Citation Nr: 1319978 Decision Date: 06/20/13 Archive Date: 07/02/13 DOCKET NO. 06-28 369 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include anxiety disorder NOS, personality disorder NOS, and posttraumatic stress disorder (PTSD), claimed as a residual of exposure to herbicides. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD William Alan Nelson II, Associate Counsel INTRODUCTION The Veteran had active service from January 1969 to January 1971. This appeal comes to the Board of Veterans' Appeals (Board) from an August 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which denied the Veteran's claims for service connection for an acquired psychiatric disorder and for a neurological disorder. The Board considers the Veteran's claim for an acquired psychiatric disorder as encompassing all psychiatric disorders evident in the record, pursuant to the decision of the Court of Appeals for Veterans Claims in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental health disability that could reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). The claim at issue was previously remanded by the Board in October 2010 for further evidentiary development of providing the Veteran a medical examination and opinion for his psychiatric disorder. This was accomplished, and the Board concludes that it may proceed with a decision at this time. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand 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 (Fed. Cir. 2002). The Board has reviewed the Veteran's physical claims folder, as well as the Veteran's electronic folder through Virtual VA, to ensure a complete review of the evidence in this case. FINDINGS OF FACT 1. The Veteran had "service in the Republic of Vietnam" and was exposed to herbicides during active service. 2. The Veteran did not engage in combat with the enemy. 3. The medical evidence of record does not support the conclusion that the Veteran meets the DSM-IV criteria for PTSD at this time based on the best medical evidence. 4. To the extent the Veteran is found to meet the DSM-IV criteria for PTSD, PTSD has not been shown to be the result of a verified in-service stressor. 5. The Veteran was treated for and diagnosed with mixed personality disorder in service. 6. There is no evidence of a superimposed injury in service or evidence of permanent worsening of the personality disorder in service. 7. Symptoms of a psychiatric disorder other than personality disorder were not chronic in service and have not been continuous since service separation. 8. The post-service symptoms of psychiatric disorder are not related to service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The notice requirements of VCAA require VA to notify the claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. The Board notes that a "fourth element" of the notice requirement requesting the claimant to provide any evidence in the claimant's possession that pertains to the claim was removed from the language of 38 C.F.R. § 3.159(b)(1). See 73 Fed. Reg. 23,353-356 (April 30, 2008). The United States Court of Appeals for Veterans Claims (Court) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service-connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. In a timely May 2005 letter, the RO provided notice to the Veteran regarding what information and evidence is needed to substantiate a claim for service connection, what information and evidence must be submitted by the Veteran, and what subset information or evidence VA will attempt to obtain. A May 2006 letter included provisions for disability ratings and for the effective date of the claim. The Veteran was provided with a VA examination in November 2012. To that end, 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, 312 (2007). The Board finds that the VA opinion/findings obtained in this case are adequate, as the opinion is predicated on a full reading of the private and VA medical records in the Veteran's claims file. The VA nexus opinion provided considers all of the pertinent evidence of record, to include service treatment records, VA treatment records, comprehensive physical examinations, and the statements of the Veteran, and provides a complete rationale for the opinion stated, relying on and citing to the records reviewed. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the issue on appeal has been met. 38 C.F.R. § 3.159(c)(4). For the reasons set forth above, the Board finds that VA has complied with the VCAA's notification and assistance requirements. The Board is also satisfied VA has made reasonable efforts to obtain relevant records and evidence, including affording a VA examination. Specifically, the information and evidence that has been associated with the claims file includes the Veteran's service treatment records, post service VA and private treatment records, VA examination, and the Veteran's statements. For these reasons, the Board finds that VA has fulfilled the duties to notify and assist the Veteran. Service Connection Laws and Regulations Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. The condition at issue, an acquired psychiatric disorder (psychosis), is a "chronic disease" listed under 38 C.F.R. § 3.309(a), therefore, 38 C.F.R. § 3.309(b) applies. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as psychosis, to a degree of 10 percent or more within one year from separation from service, such diseases may 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. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.307, 3.309. In adjudicating a claim for service connection for PTSD, 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). If it is determined through military citation or other supportive evidence that a veteran engaged in combat with the enemy, and the claimed stressors are related to combat, a veteran's lay testimony regarding the reported stressors must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary, provided that the testimony is found to be satisfactory, that is, not contradicted by service records, and "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d),(f); Doran v. Brown, 6 Vet. App. 283, 289 (1994). To gain the benefit of a relaxed standard for proof of service incurrence of an injury or disease, 38 U.S.C.A. § 1154(b) requires that a veteran have actually participated in combat with the enemy. See VAOPGCPREC 12-99. If it is determined, as here, 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 a veteran's testimony or statements as to the occurrence of the claimed stressors. See Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). Effective July 13, 2010, VA amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the required in-service stressor. Specifically, the final rule amends 38 C.F.R. § 3.304(f) by redesignating current paragraphs (f)(3) and (f)(4) as paragraphs (f)(4) and (f)(5), respectively, and by adding a new paragraph (f)(3) that reads as follows: (f)(3) If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, "fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 75 Fed. Reg. 39843 (July 13, 2010). The provisions of this amendment apply to applications for service connection for PTSD that were appealed to the Board before July 13, 2010 but have not been decided by the Board as of July 13, 2010. Thus, they apply to the Veteran's claim. Personality disorders are considered congenital or developmental defects and, therefore, generally are not diseases or injuries for the purposes of service connection. 38 C.F.R. §§ 3.303(c), 4.9, 4.127 (2011); see also Winn v. Brown, 8 Vet. App. 510, 516 (1996). However, if a disease or injury is superimposed over the congenital or developmental defect during service, service connection may be warranted for the resultant disability. VAOPGCPREC 82-90. A veteran who, during active military service, served in Vietnam during the period beginning in January 1962 and ending in May 1975, is presumed to have been exposed to herbicides. 38 C.F.R. §§ 3.307, 3.309. For the purposes of this section, the term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 C.F.R. § 3.307(a)(6). The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the Vietnam era. "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307. The presumption requires that a veteran actually stepped foot on land in Vietnam. Haas v. Peake, 525 F.3d 1168 (2008); VAOPGCPREC 27- 97. An opinion of the General Counsel for VA interpreted that service on a deep-water naval vessel off the shores of Vietnam may not be considered service in the Republic of Vietnam for purposes of 38 U.S.C. § 101(29)(A), which defines the Vietnam era as the period beginning on February 28, 1961, and ending on May 7, 1975, and that this was not inconsistent with the definition of service in the Republic of Vietnam found in 38 C.F.R. § 3.307(a)(6)(iii). VAOPGCPREC 27-97. A veteran must demonstrate actual duty or visitation in the Republic of Vietnam to have qualifying service. Id. Since issuance of that General Counsel opinion, VA has reiterated its position that service in deep-water naval vessels offshore of Vietnam (as opposed to service aboard vessels in inland waterways of Vietnam) is not included as "service in the Republic of Vietnam" for purposes of presumptive service connection for Agent Orange diseases. 66 Fed. Reg. 23166 (May 8, 2001). The following diseases are deemed associated with herbicide exposure, under current VA regulation: chloracne or other acneform diseases consistent with chloracne, Type 2 diabetes, Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). The foregoing diseases shall be service connected if a veteran was exposed to an herbicide agent during active military, naval, or air service, if the requirements of 38 U.S.C.A. § 1116, 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. 38 U.S.C.A. §§ 501(a), 1116 (West 2002); 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). VA regulations specify that the last date on which a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975. 38 C.F.R. § 3.307(a)(6)(iii). The Secretary of Veterans Affairs has determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 59 Fed. Reg. 341-346 (1994); see also 61 Fed. Reg. 41,442-41,449, and 61 Fed. Reg. 57,586-57,589 (1996). Notwithstanding the foregoing presumption provisions, a claimant is not precluded from establishing service connection for a disability due to exposure to herbicides with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); Ramey v. Brown, 9 Vet. App. 40, 44 (1996), aff'd sub nom, Ramey v. Gober, 120 F.3d 1239 (Fed. Cir. 1997), cert. denied, 118 S. Ct. 1171 (1998). In rendering a decision on appeal the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67 (1997); Layno v. Brown, 6 Vet. App. 465 (1994); Cartwright v. Derwinski, 2 Vet. App. 24 (1991) (although interest may affect the credibility of testimony, it does not affect competency to testify). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465. The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). 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. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the veteran's claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Medical evidence that is speculative, general, or inconclusive in nature cannot support a claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). A physician's statement framed in terms such as "may" or "could" is not probative. See Warren v. Brown, 6 Vet. App. 4, 6 (1993). A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The Board has reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by a veteran or obtained on a veteran's behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Service Connection for a Psychiatric Disorder Service connection for PTSD requires: medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (conforming to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)); 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. 38 C.F.R. § 3.304(f). The applicable regulation requires that the in-service stressor or traumatic event involve actual or threatened death, serious injury, or a threat to the physical integrity of self or others and the person's response involve intense fear, helplessness, or horror. See DSM-IV § 309.81 (4th ed. 1994). In the Veteran's case, the evidence does not show, nor does he allege, that he engaged in combat with the enemy during active service. The Veteran has specifically stated that his claimed psychiatric disorder is not due to combat experiences, but rather is the result of exposure to herbicides, driving over two people while on a bicycle in Vietnam, and being involved in a motor vehicle accident while intoxicated. The Board also finds that there is no objective evidence, or even suggestion, that the Veteran "engaged in combat with the enemy." For these reasons, 38 U.S.C.A. § 1154(b) is not applicable in this case. It is also noted that the revised PTSD regulation, 38 C.F.R. § 3.304(f)(3), does not apply in this case. The Veteran has claimed PTSD due to non-combat stressors, specifically exposure to herbicides, driving over two people while on a bicycle in Vietnam, and being involved in a motor vehicle accident while intoxicated. This does not meet the initial criterion for the new regulation of "fear of hostile military or terrorist activity." With regard to the first element necessary for a grant of service connection (medical evidence of PTSD), while there are indications of PTSD in the claims file, the weight of the competent evidence of record indicates that the Veteran does not have PTSD in accordance with DSM-IV criteria. A November 1992 private treatment record reflects a diagnosis of PTSD. In a February 1993 VA treatment record, the Veteran reported being treated for PTSD at the VA medical center. February 1996, November 1996, and October 1997 private treatment records reflect a diagnosis of PTSD. A February 2012 private treatment record reflects a diagnosis of PTSD. In a November 2012 VA mental disorders examination, the VA examiner provided an Axis I diagnoses of personality disorder NOS and anxiety disorder NOS. The Board finds the November 1992, February 1996, November 1996, October 1997, and February 2012 diagnoses of PTSD to be of little probative value. While these records demonstrate the presence of some symptoms of PTSD, they are not diagnoses of PTSD that meet the criteria of 38 C.F.R. § 4.125(a). It does not appear that on any of these instances, the medical professionals took the time to actually assess whether the Veteran met the criteria for a diagnosis of PTSD per the DSM-IV. Rather, it appears that the diagnosis was reflective of the fact that in prior treatment sessions it was thought that the Veteran might have PTSD. While they indicate possible PTSD, providing some evidence in support of this case, indications of this problem within these records were, at best, constrained. They only provide the basis for further investigation of this issue by the VA in a substantive evaluation of this issue contained within the November 2012 VA psychiatric examination assessment. There is also no evidence that any of these examiners reviewed the Veteran's claims file, service treatment records, or otherwise based the diagnosis on a thorough and accurate history. While this is not needed, the fact remains that the best, most comprehensive evaluation of the Veteran's problems found that the Veteran does not have PTSD at this time. The Board finds the November 2012 VA psychiatric examination assessment that the Veteran did not have PTSD to be very probative. The VA examiner who conducted the examination was identified as a licensed psychologist. The report notes that it was based on a psychiatric interview. The report set forth in detail the Veteran's relevant social, military, and medical history. The examiner opined that the Veteran did not present with PTSD during the examination. The Board finds this opinion to be the most probative piece of evidence as it actually address the symptoms which would be needed for a diagnosis of PTSD to be rendered, but which the Veteran was not experiencing. As this opinion is found to be the most probative, it is afforded the greatest weight, and therefore the Board concludes that the Veteran does not meet the criteria for PTSD. It provides, as a whole, detailed reasoning that the Board finds persuasive. Only those with specialized medical knowledge, training, or experience are competent to provide evidence on the question of diagnosis and causation. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). To the extent that the Veteran asserts that he has PTSD related to service, as opposed to some other form of disability, as a lay person, he is not competent to offer an opinion on a matter clearly requiring medical expertise, such as providing a diagnosis or a medical nexus opinion regarding the claimed PTSD. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). Moreover, even if it was concluded that the Veteran had PTSD, the requirements for service connection would still not be met for the following reasons. Once a diagnosis is established, the second criteria for service connection for PTSD is credible supporting evidence that the claimed in-service stressor (upon which a diagnosis is based) occurred. As noted, there is no evidence that the Veteran engaged in combat with the enemy, and PTSD was not diagnosed in service. The Board finds that the Veteran's claimed in-service stressors have not been corroborated by service records or other credible supporting evidence. In an October 2006 formal finding, the Joint Services Records Research Center (JSRRC) reported that they were unable to verify the reported PTSD stressors based upon the evidence the Veteran had submitted. As such, there is no confirmation of the non-combat stressors upon which the Veteran's PTSD claim is based. As such, even if it was accepted that the Veteran had PTSD, which as explained above, the evidence does not support; an in-service stressor sufficient to cause PTSD has not been verified. As such, the criteria for service connection for PTSD have not been met, and the Veteran's claim is denied. The Board has also considered whether service connection is warranted for an acquired psychiatric disability, other than PTSD. As noted above, the Veteran has argued that exposure to Agent Orange caused him to develop his current acquired psychiatric disorder. "Service in Vietnam" for purposes of applying the herbicide presumption includes service in the waters offshore or service in other locations if the conditions of service involved duty or visitation to Vietnam from January 9, 1962 to May 7, 1975. See 38 C.F.R. §§ 3.307(a)(6)(iii); 3.313(a). The Veteran's service personnel records (SPRs) show that he had military service in Vietnam dating from June 1960 to June 1970, such that exposure to herbicides is conceded. The Board notes that the Veteran has submitted various documents which appear to relate to disorders which VA was considering for presumptive service connection due to herbicide exposure. At this time, none of the acquired psychiatric disorders evident in the record are considered presumptively due to herbicide exposure. The fact that the Veteran cannot be service-connected for acquired psychiatric disorder on a presumptive basis does not, however, preclude the Veteran from establishing his entitlement to service connection for the claimed condition with proof of actual direct causation. Combee, 34 F.3d at 1044. The Veteran contends that he has a current psychiatric disorder which originated in service and has continued since that time. After a review of the evidence, the Board finds that the weight of the evidence shows no diagnosis of an acquired psychiatric disorder in service, but rather, a personality disorder, for which there is no credible or competent evidence of aggravation in service, or evidence of psychological injury in service, including no psychiatric disorder superimposed over the personality disorder. The Veteran was diagnosed with mixed personality disorder in service. The Veteran was referred for a psychiatric evaluation during service in October 1970. In an October 1970 psychological examination, the service examiner reported that the Veteran was mentally responsible and had the mental capacity to understand and participate in the examination. The diagnosis was passive-aggressive personality. The service examiner recommended that the Veteran be psychiatrically cleared for any administrative action and released to duty. Personality disorders generally are not diseases or injuries for the purposes of service connection. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. In addition, in this case, there is no competent evidence of record showing that a superimposed injury in service aggravated the Veteran's personality disorder. See VAOPGCPREC 82-90. The Veteran's service treatment records do not reflect a diagnosis of an acquired psychiatric disorder, but rather, a personality disorder for which there is no credible or competent evidence of psychological injury or disease in service (other than personality disorder), or aggravation of personality disorder in service, or of a psychiatric disorder superimposed over the personality disorder. The competent and credible evidence shows that symptoms of an acquired psychiatric disorder were not chronic in service; all psychiatric symptoms were related to the personality disorder. Service treatment records are negative for any complaints or treatment for a psychiatric disorder, other than personality disorder. In a November 1992 private treatment record, the Veteran reported being treated for a psychiatric disorder in a hospital in Vietnam; however, the October 1970 service treatment record reflects that the Veteran was hospitalized in Vietnam for suspected alcoholism. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (upholding a BVA decision that gave higher probative value to a contemporaneous letter a veteran wrote during VA hospitalization than to the veteran's subsequent assertion years later). The Board notes that alcoholism is not a disability for which service connection may be granted as directly incurred in service. See 38 U.S.C.A. § 1110 (West 2002); see also Allen v. Principi, 237 F.3d 1368, 1375 (Fed. Cir. 2001). In the December 1970 service separation examination report, which includes a summary of the Veteran's significant in-service medical history, the service examiner's review of the history is negative for any reports by the Veteran of symptoms of a psychiatric disorder. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). The Board next finds that the weight of the evidence demonstrates that symptoms of a psychiatric disorder other than personality disorder have not been continuous since service separation in December 1970. As noted above, the December 1970 service separation examination reflected that the Veteran was not diagnosed with any psychiatric disorder. Curry v. Brown, 7 Vet. App. 59 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by the veteran). Following service separation in December 1970, the evidence of record shows no complaints, diagnosis, or treatment for a psychiatric disorder until 1992. The absence of post-service findings, diagnosis, or treatment for 22 years after service is one factor that tends to weigh against a finding of continuous psychiatric symptoms after service separation. See Buchanan (holding that the Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). While the Veteran is competent to state that he had psychiatric symptoms at any time, including in service, the Board finds that the Veteran's more recent assertions of chronic psychiatric symptoms in service and continuous psychiatric symptoms since service, made in the context of the September 2004 claim for service connection (VA disability compensation) for a psychiatric disorder, are outweighed by the other, more contemporaneous, lay and medical evidence of record, and are not credible. See Charles v. Principi, 16 Vet. App. 370 (2002). The recent statements of chronic psychiatric symptoms in service (other than personality disorder) and continuous post-service psychiatric symptoms are inconsistent with the service treatment record evidence, an absence of complaints or treatment for many years after service, and the histories and symptoms credibly reported by the Veteran during post-service private treatment. See Curry (noting that contemporaneous evidence has greater probative value than history as reported by the veteran). The Veteran's recent statements of chronic psychiatric symptoms in service and continuous post-service psychiatric symptoms are inconsistent with the Veteran's own histories and the findings during service and in post-service private treatment records. In a private treatment record dated November 1992, the Veteran reported the only post-service psychiatric treatment he received was in Alcoholics Anonymous (AA) for the past five years and specifically denied any outpatient treatment for a psychiatric disorder. For treatment, the Veteran would be expected to give a full and accurate history to get good treatment. In this examination for treatment, the Veteran does not mention continuous psychiatric symptoms since service separation. See Cartright, 2 Vet. App. at 25; Pond v. West, 12 Vet. App. 341 (1991); Gardin v. Shinseki, 613 F.3d 1374, 1380 (Fed. Cir. 2010) (upholding Board finding that vague and inconsistent lay statements were not credible because they were in direct contradiction to the more credible, competent, reliable, and clearly documented medical evidence). Other evidence tending to weigh against continuous symptoms of a psychiatric disorder includes a November 1998 private treatment record, where the private examiner reported the Veteran showed no signs of significant mental or emotional impairment. See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes). In a January 1999 private treatment record, the Veteran reported feeling great and denied flashbacks or nightmares. See Caluza, 7 Vet. App. at 512, aff'd per curiam, 78 F.3d. 604 (Fed. Cir. 1996) (credibility can be affected by inconsistent statements); see also Gardin, 613 F.3d at 1380. In a July 1999 private treatment record, the Veteran reported not having flashbacks anymore. In a September 1999 private treatment record, the Veteran reported always feeling happy. In a February 2000 private treatment record, the Veteran reported feeling fine. The Board notes that the Veteran has also related his psychiatric symptoms to post-service events and that the psychiatric disorder had a post-service onset. For example, in a February 1999 private treatment record, the Veteran reported his depression was due to his wife's illness. See Harvey, 6 Vet. App. at 394. While the Board does not doubt the sincerity of the Veteran's current belief that his symptoms have been present since his years in service, the evidence contains many inconsistencies that diminish the reliability of the Veteran's current recollections. Based on the Veteran's conflicting statements, the Board finds that the Veteran is not credible to the extent that he reports the onset of his psychiatric disorder. Caluza, 7 Vet. App. at 510-11. The Board, on a factual basis, finds that the Veteran is currently not an accurate historian and that his early statements to health care provides actually provides highly probative evidence against the Veteran's claim. The Board finds that the contemporaneous in-service reports by the Veteran and clinical findings, the Veteran's statements indicating a lack of continuity of psychiatric disability symptomatology made to health care professionals for treatment purposes, and the absence of evidence of post-service complaints, findings, diagnosis, or treatment for many years after service are more probative than the more ambivalent and inconsistent statements regarding psychiatric disability made pursuant to the recent claim for compensation benefits. See Cartright, at 25; Pond (interest may affect the credibility of testimony). The Board further finds that the weight of the competent evidence demonstrates that the Veteran's psychiatric disorder is not related to service. In the November 2012 VA psychiatric examination, which weighs against the Veteran's claim, the Veteran was given Axis I diagnoses of Anxiety Disorder NOS and Personality Disorder NOS. The Axis I diagnosis of personality disorder is not a disability for VA disability compensation purposes. See 38 C.F.R. §§ 3.303(c), 4.9 (2012). The VA examiner opined that it was less likely than not that the Veteran's psychiatric disorder was related to service. The VA examiner reasoned that the Veteran's current symptoms were more than likely related to post-service intercurrent stressors that included the Veteran's report of not feeling safe in prison and seeing fellow inmates beaten and killed on a daily basis. The November 2012 VA psychiatric opinion is of high probative value because it is based on a factually accurate history, as it appears the VA examiner was informed of the relevant evidence in this case. The VA examiner relied on accurate facts, and gave a fully articulated opinion that is consistent with the accurate facts found in this case and is supported by sound reasoning. The Board finds that there is no competent or credible evidence of a relationship between the Veteran's current psychiatric disorder and his military service. The only evidence of record supporting the Veteran's claim is his own lay opinion that his currently diagnosed psychiatric disorder is related to his period of service. In this regard, the Board acknowledges that the Veteran can provide competent evidence about what he experienced; for example, his statements are competent evidence as to his continuous psychiatric disorder symptoms after service separation; however, as noted above, the Board has found his statements of continuous post-service symptomatology to not be credible. See e.g., Layno, 6 Vet. App. at 465; Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In addition, lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (i.e., where the condition is simple, for example, a broken leg), (2) the lay person 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. However, while the Veteran may be sincere in his belief that his psychiatric disorder is related to his service, his expressions of such belief have little, if any probative value. The determination of whether a current disability is related to service is a complex medical question not capable of resolution by mere lay observation; it requires medical expertise. In addition, the Board does not find that the Veteran's psychiatric disorder is subject to lay diagnosis, as medical tests are required to establish such an assessment. The Veteran is a layperson with no medical training; he does not cite to any medical texts or treatises to support his self-diagnoses and/or theory of causation; and he does not offer any explanation or rationale for his opinions. See Jandreau, 492 F.3d at 1377. Specialized education and/or training are required for a determination as to determine the etiology of a psychiatric disorder. The Veteran is not competent to provide an opinion on the causation of his psychiatric disorder. Based on the evidence of record, the weight of the competent and credible evidence demonstrates no relationship between the Veteran's current psychiatric disorder and active military service, including no credible evidence of continuity of symptomatology of psychiatric disorder which would serve either as a nexus to service or as the basis for a medical nexus opinion. See Charles. The only probative nexus opinion on file, in November 2012, which included a review of the claims file, weighs against the claim. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection for psychiatric disorder, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for an acquired psychiatric disorder, to include PTSD, anxiety disorder NOS, and personality disorder NOS, is denied. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs