Citation Nr: 1304757 Decision Date: 02/08/13 Archive Date: 02/19/13 DOCKET NO. 09-10 991A ) 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). REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Adams, Counsel INTRODUCTION The Veteran had active service from February 1990 to October 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a regional office (RO) rating decision of December 2007, which denied service connection for PTSD. A VA examination in April 2011 resulted in a diagnosis of depressive disorder, and `the United States Court of Appeals for Veterans Claims (Court), has held that in a case involving service connection for PTSD when the record showed diagnoses of other mental conditions, such conditions were part of the claim. Clemons v. Shinseki, 23 Vet. App. 1 (2009). This claim was implicitly denied by the RO in the April 2011 supplemental statement of the case, and, therefore, the expanded issue is properly before the Board. See Adams v. Shinseki, 568 F.3d 956 (Fed. Cir. 2009). In August 2011, the Veteran appeared at a hearing held at the RO before the undersigned Acting Veterans Law Judge (i.e., Travel Board hearing). A transcript of that hearing is of record. At the hearing, the Veteran submitted additional evidence with a waiver of RO initial consideration. 38 C.F.R. §§ 19.9, 20.1304(c). In March 2012, the Board remanded the claim for additional development. The Board is satisfied that the directives in this remand have been accomplished. The Board has reviewed the Veteran's physical claims file, as well as his electronic file through the "Virtual VA" system, to ensure a complete review of the evidence in this case. FINDINGS OF FACT 1. The preponderance of the evidence weighs against a finding that the Veteran currently has from PTSD. 2. The preponderance of the evidence weighs against a finding that the Veteran currently suffers from any acquired psychiatric disorder related to his period of active military service, to include any incident or event therein. CONCLUSION OF LAW An acquired psychiatric disorder, to include PTSD, was not incurred during active military service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002 & Supp 2012); 38 C.F.R. §§ 3.102, 3.156, 3.303, 3.304, 3.307. 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating their claims for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the decision of the U.S. Court of Veterans Appeals (Court) in Dingess v. Nicholson, 19 Vet. App. 473 (2006), requires more extensive notice in claims for compensation, e.g., as to potential downstream issues such as disability rating and effective date. If complete notice is not provided until after the initial adjudication, such a timing error can be cured by subsequent legally adequate VCAA notice, followed by readjudication of the claim, as in an SOC or Supplemental SOC (SSOC). Moreover, where there is an uncured timing defect in the notice, subsequent action by the RO which provides the claimant a meaningful opportunity to participate in the processing of the claim can prevent any such defect from being prejudicial. Mayfield v. Nicholson, 499 F.3d 1317, 1323-24 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). An error in VCAA notice should not be presumed prejudicial, and the burden of showing harmful error rests with the party raising the issue, to be determined on a case-by-case basis. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). As will be explained below, neither the Veteran, his former attorney, nor his current representative has alleged prejudicial error and, upon review of the record, we find that none has otherwise been shown. The RO, in a March 2007 notice letter, advised the Veteran that he may submit evidence showing that his claimed disorder existed from military service to the present time and described the types of information and evidence that he should submit in support of his claim. The RO also explained what evidence VA was responsible for obtaining or would assist in obtaining on the Veteran's behalf in support of his claim. The RO further explained how VA determines the disability rating and the effective date, which satisfied Dingess notice requirements. The Board notes that the March 2007 notice letter was sent before the initial denial of the claim and adequately satisfied VCAA notice requirements with respect to the Veteran's claim. Upon remand, additional notification efforts were undertaken via a March 2012 letter which asked the Veteran for information needed to adjudicate his claim. In this regard, in the March 2012 remand, the Board requested that the Veteran be asked to submit copies of any information concerning his overseas TDY assignments (including specific dates) and a statement of his claimed overseas stressors with specific dates of the claimed stressful incidents. However, the Veteran failed to respond to the RO's request. The record further reflects that the Veteran has been provided with a copy of the above rating decision, the SOC, and the SSOC, which cumulatively included a discussion of the facts of the claims, pertinent laws and regulations, notification of the bases for the decisions, and a summary of the evidence considered to reach the decisions. While the Veteran has not been provided with notice regarding the amendment to the PTSD regulation, failure to do so is harmless error because the Veteran is not shown to have a current DSM-IV diagnosis of PTSD. Therefore, the amended regulation is inapplicable in this case. Moreover, neither the Veteran nor his representative has alleged any prejudice with respect to the notice received for the claim. The Veteran has been provided with ample opportunity to submit evidence and argument and to participate effectively in the processing of his claim during the course of this appeal. In consideration of the foregoing, the Board concludes that the requirements of the notice provisions of the VCAA have been met, and there is no outstanding duty to inform the Veteran that any additional information or evidence is needed. Regarding VA's statutory duty to assist in claims development, the Board notes that the Veteran's service treatment records (STRs) and service personnel records are included in the claims folder. Also, treatment records adequately identified as relevant to the Veteran's claim have been obtained, to the extent possible, and are associated with the record. These include additional treatment records from the VA Medical Center in Dallas, Texas, which, in accordance with the March 2012 remand, has been associated with the Veteran's electronic folder through Virtual VA and have been considered by the RO and in the Board in the decision below. The Board notes that a VA examination pertinent to the Veteran's claim was obtained in April 2011. A review of the report of examination shows that all subjective and objective findings necessary for evaluation of the Veteran's claim were observed and recorded. Thus, for reasons further explained below, the examination appears to be complete and adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Finally, as previously noted, the Veteran was afforded a Travel Board hearing before the Board in August 2011 before the undersigned, at which time the elements of the claim on appeal, as well as the types of evidence that would contain pertinent findings, were discussed. See Bryant v. Shinseki, 23 Vet. App. 488 (2010). The Veteran has not made VA aware of any other evidence relevant to his appeal that needs to be obtained. Based on the foregoing, 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 the claim. In view of the foregoing, the Board will proceed with appellate review. II. Service Connection It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C.A. § 7104(a). The Board has thoroughly reviewed all the evidence in the record. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the veteran). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court of Appeals for Veterans Claims held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. The Court has also stated, "It is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. Service connection may be granted for disability or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). As a general matter, service connection for a disability on the basis of the merits of such claim requires (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). 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 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d). Chronic diseases, such as psychoses, will be presumed to have been incurred in service if it had become manifest to a degree of ten percent or more within one year of the Veteran's separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay persons can also provide an eye-witness account of an individual's visible symptoms. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that a layperson may comment on lay-observable symptoms). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter 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"). The Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1137 (Fed. Cir. 2006). Factors for consideration in assessing credibility include a showing of interest, bias, inconsistent statements, consistency with other evidence, and a lack of contemporaneous medical evidence, although that alone may not bar a claim for service connection. Buchanan, 451 F.3d at 1336-37; Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996), superseded in irrelevant part by statute, Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000). 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). PTSD To establish entitlement to service connection for PTSD the evidence must satisfy three basic elements. Generally, there must be (1) medical evidence diagnosing PTSD; (2) a link, established by medical evidence, between current symptoms of PTSD and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred (although several presumptions exist which serve to ease this evidentiary burden in some cases). 38 C.F.R. § 3.304(f). The PTSD diagnosis must be made in accordance with the criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 38 C.F.R. § 4.125(a). A revision of 38 C.F.R. § 3.304(f) (3) (effective July 13, 2010) (which would apply in the instant case, if pertinent, as an appeal in this matter was before the Board but not yet decided on July 13, 2010) does not, in fact, apply as the Veteran did not have serve in combat, and the record does not show or suggest that he had any exposure to terrorist activity. In this case, the Veteran contends that he currently has PTSD that is due to his Gulf War service. His stressors include combat exposure, witnessing the deaths of soldiers and civilians, participating in a rescue mission to retrieve a pilot who was taken as a prisoner of war (POW) in 1991, seeing the body of a fellow service member who committed suicide, and being one of the last people to see a sergeant alive before he died in a car accident. In this regard, the first step is to determine whether the Veteran's psychiatric symptoms satisfy the DSM-IV criteria for a diagnosis of PTSD. In order to prevail on the issue of service connection, there must first be evidence of a current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). Here, the Board recognizes that the Veteran has been diagnosed with PTSD. However, at best, this diagnosis appears to be a result of the Veteran's own report and not the opinion of a medical professional based on a comprehensive psychiatric evaluation of the Veteran and review of the record. A review of the evidence of record shows that although the Veteran has been shown to be diagnosed with PTSD, such evidence does not show that the Veteran has a current diagnosis of PTSD in accordance with DSM-IV. VA treatment records include an August 2005 PTSD screen which was negative; the Veteran denied having any PTSD symptomatology at that time. However, a February 2007 primary care report reflects an assessment of PTSD/depression for which he was referred to a mental health clinic. In May 2007 stressor statements, the Veteran identified the following stressors: (1) loading the cargo bay of a KC-10 with dead bodies and military equipment in Jeddah, Saudi Arabia and soon after take-off witnessing enemy fire; (2) seeing the body of a fellow soldier "J.M.," with whom he served on Honor Guard, hanging from a staircase; (3) performing funerals for soldiers that he knew while on Honor Guard detail; (4) being one of the last people to see SSGT "R." alive before