Citation Nr: 1322112 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 05-27 645 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, other than posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for a scar on the dorsal aspect of the third finger of the right hand (hereinafter "right finger scar"). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran-Appellant ATTORNEY FOR THE BOARD H. Bunker, Associate Counsel INTRODUCTION The Veteran served on active duty from November 1968 to November 1971. He appealed to the Board of Veterans' Appeals (Board/BVA) from March 2004 and December 2005 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the right finger scar claim in May 2007, September 2009 and November 2011 for further development. The remand of the claim to the RO was via the Appeals Management Center (AMC). As support for his claims, the Veteran since has testified at a videoconference hearing in April 2012 before the undersigned Veterans Law Judge of the Board. Most recently these claims were before the Board in September 2012, at which time the Board recognized a separate issue of entitlement to service connection for a psychiatric disorder other than PTSD, as the claim for PTSD was denied in that most recent decision. The Board's election to bifurcate the claim was in light of the holding in Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009), indicating the scope of a claim for service connection for a mental disability includes any mental disability that reasonably may be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. see also Brokowski v. Shinseki, 23 Vet. App. 79, 85 (2009) (A claimant's identification of the benefit sought does not require any technical precision), citing Ingram v. Nicholson, 21 Vet. App. 232, 256-57 (2007) (It is the pro se claimant who knows what symptoms he is experiencing and that are causing him disability); see, too, Robinson v. Nicholson, 21 Vet. App. 545, 552 (2008) (The Board is required to consider all issues raised either by the claimant or the evidence of record). Clemons had concerned VA's failure to consider a claim of entitlement to service connection for a psychiatric disorder other than the one specifically claimed, even though it shared the psychiatric symptomatology for which the Veteran was seeking service connection. The Clemons Court found that, where a Veteran's claim identifies PTSD without more, it cannot be a claim limited only to that diagnosis, rather must be considered a claim for any mental disability that reasonably may be encompassed by the evidence of record. The Clemons Court indicated that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. In the September 2012 remand, the claims were sent back to the RO via the AMC, as the Agency of Original Jurisdiction (AOJ), for further development to include advising the Veteran of how to substantiate his claims, obtaining outstanding VA treatment records, and obtaining an addendum opinion regarding his right finger scar claim. He resultantly was advised in October 2012 of the elements required to substantiate his claims. His most recent VA treatment records also were obtained and associated with his claims file for consideration. As well, the RO/AMC obtained an addendum opinion in February and April 2013 concerning his right finger scar claim. Thus, the Board finds there was compliance with these remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (where the remand orders of the Board are not complied with, the Board itself errs as a matter of law when it fails to ensure compliance). FINDING OF FACT It is not shown the Veteran has an acquired psychiatric disorder or right finger scar because of his military service. CONCLUSION OF LAW These claimed psychiatric disorder and right finger scar are not shown to be due to disease, injury or event incurred in or aggravated by his active military service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION In deciding these claims, the Board has reviewed all the evidence in the Veteran's claims folder, both his physical claims file and electronic ("Virtual VA") file. Although the Board has an obligation to review the entire record, the Board does not have to discuss each piece of evidence reviewed, certainly not in exhaustive detail. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). It is VA's defined and consistently applied policy to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, this doubt will be resolved in favor of the claimant. By reasonable doubt it is meant that an approximate balance of positive and negative evidence exists which does not satisfactorily prove or disprove the claim. Reasonable doubt is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2012). The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duties to notify and assist a claimant in substantiating a claim for VA benefits upon receipt of a complete or substantially complete application. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). These notice requirements were met in this case by way of several letters sent to the Veteran. These letters advised him of the type of information and evidence needed to substantiate his claims and of his and VA's respective obligations in obtaining specified types of evidence. See Quartuccio v. Principi, 16 Vet. App. 183 (2002); 38 C.F.R. § 3.159(b). These letters also advised him of all five elements of his claims: 1) Veteran status, 2) existence of a disability, 3) a relationship between the disability and his military service, but also concerning the "downstream" 4) disability rating and 5) effective date in the eventuality service connection ultimately is granted. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Not all of those notice letters preceded the initial adjudication of his claims; some did whereas others did not, so not all of them were provided in the preferred sequence. See Pelegrini v. Principi, 18 Vet. App. 112, 120-121 (2004) ("Pelegrini II"). If, however, for whatever reason notice was not provided prior to initially adjudicating a claim, or the notice provided was inadequate or incomplete, this timing error can be effectively "cured" by providing any necessary VCAA notice and then readjudicating the claim - including in a statement of the case (SOC) or supplemental SOC (SSOC), such that the intended purpose of the notice is not frustrated, rather preserved, and the Veteran is given ample opportunity to participate effectively in the adjudication of the claim. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). The U. S. Supreme Court has made clear that VCAA notice errors, such as in timing or content, even when shown to have occurred, are not presumptively prejudicial, instead, must be judged on an individual case-by-case basis. And as the pleading party attacking the agency's decision, the Veteran has this burden of proof of not only establishing error but also, above and beyond that, showing how it is unduly prejudicial, meaning outcome determinative of his claim. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). There is no such pleading or allegation in this instance. VA also as mentioned has a duty to assist the Veteran in fully developing his claims, including by obtaining all potentially relevant records and scheduling a VA examination for a medical opinion when needed to assist in deciding his claim. To this end, his service treatment records (STRs) and post-service VA treatment records were obtained and are in the file for consideration. He has not indicated there are any additional records still needing to be obtained, so the duty to assist in obtaining pertinent medical records has been satisfied. The duty to assist also includes providing a medical examination or obtaining a medical opinion when necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4). The case of McLendon v. Nicholson, 20 Vet. App. 79 (2006), held that an examination is required when (1) there is evidence of current disability or persistent or recurrent symptoms of disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication the current disability may be related to the in-service event, but (4) insufficient evidence to decide the claim. See also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (When determining whether a VA examination is required under 38 U.S.C. § 5103A(d)(2), the law requires competent evidence of a disability or persistent or recurrent symptoms of a disability, but does not require competent evidence of a nexus, only that the evidence suggest an association between the disability and service or a service-connected disability.) Recognizing this obligation in this circumstance, the RO obtained medical opinions concerning these claims of entitlement to service connection for a psychiatric disorder and right finger scar. The opinions rendered were by medical personnel having the necessary training to comment on the determinative issues of diagnosis and etiology, and were given following review of the claims file for the pertinent history of these claimed disabilities, personal interview of the Veteran, and objective clinical evaluations of him. The examiners also provided the required explanatory rationale for their opinions, which is where most of the probative value of a medical opinion is derived. In Neives-Rodriguez v. Peake, 22 Vet. App. 295 (2008), the Court held that a medical opinion should contain a conclusion and a reference to supporting data with a "reasoned medical explanation connecting the two." Neives-Rodriguez, at 301. Therefore, the Board finds that the opinions are adequate for purposes of deciding these service-connection claims. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (When VA undertakes the effort to provide an examination for a service-connection claim, it must ensure the examination and resulting opinion obtained are adequate, else, notify the Veteran why an adequate examination or opinion cannot or will not be provided.). Unless the claimant challenges the adequacy of the examination or opinion, the Board may assume the examination report and opinion are adequate and need not affirmatively establish the adequacy of the examination report or the competence of the examiner. Sickels v. Shinseki, 643 F.3d, 1362, 1365-66 (Fed. Cir. 2011) (holding that, although the Board is required to consider issues independently raised by the evidence of record, the Board is still "entitled to assume" the competency of a VA examiner and the adequacy of a VA opinion without "demonstrating why the medical examiners' reports were competent and sufficiently informed"); see also Rizzo v. Shinseki, 580 F.3d 1288, 1290-1291 (Fed. Cir. 2009) (holding that the Board is entitled to assume the competency of a VA examiner unless the competence is challenged). Id. But even when this is called into question or challenged, the Board may assume the competency of any VA medical examiner, including even nurse practitioners, as long as, under 38 C.F.R. § 3.159(a)(1) , the examiner is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. See Cox v. Nicholson, 20 Vet. App. 563 (2007). The VA examination and opinion are adequate for deciding these claims. In this regard, the examiners reviewed the claims file and medical history, conducted an examination of the Veteran and recorded the clinical findings, and provided a clear explanation for the opinions stated which are consistent with the examiners' findings and the credible evidence of record. See Monzingo v Shinseki, 26 Vet. App. 97, 107 (2012) (holding that "examination reports are adequate when, as a whole, they sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for that opinion" even when the rationale does not explicitly "lay out the examiner's journey from the facts to a conclusion") (citing Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that the law imposes no reasons-or-bases requirement on examiners)); see also D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) (holding that an examination is adequate when it is based on consideration of the claimant's medical history and describes the disability in sufficient detail so that the Board's evaluation of the disability will be a fully informed one). There are no apparent inconsistencies or ambiguities in the examination reports, and the claimant has not challenged their adequacy or thoroughness, or the competency of the examiners. See Sickels, 643 F.3d at 1365-66; Rizzo, 580 F.3d at 1290-1291. Accordingly, the duty to obtain a VA examination and opinion has been met. See 38 C.F.R. §§ 3.159(c)(4); 3.326(a); McLendon, 20 Vet. App. at 83; Barr, 21 Vet. App. at 312. The Veteran has received all essential notice and assistance with his claims, has had a meaningful opportunity to participate in their development, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). Given all that has occurred, it is difficult to discern what additional guidance VA could have provided him regarding what further evidence he should submit to substantiate his claims. See Livesay v. Principi, 15 Vet. App. 165, 178 (2001) (en banc) (observing that "the VCAA is a reason to remand many, many claims, but it is not an excuse to remand all claims."). See also Reyes v. Brown, 7 Vet. App. 113, 116 (1994) and Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (both observing circumstances when a remand would not serve any useful or meaningful purpose or result in any significant benefit to the Veteran). Service Connection Service connection is granted for current disability resulting from a disease contracted or an injury sustained in the line of duty during active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for a disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain diseases are considered chronic, per se, including arthritis and psychoses, and therefore will be presumed to have been incurred in service if manifested to a compensable degree of at least 10-percent disabling within one year after service. This presumption, however, is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). According to 38 C.F.R. § 3.384, a "psychosis" includes the following specific disorders: brief psychotic disorder, delusional disorder, psychotic disorder due to general medical condition, psychotic disorder not otherwise specified (NOS), schizoaffective disorder, schizophrenia, schizophreniform disorder, shared psychotic disorder, and substance-induced psychotic disorder. So service connection may be established either by showing direct service incurrence or aggravation or by using applicable presumptions, if available. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection on a direct-incurrence basis requires competent and credible evidence showing: (1) the Veteran has the alleged disability or, at the very least, indicating he has at some point since the filing of his claim; (2) in-service incurrence or aggravation of a relevant disease or an injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002). Also of application to claims for direct service connection is the principle that where a chronic disease is shown during service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. On the other hand, continuity of symptomatology is required where the condition noted during service is not shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned. In this circumstance, a showing of continuity of symptomatology since service is required to establish chronicity of disease or injury in service and in turn link current disability to service. 38 C.F.R. § 3.303(b). However, the U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court) since has clarified in Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013), that this notion of continuity of symptomatology is limited to where involving those specific diseases denoted as "chronic" (and for which presumptive service connection is otherwise available) under 38 C.F.R. § 3.309(a). The determination as to whether the requirements for service connection are met is based on an analysis of all the relevant evidence of record, medical and lay, and the evaluation of its competency and credibility to determine its ultimate probative value in relation to other evidence. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). All reasonable doubt material to the determination is resolved in the Veteran's favor. 38 C.F.R. § 3.102. Generally, lay statement evidence may have direct relevance to establishing underlying components of a claim for service connection. In Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), the Federal Circuit Court commented that competence to establish a diagnosis of a condition can exist 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. Lay testimony where found credible is also competent to establish the presence of continuity of symptomatology for a claimed disability during and since separation from military service (again, subject to the limitation that a "chronic" disease is involved as defined under 38 C.F.R. § 3.309(a)). See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The Federal Circuit Court has further held in Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010) and in Waters v. Shinseki, 601 F.3d 1274, 1278 (2010), that it is error to suggest that lay evidence can never be sufficient to satisfy the requirement of 38 U.S.C.A. § 5103A(d)(2)(B) that there be a nexus between military service and a claimed condition. But as also observed by the Federal Circuit Court, lay evidence must "demonstrate some competence." See King v. Shinseki (Fed. Cir. 2012) (citing 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 3.307(b)) (internal quotation marks omitted). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is "credible", or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 (2007) (Observing that once evidence is determined to be competent, the Board must determine whether the evidence also is credible). Only if evidence is both competent and credible does it ultimately have probative value. See Layno v. Brown, 6 Vet. App. 465 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")); Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, whereas credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). In ascertaining the competency of lay evidence, lay evidence has been found competent with regards to a disease with "unique and readily identifiable features" that is "capable of lay observation." See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet). Laypersons equally have been found not competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever). See also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (concluding that a Veteran's lay belief that his schizophrenia had aggravated his diabetes and hypertension was not of sufficient weight to trigger VA's duty to seek a medical opinion on the issue). Competent medical evidence, as opposed to lay evidence, is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza at 511-512 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see also Madden v. Brown, 125 F.3d 1447 (Fed Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"). The standard of proof to be applied in decisions on claims for Veterans' benefits is set forth in 38 U.S.C.A. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See also 38 C.F.R. § 3.102. When the evidence is in relative equipoise, he prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 1990). The preponderance of the evidence must be against the claim for benefits to be denied. Alemany v. Brown, 9 Vet. App. 518 (1996) (recognizing that an "absolutely accurate" determination of etiology is not a condition precedent to granting service connection, nor is "definite" or "obvious" etiology). Analysis The Veteran claims he served in Vietnam and that, as a result of his service there, he was exposed to several incidents that were especially stressful or traumatic and eventually caused him to develop a psychiatric disorder. He also claims that he injured his right hand at the same time his left hand was injured. He says there was an explosion that blew glass into his right hand, thus causing the scar of his right third finger. For reasons and bases that will be discussed, however, the preponderance of the evidence is against his claims, so they must be denied. The Board has reviewed his STRs and sees that he was given an examination at entrance into service in October 1968. He reported no trouble sleeping, no depression or excessive worry, no loss of memory, no nervous trouble and no periods of unconsciousness. On examination no psychiatric disorder was found nor was there evidence of a right finger scar. During a subsequent September 1970 medical examination there again was no evidence of a right finger scar or psychiatric disorder, either in the way of a relevant subjective complaint or objective clinical finding such as a pertinent diagnosis. In a September 1970 treatment record he reported headaches, dizzy spells, and a short temper. He stated that he had been short tempered since 7th grade and he was diagnosed with situational mild anxiety reaction. In a November 1970 treatment record he complained of an injury to his left hand which had required stitches. There is no reference to a right hand disability or to injury to his right third finger, in particular, such as in the way of a consequent scar. During his military separation examination in October 1971 he had a scar on his right cheek, but no other indication of scarring, including on his right third finger. There equally was no evidence or further diagnosis of a psychiatric disorder of any sort. So, as concerning the potential for mental illness while in service, there is no indication of a chronic - meaning permanent - psychiatric disorder. Rather, the symptoms the Veteran had in service appear to be similar to or the same as those he had experienced even prior to his service, and in any event his symptoms were determined to have been merely situational rather than chronic, per se, and described as relatively mild. Chronicity of disease or injury in service therefore is not shown, certainly is legitimately questionable. His military service ended in November 1971. In a VA treatment record from many years later, in December 2002, he reported that his life had changed dramatically after he was in a car accident just a few years earlier, so in the intervening years since his military service had ended. He nonetheless reported service in Vietnam and that he had helped to evacuate the United States Embassy during an attack. The diagnosis was adjustment disorder. He had a VA examination in February 2004 for his hands. He reported he was standing outside the Embassy building in Vietnam when there was an explosion and glass shattered and fell on his hands. The examiner observed a scar on the right third finger that was 1/2 inch in length and 1/8 inch in width. In a January 2005 VA treatment record the Veteran reported recurring dreams about his friends who were killed in Vietnam. He also reported receiving shrapnel wounds during his tour of duty, presumably referring to the incident at the Embassy building in Vietnam. The diagnosis was dysthymic disorder. In an April 2005 VA treatment record he indicated he was taking medication for his psychiatric disorder symptoms, although he was interested in being done taking them. The diagnosis was depressive disorder. In a June 2007 VA treatment record he reported having flashbacks, trouble sleeping, and recollections of his time in Vietnam. The diagnosis was personality disorder, narcissistic traits and subthreshold depression. In a June 2010 VA treatment record the diagnosis again was depressive disorder. See also an intervening April 2008 VA treatment record. In an April 2011 VA treatment record he reported having a history of anxiety. He again reported the instance of an attack while stationed in Vietnam. Anxiety disorder was diagnosed. See also October 2010 VA treatment record. In a September 2011 VA treatment record he voiced frustration with the VA claims process and stated that he gets aggravated very easily and that he tends to be hostile. The diagnosis again was depressive disorder. See also August 2012 VA treatment record. In July 2011 VA obtained a medical opinion from a psychiatrist regarding the Veteran's claim of entitlement to service connection for a psychiatric disorder. The examiner reviewed the claims file and noted that the Veteran had reported some symptoms in September 1970. But the examiner found no evidence to show that an anxiety reaction was related to service. His rationale was that the Veteran's complaints did not match with the symptoms of a situational phobia, as was complained of in service in 1970. With regards to other psychiatric diagnoses, the July 2011 commenting VA psychiatrist observed the Veteran had been diagnosed with multiple disorders. But he determined the Veteran's diagnoses of depression, anxiety disorder, and dysthymic disorder were more likely related to his multiple medical problems, financial issues, an unsatisfactory living situation, and ongoing compensation claims. This examiner concluded it was unlikely these diagnoses were related to the Veteran's military service. He also noted the Veteran met the criteria for a personality disorder, but that it, too, was unlikely related to his military service. In a more recent April 2013 medical opinion the examiner reviewed the Veteran's claims file and offered an opinion that his right finger scar was unrelated to his military service. This additional examiner's rationale was that there was no evidence in the STRs of a right finger injury during the November 1970 left hand complaint, or at any other time. There also was no evidence of a right finger scar during the Veteran's military separation examination. See also February 2013 medical opinion. During his April 2012 videoconference hearing before the Board, the Veteran testified that he was experiencing depression due to his experiences in Vietnam. He testified that he had first received treatment for a psychiatric disorder in 1987, but that he was currently taking medications for depression, stress, and anxiety. He also testified that he had experienced aggravation and agitation. Regarding his right hand, he testified that he had injured it the same time he injured his left hand during a building explosion in Vietnam, again, presumably referring to the incident at the U. S. Embassy. The preponderance of the competent and credible, so ultimately probative, evidence of record weighs against the Veteran's assertion that his psychiatric diagnoses and right finger scar are the result of his military service. It is noteworthy that no less than two VA physicians have opined that these conditions are unrelated to his military service, and there is no medical evidence to the contrary. Establishing entitlement to service connection does not just require showing relevant injury in service or current disability since there also has to be competent and credible evidence establishing the required linkage or correlation between the current disability and the injury, event or disease during service. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service."). Despite his several diagnoses, the Veteran does not have a psychosis as defined by 38 C.F.R. § 3.384. His diagnoses resultantly are not the type of conditions that are considered "chronic" under 38 C.F.R. § 3.309(a). He therefore cannot circumvent or refute the VA compensation examiner's unfavorable opinion disassociating any of these diagnoses from service merely by claiming to have experienced continuous symptoms since service under § 3.303(b). And this is true even accepting that continuous symptoms, not necessarily instead treatment for them, is the essence of § 3.303(b). Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991). In interpreting sections 1110 and 1131 of the statute and section 3.303(a) of the regulations, the U. S. Court of Appeals for the Federal Circuit held that a three-element test must be satisfied in order to establish entitlement to service connection. Walker v. Shinseki, 708 F.3d 1331, 1333 (citing Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004))). Specifically, the evidence must show (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or an injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Id. However, claims for certain chronic diseases - namely those listed in 38 C.F.R. § 3.309(a) - benefit from a somewhat more relaxed evidentiary standard under 38 C.F.R. § 3.303(b). See Walker, 708 F.3d at 1339 (holding that "[t]he clear purpose of the regulation is to relax the requirements of § 3.303(a) for establishing service connection for certain chronic diseases"). Specifically, when a chronic disease is established during active service, then subsequent manifestations of the same chronic disease at any later date, however remote, will be entitled to service connection, unless clearly attributable to causes unrelated to service ("intercurrent causes"). 38 C.F.R. § 3.303(b). In order to establish the existence of a chronic disease in service, the evidence must show 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." Id. Thus, the mere manifestation during service of potentially relevant symptoms does not establish a chronic disease at that time unless the identity of the disease is established and its chronicity may not be legitimately questioned. Id. If chronicity in service is not established, then a showing of continuity of symptoms after discharge is required to support the claim. Id. But the Federal Circuit Court explained that the requirement of showing a continuity of symptomatology after service under subsection 3.303(b) is a distinct and lesser evidentiary burden than the nexus element of the three-part test discussed above: "The primary difference between a chronic disease that qualifies for § 3.303(b) analysis, and one that must be tested under § 3.303(a), is that the latter must satisfy the 'nexus' requirement of the three-element test, whereas the former benefits from presumptive service connection . . . or service connection via continuity of symptomatology" (emphasis added). Walker, 708 F.3d at 1338-1339. Thus, showing a continuity of symptomatology after service is an "alternative path to satisfaction of the standard three-element test for entitlement to disability compensation" for chronic diseases. Id. at 1338; see also id. at 1336 (observing that section 3.303(b) provides a "second route by which a veteran can establish service connection for a chronic disease"). A continuity of symptoms after service itself "establishes the link, or nexus" to service and also "confirm[s] the existence of the chronic disease while in service or [during the] presumptive period." Id. at 1338. Not all diseases that may be considered "chronic" from a medical standpoint qualify for the more relaxed evidentiary standard under section 3.303(b), however. Rather, the Federal Circuit Court held that this subsection only applies to the specific chronic diseases listed in 38 C.F.R. § 3.309(a). Id. Thus, if the claimed disability is not one of the chronic diseases included in section 3.309(a), then the more relaxed continuity-of-symptomatology standard does not apply, and "the 'nexus' requirement of the three-element test" must be satisfied in order to establish entitlement to service connection benefits. Id. This is critically important here, and ultimately fatal to the Veteran's claim, because none of his psychiatric disorders are readily amenable to probative lay comment regarding their diagnoses and etiologies, including especially in terms of any potential relationship with his military service. So there needs to be supporting medical evidence, not just his unsubstantiated lay allegation, which unfortunately there is not, only instead evidence against his claim. He has presented only Vietnam-related stressors. He has alleged participation in combat, namely, that he supposedly was involved in guarding the U.S. Embassy in Saigon against enemy attacks during the Vietnam War in 1969 or 1970. Further, he maintains that he suffered hand injuries when there was an explosion at the U.S. Embassy and his hands were hit by shrapnel and glass. In addition, he claims that persons he served with in Vietnam were killed, including a servicemember who traded duties with him, then was killed in a vehicle accident along with other persons. Additionally, he states that he served on guard perimeter duty. His service personnel records (SPRs), however, do not indicate his receipt of a combat citation or list participation in an overseas or foreign deployment. There is one record, purportedly authored by the National Personnel Records Center (NPRC) in 2001, which showing he is entitled to wear the Vietnam Service Medal (VSM). However, this is indicative of service during the Vietnam Era, not necessarily of combat or in-country Vietnam service. Also, his DD Form 214 reflects that he had no foreign service, and in June 2003 the NPRC determined that no evidence could be found to substantiate that he had any service in Vietnam. Furthermore, upon review of his service personnel history supplied by the NPRC in November 2005, it appears that the during his military service he was stationed at Ft. Bliss, Texas, in November 1968; at Ft. Huachuca, Arizona, in February 1969; at Ft. Dix, New Jersey, in June 1969; at Ft. Benning, Georgia, in August 1969; and at Ft. Bragg, North Carolina, from January 1970 through 1971 where he had his military separation examination. There is no indication or suggestion of any service in the Republic of Vietnam, where many of the events in question are said to have occurred. As for indication of relevant disease, injury or event in service, there is a lesser pleading and proof requirement when the event in question is said to have occurred in combat and when shown to be consistent with the places, types, and circumstances of the particular Veteran's service. 38 U.S.C.A. § 1154(a) and (b); 38 C.F.R. § 3.304(d). Combat, however, means the Veteran personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality, and did not merely instead serve in a general combat area or combat zone. This is a case-by-case determination, so fact specific. See Moran v. Peake, 525 F.3d 1157 (Fed. Cir. 2008); VAOPGCPREC 12-99 (October 18, 1999). In cases where a Veteran asserts service connection for injuries or disease incurred or aggravated in combat, 38 U.S.C.A. § 1154(b) and its implementing regulation, 38 C.F.R. § 3.304(d), ease the evidentiary burden of a combat Veteran by permitting the use, under certain circumstances, of lay evidence. If the Veteran was engaged in combat with the enemy, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). The Federal Circuit Court has held that, in the case of a combat Veteran, not only is the combat injury presumed, but so, too, is the disability due to the in-service combat injury. Reeves v. Shinseki, 682 F.3d 988, 998-99 (Fed. Cir. 2012). To establish entitlement to service connection, however, there still must be evidence of a current disability and a causal relationship between the current disability and the combat injury. Id. (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The Veteran has neither shown his engagement in combat, owing to the fact that there is no suggestion, much less confirmation, he ever served in Vietnam as alleged, nor has he established he has a psychiatric disorder of any sort as a result or consequence. The competency of evidence differs from the weight assigned to the evidence, which varies according to its credibility and probative value. See Layno, 6 Vet. App. at 469; accord Rucker v. Brown, 10 Vet. App. 67, 74 1997); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (stating that "although interest may affect the credibility of testimony, it does not affect competency to testify."). The Board discounts the weight of evidence it finds not to be credible. See Washington, 19 Vet. App. at 368 (noting that the witness's credibility affects the weight to be given to his testimony). In determining whether statements submitted by a Veteran are credible, the Board may consider their internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. at 711, aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see also Madden v. Brown, 125 F.3d 1447 (Fed Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"). Further, the Federal Circuit Court has held that, while the absence of contemporaneous medical records does not, in and of itself, render lay testimony not credible, the Board may weigh the absence of contemporaneous records when assessing the credibility of lay evidence. See Buchanan, 451 F.3d at 1336 ("Nor do we hold that the Board cannot weigh the absence of contemporaneous medical evidence against the lay evidence of record."). Moreover, although the Board cannot reject a claimant's statements merely because he is an interested party, the claimant's interest may affect the credibility of his testimony when considered in light of the other factors. See Cartright, 2 Vet. App. at 25; accord Buchanan, 451 F.3d at 1337 (holding that "the Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias . . . ."). The Veteran's STRs further reflect treatment for various medical complaints which was rendered only within the United States. Included in these treatment reports is a November 1970 record showing the Veteran had injured his left hand and resultantly had received stitches while he was stationed at Fort Bragg, North Carolina. During the time period when he alleges being near an explosion in Saigon, his SPRs confirm that he was actually serving in Ft. Bragg, North Carolina. In essence, then the Board finds that his DD Form 214, the June 2003 finding of the NPRC, and his SPRs and STRs, which all reflect no history of service in Vietnam, outweigh the isolated 2001 record, which, at best, suggests he was eligible for the VSM, which, as noted, does not confirm in-country Vietnam service. Thus, the Board finds that he did not have in-country Vietnam service. As this is the case, the Board finds he is not credible in his statements regarding incidents in service purportedly causing his psychiatric disorders and right finger scar. The most credible evidence of record suggests his psychiatric disorder and right hand scar are a result of incidents unrelated to his service. Moreover, the July 2011 VA medical opinion concluded that his psychiatric disorders are not related to his service, irrespective of the particular diagnosis. An April 2013 examiner also found that the Veteran's right finger scar is unrelated to his service. Accordingly, the Board concludes that the preponderance of the evidence is against these claims of entitlement to service connection for a psychiatric disorder and right finger scar. The benefit-of-the-doubt rule therefore does not apply since there is no reasonable doubt to resolve in the Veteran's favor. See 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). ORDER The claim of entitlement to service connection for a psychiatric disorder is denied. The claim of entitlement to service connection for a scar on the right third finger also is denied. ____________________________________________ KEITH W. ALLEN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs