Citation Nr: 1306107 Decision Date: 02/21/13 Archive Date: 04/10/13 DOCKET NO. 09 22 9 3 DATE FEB 21 2013 On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder. 2. Entitlement to service connection for a gastrointestinal disorder, to include as secondary to an acquired psychiatric disorder. REPRESENTATION Appellant represented by: Tennessee Department of Veterans' Affairs WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J. H. Nilon, Counsel INTRODUCTION This appeal has been advanced on the Board's docket pursuant to 38 U.S.C.A. § 7107(a)(2) (West 2002) and 38 C.F.R. § 20.900(c) (2012). The Veteran served on active duty from June 1953 to June 1957. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued March 2002 by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee that declined to reopen a previously-denied claim of entitlement to service connection for a stomach disorder and also denied service connection for depression. The Veteran testified before the undersigned Veterans Law Judge in a hearing at the RO ("Travel Board" hearing) in March 2011. A transcript of the hearing is of record. In a decision issued in November 2011 the Board reopened the claim of entitlement to service connection for a gastrointestinal disorder. The Board's action also observed that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record; see demons v. Shinseki, 23 Vet. App. 1 (2009). The issues have been recharacterized to comport with the evidence and arguments currently of record. In its November 2011 action the Board remanded these issues to the Originating Agency for further development, which has been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). FINDINGS OF FACT 1. The Veteran is not diagnosed with posttraumatic stress disorder, and competent and uncontroverted medical opinion of record states his diagnosed mood disorder is not likely related to service. -2- 2. The Veteran's gastrointestinal disorder, diagnosed as gastroesophageal reflux disease (GERD), is not etiologically related to service or to a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a psychiatric disorder are not met. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 2. The criteria for service connection for a gastrointestinal disorder are not met. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Upon receipt of a complete or substantially complete application, VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. The Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009 (reversing prior cases law imposing a presumption of prejudice on any notice deficiency and clarifying that the burden of showing harmful or prejudicial error normally falls on the party attacking the agency's determination). Further, in his March 2011 hearing before the Board the Veteran expressly waived any error in the content or timing of the notice provided. -3- The Veteran's service treatment records and service personnel records have been obtained, as well as treatment records from those VA and private medical providers identified by the Veteran as having records relevant to the issues on appeal. The Veteran has also been afforded a hearing before the Board, at which he presented oral argument in support of his claims with the assistance of a service representative. The Board remanded the case for additional development, including medical examinations, which were performed in January 2013. The examinations substantially complied with the requirements articulated in the Board's remand. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999). There is no indication that any additional evidence relevant to the issues decided is available and not part of the claims file. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). As there is no indication that any failure on the part of VA to provide any additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfleld v. Nicholson, 20 Vet. App. 537 (2006); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 486 (2006); Sanders, 129 S.Ct. 1696. Applicable Laws and Regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by military service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of service connection there must generally be medical evidence of a current disability; medical evidence, or in some cases lay evidence, of in-service occurrence or aggravation of a disease or injury; and, medical evidence of a nexus between an in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). -4- Service connection may also be granted for disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet App. 439 (1995). To prevail on the issue of secondary service causation, the record must show evidence of a current disability, evidence of a service-connected disability and medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). When there is a proximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2011). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Evidence and Analysis Service connection for an acquired psychiatric disorder Service treatment records (STRs) show the Veteran had a clinical psychiatric evaluation of "normal" in his enlistment physical examination in June 1953. The file contains a physical profile dated in August 1953 as part of recruit training showing defects of "dull normal intelligence" and "mild character disorder" as a result of which the Veteran was assigned a PULHES profile of S-2. (The "PULHES" profile reflects the overall physical and psychiatric condition of an individual on a scale of 1 (high level of fitness) to 4 (medical condition or physical defect that is below the level of medical fitness required for retention in the military service). The "P" stands for "physical capacity or stamina;" the "U" indicates "upper extremities;" the "L" is indicative of "lower extremities;" the "H" reflects the condition of the "hearing and ears; the "E" is indicative of the "eyes;" and the "S" stands for "psychiatric condition." Odiorne v. Principi, 3 Vet. App. 456,457 (1992). See generally Hanson v. Derwinski, 1 Vet. App. 512, 514 (1991), for an explanation of the military medical profile system.) -5- STRs are silent in regard to any active psychiatric symptoms or treatment during service. A physical examination on Release from Active Duty (RAD) in May 1957 notes psychiatric evaluation as "NE" (Not Examined). An April 2000 treatment note by a VA psychiatrist states the Veteran had been treated at the VA mental health clinic (MHC) since at least November 1998. The current clinical impression was dysthymia. A subsequent MHC treatment note in September 2000, by the same VA psychiatrist, states the Veteran had a history of depression and dysthymia as well as chronic medical problems; the current clinical impression was major depression in the context of dysthymia. However, in November 2000 the same VA psychiatrist changed the clinical impression to recurrent major depression (mild) with significant generalized anxiety The Veteran underwent a VA neuropsychology evaluation in July 2001 that discussed the Veteran's current cognitive functioning and characterized such function as essentially within normal limits. No psychiatric diagnosis was articulated. Subsequent VA MHC treatment records show the Veteran had lost his job as a part-time security guard in approximately March 2001 and was unable thereafter to find another job. An MHC note in September 2001 states the Veteran remained very frustrated about his current lack of employment; current clinical impression was major depression in the context of chronic anxiety, with the primary stressor being his continued lack of employment. In March 2002 the RO issued a rating decision that denied service connection for depression. The rating decision acknowledged the Veteran had been identified with a personality disorder in service but noted that a personality disorder is not a disability for which service connection can be considered. The earliest evidence of a psychiatric disorder for which service connection can be considered was in April 2000. The Veteran had thereafter been identified variously with dysthymia, major depression and chronic anxiety, but there was no evidence to relate these disorders to service. -6- In June 2002 the Veteran submitted a Notice of Disagreement (NOD) in regard to the March 2002 rating decision, and also stated a new claim for service connection for posttraumatic stress disorder (PTSD). A rating decision in October 2002 denied service connection for PTSD, based on a determination that the record did not show a diagnosis of PTSD or an in-service stressor. The Veteran testified before the RO's Decision Review Officer (DRO) in December 2002 that he had been encouraged to file a claim for PTSD by his VA psychiatrist. The Veteran was unable to remember any stressful events in service other than an initiation ceremony performed when crossing the equator. A September 2007 MHC treatment note by the Veteran's psychiatrist shows a new clinical impression of mood disorder not otherwise specified (NOS). An RO Memorandum dated in August 2008 states the Veteran had been asked to provide verifiable in-service stressors, but he had failed to respond. Accordingly, there was insufficient information to submit a request for corroboration to the U.S. Army and Joint Services Records Research Center (JSRRC) or the National Archives and Records Administration (NARA). MHC treatment notes during the period March-August-December 2009, by a psychiatrist, state the Veteran continued to be frustrated by financial problems and by current health concern of both the Veteran and his wife. The Veteran was living on Social Security Administration (SSA) retirement benefits but had been denied SSA disability benefits. The psychiatrist continued the previous clinical impression of mood disorder NOS. The Veteran testified before the Board in March 2011 that he had not, to his knowledge, ever been formally diagnosed with PTSD. The Veteran submitted Statements in Support of Claim in February 2011 and December 2011 in which he described an in-service stressor consisting of an -7- incident that occurred in late 1954 or early 1955 while the Veteran, then a member of a Navy mobile construction battalion (CB, or "Seabees"), was building an airfield in the Philippines. The Veteran witnessed the death of a fellow Seabee named Curly, who was crushed when an earth mover he was driving flipped over. The Veteran reported having frequent nightmares relating to this incident. A MHC treatment note dated in May 2011 continued the clinical impression of mood disorder NOS. The Veteran had a VA psychiatric compensation and pension (C&P) examination in July 2011, performed by a psychologist who reviewed the claims file. The Veteran denied having participated in combat. The examiner noted the Veteran was currently receiving medication for symptoms of depression and anxiety. The examiner performed a mental status evaluation (MSE) and noted observations in detail. The examiner diagnosed mood disorder NOS (Axis I) and personality disorder NOS (Axis II). The examiner stated an opinion that the diagnosed mood disorder was not likely caused by or a result of service. As rationale, the examiner stated the Veteran had not reported any events or experiences in service that he believed had impacted his mental health. A December 2012 RO Memorandum states the Veteran's stressor of witnessing the death of a fellow Seabee in the Philippines was not sufficiently detailed to be sent to JSRRC or NARA for verification. Per review of the Veteran's service personnel record, such an incident may have occurred in during a 10-month period (September 1955 to July 1956) at Cubi Point, in the Philippines, but the period was too long to submit for verification and the Veteran had been unable to narrow the period. Also, the Navy had been asked to verify the death of "Curly" but was unable do so without a full name; the RO asked the Veteran to provide a full name but the Veteran was unable to comply. The RO concluded that the Veteran's claimed stressor could not be conceded without corroborating information. The Veteran had a VA examination in January 2013, performed by a psychologist who reviewed the claims file and noted the Veteran had a current diagnosis of mood disorder NOS; no other current psychiatric diagnoses were shown. The Veteran reported having witnessed a fellow servicemember ("Curly") get run over; thinking -8- about the incident caused the Veteran to become upset and he did not want to discuss it. The Veteran also reported frustration and stress relating to his wife's declining health. The examiner performed an MSE and noted observations in detail. The examiner stated the Veteran showed symptoms of depression and anxiety and concerns about his wife's health; he had witness an individual get run over by heavy equipment during service but the resultant effects on the Veteran appeared to actually be quite slight. The Veteran's mood-related difficulties appeared to be less likely than not due to the effects of any events in service. The scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record, demons, 23 Vet. App. 1. Further, there is no prohibition against a veteran being service-connected for more than one diagnosed psychiatric disorder; see Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009) (noting that different psychiatric diagnoses may have symptoms that are not overlapping). Accordingly, the Board must consider entitlement to service connection for every diagnosed psychiatric disorder shown after discharge from service. The only formal psychiatric diagnosis of record is mood disorder NOS, as diagnosed by the VA examiner in July 2011 and affirmed as the only current psychiatric diagnosis by the VA examiner in January 2013. The VA examiner in July 2011 also diagnosed personality disorder in Axis II, but personality disorders are deemed to be congenital or developmental abnormalities and are not considered to be disabilities for the purposes of service connection. See 38 C.F.R. §§ 3.303(c), 4.9,4.127; see also Winn v. Brown, 8 Vet. App. 510, 516 (1996). This prohibition also applies to the "character disorder" that was noted as a defect during service. The record does not show any competent diagnosis of PTSD. However, 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). -9- When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, id. While the Veteran is competent to report events in service and post-service residuals (nightmares, intrusive thoughts, etc.) the Veteran is not shown to be competent to render a diagnosis of PTSD based on such symptoms. In that regard, the VA examiner in January 2013 accepted the Veteran's reported stressor at face value and found nonetheless that the Veteran could not be clinically diagnosed with PTSD. "Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability ... in the absence of a proof of present disability there can be no claim." Brammer v. Derwinski, 3 Vet. App. 223,225 (1992). Accordingly, service connection for PTSD cannot be considered, and the claimed in-service stressor need not be discussed. The requirement of a "current disability" is satisfied when the claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, and a claimant may be granted service connection even though the disability resolves prior to the Secretary's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In that regard, post-service treatment notes show clinical impressions including dysthymia (April 2000), major depression in the context of dysthymia (September 2000), recurrent major depression with generalized anxiety (November 2000) and major depression in the context of chronic anxiety (March-September 2001). These clinical impressions indicate the current predominant symptoms but do not constitute formal multi-axial psychiatric diagnoses. Further, the treatment records in which those clinical impressions were articulated are silent in regard to any relationship between current symptoms and service. The Board will accordingly consider whether service connection may be granted for mood disorder NOS, which is the sole diagnosed psychiatric disorder of record. A veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). Where an opinion -10- is used to link the current disability to a cause during service, a competent opinion of a medical professional is required; Caluza v. Brown, 7 Vet. App. 498 (1995). "Competent medical evidence" means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159(a)(1); Cox v. Nicholson, 20 Vet. App. 563 (2007). In this case, the examining VA psychologists in July 2011 and January 2013 agreed that the Veteran's diagnosed mood disorder is not likely related to service. These opinions are not controverted by any other medical opinion of record. VA must consider all favorable lay evidence of record. 38 USCA § 5107(b); Caluza, 7 Vet. App. 498. Accordingly, in addition to the medical evidence, the Board has considered the lay evidence offered by the Veteran in the form of his correspondence to VA, his testimony before the RO and before the Board, and his statements to various medical providers and examiners. A layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995). Thus, the Veteran is competent to describe the onset and progression of his psychiatric symptoms. However, a layperson is not considered capable of opining, however sincerely, in regard to causation of a disability. Routen v. Brown, 10 Vet. App. 183,187 (1997), ajfdsub nom Routen v. West, 142 F3d 1434 (Fed. Cir. 1998), cert denied, 119 S. Ct. 404 (1998). Instead, it is the province of trained health care professionals to enter conclusions that require medical expertise, such as opinions as to diagnosis and causation. Jones v. Brown, 7 Vet. App. 134, 137 (1994). The competent and uncontroverted medical opinion of record shows the Veteran's diagnosed mood disorder is not likely related to service, so the claim must be denied. The preponderance of the evidence is against the claim; there is no doubt to be resolved; and service connection for a psychiatric disorder is not warranted. -11- Service connection for a gastrointestinal disorder STRs show the Veteran was treated for "upset stomach" in November 1956; he was treated with bicarbonate of soda and returned to duty. He complained of stomach cramps in January 1957, which was clinically attributed to early appendicitis or gastroenteritis. He was treated later in January 1957 for cold and abdominal pain. A physical examination on Release from Active Duty (RAD) in May 1957 cites clinical evaluation of the abdomen and viscera as "normal." The Veteran was treated by VA for gastritis with reflux in August-September 1992. He reported at the time that he had stomach pains for the past three years that were associated with peptic ulcer disease (PUD). The Veteran underwent a VA endoscopy in September 1992 that showed an impression of gastritis; no ulcer was shown. In October 1992 his digestive disorder was recharacterized as gastroesophageal reflux disease (GERD). Treatment for GERD continued through November-December 1992. The Veteran filed an original claim for service connection for a stomach disorder in October 1992. The Veteran asserted in his claim that stomach problems had developed in service and had continued since then. In his claim, the Veteran asserted he had been treated for stomach problems by Dr. John A. Turner from 1957 to 1960 and by Dr. J.R. Quarles from 1960 to 1990. The RO requested treatment records from Dr. Turner, but Dr. Turner responded by a letter in January 1993 stating he had not seen the Veteran for the past 8-9 years, and any clinical treatment records more than 7 years old had been destroyed. The RO denied service connection for a stomach condition by a rating decision in February 1993. In its decision the RO acknowledged that the Veteran had been treated in service for stomach complaints in 1956 and 1957 but had been found normal at discharge. The RO found the evidence of record showed the Veteran's stomach problems in service were acute and transitory with no disabling residuals. A VA treatment note in April 1993 characterized the Veteran's current digestive disorder as "persistent GERD." -12- Dr. Turner submitted a letter dated in April 1993 stating he had treated the Veteran in 1957 for gastrointestinal disturbances that could have been caused by nervous tension. The Veteran testified before the RO's Hearing Officer in April 1993 that he had no gastrointestinal problems prior to service. He was first treated for stomach complaints in 1953 while en route to Guam; he told at the time that he was probably just nervous about the movement to Guam and was given an over-the-counter antacid. He was treated again in 1956 for digestive problems manifested by abdominal pain and cramping. He was treated three times in 1957. His discharge physical examination was very cursory. He was discharged from service in June 1957, but his symptoms of abdominal pain and cramping continued and he consulted Dr. Turner in August-September 1957. Dr. Turner provided the Veteran a prescription medication, which resolved his symptoms. However, the Veteran continued to consult physicians 8-10 times per year for digestive complaints; he saw Dr. Turner until 1962 or 1963 and after that he was treated by Dr. Quarles; he had also been treated by the VA hospital. He was variously told his abdominal symptoms were related to stomach acidity, nervous tension and/or gastritis. He also reported that Dr. Quarles had gone out of business. Dr. J.R. Quarles submitted a letter to VA in June 1993 stating the Veteran had been his patient from 1962 until he closed his practice in January 1992. During that period Dr. Quarles treated the Veteran for stomach problems on several occasions. The Hearing Officer issued a decision in August 1993 that continued the denial of service connection, based on a finding that the objective evidence of record failed to establish a chronic stomach disorder in service or continuity of symptomatology following service to relate the onset of a current chronic disorder to service. The Veteran subsequently perfected an appeal to the Board. In November 1995 the Board issued a decision that continued the denial of service connection for a claimed stomach condition. The Board noted the Veteran's contention that his stomach problems began in service and that he had stomach problems since that time, but the Board found as fact that in-service stomach symptoms were acute and -13- transitory and had resolved without residuals, and that the Veteran's post-service stomach problems were not shown to be related to service. The Board concluded that the Veteran's current stomach condition was not incurred on or aggravated by service. The Veteran underwent VA Sigmoidoscopy in May 2002. The clinical impression was diverticulosis of the sigmoid colon. The Veteran had a VA upper endoscopy esophagogastroduodenoscopy (EGD) in October 2006. The impression was essentially unremarkable examination. In regard to the Veteran's complaint of dyspepsia since 1956, the clinician suspected such symptoms were related to upper gastrointestinal dysmotility. The Veteran testified before the RO's Decision Review Officer (DRO) in December 2002 that during service he had stomach problems related to the poor quality of the food; he was not hospitalized in service but received antacids from sick bay. He was treated by Dr. Turner for stomach problems within a few weeks after discharge from service; Dr. Turner attributed his stomach problems at the time to an over-acid stomach due to "nerves." The Veteran was currently being treated by VA for stomach complaints, but nobody had ever informed the Veteran of what caused his stomach problems. Mr. JRR submitted a Statement in Support of Claim (SISC) to VA in August 2008 asserting he had known the Veteran for 50 years, shortly after the Veteran left service, and had observed the Veteran to be suffering greatly with a stomach problem. Similarly, the Veteran's sister Ms. EIF submitted a concurrent SISC stating the Veteran had good health until 1955-1957 and was now going continually to VA for treatment for stomach problems. Ms. MLB submitted a concurrent SISC stating she had known the Veteran for a long time and had observed the Veteran trying to cope with stomach problems and with stress related to his health problems and to trying to pay his bills. The Veteran was referred to the VA gastroenterology clinic in August 2008 for evaluation of abdominal pain, reportedly since at least 1955. The Veteran complained of stomach pain, reflux with sour-tasting stomach contents and foul- -14- smelling flatus. Medications had not provided much relief. The Veteran reported many stressors in his life that he associated with worsened abdominal pain. The clinical impression was GERD and non-ulcer dyspepsia. During a VA neurological consult in March 2009 the examining neurologist stated the Veteran was a poor historian and often tangential. The Veteran presented to the VA primary care clime (PCC) in May 2010 for routine follow-up. He reported acid reflux with some episodic regurgitation of food. The most recent EGD in November 2008 was normal (no ulcers or strictures). The continued clinical impression was GERD. The same clinical impression was continued in PCC follow-ups dated in March 2011 and July 2011. The Veteran testified before the Board in March 2011 he had stomach problems in service; the most effective treatment he ever received was that provided by Dr. Turner. The Veteran had a VA gastrointestinal examination in January 2013, performed by a physician (board-certified in internal medicine) who reviewed the claims file and noted the Veteran had previously been diagnosed with GERD. The Veteran complained of occasional morning diarrhea and occasional acid reflux with esophageal pain. The examiner performed a clinical examination and noted observations in detail. The examiner stated an opinion that the Veteran's claimed GERD was less likely than not caused by, related to or aggravated by active service. As rationale, the examiner stated that recent EGDs had been unremarkable, and no events during service would have caused or aggravated GERD. Review of the evidence shows the Veteran had occasional treatment during service for stomach problems. He now asserts that stomach problems, currently diagnosed as GERD, have been continuous since service. A veteran's reports of a continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). -15- Lay testimony is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465,469 (1994). However, once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, id. (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza, 7 Vet. App. 498. The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but 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 (Fed. Cir. 2006). The Board may not ignore a veteran's testimony simply because he or she is an interested party and stands to gain monetary benefits, but personal interest may affect the credibility of the evidence. Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). The Board finds the Veteran's account of chronic GERD that began in service and has been continuous since discharge from service is not credible because such assertion is contradicted by the discharge examination in which his digestive system was noted to be normal. Private physicians Drs. Turner and Quarles are shown to have treated the Veteran intermittently after his discharge from service for digestive complaints, but those providers are not shown to have treated a single chronic digestive disorder. Similarly, the lay statements offered by the Veteran's friends and family in August 2008 show a long history of digestive symptoms but do not show the presence of a chronic digestive disorder since service. Finally, the Veteran is shown by medical evidence to be an unreliable historian. For these reasons, the Board finds the Veteran's account of chronic GERD since service is not credible, and service connection as a chronic condition under 38 C.F.R. § 3.303(b) is not warranted. -16- Turning to entitlement to direct service connection under 38 C.F.R. § 3.304 for GERD diagnosed after service, the competent and uncontroverted medical opinion of record, in the form of the VA examination in January 2013, states the Veteran's GERD is not likely related to service. The findings of a physician are medical conclusions that the Board cannot ignore or disregard. Willis v. Derwinski, 1 Vet. App.66(1991). Finally, the Veteran has asserted his belief that GERD is proximately caused, or aggravated by, a psychiatric disorder. However, he does not have any service-connected psychiatric or medical disabilities on which a claim for secondary service connection can be based. The preponderance of the evidence is against the claim; there is no doubt to be resolved; and service connection for a gastrointestinal disorder is not warranted. ORDER Service connection for an acquired psychiatric disorder is denied. Service connection for a gastrointestinal disorder is denied. RONALD W. SCHOLZ Veterans Law Judge, Board of Veterans^ Appeals -17-