Citation Nr: 1319953 Decision Date: 06/20/13 Archive Date: 07/02/13 DOCKET NO. 01-03 402 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUE Entitlement to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Virginia A. Girard-Brady, attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Stephen Eckerman, Counsel INTRODUCTION The Veteran served on active duty from August 1971 to August 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2000 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona, which denied the Veteran's claim for service connection for PTSD. The Veteran appealed, and in November 2005, the Board denied the claim. The Veteran appealed to the United States Court of Appeals for Veterans Claims ("Court"). In March 2008, the Court issued an Order and a Memorandum Decision that vacated the Board's November 2005 decision. In November 2008, the Board remanded the claim for additional development. In November 2005, the Veteran testified at a videoconference hearing before a Veterans Law Judge who is no longer at the Board. In March 2013, the Veteran was notified that he was entitled to another hearing before a Veterans Law Judge who would decide his claim. See 38 U.S.C.A. § 7107(c) (West 2002 & Supp. 2012). He was given 30 days to respond, after which he was told that it would be assumed that he did not desire another hearing. However, there is no record of a response. FINDING OF FACT The Veteran does not have an acquired psychiatric disorder, to include PTSD, as a result of his service. CONCLUSION OF LAW An acquired psychiatric disorder, to include PTSD, was not incurred or aggravated during the Veteran's active military service. 38 U.S.C.A. §§ 1110, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304(f) (2012). REASONS AND BASES FOR FINDING AND CONCLUSION I. Service Connection The Veteran asserts that he has an acquired psychiatric disorder, to include PTSD, as a result of his active military service. With regard to PTSD, he argues that he witnessed a number of stressors during the performance of his duties. He has also asserted that on February 6th or 7th, 1972, he was physically assaulted (beaten) by several men on two occasions, within two hours. He states that he was treated at the "Pioneer Kaserne" dispensary, and that as a result of his beating, his jaw was broken in three places, his ribs were broken in four places, and he sustained brain damage from a concussion. He further asserts that he was beaten by 6 to 7 men in about May 1973, and that he was beaten by 8 to 10 men in July 1973. Finally, he argues that he witnessed a number of deaths as a result of performing duties as a medic and an ambulance driver in Germany. See Veteran's stressor statements, received in August 1999, September 2002 and June 2005; Veteran's statement, received in February 2004. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Service connection may also be granted for arthritis, or a psychosis, when manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Applicable regulations provide that service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), a link, established by medical evidence between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). In addition to the previously noted law, 38 C.F.R. § 3.304(f)(3) provides: If a post-traumatic stress disorder claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; 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: 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. VA will not deny a post-traumatic stress disorder claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f)(3). During the pendency of this appeal, a new version of 38 C.F.R. § 3.304 was enacted. See 75 Fed. Reg. 39843 (July 13, 2010). Among other things, in some cases, the new regulation significantly changes the criteria for determining whether or not a claimed stressor is considered to have been verified. However, as discussed infra, the Veteran is not shown to have participated in combat, or to have served in a war zone; his stressors are alleged to have occurred in Germany in the 1970s, and the changes are not applicable to his claim. Personality disorders are not compensable diseases or injuries within the meaning of veterans' benefits law. 38 C.F.R. §§ 3.303(c), 4.9 (2012); Winn v. Brown, 8 Vet. App. 510, 516 (1996); Beno v. Principi, 3 Vet. App. 439 (1992). Compensation is not payable for a disability that is a result of the appellant's own alcohol or drug abuse. See 38 U.S.C.A. §§ 105, 1110 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.1(n), 3.301(c) (2012); Omnibus Budget Reconciliation Act (OBRA) of 1990, Pub. L. No. 101-508, § 8052, 104 Stat. 1388, 1388-351; see also VAOPGCPREC 7-99, 64 Fed. Reg. 52,375 (1999); VAOPGCPREC 2-98, 63 Fed. Reg. 31,263 (1998). General Counsel opinions are binding on the Board. 38 U.S.C.A. § 7104(c) (West 2002 & Supp. 2012); Brooks v. Brown, 5 Vet. App. 484 (1993). Given the foregoing, the term "acquired psychiatric disorder" is not intended to include a personality disorder, or alcohol or substance abuse. The evidence necessary to establish the incurrence of a stressor during service to support a claim of entitlement to service connection for PTSD will vary depending on whether or not the veteran was "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60, 66 (1993). In this case, the Veteran does not argue, and the evidence, including a review of the information contained in the Veteran's personnel file and his discharge (DD Form 214), does not show, that he participated in combat. In addition, the claimed stressors are not related to combat. Where a determination is made that a veteran did not "engage in combat with the enemy," or the claimed stressor is not related to combat, a veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. In such cases, the record must contain service records or other corroborative evidence which substantiates or verifies the veteran's testimony or statements as to the occurrence of the claimed stressor. See Cohen v. Brown, 10 Vet. App. 128, 147 (1997). The Veteran's service treatment reports show that he was treated for complaints of chest pain in January and June of 1973. The July 1973 report shows that the Veteran was treated for complaints of a six-month history of chest pain that were "pretty clearly hyperventilation." The examiner noted that he "stoves around inappropriately," and that his lungs were "perfectly clear." The assessment was hyperventilation and anxiety. The Veteran's separation examination report, dated in August 1973, shows that his psychiatric condition was clinically evaluated as normal. As for the post-service medical evidence, it consists of VA reports, dated between 1977 and 2013. This evidence includes private treatment reports which show that in December 1987, the Veteran was treated for an open fracture, midshaft left tibia and fibula, and closed fracture, left proximal tibia, after he was involved in a motor vehicle accident (MVA). A private psychiatric evaluation report, dated in February 1989, shows that the Axis I diagnosis was adjustment disorder with anxious mood, moderate. The Axis II diagnosis was passive-aggressive personality disorder, moderate. A private treatment report, dated in November 1993, shows treatment for a self-inflicted gunshot wound to the right hand. A decision of the Social Security Administration (SSA), dated in June 1995, shows that the SSA determined that the Veteran was disabled as of December 1987 due to his lower extremity injuries incurred in an MVA. A private psychiatric evaluation report, dated in February 1999, indicates that the evaluation was carried out in association with the Veteran's claim for SSA disability benefits. The report notes that the Veteran had undergone a number of surgeries after his 1987 MVA, and that he had not worked since that time. The Veteran reported that he "has had some mental disorders," which he attributed to his brother's injury in Vietnam, as well as the Veteran's loss of income, and a marked change in his lifestyle. The report notes "Question psychological problems and/or possibly cognitive deficits contributing to his disability." A VA examination report, dated in September 1999, shows that the Axis I diagnosis was PTSD "questionable in terms of its level of severity, is probably mild to moderate." The Axis II diagnosis was rule out personality disorder on the basis of assaultive behaviors in the past initiated by himself. VA progress notes, dated between 1988 and 2010, show that beginning in 2000, the Veteran was noted to have acquired psychiatric disorders that included anxiety, depression, ETOH (alcohol) abuse, bipolar disorder, and PTSD. Reports, dated in April 2001, include notations of a paranoid/schizoid personality, and a diagnosis of rule out dysthymia vs. dysphoria of personality disorder vs. malingering. A February 2005 report notes a personality disorder with narcissistic, borderline, and likely, antisocial traits. The reports also note a history of IV (intravenous) drug abuse. See e.g., April 2004 report. A 2001 report from J.F.H. Ph. D., indicates that it was based on three treatments provided between March and April of 2001. The report shows that the Veteran reported that during service in Germany, he was traumatized by multiple racially-motivated assaults and by dealing with victims of stabbings, shootings, and accidents. During service, he reported being beaten several times, as well as seeing the remains of someone who was run over by a train, and seeing another person who had run his vehicle into a stationary tank. He also reported having significant physical pain since his 1987 MVA, and significant financial difficulties. The Axis I diagnoses were provisional PTSD, major depression, and rule out cognitive disorder. A summary report from Dr. H, dated in April 2002, notes that the Veteran had been treated during the course of 19 sessions between March 2001 and March 2002, and that it appeared that he suffered a cognitive disorder secondary to his 1987 MVA, or his assaults in the military. Dr H stated that he had had to initiate a very concrete approach to treatment in which he actively kept the Veteran focused on relevant issues, but that, "His tendency was to shift to how the VA has not appropriately adjudicated his service-connected claim..." In May 2005, the RO requested a medical opinion. The RO stated that none of the Veteran's claimed stressors had been verified, however, because he had asserted that he had been assaulted during service, an opinion was requested as to whether or not the Veteran had unexplained changes in his behavior during or after service sufficient to show that he was assaulted during service, and, if so, whether the stressor was sufficient to account for a diagnosis of PTSD. A VA opinion, dated in June 2005, shows that a psychologist (Ph.D.) stated that the Veteran's records had been reviewed. The reports notes the following: the Veteran was treated in 2001, but he was only provided with a provisional diagnosis that does not firmly establish a diagnosis of PTSD. The Veteran was treated 19 times by a private physician, Dr. H, whose closing note does not mention PTSD. The Veteran's records are replete with his self-reports where he indicates that he has PTSD secondary to being assaulted by some black soldiers while stationed in Germany. His service treatment records make no mention of this, but they do mention that he had drug problems while in the military. The Veteran received treatment from T.L., M.D., and the only firm diagnosis was a personality disorder. There was no indication in the Veteran's records to show significantly changed behavior after his alleged assault. Most of the indications of PTSD are based on the Veteran's self-reported symptoms. The bulk of the evidence does not firmly support a diagnosis of PTSD. If PTSD does exist, it may be secondary to the Veteran's severe MVA. In conclusion, the issue of the Veteran's diagnosis cannot be resolved without resorting to mere speculation. While there are some references to PTSD secondary to an inservice assault, no firm diagnosis appears to be offered and the stressors are not supported through documentation. In January 2010, the RO determined that two verified stressors existed: the stabbing of an individual in June 1972, in which four soldiers were convicted, and the death of a soldier in a commercial railway incident in March 1973. Both stressors occurred in Germany. A VA examination report, dated in June 2010, shows that a VA psychologist stated that the Veteran's claims file had been reviewed. The Veteran reported a history that included being expelled from school after assaulting a teacher. The Veteran was noted to present a long list of events which allegedly occurred during service, to include being beaten up by three men at his first assignment, from whom he ran away, and that he was hit by several cars while trying to cross a freeway. This resulted in a broken pelvis, back and ankle, from which he walked away, only to be beaten by the same men who had beaten him earlier, along with the help of a white man in a black Mercedes. He reported being in 60 to 70 fights with other races, with gangs, and with drug dealers, always in self-defense. He further reported seeing many victims of motor vehicle accidents. The psychologist noted that the Veteran's claimed stressors appeared to cause him little if any actual clinical distress, and that he was fixated on his 60 to 70 fights with African-Americans. The examiner stated, "He also gets somewhat lost in tales of how returning veterans of Vietnam were treated on arrival and how that somehow also happened to him and is a big part of what he calls his PTSD." The examiner stated, "It is difficult to discern from the patient's descriptions what is real in many cases from what is delusional as he has rehearsed these tales for many years and they have become his identity and because they are also his claim to fame he appears to enjoy talking about them." He stated that, "It is only by their extreme excess that many of the tales become implausible." He characterized the Veteran's account of getting up and going back to the bar where he was beaten, after having multiple broken bones from being hit by several cars, as "miraculous." The examiner stated the following: the Veteran may be conflating his 1987 MVA injuries with his accounts of injuries during service. The Veteran has a tendency to violent anger and antisocial behavior that was present prior to service, including assaulting a teacher, stealing, speeding, and DWIs (driving while intoxicated). This behavior continued in the military and has continued after the military. There is no evidence of delusional or psychotic behavior prior to or in the military, other than it was problematic for him prior to his 1987 MVA. The examiner concluded that the Veteran did not report any symptoms of avoidance, that he enjoyed talking about his stressors, and that he did not meet the DSM criteria for PTSD. The Axis I diagnosis was psychotic disorder NOS (not otherwise specified), cannabis abuse, and polysubstance dependence/abuse in remission. The Axis II diagnosis was strong paranoid, narcissistic, and anti-social features. The examiner further concluded that the Veteran's diagnosis of psychosis NOS has multiple possible etiologies including being the result of his 1987 MVA and/or long-term polysubstance abuse. In June 2012, the RO requested an etiological opinion as to whether the Veteran has an acquired psychiatric disorder, to include PTSD, as a result of his service. A VA disability benefits questionnaire (DBQ), dated in June 2012, shows that a psychologist indicated that the Veteran's claims file had been reviewed. The psychologist concluded that the Veteran does not meet the DSM-IV criteria for a diagnosis of PTSD, not because he did not have a stressor but because he does not meet sufficient additional criteria to support the diagnosis. She stated: In my review of the patient's records I cannot find any document which provides clear evidence of presence of sufficient symptoms to support this diagnosis, this is true of the above, including the Sept[ember] 1999 exam where many symptoms were listed (stress over physical problems, thought impairment, fear of brother, need to defend self, poor attention and tracking, depression, belief that he is being stalked by brother, intrusive thoughts, flashbacks and dreams) but the symptoms required to make a diagnosis of PTSD were not sufficient. There is evidence of re-experiencing but there is no evidence [of] arousal or avoidance related to his identified military stressors. The patient continues not to meet sufficient criteria to support a diagnosis of PTSD. The psychologist went on to state the following: the Veteran did not meet the criteria for a mood disorder, and that, "There is no evidence throughout his file that any depressive symptoms are related to, caused by, the result of, or aggravated by, his military stressors or experiences." The Veteran has been noted to have a delusional presentation in the last several years, and, "It is more likely than not that these symptoms are related jointly and equally to his MVA and his long term substance abuse. There is no evidence that they are in any way related to, caused by, a result of or aggravated by his military stressors or experiences." There is no evidence that the Veteran's substance abuse, which began in adolescence and continued throughout adulthood, is in any way the result of his military stressors. The Veteran's symptoms of personality disorder, particularly anti-social and narcissistic, have been present since adolescence and there is no evidence that these symptoms or features are in any way connected to his military stressors. For all of the Veteran's disorders, where a time frame has not been provided, it is because the data does not lend itself to interpretation without recourse to mere speculation. As an initial matter, the Board finds that the Veteran is not a credible historian. In this regard, although two of the claimed stressors have been accepted, these two stressors do not pertain to the Veteran's allegations of being a victim of several inservice assaults. The Veteran has claimed, in part, that he was beaten twice in one day, upon his arrival in Germany. In his letters and statements, he has asserted that as a result of these beatings, his jaw was broken in three places, his ribs were broken in four places, and he sustained brain damage from a concussion. During his June 2010 VA examination, he gave a significantly different description of his injuries from these beatings, which he claimed had resulted from being hit by several cars while trying to cross a freeway as he was running away. Specifically, he stated that he sustained a broken pelvis, back, and ankle, "from which he walked away." Service treatment reports do not show any such injuries. The June 2010 VA examiner stated that it is difficult to discern from the patient's descriptions what is real in many cases from what is delusional, "as he has rehearsed these tales for many years and they have become his identity and because they are also his claim to fame he appears to enjoy talking about them." The examiner further stated that, "It is only by their extreme excess that many of the tales become implausible." He characterized the Veteran's account of getting up and going back to the bar where he was beaten, after having multiple broken bones from being hit by several cars, as "miraculous." He also stated that the Veteran may be conflating his 1987 MVA injuries with his accounts of injuries during service. The Board further notes that the Veteran has also asserted that he was beaten by 6 to 7 men in about May 1973, and that he was beaten by 8 to 10 men in July 1973. However, service treatment reports do not corroborate any such attacks. In addition, the Veteran is shown to have a long history of substance abuse, to include IV drug use, and VA progress notes show that he was repeatedly found to be exhibiting drug/medication-seeking behaviors. See e.g., reports, dated in April 2004, January and February of 2005. Finally, an April 2004 VA progress note indicates that the Veteran asserted that he had served in Vietnam; however, service in Vietnam is not shown. Given the foregoing, the Board finds that the Veteran is not a credible historian. See Wilson v. Derwinski, 2 Vet. App. 16, 19-20 (1991); see also Caluza v. Brown, 7 Vet. App. 498 (1995) (holding that in weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness). With regard to PTSD, the Board finds that the claim must be denied, as the preponderance of the evidence shows that the Veteran does not have PTSD. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (under 38 U.S.C.A. § 1110, an appellant must submit proof of a presently existing disability resulting from service in order to merit an award of compensation). In this regard, the opinions of the June 2010 and June 2012 VA psychologists both weigh against a finding that the Veteran has PTSD. In particular, the June 2012 opinion is the most recent opinion of record, and it is shown to have been based on a review of the Veteran's C-file, and the psychologist's conclusion is accompanied by a sufficient explanation. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion.); Neives-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The June 2010 VA examiner similarly determined that the Veteran does not have PTSD. The 2010 and 2012 VA opinions are also consistent with the opinion of the June 2005 VA psychologist, to the extent that she stated that there was no indication in the Veteran's records to show significantly changed behavior after his alleged assault, and that the bulk of the evidence does not firmly support a diagnosis of PTSD. See also Dr. H's 2001 report (noting that the Veteran's PTSD diagnosis was "provisional" only, because he did not describe nightmares related to his assaults, difficulty handling reminders of the assault, alienation and estrangement from others, as well as sleep disturbance and irritability). In reaching this decision, the Board has considered the evidence indicating that the Veteran has PTSD. However, the September 1999 VA examination report is over 13 years old, and it is therefore not based on a complete review of the records. See Boggs v. West, 11 Vet. App. 334, 344 (1998) (holding that the Board may adjudge a more recent medical opinion to have greater probative value, particularly where the subsequent examiner had additional evidence available in rendering the opinion). While the VA progress notes contain some notations of PTSD, some of these are "by history" only. In addition, to the extent that this evidence may be interpreted to indicate that medical personnel may have concluded that the Veteran has PTSD due to his service, none of these reports are based on either of the Veteran's two verified stressors, they are not shown to have been based on a review of the Veteran's claim file, or any other detailed and reliable medical history, and they are unaccompanied by a sufficiently detailed rationale. Prejean; Nieves-Rodriguez. In this regard, to the extent that they may have been based on the Veteran's alleged stressors, the Board has determined that he is not a credible historian. Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005). Accordingly, this evidence is insufficiently probative to warrant a grant of the claim. With regard to an acquired psychiatric disorder other than PTSD, the Board has determined that the claim must be denied. The Veteran was not treated for psychiatric symptoms during his service, although there was a July 1973 notation of anxiety in association with complaints of chest pain. However, the Veteran's August 1973 separation examination report shows that his psychiatric condition was clinically evaluated as normal. Therefore, a chronic condition is not shown during service. See 38 C.F.R. § 3.303(a), (b). The earliest medical evidence to show the existence of an acquired psychiatric disorder is dated in 1989, which is about 15 years following separation from service. In this regard, to the extent that the Veteran has repeatedly been diagnosed with acquired psychiatric disorders other than a psychosis, these are not disorders listed at 38 C.F.R. § 3.309(a) (2012), and the U.S. Court of Appeals for the Federal Circuit has recently held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic at 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). There is no competent and probative evidence to show that an acquired psychiatric disorder is related to the Veteran's service. In this regard, the only competent opinion is found in the June 2012 VA DBQ, and this opinion weighs against the claim. Finally, there is no evidence to show that a psychosis was manifest to a compensable degree within one year of the Veteran's separation from service. See 38 C.F.R. §§ 3.307, 3.309 (2012). Accordingly, the Board finds that the preponderance of the evidence is against the claim, and that the claim must be denied. With respect to the Veteran's own contentions, and the lay statements, a layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998) citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992) (a layperson without the appropriate medical training and expertise is not competent to provide a probative opinion on a medical matter, to include a diagnosis of a specific disability and a determination of the origins of a specific disorder). Lay testimony is competent, however, to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). 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. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this case, the post-service medical records show that the Veteran has been diagnosed with acquired psychiatric disorders. The Board has determined that the Veteran is not a credible historian, and that he does not have PTSD. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, whether the Veteran has an acquired psychiatric disorder, to include PTSD, due to his service, which ended in 1973, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). The Board has determined that the service and post-service medical evidence outweighs the Veteran's contentions, and the lay statements, to the effect that he has the claimed condition that is related to his service. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and that the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt, however, as is stated above, the preponderance of the evidence is against the appellant's claim, and the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). II. Duties to Notify and Assist The Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012). The notification obligation in this case was accomplished by way of letters from the RO to the Veteran dated in February 2004, and in February 2005. Quartuccio v. Principi, 16 Vet. App. 183 (2002); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F. 3d 1328 (Fed. Cir. 2006); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In addition, in September 2012, after the scope of the issue was expanded to include acquired psychiatric diagnoses other than PTSD, the RO issued another supplemental statement of the case. See Prickett v. Nicholson, 20 Vet. App. 370, 377-78 (2006) (holding that VA cured any failure to afford statutory notice to claimant prior to initial rating decision by issuing notification letter after decision and readjudicating claim and notifying claimant of such readjudication in the statement of the case). The RO also provided assistance to the appellant as required under 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c), as indicated under the facts and circumstances in this case. It appears that all known and available service treatment reports, and post-service records relevant to the issue on appeal have been obtained and are associated with the Veteran's claims files. The RO has obtained the Veteran's VA and non-VA records, and SSA records. The Veteran has been afforded examinations, and etiological opinions have been obtained. In November 2008, the Board remanded this claim. The Board directed that attempt be made to verify the Veteran's claimed stressors with the JSRRC (the U.S. Army and Joint Services Records Research Center), and that an attempt be made to obtain the personnel files of two men whom the Veteran claimed had assaulted him. Thereafter, the RO contacted the National Personnel Records Center (NPRC), seeking any records they may have showing treatment at the dispensary at Pioneer Kaserne. However, in November 2009, the NPRC stated that it was unable to search due to insufficient information. That same month, the RO sent a duty-to-assist letter to the Veteran requesting additional details, however, there is no record of a reply that is responsive to the RO's request. The RO also obtained reports from the JSRRC (via DPRIS) (Defense Personnel Records Information Retrieval System), which resulted in the conclusion that two of the claimed stressors were sufficiently verified, i.e., the death of a soldier in a commercial railroad incident in Germany in March 1973, and the death of a soldier in a stabbing incident at Ayers Caserne in Kirch-Goens in June 1972. The RO also obtained the personnel file of one of the two men whom the Veteran asserted had assaulted him (P.D.H.). As a final matter, the Board points out that given its determination that the Veteran does not have PTSD, any failure in the duty to assist concerning stressor verification could be no more than harmless error. Given the foregoing, the Board finds that there has been substantial compliance with its remand. See Dyment v. West, 13 Vet. App. 141, 146-147 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998) where Board's remand instructions were substantially complied with); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). Based on the foregoing, the Board finds that the Veteran has not been prejudiced by a failure of VA in its duty to assist, and that any violation of the duty to assist could be no more than harmless error. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). ORDER The appeal is denied. ____________________________________________ JONATHAN A. KRAMER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs