Citation Nr: 1318091 Decision Date: 06/04/13 Archive Date: 06/11/13 DOCKET NO. 08-31 124 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia THE ISSUE Entitlement to service connection for an innocently acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD G. E. Wilkerson, Associate Counsel INTRODUCTION The Veteran served on active duty from December 1969 to January 1972. This appeal comes before the Board of Veterans' Appeals (Board) from an August 2007 rating decision of the RO. In August 2010, the Board reopened and remanded the claim of service connection for an innocently acquired psychiatric disorder, to include PTSD. For the reasons discussed below, the RO/Appeals Management Center (AMC) complied with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). A review of the Veteran's Virtual VA electronic claims file reveals no additional records. FINDINGS OF FACT 1. The Veteran is not shown to have manifested complaints or findings referable to an innocently acquired psychiatric disorder during active service or for several years thereafter. 2. The Veteran is not shown to have met the criteria warranting a diagnosis of PTSD. 3. The Veteran is not shown to have another innocently acquired psychiatric disorder that is causally linked to an event or incident of a period of active service, including that in the Republic of Vietnam. CONCLUSION OF LAW The Veteran does not have an innocently acquired psychiatric disability, to include PTSD, due to disease or injury that was incurred in or aggravated by active service, nor may a psychosis be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1103, 1110, 1112, 1113, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.301, 3.303, 3.304, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 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, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The RO provided VCAA notice letter to the Veteran in March 2007. The letter notified the Veteran of what information and evidence must be submitted to substantiate a claim for service connection. The letter also informed the Veteran of what information and evidence must be provided by the Veteran and what information and evidence would be obtained by VA. The Veteran was also told to inform VA of any additional information or evidence that VA should have, and was told to submit evidence in support of his claim to the RO. The content of the letters complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). The requirements of VCAA also include notice of a disability rating and an effective date for award of benefits if service connection is granted. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Veteran was provided with notice of the type of evidence necessary to establish a disability rating and effective dates in the March 2007 letter. The Board finds that all relevant evidence has been obtained with regard to the Veteran's claim, and the duty to assist requirements has been satisfied. All available service treatment records were obtained. The VA treatment records dated through 2007 are associated with the claims folder. The Veteran's Social Security Administration (SSA) records and private treatment records have also been obtained. The Veteran underwent VA examinations in August 2010 to obtain medical evidence as to the nature and likely etiology of the claimed psychiatric disorder, as instructed in an August 2010 remand. The examiner provided the requested opinions thus complied with the Board's remand instructions in this regard. Stegall, 11 Vet. App. at 271. The Board has considered the Veteran's assertions that the August 2010 VA examination was inadequate, as his Vietnam service was not discussed. The Board's review of the examination report reflects that the examiner noted the Veteran's service and duties in the Republic of Vietnam and asked how the Veteran thought that this experience had changed him. The examiner also noted that he interviewed the Veteran regarding his Vietnam-related stressors. In addition, the examiner discussed reports in the Veteran's previous treatment records regarding his service in the Republic of Vietnam. As such, the Board finds this examination adequate for adjudication purposes. Under the circumstances, the Board finds that there is no reasonable possibility that further assistance would aid the Veteran in substantiating the claim. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). Service Connection Laws and Regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third elements is through a demonstration of continuity of symptomatology. However, 38 C.F.R. § 3.303(b), applies to only those chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). With respect to the current appeal, this list includes psychoses. See 38 C.F.R. § 3.309(a). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including psychoses, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a), 3.309(a). Service connection for PTSD requires medical evidence diagnosing the disorder in accordance with 38 CFR § 4.125(a), medical evidence linking current symptoms to an in service stressor, and, in some circumstances, credible supporting evidence that the claimed in service stressor actually occurred. 38 C.F.R. § 3.304(f). Prior to July 13, 2010, the evidence necessary to establish that an in service stressor actually occurred depended upon whether the Veteran "engaged in combat with the enemy." 38 C.F.R. § 3.304(f); See also Hayes v. Brown, 5 Vet. App. 60, 66-67 (1993). If the evidence showed that the Veteran engaged in combat with the enemy or was a prisoner of war (POW) and the claimed stressor was related to those experiences, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, his lay testimony alone was sufficient to establish the occurrence of the claimed in service stressor. If, however, the Veteran did not engage in combat with the enemy and was not a POW, or the claimed stressor was unrelated to the Veteran's combat or POW experiences, some evidence corroborating the Veteran's lay statements is required in order to establish that an in service stressor actually occurred. 38 C.F.R. 3.304(f)(2) (2009). The only other exception to the requirement for verification of an in-service stressor in effect at that time involved cases when the Veteran was diagnosed with PTSD during service and the claimed stressor was related to that service. In such cases, the Veteran's lay testimony alone was sufficient to establish the occurrence of the claimed stressor, absent clear and convincing evidence to the contrary, provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service. 38 C.F.R. 3.304(f)(1) (2009). However, on July 30, 2010, the exceptions to the stressor verification requirement were substantially expanded. The current 38 C.F.R. § 3.304(f)(3) states: If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and A VA psychiatrist or psychologist or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support the diagnosis of [PTSD] and that the Veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the in service stressor. For purposes of this paragraph, 'fear of hostile military or terrorist activity' means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Id. With compensation claims, the VA adjudicators are directed to assess both medical and lay evidence. In certain circumstances, lay evidence may be sufficient to establish a medical diagnosis or nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In addressing lay evidence and determining its probative value, if any, attention is directed to both 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"). See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In terms of competency, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot). 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. See generally Caluza v. Brown, 7 Vet. App. 498 (1995). 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. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006); but see Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim). Once the evidence has been assembled, it is the Board's responsibility to evaluate the evidence. 38 U.S.C.A. § 7104(a). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 7105; 38 C.F.R. §§ 3.102, 4.3. Analysis The Veteran asserts that he developed PTSD or another psychiatric disorder as the result of his combat experiences during military, to specifically include his active duty in the Republic of Vietnam. In various written statements, the Veteran expressed that he experienced problems with his nerves since service. He reported being exposed to grenade and mortar attacks during his service in Vietnam. He also described an incident when he was ordered to retrieve a truck that had been mortared and found human remains and body parts. He reported that the images of this incident still bothered him. The Veteran's service treatment records in this case do not show complaints or findings referable to an innocently acquired psychiatric disorder. His January 1972 discharge examination reflects normal psychiatric findings. The service personnel records reflect that the Veteran served in the Republic of Vietnam from July 1970 to July 1971 with the 136th Light Maintenance Company. He is in receipt of the Vietnam Service Medal and Vietnam Campaign Medal with 60 device. Following the Veteran's discharge from service, a June 1983 private treatment report reflected that the Veteran indicated that his nerves were "awful." It was noted that the Veteran was working hard at two jobs. A January 1996 VA outpatient treatment report reflected that the Veteran had been anxious for the past few years. He indicated that his nervousness had gotten worse and that he was unable to eat and slept poorly. It was noted that the Veteran was a Vietnam veteran who saw action. A diagnostic impression of rule out PTSD was noted. An April 1997 VA examination report reflected the Veteran reported that he had been somewhat tense for the past 8 to 10 years and that it had been worse for the past 3 to 4 years. He reported being nervous all over and experiencing night sweats. He had not had any prior psychiatric treatment and had not previously taken any psychotropic medications. He described no pressures, financial or personal and took no medication that could have produced any sense of anxiety. A diagnosis of anxiety disorder, not otherwise specified, mild, was assigned. SSA records include a March 1998 psychiatric evaluation report. On examination, the Veteran reported not receiving any psychiatric treatment but taking medication for his nerves in the past. He indicated that he got his nerve problems from service in Vietnam. The Veteran reported that he was in combat and received a meritorious service award. He reported drinking beer in service a bit, but having no alcohol-related problems. After a mental status examination, the examiner did not assign any psychiatric diagnosis. It was noted that the Veteran had not been in any psychiatric treatment and felt that he did not need any psychiatric treatment. This report was reviewed by Dr. S. in April 1998. He noted that the Veterans' SSA application reflected stress and pressure pertaining to military service and job stress. He noted that there was no medically determinable mental impairment. A March 2000 SSA psychiatric medical summary noted findings of organic mental disorders, affective disorders, and substance addiction disorders. An August 2000 report reflected that the Veteran had completed a 28-day treatment program for substance dependence. A February 2001 psychiatric report reflected the Veteran's report that he started drinking heavily while in the service. After a mental status examination, diagnoses of alcohol dependence, cognitive disorder involving marked concentration and memory deficits, probably related to previous head injury, and adjustment disorder with depressed and anxious mood were assigned. A June 2001 VA social work note noted that the Veteran reported being charged with 2 DUI's in 1999 and going to jail for 3 weeks. He also went to a rehabilitation program. He also noted that, after being struck in the head in 1999, small amounts of alcohol caused him to be confused and disoriented. In addition, the Veteran reported being prescribed medication for his nerves around 1975 and taking the medication for approximately 20 years. A June 2001 report from the Chestnut Ridge Hospital reflected that the Veteran was admitted for alcohol use stemming from his feelings of depression. He stated that his alcohol consumption began around age 18 while in service. A diagnostic impression of alcohol dependence and rule out PTSD as a result of service in Vietnam was noted. The Veteran was discharged later in June 2001 with diagnoses of alcohol dependence and substance-induced mood disorder. It was noted that the Veteran admitted that he had had a problem with drinking since Vietnam. He reported wanting to go to the VA hospital for treatment because he wanted to get disability. On treatment in August 2001, the Veteran reported experiencing depressive symptoms since 1999. He noted that these symptoms followed a 1999 incident when he got hit on the head and fractured his ribs. In addition, the Veteran reported experiencing panic attacks since 1982. Diagnoses of major depression and panic disorder without agoraphobia were assigned. A January 2002 SSA determination report reflected that the Veteran was determined to be disabled as of May 2000 due to a number of severe impairments including a cognitive disorder, an adjustment disorder with depressed and anxious mood, alcohol dependence, lumbar strain, degenerative arthritis of the right elbow, and chronic knee strain. A February 2002 VA general medical examination report included a notation of a significant history of depression and panic disorders. Diagnosis of depression with panic attacks was noted. On VA treatment in May 2004, the Veteran reported being last seen in mental health facility in November 2001. He served from 1969 to 1972 with a tour of duty in Vietnam and was a wheel and track mechanic. He noted that he saw some combat but that it was not that extensive. He denied that he was distressed by any of his military experiences. A March 2006 VA psychiatric note reflected that the Veteran was diagnosed with recurrent major depression. On VA treatment in January 2007, the Veteran requested information regarding the PTSD program. He reported witnessing an incident in service when another soldier fell off of a ladder, catching his finger on a rung and tearing off his finger. He stayed with the soldier until further assistance arrived. He reported having panic attacks and problems with stress, but denied nightmares about Vietnam, flashbacks, or intrusive thoughts. The VA records also include a February 2007 brief clinical notation of diagnosis of mild to moderate PTSD from a licensed social worker. In May 2007, the treating social worker noted an assessment of some anxiety symptoms and some PTSD symptoms. The Veteran reported for group therapy from April to June 2007. On VA examination in August 2010, the examiner, a clinical psychologist, indicated that he reviewed the Veteran's entire claims file. He discussed the Veteran's symptoms and performed a mental status examination. The Veteran indicated that he used to drink heavily to calm his nerves and relax. It was noted that the Veteran served as a tank mechanic in Vietnam. When asked how his Vietnam experiences impacted him, the Veteran reported that "it was a good experience" that made him "grow up fast." He indicated that he did well in the service and rose quickly in rank. The Veteran also stated that, in Vietnam, he never knew if he was going to be alive or dead the next day, but coming home was a worse war zone because he was deeply hurt by the harassment and criticism he received upon his homecoming. The Veteran had few or no combat nightmares. He avoided thinking about seeing the body parts in the truck they towed back to base camp. He had poor sleep with intermitting waking, unrelated to his Vietnam dreams or experiences. The Veteran also had difficulty concentrating, which the examiner indicated could be due to head injury, alcohol abuse or educational deficits. The examiner noted that the Veteran did not meet the PTSD stressor criterion, nor did the Veteran meet the DSM-IV criteria for a diagnosis of PTSD. Rather, he assigned a diagnosis of generalized anxiety disorder. The examiner also found that the Veteran did not have a psychiatric condition that was related to his active duty service. In so finding, the examiner noted the Veteran's various alleged stressors, including witnessing the soldier who tore off his ring finger, witnessing an incident where soldiers were injured as a result of 3 grenades exploding in the Enlisted Men's Club, and seeing body parts in a vehicle that had been blown up. With respect to the latter stressor, the Veteran reported that the event caused strong memories "if he thought about it." The examiner noted that, while the Veteran showed distress, he did not display intense feelings of fear, helplessness, or horror with respect to his stressors. The evidence includes conflicting medical evidence as to the question of whether the Veteran actually met the diagnostic criteria for PTSD. While the August 2010 VA examination report reflected that the Veteran does not meet the criteria for the diagnosis, the VA treatment records dated in 2007 that included a diagnosis of and treatment for PTSD. It is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). When reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. See also Obert v. Brown, 5 Vet. App. 30 (1993); Colvin v. Derwinski, 1 Vet. App. 171 (1991). In assessing medical opinions, the failure of the physician to provide a basis for his opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). A medical opinion may not be discounted solely because the examiner did not review the claims file. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the Board accepts the August 2010 VA examiner's opinion that the Veteran does not meet the criteria for a diagnosis of PTSD as highly probative evidence on this point. The Board notes that the examiner rendered this opinion after thoroughly reviewing the claims file and medical records and examining the Veteran. The examiner noted the pertinent history, elicited and described the Veteran's symptoms in detail, described the specific diagnostic criteria set forth in DSM-IV, and provided a reasoned analysis of the case. See Hernandez-Toyens, 11 Vet. App. at 383; Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994) (the probative value of a physician's opinion depends in part on the reasoning employed by the physician and whether or not (or the extent to which) he reviewed prior clinical records and other evidence). By contrast, the medical evidence indicating a diagnosis of PTSD-namely VA treatment records-does not show that the VA treatment providers had had an opportunity to review the Veteran's claims file. Moreover, unlike the VA examiner, these treatment providers merely concluded that the Veteran's stressors and symptoms were sufficient to meet the criteria for the diagnosis. They did not provide any rationale for the conclusion reached or specifically discuss the PTSD criteria, as the VA examiner provided. Thus, the most persuasive, competent evidence on the question of current diagnosis of PTSD weighs against the claim. The Board has also considered the lay statements of the Veteran to the effect that he has PTSD. Lay evidence is competent when reporting a contemporaneous diagnosis. Jandreau, 492 F3d. at 1372. Given that the Veteran's treatment records reflect previous diagnosis of PTSD, the Veteran appears to reporting a contemporaneous diagnosis and is thus competent in this regard. However, as noted, this diagnosis was rendered without discussion of whether the Veteran's stressors and symptoms were sufficient to meet the criteria for the diagnosis. The treatment providers did not provide any rationale for the conclusions reached or specifically discuss each the PTSD criteria. Accordingly, the probative value of the Veteran's general assertions in this regard is outweighed by the probative value of the specific, reasoned opinion of the August 2010 VA examiner, who determined that the Veteran did not meet the criteria for diagnosis of PTSD. The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C.A. § 1110. See also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Thus, without persuasive evidence of current diagnosis of PTSD, there is no basis upon which to award service connection as a discussion of the remaining criteria of 38 C.F.R. § 3.304(f) is unnecessary. As to the issue of service connection for an acquired psychiatric disorder other than PTSD, the record clearly establishes that the Veteran had been diagnosed with adjustment disorder, anxiety disorder and depression. However, the record does not document a diagnosis for a psychiatric disability until the late 1990s, more than 25 years since the Veteran's discharge from service and well beyond the one year presumptive period. Moreover, as noted, the Federal Circuit recently clarified that the continuity of symptomatology language in § 3.303(b) "restricts itself to chronic diseases" found in 38 C.F.R. § 3.309(a). See Walker, 708 F.3d at 1331. Under 38 C.F.R. § 3.384, psychoses include the following specific disorders: brief psychotic disorder, delusional disorder, psychotic disorder due to general medical condition, psychotic disorder, not otherwise specified, schizoaffective disorder, schizophrenia, schizophreniform disorder, shared psychotic disorder, and substance-induced psychotic disorder. In comments accompanying 38 C.F.R. § 3.384, VA decided to exclude major depression from the term "psychosis" because it did not conform to the terminology employed in DSM-IV. See 71 Fed. Reg. 42,758 - 60 (July 28, 2006). Furthermore, none of the competent evidence supports a finding that an innocently acquired psychiatric disorder had its clinical onset during. The only pertinent medical opinion of record is that of the August 2010 VA examiner, who had a thorough review of all pertinent evidence and stated there was no relationship between the Veteran's anxiety disorder and any circumstance of his service. Thus, neither the Veteran nor his representative has presented or identified any medical opinion or other competent evidence that, in fact, supports the Veteran's claim. To the extent that the Veteran has been diagnosed with alcohol dependence, the Board notes that, under 38 C.F.R. § 3.301(c), if disability or death results from the drinking of a beverage to enjoy its intoxicating effects, the disability will be considered the result of the person's willful misconduct for which service connection may not be granted. Further, an injury or disease incurred during active service is not deemed to have been incurred in the line of duty if such injury or disease was the result of the abuse of alcohol or drugs by the person on whose service benefits are claimed. 38 C.F.R. § 3.301(d). For purposes of applying the above rule, alcohol abuse means the use of alcoholic beverages over time, or such excessive use at one time, sufficient to cause disability or death of the user. Id. In this case, however, while the Veteran has occasionally suggested that he used alcohol as self-medication of his psychiatric symptoms, no objective evidence of record supports such a finding. But more importantly, the Veteran is not service-connected for any underlying psychiatric disorder to which alcohol and drug abuse could be secondary. See 38 C.F.R. § 3.310. Finally, the Board has also considered the Veteran's statements to the effect that he has a current psychiatric disability that is related to his military service. As a lay person, the Veteran is competent to report that he personally observed. He is competent to report his present and past psychiatric symptoms. See Layno, 6 Vet. App. at 470. However, the question of diagnosis or etiology goes beyond a simple and immediately observable cause-and-effect relationship. As such, he is not competent to render a diagnosis or opinion as to the etiology as to his claimed psychiatric disorder. See Jandreau, 492 F.3d at 1372. "The beliefs of lay witnesses (including claimants) on issues of diagnosis and medical causation are not competent evidence in situations where those issues require medical expertise to resolve." Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (Lance, J., concurring). In any event, the probative value of the Veteran's general assertions in this regard is outweighed by that of the specific, well-reasoned opinion of the physician who performed the August 2010 VA examination. Accordingly, the claim for service connection for an innocently acquired psychiatric disorder, to include PTSD, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of- the-doubt doctrine. However, on these facts, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Service connection for an innocently acquired psychiatric disorder, to include PTSD, is denied. ____________________________________________ STEPHEN L. WILKINS Veterans Law Judge Board of Veterans' Appeals Department of Veterans Affairs