he died in a car accident; and (5) the shooting down of Colonel "E.'s" who was taken as a POW during the first Gulf War. He stated that all of these events occurred from June 1990 to October 1993. VA treatment records include a May 2007 mental health evaluation at which time the Veteran reported that he began having sleep problems and anxiety during service when his unit participated in a rescue mission to retrieve a pilot who was taken as a POW in 1991. He also stated that he saw a soldier who hung himself and experienced combat-related events. He also stated that he once flew back from Jeddah with 12 caskets which was a terrifying experience; shared a plane ride with a staff sergeant who later died in an accident; and witnessed the deaths of soldiers and civilians "on the front lines." The Veteran was diagnosed with PTSD which a VA psychiatrist related to his service in the Persian Gulf from 1990 to 1993. Although this diagnosis was rendered after a complete mental health evaluation, the psychiatrist did not indicate how each of the prongs of the DSM-IV criteria were met, limiting the probative value of such diagnosis. In addition, to the extent that the VA psychiatrist based his opinion on the assumption the stressors had been verified, the opinion was based on a false factual premise and carries no probative value. Therefore, it cannot be used to verify the stressors actually occurred. Notably, in August 2007, VA issued a formal finding based on a lack of information required to verify the Veteran's PTSD stressors. They determined that the information required to verify the stressful events described by the Veteran was insufficient to send to the Joint Service Records Research Center (JSRRC). All efforts to obtain the needed information were exhausted and any further attempts were futile. VA treatment records include a May 2008 report which shows that the Veteran reported a new stressor of watching a friend of his "catch on fire and die while they were working on an aircraft" during service. It was noted that he appeared to meet criteria for PTSD. VA treatment records show that in November 2008, the Veteran was invited to participate in the mental health PTSD group starting in December 2008. The Veteran was afforded a VA PTSD examination in April 2011, at which time the Veteran described his most significant problem as consisting of depression which began 15 or 20 years ago. He stated that he received a full scholarship to play football after high school, but was unable to attend college after his girlfriend became pregnant. As regards military stressors, he described three particularly upsetting experiences: (1) the death of SSGT "R."; (2) Colonel "E." being shot down during the first Gulf War, although he did not witness the incident and Colonel "E." later returned to his troops; and (3) seeing the body of a fellow soldier hanging by the neck from a rope tied to the stairs between two buildings and trying to resuscitate the soldier, but he was already dead. The examiner found that the incidents described by the Veteran at that time did not meet the criteria for a stressor under DSM-IV and diagnosed him with depressive disorder, NOS (not otherwise specified), that was less likely as not caused by or a result of service. The examiner also noted that the stressors described were not related to the fear of hostile military or terrorist activity. He further explained that it appeared that the Veteran's depressive disorder was primarily related to his frustration and disappointment in his life since prior to service in high school when his then girlfriend and current ex-wife got pregnant. At his Board hearing before the undersigned in August 2011, the Veteran testified that when he came back from Saragossa Air Base, Sergeant "R.," with whom he served as a crew chief on a KC-10, died in a car accident. He also testified that he had trouble sleeping after Colonel "E.'s" plane was shot down. He stated that he first sought psychiatric treatment in 1995. While his DD-214 lists a MOS (military occupational specialty) of strategic aircraft maintenance specialist, he testified that he was a flyer crew chief and a master sergeant and was on flight status during service. Virtual VA treatment records dated from December 2008 to May 2012 include diagnoses of PTSD. However, none of these relate the Veteran's PTSD to his service or show that any of these diagnoses were made in accordance with DSM-IV. The Board notes that PTSD is not a simple medical condition that the Veteran as a lay person can perceive based on mere personal observation, that is, by visual observation or by any other of the senses. For these reasons, the Veteran as a lay person is not competent to declare that he has PTSD or to offer an opinion that PTSD is related to the incident in service as the Veteran has described as PTSD is not a simple medical condition. In addition, it has not been established that the Veteran is otherwise qualified through specialized education, training, or experience to state that he has PTSD or to offer an opinion on a condition that is medical in nature. Therefore, the Board rejects the Veteran's statements, that is, the lay evidence, as competent evidence that the Veteran has PTSD related to service either based on continuity of symptomatology under 38 C.F.R. § 3.303(b) or on initial diagnosis after service under 38 C.F.R. § 3.303(d). In light of the above, the weight of the evidence is against a finding that the Veteran meets the criteria for a current diagnosis of PTSD. Given the finding that the Veteran does not have PTSD, stressor verification is simply not warranted. Thus, for the foregoing reasons, the Board concludes that the Veteran is not entitled to service-connected compensation benefits for PTSD because he does not currently suffer from the disability. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). In the absence of a present disability, there can be no valid claim. Brammer v. Derwinski, 2 Vet. App. 141 (1992). Therefore, because the preponderance of the evidence is against his claim, service connection for PTSD is not warranted. Psychiatric disorders other than PTSD Pursuant to the Clemons case, the Board must also consider whether service connection is warranted for any current psychiatric disorders other than PTSD. In this case, on VA examination in April 2011 the Veteran was diagnosed with depressive disorder. Because a current psychiatric disorder has been established, the Board will next consider whether the evidentiary record supports in-service incurrence. In this regard, the Veteran's STRs are completely devoid of any mention of psychological problems. The Veteran was afforded a VA Gulf War examination in November 1993 at which time he complained of increased anger, difficulty talking with friends, and increased drug and alcohol use. The assessment was that he seemed to be adjusting from his recent separation from the military. VA treatment records include an August 2005 depression screen at which time the Veteran denied any loss of interest in usually pleasurable things or feelings of sadness and hopelessness. However, as previously noted, a February 2007 primary care report reflects an assessment of depression. A May 2007 report also reflects a psychiatric history which includes a diagnosis of major depressive disorder (MDD). Notably, none of these reports relates the Veteran's psychiatric disorder to his service. Virtual VA treatment records dated from December 2008 to May 2012 include a July 2009 report which reflects a diagnosis of MDD, recurrent, severe with psychosis. Additional treatment records reflect additional diagnoses and treatment of MDD. However, none of these records relate the Veteran's psychiatric disorder to his service. As previously discussed, on VA examination in April 2011, the Veteran was diagnosed with depressive disorder, NOS, that the examiner opined was less likely as not caused by or a result of service. The rationale provided was that the Veteran's depressive disorder appeared to be primarily related to his frustration and disappointment in his life since prior to service in high school when his then girlfriend and current ex-wife got pregnant. Upon review of the evidence of record, the Board finds that the preponderance of the evidence weighs against a finding that the Veteran's current major depressive disorder is related to his period of active service for reasons explained below. The Board notes that the first evidence of a diagnosed psychiatric disorder included in the record is dated in February 2007, approximately 14 years after service. See 38 C.F.R. § 3.303(b); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (noting that a lengthy period of absence of complaints and medical treatment for a condition can be considered as a factor in resolving a claim). Notably, at this time, the February 2007 report made absolutely no mention of any psychiatric symptomatology during his period of active service or having had a continuity of psychiatric problems since his service. The Board notes that it is likely that the Veteran would have accurately reported his history while seeking medical treatment for the symptomatology. In addition, although the Veteran testified that he first sought psychiatric treatment in 1995, this assertion is not corroborated by the medical evidence of record. As it relates to the Veteran's competent account of having been one of the last people to see Sergeant "R." alive before his death and seeing the body of a fellow serviceman hanging from the dorm's staircase, there is no indication in the record that his accounts are not credible. However, as it relates to the competent account of: (1) loading the cargo bay of a KC-10 with dead bodies and military equipment in Jeddah, Saudi Arabia and witnessing hostile fire; (2) serving in the Honor Guard; (3) participating in a rescue mission to retrieve a pilot who was taken as a POW in 1991; (4) witnessing the deaths of civilians and soldiers; and (5) participating in combat, these events do not seem to be consistent with the circumstances of his service. In this regard, the available evidence does not indicate his combat participation and his occupational specialty was as a strategic aircraft maintenance specialist, for the KC-10 aircraft. The KC-10 is a tanker primarily used for aerial refueling of combat aircraft; as such, it would be unlikely to fly in combat. Moreover, his performance evaluations refer to his servicing and ground handling of the aircraft. The Veteran's service personnel records do not in any way corroborate his unsubstantiated accounts of alleged events that occurred during his service. For these reasons, we do not find the Veteran's assertion of having a psychiatric disorder that is related to his service to be credible evidence and, consequently, afford it no probative value. Although the Veteran has repeatedly asserted that he suffers from a psychiatric disorder related to service, he, as a lay person, is not competent to render a medical opinion regarding the etiology of claimed psychiatric disorder. While he is competent to report his experience of symptomatology and has alleged a continuity of symptomatology since service, the Board does not consider alleged continuity of symptomatology to be credible when weighed against the other evidence of record, as discussed above. Moreover, the Veteran did not seek any treatment for psychiatric problems during service. In addition, the first indication of a psychiatric disorder is not shown until 14 years after service. Moreover, there is no competent probative medical opinion evidence that links the Veteran's current psychiatric disorder to his service. For these reasons, the Board concludes that the Veteran is not entitled to service-connected compensation benefits for his current psychiatric disorder. Therefore, because the preponderance of the evidence is against his claim, service connection for an acquired psychiatric disorder other than PTSD is also not warranted. In reaching this conclusion, the Board notes that under the provisions of 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102, a reasonable doubt is to be resolved in the claimant's favor in cases where there is an approximate balance of positive and negative evidence in regard to a material issue. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for an acquired psychiatric disorder, to include PTSD, is denied. ____________________________________________ T. D. JONES Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs