Citation Nr: 1319626 Decision Date: 06/18/13 Archive Date: 06/27/13 DOCKET NO. 08-25 817 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for an acquired psychiatric disorder, other than PTSD, to include as secondary to a service-connected disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J.R. Bryant, Counsel INTRODUCTION The Veteran served on active duty from August 1972 to October 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2008 and June 2010 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in May 2011. A transcript of the hearing has been associated with the claims file. In June 2011, the Board remanded the appeal to the RO via the Appeals Management Center (AMC) in Washington, DC, for further development. After completing additional development, the AMC continued to deny the claim (as reflected in a May 2012 supplemental statement of the case (SSOC)), and returned this matter to the Board for further appellate consideration. In June 2012, the Veteran submitted additional supporting evidence consisting of lay statements from his siblings. That evidence was received with the appropriate waiver of agency of original jurisdiction review under 38 C.F.R. § 20.1304 (2012). Therefore, the Board may properly consider such newly received evidence. FINDINGS OF FACT 1. The evidentiary record does not establish that the Veteran was engaged in combat with the enemy or that he was exposed to hostile military or terrorist activity while on active duty. 2. The Veteran's claimed in-service stressful experiences have not been corroborated by service records, or by other credible supporting evidence, and he has not provided sufficient information for VA to attempt to corroborate independently any such in-service stressor events. 3. The competent and probative medical evidence of record establishes that the Veteran does not have PTSD. 4. There is no competent medical evidence that an acquired psychiatric disorder, other than PTSD, was manifested in service or that a psychosis was manifested within one year thereafter; nor is there competent evidence that any currently diagnosed psychiatric disorder is causally or etiologically related to service in any way or to any service-connected disability. CONCLUSIONS OF LAW 1. PTSD was not incurred in, or aggravated by, the Veteran's military service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304(f) (2012). 2. An acquired psychiatric disorder, other than PTSD, was not incurred in, or aggravated by, the Veteran's military service and is not proximately due to or aggravated by any service-connected disability. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify and Assist Before addressing the merits of the issue on appeal, the Board notes that VA has a duty to notify and a duty to assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. §§ 3.159, 3.326(a). Proper notice from VA must inform the claimant and his representative, if any, prior to the initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ) of any information and any 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 claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002). These notice requirements apply to all five elements of a service-connection claim (Veteran status, existence of a disability, a connection between the Veteran's service and the disability, degree of disability, and effective date of the disability). Dingess v. Nicholson, 19 Vet. App. 473 (2006). Information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded must be included. Id. Here, the Veteran was notified via letters dated in February 2007 and January 2010 of VA's duty to assist him in substantiating a service connection claim, and the effect of this duty upon his claim. These letters also informed him of how disability ratings and effective dates are assigned. See Dingess, 19 Vet. App. at 484. Because the letter addressed all notice elements and predated the initial adjudications by the AOJ in January 2008 and June 2010, nothing more was required. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). Neither the Veteran nor his representative has alleged prejudice with respect to notice, as is required. Shinseki v. Sanders, 129 S. Ct. 1696 (2009); Goodwin v. Peake, 22 Vet. App. 128 (2008); Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). None is found by the Board. Indeed, VA's duty to notify has been more than satisfied. The Board also finds that VA has satisfied its duty to assist the Veteran in the development of the claim adjudicated herein. Pertinent in-service and post-service treatment reports have been obtained and associated with the claims file and/or Virtual VA folder. Additionally, the Veteran has not indicated that he is in receipt of, and VA does not have knowledge of, disability benefits from the Social Security Administration (SSA). Therefore, any failure on the part of the RO to request and/or obtain pertinent SSA disability determinations and the medical records considered in making those decisions was not in error. 38 C.F.R. § 3.159(c)(2). To the extent that the Veteran was able to provide identifying information, actions were taken to attempt to obtain evidence that would corroborate his claimed stressors including a request to the U.S. Army Crime Records Center in Quantico, Virginia. Pursuant to the Board's June 2011 remand, a VA examination was obtained in April 2012 to assist in determining whether the Veteran's claimed psychiatric disorder is attributable to his military service. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board finds that the VA examination is more than adequate, as it reflects a full review of all medical evidence of record, is supported by sufficient detail, and refers to specific documents and medical history as well as the Veteran's in-service stressor history to support the conclusions reached. There is also no medical evidence of record that suggests a nexus between any currently diagnosed psychiatric disorder and his military; nor has the Veteran provided credible evidence of continuity of symptomatology since separation from service. Accordingly, there is no basis to conclude that the VA medical opinion is inadequate, or that a remand for a new examination is required. Dyment v. West, 13 Vet. App. 141 (1999) (noting that a remand is not required under Stegall v. West, 11 Vet. App. 268 (1998) where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). As will be explained below, the VA psychologist stated that she was unable to provide an etiological opinion without resorting to speculation." In this regard, the Board has considered the Court's recent holding in Jones v. Shinseki, 23 Vet. App. 382 (2010), that, when a medical examiner concludes that he or she is unable to provide a nexus opinion without speculation, this alone does not make the medical opinion inadequate, as a medical opinion with such language may be adequate if the examiner sufficiently explains the reasons for this inability. Id. at 389-90. Here, the examiner concluded that a definitive opinion with regard to the diagnosis of PTSD could not be made without resorting to speculation because of a lack of evidence and the inconsistencies in the Veteran's chart, including his sworn testimony. The Board does not find this examination or opinion to be inadequate under Jones and will proceed to adjudicate this claim based on this examination report and all other relevant evidence of record. Thus, the Board finds that VA has satisfied its duty to assist the Veteran in apprising him as to the evidence needed, and in obtaining evidence pertinent to his claim under the VCAA. No useful purpose would be served in remanding this matter for yet more development. A remand would result in unnecessarily imposing additional burdens on VA, with no additional benefit to the Veteran. 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); & Quartuccio v. Principi, supra. Law and Analysis The Veteran is seeking service connection for his psychiatric symptoms which he asserts had their onset during military service. In the alternative, he has also alleged that his psychiatric symptoms were caused, or made worse, by service-connected disability. He has essentially predicated his claim on establishing service connection for disability manifested by joint pain. See May 2011 hearing transcript (Tr.) at pages 10 and 11. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. §§ 3.303(a), 3.304. Service connection for certain specified chronic diseases, such as psychoses, may be established on a presumptive basis by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). For the showing of 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. Id. When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Id. For this purpose, a chronic disease is one listed at 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). (holding that the term "chronic disease in 38 C.F.R. § 3.309(b) is limited to a chronic disease listed at 38 C.F.R. § 3.309(a)). A grant of service connection under 38 C.F.R. § 3.303(b) does not require proof of the nexus element; it is presumed. Id. Service connection may also be established on a secondary basis for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires (1) competent evidence (a medical diagnosis) of current chronic disability; (2) evidence of a service-connected disability; and (3) competent evidence that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). There must be medical evidence of a current disability; evidence of a service-connected disability; and medical evidence of a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-7 (1995). To establish entitlement to service connection for PTSD, the record must contain the following: (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 diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a), which mandates that, for VA purposes, all mental disorder diagnoses must conform to the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders, 4th ed. (DSM-IV). 38 C.F.R. § 3.304(f). The Court of Appeals for Veterans Claims (Court) has taken judicial notice of the mental health profession's adoption of the DSM-IV. Cohen, supra. According to the current criteria, a diagnosis of PTSD requires exposure to a traumatic event, or stressor. 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. The sufficiency of a stressor is a medical determination, and the occurrence of a claimed stressor is an adjudicatory determination. Id. Furthermore, the pertinent regulation provides that, if the evidence establishes that the veteran engaged in combat with the enemy and that 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 the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f)(1). However, in order to grant service connection for PTSD to a non-combat veteran, there must be credible evidence to support the veteran's assertion that the stressful event occurred. A medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. Cohen v. Brown, supra, at 142; Moreau v. Brown, 9 Vet. App. 389, 395-396 (1996). The Board notes that, with regard to stressor verification, the VA regulation at 38 C.F.R. 3.304(f) was recently amended to liberalize the requirement of verification or corroboration of a veteran's claimed in-service stressor events in a PTSD claim. 38 C.F.R. § 3.304(f)(3) (2012), as added in 75 Fed. Reg. 39,843 -852 (July 13, 2010). However these revisions do not pertain to claims for PTSD that, as here, are predicated on personal assault. Hall v. Shinseki, 2012-7115, (Fed. Cir. Jun. 7, 2013) (holding that § 3.304(f)(3) can apply only if a veteran's claimed in-service PTSD stressor relates to an event or circumstance that a veteran experienced, witnessed, or was confronted with and that was perpetrated by a member of an enemy military or by a terrorist). The only notable change for claims predicated on sexual assault was the redesignation of this type of claim from subpart (f)(4) to (f)(5). Cases involving allegations of personal assault fall within the category of situations in which it is not unusual for there to be an absence of service records documenting the events of which the veteran complains. If a PTSD claim is based on an in-service personal assault, evidence from sources other than the Veteran's service records may corroborate his or her account of the stressor incident. Examples of such evidence include, but are not limited to the following: records from law enforcement authorities, mental health counseling centers, hospitals, or physicians, and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to the following: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(5); see Patton v. West, 12 Vet. App. 272 (1999) (holding that special VA Adjudication Procedure Manual evidentiary procedures apply in PTSD personal assault cases). 38 C.F.R. § 3.304(f)(5) further provides that VA may submit any such evidence as is described under that provision to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. In essence, unlike claims for PTSD that do not involve an assertion of personal or sexual assault, VA can take into account the opinion of a medical professional as to the likelihood that the stressor actually occurred, rather than just relying on such a professional to determine whether or not a stressor supports a diagnosis of PTSD. The Board is not required to accept the veteran's uncorroborated account of his 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 the Veteran's statements regarding his alleged stressors, if the Board does not find the statements regarding his stressors to be credible. After considering all information and lay and medical evidence of record in a case 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 benefit of the doubt will be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The benefit of the doubt rule is inapplicable when the evidence preponderates against the claim. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). In this case, there is no evidence that the Veteran had combat service for the purposes of the controlling regulations. Moreover, his stressors do not even relate to combat; rather, he contends that his psychiatric problems stem from various traumatic events in service, including an accidental grenade explosion during basic training and multiple incidents of personal assaults, including fights with other service members, in-service robberies, and sexual trauma. With regard to a psychiatric disorder other than PTSD, the Veteran alleges that he began experiencing symptoms of anxiety and depression in service and that these symptoms continue today. He testified in May 2011 that he received a hardship discharge from service to allow him to assist his with his ailing elderly parents on the family farm following the deaths of two of his brothers within weeks of each other. Lay statements submitted by the Veteran's family members describe how they noticed a change in the Veteran's personality as early as 1973, around the time of service discharge. See lay statements from the Veteran's mother, sister, and two long-time family friends, dated in December 1978. Since combat status has not been established, the Veteran's statements alone cannot constitute conclusive evidence of the occurrence of the in-service stressor; rather, corroborating evidence is needed. In such cases, the record must contain service records or other corroborative evidence that substantiates or verifies the Veteran's testimony or statements as to the occurrence of the claimed stressor. Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). In support of his claim, the Veteran has identified several events which he considers to be the precipitating causes of his claimed PTSD. He reported that, during basic training, he was attempting to throw a grenade when his drill sergeant grabbed his wrist causing him to drop the grenade. They both had to jump into the bunker as the grenade went off. No one was injured, but the Veteran stated that he was constantly harassed by fellow servicemen after the incident. He also reported that he witnessed a sexual act between his roommate and another serviceman while stationed in Germany. He stated that the next day he reported the incident and his roommate and other servicemen received an Article 15. The Veteran has also described multiple instances of attempted robberies, including one where he was offered a ride by a car full of soldiers who intended to rob him. According to various statements, the Veteran refused the ride, but the soldiers were lying in wait for him after he decided to catch a cab and he had to defend himself against his attackers with a knife. He reported the incident to the MP (military police), but nothing was done about it because they were off post. After that incident the Veteran began to carry a knife, which he apparently used to defend himself against several attackers at a bar. Although he reported the attack he was confined to his barracks and sent to anger management. On another occasion, while stationed at Fort Sill, he defended himself against two men while he was on a trail. He cut one of the men with his knife that later died. The Veteran was accused of murder and subsequently went to trial for the death. He indicated that a Sergeant Blackburn assisted him at his trial and he served 30 days. See VA outpatient treatment record dated November 15, 2004, VA Forms 21-4138 received in February 2010 and October 2011, and VA Forms, 21-0781 received in December 2011. The Board has searched the Veteran's service treatment and service personnel records for the various types of evidence which may constitute evidence of a personal or physical assault, such as evidence of behavioral changes, or treatment for physical conditions consistent with the claim, see e.g., M21-1, paragraph 11.38c, but unfortunately the evidence does not support his claim. Service treatment records are entirely negative for psychiatric complaints or symptomatology. These records do not show that the Veteran ever received psychiatric counseling during active duty and do not contain any indication of treatment for any physical injuries such as contusions, or lacerations consistent with physical assaults. His separation examination report shows no psychiatric abnormality, and he specifically denied a history of depression, excessive worry, nervous trouble, nightmares, or trouble sleeping. Further, and of significant probative value, are the Veteran's service personnel records, which are pertinent to the claim and are the only objective evidence which reflect upon his attitude, bearing, and behavior in service. However, his military service records do not indicate that there was any inexplicable decline in his overall performance, nor do they indicate that he was ever reprimanded for fighting or other related misconduct, or was otherwise a disciplinary problem. Rather, these records do confirm that the Veteran received a hardship discharge to care for his elderly and ill parents, a home situation that was made worse by the deaths of the Veteran's two brothers. There is no service personnel evidence of deterioration in work performance. Moreover, the Veteran has not submitted any other evidence, such as statements from fellow veterans, which would serve to support his accounts. Further, in January 2012, the RO requested information from the Army Crime Records Center, concerning the Veteran's claim of a criminal investigation and trial. The RO received a negative response (i.e. a notation "no record"), the same month. In a March 2012 memorandum, the RO notified the Veteran of the negative response. Having considered the Veteran's descriptions of his purported in-service assaults, the Board finds that the service records do not provide credible supporting evidence that the claimed in-service stressors pertaining to personal assault occurred. In any event, the critical element in this case is that, based on the record as a whole, the Veteran lacks a diagnosis of PTSD consistent with DSM-IV criteria. Of record are post-service medical reports dated from 1978 to 2012, show psychiatric treatment for symptoms variously attributed to schizophrenia, adjustment disorder with depressed mood, psychotic disorder, depressive disorder. See VA examination report dated October 1978, private medical opinion from Creoks Mental Health Services, dated in October 1983, and VA outpatient treatment records dated in December 2004, and September 2005. The Board notes that when examined by VA in October 1978 the Veteran offered no details of his life history other than discussing the deaths of his two brothers making no mention of military service. The Board acknowledges that the Veteran has also received provisional diagnoses of PTSD following some evaluations. See VA outpatient treatment record dated September 20, 2002 and August 20, 2010. Arguably, considered in isolation, these VA treatment records could be construed as supporting the Veteran's contention that he has a current diagnosis of PTSD based on his claimed in-service physical assault. However, the diagnoses are in large part based upon vague and general reference to symptoms without a specific discussion of the DSM-IV criteria. Accordingly, the Board does not presume that the PTSD diagnoses were made in accord with DSM-IV. Cohen, at 140. Thus, the Board assigns minimal probative weight to them. Moreover, the Veteran was afforded a VA examination in April 2012 where the psychologist concluded the Veteran does not have a diagnosis of PTSD that conforms to DSM-IV criteria. At that time, she took a detailed history of the Veteran's in-service stressors, post-service symptoms, and the letters submitted by the Veteran's sisters stating that he was under mental health treatment in the late 1970s and early 1980s. When asked about his alleged stressors, the Veteran recounted that he stabbed a fellow service member to death, which an investigation ruled was in self defense. He also reported stabbing two individuals at an airport while returning home on leave and stabbing an individual in Fort Sill who tried to rob him. Instead, she concluded the Veteran met the full criteria for current Axis I diagnoses of recurrent moderate major depressive disorder, antisocial personality disorder, and psychosis in remission. She referred to his history of treatment for mental health issues in beginning in 1978 when he was diagnosed with schizophrenia followed by diagnoses of nervous condition in 1982, and schizophrenia in 1983. She noted that private treatment providers diagnosed the Veteran with adjustment disorder with depressed mood. Most recently in 2010, the Veteran was diagnosed with major depressive disorder, rule out PTSD and psychotic disorder in remission. The psychologist opined that it was less likely than not that the major depressive and psychotic disorders were the result of military service and clearly began following his discharge from the Army based on the treatment records. She also opined that the Veteran's diagnosis of antisocial personality disorder predated service as it is a personality issue. With regard to PTSD, she explained that, although the Veteran related several incidents that meet requirements for a Criterion A stressor, there was a vast discrepancy in the claims file, his military record, and his testimony regarding his stressors. The psychologist noted that nowhere is it mentioned in the chart that the Veteran killed someone while stationed in Germany, but during this interview he mentioned stabbing to death a fellow soldier and there being an investigation. The Veteran furthermore had never mentioned stabbing two individuals in an airport in 1973 while returning home on leave, and he never mentioned purposefully letting an individual try to take him in the car and rob him just so he could stab him while stationed in Fort Sill. He reported this as a planned incident and looked forward to killing the individual in a vigilant action. This also is based on the Veteran's lay testimony with no supporting evidence found. Because of the lack of evidence and the inconsistencies in the chart, including the Veteran's sworn testimony regarding these incidents, she was unable to provide any opinion on a diagnosis of PTSD as she would have to resort to mere speculation. However if further evidence is found, the Veteran should be provided another examination. While the 2012 VA examiner could not determine, without resorting to speculation, whether the Veteran has PTSD, she has explained specifically why she was not able to offer such an opinion. See Jones, 23 Vet. App. at 390. She cited to the relevant available evidence and questioned the Veteran's credibility, noting that the Veteran noting the inconsistencies between the account of the assaults and the lack of evidence in the claims file. The Board finds her explanation to be sufficient and concludes that the opinion and rationale are competent and credible and provide probative evidence. To that end, if the question of etiology cannot be determined without resorting to speculation, then it has not been proven to the level of equipoise. Chotta v. Peake, 22 Vet. App. 80, 86 (2008) (Board may not award benefits when the award would be based upon pure speculation); see also Fagan v. Shinseki, 573 F.3d 1282, 1289 (Fed. Cir. 2009) ("The examiner's statement, which recites the inability to come to an opinion, provides neither positive nor negative support for service connection. Therefore, it is not pertinent evidence, one way or the other, regarding service connection."). In summary, the Veteran's claim for PTSD is implausible since there is no credible medical diagnosis of this condition in the record. A substantial negative piece of evidence is the 2012 VA examination report, which was conducted for the express purpose of determining whether the Veteran met the diagnostic criteria for PTSD. Here, the VA psychologist reviewed the complete claims file and was able to fully consider and comment upon all the evidence currently of record in expressing her diagnostic opinion. Moreover, in rendering her opinion, she referred to the Veteran's stressors and specific medical history to support her conclusions. She considered the relevant diagnostic criteria and specified the ways in which the Veteran failed to meet the criteria for a diagnosis of PTSD. Thus, the Board finds the 2012 VA medical opinion to be of greater probative value than the VA outpatient treatment records showing provisional diagnoses of PTSD. The Board has thoroughly considered the Veteran's claim for service connection for PTSD based on physical assaults. However, in the absence of evidence reasonably supporting such assaults in service, service connection for PTSD must be denied. With regard to any acquired psychiatric disorders, other than PTSD, the Board notes that the scope of a mental health disability claim includes any mental disability that reasonably may be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Therefore, VA must consider service connection for a disability manifested by those symptoms, regardless of how it is diagnosed. The weight of credible medical evidence in the present appeal shows that after service, the Veteran was treated for various psychiatric diagnoses, to include schizophrenia, adjustment disorder with depressed mood, psychotic disorder, depressive disorder, and personality disorder. Unfortunately, the Board is unable to attribute the post-service development of any diagnosed psychiatric disorder to the Veteran's military service. Service treatment records are entirely negative for any psychiatric complaints, treatment, or diagnoses and there is no evidence that a psychoses was manifested in the first post-service year. Moreover post-service treatment records do not show that the schizophrenia first documented in 1978, five years post service, was manifested prior to that date. Also, during those intervening years the Veteran did not complain of or receive psychiatric treatment for any pertinent symptoms consistent with 38 C.F.R. § 3.303(b). Although not a dispositive factor, the significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000). What remains for consideration is whether or not in the absence of a diagnosis in service and/or continuity of symptoms the Veteran's diagnosed major depressive and psychotic disorders may nonetheless somehow otherwise be related to his service. However, there is no medical evidence linking the Veteran's psychiatric disorder to his military service years earlier, and the Veteran has not submitted any medical opinion that relates them to his service/events therein. See Hickson v. West, 12 Vet. App. 247. Notably, the 2012 VA examination report specifically found that the Veteran's current major depressive disorder and psychotic disorder were not related to service. As an acquired psychiatric disorder other than PTSD was not shown during service or for years thereafter, service connection can only be granted if there is some competent evidence linking the current disorder to service. Here, there is no such competent evidence. To the degree that the Veteran's psychiatric symptoms have been attributed to a personality disorder, service connection also is not warranted because personality disorders are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). Consequently, there is no legal basis to grant service connection for this disorder. Because the law, rather than the evidence, is dispositive on this issue, service connection is not warranted for the Veteran's personality disorder. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Finally, as discussed above, the Veteran also seeks service connection for an acquired psychiatric disorder, other than PTSD on a secondary basis. However, service connection for a disability manifested by joint pain was previously denied by the Board in June 2011, and service connection is not otherwise in effect for any other disability. Because there is no predicate disability upon which secondary service connection may be granted, this argument does not provide a basis for a grant of service connection. 38 C.F.R. § 3.310; Allen supra. In other words, there is no legal basis to grant service connection on this basis. Again, as there is a lack of entitlement under the law, the application of the law to the facts is dispositive. See Sabonis supra. In reaching this conclusion, the Board has not overlooked the Veteran's contentions, his statements to healthcare providers, his written statements regarding his mental condition, or his hearing testimony. His primary argument is that his psychiatric problems are related to his military service. The Board is keenly aware that lay testimony is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Jones v. Brown, 7 Vet. App. 134, 137 (1994); Layno v. Brown, 6 Vet. App. 465, 469 (1994) Buchanan v. Nicolson, 451 F.3d 1331 (Fed. Cir. 2006). When a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Federal Circuit Court has held, however, that the Board retains the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. So, to ultimately have probative value, the Veteran's assertions also have to be credible and judged in relation to the other evidence in the file - including any medical evidence addressing the determinative issue of causation. See Rucker v. Brown, 10 Vet. App. 67 (1997) and Layno, 6 Vet. App. at 469 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating and determining causal connections for psychiatric disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, this lay evidence does not constitute competent medical evidence and lacks probative value. Although the Board recognizes the sincerity of the arguments advanced by the Veteran, his contentions as to the etiology/onset of his claimed psychiatric disorder(s) are not statements merely about symptoms, an observable medical condition, or a contemporaneous medical diagnosis, but rather clearly fall within the realm of requiring medical expertise, which he simply does not have. That is to say, schizophrenia, major depressive disorder, and PTSD are not the types of conditions that are readily amenable to mere lay diagnosis or probative comment on their etiology. So, while the Veteran is competent to say that he has experienced certain symptoms, even symptoms that often may be associated with an eventual psychiatric diagnosis, he is not in turn competent to ascribe these symptoms to disability related to his military service. In this case, the Veteran's opinion is far outweighed by the more thoroughly explained and detailed opinion from the VA medical professional. Jandreau supra & Buchanan supra. Accordingly, the preponderance of the evidence is against the claim, and there is no reasonable doubt to be resolved. 38 U.S.C.A. § 5107(b). ORDER Service connection for PTSD is denied. Service connection for an acquired psychiatric disorder, other than PTSD, to include as secondary to a service-connected disability, is denied. ____________________________________________ THERESA M. CATINO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs