Citation Nr: 1320823 Decision Date: 06/27/13 Archive Date: 07/05/13 DOCKET NO. 94-17 740 ) DATE RECONSIDERATION ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for a psychiatric disorder to include posttraumatic stress disorder. REPRESENTATION Veteran represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL Veteran, F.M., and C.E. ATTORNEY FOR THE BOARD M. Taylor, Counsel INTRODUCTION The Veteran, who is the appellant, served on active duty from November 1959 to November 1962. This matter is before the Board of Veterans' Appeals (Board) on appeal of a rating decision in May 1993 of a Department of Veterans Affairs (VA) Regional Office (RO). Procedural History In a decision in January 1997, the Board denied service connection for a psychiatric disorder to include posttraumatic stress disorder. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In March 1999, pursuant to a joint motion, the Court vacated the Board's decision and remanded the case to the Board. In a decision in July 1999, the Board again denied the claim. The Veteran appealed the Board's decision to the Court, but he subsequently withdrew his appeal in favor of a motion for reconsideration by the Board. In March 2000, an Order for Reconsideration by an expanded panel of the Board was granted by the Vice Chairman of the Board. The newly constituted Reconsideration Panel remanded the case to the RO in April 2000. In a decision in June 2003, the Reconsideration Panel denied the claim of service connection for a psychiatric disorder to include posttraumatic stress disorder. The Veteran then appealed the decision to the Court. In an order in March 2006, the Court vacated the Board's decision and again remanded the case to the Board in order that the Reconsideration Panel could conduct further development. In December 2009, August 2009, April 2011, October 2011, and August 2012, the Board remanded the claim for further development. As the requested development has been completed, no further action to ensure compliance with the Board's remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). FINDINGS OF FACT 1. The Veteran did not serve in combat in Vietnam. 2. During the appeal period, posttraumatic stress disorder has not been diagnosed. 3. A psychiatric disorder other than posttraumatic stress disorder, namely, cognitive disorder or adjustment disorder, is unrelated to an injury, disease, or event in service. CONCLUSIONS OF LAW 1. Posttraumatic stress disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 1154, 5107(b) (West 2002); 38 C.F.R. §§ 3.303 and 3.304(f) (2012). 2. A psychiatric disorder other than posttraumatic stress disorder, namely, cognitive disorder or adjustment disorder, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 1154, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2012). The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R. § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate a claim. Duty to Notify Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), when VA receives a complete or substantially complete application for benefits, it will notify the claimant of the following: (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. Also, the VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: (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. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The VCAA notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The RO provided post-adjudication VCAA notice by letters November 2002, January 2007, and in January 2010. The Veteran was notified of the evidence needed to substantiate a claim of service connection. The Veteran was notified that VA would obtain service records, VA records, and records of other Federal agencies, and that he could submit other records not in the custody of a Federal agency, such as private medical records or with his authorization VA would obtain any such records on her behalf. The VCAA notice included the general provisions for the effective date of a claim and the degree of disability assignable. As for the content of the VCAA notice, the documents complied with the specificity requirements of Quartuccio v. Principi, 16 Vet. App. 183 (2002) (identifying evidence to substantiate a claim and the relative duties of VA and the claimant to obtain evidence); of Charles v. Principi, 16 Vet. App. 370 (2002) (identifying the document that satisfies VCAA notice); and of Dingess v. Nicholson, 19 Vet. App. 473 (2006) (notice of the elements of the claim). To the extent that the VCAA notice came after the initial adjudication, the procedural defect was cured as after the RO provided content-complying VCAA notice, the claim was readjudicated as evidenced by the supplemental statement of the case in March 2013. See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007) (Timing error cured by adequate VCAA notice and subsequent readjudication without resorting to prejudicial error analysis.). Duty to Assist Under 38 U.S.C.A. § 5103A, VA must make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate a claim. The RO has obtained the available service personnel records and the service treatment records, VA records, and records of the Social Security Administration. In July 1997 and in August 1997, a representative of the National Archives and Records Administration reported that there no additional service personnel records. In 2002, it was reported by the National Archives and Records Administration that there were no records of the Veteran, pertaining to temporary duty orders, hostile pay, individual pay, travel vouchers, or in-patient records at either the hospital at Clark Air Force Base or the Subic Bay Naval hospital in the Philippines or the 8th Army Field Hospital in Vietnam. It was also reported that the morning reports for the Veteran's unit showed no change in the Veteran's status while the Veteran was assigned to Ansbach, Germany, from May 1962 to October 1962, when the Veteran was transferred to Fort Hamilton, New York. In December 2006, in its remand, the Board directed the RO to request records from the U. S. Department of State. In February 2007, a representative of the U.S. Department of State stated that after 25 years records are transferred to the National Archives and Records Administration and that the request should be referred there. In March 2007, the RO forwarded the request to National Archives and Records Administration. In July 2007, it was reported by the National Archives and Records Administration that if the Veteran had served in Vietnam his name would appear on special orders from the Military Assistance Advisory Group Vietnam, but the date that the Veteran arrived in Vietnam was needed to conduct a search. The letter also advised that a request be submitted for morning reports for the Veteran's battery in Germany. In February 2008, it was reported by the National Archives and Records Administration that no additional records were found and reiterated the report of 2000. In March 2008, a representative of the National Archives and Records Administration stated that the unit to which the Veteran was assigned in Vietnam was needed. In April 2008, the RO asked the Veteran to provide the unit to which he was assigned in Vietnam. In May 2008, the Veteran stated that he did not remember the name of his unit due to the time that had elapsed and due to the effects of a brain aneurysm. In August 2008, the RO notified the Veteran of the unavailability of additional service records, concerning his allegation that he was in Vietnam in 1962 as a military advisor. In August 2009, in its remand, the Board directed a search by the National Archives and Records Administration for special orders of the Military Assistance Advisory Group to verify whether the Veteran was in Vietnam in April 1962, in May 1962, or in June 1962. In February 2010, it was reported by the National Archives and Records Administration that after an extensive search of the records in their custody there were no additional personnel records indicating that the Veteran was in Vietnam. In September 2010, it was reported by the National Archives and Records Administration the search of special orders of the Military Assistance Advisory Group for the month of May 1962 did not show that the Veteran was assigned to the advisory group. In June 2010, the RO notified the Veteran of the unavailability of additional service records, concerning his allegation that he was in Vietnam in 1962 as a military advisor. In September 2010, it was reported by the National Archives and Records Administration that a review of Special Orders from 1953 to 1964 did not show that the Veteran was assigned to Military Assistance Advisory Group. The Veteran was notified of the unavailability of the records in the supplemental statement of the case in January 2011. In April 2011, in its remand, the Board directed search by the U.S. Army and Joint Services Research Center for morning reports and unit history of the Veteran's unit for May 1962. In June 2011, a representative of the U.S. Army and Joint Services Research Center reported that records requested were not held by the Center and referred the RO to the National Archives and Records Administration. In June 2011, the RO made a formal finding that the records requested by the Board were unavailable and notified the Veteran in the supplement statement of the case in August 2011. In October 2011, in its remand, the Board directed that the Veteran be afforded a VA examination, which was conducted in November 2011. The Veteran was also examined by VA in December 1995. As the examination reports were based on a review of the Veteran's history and described the current findings in sufficient detail so that the Board's review is a fully informed one, the examination reports are adequate to decide the claim. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (holding an examination is considered adequate when it is based on consideration of the appellant's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the disability will be a fully informed one) In August 2012, in its remand, the Board directed that sick reports and the Veteran's unit history from May 1962 to October 1962 be obtained. In October 2012, the federal custodian of the records found no unit history for the period requested and reported that sick reports were discontinued after 1953. In March 2013, the RO made a formal finding that the records requested by the Board were unavailable and notified the Veteran in the supplement statement of the case in March 2013. In March 2013, the Veteran's representative requested that VA follow its own procedures for developing the Veteran's participation in a classified operation. There is no evidence that the Veteran's mission was classified. And a classified mission would not have precluded a trace of the Veteran's presence in Vietnam by other records, such as unit morning reports or on the roster for assignment with the Military Assistance Advisory Group in Vietnam. After an exhaustive search for service records over a period of 15 years, there is no indication of the existence of additional evidence to substantiate the claim, and the Board concludes that no further assistance to the Veteran in developing the facts is required to comply with the duty to assist. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Principles of Service Connection 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 and 1131. Generally, to establish a right to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed.Cir. 2004). Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). The showing of a chronic disease in service requires a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). 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). Service connection for posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) , that is, a diagnosis that conforms to the Diagnostic and Statistical Manual of Mental Disorders (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 actually occurred. 38 C.F.R. § 3.304(f). Unless posttraumatic stress disorder is diagnosed in service and the in-service stressor is related to service, or the in-service stressor is related to combat or to fear of hostile military or terrorist activity, or to a prisoner -of-war experience, or to a personal assault, the Veteran's lay testimony alone may not establish the occurrence of an alleged noncombat in-service stressor and the record must contain credible supporting evidence that the alleged noncombat in-service stressor actually occurred. 38 C.F.R. § 3.304(f); see Patton v. West, 12 Vet. App. 272, 280 (1999) (rejecting the requirement that medical nexus evidence is required for credible supporting evidence in a personal assault case). Evidentiary Standards VA must give due consideration to all pertinent lay and medical evidence in a case where a Veteran is seeking service connection. 38 U.S.C.A. § 1154(a). Although the Veteran alleges that he was in combat in Vietnam, the Board has made a factual determination that he was not, and the combat provision of 38 U.S.C.A. § 1154(b) do not apply. Competency is a legal concept in determining whether lay or medical evidence may be considered, in other words, whether the evidence is admissible as distinguished from credibility and weight, factual determinations going to the probative value of the evidence, that is, does the evidence tend to prove a fact, once the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Competency is a question of fact, which is to be addressed by the Board. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007). When the evidence is admissible, the Board must then determine whether the evidence is credible. "Credible evidence" is that which is plausible or capable of being believed. See Caluza v. Brown, 7 Vet. App. 478, 511 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (the determination of credibility is a finding of fact to be made by the Board in the first instance). If the evidence is credible, the Board, as fact finder, must determine the probative value or weight of the admissible evidence, that is, does the evidence tend to prove a material fact. Washington v. Nicholson, 19 Vet. App. 362, 369 (2005). If the evidence is not credible, the evidence has no probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.A. § 5107(b). Evidence The service department administrative records, including the "Chronological Record of Military Service," show that the Veteran began service in November 1959. After completing basic and advanced individual training, the Veteran was transferred to USAEUR (United States Army, Europe) in November 1960. He was then assigned to Battery C, 1st Howitzer Battalion, 75th Artillery, APO 177, and remained with that unit until October 24, 1962, when he was transferred to the United States for discharge from service at Fort Hamilton, New York in November 1962. The Department of Defense (DD) Form 214 shows that the Veteran had two years of overseas service with USAREUR (United States Army, Europe). There is no indication of service in Vietnam or elsewhere in Southeast Asia. The Veteran received the Good Conduct Medal, but no other award or decoration. The service medical records contain no complaint, finding, history, treatment, or diagnosis of a psychiatric disorder, including posttraumatic stress disorder. The records do show in August 1962 the Veteran was a patient for one day at the 536th General Dispensary, APO 177. His unit was identified as C Battery, 1st Howitzer Battalion, 75th Artillery, 7th Army, APO 177. Other clinical records show radiographic and laboratory testing performed on August 30, 1962, at which time the Veteran's unit was listed as again listed as C/1/75 or C Battery, 1st Howitzer Battalion, 75th Artillery. The "Abstract of Service" report (DD Form 735) in the service medical records indicates the Veteran was assigned to a unit in Europe from November 1960 to October 9, 1962. On separation medical examination in September 1962, there was no reference to any psychiatric symptoms or hospitalization. On the "Report of Medical Examination" form, the psychiatric evaluation was normal. After service, VA records show that December 1992 the VA hospitalized for a subarachnoid hemorrhage, resulting in a right frontotemporal craniotomy with repair of an artery aneurysm. In his initial application for VA disability compensation in January 1993, the Veteran described his disability as "nerves." He gave a history of hospitalization for three months prior to his separation from service, after returning from Vietnam as an advisor in 1962. The only post-service treatment he reported for the claimed psychiatric disability was hospitalization in December 1992, which involved surgery for a brain aneurysm. In August 1994, the Social Security Administration determination that the Veteran was disabled due to dementia. Adjustment disorder was listed as a secondary diagnosis. The disability began in December 1992. In May 1995, the Veteran testified that he first had nervous problems when he was in Vietnam as an advisor for three months in 1962. He stated that before he went to Vietnam he was in an artillery battery in Germany, and he had volunteered with four or five others to serve as advisors. He stated they trained the South Vietnamese and were located somewhere close to Saigon. His stated that his "nervous condition" was triggered when his patrol was ambushed and most of his patrol was killed. He stated he was treated for this condition at a military hospital in the Philippines for three months. He did not remember the name of the hospital, but he thought it was near an air base. The Veteran further testified that after he got back to the United States he received treatment from a private doctor, who prescribed Valium. He stated that in 1993 he had an aneurysm, and he believed that his crying spells were caused by his time in Vietnam. A witness, Ms. F.M., stated that she knew the Veteran since 1962 and that he would get depressed and cry. In December 1995 on VA examination, the Veteran gave a history of spending six months as an advisor in Vietnam towards the end of his enlistment. He stated that his nervous condition began after an ambush with casualties in Vietnam. He stated that he was hospitalized in the Philippines for a nervous condition. The VA examiner stated that there was no real indication of posttraumatic stress disorder and no depression. The diagnosis was "PTSD," posttraumatic stress disorder, not shown. In June 1996, the Veteran testified that he went to Vietnam as an advisor in May of 1962 to train the South Vietnamese in the use of small arms. He stated that he was in Vietnam for about three months. He also testified that he could not remember the unit he was attached to in Vietnam. The Veteran indicated that his nervous condition was triggered when his patrol was ambushed and seven or eight Vietnamese were killed. He testified further that after the incident he went to a military hospital in the Philippines at an air base where he remained for two and a half months. The Veteran stated that he then went to the United States, where he was released from service at Fort Hamilton, n New York. He stated that five or six months later, he received treatment from a Dr. M. in Lubbock, Texas. C.E., the brother of the Veteran, stated that he had notice a difference in the Veteran after he separated from the service. The brother further stated that the Veteran's memory had not been the same since the aneurysm. In July 1997, a VA psychologist stated that the Veteran underwent neuropsychological assessment in November 1995, and that on the memory section of the examination, the Veteran placed in the average or above average range. It was also that on July 2, 1997, the Veteran was again seen for neuropsychological evaluation, specifically for memory functioning, and the Veteran placed in the above average range. In September 1997, the Veteran testified that part of his service records had been lost, including his travel records. The Veteran's brother indicated that the Veteran had experienced memory loss since an aneurysm, but his memory was coming back, as evidenced by the VA report in July 1997. Thereafter as detailed under the duty to assist, the Board remanded the case several times for additional development in order to obtain any additional service department records that could establish that the Veteran served in Vietnam in 1962, including temporary duty orders, hostile pay vouchers, individual pay vouchers, travel vouchers, in-patient records at either the hospital at Clark Air Force Base or the Subic Bay Naval hospital in the Philippines or the 8th Army Field Hospital in Vietnam, morning reports for the Veteran's unit, records of the U. S. Department of State, a unit history, and special orders from the Military Assistance Advisory Group in Vietnam. Neither the National Archives and Records Administration nor the U.S. Army and Joint Services Research Center was unable to provide any evidence that the Veteran was in Vietnam in 1962, including a search of records of the State Department. The National Archives and Records Administration did report that there was no change in the Veteran's status while the Veteran was assigned to Ansbach, Germany, from May 1962 to October 1962, when the Veteran was transferred to Fort Hamilton, New York. And the Veteran has been notified that the records requested by the Board are unavailable. On VA examination in November 2011, the diagnoses were cognitive disorder and a history of adjustment disorder. After a review of the Veteran's history as described above, the VA examiner stated that the Veteran did not meet the criteria for any other psychiatric disorder and that it was less likely than not the mental health disorders were caused by or the result of service. Analysis Posttraumatic Stress Disorder Alleged In-Service Stressor The Veteran asserts that PTSD began in May 1962 in Vietnam where he was a volunteer military advisory and when his patrol was ambushed, resulting in casualties, and he was hospitalized for three months. Essentially, the in-service stressor is engagement in combat or fear of hostile military activity. The Veteran has not identified any other in-service stressor. In the absence of clear and convincing evidence to the contrary, if the evidence establishes that the Veteran engaged in combat or experienced fear of hostile or terrorist activity, the Veteran's lay testimony alone may establish the occurrence of the alleged in-service stressor provided that the stressor is consistent with the circumstances and conditions of the Veteran's service. 38 C.F.R. § 3.304(f)(2) and (3). The record shows that beginning in 1997 the National Archives and Records Administration reported that there no additional service personnel records, including a search for temporary duty orders, hostile pay vouchers, individual pay vouchers, travel vouchers, or in-patient records at either the hospital at Clark Air Force Base or the Subic Bay Naval hospital in the Philippines or the 8th Army Field Hospital in Vietnam. In December 2006, in a request for records from the U. S. Department of State, State Department referred the request to the National Archives and Records Administration, resulting in the search of special orders of the Military Assistance Advisory Group in Vietnam. In 2010, it was reported by the National Archives and Records Administration that after an extensive search of the records in their custody there were no additional personnel records indicating that the Veteran was in Vietnam, including the search of Special Orders from 1953 to 1964 of the Military Assistance Advisory Group in Vietnam. In 2011, the U.S. Army and Joint Services Research Center referred the request for a unit history and sick reports to the National Archives and Records Administration. In 2012, the federal custodian of the records found no unit history for the period requested and reported that sick reports were discontinued after 1953. Finally, according to the National Archives and Records Administration, the morning reports for the Veteran's unit showed no change in the Veteran's status while the Veteran was assigned to Ansbach, Germany, from May 1962 to October 1962, when the Veteran was transferred to Fort Hamilton, New York. The Board finds that the evidence is clear and convincing that the Veteran was not in Vietnam on the basis of the morning reports for the Veteran's unit which showed no change in the Veteran's status while the Veteran was assigned to Ansbach, Germany, from May 1962 to October 1962, combined with the search of records by National Archives and Records Administration, including referrals from the State Department and the U.S. Army and Joint Services Research Center, which included a search of Special Orders from 1953 to 1964 of the Military Assistance Advisory Group in Vietnam. For these reasons, the alleged in-service stressor is not consistent with the circumstances and conditions of the Veteran's service and the Veteran's lay testimony alone does not establish the occurrence of the alleged in-service. 38 C.F.R. § 3.304(f)(2) and (3). And the Board concludes that there is no credible supporting evidence that the alleged in-service stressor occurred. Other Lay and Medical Evidence On the basis of the service treatment records alone, in the absence of any evidence of a complaint, finding, history, treatment, or diagnosis of posttraumatic stress disorder (PTSD), PTSD was not affirmatively shown to have been present during service, and service connection under 38 U.S.C.A. §§ 1110 and 1131 as implemented by 38 C.F.R. § 3.303(a) (affirmatively showing inception in service) is not warranted. Pursuant to 38 C.F.R. § 3.304(f), the diagnosis of posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance 38 C.F.R. § 4.125, that is, a diagnosis that conforms to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer a medical diagnosis or opinion. 38 C.F.R. § 3.159. After service on VA examination in December 1995, the VA examiner, a physician, who is qualified through education, training, or experience to offer a medical diagnosis or opinion, concluded the Veteran did not have posttraumatic stress disorder. On VA examination in November 2011, the VA examiner, a psychologist, who is qualified through education, training, or experience to offer a medical diagnosis or opinion, concluded that except for cognitive disorder an adjustment disorder, the Veteran did not meet the diagnostic criteria for any other psychiatric disorder. There is no other pertinent medical evidence in the record. Based on the foregoing, there is no competent medical evidence that the Veteran has been diagnosed with posttraumatic stress disorder during the appeal period. As for the lay evidence, the Veteran as a lay person is competent to identify a simple medical condition, or describe a contemporaneous medical diagnosis or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran as a lay person is also competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). To the extent the Veteran's statements and testimony are offered as evidence of posttraumatic stress disorder, as the diagnosis of posttraumatic stress disorder requires medical evidence, posttraumatic stress disorder is not a simple medical condition that the Veteran as a lay person is competent to identify. And posttraumatic stress disorder is not a condition under case law where lay evidence has been found to be competent evidence to establish a diagnosis. And it is not argued or shown that the Veteran is otherwise qualified through specialized education, training, or experience to diagnosis posttraumatic stress disorder. Although the Veteran as a lay person is competent to report a contemporaneous medical diagnosis or to describe symptoms, which supports a later diagnosis by a medical professional, the Veteran has not submitted any such medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). As for the lay statements of the witness and the Veteran's brother, the lay witnesses are competent to describe symptoms they have observed, such as the Veteran's symptoms of depression, tearfulness, and a difference in the Veteran since he returned from service. But it is not argued or shown that the lay witnesses are qualified through specialized education, training, or experience to relate the symptoms to posttraumatic stress disorder and the lay testimony is not competent evidence. Because the Veteran's statements and testimony and the lay testimony are not competent evidence on the question of a diagnosis of posttraumatic stress disorder, the statements and testimony are excluded, that is, not admissible, as evidence favorable to the claim. As the Veteran's lay evidence is not competent evidence as to the diagnosis posttraumatic stress disorder, the Veteran's opinion that he has posttraumatic stress disorder related to service is not competent lay evidence, because an inference based on what is not personally observable cannot be competent lay evidence. To the extent the lay evidence is not competent evidence on the questions of the diagnosis of posttraumatic stress disorder or of a nexus to service, the Board need not address credibility. As there is no satisfactory proof, that is, medical evidence that the Veteran has a current diagnosis of posttraumatic stress disorder that conforms to DSM-IV, there is no valid claim of service connection for posttraumatic stress disorder. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the absence of competent medical evidence of a current diagnosis of posttraumatic stress disorder, the preponderance of the evidence is against the claim and the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). Cognitive Disorder and Adjustment Disorder On the basis of the service treatment records alone, in the absence of any evidence of a complaint, finding, history, treatment, or diagnosis of cognitive disorder or adjustment disorder, the disorders were not affirmatively shown to have been present during service, and service connection under 38 U.S.C.A. §§ 1110 and 1131 as implemented by 38 C.F.R. § 3.303(a) (affirmatively showing inception in service) is not warranted. Neither cognitive disorder nor adjustment disorder is listed as a chronic disease in 38 C.F.R. § 3.309(a), and chronicity and continuity of symptomatology under 38 C.F.R. § 3.303(b) do not apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (continuity of symptomatology avenue to service connection, creating a presumption of service connection for chronic diseases manifesting during service and then again at any later date, is available only for chronic diseases enumerated in 38 C.F.R. § 3.309(a), the only regulation listing named chronic diseases). On VA examination in November 2011, the diagnoses were cognitive disorder and a history of adjustment disorder. After a review of the Veteran's history, the VA examiner stated that the Veteran did not meet the criteria for any other psychiatric disorder and that it was less likely than not the [current] mental health disorders were caused by or the result of service. There is no other pertinent medical evidence in the record. The Board finds that the opinion of the VA examiner is persuasive evidence, which opposes, rather than supports, the claim. Based on the foregoing, there is no competent medical evidence that either cognitive disorder or adjustment disorder had onset in service or is otherwise related to an injury, disease, or event in service. As for the lay evidence, neither cognitive disorder nor adjustment disorder is a condition under case law where lay evidence has been found to be competent evidence to establish a diagnosis. And like posttraumatic stress disorder, the diagnosis of cognitive disorder or adjustment disorder requires medical evidence diagnosing the condition in accordance 38 C.F.R. § 4.125, that is, a diagnosis that conforms to DSM-IV. Although the Veteran as a lay person is competent to identify a simple medical condition, as the diagnosis of cognitive disorder or adjustment disorder requires medical evidence, the Veteran's lay evidence is not competent evidence. And it is not argued or shown that the Veteran is otherwise qualified through specialized education, training, or experience to diagnosis cognitive disorder or adjustment disorder. Although the Veteran as a lay person is competent to report a contemporaneous medical diagnosis or to describe symptoms, which supports a later diagnosis by a medical professional, there is no diagnosis of a psychiatric disorder before 1992 and there is no medical evidence that relates either cognitive disorder or adjustment disorder to an injury, disease, or event in service. Jandreau at 1377. As for the lay statements of the witness and the Veteran's brother, the lay witnesses are competent to describe symptoms they have observed, such as the Veteran's symptoms of depression, tearfulness, and a difference in the Veteran since he returned from service. But it is not argued or shown that the lay witnesses are qualified through specialized education, training, or experience to relate the symptoms to a psychiatric diagnosis and the lay testimony is not competent evidence. Because the Veteran's statements and testimony and the lay testimony are not competent evidence on the question of a diagnosis of cognitive disorder or adjustment disorder, the statements and testimony are excluded, that is, not admissible, as evidence favorable to the claim. As the Veteran's lay evidence is not competent evidence to diagnosis cognitive disorder or adjustment disorder, any lay opinion on a question, requiring medical evidence, is not competent lay evidence. To the extent the lay evidence is not competent evidence on the questions of a diagnosis or of a nexus to service, the Board need not address credibility. As there is no favorable competent lay or medical evidence that cognitive disorder or adjustment disorder is related to service, the preponderance of the competent medical evidence is against the claim, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). ORDER Service connection for a psychiatric disorder to include cognitive disorder, adjustment disorder, and posttraumatic stress disorder is denied. __________________________ ____________________________ Mark D. Hindin Ronald W. Scholz Veterans Law Judge Veterans Law Judge Board of Veterans' Appeals Board of Veterans' Appeals _____________________________ George E. Guido Jr. Veterans Law Judge Board of Veterans' Appeals Department of Veterans Affairs