examiner noted that the Veteran was vague, inconsistent, and not forthcoming when discussing his use of alcohol. The March 2011 VA examiner found that the Veteran's comments regarding alcohol consumption were "unreliable." During the March 2011 VA examination, the Veteran stated that he entered a rehabilitation program while in service due to his use of LSD. In the September 2010 evaluation and in the VA treatment records there is no mention of the use of LSD. In the September 2010 examination, the Veteran reported that he had not used marijuana since 1974; however, in the March 2011 VA examination and VA progress notes dated December 2010 to June 2012, the Veteran confirmed his use of marijuana on multiple occasions since 1974. The March 2011 VA examiner also reported that the Veteran's psychometric assessment scores were invalid as they indicated "extreme exaggeration" and a standard interpretation of the score would result in a description that would not reflect the Veteran's current status. Given the numerous inconsistencies in the Veteran's statements, the Board finds the Veteran's reported histories are not credible. For these reasons, the Board finds that the VA progress notes, which are based primarily on the Veteran's inconsistent statements, to be of little probative weight. Accordingly, the Board finds the September 2010 and March 2011 VA evaluations to be the most probative evidence of record because they include clinical objective testing, a review of the claims file and the Veteran's medical history, and also account for the discrepancies in the Veteran's statements to medical professionals. As such, the Board finds that the greater weight of probative evidence is against finding that the Veteran has a diagnosed psychiatric disorder of PTSD. The threshold requirement for service connection to be granted is competent medical evidence of the current existence of the claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Therefore, without a current disability of PTSD, there may be no service connection for the claimed PTSD. As such, the weight of the competent and credible evidence of record does not satisfy the elements of a PTSD claim under the criteria of 38 C.F.R. § 3.304(f) because it shows that the Veteran does not have PTSD. For these reasons, the Board finds that a preponderance of the evidence is against the aspect of the Veteran's claim for service connection for PTSD, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Service Connection for an Acquired Psychiatric Disorder Evidence of record shows that the Veteran has also been diagnosed with an anxiety disorder NOS and dysthymia. See December 2010, March 2011 VA examination, and May 2011 VA progress note. Thus, in accordance with Clemons, the Board will consider whether the Veteran's anxiety disorder is etiologically related to his military service. See Clemons, 23 Vet. App. 1. The Board finds that the weight of the evidence shows no in-service injury or disease, including no superimposed injury on the personality disorder, including no chronic symptoms of anxiety disorder or dysthymia during service. Service treatment records appear complete and are negative for any complaints, treatment, or diagnosis of an anxiety disorder and dysthymia. Service treatment records reflect that the Veteran sought treatment during service for other disorders, including: elbow pain and swelling, blurred vision, hepatitis, venereal disease, back pain, and chest pain. Also during service, the Veteran reported to the Naval Drug Rehabilitation Center in July 1974 due to his extensive drug abuse history. In a October 1974 narrative summary, the physician noted that the Veteran was assigned to project therapy track where he was evaluated and placed in a group. According to the physician, the Veteran appeared "hostile and anxious" and was, at first, unwilling to participate. The reporting physician stated that over time, the Veteran gained confidence and began making personal gains. The Veteran verbalized some of his attitudes and revealed a negative self-image which, according to the physician, appeared to be at the base of much of the Veteran's difficulties. Finally, the physician stated that in light of the Veteran's improved attitude, and gains in therapy, the Veteran was seen as a benefit to the military and was recommended for retention on active duty. Service treatment records reflect that the Veteran sought treatment for various disorders or symptoms, including blurred vision, elbow pain diagnosed as tendonitis, venereal disease (recurrent gonorrhea), upper respiratory infections (flu), low back pain and muscle ache, sinus congestion and sore throat, dermatitis, chest pains, fever, and symptoms that were diagnosed as hepatitis. In light of the extensive visits for treatment and therapy, in the context of service treatment records that appear to be complete, the Board finds that, had the Veteran been suffering from anxiety, dysthymia, or any other psychiatric symptoms during service, such complaints would have been reflected in the treatment records. See Kahana v. Shinseki, No. 24 Vet. App. 428, 439 (2011) (citing Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (Lance, J., concurring) (VA may use silence in the service treatment records as evidence contradictory to a veteran's assertions if the service treatment records appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred). For these reasons, the Board finds that symptoms of a psychiatric disorder, to include an anxiety disorder and dysthymia were not chronic in service. The Board next finds that the weight of the evidence demonstrates that symptoms of an anxiety disorder and dysthymia have not been continuous since service separation in January 1976. The evidence in this case includes the July 1974 service separation examination report, which indicated a normal psychiatric evaluation. Post-service medical records reveal that the Veteran's earliest treatment for any psychiatric disorder is November 2010, four months after filing his VA compensation claim for PTSD. The Board acknowledges that symptoms, not treatment, are the essence of any evidence of continuity of symptomatology (Savage v. Gober, 10 Vet. App. 488, 496 (1997)); however, here, despite filing other VA compensation claims in November 2009 and December 2009 (service connection for right elbow fracture, hearing loss, tinnitus, and hepatitis), the Veteran first filed a claim for service connection for PTSD in July 2010, 34 years after leaving service. While inaction regarding filing a claim is not necessarily indicative of the absence of symptomatology, where, as here, a veteran takes action regarding other claims, it becomes reasonable to expect that the veteran is presenting all issues for which he is experiencing symptoms that he believes are related to service. In other words, in this case, the Veteran demonstrated that he understood the procedure for filing a claim for VA disability compensation, and he followed that procedure in other instances where he believed he was entitled to those benefits. In such circumstances, it is more reasonable to expect a complete reporting than for certain symptomatology to be omitted. Thus, the Veteran's inaction regarding a claim for a psychiatric disorder, when viewed in the context of his action regarding other claims for compensation on various occasions, may reasonably be interpreted as indicative of the Veteran's belief that he did not sustain a psychiatric disorder in service and a lack of symptomatology at the time he filed the claims. For these reasons, the Board finds that symptoms of a psychological disorder, including an anxiety disorder and dysthymia, have not been continuous since service separation. Moreover, the Board finds that there is no competent evidence of a relationship between the Veteran's current psychological disorders and his military service. The Board finds that the weight of the lay and medical evidence of record reflects that the Veteran's current anxiety disorder and dysthymia are not related to active service. The March 2011 VA examiner opined that the Veteran's anxiety disorder was not caused by or a result of his exposure to traumatic events while in service. The examiner reasoned that, after 35 years of life-cycle events, it was virtually impossible to partial out signs and symptoms. The examiner concluded that it would be a matter of resorting to speculation to etiologically determine the importance of one event over the other. Importantly, there is no other medical evidence of record that establishes a link between the Veteran's anxiety disorder and dysthymia to any in-service event. For these reasons, in the context of no in-service symptoms and no continuous post-service symptoms, the Board finds that the medical evidence of record weighs against the claim for service connection for a psychiatric disorder to include an anxiety disorder and dysthymia. The Veteran also has a diagnosis of episodic alcohol abuse and marijuana dependence. See September 2010 VA examination, March 2011 VA examination, February 2012 and June 2012 VA progress notes. VA's General Counsel has interpreted that direct service connection for disability resulting from a claimant's own drug or alcohol abuse is precluded for all VA benefit claims filed after October 31, 1990. See VAOPGCPREC 7-99; VAOPGCPREC 2-98. That notwithstanding, the Board has considered the Veteran's statements in which he contends that his drug and alcohol abuse is used as a coping method to help relieve the intrusive thoughts associated with service. See Veteran's August 2012 statement. Service connection may be granted for an alcohol or drug abuse disability acquired secondary to or as a symptom of a service-connected disability. See Allen, 237 F.3d at 1376. Although currently service connected for degenerative joint disease of the right elbow, and pain disorder associated with his right elbow, the Veteran does not contend that his drug and alcohol abuse is related to those service-connected disabilities. Instead, the Veteran claims that he uses drugs and alcohol to cope with the intrusive thoughts associated with service. Because the Veteran is not service connected for his intrusive thoughts or any psychiatric disorder which may contemplate symptoms such as intrusive thoughts, the Board finds that secondary service connection on this basis is not warranted. Next, the Veteran was assigned an Axis II diagnosis of avoidant personality disorder. See March 2011 VA examination, see also May 2011, February 2012, and June 2012 VA progress notes. The Board finds that the diagnosis of avoidant personality disorder is not a disability for VA disability compensation purposes. See 38 C.F.R. §§ 3.303(c), 4.9 (2012) (congenital or developmental defects, refractive error of the eye, personality disorders, and mental deficiency as such are not diseases or injuries within the meaning of applicable legislation); see also VAOPGCPREC 82-90. In this case, the Board finds that a personality disorder was not noted in service and there was no evidence of aggravation of a personality disorder, or of a superimposed disorder, during service. As indicated, service treatment records and post-service medical evidence indicates no psychiatric problems either related to the Veteran's personality disorder, or irrespective of the personality disorder. Medical professionals deemed the Veteran psychiatrically normal at service entrance and separation. In fact, the Veteran was not diagnosed with a personality disorder until the March 2011 VA examination, 35 years following service. The Board further notes that the Veteran has never asserted that his active service aggravated his personality disorder, or caused a superimposed injury or disease on his personality disorder during service. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection for an acquired psychiatric disorder, to include PTSD, anxiety disorder, and dysthymia, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), anxiety disorder, and dysthymia is denied. ____________________________________________ J. PARKER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs