Citation Nr: 1318834 Decision Date: 06/10/13 Archive Date: 06/21/13 DOCKET NO. 06-07 520 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Robert W. Gillikin, Attorney at Law WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Mary E. Rude, Associate Counsel INTRODUCTION The Veteran served on active duty from November 1965 to November 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2005 rating determination of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania, which denied the Veteran's claims of entitlement to service connection for PTSD and hepatitis C. The Veteran appeared and testified before the undersigned Veterans Law Judge at a May 2008 Travel Board hearing held at the RO. A transcript of the hearing is of record. In July 2008, the Board remanded the Veteran's claims to the Appeals Management Center (AMC) for further development. In a May 2009 decision, the Board denied the Veteran's claims of entitlement to service connection for PTSD and hepatitis C. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In a January 2010 Order, the Court vacated, in part, the May 2009 Board decision, and remanded the matter of entitlement to service connection for PTSD for readjudication in accordance with instructions in the Joint Motion for Partial Remand. The claim of entitlement to service connection for hepatitis C was dismissed, and the claim for entitlement to service connection for PTSD was expanded to include the broader issue of service connection for a psychiatric disorder, to include PTSD, and remanded in September 2010 and March 2011 for further development. The case is now again before the Board for review. As a final preliminary matter, the Board notes that, in addition to the paper claims file, there is a paperless, electronic claims file associated with the appellant's claim. A review of the documents in such file reveals that they contain VA treatment records that are relevant to the issue on appeal. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has an acquired psychiatric disorder, to include PTSD, that is related to active military service or events therein; and there is no evidence of a compensably disabling psychosis within one year following discharge from active duty. CONCLUSION OF LAW The criteria to establish service connection for an acquired psychiatric disorder, to include PTSD, are not met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002) redefined VA's duty to assist a claimant in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). The notice requirements of the VCAA require VA to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, VA will attempt to obtain. 38 C.F.R. § 3.159(b). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO). Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule). VA has a duty to notify a veteran and his/her representative, if any, of the information and evidence needed to substantiate a claim. In this case, the notification obligation was accomplished by way of letters from the RO to the Veteran dated in May 2005 and June 2005. These letters effectively satisfied the notification requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) by: (1) informing the Veteran about the information and evidence not of record that was necessary to substantiate the claims; (2) informing the Veteran about the information and evidence VA would seek to provide; and (3) informing the Veteran about the information and evidence he was expected to provide. A March 2006 letter informed the Veteran of how the RO assigns disability ratings and effective dates if a claim for service connection is granted, in compliance with the holding of Dingess, 19 Vet. App. 473. The case was last adjudicated in March 2013. The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the appeal. Pertinent medical evidence associated with the claims file consists of service treatment records, VA treatment records, the reports of VA examinations, and various statements submitted by the Veteran, his friends, and his attorney. Pursuant to the Board's prior remands, VA has given the Veteran an opportunity to submit additional evidence and information in support of his appeal, and the Veteran has not made VA aware of any additional evidence that needs to be obtained in order to fairly decide his claim. Following the March 2011 remand, VA requested records from the White Oak Vet Center in McKeesport, Pennsylvania, but in January 2012 received a response indicating that this facility did not have any records pertaining to the Veteran. VA has obtained additional relevant VA treatment records and afforded the Veteran additional VA examinations as required. The March 2011 remand also directed the RO/AMC to again attempt to verify the Veteran's stressor event information with the United States Center for Unit Records Research, Defense Personnel Records Image Retrieval System (CURR). As the Veteran's stressor events have since been conceded on the basis of other evidence of record, the failure to again attempt to verify the information through CURR is deemed harmless, non-prejudicial error. Hence, the Board finds that the RO/AMC has substantially complied with all prior remand instructions, and no further action is warranted. See Stegall v. West, 11 Vet. App. 268, 271 (1998). As discussed above, the VCAA provisions have been considered and complied with. The Veteran was notified and aware of the evidence needed to substantiate his claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. The Veteran was an active participant in the claims process by submitting evidence and argument. Thus, the Veteran was provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notices is not shown to have affected the essential fairness of the adjudication or to cause injury to the Veteran. Therefore, any such error is harmless and does not prohibit consideration of this matter on the merits. See ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). Relevant Laws and Regulations Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Moreover, where a veteran served continuously for ninety (90) days or more during a period of war, or during peacetime service after December 31, 1946, and a psychosis becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). Service connection for PTSD requires medical evidence establishing a diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. Cohen v. Brown, 10 Vet. App. 128 (1997). The diagnostic criteria, including those related to stressors, set forth in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, (4th ed. 1994) (DSM-IV) for mental disorders have been adopted by the VA. 38 C.F.R. § 4.125 (2012). A diagnosis of PTSD requires exposure to a traumatic event and a response involving intense fear, helplessness, or horror. A stressor involves exposure to a traumatic event in which the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and the person's response involved intense fear, helplessness, or horror. See Cohen, 10 Vet. App. 128. The sufficiency of a stressor is a medical determination and is presumed by a medical diagnosis of PTSD. Id. The evidence necessary to establish the occurrence of a stressor during service to support a diagnosis of PTSD will vary depending upon whether the Veteran engaged in "combat with the enemy" as established by official records. See 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f); Dizoglio v. Brown, 9 Vet. App. 163, 164 (1996); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). For stressors unrelated to combat, credible supporting evidence is necessary in order to grant service connection. "Credible supporting evidence" of a noncombat stressor may be obtained from service records or other sources. Moreau v. Brown, 9 Vet. App. 389 (1996). The Court has held that the regulatory requirement for "credible supporting evidence" means that "the appellant's testimony, by itself, cannot, as a matter of law, establish the occurrence of a noncombat stressor." Dizoglio, 9 Vet. App. 163. Therefore, the Veteran's lay testimony is insufficient, standing alone, to establish service connection. Cohen, 10 Vet. App. at 147 (citing Moreau, 9 Vet. App. at 395). The regulations governing PTSD were amended, effective July 13, 2010. 75 Fed. Reg. 39843 -52 (July 13, 2010). Specifically, this amendment eliminates the requirement for corroborating that the claimed in-service stressor occurred if a claimed stressor is related to a 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 a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, provided that the claimed stressor is consistent with the places, types, and circumstances of the veteran's service. Id. Beyond the above, following the point at which it is determined that all relevant evidence has been obtained, it is the Board's principal responsibility to assess the credibility, and therefore the probative value of proffered evidence of record in its whole. Owens v. Brown, 7 Vet. App. 429, 433 (1995). In determining whether documents submitted by a veteran are credible, the Board may consider internal consistency, plausibility, and consistency with other evidence submitted on behalf of the Veteran. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The law provides, however, that the Board is not required to accept a veteran's uncorroborated account of his or her active service experiences. See Wood v. Derwinski, 1 Vet. App. 190, 192 (1991). It is also clear that the Board is not required to accept a veteran's statements regarding his alleged symptoms, including nightmares, flashbacks, and other difficulties associated with active service, if the Board does not find the statements regarding symptoms to be credible. The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the veteran prevails in a claim when (1) the weight of the evidence supports the claim or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board has reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Analysis The Veteran seeks service connection for PTSD. The Veteran claims that he developed PTSD while serving in Vietnam from 1966 to 1967. He has stated that during that time he served as a military policeman near an active war zone, was frequently shot at, was required to carry dead and wounded soldiers from the field to nearby hospitals, saw mutilated corpses, and was almost blown out of a bunker by mortar fire. The Veteran has stated that he developed symptoms of nervousness and insomnia soon after his separation from service in 1968 and which have continued to the present day. The Veteran's DD Form 214 lists his military occupational specialty as Military Policeman and indicates that he spent one year in Vietnam. The Veteran's personnel records show that he participated in the Vietnam Counter Offensive Campaign and the Vietnam Counter Offensive Campaign Phase II. The personnel records also show that the Veteran was stationed with the 716th Military Police Battalion in Vietnam from May 1966 to May 1967. While the Veteran's specific stressor events were not able to be verified, a November 2008 CURR records response did show that three military policeman from the 716th Battalion were killed in April 1966, and in May 1966 seven Americans were wounded when a truck carrying Viet Cong soldiers attacked military policemen in Saigon. Applying the benefit-of-the-doubt doctrine in favor of the Veteran, the Board finds that the Veteran's service personnel records and reported history, along with CURR verification that enemy attacks did occur against the Veteran's military police battalion, provide some credible supporting evidence of the occurrence of the claimed in-service stressors, and as such the Veteran's in-service stressor events are conceded. See Moreau, 9 Vet. App. 389. The claim therefore turns on the question of whether the Veteran has a current diagnosis of PTSD or other acquired psychiatric disability which has been linked to his experiences during service. The Veteran has described his symptoms as feeling nervous and jumpy, being bothered by loud noises, and experiencing feelings of depression and anxiety. The Veteran has stated that he has bad dreams and had to give up hunting because of his symptoms. At his May 2008 Board hearing, the Veteran stated that loud noises and "bangs" make him jump and that his "nerves" make it difficult for him to drive. He stated that his psychological problems caused him to start abusing alcohol after his separation from service and that now he takes medication for nerves and for sleeping. A friend of the Veteran's submitted a statement saying that he had known the Veteran since the time of his service, that he "was very shaken during his tour," and that he continues to have symptoms of nervousness and jumpiness, including sensitivity to loud noises. Another friend of the Veteran's submitted a statement indicating that she has known the Veteran for 10 years and that he has symptoms of nervousness, insomnia, jumpiness, and lack of interest in sex. The Veteran's service treatment records are silent for any complaints, treatment, or diagnosis of PTSD or any other psychiatric diagnoses or complaints. The Veteran has undergone three VA examinations with a psychiatrist or psychologist, none of which have found that the Veteran meets the criteria for a diagnosis of PTSD, nor have they found that he has another psychiatric diagnosis which is related to his service. In December 2008, the Veteran underwent a VA psychiatric examination with a board-certified psychiatrist. During the examination, the Veteran reported that while on patrol in January or February 1967 in the Kanu area, he helped to retrieve the mutilated body of an American service member from a canal. The examiner noted this stressor in addition to the Veteran's report of taking the dead and wounded to nearby field hospitals and getting blown out of bunkers by mortars. The Veteran reported that he began drinking alcohol on a daily basis from the time of his separation from service until 2006. He stated that he currently had symptoms that included poor sleep, nightmares, and nervousness. The Veteran showed no signs of impairment of thought processes or communication, inappropriate behavior or speech, or hallucinations. The examiner ran a series of psychological tests and concluded in their totality, the scores were consistently high and were likely reflecting a significant degree of over-reporting due to their inconsistency with the Veteran's current symptoms, complaints, and level of functioning. The examiner diagnosed the Veteran with depressive disorder, not otherwise specified and unrelated to military service, and alcohol abuse, unrelated to military service. The examiner stated the Veteran did not meet the criteria for a diagnosis of PTSD per the DSM-IV. The Veteran was not presenting with the full constellation of symptoms to receive this diagnosis. The Veteran was afforded an additional VA examination in September 2010 by a psychologist. The examiner reviewed the Veteran's claims file and medical records and noted that the Veteran had never received a psychiatric diagnosis of PTSD and had a history of over-reporting symptoms on psychometric testing. The Veteran described his in-service stressors as finding a dead body floating in the canal, bringing the dead and wounded to field hospitals, and being "blown out of a few bunkers." The Veteran reported that after separation from service he was able to effectively hold down jobs without any decreased productivity from psychiatric symptoms, but that he now has symptoms of hyperstartle response to loud noises, difficulty sleeping, nightmares, and frequent depression. He stated that he formerly had suicidal ideation but has never attempted suicide. The examiner noted that the Veteran was anxious but with appropriate behavior, thought processes, and communication. The examiner administered several psychological screening instruments to the Veteran, but found that the Veteran's scores were in an extreme range and were likely an exaggeration or over-reporting of symptoms. The examiner found that while the Veteran described having some symptoms of PTSD, he did not have the full symptom constellation required for a diagnosis of PTSD. The examiner diagnosed the Veteran with depressive disorder, not otherwise specified and unrelated to military service, and alcohol abuse, unrelated to military service. The examiner further opined that the Veteran's depressive disorder was less likely than not related to military service and that his alcohol use over the years had likely exacerbated his sleep disturbance, irritability, and depression. The Veteran also underwent a VA examination in December 2011 by a psychologist. The examiner reviewed the Veteran's claims file and medical records. The Veteran described his stressor event has finding a washed-up dead body and bringing it back to base. He stated that it was in Vietnam that he first began drinking heavily. The Veteran reported that he had nightmares about events that happened in service, was sensitive to being touched, and was very nervous and jumpy. He stated that he does not socialize much, but tried to be around other Vietnam veterans who understand what he has gone through. He stated that he had not been seen by a psychiatrist for several years, and that while he had been prescribed psychiatric medication by his physician, he had not been taking it. The examiner found that the Veteran's thoughts were logical, with normal behavior and speech. The examiner noted that the Veteran's descriptions of his stressor event reflected anger, but not fear or horror, that he continues to relate well with his family and to watch news and documentaries about war, and ultimately found that the Veteran did not have the frequency or severity of symptoms necessary for a diagnosis of PTSD. The examiner diagnosed the Veteran with depressive disorder, not otherwise specified and unrelated to military service, and alcohol dependence, reportedly in remission and unrelated to military experience. The Veteran has also been undergoing psychiatric treatment at the Pittsburgh VA Medical Center since March 2005. As will be discussed below, these records are also insufficient to demonstrate that the Veteran has or has ever had PTSD or other acquired psychiatric disorder that is related to his service. In March 2005 the Veteran tested positive on screens for depression and PTSD and was scheduled for an evaluation with a therapist. Before a complete evaluation took place, the Veteran was seen by a nurse practitioner who discussed some of the Veteran's history with him and provided a diagnosis of PTSD and depression. In June 2005, the Veteran underwent a thorough PTSD examination with a clinical psychologist. The psychologist discussed the Veteran's stressful events in service and his post-service history. The Veteran reported having depression, nightmares, irritability, and mistrust towards Asians. The examiner found that the Veteran was not reporting adequate symptoms or impairment indicative of PTSD and diagnosed the Veteran with alcohol dependence, rule out adjustment disorder with mixed anxiety and depressed mood and rule out substance induced mood disorder with mixed features with onset during withdrawal. At a July 2005 follow-up counseling session, the psychologist again reiterated to the Veteran that he did not meet the criteria for PTSD and that his alcohol use was either contributing to or causing his distress. She diagnosed the Veteran with alcohol dependence, rule out substance induced mood disorder with mixed features with onset during withdrawal. In October 2005, the Veteran began treatment with a psychiatrist. The psychiatrist discussed the Veteran's history with him and noted that he had symptoms of irritability, anxiety, worry, and occasional hyperarousal. The psychiatrist diagnosed the Veteran with anxiety disorder not otherwise specified (probably mixed anxiety/depressive disorder), rule out substance induced mood disorder, rule out mood disorder secondary to general medical condition, and alcohol abuse/misuse disorder. The Veteran continued to see the psychiatrist occasionally from 2005 to 2007, and was always given diagnoses of anxiety disorder, depressive disorder, or alcohol abuse. At no time did the psychiatrist find that any of the Veteran's symptoms were related to his service. In August 2008, the Veteran's primary care providers also began following his psychiatric treatment, diagnosing the Veteran with depression. In January 2010, the Veteran's primary case physician included "depression/possible PTSD" in the Veteran's assessment list, noting only that he was advised to follow-up with psychiatry. In April 2011, the physician listed "depression/PTSD" as one of the Veteran's diagnoses and again recommended he follow-up with psychiatry or social work. In August 2011, the Veteran reported to his physician that he was feeling depressed. At several additional primary care evaluations, the Veteran's physician continued to note "PTSD" as a diagnosis. In February 2012, the Veteran was evaluated by a social worker. The Veteran reported that his experiences in Vietnam now caused him to have nightmares. The social worker diagnosed the Veteran with depression, not otherwise specified, and anxiety. In an August 2012 clinical social work assessment, the examiner noted that the Veteran showed some signs of PTSD. Having carefully considered the claim in light of the record and the applicable law, the preponderance of the evidence is against the claim and the appeal must be denied. The Veteran currently has several psychiatric diagnoses from a variety of sources, some of which conflict in their findings. When evaluating medical opinions it is the province of the Board to weigh the evidence and decide where to give credit and where to withhold the same, and in so doing, to also accept certain medical opinions over others. See Evans v. West, 12 Vet. App. 22, 30 (1999); Schoolman v. West, 12 Vet. App. 307, 310-11 (1999); Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board cannot make its own independent medical determinations and that there must be plausible reasons for favoring one opinion over another. See also Rucker v. Brown, 10 Vet. App. 67, 74 (1997), citing Colvin v. Derwinski, 1 Vet. App. 171 (1991). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail and whether there was review of the Veteran's claims file. Prejean v. West, 13 Vet. App. 444 (2000). An evaluation of the probative value of a medical opinion or diagnosis is based on the medical expert's personal examination of the patient, the examiner's knowledge and skill in analyzing the data, and the medical conclusions reached. The Board may then determine the credibility and weight to be attached to such opinions. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). In this case, the only medical professionals to diagnose the Veteran with PTSD were a nurse practitioner in May 2005 and a primary care physician in several general physical examinations. Neither of these medical professionals had access to the Veteran's claims file or military records. While they both were able to discuss the Veteran's history and symptoms, neither performed full psychiatric evaluations of the Veteran or any kind of psychiatric evaluative testing. There is no indication that either used the criteria required by the DSM-IV when assigning the Veteran a diagnosis of PTSD, as there is no discussion of his specific stressors or the qualifying symptomatic criteria. See 38 C.F.R. § 4.125(a). Furthermore, neither the nurse practitioner nor the primary care physician are specialists in the area of mental disorders. The examinations provided by numerous psychologists and psychiatrists during the course of the Veteran's appeal which all found that the Veteran did not meet the criteria for a diagnosis of PTSD have far greater probative value, as psychiatrists and psychologists have greater training, experience, and skill in diagnosing mental disorders than a nurse practitioner or a general practice physician. The Board notes that the Veteran's attorney submitted a letter in December 2010 asserting that the Veteran's diagnoses of PTSD "by history" and his positive scores on numerous PTSD screenings also constitute evidence of a current diagnosis of PTSD. The Board emphasizes that such notations in the Veteran's VA treatment records do not constitute valid diagnoses of PTSD, as such a diagnosis must be in accordance with the criteria of the DSM-IV. 38 C.F.R. § 4.125(a). References to PTSD "by history" are likewise not current diagnoses, but are taken from prior records or self-reported medical history. These medical records therefore provide no probative value in deciding the current claim. The Board also notes that the May 2009 Board decision, which was vacated by the Court in a January 2010 Order, stated that the Veteran had a valid diagnosis of PTSD. While the Board was correct at that time in noting that the Veteran had received a diagnosis of PTSD, the diagnosis referred to was from a nurse practitioner in May 2005, treatment performed before the Veteran had received any full psychiatric evaluations. Since that time, the further development that has been completed since May 2009, including two additional VA psychiatric examinations with qualified psychologists, has made it clear that the overwhelming majority of the evidence weighs against the Veteran's claim that he has PTSD. Central to any service connection claim is a current diagnosis of the claimed disorder. In the current case, the weight of the evidence clearly indicates that the Veteran's symptoms do not meet the DSM-IV criteria for a diagnosis of PTSD. The law limits entitlement for service-related diseases and injuries to cases where an underlying in-service incident has resulted in the claimed current disability. See 38 U.S.C.A. §§ 1110, 1131. In the absence of proof of a present disability, there is no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Veteran does, however, have other valid psychiatric diagnoses provided by competent psychiatrists and psychologists, but these disorders have not been shown by any competent medical evidence to be related to his service. The December 2008, November 2010, and December 2011 VA examiners all diagnosed the Veteran with depressive disorder and alcohol abuse, but also opined that these disorders were unrelated to his military service. The Veteran's treating medical professionals have also diagnosed the Veteran with anxiety disorder as well as depressive disorder. While they have noted that the Veteran has bad dreams that are related to his military experience, not one of these medical professionals have stated that the Veteran's anxiety disorder or depressive disorder was caused by or was otherwise etiologically related to his military service. Thus, the overwhelming majority of the medical evidence of record indicates that the Veteran has a psychiatric disorder, to include depressive disorder and anxiety disorder, but that there is no nexus connecting that disorder to his service. The Veteran nevertheless contends that he does have PTSD as a result of his experiences in Vietnam. The Board recognizes that the Veteran, as a layperson, is competent to report on matters observed or within his personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board acknowledges the Veteran's statements regarding the stress of serving in Vietnam and deems him competent to report on his current psychiatric symptoms, such as having nightmares. However, a diagnosis of a psychiatric disability, including PTSD, requires not just observation of certain symptoms, but also specialized training to diagnose psychiatric disorders. Additionally, a probative medical opinion on the etiology or underlying causes of any other psychiatric condition likewise requires the specialized training of a medical professional. In this case, as a layperson not shown to possess appropriate medical training and expertise, the Veteran is not competent to render a persuasive or competent medical opinion on whether he currently has or has ever suffered from PTSD or whether his currently diagnosed depression or anxiety was caused by or otherwise related to his military service. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir 2006) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). Hence, his assertions in this regard do not constitute competent and persuasive evidence in support of the claim for service connection. Furthermore, the Board has also considered whether service connection for a psychiatric disorder is warranted on a presumptive basis. Psychosis shall be presumed to have been incurred in service when the Veteran has served continuously for 90 days or more during a period of war and it manifests to a degree of 10 percent or more within one year from termination of service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In this case, although the Veteran reported feeling stress after his separation from service, there is no evidence that he had any psychiatric treatment or complaints prior to 2005, which is over 36 years after his separation from service, nor has the Veteran at any time been diagnosed with or shown to have symptoms of a psychosis. Therefore, this presumption is inapplicable in the current case. In short, there is no competent and probative evidence showing that the Veteran has a valid, current diagnosis of PTSD or that he has had a diagnosis of another psychiatric disability which has been connected through competent and probative evidence to his service, either directly or presumptively. Accordingly, the preponderance of the evidence is against the claim for service connection. In reaching the conclusions above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-57. ORDER Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is denied. ____________________________________________ CHERYL L. MASON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs