Citation Nr: 1322734 Decision Date: 07/17/13 Archive Date: 07/24/13 DOCKET NO. 10-15 717 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, and obsessive compulsive disorder. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Rutkin, Joshua M. INTRODUCTION The Veteran served on active duty from April 1968 to March 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. FINDINGS OF FACT 1. The Veteran does not have PTSD or obsessive compulsive disorder. 2. A psychiatric disorder, including depression, did not manifest during active military service, and the Veteran's depression is not otherwise related to a disease, injury, or event during service. CONCLUSION OF LAW An acquired psychiatric disorder, including PTSD, depression, and obsessive compulsive disorder, was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board has thoroughly reviewed all the evidence of record, and has an obligation to provide an adequate statement of reasons or bases supporting its decision. See 38 U.S.C.A. § 7104(d)(1) (West 2002); Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). While the Board must review the entire record, it need not discuss each piece of evidence. See id. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. 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 claimant). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). The standard of proof to be applied in decisions on claims for veterans' benefits is the benefit-of-the-doubt rule set forth in 38 U.S.C.A. § 5107 (West 2002). Under this standard, a claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. When the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The preponderance of the evidence must weigh against a claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). I. VA's Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000) (codified as amended at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107 (West 2002), sets forth VA's duty to notify and assist claimants in substantiating a claim for VA benefits. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In order to satisfy its duty to notify the claimant under the VCAA, the United States Court of Appeals for Veterans Claims (Court) held that VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). All notice under the VCAA should generally be provided prior to an initial decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, a delay in timing of the notice is "cured," and therefore harmless, when a fully compliant VCAA notification letter is followed by readjudication of the claim (such as through issuing a statement of the case or supplemental statement of the case) after the claimant has had an opportunity to submit additional evidence. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370 (2006). A claim of entitlement to service connection consists of five elements: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484 (2006). The Court has held that notification of what evidence is necessary to substantiate the claim under 38 U.S.C.A. § 5103(a) requires notice of these five elements. See id. at 486; Quartuccio, 16 Vet. App. at 187. Here, prior to the initial rating decision in this matter, an August 2008 letter informed the Veteran of all five elements of service connection, gave examples of the types of evidence he could submit in support of his claim, and provided notice of the Veteran's and VA's respective responsibilities for obtaining relevant records and other evidence on his behalf. Therefore, the duty to notify is satisfied. See id. VA's duty to assist under the VCAA includes helping the claimant to obtain service treatment records and other pertinent records, as well as providing an examination or obtaining a medical opinion when such is necessary to make a decision on the claim. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). The Veteran's service treatment records and service personnel records are in the claims file, as well as VA examination reports. Private medical records from J. Brown, M.D. have also been obtained. Of note, the Veteran indicated that he had been hospitalized at Fairbanks Hospital from March 1987 to April 1987. A September 2010 letter is of record from Fairbanks Hospital to the Veteran stating that his medical records had been destroyed per hospital protocol, but confirming that he had been hospitalized at this facility during the aforementioned time period. Thus, efforts to obtain records from this facility on the Veteran's behalf are not warranted. See 38 C.F.R. § 3.159(c)(2) (providing that VA need not make further efforts to obtain records on a claimant's behalf if it is advised that such records do not exist). The Veteran has not identified any other records or evidence that remains outstanding. Thus, the duty to obtain relevant records on the Veteran's behalf is satisfied. See 38 C.F.R. § 3.159(c). The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law. See 38 U.S.C.A. § 5103A; 38 C.F.R. §§ 3.159(c)(4), 3.326(a); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 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. Here, a VA psychiatric examination of the Veteran was performed by a clinical psychologist in December 2009. The VA examination is adequate for deciding this claim. In this regard, the examiner 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 opinion stated which is consistent with the evidence of record and enables the Board to make an informed decision. 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 report, and the Veteran has not challenged its adequacy or thoroughness, or the competency of the examiner. See Sickels, 643 F.3d at 1365-66; Rizzo, 580 F.3d at 1290-1291. Accordingly, VA's duty to provide 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. In sum, VA's duties to notify and assist under the VCAA have been satisfied. The Veteran has had ample opportunity to participate in the development of his claim. See Arneson v. Shinseki, 24 Vet. App. 379, 389 (2011) (citing Overton v. Nicholson, 20 Vet. App. 427, 435 (2006) (finding that any error depriving a claimant of "a meaningful opportunity to participate effectively in the processing of his or her claim . . . . must be considered prejudicial")). As shown above, any defect in the notice or assistance provided did not affect the outcome of this claim or compromise the "essential fairness of the adjudication." See Mayfield v. Nicholson, 19 Vet. App. 103, 116 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). Thus, any error in the notice or assistance provided was harmless, and no prejudice exists. See Shinseki v. Sanders 556 U.S. 396, 407, 410 (2009) (holding that the "rule of prejudicial error" requires a case-by-case determination as to whether the error in question was harmless, and that it is the burden of the claimant to show that the error was harmful by at least providing an explanation as to how the error caused harm); see also 38 U.S.C.A. § 7261(b)(2) (West 2002) (providing that the Court must take due account of the rule of prejudicial error). Accordingly, the Board may proceed with appellate review. II. Analysis The Veteran claims entitlement to service connection for an acquired psychiatric disorder, to include PTSD, depression, and obsessive compulsive disorder. For the following reasons, the Board finds that service connection is not warranted. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Federal Circuit has distinguished two evidentiary requirements for establishing service connection depending on the type of disorder being claimed. For any disorder not defined by VA as a "chronic disease," the Federal Circuit held that a three-element test must be satisfied under subsection 3.303(a) of the regulations 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 injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the "nexus" requirement). Id. However, claims for chronic diseases-namely those listed in 38 C.F.R. § 3.309(a)-benefit from a somewhat more relaxed evidentiary requirement under subsection 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 (such as joint pain in a claim for arthritis or abnormal heart action in a claim for heart disease) 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. The Federal Circuit noted 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. In other words, while a current disability must always be established in any service connection claim, the evidence required to show that the disability was incurred in or aggravated by active service differs according to whether the disability is defined as a chronic disease. If the disability in question is not defined as a chronic disease, then a "medical nexus" between active service and the claimed disability must be established under the three-part test set forth in Shedden discussed above. If the claimed disability is considered a chronic disease, then a relationship to service may be established by a chronicity in service or a continuity of symptoms after service, which is a less demanding evidentiary showing. See id. Not all diseases that may be considered "chronic" from a medical standpoint qualify for the more relaxed evidentiary requirements under section 3.303(b). Rather, the Federal Circuit 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 enumerated in section 3.309(a), then the more relaxed continuity-of-symptomatology requirement 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. Psychoses are among the conditions identified in 38 C.F.R. § 3.309(a) as chronic. Under 38 C.F.R. § 3.384 (2012), 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. As the Veteran has not been diagnosed or otherwise shown to have any of these disorders during the pendency of this claim, the evidentiary criteria applicable to chronic diseases set forth above do not apply. Likewise, the provisions for presumptive service connection under 38 C.F.R. § 3.307 (2012) do not apply, as the Veteran's diagnosed depression is not a disease eligible for presumptive service connection under section 3.309. Specific to claims for PTSD, there must be medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125(a) (2012), credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f). With regard to evidence of a diagnosis of PTSD in accordance 38 C.F.R. § 4.125(a), this regulation provides that, for VA purposes, all mental disorder diagnoses must conform to the Fourth Edition of the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (DSM-IV). In Cohen v. Brown, 10 Vet. App. 128, 139-42 (1997), the Court held that mental health care professionals are presumed to know and take into account the DSM-IV criteria in diagnosing PTSD. Thus, once a diagnosis of PTSD is established (whether or not it appears to conform to the DSM) and a nexus linking current symptomatology to a claimed in-service stressor, the Board may only apply the DSM-IV as a basis for returning a VA examination for clarification. Id. (citing 38 C.F.R. § 4.125(a)). The Board cannot use the DSM-IV as a basis for rejecting favorable medical evidence regarding the adequacy of the Veteran's symptomatology. Id. In other words, diagnoses of PTSD are presumed to have been made in accordance with the DSM-IV criteria. With regard to the requirement that be credible supporting evidence that the claimed in-service stressor occurred, section 3.304(f) sets forth circumstances that are exceptions to this rule and allow a claimant's lay testimony alone, to establish the occurrence of the alleged stressor. Specifically, and pertinent to this claim, if a stressor claimed by a Veteran is related to his "fear of hostile military or terrorist activity" and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. Id., at (f)(3). For purposes of the relaxed evidentiary requirements under subsection 38 C.F.R. § 3.304(f)(3), "fear of hostile military or terrorist activity" means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Id. This recent amendment to section 3.304(f) applies to claims that were pending on the date of its enactment, and thus applies to the present claim. See Stressor Determinations for PTSD, 75 Fed. Reg. 39843 (July 13, 2010) (amending 38 C.F.R. § 3.304(f)); see also Ervin v. Shinseki, 24 Vet. App. 318, 323 (2011) (holding that this amendment also applies to claims pending before the Court on the date of its enactment). The Veteran's reported in-service stressor has been established. Specifically, his service personnel records show that he served in Vietnam during the Vietnam war. In a March 2009 statement, the Veteran related that his unit was under constant rocket and artillery fire, and that he had to retreat to a bunker three or four nights per week. He stated that as a result he was under constant stress and felt a lot of fear and anxiety. He further related that as a result he would drink alcohol every day during his tour in Vietnam, and that his alcohol use lasted until March 1987, when he was hospitalized for alcoholism and depression. The RO was able to confirm that the Veteran's unit, Service Battery, 2nd Battalion, 94th Artillery, stationed at Dong Ha, Vietnam, was "subjected to numerous rocket and mortar attacks" in April, July, and October 1969, as shown by "Lessons Learned" reports issued by the headquarters of his unit, which were obtained from the Defense Technical Information Center. The RO thus issued a November 2009 memorandum for the record making a formal finding that the Veteran's reported stressors had been verified. Thus, because the Veteran served in a combat zone and has reported stressors related to fear of hostile military activity, and because these stressors were verified, the requirement of an in-service stressor has been satisfied. See 38 C.F.R. § 3.304(f). However, the competent evidence does not show that the Veteran has had PTSD during the pendency of this claim. His service treatment records do now show treatment, reports, or diagnoses of anxiety, nervous trouble, difficulty sleeping, or nightmares. Private treatment records dating from December 1995 to April 2001 reflect diagnoses of depression, but are negative for diagnoses of PTSD. They also make no mention of the Veteran's military service. There are no other treatment records in the file. At the December 2009 VA examination, the Veteran related similar stressors during Vietnam as described above, and also stated that he saw dead bodies while out on supply runs. He reported being "scared to death" during his tour of duty, and that he drank alcohol daily from the time he was in Vietnam until 1987. With regard to current symptoms, he related having difficulty falling to sleep and staying asleep. He generally did not remember his dreams, but described "chaotic" dreams two to three times per week. He also had dreams of not being able to get out of Vietnam, with the last such dream occurring about a year earlier. He denied avoidance of reminders of his Vietnam experiences, and also denied intrusive recollections or other "re-experiencing symptoms." The examiner concluded that while the Veteran's stressor met the criteria for PTSD, he did not meet the hyperarousal, avoidance, or re-experiencing criteria for a diagnosis of PTSD. Thus, the examiner found that the Veteran's symptoms did not warrant a diagnosis of PTSD. Rather, the examiner diagnosed the Veteran with depression. The Board observed that this diagnosis is consistent with the diagnoses of depression in the private treatment records. The December 2009 VA examination report is highly probative and carries a lot of weight in the Board's determination as to whether the Veteran has had PTSD during the pendency of this claim. The examination was performed by a licensed VA psychologist who has the expertise to make such an assessment. She reviewed the medical history as reflected in the claims file and reported by the Veteran, conducted a psychiatric evaluation, and concluded that the Veteran's symptoms did not warrant a diagnosis of PTSD as they did not meet the diagnostic criteria for this disorder. There is no competent evidence of record otherwise supporting a diagnosis of PTSD. The Veteran's lay contention that he has PTSD does not constitute competent evidence and is outweighed by the findings of the VA psychologist, who is a medical professional with the expertise to make this assessment. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the "authority to discount the weight and probity of evidence in the light of its own inherent characteristics in its relationship to other items of evidence"). In this regard, the Veteran is competent to testify as to matters within his experience and personal knowledge, such as his symptoms and medical history. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (holding that lay evidence can be competent with respect to both the diagnosis and the etiology of a disability); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (holding that appellant was competent to testify as to factual matters of which he had first-hand knowledge). However, as a lay person, the Veteran does not have the medical training or expertise to offer a competent opinion as to whether he has PTSD, as this is a medical determination that is too complex to be made based on lay observation alone. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007) (observing that a layperson can be competent to identify conditions that are simple, such as a broken leg, but is not competent to identify more complex conditions such as a form of cancer); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007) (holding that lay testimony is competent as to matters capable of lay observation, but not with respect to determinations that are "medical in nature"); Layno v. Brown, 6 Vet. App. 465, 469- 71 (1994) (holding that in order for testimony to be probative of any fact, the witness must be competent to testify as to the facts under consideration, and that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). Thus, the Veteran's opinion that he has PTSD carries little weight and is outweighed by the findings of the December 2009 VA examiner. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the medical issue in question); see also Layno, 6 Vet. App. at 469. Accordingly, because the competent evidence does not show that the Veteran has had PTSD during the pendency of this claim, service connection for PTSD must be denied. See 38 C.F.R. § 3.304(f); Shedden, 381 F.3d at 1166-67. The evidence also does not show that the Veteran has obsessive compulsive disorder. Although an April 1995 private treatment record states that the Veteran was "obsessive a bit" and bothered by "little things," a diagnosis of obsessive compulsive disorder was not made in this or any other private treatment record. Indeed, a December 1995 private treatment record states that there was "[n]o evidence of obsessions or compulsions." At the December 2009 VA examination, the Veteran reported checking lights and door locks two or three times per day because he could not remember whether he had locked the doors or turned off the lights. He denied handwashing for fear of germs, but stated that he "worries about the security of the house." Based on the Veteran's reported behavior and symptoms, the examiner concluded that the Veteran did not meet the criteria for obsessive compulsive disorder ("OCD"). The Board accords more weigh to the VA examiner's findings than to the Veteran's opinion that he has a compulsive disorder. See King, 700 F.3d at 1345; see also Layno, 6 Vet. App. at 469. The Veteran, as a lay person, does not have the medical background or expertise to render a competent opinion in this regard, as this is a complex medical determination and thus cannot be made based on lay observation alone. See Jandreau, 492 F. 3d at 1376-77; Barr, 21 Vet. App. at 309. By contrast, the VA examiner does possess such expertise, and found that the Veteran's behavior and symptoms were not sufficient to warrant a diagnosis of OCD. Thus, the preponderance of the evidence shows that the Veteran does not have obsessive compulsive disorder. Therefore, service connection for this disorder is not warranted. See Shedden, 381 F.3d at 1166-67 (providing, in pertinent part, that entitlement to service connection requires evidence of a current disability); see also Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). With regard to the Veteran's depression, the preponderance of the evidence weighs against a relationship between this disorder and the Veteran's service. His service treatment records do not reflect treatment or diagnoses of depression or any other psychiatric disorder, and there is no evidence that the Veteran sought counseling at the time. Moreover, he denied depression at separation in the March 1970 Report of Medical History. The earliest diagnosis of depression is reflected in an April 1995 private treatment record. According to the Veteran's statements, he was diagnosed with depression in 1987 when he sought treatment for alcohol dependence. At the December 2009 VA examination, the Veteran reported that he became depressed when he stopped drinking in 1987. The examiner opined that the Veteran's depression was less likely than not related to active service due to the time gap of approximately seventeen years between his separation from service and the onset of his symptoms in 1987. In a September 2010 statement, the Veteran's spouse wrote that when the Veteran returned from Vietnam in March 1970, he was depressed, angry, and withdrawn, and also had OCD at the time. The long period of time between the Veteran's active service and the earliest evidence of depression in 1987, in conjunction with the VA examiner's opinion, weighs against a relationship to service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a proper consideration for the trier of fact is the amount of time that has elapsed since military service, and that evidence of a prolonged period without medical complaint can be considered, along with other factors concerning the Veteran's health and medical treatment during and after military service, as evidence of whether a condition was incurred in service). The VA examiner's opinion carries more weight than the Veteran's contention that his depression is related to service, for the reasons discussed above. See King, 700 F.3d at 1345 (affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation); see also Jandreau, 492 F. 3d at 1376-77; Barr, 21 Vet. App. at 309; Layno, 6 Vet. App. at 469. The evidence does not otherwise support a relationship between the Veteran's depression and a disease, injury, or event during service. While the Veteran may have been depressed when he returned from Vietnam, according to the September 2010 statement by his wife, this fact alone does not show that a depressive disorder manifested at the time or that his current depression is related to his depressed feelings in 1970. Moreover, the understandable bias of the Veteran's spouse in favor of the Veteran's claim, in addition to the fact that her statements directly conflict with the Veteran's statement asserting that his depression began in 1987, as well as his denial of depression in the March 1970 Report of Medical History, lead to a finding that it is not credible that his depression began during or shortly after service. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (stating 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 . . . ."); Caluza, 7 Vet. App. at 511 (holding that when determining whether lay evidence is satisfactory, the Board may properly consider, among other things, its consistency with other evidence submitted on behalf of the Veteran); Curry v. Brown, 7 Vet. App. 59, 68 (1994) (holding that contemporaneous evidence has greater probative value than history as reported by the claimant); Madden, 125 F.3d at 1480 (observing that "lay evidence which is in fundamental conflict with other lay evidence and is, for that reason, found not credible in a given case, is surely suspect."). Finally, to the extent the Veteran's depression was caused or aggravated by his alcohol use in Vietnam, service connection on this basis may not be awarded as a matter of law. See 38 C.F.R. § 3.301(b)(c) (2012) (providing that compensation is not payable for any condition due to the veteran's own willful misconduct, including the abuse of alcohol or drugs). Accordingly, because the preponderance of the evidence weighs against a relationship between the Veteran's depression and his period of service, the nexus element of the three-part test set forth in Shedden has not been satisfied. Shedden, 381 F.3d at 1166-67. Therefore, service connection under 38 C.F.R. § 3.303(a) is not warranted. See Walker, 708 F.3d at 1338-1339. Further, service connection is not warranted under subsection 3.303(b). In this regard, because depression is not defined as a chronic disease under VA law, allegations of a continuity of symptomatology are not sufficient to support the claim. See id. at 1336-37, 1340 (holding that the claimant's allegation of a continuity of hearing loss ever since active service was not sufficient to support the claim under subsection 3.303(b), as it found that the claimant's hearing loss was not among the chronic diseases listed in section 3.309(a)). Moreover, for the reasons discussed above, the preponderance of the evidence weighs against a chronicity in service or continuity of symptoms after service. In sum, the preponderance of the evidence is against the Veteran's claim. Consequently, the benefit-of-the-doubt rule does not apply, and service connection for an acquired psychiatric disorder, including PTSD, depression, and obsessive compulsive disorder, is denied. See 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depression, and obsessive compulsive disorder is denied. ____________________________________________ P.M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs