Citation Nr: 1322962 Decision Date: 07/18/13 Archive Date: 07/24/13 DOCKET NO. 10-02 762 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Entitlement to service connection for multiple sclerosis. 2. Entitlement to service connection for a right hip/thigh disorder. 3. Entitlement to service connection for a right knee disorder. 4. Entitlement to service connection for a low back disorder. 5. Entitlement to service connection for bilateral upper extremity neuropathy. 6. Entitlement to service connection for bilateral lower extremity neuropathy. 7. Entitlement to service connection for the residuals of a stroke. 8. Entitlement to service connection for a lung disorder, to include asbestosis. 9. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD T. Azizi-Barcelo, Counsel INTRODUCTION The Veteran served on active duty from December 1981 to December 1984. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2008 decision of the Detroit, Michigan, Regional Office (RO) of the Department of Veterans Affairs (VA). In May 2011, the Board remanded the claims for additional development, which has been completed. FINDINGS OF FACT 1. The preponderance of the evidence shows that the Veteran's multiple sclerosis did not manifest during, or as a result of, active military service. 2. The preponderance of the evidence shows that the Veteran's a right hip/thigh disorder first manifested many years after his separation from service and is not related to his period of service or to any incident therein. 3. The preponderance of the evidence shows that the Veteran's right knee disorder first manifested many years after his separation from service and is not related to his period of service or to any incident therein. 4. The preponderance of the evidence shows that the Veteran's low back disability first manifested many years after his separation from service and is not related to his period of service or to any incident therein. 5. The preponderance of the evidence shows that the Veteran's bilateral upper extremity neuropathy did not manifest during, or as a result of, active military service. 6. The preponderance of the evidence shows that the Veteran's bilateral lower extremity neuropathy did not manifest during, or as a result of, active military service. 7. The service treatment records are negative for any findings attributable to cardiovascular or cerebrovascular disease, to include a cerebrovascular accident or stroke; there is no evidence of such disease, to include residuals of a stroke until approximately 20 years post-service discharge; there is no competent medical evidence of a nexus between residuals of a stroke and any incident of service. 8. The competent medical does not show that the Veteran currently suffers from a lung disability, including asbestosis, or any respiratory disability due to asbestos exposure. 9. The record does not contain competent medical evidence establishing a diagnosis of PTSD based on an in-service traumatic event or stressor; an acquired psychiatric disorder was not documented during service, nor was a psychosis shown within one year of separation from service; and the weight of the competent medical evidence is against finding a nexus between the post-service diagnosis of any psychiatric disorder and service. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for multiple sclerosis have not been met. 38 U.S.C.A. §§ 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). 2. The criteria for establishing entitlement to service connection for right hip/thigh disorder have not been met. 38 U.S.C.A. §§ §§ 1111, 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 3. The criteria for establishing entitlement to service connection for a right knee disability have not been met. 38 U.S.C.A. §§ 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 4. The criteria for establishing entitlement to service connection for a low back disability have not been met. 38 U.S.C.A. §§ 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 5. The criteria for establishing entitlement to service connection for bilateral upper extremity neuropathy have not been met. 38 U.S.C.A. §§ 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 6. The criteria for establishing entitlement to service connection for bilateral lower extremity neuropathy have not been met. 38 U.S.C.A. §§ 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 7. The criteria for establishing entitlement to service connection for residuals of a stroke have not been met. 38 U.S.C.A. §§ 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 8. The criteria for establishing entitlement to service connection for a lung disorder, to include as due to exposure to asbestos, have not been met. 38 U.S.C.A. §§ 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 9. The criteria for establishing entitlement to service connection for an acquired psychiatric disorder, to include PTSD, have not been met. §§ 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist VA has a duty to provide the Veteran notification of the information and evidence necessary to substantiate the claims submitted, the division of responsibilities in obtaining evidence, and assistance in developing evidence, pursuant to the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). The notice requirements were accomplished in letters sent in September 2007, March 2008, July 2008, and June 2011. Mayfield v. Nicholson, 444 F.3d 1328, 1333 (Fed. Cir. 2006). The letters also provided notice of the type of evidence necessary to establish a disability rating or effective date for the claimed disabilities under consideration, pursuant to the recent holding in Dingess v. Nicholson, 19 Vet App 473 (2006). Additionally, the claims were readjudicated in the June 2012 supplemental statement of the case. The Board also finds that all relevant facts have been properly developed, and that all evidence necessary for equitable resolution of the issues has been obtained. The Veteran's service treatment records, Social Security Administration records, Virtual VA file, and private and VA treatment records have been obtained. In addition, the Veteran has been provided with VA examinations in connection with his claims herein decided. Finally, the Veteran has not indicated that there are any additional records that VA should seek to obtain on his behalf. Therefore, the Board concludes that all reasonable efforts were made by VA to obtain evidence necessary to substantiate the Veteran's claims, and no further assistance to develop evidence is required. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of recurrence of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Moreover, where a Veteran served continuously for ninety (90) days or more during a period of war, or during peacetime service after December 31, 1946, including organic diseases of the nervous system such as peripheral neuropathy, psychoses, cerebrovascular disease, or arthritis, becomes manifest to a degree of 10 percent within one year from date of termination of such service, or multiple sclerosis becomes manifest to a degree of 10 percent or more within seven years after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Every Veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111 (West 2002). In order to rebut the presumption of soundness at service entry, there must be clear and unmistakable evidence showing that the disorder pre-existed service and there must be clear and unmistakable evidence that the disorder was not aggravated by service. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the 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. Davidson, 581 F.3d at 1316; Jandreau, 492 F.3d at 1376-77. When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d at 1376-77. 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). Indeed, 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) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (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). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). Service connection for multiple sclerosis, stroke, neuropathy of the upper and lower extremities, a low back disorder, a right hip/thigh disorder, and a right knee condition The Veteran seeks service connection for multiple sclerosis, residuals of a stroke, neuropathy of the upper and lower extremities, a low back disorder, a right hip/thigh disorder, and a right knee condition. In a March 2008 statement, he reported in-service head and back trauma, along with onset of pain in his back and upper and lower extremities during the performance of his duties in service. Initially, the Board notes that the Veteran was without any right hip/thigh condition or similar defect at the time of his October 1981 enlistment examination, as no clinical findings/abnormalities with respect to his lower extremities or spine/musculoskeletal system were noted. At the time of enlistment, he reported pre-service history of right hip/thigh surgery, but an orthopedic examination performed at this time revealed no clinical abnormality/diagnosis, aside from a surgical scar. The Court has made clear that the Veteran's statements and the mere notation of this account, at the time of enlistment by a military examiner, are not sufficient evidence to rebut the presumption of soundness. See Miller v. West, 11 Vet. App. 345, 348 (1998); see also Crowe v. Brown, 7 Vet. App. 238 (1994). As such, the Board finds that no right hip/thigh condition was noted at the time of the Veteran's enlistment and there is insufficient evidence to rebut the presumption of soundness, as required under 38 U.S.C.A. § 1111 (West 2002); therefore, the analysis to follow will proceed accordingly. See 38 C.F.R. § 3.304(b)(1) (2012); Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Crowe v. Brown, 7 Vet. App. 238, 245 (1994). Having established that the Veteran is entitled to a presumption of soundness with respect to the claimed disabilities, the next step of the inquiry is to determine whether the Veteran developed multiple sclerosis, a stroke, or developed a chronic disability affecting the spine, the upper and lower extremities, a right hip/thigh disorder, or a right knee condition during active service. The Board must assess the Veteran's competence and credibility to assert that the claimed disabilities had onset in service. A Veteran is competent to testify to factual matters of which he had first-hand knowledge. The Board finds that the Veteran is competent to report that he had low back problems following an in-service injury, or that he experienced pain and numbness throughout his body in service and remained symptomatic since service. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994); 38 C.F.R. § 3.159(a)(2) (2012). To the extent that the Veteran reports recurrence of symptomatology since service, the Board acknowledges that lay evidence concerning recurrent symptoms after service, if credible, can be competent, despite the lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). 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. Gabrielson v. Brown, 7 Vet. App. 36 (1994); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). Here the Board finds that the Veteran's contentions are not credible because they are inconsistent with the contemporaneous evidence of record. The service treatment records contain no complaints, history, diagnosis or findings consistent with multiple sclerosis, a stroke, a right hip condition, a right thigh condition, a right knee condition, neuropathy of the upper or lower extremities, or a back injury or low back disorder, and on separation from service in October 1984 the Veteran's neurological and musculoskeletal system, to include the spine and upper and lower extremities, were clinically evaluated as normal. The Board finds that the service treatment records lack the combination of manifestations sufficient to identify a chronic disability affecting the lower back, hips, knees, upper or lower extremities, and the evidence does not show that a stroke or multiple sclerosis was documented in service. After service, VA treatment records show that in February 2007 the Veteran presented complaints of numbness of the hands. Reportedly he had recently been seen by a private physician who prescribed medication, but was unsure as to what was causing the Veteran's symptoms. At that time, the Veteran denied a history of cerebral vascular accident. A February 2007 MRI revealed a cyst of the pineal gland. An August 2007 clinical record shows complaints of bilateral leg weakness along with a past medical history of neuromuscular disorder. The clinician noted right leg pain and numbness associated with a stroke 3 weeks earlier. The Veteran also related having recently fallen and re-injured his right knee. A private clinical treatment record in August 2007 noted neurological testing was consistent with a demyelinating disorder such as multiple sclerosis. A VA clinician in December 2007 reported that the Veteran had been initially diagnosed with multiple sclerosis in November 2007, following onset of symptoms earlier that summer. A history of neuropathy was also noted. A January 2008 VA neurological consultation report recorded a diagnosis of multiple sclerosis. On VA examination in September 2008 the Veteran reported being diagnosed with multiple sclerosis in 2007. X-rays of the right knee showed degenerative osteoarthritis. In June 2009, the Veteran complained of chronic pain in the lower extremities and back. A clinician in November 2009 reported severe arthritis of the back and knee, along with a history of anxiety, depressive disorder, unspecified idiopathic peripheral neuropathy and multiple sclerosis. A VA treatment record in July 2010 noted no residuals symptoms due to the stroke, however, in May 2012 a clinician reported left foot drop as residual of a stroke. In summary, following service discharge, the next record of treatment any of the claimed disorders, to include a stroke, multiple sclerosis, a back condition, right hip condition, right knee disability, right thigh disorder, or neuropathy of the lower or upper extremities, is not until 2007, approximately 23 years after service, when the Veteran was seen for complaints of numbness in the hands and was subsequently diagnosed with a stroke followed by a diagnosis of multiple sclerosis and peripheral neuropathy. Additionally, the initial radiographic documentation of degenerative changes of the back, knee, hip or thigh, is well beyond the one-year presumptive period for manifestation of arthritis, service connection cannot be established for arthritis of affecting the spine, right knee, hip and thigh, on a presumptive basis. With regards to residuals of a stroke, there is no indication that the stroke occurred during service or within one year of discharge from service and as such service connection for a cerebrovascular condition cannot be established on a presumptive basis. Similarly, peripheral neuropathy was not shown to have had onset during service or within 1 years of discharge from service. Finally, the evidence shows that the Veteran has been consistently diagnosed with multiple sclerosis since 2007, and there is no indication that the condition or symptoms thereof, had its onset during or within the first seven years of separation from service. 38 U.S.C.A. § 1112 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). The Board has weighed statements made by the Veteran as to incurrence of multiple sclerosis, stroke, neuropathy of the upper and lower extremities, a low back disorder, a right hip/thigh disorder, and a right knee condition, during service and recurrence of related symptoms, and finds the current recollections and statements made in connection with the claims for benefits to be of less probative value. As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran. Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007). In considering the statements of the Veteran as to the incurrence of multiple sclerosis, stroke, neuropathy of the upper and lower extremities, a low back disorder, a right hip/thigh disorder, and a right knee condition, during service, and recurrent symptoms since service, in light of the evidence discussed, the Board finds that they did not present a persuasive history because they contradict other evidence of record. In this regard, as previously noted, none the claimed disabilities were not diagnosed in service, and on separation from service in October 1984 the Veteran's neurological and musculoskeletal system, to include the spine and upper and lower extremities, were clinically evaluated as normal. Significantly, post-service discharge the medical treatment records do not show complaints, clinical findings or diagnoses consistent with any of the claimed disabilities until approximately 23 years after discharge from service, following the Veteran's stroke. Therefore, the Board finds that recurrence of symptoms has not been established, either through the competent evidence or through the Veteran's statements. This is because his statements as to having an injury with recurrence of symptoms are less persuasive than the service treatment records. Therefore, the Board finds that recurrence of symptomatology has not here been established, either through the competent evidence or through the Veteran's statements, because his statements are not considered credible. On the question of medical causation or medical evidence of an association or link between the claimed multiple sclerosis, stroke, neuropathy of the upper and lower extremities, a low back disorder, a right hip/thigh disorder, and a right knee condition, first noted after service, and service, VA obtained medical opinions, which considered the Veteran's contentions and the service medical records. However, the medical opinions did not associate the Veteran's disabilities with service. 38 C.F.R. § 3.303(d) (2012). The Veteran underwent a VA brain and spinal cord examination in June 2011. The examiner noted that in February 2007 the Veteran developed numbness and burning in his hands of one month's duration. An August 2007 brain MRI showed demyelinating disease and an old hemorrhagic infarct. He was diagnosed with stroke. In November 2007 he was diagnosed with multiple sclerosis. The condition progressively worsened with symptoms of weakness in the lower extremities. It was felt that the Veteran's neuropathy, which was noted too have onset in 2006/2007, was secondary to multiple sclerosis. Following an examination of the Veteran the examiner diagnosed neuropathic pain likely secondary to multiple sclerosis, with no documented clinical evidence of peripheral neuropathy. The examiner opined that the Veteran's multiple sclerosis and neuropathic pain complaints were not related to military service, nor did they have onset prior to 1991. In this regard, the Veteran initially presented complaints and symptoms associated with multiple sclerosis and burning and numbness of the extremities in 2007. There was no evidence in service or within 7 years of discharge from service documenting complaints and or treatment for numbness or burning of the extremities or a stroke. The Veteran also underwent a VA joints examination in June 2011. The examiner noted a history of a right femur and hip injury in a motorcycle accident which preceded service. Upon service induction the condition had healed and the Veteran was able to enlist without any restrictions. He also reported injuring his right knee in 1998 while playing football. With regards to low back pain, the Veteran reported onset of the condition in 1995. He denied a history of trauma to the back. X-rays revealed moderate degenerative changes in the right knee, and minimal degenerative changes in the right hips/pelvis with a small area of heterotopic ossification. X-rays of the lumbar spine showed mild degenerative changes. He was diagnosed with lumbar spine strain with age related degenerative changes. Following an examination of the Veteran and a review of the medical evidence, to include the service treatment records, the examiner opined that the right hip, right thigh, right knee, and low back conditions were less likely than not related to service. In this regard the examiner noted that there was no documentation a right hip, right thigh, right knee, and low back condition in the service treatment records. The examiner further indicated that the Veteran's motor and neurologic examination findings were most likely associated with multiple sclerosis. Consistent with this opinion in September 2008 opined that it was not likely that the Veteran's right knee disability was etiologically related to service because a right knee condition was not shown in service. The VA examiners, unlike the Veteran, have specialized expertise in the area of neurological and orthopedic disorders and are able to render a competent opinion regarding the likelihood that the claimed disabilities are related to service. Also, the VA examiners' opinions were based on review of the claims folder, to include the Veteran's service and post-service treatment records. The examiners explained, based on sound medical principles, why the Veteran's multiple sclerosis and neuropathic pain complaints, and the low back, right knee, right thigh, and right hip disabilities, were less likely than not related to service, despite the Veteran's assertions. While the Veteran is competent to report his symptoms of pain and numbness, he is not competent to render an opinion regarding their etiology. Thus, in summary, the preponderance of the credible and probative evidence shows that his current multiple sclerosis, neuropathy of the upper and lower extremities, low back disorder, right hip/thigh disorder, right knee condition, or claimed residuals of a stroke, manifested more than 7 years after discharge from service and are not otherwise related to active service. For these reasons, the preponderance of the evidence weighs against the award of service connection for multiple sclerosis, neuropathy of the upper and lower extremities, low back disorder, right hip/thigh disorder, right knee condition, or claimed residuals of a stroke, and thus service connection must be denied. To the extent that the Veteran's neuropathic pain complaints have been attributed to multiple sclerosis, as service connection has not been established for multiple sclerosis, there is no legal basis for entitlement to service connection for peripheral neuropathy of the lower or upper extremities as secondary to multiple sclerosis under 38 C.F.R. § 3.310(a). In reaching these conclusions, the Board notes that, under the provisions of 38 U.S.C.A. § 5107(b), the benefit of the doubt is to be given to the claimant in cases where there is an approximate balance of positive and negative evidence in regard to a material issue. The preponderance of the evidence, however, is against the Veteran's claims in this case, and that doctrine is not applicable. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Lung disorder The Veteran seeks service connection for a lung disorder, to include asbestosis. In a March 2008 statement, the Veteran provided a competent account of in-service asbestosis exposure. In cases involving asbestos exposure, the claim must be analyzed under VA administrative protocols. Ennis v. Brown, 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993). Although there is no specific statutory or regulatory guidance regarding claims for residuals of asbestos exposure, VA has several guidelines for compensation claims based on asbestos exposure. VBA Adjudication Procedure Manual M21-1 Manual Rewrite (M21-1 MR), Part IV, Subpart ii, Ch. 2, Section C, Topic 9 and Section H, Topic 29 (Dec. 13, 2005). Additionally, the Board must follow development procedures specifically applicable to asbestos-related claims. Ashford v. Brown, 10 Vet. App. 120, 124-125 (1997). VA must determine whether military records demonstrate evidence of asbestos exposure during service, whether there was pre-service or post-service occupational or other asbestos exposure, and whether there is a relationship between asbestos exposure and the claimed disease. The Veteran's service personnel records confirm his service aboard a Navy vessel and military occupational specialty as an Electrical Equipment/Mechanical Repairman. In August 1982 the Veteran was placed under surveillance for asbestos exposure. The service treatment records contain no complaint, history or findings consistent with a respiratory disorder, to include asbestosis or another asbestos-related disease, and on separation from service in October 1984 the Veteran's nose, sinuses, mouth, throat, lungs and chest were clinically evaluated as normal. The Veteran underwent a VA respiratory disorders examination in June 2011. The examiner noted that the Veteran had been exposed to asbestos during service. In this regard, it was noted that the evidence showed that the Veteran was placed in surveillance for the condition during active duty. However, the examiner noted that there was no evidence of a diagnosis of asbestosis in service. Moreover, on examination the Veteran denied any respiratory problems and the post-service treatment records did not show any findings consistent with a respiratory condition. Significantly, VA and private treatment records do not contain a diagnosis of a respiratory disorder, to include asbestosis, and in May 2012 a VA clinician confirmed that the Veteran's medical history was negative for respiratory problems. The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v Brown, 104 F. 3d 1328 (1997) (38 U.S.C.A. § 1110 and 38 U.S.C.A. § 1131 require the existence of a current disability for VA compensation purposes). Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. The competent medical evidence shows that the Veteran does not currently have a respiratory disability. Here there is no medical evidence of a confirmed diagnosis of any lung disability, asbestosis, or any respiratory disability due to asbestos exposure during service. With no medical evidence of the claimed disability, the analysis ends, and service connection must be denied. The Board recognizes the Veteran's contention that service connection should be granted for a lung disorder. As a layperson, however, he is not competent to provide an opinion requiring medical knowledge, such as a diagnosis of medical disability, or the relationship of any disability to service or to claimed asbestos exposure. While the Veteran is competent to give evidence about what he experiences, he is not competent to render an opinion regarding the etiology of his symptoms. As a result, his assertions do not constitute competent medical evidence that he currently has a respiratory disability. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994); 38 C.F.R. § 3.159(a)(2) (2012). As there is no competent medical evidence of a current diagnosis of a lung disability, including asbestosis, or any respiratory disability due to claimed asbestos exposure, additional development is not needed. No asbestos-related disability is shown by the evidence of record. In the absence of proof of a present disability there can be no valid claim. Rabideau v. Derwinski, 2 Vet. App. 141 (1992); Brammer v. Derwinski, 3 Vet. App. 223 (1992). In reaching these conclusions, the Board notes that, under the provisions of 38 U.S.C.A. § 5107(b), the benefit of the doubt is to be given to the claimant in cases where there is an approximate balance of positive and negative evidence in regard to a material issue. The preponderance of the evidence, however, is against the Veteran's claim in this case, and that doctrine is not applicable. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Acquired psychiatric disorder, to include PTSD The Veteran asserts that he developed a psychiatric disability in service. Specifically, he contends that he developed PTSD due to his experiences aboard a Navy vessel because the ship had carriers, which became a source of stress for the Veteran, and he saw someone's arm amputated in service. Claims for service connection for PTSD encompass claims for service connection for all psychiatric disabilities that are reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (under the criteria of DSM-IV); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) (2012). VA considers diagnoses of mental disorders in accordance with the American Psychiatric Association: The DSM-IV criteria for a diagnosis of PTSD include: (A) exposure to a traumatic event; (B) the traumatic event is persistently experienced in one or more ways; (C) persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness is indicated by at least three of seven symptoms; (D) persistent symptoms of increased arousal are reflected by at least two of five symptoms; (E) the duration of the disturbance must be more than one month; and (F) the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994) (DSM-IV). According to the DSM-IV criteria, the traumatic event, or stressor, must involve experiencing, witnessing, or being confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. In addition, the response must involve intense feelings of fear, hopelessness, or horror. If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the circumstances, conditions, or hardships of service, lay testimony alone may establish the occurrence of the claimed stressor. 38 C.F.R. § 3.304(f) (2012). When the evidence does not establish that a Veteran is a combat Veteran, his assertions of service stressors are not sufficient to establish the occurrence of such events. Rather, his reported service stressors must be established by official service record or other credible supporting evidence. 38 C.F.R. § 3.304(f) (2012); Pentecost v. Principi, 16 Vet. App. 124 (2002). If a stressor claimed by a Veteran is related to the Veteran's 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 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. 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. 38 C.F.R. § 3.304(f)(3) (2012). The service treatment records contain no complaint, history or findings consistent with a psychiatric disorder and on separation from service in October 1984 he was psychiatrically evaluated as normal. The Veteran also denied a history of nervous trouble. An acquired psychiatric disorder was not affirmatively shown to be present during service. An acquired psychiatric disorder was not affirmatively shown to be present during service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303 (2012). The service personnel records in April 1984 document a pattern of misconduct, to include nonjudicial punishment for participating in greasing of a petty officer, several instances of unauthorized absences and missing ship's movement. With regards to the Veteran's reports regarding the circumstances of his service, and his claimed inability to cope with stress, the service treatment records failed to show any mental health problems nor do the records corroborate the Veteran's reported stressors. Rather, the service personnel file shows that the Veteran's service was characterized by numerous instances of disciplinary problems. To the extent that the Veteran asserts recurrence of symptomatology, the Board finds that the evidence of ongoing psychiatric symptoms fails not because of the lack of documentation, rather the assertion of recurrence of symptoms is less probative than the negative evidence and recurrence of symptomatology is not established. 38 C.F.R. § 3.303(b) (2012); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). After service, a January 2008 VA clinical treatment note recorded an assessment of depression. He was being treated for anxiety and depression associated with multiple sclerosis. A November 2009 clinical treatment note shows that the Veteran screened positive for PTSD and a history of PTSD was noted. Later that month he was seen for depression due to multiple sclerosis. Reportedly he continued to struggle with the diagnosed multiple sclerosis. He also related nightmares of seeing shipmates attempting suicide by cutting their wrists. The assessment was mood disorder secondary to general medical condition. On neuropsychological consultation in April 2010, the clinician recorded a history of a stroke. Subsequent to the stroke he developed hand numbness. Following neuroimaging he was diagnosed with multiple sclerosis. He was diagnosed with anxiety disorder not otherwise specified and referred for a mental health consultation. In May 2010 he was diagnosed with major depression. In July 2010 he reported intrusive memories of being aboard the ship in service because they had carriers and one time he saw someone's arm amputated. The assessment was adjustment disorder with depressed and anxious mood. In summary, a diagnosis of a psychiatric condition was first recorded in 2008, approximately 24 years after discharge from service, and there is no indication that psychoses, had its onset during or within 1 year of separation from service. 38 U.S.C.A. § 1112 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). As a finder of fact, the Board, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran. Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements). In considering the statements of the Veteran as to recurrence of symptomatology, in light of the evidence discussed, the Board finds that they did not present a credible history because these are inconsistent and contradictory of other evidence of record. Moreover, at the time of separation, the Veteran affirmatively denied psychiatric symptomatology and the examination findings were normal. Therefore, the Board finds that recurrence of symptomatology has not here been established, either through the competent evidence or through the Veteran's statements, because his statements are not considered credible. To the extent that the Veteran claims that he has a psychiatric disability related to service, where the determinative issue involves a question of a medical diagnosis, not capable of lay observation, competent medical evidence is required to substantiate the claim. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer a medical diagnosis or medical opinion. 38 C.F.R. § 3.159 (2012). As a lay person, the Veteran is not qualified or competent, through education, training, or experience to offer a medical diagnosis of a psychiatric disorder. Although the Veteran is competent to describe symptoms of anxiety and sadness, the diagnosis of a psychiatric condition and the medical causation are not subject to lay observation. Additionally, by regulation, the diagnosis of PTSD requires medical evidence diagnosing the condition in accordance 38 C.F.R. § 4.125, that is, a diagnosis that conforms to the Diagnostic and Statistical Manual of Mental Disorders (DSM- IV). 38 C.F.R. § 3.304(f) (2012). For that reason, a psychiatric disorder is not a simple medical condition that a lay person is competent to identify, and the statements of the Veteran that he has a psychiatric disorder related to service are not competent evidence. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To the extent that the post-service treatment records noted a positive PTSD screening or a history of PTSD, the clinicians who noted PTSD did not identify a service stressor and no VA psychologist or psychiatrist has diagnosed PTSD based on a fear of hostile military or terrorist activity and the Veteran did not serve in combat. In sum, the Board finds that the there is no evidence of record to support a finding that the Veteran meets the criteria for a DSM-IV diagnosis of PTSD. As the competent medical evidence does not show that it is at least as likely as not that the Veteran currently suffers from PTSD that meets the criteria for a DSM-IV diagnosis of PTSD, service connection for PTSD must be denied. Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). With regard to service connection for a psychiatric disorder, other than PTSD, post-service medical records document psychiatric treatment and diagnoses, to include adjustment disorder and depressive disorder. Those disabilities were diagnosed after the Veteran's separation from service. The determinative question in this case involves causation. On the question of medical causation, medical evidence of an association or link between a current psychiatric disorder, first noted after service, and service, there is no competent medical evidence that supports the claim. 38 C.F.R. § 3.303(d) (2012). None of the Veteran's medical providers have related a psychiatric disorder, other than PTSD, to his reported stressors or to any other aspect of his military service. The Veteran's symptoms of mental health disorders have been associated with situational stressors, to include the Veteran's own medical problems. Significantly, on VA mental health disorders examination in July 2011, the Veteran reported being stressed out during service because his vessel had carriers and once he saw someone's arm amputated. Following an examination of the Veteran the examiner diagnosed anxiety disorder not otherwise specified. The examiner opined, based on a review of the medical evidence and history provided by the Veteran, that his current psychiatric disorder was not related to service. Rather his mental disorder was associated with and followed by the diagnosis of multiple sclerosis. Therefore, the evidence lacks evidence to link any mental disorder other than PTSD to the Veteran's service. To the extent that the Veteran's psychiatric disorder has been attributed to multiple sclerosis, as service connection has not been established for multiple sclerosis, there is no legal basis for entitlement to service connection for a psychiatric disorder as secondary to multiple sclerosis under 38 C.F.R. § 3.310(a). The Board may consider only competent, medical evidence to support its findings as to questions involving a medical diagnosis that is not capable of lay observation. The Board may only consider competent medical evidence of medical causation because lay assertion on medical causation is not competent evidence. In the absence of competent medical evidence of a diagnosis of PTSD that meets the DSM-IV requirements and is due to a stressor in service or due to fear of a hostile military or terrorist act, and as the weight of the competent medical evidence is against a finding that any psychiatric disorder, other than PTSD, is causally related to service, the Board finds that the preponderance of the evidence is against the claim that a psychiatric disorder was incurred in service, and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for multiple sclerosis is denied. Service connection for a right hip/thigh disorder is denied. Service connection for a right knee disorder is denied. Service connection for a low back disorder is denied. Service connection for bilateral upper extremity neuropathy is denied. Service connection for bilateral lower extremity neuropathy is denied. Service connection for the residuals of a stroke is denied. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, is denied. ____________________________________________ STEVEN D. REISS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs