Citation Nr: 1322298 Decision Date: 07/11/13 Archive Date: 07/18/13 DOCKET NO. 11-25 860 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Honolulu, Hawaii THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for an acquired psychiatric disorder other than PTSD. REPRESENTATION Appellant represented by: Hawaii Office of Veterans Services WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. Nichols, Associate Counsel INTRODUCTION The Veteran served on active duty from August 1964 to December 1967. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an May 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Honolulu, Hawaii. In November 2011, a Decision Review Officer (DRO) hearing was held at the RO. The Veteran testified before the undersigned Veterans Law Judge (VLJ) in September 2012 at a travel Board hearing. The transcript of the hearing has been associated with the claims file. By way of history, in October 2012, the Board requested a medical expert opinion from the Veterans Health Administration (VHA). See 38 C.F.R. § 20.901(a). The requested medical opinion was received in February 2013. In March 2013, the Board sent the Veteran a copy of the opinion for his review and response. See 38 C.F.R. § 20.903(a). In April 2013, the Veteran submitted a Medical Opinion Response Form wherein he stated that he was submitted the enclosed argument and did not waive RO consideration of the evidence. He requested his case to be remanded to the RO for consideration of the new evidence in the first instance. Thus, the Board remanded this issue in May 2013 for the RO to readjudicate the issue with consideration of the additional evidence. A supplemental statement of the case (SSOC) was subsequently issued in May 2013. In June 2013, the Board received medical records from Tripler Army Medical Center. A RO review of the evidence and SSOC was not issued with respect to consideration of this evidence. However, the Board finds that there is no prejudice to the Veteran in proceeding with adjudication at this juncture; the evidence from Tripler deals with a right elbow injury which is not the subject of this appeal. Thus, the Board finds that this evidence is not pertinent to the present appeal. The matter is ready for Board consideration. The Board has bifurcated the issue as seen on the title page to address service connection for PTSD and service connection for a psychiatric disorder other than PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record). A review of the Virtual VA paperless claims processing system reveals documents that are pertinent to the present appeal, but are duplicates. Please note 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 diagnosis of PTSD based on the Veteran's claimed stressor. 2. An acquired psychiatric disorder other than PTSD did not manifest in service; symptoms of a psychiatric disability were not present until many years after separation from service; and no current psychiatric disability is related to service. 3. The Veteran has been diagnosed with a personality disorder. CONCLUSION OF LAW 1. PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2012). 2. An acquired psychiatric disorder other then PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. § 3.303. 3. A personality disorder is not a disease or injury within the meaning of VA regulations. 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claims. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The RO provided a VCAA-compliant letter to the Veteran in August 2010 prior to the initial adjudication of his claim for service connection for PTSD. The letter notified the Veteran of what information and evidence must be submitted to substantiate his claim, as well as what information and evidence must be provided by the Veteran and what information and evidence would be obtained by VA. He was also told to inform VA of any additional information or evidence that VA should have, and was told to submit evidence in support of his claim to the RO. The content of the letter complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). The requirements of VCAA also include notice of a disability rating and an effective date for award of benefits if service connection is granted. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). He was provided with notice of the type of evidence necessary to establish a disability rating and effective dates. In addition, during the September 2012 Board hearing, the VLJ clarified the issue on appeal, explained the concept of service connection for a psychiatric disorder (including PTSD), identified an evidentiary deficit, and suggested the submission of additional evidence to support the Veteran's claim. The VLJ left the record open for a 30-day period following the hearing to allow for the submission of additional evidence. The actions of the VLJ supplement the VCAA and comply with any related duties owed during a hearing. See 38 C.F.R. § 3.103. With respect to the VHA medical opinion obtained in this case, the Veteran was provided notice in March 2013 that he had 60 days to respond to the medical opinion and to send VA any additional evidence or argument. In April 2013, the Veteran submitted additional evidence that was considered by the RO prior to its issuance of the May 2013 SSOC. The Board finds that all relevant evidence has been obtained with regard to the Veteran's claims of service connection for PTSD and other psychiatric disorders other than PTSD, and the duty to assist requirements have been satisfied. All available service treatment records and post-service private and VA treatment records were obtained. As discussed above, the VCAA provisions have been considered and complied with. The Veteran was notified and aware of the evidence needed to substantiate his claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA. The Veteran was an active participant in the claims process by providing evidence and argument and presenting for VA examination. Therefore, he was provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notice is not shown to have affected the essential fairness of the adjudication or to have caused injury to the Veteran. See Pelegrini, 18 Vet. App. at 121. Therefore, any such error is harmless and does not prohibit consideration of these matters on the merits. See Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004). Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in the development of his claim. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). Pertinent Law and Regulations As an initial matter, the Board notes that the evidence does not suggest, and the Veteran does not contend, that he engaged in combat with the enemy or that his claimed PTSD is related to combat. In addition, the Veteran's service personnel records and DD 214 do not reflect that he received any medals indicating combat service. Thus, the combat provisions of 38 U.S.C.A. § 1154 are not applicable in this case. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). 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. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). Service connection may also be granted for a disease first 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). Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran filed the service connection claim at issue in this case in June 2010. As explained by the Federal Circuit, in order for a veteran to qualify for entitlement to compensation under the pertinent statutes and regulations pertaining to direct service connection, a veteran must prove existence of a disability, and one that has resulted from a disease or injury that occurred in service. See Sanchez-Benitez v. Principi, 259 F.3d 1356, 1361-1362 (2001). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). PTSD There are particular requirements for establishing entitlement to service connection for PTSD in 38 C.F.R. § 3.304(f) that are separate from those discussed above for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Establishing service connection for PTSD requires (1) a diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in- service stressor. 38 C.F.R. § 3.304(f). The diagnosis of PTSD must comply with the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, of the American Psychiatric Association (DSM- IV). Id.; see also 38 C.F.R. § 4.125(a). The Veteran contends that he has a diagnosis of PTSD due to an in-service stressful event aboard the USS Somers when a gun mount on the ship ignited accidentally, causing an explosion and killing a fellow crewmember. The Veteran avers that hearing the news of his fellow crewmember's death and the fear of the ship sinking from the explosion constitutes a stressful, traumatic event in service. The Veteran stated during his Decision Review Officer (DRO) hearing in November 2011 that he has felt psychological effects, such as anger and depression, as he was affected by the stressful event in service since approximately one year after separation from service, and that upon reporting such symptoms to a veteran counselor, he was told that he had PTSD. He also stated that his private physician, Dr. A.G., diagnosed him with PTSD based on his reported symptoms and in-service stressor. The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U. S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). In fact, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a). Moreover, the Court has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). In this case, the Veteran's service treatment records show no complaints, diagnoses, or treatment for PTSD or another psychiatric disorder in service. The August 1964 entrance examination and report of medical history reveals no defects mentally (findings were normal) and no psychiatric symptomatology, and the Veteran was deemed fit for service. The Board notes that the Veteran was seen at a psychiatric clinic in October 1966 in connection with disciplinary issues during service. The Veteran was found to have difficulty conforming to the way of life in service as he showed resentment towards his authorities. A psychologist examined the Veteran and found him to have an emotionally unstable personality, passive-aggressive type, as manifest by impairment of interpersonal relationships and chronic passive obstructionist behavior patterns. A March 1967 radiation physical examination report indicates that the Veteran did not have any psychological issues or a psychiatric illness. Upon separation examination in December 1967, the examining physician noted a normal psychiatric evaluation, finding no mental or physical defects, no psychiatric illnesses or symptomatology, and the Veteran was deemed eligible for separation. VA outpatient treatment records reflect that the Veteran underwent several mental health evaluations and therapy sessions, but did not ever meet the criteria for a PTSD diagnosis. A June 2010 VA mental health assessment with Dr. C.L. reveals that the Veteran wanted to establish mental health care. He relayed a history of relationship problems. The Veteran indicated that he was homeless. He also relayed his personal and military history, to include the event of his friend being killed by an explosion. Upon examination, the Veteran did not have any delusions, hallucinations, or suicidal or homicidal ideations. The examiner also noted a history of sleep problems which may have been caused by not taking medication appropriately. The Veteran was shown to have a negative screening for PTSD and depression. He denied having nightmares, avoidance issues, detachment issues, and feelings of being on-guard. Based upon the examination, Dr. C.L. concluded that the Veteran did not have the symptoms for a PTSD diagnosis. He made an Axis I assessment of rule out relationship problem versus dysthymic disorder. An August 2010 mental health study note shows that the Veteran reported symptoms of loss of pleasure, loss the sleep, and change in appetite on the Beck Depression Inventory. At an August 2010 mental health diagnostic interview, the Veteran saw Dr. J.M. for the first time. He mentioned that he was filing for a VA disability claim. The Veteran discussed his background and stated that the most troubling thing to him at the time was "state of mind" referencing issues of faith, spirituality, and attitude regarding retirement. He denied having suicidal or homicidal ideations, indicated that he exercised, had an appetite, and engaged with friends. The Veteran discussed the traumatic event of learning about his fellow serviceperson's death - it was noted as an accidental death of an "acquaintance." Based on the interview, Dr. J.M. found that the Veteran did not meet the diagnosis for PTSD. She provided an assessment of Axis I, transient situational disturbance and Axis II, possible anti-social qualities. In an August 2010 follow-up psychological assessment report by Dr. J.M., she noted inconsistencies in the Veteran's statements. The Veteran identified having angry outbursts in the military which led to disciplinary actions against him, but the only "trauma" that the Veteran identified was learning about the gruesome death of an acquaintance. Dr. J.M. noted that the Veteran was defensive and reluctant to discuss some of his personal problems. Based on her assessment of the Veteran, Dr. J.M. deferred an Axis I diagnosis, indicating rule-out impulse control disorder, and Axis II, possible anti-social qualities. A September 2010 mental health individual therapy note showed that the Veteran primarily complained of relationship issues. Dr. J.M. noted that there was no indication that the Veteran met the PTSD criteria. The Veteran still denied having suicidal or homicidal ideations. There was only an Axis II assessment of possible antisocial behavior (no Axis I diagnosis). In March 2011, the Veteran was afforded a VA examination for PTSD with Dr. M.K. The Veteran reported symptoms of reoccurring dreams concerning abandonment issues, past relationships, and trust issues. The Veteran was self-employed in the landscaping business. He had a history of delinquency and adjustment problems in the military. The Veteran relayed his history of personal problems post-military, to include relationship issues, financial issues, and issues with the criminal justice system. For the first time, he relayed that he has had thoughts of suicide after his first divorce, although no attempts have been made (he previously denied having suicidal ideations). The Veteran relayed his in-service stressful event to Dr. M.K. He denied having witnessed anyone being killed, injured, wounded, and he was not exposed to seeing dead bodies in service. He actually denied being exposed to a traumatic event and stated that his friend was killed but could not recall the name of his friend. The Veteran indicated that he did not believe that his life was threatened. He stated that he was at the "battle station" during the event and was unaware of his friend's death until he heard about it later. The Veteran denied talking to anyone about the event and his overall level of traumatic stress based on severity of the incident was low. The Veteran denied being stunned or shocked and did not feel disconnected to people as a result of the event. At the conclusion of the interview, Dr. M.K. indicated that the Veteran did not meet the PTSD criteria for re-experiencing the event, avoidance of stimuli, or increased arousal. The following objective findings were found during the March 2011 VA examination. The Veteran did not have delusions, hallucinations, suicidal or homicidal ideations. He only indicated that he had a suicidal thought after his first divorce. The Veteran experienced mild depression two to three times per month and it was related to his inability getting along with his significant other and financial issues. He felt not as productive at work. The Veteran experienced anxiety once per month and it was also related to his significant other and financial issues. No sleep impairment was noted. Dr. M.K. found that there was no PTSD diagnosis or any mental health diagnosis for Axis I. Axis II diagnosis was borderline personality disorder and antisocial personality disorder. The Veteran's Global Assessment of Functioning (GAF) score was 70. Dr. M.K. noted that there was occasional decrease in work efficiency but generally satisfactory functioning. She noted that the Veteran had mild depression when relationships surface, a history of anger problems, a history of relationship problems, and fear of abandonment issues. She noted that he has had these symptoms since he was an adolescent. Finally, she specifically stated that the Veteran's claimed stressor is not related to a fear of hostile military or terrorist activity. In July 2011, the Veteran sought psychiatric counseling from a private psychologist, Dr. A.G., who diagnosed the Veteran with PTSD. The Veteran's initial intake report indicates that a good friend for weeks died during service when discussing his in-service stressful event. The Veteran also indicated that he had past suicidal thoughts and plans after his first divorce, but also after his experience in Vietnam. He reported nightmares, having intrusive thoughts, avoidance issues, hypervigilance, and anger/relationship problems. The Veteran submitted a letter dated August 2011 from Dr. A.G., which indicated that after two assessment sessions, Dr. A.G. diagnosed the Veteran with PTSD based on his stressor of a gun pre-igniting on the ship during service and how the Veteran was shocked and horrified by the news of his friend's death. Dr. A.G. mentioned that the Veteran had symptoms of nightmares, intrusive thoughts triggered by loud explosions, soldiers, police in uniform, or the sight of Vietnamese people. The Veteran reported hypervigilance, avoided discussions of Vietnam, and was uncomfortable around people. He reported having anger issues since he returned from Vietnam. A September 2011 intake note from Dr. A.G. showed that their treatment was strongly focused on PTSD as the Veteran had passing suicidal thoughts. There was a notation that therapy was not continued. A November 2011 intake note from Dr. A.G. indicated that the Veteran resumed therapy with him after a hiatus. Prominent relationship issues were identified and the Veteran had passing suicidal ideations. There was a focus on PTSD issues and a notation that the Veteran will continue with VA treatment. At the November 2011 DRO hearing, the Veteran testified that he and Jimmy, the deceased crewmember, were good friends and discussed his fear of drowning on the ship. The Veteran elaborated on the details surrounding the claimed stressor and asserted that the anger he experienced, particularly with respect to his failed past relationships, homelessness, and the disciplinary issues he faced in service all arose from his traumatic experience aboard the ship. The Veteran averred that he did not realize that the symptoms he was experiencing since separation from service was PTSD until he consulted with a veteran counselor who encouraged him to file a claim with VA. The RO verified the death of the Veteran's fellow crewmember, Jimmy, conceded the Veteran's claimed stressor, and ordered a VA examination for further development of the claim in February 2012. Upon VA examination in February 2012, the examiner, Dr. D.P., considered all of the relevant history and reports of symptomatology from the Veteran. Dr. D.P. found no diagnosis for PTSD or a mental health disorder. The Veteran's GAF was 70. Dr. D.P. noted that the Veteran was exposed to low levels of traumatic stress; he was not in psychiatric care nor was he taking medications at this time. He indicated that the claimed stressor cannot support a PTSD diagnosis and is not related to any fear of hostile military or terrorist activity because the explosion was accidental. Dr. D.P. noted that the traumatic event was not persistently reexperienced and there was no persistent avoidance of stimuli. Although the Veteran displayed irritability and outbursts of anger, he did not meet the full criteria for PTSD. He also found no objective evidence of the Veteran suffering from another mental illness. In September 2012, the Veteran testified before the undersigned at a travel Board hearing. He mainly elaborated on the events aboard the ship where his friend died. In October 2012, the Veteran's private physician, Dr. A.G., submitted a letter to clarify his diagnosis of PTSD. Dr. A.G. reiterated the diagnosis and symptomatology he described in his previous August 2011 letter and listed out the five criteria enumerated in the DSM-IV with respect to PTSD, linking the Veteran's PTSD to his in-service stressor. In October 2012, the Board requested a VHA medical opinion, and a VHA advisory medical opinion was furnished in February 2013. The VA medical expert reviewed the claims folder, including service treatment records, psychiatric evaluations of record (both VA and private) and lay statements. The expert reviewed and commented on the pertinent aspects of the Veteran's clinical evaluations and examinations related to the Veteran's claim of service connection for PTSD, to include the Veteran's treatment notes from his private psychologist, Dr. A.G. The VA expert noted that the initial two visits to Dr. A.G. were for diagnostic assessment and the last visit was for resumed therapy after a hiatus. He commented that the notes from these visits are brief and do not meet the usual standards for a diagnostic assessment nor do they reflect that psychotherapy has occurred despite the indication of symptoms of PTSD. The August 2011 letter contained additional details not present in the treatment notes, thus the expert questioned Dr. A.G.'s conclusion that the Veteran had PTSD related to his military experience. The expert found this to stand in contrast to the VA examinations of record. He noted that during the Board hearing, the Veteran's representative attempted to explain the discrepancies between Dr. A.G.'s notes and Dr. A.G.'s August 2011 letter, suggesting that the Veteran was in ongoing therapy with Dr. A.G. opening up more with him during their 3 to 4 visits in 4 months. However, the private notes do not support this suggestion as there were only three visits and no documentation of psychotherapy. Thus, the VA expert concluded that it was less likely than not that the Veteran has PTSD due to an event in service. Additionally, he noted that there was no evidence of any other psychiatric disorder related to service. In fact, he explained that the way the Veteran's story evolved over time supported the possibility that suggestion may have played a role in what he told the service representative and Dr. A.G. The expert noted that earlier on, the Veteran was unable to supply the name of his friend who was killed on the ship, but then he told Dr. A.G. that they were "good friends for weeks." Thus, the expert questioned the significance of the alleged trauma. He also stated that the repeated mention of antisocial traits and the fact that the Veteran was not forthright further supported the very tentative possibility that he is malingering. In sum, the medical evidence of record shows a negative finding for a PTSD diagnosis by way of VA examiners and the VHA medical expert, and a positive finding for a PTSD diagnosis from the Veteran's private psychologist, Dr. A.G. The Board notes at the outset that lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Layno v. Brown, 6 Vet. App 465 (1994). There are three Jandreau exceptions where a layperson is deemed competent to establish a diagnosis. The Jandreau exceptions are as follows: lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (2007). Thus, the Veteran is competent to report his symptomatology of PTSD and also what medical professionals have relayed to him in the course of treatment. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board acknowledges that the Veteran is competent to relay the diagnosis of PTSD told to him by Dr. A.G. However, the probative weight to be assigned to his own statements and that of Dr. A.G. are matters to be determined by the Board. To the extent that the Veteran was told that he has PTSD by Dr. A.G. (or his veteran counselor) is of little probative value, since Dr. A.G.'s report has insufficient reasoning. In regard to the Veteran relating Dr. A.G.'s opinion, his lay evidence is accorded no greater probative value than the opinion of Dr. A.G. Regardless, a reading of the entire body of evidence in this case establishes that the Veteran is not a credible historian as his reported symptoms and the details surrounding his in-service stressful event have been inconsistent throughout the record, particularly when comparing statements he has made to VA treating physicians, his private physician, and during his DRO and Board hearings. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed.Cir.2006) (Board can consider bias in lay evidence and conflicting statements of the veteran in weighing credibility). Treatment by VA psychiatrist indicate that the Veteran did not report suffering from nightmares or having avoidance issues or other symptoms typically associated with PTSD. However, the Veteran reported having the typical PTSD symptoms to his private psychologist. The Board observes that since the private psychologist's assessment of the Veteran as having PTSD was based upon a less than credible reported history, that medical opinion is entitled to little, if any, probative value. See Coburn v. Nicholson, 19 Vet. App. 427, 432 (2006) (holding that reliance on a veteran's statement renders a medical report incredible only if the Board rejects the statements of the Veteran). Conversely, the VA examiner in 2011 and 2012 considered the Veteran's history, including the in-service findings, made mention of the pertinent findings relative to psychiatric health both during and after service, examined the Veteran, provided a fully articulated opinion, and also furnished a reasoned analysis. The VA examiners specifically found that the Veteran's symptoms do not support a diagnosis of PTSD, and both provided rationales for their conclusions. Accordingly, these opinions are entitled to great probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value to a medical opinion). Furthermore, the Board finds that the VA medical expert who rendered the advisory opinion in response to a VHA request in February 2013 considered all of the medical evidence of record, to include service treatment records, VA and private medical records, and lay statements and testimony and provided a detailed medical opinion in finding that it was less likely than not that the Veteran had a PTSD diagnosis. He provided specific rationale which discounted the private doctor's opinion and gave reasons why the VA examinations were a more accurate assessment of the Veteran's psychological condition. The Board therefore attaches significant probative value to the VHA medical opinion and the most probative value in this case, as it is well reasoned, detailed, consistent with other evidence of record, and included an access to the accurate background of the Veteran. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). In summary, although a private physician diagnosed PTSD, such diagnosis was based on a report of history and symptomatology provided by the Veteran that is not found to be credible. Furthermore, the Board notes that Dr. A.G. only treated the Veteran in three sessions and his notes do not provide evidence that thorough testing for which a PTSD diagnosis is based on occurred during those sessions. In contrast, the VA psychologists, to include the two VA examiners in 2011 and 2012, and VA medical expert have determined that the Veteran does not suffer from PTSD. As a diagnosis of PTSD based on the DSM-IV criteria is a necessary requirement for service connection for PTSD, it is clear that the preponderance of the evidence is against the claim for service connection for PTSD. Therefore, a further discussion of the nexus requirement is not necessary at this juncture. Psychiatric Disorder (other than PTSD) To the extent that the Veteran himself believes that he suffers from another psychiatric disability (other than PTSD) related to service, the Board finds that the probative evidence of record shows a finding against his claim for service connection. In this case, there is no evidence of an acquired psychiatric disorder in service, and the separation examination reveals normal findings. Furthermore, there is no evidence of a psychiatric disorder in proximity to separation from service. As previously mentioned, a personality disorder was identified in service as a psychologist examined the Veteran and found him to have an emotionally unstable personality, passive-aggressive type, as manifest by impairment of interpersonal relationships and chronic passive obstructionist behavior patterns. However, the Board notes that a personality disorder is not a disease or injury within the meaning of compensation benefits. See 38 C.F.R. § 3.30. Following service, VA treatment records show psychiatric treatment beginning in June 2010, when the Veteran wanted to establish mental health care. At the very earliest, the Board notes that the Veteran mentioned at the 2011 VA examination that he received counseling for relationship issues in the 1990s and anger management sessions related to a domestic violence dispute in 2007. Still, the evidence reflects a multi-year gap from the time of separation from service and the time he sought psychiatric care for a claimed psychiatric disability. The Board has considered the lay evidence as it pertains to in-service symptoms and continuity of symptomatology after service. However, the Board notes that to the extent that the Veteran is alleging continuity of symptomatology, the record does not show that the Veteran ever had an acquired psychiatric disorder which would allow him consideration under Walker. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). The service treatment records and post-service treatment records show no evidence of psychoses during service or thereafter. Instead, there is scant evidence in the VA treatment records which may indicate that Dr. L.E. in June 2010 believed that the Veteran may have dysthymic disorder (still long after separation from service). However, the rest of the medical evidence does not show that the Veteran has an acquired psychiatric disorder or condition on Axis I or II. Although the Veteran appears to have assessments of antisocial tendencies and personality issues as indicated primarily as an Axis II diagnosis, the Board notes that service connection cannot be granted for a personality disorder. See § 3.303(c). VA compensation may not be paid for a personality disorder as it is specifically excluded as a disease or injury within the meaning of applicable legislation providing for VA compensation benefits. So, generally speaking, a personality disorder is not service connectable as a matter of express VA regulation. See 38 C.F.R. §§ 3.303(c), 4.9, 4.127. In any event, even assuming that the Veteran has a psychiatric disability currently, none of the medical evidence relates an acquired psychiatric disorder to an event in service. The private medical records from Dr. A.G. do not include any other psychiatric diagnosis with the exception of PTSD. Thus, to the extent that the Veteran is alleging that he has an acquired psychiatric disorder that is related to service, he is relying on his own statements and testimony. Again, the Board fully acknowledges that lay witnesses are competent to opine as to some matters of diagnosis and etiology, and the Board must determine on a case by case basis whether a veteran's particular disability is the type of disability for which lay evidence is competent. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 433, n.4 (2011). To the extent that the Veteran is competent to so state that he has a psychiatric disability related to service, the Board finds the opinions of the VA examiners to be of greater probative value than the Veteran's own lay contentions. The March 2011 VA examiner opined that the Veteran has had antisocial tendencies and anger issues as an adolescent. The examiner also found that the Veteran had mild depression and anxiety, although it was noted that such depression and anxiety were related to the Veteran's issues with his personal relationships and finances. There is no indication in the record that the Veteran's reported symptomatology of depression and anxiety amounted to an actual diagnosis of a psychiatric disability. There is also no evidence linking such disability to an event in service. In fact, even considering such symptomatology, the March 2011 VA examiner did not find that the Veteran had a psychiatric disability. Furthermore, the VHA medical expert who considered all of the medical and lay evidence of record, concluded that there was no evidence of a psychiatric disorder related to service. In fact, he explained that the way the Veteran's story evolved over time supported the possibility that suggestion may have played a role in what he told his service representative and his doctor. The expert pointed to the various inconsistencies in the record and stated that there may be a tentative possibility of malingering. It is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993). The Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App 171 (1991). The weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Sklar v. Brown, 5 Vet. App. 140 (1993). The Board finds that these inconsistencies between the Veteran's statements made to health care providers and later statements made during the course of the appeal for compensation benefits weigh against the Veteran's credibility. This is particularly evident when comparing the statements that he made to VA medical professionals, his reports of symptomatology to Dr. A.G., and his hearing testimony. Thus, the only probative evidence of record are the findings and opinions from the VA examiners and the VHA medical expert, all of whom found that the Veteran does not have a psychiatric disability related to service. In sum, the evidence deemed most probative by the Board establishes that service connection for an acquired psychiatric disorder other than PTSD is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Service connection for PTSD is denied. Service connection for an acquired psychiatric disorder other than PTSD is denied. ____________________________________________ H. N. SCHWARTZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs