Citation Nr: 1319161 Decision Date: 06/12/13 Archive Date: 06/21/13 DOCKET NO. 08-32 444 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Whether new and material evidence has been submitted to reopen a previously denied claim of entitlement to service connection for an eye disability. 2. Entitlement to service connection for a neck disability. 3. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). ATTORNEY FOR THE BOARD B. R. Mullins, Counsel INTRODUCTION The Veteran had active service from April 1960 to December 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from December 2007 and April 2009 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico. In June 2005, the Board denied the claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD. The Board in its decision/remand in February 2011 determined that as personnel records were received subsequent to the June 2005 Board decision, the claim for service connection for a psychiatric disorder, to include PTSD, is to be reconsidered without consideration of whether there is new and material evidence. See 38 C.F.R. § 3.156(c). These claims were again remanded by the Board in November 2012 for further evidentiary development. FINDINGS OF FACT 1. The claim of entitlement to service connection for an eye disability was denied in a May 1994 rating decision. The Veteran did not appeal this decision and it is now final. 2. Evidence received since the May 1994 rating decision is new, but it does not address an unestablished fact necessary to substantiate the merits of the claim of entitlement to service connection for an eye disability or raise a reasonable possibility of substantiating the claim. 3. The Veteran does not suffer from a neck disability that manifested during, or as a result of, active military service. 4. The Veteran does not suffer from a psychiatric disorder, to include PTSD, that manifested during, or as a result of, active military service. CONCLUSIONS OF LAW 1. The May 1994 rating decision denying the claim of entitlement to service connection for an eye disability is final. 38 U.S.C.A. § 7104 (West 2002); 38 C.F.R. § 20.1100 (2012). 2. New and material evidence has not been received and the claim of entitlement to service connection for an eye disability remains closed. 38 U.S.C.A. §§ 5107, 5108, 7105 (West 2002); 38 C.F.R. § 3.156 (2012). 3. The criteria for establishing entitlement to service connection for a neck disability have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5103(a), 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310 (2012). 4. The criteria for establishing entitlement to service connection for a psychiatric disability, to include PTSD, have not been met. 38 U.S.C.A. §§ 1101, 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify VA has a duty to notify and assist veterans 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 and 3.326(a) (2012). Proper notice from VA must inform the Veteran of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the Veteran is expected to provide in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the notice requirements apply to all five elements of a service-connection claim, including: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. In claims to reopen, VA must both notify a claimant of the evidence and information that is necessary to reopen the claim and notify the claimant of the evidence and information that is necessary to establish entitlement to the underlying claim for the benefit that is being sought. Kent v. Nicholson, 20 Vet. App. 1 (2006). To satisfy this requirement, VA is required to look at the bases for the denial in the prior decision and to provide the veteran with a notice letter that describes what evidence would be necessary to substantiate those elements required to establish service connection that were found insufficient in the previous denial. Letters sent to the Veteran in August 2007, September 2007, January 2009, March 2009, March 2011, and December 2012 addressed all notice elements listed under 3.159(b)(1). The letters also informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. The March 2011 letter also included the criteria for reopening a previously denied claim, the criteria for establishing service connection, and information concerning why the claim of service connection for an eye disability was previously denied. While all of this notice was not provided to the Veteran prior to the initial adjudication of his claims, the claims were subsequently readjudicated, no prejudice has been alleged, and none is apparent from the record. See Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant notification followed by readjudication of the claim, such as a statement of the case or supplemental statement of the case, is sufficient to cure a timing defect). Under these circumstances, the Board finds that the notification requirements have been satisfied as to both timing and content. Adequate notice was provided to the Veteran prior to the transfer and certification of his case to the Board that complied with the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b). Duty to Assist Next, VA has a duty to assist the Veteran in the development of the claim. This duty includes assisting him in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). VA obtained the Veteran's service treatment records. Also, the Veteran received VA psychiatric examinations in July 2004 and July 2011 and a VA examination of the cervical spine in June 2011. VA has obtained these records as well as the records of the Veteran's outpatient treatment with VA. Copies of VA treatment records through April 2012 have also been associated with the Veteran's electronic paperless file (Virtual VA). Private treatment records have also been associated with the claims file, and in December 2012, the Social Security Administration (SSA) informed VA that there were no medical records associated with this Veteran. Significantly, neither the Veteran nor his representative has identified any additional existing evidence that is necessary for a fair adjudication of the claims that has not yet been obtained. 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), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Additionally, the Board finds there has been substantial compliance with its most recent remand directives of November 2012. The Board notes that the Court has held that "only substantial compliance with the terms of the Board's engagement letter would be required, not strict compliance." See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268) violation when the examiner made the ultimate determination required by the Board's remand). The record indicates that the Appeals Management Center (AMC) contacted the Veteran and requested that he identify any outstanding records of pertinent medical treatment. SSA was also contacted, but notified VA that they had no records for this individual. The AMC later issued a Supplemental Statement of the Case (SSOC). Based on the foregoing, the Board finds that the AMC substantially complied with the mandates of its remand. See Stegall, supra, (finding that a remand by the Board confers on the appellant the right to compliance with its remand orders). New and Material Evidence for an Eye Condition Relevant Laws and Regulations Governing regulations provide that an appeal consists of a timely filed notice of disagreement in writing and, after a statement of the case has been furnished, a timely filed substantive appeal. 38 C.F.R. § 20.200. Rating actions from which an appeal is not timely perfected become final. 38 U.S.C.A. § 7105; 38 C.F.R. § 20.1103. In general, Board decisions which are unappealed become final. 38 U.S.C.A. § 7104; 38 C.F.R. § 20.1100. A final decision cannot be reopened unless new and material evidence is presented. 38 U.S.C.A. § 5108. The Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to that claim. Knightly v. Brown, 6 Vet. App. 200 (1994). New evidence means existing evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and it must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The United States Court of Appeals for Veterans Claims (Court) has emphasized that the final sentence of 38 C.F.R. § 3.156(a), especially the phrase "raise[s] a reasonable possibility of substantiating the claim," does not create a third element or separate determination in the reopening process, but is a component of the question of what is new and material evidence. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010) (noting that 38 U.S.C.A. § 5108 requires only new and material evidence to reopen). Shade further holds that 38 C.F.R. § 3.156 "suggests a standard that would require reopening if newly submitted evidence, combined with VA assistance and considering the other evidence of record, raises a reasonable possibility of substantiating the claim[.]" Id. Further, the Board should not focus solely on whether the evidence remedies the principal reason for denial in the last prior decision, and regulations do not require new and material evidence as to each previously unproven element of a claim. Id. Rather, the Board should focus on whether the evidence, taken together, could at least trigger the duty to assist by providing a medical opinion. Id., see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Court has elaborated on what constitutes "new and material evidence." New evidence is not that which is cumulative of other evidence already present in the record. In determining whether new and material evidence has been submitted, the Board must consider the specific reasons for the prior denial. Evans v. Brown, 9 Vet. App 273, 283 (1996). See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). Only evidence presented since the last final denial on any basis (either upon the merits of the case, or upon a previous adjudication that no new and material evidence has been presented) will be evaluated in the context of the entire record. Evans, 9 Vet. App. at 273. Analysis The Veteran's claim of service connection for an eye disorder was previously denied in a May 1994 rating decision. The Veteran did not appeal this decision and it is now final. The Veteran's claim was denied because his service medical records were negative for an eye condition and because an eye condition is not subject to the Agent Orange presumption. Therefore, for the evidence to be material in this case, it should address these unestablished facts. With that having been said, the Board finds that new and material evidence sufficient to reopen a claim of entitlement to service connection for an eye condition has not been submitted. At the time of the previous denial, the evidence of record consisted of the Veteran's service treatment records and his original claim in which he asserted that he suffered from an eye disability secondary to Agent Orange exposure in Vietnam. Since the May 1994 rating decision, several pieces of new evidence have been associated with the claims file. According to a May 1994 VA examination report (performed several days after the May 1994 rating decision was prepared), the Veteran's pupils were equal, round, and reactive to light and accommodation (PERRLA) with normal extraocular movements (EOMs). As there was no finding of an eye condition related to service or Agent Orange, this report is immaterial to the Veteran's claim. The record also contains an April 2000 VA treatment record. According to this record, the Veteran's vision was impaired. No actual diagnosis was assigned at this time. Nonetheless, a March 2003 VA treatment record notes that the eyes were PERRLA, EMOI, had no corneal lesions, and the conjunctivae were clear. It was also noted that the Veteran had no history of illness except for surgery of the left knee. These records fail to suggest that the Veteran suffers from any eye condition related to military service. A September 2006 VA treatment record notes that the Veteran sustained trauma to the left eye that morning when he tripped and hit his left eye with a fence. A left eye conjunctival hemorrhage was diagnosed. There was no mention of a preexisting eye condition or an eye condition that had existed since military service. Evidence of an eye injury incurred some 37 years after separation from active duty is not material to the Veteran's claim of entitlement to service connection. According to a September 2010 VA treatment record, the Veteran denied any recent visual changes such as blurry vision, diplopia, photophobia, decreased visual acuity, or excessive lacrimation. A February 2012 VA treatment record also indicates that there were no symptoms associated with the eyes and that the conjunctivae and lid, pupils, and irises and sclera were all normal. The Veteran also noted in his claim of February 2009 that he had an "eye condition" that was incurred coincidental to his military service. The Veteran did not specify the nature of his claimed eye condition or how it was related to service. In fact, a review of the record reveals that the Veteran has never in fact identified what disability of the eyes he is claiming, nor has he ever indicated why he is of the opinion that he suffers from an eye disability due to military service (aside from noting Agent Orange exposure in his November 1993 claim). As such, the mere assertion that an eye condition is due to military service is not new, as the Veteran made the same assertion in his original claim of November 1993. In summary, while the record contains new evidence, there is nothing of record that is material to the Veteran's claim of service connection for an eye condition. The record contains no evidence of an eye condition that manifested during, or as a result of, active military service. Rather, the records reveal normal eye evaluations for many years following separation from active duty. The only evidence of an injury to the eye is from September 2006 when the Veteran injured it on a fence. The Veteran has not identified what specific disability he is seeking service connection for (aside from merely noting an eye condition), nor has he provided VA with a history of an in-service eye injury or disease or any associated symptomatology. Finally, while a single VA treatment record indeed notes impaired vision, subsequent records fail to mention this and there is still no evidence of record of any in-service symptomatology, injury or disease or any competent evidence linking a current eye condition to military service. As such, the evidence submitted since the previous denial of May 1994 is not material to the Veteran's claim. The Board has also considered whether the evidence of record, taken together, could at least trigger the duty to assist by providing a medical opinion. See Shade, 24 Vet. App. at 117. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. None of the evidence received since May 1994 suggests that the Veteran suffers from a condition of either eye that manifested during, or as a result of, active military service. The Veteran has not identified any in-service injury or disease, nor has he alleged any symptomatology that had existed since military service. As such, a VA examination would serve no useful purpose in this case and VA's duty to assist has not been triggered by the newly submitted evidence. See McLendon, 20 Vet App. at 79. Finally, if VA receives or associates with the claims folder relevant official service department records at any time after a decision is issued on a claim that had not been associated with the claims folder when VA first decided the claim, VA will reconsider the claim without requiring new and material evidence. 38 C.F.R. § 3.156(c). In the present case, the Veteran's personnel records have been associated with the claims file since the previous denial of May 1994. A review of these records reveals no treatment, complaints, or history of an eye condition. As such, they are not relevant to the Veteran's claim for an eye condition, and new and material evidence is still required to reopen this claim. Therefore, evidence that is both new and material regarding the claim of entitlement to service connection for an eye condition has not been received, and the claim remains closed. Service Connection Claims Relevant Laws and Regulations Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet. App. 309, 314 (1993); see also Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). To establish service connection, there must be: (1) a medical diagnosis of a current disability; (2) medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999) (citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996)). Where a veteran has served for 90 days or more during a period of war, or during peacetime service after January 1, 1947, and a chronic disorder, such as arthritis or psychosis, becomes manifest to a degree of 10 percent within one year from the 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, 1137; 38 C.F.R. §§ 3.307, 3.309 (2012). In order to show a chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a claim. There must be competent medical evidence unless the evidence relates to a condition as to which lay observation is competent to identify its existence. See 38 C.F.R. § 3.303(b) (2012). A recent decision of the United States Court of Appeals for the Federal Circuit (Federal Circuit Court), however, clarified that this notion of continuity of symptomatology since service under 38 C.F.R. § 3.303(b), which as mentioned is an alternative means of establishing the required nexus or linkage between current disability and service, only applies to conditions identified as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, ___ F.3d ___, No. 2011-7184, 2013 WL 628429 (Fed. Cir. Feb. 21, 2013). Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be 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 v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that " [w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). Neck Disability The Veteran contends that he is entitled to service connection for a neck disability. However, as outlined below, the preponderance of the evidence of record demonstrates that the Veteran does not suffer from a neck disability that manifested during, or as a result of, active military service. As such, service connection is not warranted. The Veteran's service treatment records fail to reflect that he suffered from a chronic neck disorder upon separation from active duty. According to a January 1966 in-service treatment note, the Veteran was experiencing pain and stiffness of the neck for the past 2 days. It was noted that it was of sudden onset without any injury. The record does not contain further evidence of in-service treatment for neck symptomatology. Service treatment records also note that the Veteran fell down a stairway in June 1966. However, there is no evidence of injury or symptomatology associated with the neck as a result of this fall. Also, according to the Veteran's December 1969 discharge examination, an evaluation of the neck, spine, and other musculoskeletal system was deemed to be normal. No defects or diagnoses were noted, and the Veteran denied a history of bone, joint, or other deformity in his report of medical history associated with this examination. As such, there is no evidence of a chronic disability during active military service. Likewise, post-service evidence fails to suggest that the Veteran suffers from a neck disability that manifested during, or as a result of, active military service. The first evidence of symptomatology associated with the neck is a September 1997 VA psychiatric examination. During this examination, the Veteran reported that a doctor told him that he had a lumbar condition for the rest of his life and that he suffered from neck pain. An October 1997 VA examination report reflects that the Veteran was experiencing cervical pain. No specific diagnosis was associated with this pain and no further history was provided. The record also contains a general VA examination report from some three years earlier dated May 1994. This report fails to reflect any complaints involving the neck or cervical spine, and instead simply notes a "[s]upple neck." According to a November 2004 computed tomography (CT) scan of the neck, the Veteran had a six centimeter abscess. The Veteran was diagnosed with left facial cellulitis that was believed to be secondary to an underlying severe dental infection. No disability of the cervical spine was noted in the report. The next evidence of symptomatology associated with the neck is the Veteran's claim received in October 2008. The Veteran merely reported having a cervical condition. He did not indicate how or why he believed this condition was associated with his military service. In a June 2009 statement, he did suggest that this condition was incurred due to his combat service. Again, however, he did not provide any argument as to why he believed his neck condition was related to military service. The only other evidence of record regarding the neck is a June 2011 VA examination report. The Veteran reported that during military service he developed cervical pain associated with falls while in combat. The Veteran reported that the pain resolved without treatment during military service and that he then experienced intermittent cervical pain. Imaging revealed significant intervertebral osteochondral changes and spondylosis of the lower cervical spine. The examiner opined that it was less likely as not that this condition was caused by or a result of incidents during military service. The examiner noted the in-service reports of neck pain. However, subsequent records noted the neck to be normal. Therefore, the examiner opined that the in-service report of neck pain was related to a mild and transitory condition with no neurologic or recurrent musculoskeletal residuals that resolved upon treatment. The examiner was of the opinion that the present findings were related to the normal process of aging. The preponderance of the above evidence demonstrates that the Veteran is not entitled to service connection for a neck disability. While the Veteran did report neck pain associated with no injury during military service, subsequent records are silent for complaints involving the neck, and the neck was deemed to be normal at the time of discharge in 1969. Therefore, the in-service symptomatology appears to have been associated with an acute and transitory condition. The record contains no further evidence involving neck symptomatology until 1997 - some 28 years after separation from active duty. When considering whether or not to grant a claim for service connection, the Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disorder at issue. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact, i.e., the lack of evidence is itself evidence). In the present case, the absence of any medical evidence of neck pain for approximately 28 years tends to suggest that this condition was not chronic since military service. This conclusion is further supported by the May 1994 VA examination reports that are entirely silent as to any complaints associated with the neck. Finally, the June 2011 VA examiner, after reviewing the evidence of record and examining the Veteran, concluded that it was less likely as not that the Veteran's current neck disability was related to military service, but rather, to the aging process. As such, the preponderance of the evidence of record demonstrates that service connection for a neck condition is not warranted. The Board recognizes that the Veteran has reported combat during his military service. The "combat presumption" means that in the case of a veteran who engaged in combat with the enemy in a period of war, lay evidence of in-service incurrence or aggravation of a disease or injury shall be accepted if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the lack of official record of such incurrence or aggravation. 38 U.S.C.A. § 1154(b); Libertine v. Brown, 9 Vet. App. 521, 524 (1996); Collette v. Brown, 82 F.3d 389, 392-94 (Fed. Cir. 1996). The phrase "engaged in combat with the enemy" requires that the Veteran have personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. VAOPGCPREC 12-99 (October 18, 1999); Gaines v. West, 11 Vet. App. 353 (1998). In the present case, the Veteran's DD-214 reflects that he received the Vietnam Service Medal and the Vietnam Campaign Medal. However, he did not receive any medals specifically denoting combat. The record, including the Veteran's personnel records, contains no other evidence of the Veteran actually participating in combat, and as such, the combat presumption does not apply. Finally, the Board has considered the Veteran's lay statements that he suffered neck pain in service and that he has experienced intermittent pain since that time. Neck pain is certainly something that the Veteran is competent to provide statements about. However, while the Veteran is competent to offer these statements, the Board does not find them to be credible. The Veteran did not report a history of intermittent neck pain upon discharge from active duty. Furthermore, the Veteran went without treatment for the neck for nearly three decades, greatly calling into question his claim of chronic symptomatology. Finally, while undergoing a VA examination of his joints in 1994, the Veteran made no mention of a history of neck pain for the past 25 years. As such, the Board does not find the Veteran's current report of chronic intermittent neck pain since service to be credible. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for a neck disability must be denied. Psychiatric Disorder The Veteran also contends that he is entitled to service connection for an acquired psychiatric disorder, to include PTSD. However, as outlined below, the preponderance of the evidence of record also demonstrates that the Veteran does not suffer from a psychiatric disorder (for which service connection may be established) that manifested during, or as a result of, active military service. As such, service connection for a psychiatric disorder is not warranted. The Veteran's service treatment records are entirely silent regarding any psychiatric complaints or symptomatology. The first post-service evidence of psychiatric symptomatology is the Veteran's claim of November 1993 - some 24 years after his separation from active duty. In a February 1994 statement, the Veteran indicated that while he was in Vietnam, his unit was constantly attacked and bombarded. The Veteran was subsequently afforded a VA psychiatric examination in May 1994. The Veteran reported that he saw many dead soldiers and that he was exposed to attacks while traveling in convoys. The Veteran denied any prior psychiatric treatment or evaluation. The examiner diagnosed the Veteran with dysthymia and did not offer any opinion as to etiology. The Veteran was afforded an additional VA psychiatric examination in September 1997. It was again noted that the Veteran was not receiving any psychiatric treatment. The Veteran was diagnosed with mild depression, not otherwise specified (NOS), with some mild anxiety. The record also contains a handwritten statement dated September 2001 from a private doctor of internal medicine. According to this physician, the Veteran experienced many traumatic events involving the deaths of other people and life-threatening harm to himself. It was noted that the Veteran had "evidently" suffered from PTSD and that he was also having depression with anxiety. The physician indicated that this seemed to be due to military service and that it was "most [sic] probably than not" that the Veteran's psychiatric problems were due to his Vietnam service. The Veteran was afforded another VA examination in February 2003. It was noted that the Veteran had no psychiatric hospitalization or treatment in the computer files. The examiner indicated that the Veteran served in Vietnam and it was specifically noted that he was not exposed to combat stressors. It was noted that while the Veteran wrote that he remembered being attacked and bombarded, there was no specific exposure to stressful situations. Upon examination, it was determined that the Veteran did not meet the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) criteria for a diagnosis of PTSD. Rather, the examiner diagnosed the Veteran with an anxiety disorder NOS and alcohol dependence. Another examination was performed in July 2004. The Veteran again reported that he had never been in psychiatric treatment before. The Veteran reported that while in Vietnam he saw dead soldiers and wounded soldiers that were taken from the field to the camp. He was never in a combat situation in front of the enemy, but he was occasionally in a truck that was attacked by the enemy. The Veteran was not able to specify or describe in detail a severe and horribly traumatic event while in Vietnam. It was again determined that the Veteran did not meet the DSM-IV criteria for a diagnosis of PTSD. Rather, the Veteran was noted to be suffering from an anxiety disorder NOS and alcohol dependence in sustained partial remission. The examiner concluded that the Veteran's anxiety disorder was precipitated by his prolonged history of alcohol dependence and, therefore, not related to service. The same physician that submitted the 2001 statement submitted an additional statement in June 2007. It was noted that the Veteran started abusing alcohol since Vietnam to calm his nerves. The physician opined that the Veteran's emotional condition was most probably PTSD and that he developed all of his emotional symptoms while in Vietnam. The Veteran was most recently afforded a VA psychiatric examination in July 2011. Again, the Veteran clarified that he did not receive any other psychiatric treatment. The Veteran reported combat experience during this examination. He indicated that he experienced multiple attack events from the enemy but he was not able to specify or describe in detail his traumatic or overall experience in Vietnam. The Veteran reported a past history of heavy daily alcohol intake of 20 to 24 cans of beer and rum daily. It was noted that he had social problems related to alcohol and alcoholic amnesia. The Veteran reported that he was no longer drinking daily but he did not specify his current drinking pattern. The examiner concluded that the Veteran did not meet the DSM-IV criteria for a diagnosis of PTSD. Rather, the Veteran was suffering from an alcohol induced mood disorder. The examiner opined that it was less likely as not that this condition was caused by or a result of the Veteran's active duty. After reviewing the claims file, the examiner concluded that there was a long history compatible with alcohol dependence. Alcohol induced mood disorder and alcohol dependence were two related conditions, with one depending on the other. By the Veteran's own history, there had not been a complete remission in his alcohol related condition. The examiner concluded that it was evidence that the mental deterioration suffered by the Veteran was mostly on account of his alcohol abuse. His alcohol dependence and alcohol induced mood disorder overshadowed any other possible mental disorder at present. The preponderance of the above evidence demonstrates that the Veteran is not entitled to service connection for an acquired psychiatric disorder, to include PTSD. Establishment of service connection for PTSD requires: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). A "clear" diagnosis of PTSD is no longer required. Rather, a diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which simply mandates that, for VA purposes, all mental disorder diagnoses must conform to the fourth edition of the DSM-IV. See 38 C.F.R. § 3.304(f). The United States Court of Appeals for Veterans Claims (Court) has taken judicial notice of the mental health profession's adoption of the DSM-IV as well as its more liberalizing standards to establish a diagnosis of PTSD. The Court acknowledged the change from an objective "would evoke ... in almost anyone" standard in assessing whether a stressor is sufficient to trigger PTSD to a subjective standard (e.g., whether a person's exposure to a traumatic event and response involved intense fear, helplessness, or horror). Thus, as noted by the Court, a more susceptible person could have PTSD under the DSM-IV criteria given his or her exposure to a traumatic event that would not necessarily have the same effect on "almost everyone." Cohen, 10 Vet. App. 128 at 140-41. If the evidence establishes that a veteran engaged in combat with the enemy and the claimed stressor is related to that combat, 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 a veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(1). See also 38 U.S.C.A. § 1154(b). The ordinary meaning of the phrase "engaged in combat with the enemy," as used in 38 U.S.C.A § 1154(b), requires that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. The issue of whether any particular set of circumstances constitutes engagement in combat with the enemy for purposes of section 1154(b) must be resolved on a case-by-case basis. See VAOPGCPREC 12-99 (October 18, 1999). If there is no combat experience, or if there is a determination that a veteran engaged in combat but the claimed stressor is not related to such combat, there must be independent evidence to corroborate the veteran's statement as to the occurrence of the claimed stressor. Doran v. Brown, 9 Vet. App. 163, 166 (1996). Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. Cohen v. Brown, 10 Vet. App. 128, 142 (1997); Moreau v. Brown, 9 Vet. App. 389, 395-96 (1996). As discussed in the previous section, the Veteran's DD-214 fails to confirm that he was exposed to combat during military service. The Veteran also explicitly denied combat exposure during his February 2003 and July 2004 VA examinations. As such, a verified stressor is required in this case. VA attempted to verify the Veteran's reported stressors, but in December 2007, a formal finding of a lack of information required to corroborate a stressor was issued. The Veteran has not since provided VA with any more specific details regarding his alleged in-service stressor. He has continued to claim he saw vehicles attacked and that people were injured or killed. He has not provided VA with any names or dates or additional information that was not already of record at the time of the previous attempt to verify his reported stressors. Therefore, there is no verified in-service stressor in this case. While the regulations pertaining to PTSD were recently amended, and 38 C.F.R. §3.304(f)(3) no longer requires the verification of an in-service stressor if the Veteran was in a location involving "fear of hostile military or terrorist activity." Such a location can be evidenced by awards such as the Iraq Campaign Medal or the Vietnam Service Medal. Lay testimony alone can be used to establish the occurrence of an in-service stressor in these situations. The new regulatory provision requires that: (1) A VA psychiatrist or psychologist, or contract equivalent, must confirm that the claimed stressor is adequate to support a diagnosis of PTSD; (2) the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service; and (3) the Veteran's symptoms are related to the claimed stressor. Id. The liberalizing criteria contained in the new § 3.304(f)(3) will be applied to PTSD service connection claims that are pending as of the effective date of the regulation (July 13, 2010) and to claims filed on or after this effective date. However, a confirmed diagnosis of PTSD is still required, which the Veteran does not have in this case. The Board recognizes that the private physician of record assigned a diagnosis of PTSD to the Veteran. Just because a physician or other health professional accepted the appellant's description of his service experiences as credible and diagnosed the appellant as suffering from PTSD, however, does not mean the Board is required to grant service connection for PTSD. Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). The Board is not required to accept an appellant's uncorroborated account of his active service experiences. See Swann v. Brown, 5 Vet. App. 229, 233 (1993) and Wood v. Derwinski, 1 Vet. App. 190, 192 (1991). According to the September 2001 statement, the Veteran had "evidently" been suffering from PTSD. In July 2007, it was noted that the Veteran "most probably" suffered from PTSD. These opinions are of little probative value. It is unclear from the statements of the private physician what evidence or criteria were relied upon in assigning a diagnosis. Furthermore, concluding that the Veteran "probably" suffered from PTSD is not a confirmed diagnosis. The VA examiners of record, however, upon review of the evidence of record and examination of the Veteran concluded that he did not meet the DSM-IV criteria for a diagnosis of PTSD. The Board finds these opinions to be more probative. The Board recognizes that the Veteran has received other psychiatric diagnoses during the pendency of his claim, including depression and anxiety. However, the preponderance of the evidence of record reflects that these disabilities did not manifest during, or as a result of, active military service. There is no evidence of psychiatric symptomatology or complaints during military service and the first post-service evidence is from several decades after separation from active duty. Furthermore, the July 2011 VA examiner opined that the Veteran was suffering from an alcohol induced mood disorder and alcohol dependence. The examiner concluded that the Veteran had suffered mental deterioration mostly on account of his alcohol abuse and that his alcohol dependence and alcohol induced mood disorder overshadowed any other possible mental disorder at present. As such, the preponderance of the evidence of record reflects that the Veteran does not suffer from any other mental disability that manifested during, or as a result of, active military service. The Board is aware that the Veteran's private physician suggested that he started abusing alcohol since Vietnam. However, compensation shall not be paid if a claimed disability was the result of the person's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C.A. §§ 105, 1131 (West 2002); 38 C.F.R. §§ 3.1(n), 3.301(c) (2012). With respect to alcohol and drug abuse, § 8052 of the Omnibus Budget Reconciliation Act (OBRA) of 1990, Pub. L. No. 101-508, § 8052, 104 Stat. 1388, 1388-351, prohibits, effective for claims filed after October 31, 1990, payment of compensation for a disability that is a result of a veteran's own alcohol or drug abuse. Furthermore, VA's General Counsel has confirmed that direct service connection for a disability that results from a claimant's own abuse of alcohol or drugs is precluded for purposes of all VA benefits where, as here, the claim was filed after October 31, 1990. See VAOGCPREC 7-99; VAOGCPREC 2-98. As such, service connection for any mood disorder due to alcohol abuse is not warranted. Finally, the Board recognizes that the Veteran believes he suffers from a psychiatric disorder, to include PTSD that is secondary to his military service. However, while the Veteran is competent to offer statements about events he witnessed during military service, the record fails to reflect that he has the requisite training or expertise to currently assign himself with a psychiatric diagnosis and relate this diagnosis to his military service. The VA psychiatrists, however, do have the requisite training and expertise and have concluded that the Veteran does not suffer from PTSD or a psychiatric disability that manifested during, or as a result of, active military service. As such, the Veteran's own diagnosis and opinion regarding etiology is not competent evidence of a current disability or of causation. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD, must be denied. ORDER New and material evidence having not been received, the claim of entitlement to service connection for an eye condition remains closed. Service connection for a neck disability is denied. Service connection for an acquired psychiatric disorder, to include PTSD, is denied. ____________________________________________ JENNIFER HWA Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs