Citation Nr: 1322122 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 10-19 132 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Veteran and C.J. ATTORNEY FOR THE BOARD L. J. N. Driever INTRODUCTION The Veteran served on active duty from February 1943 to June 1946. This claim comes before the Board of Veterans' Appeals (Board) on appeal of a June 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. The Veteran and C.J. testified in support of this claim during a videoconference hearing held before the undersigned Veterans Law Judge (VLJ) in December 2010. In January 2011 and November 2012, the Board remanded this claim to the RO for additional development via the Appeals Management Center (AMC) in Washington DC. According to the Veteran's electronic file (Virtual VA), there is additional pertinent evidence of record not in the claims folder, which the RO considered in support of this claim in a Supplemental Statement of the Case issued in May 2013. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. There is no medical evidence of record of a PTSD diagnosis. 2. An acquired psychiatric disorder other than PTSD is not related to the Veteran's active service. CONCLUSION OF LAW An acquired psychiatric disorder, to include PTSD, was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1154 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. The Veterans Claims Assistance Act (VCAA) Upon receipt of a complete or substantially complete application for benefits, VA is tasked with satisfying certain procedural requirements outlined in the VCAA and its implementing regulations. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The U. S. Court of Appeals for Veterans Claims (Court/CAVC) has mandated that VA ensure strict compliance with these provisions of the VCAA. Quartuccio v. Principi, 16 Vet. App. 183 (2002). A. Duty to Notify The VCAA and its implementing regulations provide that VA is to notify a claimant and his representative, if any, of the information and medical or lay evidence not of record that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and his representative, if any, of which portion of the evidence the claimant is to provide and which portion of the evidence VA will attempt to obtain on the claimant's behalf. 38 U.S.C.A. § 5103. These notice requirements apply to all five elements of a service-connection claim: (1) Veteran status; (2) existence of disability; (3) a connection between service and the disability; (4) degree of disability; and (5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007). Ideally, the RO should provide the claimant VCAA prior to its initial unfavorable decision on the claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II). If, however, for whatever reason the RO does not, or provides the notice in a timely manner but it is inadequate or incomplete, the RO can effectively cure this error by providing any necessary VCAA notice and then readjudicating the claim in a statement of the case (SOC) or supplemental SOC (SSOC). In such a case, the intended purpose of the notice is not frustrated, rather preserved, and the claimant 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) (Mayfield IV); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). The U.S. Supreme Court has made clear that VCAA notice errors, even when shown to have occurred, are not presumptively prejudicial, instead, must be judged on a case-by-case basis. As the pleading party attacking the agency's decision, the Veteran has the burden of proof of not only establishing error but also, above and beyond that, of showing how it is unduly prejudicial, meaning outcome determinative of his claim, i.e., more than harmless. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The RO provided the Veteran VCAA notice on his claim by way of letters dated in February 2009, April 2009, June2009, March 2011, July 2011, September 2011, April 2012 and November 2012. The RO most recently readjudicated this claim in a May 2013 SSOC, curing any timing deficit associated with these notice letters. Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). The content of these letters reflects compliance with the pertinent statutory and regulatory provisions and case law. Therein the RO acknowledged the Veteran's claim, notified him of the evidence needed to substantiate it, identified the type of evidence that would best do so, notified him of VA's duty to assist and indicated it was developing his claim pursuant to this duty. The RO also provided him all necessary information on disability ratings and effective dates in the event service connection is granted. As well, in these letters and Memoranda dated September 2012 and May 2013, the RO identified the evidence it had received in support of the Veteran's claim, the evidence it had requested, but not yet received, and the evidence that was unavailable and could not be obtained. The RO identified the evidence that VA is responsible for obtaining and indicated it would make reasonable efforts to assist the Veteran in obtaining all outstanding evidence provided he identified the sources of it. The RO also noted that, ultimately, it was his responsibility to ensure VA's receipt of all pertinent evidence. The RO informed the Veteran that it had attempted to obtain his service treatment records on multiple occasions, but had learned that those records are unavailable, having been destroyed in a fire that occurred at a military records storage facility. See Dixon v. Derwinski, 3 Vet. App. 261 (1992) (holding that, where a veteran's service medical records have been destroyed or lost, the Board is under a duty to advise the claimant to obtain other forms of evidence, such as lay testimony, to support his claim). The RO advised the Veteran that, given these circumstances, it would help him reconstruct his service file. The RO also identified alternate types of documents the Veteran could submit to establish in-service incurrence. Typically, VA provides claimants further notice during hearings. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that, pursuant to 38 C.F.R. § 3.103(c)(2), a VLJ who chairs a hearing must satisfy two duties: (1) fully explaining the issue; and (2) suggesting the submission of evidence that may have been overlooked. In this case, the VLJ did not satisfy these duties fully, but any decision to proceed in adjudicating this claim is harmless, not prejudicial to the Veteran or affecting the essential fairness of the adjudication of this claim. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004); Bernard v. Brown, 4 Vet. App. 384 (1993). First, during the hearing, the representative elicited testimony regarding the Veteran's claimed in-service stressors such that it was apparent the Veteran understood the nature of his claim and the evidence needed to substantiate it. In addition, following the hearing, in remands issued in January 2011 and November 2012, the Board identified evidence that had been overlooked and emphasized the importance of obtaining that evidence and an opinion as to the etiology of the Veteran's mental health complaints. The Veteran has received all essential notice, has had a meaningful opportunity to participate effectively in the development of this claim, and is not prejudiced by any technical notice deficiency along the way. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir., 2004). Neither he nor his representative asserts that VA failed to comply with VCAA's notice provisions. B. Duty to Assist VA also has a duty to assist a claimant in obtaining evidence necessary to substantiate a claim, including, in certain cases, by affording him a medical examination or obtaining a medical opinion, but such assistance is not required if there is no reasonable possibility that it would aid in substantiating the claim. 38 U.S.C.A. §§ 5103(a), 5103A; 38 C.F.R. § 3.159(b), (c). In this case, in accordance with the Board's remands, the RO obtained all available VA treatment records and afforded the Veteran VA examinations, during which examiners addressed the etiology of the Veteran's mental health complaints. Thereafter, it was determined that August 2011 and October 2011 reports of the VA examinations were inadequate to decide this claim, and a more comprehensive medical opinion was obtained in April 2013. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). However, unless the claimant challenges the adequacy of the examination or opinion, the Board may assume that 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. Indeed, even when there is this challenge, 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 Veteran here does not claim that the examination reports and opinion, considered individually or collectively, is/are inadequate to proceed. The RO attempted to obtain all evidence the Veteran identified as being potentially pertinent to his claim. However, with regard to certain treatment records, including those from service, the RO was unsuccessful. In a case such as this, where a claimant's service treatment records are unavailable through no fault of his own, there is a heightened duty to assist him in developing his claim, to provide reasons or bases for any adverse decision rendered without the benefit of these records, and to consider the benefit-of-the-doubt doctrine. See O'Hare v. Derwinski, 1 Vet. App. 365 (1991); Moore v. Derwinski, 1 Vet. App. 401 (1991) (holding that such a heightened duty to assist includes searching for alternative medical records by having the claimant complete and return National Archives (NA) Form 13055 so that the RO can obtain abstracts, etc., from the Surgeon General's Office (SGO)). See also Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005), citing Russo v. Brown, 9 Vet. App. 46, 51 (1996); and Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). Upon the RO's request, the Veteran provided certain information to reconstruct his service record and this information allowed VA to obtain records from SGO. It did not, however, aid the RO in securing alternative service evidence to substantiate the reported in-service stressors. Regardless, according to a September 2012 Memorandum, based on the Veteran's assertions of combat-related stressors in Central Europe during World War II and his service personnel records, which confirm his presence there, the RO conceded that the reported in-service stressors occurred as alleged. The RO found that such stressors were consistent with the time and circumstances of that war. By so doing, the RO lessened the importance of not having the Veteran's service personnel records to review in support of this claim. Given the development that has occurred, it is difficult to discern what additional guidance VA could have provided the Veteran regarding what further evidence he should submit to substantiate his claim. 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 and, instead, place even greater burden on VA's already limited resources). II. Analysis The Veteran seeks a grant of service connection for a psychiatric disability, including PTSD, based on his service in Central Europe during World War II. According to written statements he submitted during the course of this appeal and his hearing testimony, he developed this disability secondary to in-service combat stressors. Such stressors reportedly include: (1) participating in the initial contact assault of the Rhine River invasion as a combat engineer with the 1321st Engineers, H&S Company, Seventh Army (building and fighting in the vicinity of Wallach, Germany), during which his unit was attacked and he saw hundreds of soldiers killed by the German Army; (2) personally witnessing the deaths of two friends, T. J. and A. G., and the wounding of another, J. J., while putting in the Bailey bridge; and (3) being exposed to explosions, mortars, bombs and automatic gunfire while crossing the Rhine River. The Veteran and J. S., who testified at the hearing, contend that, although the Veteran's military occupational specialty (MOS) is not combat-related, he was subjected to combat, including while crossing the Rhine River, and he received two Bronze stars and other awards for his combat service. Allegedly at that time, when he was building the bridge, the fighting began and his commander asked that all available soldiers lend a hand. A.G., the Veteran's best friend at the time, reportedly died in the Veteran's arms. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military, naval or air service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303(a) (2012). To establish entitlement to service connection for PTSD, a claimant must submit medical evidence diagnosing PTSD in accordance with Sec. 4.125(a) of this chapter; 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) (2012). VA amended this regulation during the course of this appeal, effective July 12, 2010. This amendment eliminated the requirement of corroborating a claimed stressor if the stressor is related to a 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 a veteran's symptoms are related to the claimed stressor. 75 Fed. Reg. 39,843, 39,852 (Jul. 13, 2010); 75 FR 41092 (codified as amended at 38 C.F.R. § 3.304(f)). It applies to claims pending before the Board on or after July 12, 2010. To prevail on the issue of service connection, there must be competent evidence of: (1) a current disability; (2) in-service occurrence or aggravation of a disease or injury; and (3) a nexus between the in-service injury or disease and the current disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Once evidence is determined to be competent, its credibility must be evaluated. Layno v. Brown, 6 Vet. App. 465, 469 (1994) (distinguishing between competency, a legal concept focusing on whether testimony may be heard and considered, and credibility, a factual determination focusing on the probative value of the evidence); see also Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994) (in rendering a decision on appeal the Board must 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). Competent medical 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 or authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). A layperson is generally incapable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997), aff'd sub nom. Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998), cert. denied, 119 S. Ct. 404 (1998). In certain instances, however, a lay statement may be deemed competent and adequate to support a claim for service connection by substantiating the occurrence of lay-observable events or a disability or symptoms of disability subject to lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence); Barr v. Nicholson, 21 Vet. App. 303 (2007) (layperson is competent to report disease with unique and readily identifiable features such as varicose veins); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). If a chronic disease is shown in service, subsequent manifestations of the same disease, however remote, are to be service connected, unless clearly attributable to intercurrent causes. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). When certain chronic diseases are at issue, such as psychoses or any other disease enumerated at 38 C.F.R. § 3.309(a), see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013), a claimant may establish entitlement to service connection based on a demonstration of continuity of symptomatology. Evidence of continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or when the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). Continuity of symptomatology may be demonstrated by submitting evidence showing: (1) that a condition was "noted" during service; (2) post-service continuity of the same symptomatology; and (3) a nexus between the present disability and the post-service symptomatology. Savage v. Brown, 10 Vet. App. 488, 495-97; see also Hickson v. West, 12 Vet. App. 247, 253 (1999) (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection). Service connection may be granted for any disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). Service connection may be presumed for certain medical conditions such as psychoses if it is shown that a veteran served continuously for 90 days or more during a period of war or during peacetime after December 31, 1946, the condition manifested to a degree of 10 percent within one year from the date of discharge, and there is no evidence of record establishing otherwise. 38 U.S.C.A. §§ 1101, 1112(a), 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309(a) (2012). In the case of any veteran who has engaged in combat with the enemy in active service during a period of war, satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service, even though there is no official record of such incurrence or aggravation. 38 U.S.C.A. § 1154(b) (West 2002). "Satisfactory evidence" is credible evidence. Collette v. Brown, 82 F.3d 389, 392 (1996). Such evidence may be rebutted by clear and convincing evidence to the contrary. 38 U.S.C.A. § 1154(b). The provisions of 38 U.S.C.A. § 1154(b) do not establish a presumption of service connection in combat cases but rather ease the combat veteran's burden of demonstrating the occurrence of some in-service incident to which a current disability may be connected. Clyburn v. West, 12 Vet. App. 296, 303 (1999); Caluza v. Brown, 7 Vet. App. 498, 507 (1995). A. PTSD The Veteran's DD Form 214 establishes that the Veteran served with the 1321st Engineers, including in Rhineland in Central Europe during World War II, but his military occupational specialty was chauffeur. According to June 2007 and June 2009 Memoranda from JSRRC, the Veteran provided insufficient information to verify the stressors that allegedly occurred during his service. As previously indicated, however, in a Memorandum dated September 2012, the RO conceded that the Veteran's in-service stressors occurred as alleged. In its November 2012 remand, the Board indicated that it agreed with the RO's finding in this regard. The third element of a PTSD claim (credible supporting evidence that the claimed in-service stressor occurred) is thus satisfied under 38 C.F.R. § 3.304(f). That notwithstanding, the preponderance of the evidence is against a grant of service connection for PTSD. Medical documents of record do not satisfy the first and second elements of a PTSD claim under the former or revised criteria of 38 C.F.R. § 3.304(f) because, although the Veteran has undergone numerous mental health assessments and VA PTSD/mental disorders examinations during the course of this appeal, the reports of these assessments and examinations include no PTSD diagnosis, linked to the verified in-service stressors or otherwise. During VA examinations conducted in August 2011 and October 2011, examiners indicated that the Veteran did not meet the criteria for a PTSD diagnosis. In April 2013, one of the examiners elaborated by noting that the Veteran has not displayed all of the symptoms required for a valid PTSD diagnosis and that, even conceding the existence of an in-service stressor, the Veteran's symptomatology is not consistent with PTSD. He found significant the fact that the Veteran's treatment records do not include such a diagnosis. The Veteran has not submitted treatment records that include such a diagnosis or a medical opinion diagnosing PTSD. His assertions thus represent the only evidence of record of a PTSD diagnosis. The Veteran is competent to report and describe the nature of certain mental health difficulties he is experiencing such as feeling down or anxious as these symptoms are capable of lay observation. However, because he does not possess a recognized degree of medical knowledge to attribute these symptoms to a psychiatric disability or to diagnose PTSD, his assertions in this regard may not be considered competent. Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4 (Fed. Cir. 2007) (a layperson is not competent to offer an opinion regarding a medical question when that question may not be resolved through lay observation). Inasmuch as there is no competent medical evidence of record of a PTSD diagnosis, the Board concludes that PTSD was not incurred in or aggravated by service. A claimant is responsible for presenting evidence in support of his claim for benefits under laws administered by VA. VA is responsible for considering all such evidence, lay and medical. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA is to give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107 (West 2002); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). With regard to this particular claim, the evidence is not in relative equipoise. The benefit-of-the-doubt rule is thus not applicable. B. Psychiatric Disorder other than PTSD Reports of VA examinations conducted in August 2011 and October 2011 fail to establish the presence of a psychiatric disability. During these examinations, two separate examiners indicated that the Veteran did not meet the criteria for any psychiatric disability. VA treatment records dated during the course of this appeal, albeit prior to the VA examinations, include such diagnoses. They are therefore sufficient to establish that the Veteran currently has a psychiatric disability other than PTSD. The question is therefore whether this disability, variously diagnosed, including as adjustment disorder with depressed mood, depression and depressive disorder, not otherwise specified, is related to the Veteran's active service, including the in-service stressors. As previously indicated, the Veteran's service treatment records are not in the claims file. The Veteran does not claim that he began to exhibit mental health symptoms or that a physician diagnosed him with a psychiatric disability during active service. Rather, he claims that he experienced in-service stressors during service, which led to his development of a psychiatric disability. VA concedes that these stressors occurred as alleged. There is no evidence in the claims file indicating that the Veteran sought treatment for mental health complaints prior to 2009. That year he tested positive for a depression screen and, since then, after being referred to psychiatry based on the positive screen, he has received intermittent treatment for mental health complaints. In February 2009, upon initial referral, the Veteran noted that he had not received any psychiatric treatment. According to his son, the Veteran had become depressed during the previous few months secondary to stressors that occurred during the previous year. He identified the Veteran's stressors as: losing a daughter suddenly due to an asthma attack; retiring from his business as a cement contractor in November 2008, a business he had owned since 1941; and having $3,000 stolen from his truck and spent before he realized that the theft had occurred. Physicians prescribed the Veteran medication for depression and through 2010, they occasionally noted improvement secondary to the medication. As well, they occasionally related the Veteran's mental health to traumatic losses, including of his daughter in October 2008, his son in March 2009 and his daughter-in-law thereafter, retirement (he occasionally reported dreaming he was doing his former work) and an employee's theft and also noted that the Veteran had stress secondary to his dealings with his grandkids. During some treatment visits, the Veteran reported that, during World War II, it was his job to run messages to the front lines. No medical professional linked his psychiatric disability, however diagnosed, to his reported in-service job or otherwise to his active service, including the conceded stressors. During VA examinations conducted in August 2011 and October 2011, examiners addressed the Veteran's mental health complaints. The August 2011 examiner asked the Veteran about the nature of his complaints. The Veteran responded that he had dreams that he was working and those dreams seemed real, did not feel rested, and became sad once monthly. He denied nightmares, avoidant behaviors, and symptoms of hyperarousal. He reported positive memories of the military. That examiner noted that the Veteran had received VA mental health treatment since 2009 and that, prior to that time, had had many losses in his life and had retired. The examiner also noted a positive response to psychotropic medication intervention. He indicated that the Veteran was not endorsing any symptoms reflective of a mental health problem and that, in the past, he had some problems with situational depression secondary to losses in his life. The October 2011 examiner noted that the Veteran had been receiving VA treatment for depression that was not related to his military service. In an addendum opinion dated April 2013, that same examiner ruled out a relationship between the Veteran's psychiatric disability and service on the basis that there was insufficient evidence in the records to support such a link. Indeed, the VA examiners' findings are supported by the Veteran's treatment records, which, as noted above, link the Veteran's psychiatric disability to life events, rather than service. As the Veteran has admitted, prior to 2009, he did not seek treatment for mental health complaints. This fact supports the finding that the complaints he began expressing in 2009 were situational and arose secondary to the Veteran's unfortunate losses and his retirement, not secondary to his conceded in-service stressors experienced six or seven decades ago. Again, the Veteran's assertions represent the only evidence of record establishing the necessary nexus in this case. Inasmuch as the Veteran is not competent to relate etiologically his psychiatric disability to his active service and he has not submitted a medical opinion supporting such a relationship, the Board concludes that a psychiatric disability other than PTSD was not incurred in or aggravated by service. With regard to this particular claim, the evidence is not in relative equipoise. The benefit-of-the-doubt rule is thus not applicable. ORDER Service connection for an acquired psychiatric disorder, to include PTSD, is denied. ____________________________________________ P. M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs