Citation Nr: 1322996 Decision Date: 07/18/13 Archive Date: 07/24/13 DOCKET NO. 09-20 578 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUES Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) and delusional disorder. REPRESENTATION Appellant represented by: Oregon Department of Veterans' Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Elizabeth Jalley, Counsel INTRODUCTION The Veteran served on active duty from March 1972 to March 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. The June 2007 rating decision declined to reopen the Veteran's previously-denied claim of entitlement to service connection for PTSD. In June 2011, the Veteran testified before the undersigned Veterans Law Judge during a Travel Board hearing. A transcript of this proceeding has been prepared and associated with the appellant's VA claims file. A September 2011 Board decision reopened the Veteran's claim and remanded the issue of entitlement to service connection for PTSD for further development. In September 2012, the Board remanded this case in order to schedule the Veteran's for a VA examination to determine the nature and etiology of an acquired psychiatric disability. The requested development was completed, and the case has been returned to the Board for further appellate review. The Board has broadened the issue of entitlement to service connection for PTSD to encompass entitlement to service connection for an acquired psychiatric disability, to include PTSD and delusional disorder, pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has an acquired psychiatric disability, to include PTSD and delusional disorder, that had its onset in service or that is otherwise associated with service. 2. Personality disorder is not a disability for which service connection may be awarded. CONCLUSION OF LAW The Veteran does not have a current psychiatric disability, to include PTSD and delusional disorder, that was incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 4.9, 4.127 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Veterans Claims Assistance Act The Veterans Claims Assistance Act of 2000 (VCAA), Public Law No. 106-475, 114 Stat. 2096 (2000), substantially amended the provisions of chapter 51 of title 38 of the United States Code, concerning the notice and assistance to be afforded to claimants in substantiating their claims. VCAA § 3(a), 114 Stat. 2096, 2096-97 (2000) (now codified as amended at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2012)). In addition, VA published regulations, which were created for the purpose of implementing many of the provisions of VCAA. See 66 Fed. Reg. 45,620 (Aug. 29, 2001) (now codified, in pertinent part, at 38 C.F.R. § 3.159 (2012)). The notice requirements of the VCAA require VA to notify the veteran of any evidence that is necessary to substantiate a claim, as well as the evidence VA will attempt to obtain and which evidence the veteran is responsible for providing. Quartuccio v. Principi, 16 Vet. App. 183 (2002). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Such notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction. Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). The VCAA notice requirements, however, may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. See Dingess, supra; Pelegrini, supra. The Board finds that the notification requirements of VCAA have been satisfied in this case. In this regard, the Board notes a January 2006 evidentiary development letter in which the RO advised the appellant of the evidence needed to substantiate his service connection claim. This letter advised the Veteran of his and VA's responsibilities under VCAA, to include what evidence should be provided by him and what evidence should be provided by VA. Letters dated in March 2006 and September 2011 notified the Veteran of the information that was needed in order to verify the Veteran's claimed stressors and provided a form for him to fill out with the requested details. A July 2012 supplemental statement of the case further advised the Veteran as to the type of evidence needed to substantiate both the disability rating and effective date elements of his claim, pursuant to the Court's holding in Dingess, supra. The Board notes that the September 2011 and July 2012 notices were not issued prior to the initial adjudication of the Veteran's claim in September 2006. The Veteran's claim, however, was readjudicated following the issuance of these notices, most recently in a January 2013 supplemental statement of the case. Thus, any deficiencies in the timeliness of these notices would not be prejudicial. The Board further finds that the duty to assist requirements of VCAA have also been satisfied in this case. 38 U.S.C.A. §§ 5103 and 5103A. Specifically, the Board finds that all obtainable evidence identified by the Veteran relative to the issue on appeal has been obtained and associated with the claims folder. In particular, the Board notes that the RO obtained the Veteran's service treatment records, service personnel records, and VA medical records. As noted in the September 2011 remand, the Veteran has described six specific stressors that in connection with his PTSD claim: (1) the suicide of an unnamed recruit chief petty officer during the period March 1972 to June 1972; (2) being attacked by eight men with knives in August 1972; (3) taking photographs of part of a Tomcat F-14 that crashed near his base in June 1973; (4) going aboard and taking photographs of a sinking target ship that had been hit by training missiles in November 1973; (5) experiencing an earthquake centered on Pt. Mugu in February 1973; and (6) witnessing the death of a man while in the brig. VA has only been able to verify Stressor (5), the earthquake centered on Point Mugu. A September 2006 memorandum entitled "Formal Finding of Inability to Document the Claimed Stressor(s)" states that "the information required to corroborate the stressful events described by the veteran is insufficient to send to the U.S. Army and Joint Services Records Research Center (JSRRC) and/or insufficient to allow for a meaningful research of Marine Corps or National Archives and Records Administration (NARA) records." The memorandum states that the procedures of the JSRRC and VA's Adjudication Manual, M21-1MR (Manual Rewrite), were followed in attempting to obtain information from the Veteran in order to corroborate his reported stressors. It was determined, however, that "the veteran's claimed stressors are not events that would be verifiable by the JSRRC since the events would not have been capable of being documented. This memorandum lists "[e]xamples of claimed stressors that are extremely difficult, if not impossible, to verify." Such examples include (1) "[e]vents that 'almost happened,'" (2) "[e]vents involving civilians," (3) "[e]vents that [a] veteran claims to have seen," such as "a veteran saw dead bodies or that a veteran saw an aircraft crash," (4) "[m]istreatment of enemy prisoners," (5) "[e]vents involving the death of other government soldiers," (6) "[s]niper attacks," (7) "[e]vents occurring while traveling/driving in a convoy," and (8) "[d]uty as a door gunner." Given that the steps described by the September 2006 memorandum have been unable to uncover information that is sufficient to attempt stressor verification, the Board finds that the duty to assist has been fulfilled with respect to the RO/AMC's attempts to verify the Veteran's reported stressors and that no further verification measures are necessary in order to proceed with a decision on this claim. The Veteran also underwent VA examination in connection with his claim in October 2012. The Board finds that the resulting VA medical opinion is adequate for the purpose of determining the claim decided herein. The examination report reflects review of the claims file. During the examination, the examiner elicited from the Veteran his history of complaints and symptoms and provided clinical findings detailing the examination results. The examiner also provided a diagnosis and etiology opinion and explained the reasons and bases for this opinion. For these reasons, the Board concludes that the October 2012 VA examination report in this case provides an adequate basis for a decision on the Veteran's claim. The Veteran was also provided an opportunity to set forth his contentions during the June 2011 Board hearing. In Bryant v. Shinseki, the U.S. Court of Appeals for Veterans Claims held that 38 C.F.R. § 3.103(c)(2) requires that the "hearing officer" who chairs a hearing fulfill two duties: (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. 23 Vet. App. 488 (2010). In regard to the first duty, during the hearing, the Veterans Law Judge enumerated the issue on appeal. In regard to the second duty, the Veterans Law Judge clearly suggested the types of evidence that would be helpful for substantiating the Veteran's claim, specifically suggesting that the Veteran submit any evidence that corroborates his reported stressors. The obligations under 38 C.F.R. 3.103(c)(2) were thus met and, even if not met, there is no prejudice to the Veteran as VA has made attempts to assist the Veteran in getting the type of evidence necessary to support his claim. The evidence of record provides sufficient information to adequately evaluate the claim. Therefore, no further assistance to the Veteran with the development of evidence is required, nor is there notice delay or deficiency resulting in any prejudice to the Veteran. 38 U.S.C.A. § 5103A(a)(2); 38 C.F.R. § 3.159(d); see Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). II. Service Connection The Veteran has claimed entitlement to an acquired psychiatric disability, claimed as PTSD, that he contends was developed as a result of traumatic events that he experienced in service. In terms of specific disability, the record also contains a current diagnosis of delusional disorder that is also for consideration in this case. In general, applicable laws and regulations state that service connection may be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That a condition or injury occurred in service alone is not enough; there must be disability resulting from that condition or injury. See Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Brammer v. Derwinski, 3 Vet. App. 223 (1992). 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). Service connection may also be granted for chronic disabilities, such as psychoses, if such are shown to have been manifested to a compensable degree within one year after the Veteran was separated from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. As an alternative to the nexus requirement, service connection for these chronic disabilities may be established through a showing of continuity of symptomatology since service. 38 C.F.R. § 3.303(b)(2012). The option of establishing service connection through a demonstration of continuity of symptomatology rather than through a finding of nexus is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (rejecting the argument that continuity of symptomatology in § 3.303(b) has any role other than to afford an alternative route to service connection for specific chronic diseases). Personality disorders are considered congenital or developmental defects and, therefore, are not diseases or injuries for the purposes of service connection. 38 C.F.R. § 3.303(c), 4.9 (2012); see also Winn v. Brown, 8 Vet. App. 510, 516 (1996). However, if a disease or injury is superimposed over the congenital or developmental defect during service, service connection may be warranted for the resultant disability. VAOPGCPREC 82-90 (July 18, 1990). To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service" - the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The establishment of service connection for PTSD in particular requires: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f) (2012); see also Cohen v. Brown, 10 Vet. App. 128 (1997). The provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform to the DSM-IV. The DSM-IV criteria are as follows: A. The person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed, or ways 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; and (2) the person's response involved intense fear, helplessness, or horror. B. The traumatic event is persistently experienced in one (or more) of the following ways: (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; (2) recurrent distressing dreams of the event; (3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociate flashback episodes, including those that occur on awakening or when intoxicated); (4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; or (5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: (1) efforts to avoid thoughts, feelings, or conversations associated with the trauma; (2) efforts to avoid activities, places, or people that arouse recollections of the trauma; (3) inability to recall an important aspect of the trauma; (4) markedly diminished interest or participation in significant activities; (5) feeling of detachment or estrangement from others; (6) restricted range of affect (e.g., unable to have loving feelings); or (7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: (1) difficulty falling or staying asleep; (2) irritability or outbursts of anger; (3) difficulty concentrating; (4) hypervigilance; or (5) exaggerated startle response E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. DSM-IV, DC 309.81. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, or if a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 C.F.R. § 3.304(f)(2),(3) (2012); see also, 38 U.S.C.A. § 1154(b) (West 2002 & Supp. 2012). In the case at hand, the record, including the Veteran's service personnel records, does not reflect that the Veteran engaged in combat with the enemy, and none of the Veteran's reported stressors is related to "fear of hostile military or terrorist activity." Therefore, none of the Veteran's reported stressors could be presumed to have occurred in this case, and verification was thus required. As noted above, while the Veteran has described six in-service stressors, only one of these stressors, the experiencing of an earthquake centered on Point Mugu in February 1973, has been conceded. Several written statements and the October 2012 VA examination report contain detailed descriptions of this stressor. Specifically, the Veteran reported having been awoken by the earthquake, which he said measured 5.3 on the Richter scale. According to the VA examination report, the Veteran reported that the building shook violently and that the tremors lasted approximately one minute. He reported experiencing fear and "had a sense that he may have caused the earthquake because, the night before, he had 'just tossed' a sacred scroll on the ground and that it is this aspect of the earthquake, i.e. the possibility that his action may have brought about the earthquake, that continues to bother him." In its September 2012 remand, the Board determined that, even though the Veteran's service personnel records reflect that he was on leave the day of the earthquake, his credible, competent lay description of having been in the earthquake was consistent with media accounts of an earthquake that hit Point Mugu in February 1973 and thus corroborated his having actually been in the earthquake. Aside from this verified stressor, the Veteran's service treatment records reflect that he was found to be clinically normal psychiatrically when examined at the time of his enlistment into the Navy in March 1972. He denied any history of, or current, frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort on his March 1972 enlistment medical history report. He was examined and found to be clinically normal psychiatrically at the time of his March 1974 discharge examination. The Veteran's service treatment records include a December 1973 psychiatric evaluation that lists a diagnostic impression of immature personality disorder. This record notes that the Veteran had a multitude of social and military offenses, including two previous court martials for various offenses. The Veteran reported that his nerves were "shot." It noted that the Veteran could not adjust to the rules and regulations. He was also divorced and was concerned with his ex-wife and getting back together. On examination, the Veteran was alert and oriented, "not psychotic nor organic." The Veteran was described as a "very impulsive & immature acting out manipulative young man." His judgment was poor and he was very confused. The Veteran was determined to be unsuitable for service and it was recommended that he be processed out of service as soon as possible. He was noted to be responsible for his actions and totally unsuitable. The record also contains the Veteran's complete service personnel records, which reflect multiple periods of unauthorized absence. A performance evaluation for the period from March 1, 1973, to September 1, 1973, further describes the nature of the Veteran's difficulties in the military. This record notes that, while the Veteran "has the ability to be a very effective still photographer," he "became very lethargic during the latter portion of this marking period, the quality of his work deteriorated and his shipmates resented having to carry his share of the workload." It was noted that the Veteran's "dislike of the military is reflected in his behavior and appearance. He often willfully neglected to attend mandatory muster, and refused to keep his hair trimmed to Navy Standards." An April 1994 VA examination report notes a diagnosis of alcohol dependency by history in remission for ten months, longstanding history of polysubstance abuse, especially psychedelics. It was noted that the Veteran had been clean and sober since May 12, 1993. The examiner also diagnosed mixed personality disorder with passive-aggressive, dependent, narcissistic, and antisocial tendencies. The examiner noted that the Veteran was very mellow and demonstrated no anger or difficulty in relating. The examiner noted that the Veteran "basically demonstrates no characteristics of posttraumatic stress disorder." It was also noted that the Veteran "has no intrusive thoughts," "does not have flashbacks," and "has never undergone a major catastrophic event." An April 1994 social and industrial survey by a VA social worker notes that there was no evidence of PTSD. VA substance abuse treatment records dated in the 1990s and 2000 do not diagnose PTSD. The earliest formal PTSD diagnosis of record appears in a January 2006 VA medical record, in which the therapist opined that the Veteran "suffers from severe PTSD." The therapist noted that the Veteran controlled his PTSD symptoms though alcohol and through his work helping the homeless, both of which he had quit. He also described how his second marriage ended "due to his emotional and physical distance," which he stated "was his way to make up for what he had done and seen in VN [Vietnam] without actually dealing with and resolving the underlying issues." At this appointment, the Veteran described in great detail a stressor that particularly bothered him. This stressor consisted of "an ambush that his team walked into. He was the only survivor because he was the person that was selected to stay behind and guard the escape." He reported that "it is not a made up incident but one that he does not want to deal with due to the underlying beliefs that he has created for himself." The Veteran "describes [himself] as a coward and has extreme guilt for leaving his team members behind, not knowing if they were dead or alive." The Veteran reported that he became disillusioned with what was happening in Vietnam and "began causing problems for the individuals that were higher in rank and demanding answers including [involving] members of congress and other influential people." He reported that this is what ended his military career. He also described "other incidents that involve the risk of death that as a young Navy Seal he accepted as just part of the job." (The Board notes, however, that service personnel records reflect that the Veteran was removed from the Navy SEAL training program in April 1972 "by reason of lack of motivation.") One of these was the unverified stressor of his having to go aboard and take photographs of a sinking target ship that had been hit by training missiles in November 1973. He reported that "[h]e was asked to enter a sinking ship and find the reason for the damage knowing that the ship could sink at any moment but was under orders to take pictures of the damage before leaving." In diagnosing severe PTSD, the therapist came up with a plan for the Veteran to have individual counseling sessions to assist the Veteran in "sorting out what is fact and fiction." A November 2006 statement from the Veteran's ex-wife describes the Veteran's transformation after he enlisted in the Navy. She stated that "[h]e went from being a responsible person/father to being aloof, and non responsible. -non-conforming." She noted that "his personality/character changed such after joining the Navy," that he seemed to lose his "dreams of becoming 'Something/Someone,' and that "[i]t did not take long for him to [seem] defeated." Records also reflect that the Veteran has participated in PTSD and substance abuse group therapy sessions. Records from these sessions contain general observations regarding the Veteran's behavior and participation levels at the meetings. Some of the therapy sessions note a diagnosis of PTSD, but they do not offer specific information concerning the basis of any PTSD diagnosis. In October 2012, the Veteran underwent a VA examination with the purpose of determining whether the Veteran suffers from a current acquired psychiatric disability that is related to his military service, to include as a result of the earthquake. The resulting examination report reflects review of the claims folder and interview and examination of the Veteran. The examiner stated that: While the Veteran may or may not be suffering from PTSD, and has been diagnosed with and treated for PTSD by other mental health providers, it is this examiner's opinion that the earthquake the veteran experienced at Pt. [Mugu] Naval Air Station did not cause the Veteran to develop PTSD. When asked, in the current exam, what events from his past continue to bother him, he did not mention the earthquake at all. When asked about the earthquake, he denied reexperiencing symptoms per se, but did note he doesn't like to think about it because it makes him wonder if he may have caused the earthquake through his action of tossing a sacred scroll on the ground. The examiner found the Veteran to be a poor historian and opined that the Veteran was most likely suffering from delusional disorder, another psychotic disorder, or a personality disorder. She reported that the Veteran seemed to have trouble distinguishing truth from fiction, noting, for example, a December 2005 substance abuse/PTSD group treatment record in which the Veteran reported that "'[m]y whole world view shifted significantly when I went to Vietnam. I didn't like what I saw there and I couldn't seem to figure out the best way of letting the people I worked with know about it without serious repercussions.' Records do not show, however, that the veteran was ever in Vietnam." The examiner also noted that "[i]n the current exam the veteran was quite tangential, attempted to give significant but vague detail about numerous 'traumatic incidents' that were suggestive of conspiracy, and in the end, noted that 'thinking about ANY of it', i.e. his military experiences, was stressful because he 'can't figure it out.'" The examiner stated that she "would be required to resort to mere [speculation] in order to diagnose PTSD due to any other event in his history, given that the veteran's account of his past cannot be considered reliable and no other events have been substantiated." With respect to the earthquake stressor, the examiner determined that a diagnosis of PTSD could not be made, as the Veteran did not meet Criterion B. The examiner specifically found that the Veteran did not persistently reexperience the earthquake stressor in any manner that is listed in Criterion B. Again, she found that she could not provide a PTSD diagnosis at that time, even though the Veteran had been diagnosed with and treated for PTSD in the past. She diagnosed delusional disorder and opined that this diagnosis best describes the Veteran's current psychological state and symptomatology. She further stated the following: To clearly answer the VARO's current question, if the veteran DOES, indeed, have PTSD it is not due to the earthquake he experienced while in the service, and this examiner has no evidence to suggest that any other mental disorder that the veteran suffers from was incurred in or related to the veteran's period of active duty. The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, his knowledge and skill in analyzing the data, and his medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The Board notes the January 2006 opinion was written by an addictions therapist, and the October 2012 VA examination report was authored by a Doctor of Psychology, both of whom are highly qualified through education, training, or experience to provide competent medical evidence for the question at hand under 38 C.F.R. § 3.159(a)(1). However, the Board finds that the October 2012 opinion is more probative than the January 2006 opinion, in part because the addictions therapist's PTSD diagnosis is based in large part upon the Veteran's vivid description of a Vietnam combat experience and the profound effect that he reported this service had on the rest of his military career. The evidence, including the Veteran's own service personnel records, conclusively demonstrates, however, that the Veteran never served in a combat zone, either in Vietnam or elsewhere. The Board therefore finds the Veteran's statements concerning his reported Vietnam service, including how this service subsequently impacted his views toward the military and the course of his career, are not credible and thus cannot be used to substantiate his claim. The Board acknowledges that the PTSD diagnosis does not appear to have been based completely on the Veteran's reported Vietnam service. However, the therapist does not suggest that, if verified, the Veteran's reports of having taken photographs aboard a sinking ship would have been sufficient to establish a PTSD diagnosis independently from his noncredible report of Vietnam service. In the instant case, the examiner has not provided a diagnosis of PTSD based on a verified service stressor. As such, his assessment is of no probative value in determining whether service connection for PTSD is warranted. On the other hand, the October 2012 VA examination report clearly considers only the Veteran's verified stressor for the purpose of making a PTSD diagnosis. It clearly reflects that the reason PTSD could not be diagnosed based on the verified stressor is because the Veteran did not endorse any of the reexperiencing criteria of the applicable Criterion B under the DSM-IV in relation to the earthquake stressor. The examiner also expressly stated that, given the Veteran's unreliability, she could not diagnose PTSD based on any other reported stressor without resorting to speculation. The Court has held that, when a medical examiner concludes that he or she is unable to provide a nexus opinion, this alone does not make the medical opinion inadequate; a medical opinion with such language may be adequate if the examiner sufficiently explains the reasons for this inability. Jones v. Shinseki, 23 Vet. App. 382 (2010). Here, as highlighted above, the examiner has explained specifically why she is not able to offer an opinion as to whether PTSD may be diagnosed based on any unverified stressor. Specifically, she noted that the Veteran is a poor historian, making his assertions regarding his history noncredible. The Board thus finds that the VA examiner's opinion and rationale are adequate for the purpose of determining entitlement to service connection for PTSD in this case. Additionally, although the group therapy reports show a diagnosis of PTSD, this diagnosis lacks probative value in that there is no indication that such diagnosis was based on a verified service stressor. This is the case especially in light of the 2012 VA opinion. Moreover, the evidence does not support a grant of service connection for delusional disorder. The Veteran's service treatment records do not reflect that the Veteran complained of, or was treated for, delusional disorder during service or for many years thereafter. Furthermore, of the medical nexus opinions of record, only the October 2012 VA examination report addresses the etiology of the diagnosed delusional disorder, and this opinion weighs against the Veteran's claim. There is no medical evidence suggesting that the Veteran experienced symptoms of a psychosis in service or within one year of separation therefrom. Nor has the Veteran himself provided lay testimony suggesting the presence of a psychosis in service or within one year of separation. Thus, service connection for delusional disorder may not be granted based on continuity of symptomatology. With respect to nexus in general, the only remaining contrary opinion of record comes from the Veteran himself, who believes there is a link between a current psychiatric disorder and his military service. The Board recognizes that there are instances in which lay testimony can provide probative evidence in medical matters. A layperson may be competent to offer testimony on certain medical matters, such as describing symptoms observable to the naked eye, or even diagnosing simple conditions such as a dislocated shoulder. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). However, as a layperson, the Veteran is not competent to render a specific psychiatric diagnosis, such as PTSD or delusional disorder, especially as opposed to a personality disorder, or to assert a causal link between any current PTSD or delusional disorder and service. Therefore, entitlement to service connection for an acquired psychiatric disability, to include PTSD and delusional disorder, must be denied. Finally, the only potential evidence of a psychiatric disorder in service appears in a record that diagnoses immature personality disorder. However, service connection for a personality disorder is precluded by law and is thus not warranted. Sabonis v. Brown, 6 Vet. App. 426, 429-30 (1994). In summary, the Board finds that a preponderance of the evidence is against finding that the Veteran has a current PTSD diagnosis that is related to his military service, to include as due to any verified stressor, or that the Veteran has delusional disorder that has exhibited a continuity of symptomatology since service or within one year of separation therefrom or is otherwise related to military service. To the extent that the Veteran argues service connection for a personality disorder, the Board notes that this is not a disability for VA purposes. See 38 C.F.R. § 3.303(c). The Board has considered the doctrine of reasonable doubt. However, as the preponderance of the evidence is against this claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, entitlement to service connection for an acquired psychiatric disability, to include PTSD and delusional disorder, is not warranted. ORDER Entitlement to service connection for an acquired psychiatric disability, to include PTSD and delusional disorder, is denied. ____________________________________________ K. OSBORNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs