Citation Nr: 1323155 Decision Date: 07/19/13 Archive Date: 07/24/13 DOCKET NO. 96-45 551A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Veteran represented by: Sean A. Ravin, Attorney WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD C. Ferguson, Counsel INTRODUCTION The Veteran had active service from February 1972 to February 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 1996 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The Board has reviewed the Veteran's physical claims file, as well as the electronic file on the "Virtual VA" system, to ensure a complete review of the evidence in this case. In December 1996, the Veteran presented testimony relevant to the appeal before a hearing officer at a personal hearing held at the RO. A transcript of the hearing is of record. In August 2002, the Board denied service connection for PTSD. The Veteran appealed the decision to the U.S. Court of Appeals for Veterans Claims (Court). In December 2003, the VA's General Counsel and the Veteran's attorney filed a Joint Motion for Remand (Joint Motion) asking the Court to vacate the Board's decision and remand the matter for further appellate review. That same month, the Court issued an order granting the Joint Motion, vacated the August 2002 Board decision, and remanded the case to the Board. The case was remanded by the Board in June 2004, December 2006, December 2008, November 2009, and November 2011 for further notice and evidentiary development and is now ready for disposition. In June 2004, the Board remanded the case and directed the RO to provide the Veteran with appropriate notice of the evidence needed to substantiate a PTSD claim based on personal assault; to ask the Veteran to identify all VA and non-VA health care providers who treated him at any time following service for PTSD and obtain the records; make a determination as to whether there is any credible supporting evidence showing that the Veteran was assaulted by a fellow serviceman or servicemen during active service; arrange for the Veteran to be examined by a psychiatrist and obtain a medical opinion regarding the likelihood that the Veteran's psychiatric disability was incurred in service, manifested within a year of service, or was otherwise related to service; and readjudication of the claim. In June 2004, a notice letter was sent to the Veteran that advised him of the types of information and evidence that he may submit in order to support his claim for PTSD based on personal assault, and asked him to complete and sign a VA Form 21-4142 (Authorization and Consent to Release Information to the VA) for each VA and non-VA medical care facility and the approximate dates of such care. The Veteran did not respond to the letter. A VA mental disorders examination was performed in September 2004, and the September 2004 VA examiner rendered a medical opinion. In the September 2005 SSOC, which readjudicated the claim, the RO noted that an extensive review by the U.S. Armed Service Center for Research of Unit Records (USACRUR, now known as the U.S. Army and Joint Services Records Research Center) failed to provide any corroborating evidence of the Veteran's in-service stressors. In December 2006, the Board remanded the claim based on receipt of evidence from the Veteran's attorney describing the service personnel on board the U.S.S. Prairie, the Veteran's ship, giving aid to Vietnamese and Cambodian refugees. The Board directed the RO to consider the submission and make a specific determination on whether the Veteran was exposed to one or more stressor events in service and, if so, specify the stressors in service that have been established. The Veteran was to undergo further examination if the RO determined that one or more of the stressors had been verified, and the RO was to subsequently readjudicate the claim. Pursuant to the Board's Remand directive, in October 2007, the RO asked the Veteran to provide additional information regarding the veterans he wanted VA to locate to support the claim, supporting statements from any individuals with whom he may have discussed the incident, and additional information regarding the incident of assisting refugees. The Veteran did not respond to the letter. In January 2008, the RO sent another letter asking him to send the information requested in the October 2007 letter; however, the Veteran did not respond. The March 2008 letter from the Veteran's attorney only included further argument in support of the appeal. The RO issued the August 2008 SSOC that continued to deny the claim, explaining that the Veteran did not provide additional information needed to verify the claimed stressor events and the evidence of record showed an absence of credible supporting evidence that the claimed stressors occurred. In consideration thereof, the Board finds that there was substantial compliance with the December 2006 Board remand. In November 2009, the Board remanded the claim and directed the RO provide the Veteran with a new notice letter that advised the Veteran of the evidence needed to substantiate a claim for service connection for a psychiatric disorder, to include PTSD, in accordance with Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board directed the RO to ask the Veteran to provide information or evidence regarding any post-service mental health or social services treatment for which records had not already been obtained and obtain the records. Thereafter, the RO was to prepare a statement of the verified or corroborated stressor if any of the alleged stressors were verified, arrange for a VA psychiatric examination and medical opinion, and subsequently readjudicate the claim. The RO sent the January 2010 notice letter advising the Veteran of the evidence needed to substantiate a claim for service connection of a psychiatric disorder, to include PTSD, and the Veteran did not respond to the letter. The claim was readjudicated in March 2010. As explained in the November 2011 Board Remand, the RO did not afford the Veteran a VA examination as directed by the Board but rather only obtained a medical opinion based on review of the claims file. For that reason, the Board again remanded the claim. See November 2011 Board Remand. The Board also ordered that the Veteran be provided with updated VCAA notice, and the claim be readjudicated after the completion of the ordered development. Pursuant to the November 2011 Board Remand, the Veteran underwent further medical examination in June 2012 and a medical opinion was obtained. As explained below, the June 2012 VA medical examination report and August 2012 addendum report contain all relevant findings and a thoroughly explained medical opinion. The Veteran was provided with further notice in May 2012, and the claim was readjudicated in August 2012. In consideration of the foregoing, the Board finds that there has been compliance with the November 2011 remand directives. In consideration of the foregoing and for reasons explained above, the Board finds that there was substantial compliance the directives of the prior Board remands. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008). FINDINGS OF FACT 1. The Veteran did not engage in combat with the enemy during service. 2. The Veteran does not currently suffer from PTSD. 3. The Veteran's currently diagnosed Major Depressive Disorder (MDD) and Anxiety Disorder Not Otherwise Specified (NOS) did not manifest during service and are not causally or etiologically related to active service. 4. Symptoms of a psychosis did not manifest during service or in the first post-service year, and there have not been continuous symptoms of a psychosis since service. 5. Service connection for alcohol dependence on a direct basis is precluded by law. CONCLUSION OF LAW An acquired psychiatric disorder, to include PTSD, was not incurred in active military service and may not be presumed to have been incurred therein. 38 U.S.C.A. § 1110, 1112, 1113, 1116, 1131, 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.301, 3.303, 3.304(f), 3.307, 3.309 (2012). (CONTINUED ON NEXT PAGE) REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating their claims for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and the representative of any information, and any 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). Proper notice from 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. 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). The United States Court of Appeals for Veterans Claims (Court) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service-connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. If complete notice is not provided until after the initial adjudication, such a timing error can be cured by subsequent legally adequate VCAA notice, followed by readjudication of the claim, as in a statement of the case (SOC) or supplemental SOC (SSOC). Moreover, where there is an uncured timing defect in the notice, subsequent action by the RO which provides the claimant a meaningful opportunity to participate in the processing of the claim can prevent any such defect from being prejudicial. Mayfield v. Nicholson, 499 F.3d 1317, 1323-24 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). Collectively, in notice letters dated in June 2004, October 2007, January 2010, and May 2012, the RO apprised the Veteran of the information and evidence necessary to substantiate the claim, which information and evidence that he was to provide, and which information and evidence that VA would attempt to obtain on his behalf. The RO advised him of what the evidence must show to establish entitlement to service-connected compensation benefits, and described the types of information and evidence that the Veteran needed to submit to substantiate the claim. The RO also explained what evidence VA would obtain, and that VA would make reasonable efforts to obtain on the Veteran's behalf in support of the claim. The RO further informed the Veteran how VA determines the disability rating and effective date once service connection is established, which satisfied Dingess notice requirements. The claim was subsequently readjudicated in August 2012, which remedied any timing defect regarding the receipt of proper notice. The Board particularly notes that adequate notice of the evidence necessary to substantiate a claim for PTSD based on personal assault was provided in June 2004 and January 2010 in order to comply with the December 2003 Joint Motion. In view of the foregoing, the Board concludes that the requirements of the notice provisions of the VCAA have been met, and there is no outstanding duty to inform the Veteran that any additional information or evidence is needed. Regarding VA's duty to assist in claims development, the Board notes that the record contains all available evidence pertinent to the appeal. VA has requested records identified throughout the claims process. The Veteran was given appropriate notice of the responsibility to provide VA with any treatment records pertinent to the claim, and the record contains sufficient evidence to make a decision on the claim. The Veteran's complete service treatment records are in the claims file. Pertinent post-service treatment records adequately identified as relevant to the Veteran's claim have been obtained or submitted and are associated with the record. Additional treatment records found in the Veteran's Virtual VA file were considered by the Appeals Management Center (AMC) in the first instance. The Veteran's records from SSA are included in the record. The Veteran has also submitted letters from private mental health providers. The Veteran underwent VA medical examinations in September 2004 and June 2012 in connection with the appeal. The August 2012 addendum report was obtained from the June 2012 VA examiner. As explained below, the psychiatric diagnosis and medical opinion rendered by the September 2004 VA examiner are inadequate because the examiner admittedly had difficulty assessing the Veteran's psychiatric condition fully due to his being medicated and did not provide adequate rationale for the medical diagnosis and opinion; however, the Veteran underwent further medical examination in June 2012 and the June 2012 psychiatric diagnosis and medical opinion were adequate. The June 2012 VA examiner considered the Veteran's pertinent psychiatric history and current symptomatology, diagnoses, and treatment, as well as the claimed in-service stressor events as documented in the claims file and reported by the Veteran at the examination. The June 2012 VA examiner provided a thorough rationale for the medical opinion that the Veteran did not currently suffer from PTSD and currently suffered from MDD and anxiety disorder NOS, which had a less than 50 percent probability of having their onset during or otherwise being causally related to service. In an August 2012 addendum, the June 2012 VA examiner clarified what appeared to be conflicting information in the June 2012 examination report and definitively stated that the Veteran did not have PTSD and, instead, was diagnosed with anxiety disorder NOS. The June 2012 VA examiner had adequate information on which to base the psychiatric diagnoses and medical opinions. For these reasons, the June 2012 VA examination report and August 2012 addendum report are deemed adequate. See VAOPGCPREC 20-95 (interpreting that in some cases an accurate history by a veteran may be a valid basis for an examination report rather than claims file review); see also Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran). Neither the Veteran nor the representative has made the RO or the Board aware of any other evidence relevant to the appeal that needs to be obtained. Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to the appeal. In view of the foregoing, the Board will proceed with appellate review. Service Connection Legal Criteria It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C.A. § 7104(a). The Board has thoroughly reviewed all the evidence of record in this case. The analysis below focuses on the most 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 veteran). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The Veteran is currently diagnosed with MDD and anxiety disorder NOS, as explained below. Neither diagnosis is listed as a "chronic disease" under 38 C.F.R. § 3.309(a); however, the Veteran currently takes anti-psychotic medication to treat the currently diagnosed psychiatric disabilities and has a history of psychosis; therefore, the provisions under 38 C.F.R. § 3.303(b) for service connection based on "chronicity and continuity" are applicable based on evidence of psychosis in the record. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection for the Veteran's alcohol dependence is precluded by law. See 38 U.S.C.A. § 105(a); 38 C.F.R. § 3.301. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b) (2012). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). In addition, the law provides that, where a veteran served ninety days or more of active service, and certain chronic diseases, such as migraine headaches as an organic disease of the nervous system, become manifest to a degree of 10 percent or more within one year 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. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309(a) (2012). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). 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. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert, 1 Vet. App. at 57. Service Connection for PTSD Analysis In this case, the Veteran contends that he currently suffers from PTSD due to several traumatic events that allegedly occurred during his naval service, to include the following: 1) being assaulted and threatened by fellow service members when the Veteran informed them that they had to leave the bus due to overcrowding while driving to Kadina Air Force base; 2) being run down by a Philippine man after the Veteran would not give him money; 3) being on alert to go to Vietnam and being unable to eat or sleep for days; 4) seeing dead bodies while working with Vietnamese refugees and being afraid after receiving warning that Vietcong were among the refugees; 5) being ordered to stay aboard the U.S.S. Prairie when the ship was sabotaged and began sinking; and 6) witnessing other ships wrecked during a typhoon. During the course of this appeal, VA amended 38 C.F.R. § 3.304(f), the regulatory provision pertaining to service connection for PTSD. Prior to the amendment, the record had to show the following in order for a veteran to be awarded service connection for PTSD: (1) a current medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); (2) combat status or credible supporting evidence that the claimed in- service stressor actually occurred; and (3) medical evidence of a causal nexus between diagnosed PTSD and the claimed in- service stressor. 38 C.F.R. § 3.304(f) (in effect prior to July 13, 2010). With regard to the second criterion, evidence of an in-service stressor event, the evidence necessary to establish that the claimed stressor actually occurred varies depending on whether it can be determined that the veteran "engaged in combat with the enemy." 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). If it is determined through military citation or other supportive evidence that a 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 that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony regarding the reported stressors must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary. 38 C.F.R. § 3.304(f). Where a determination is made that the veteran did not "engage in combat with the enemy," or the claimed stressor is not related to combat, the veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. Doran v. Brown, 6 Vet. App. 283, 289 (1994); Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). In such cases, the record must contain service records or other corroborative evidence that substantiates or verifies the veteran's testimony or statements as to the occurrence of the claimed stressor. West (Carlton) v. Brown, 7 Vet. App. 70, 76 (1994); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). Effective July 13, 2010, VA amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the required in-service stressor. The amended 38 C.F.R. 3.304(f) adds the following: 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 posttraumatic stress disorder 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. For purposes of this paragraph, "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). The amendment to the regulation is effective, in pertinent part, for all claims pending at the Board on July 13, 2010. In this case, the Veteran served aboard the U.S.S. Prairie from January 1973 until service separation in February 1976. He is neither in receipt of any military citations indicative of combat service nor otherwise shown to have had combat service through service records. The DD Form 214 shows that he served with the primary specialty of interior communications technician (i.e., an electrician), and is in receipt of the National Defense Service Medal, which is not a military citation indicative of combat service. Although the Veteran initially wrote, in a June 1995 statement, that he was exposed to armed combat/enemy action and bombed booby traps during service, and received combat pay, he later wrote in a handwritten statement presumably received in 1996 that he was never in armed combat action or exposed to bombed booby traps during service. The 1996 clarification from the Veteran is more consistent with other evidence of record and far outweighs his assertions of combat service; therefore, the Board finds that the presumption afforded combat veterans under 38 U.S.C.A. § 1154(b) does not apply. The Board must also consider whether the amended regulatory provision, 38 C.F.R. § 3.304(f)(3), is applicable in this case. The Board notes, however, that the Veteran is not diagnosed with PTSD by a VA psychiatrist or psychologist or one contracted by VA as contemplated by the amended regulation. The June 2012 VA medical examiner opined that the Veteran did not suffer from PTSD. Although the September 2004 VA examiner had previously diagnosed PTSD, the diagnosis and medical opinion are not adequate for reasons explained below. Also, the Veteran's attorney has repeatedly stated that the Veteran seeks service connection for PTSD based on personal assault. See March 2008 and January 2011 letters. The revised regulatory provision pertaining to allegation of fear of hostile military activity is not applicable to alleged personal assault. For these reasons, the Board finds that the revised PTSD regulation liberalizing, in certain circumstances, the evidentiary standard for establishing the required in-service stressor does not apply in this case. After review of the record, the Board finds that the weight of the evidence is against finding that the Veteran currently suffers from PTSD. At the June 2012 VA PTSD examination, the Veteran reported the onset of psychiatric symptoms, past diagnoses and treatment for psychiatric disabilities, and described several in-service stressor events that he believed caused PTSD. After considering the Veteran's psychiatric history, current symptomatology and treatment, and identified stressor events, and performing a thorough clinical interview of the Veteran, the VA examiner found that the Veteran did not have a diagnosis of PTSD that conformed to the DSM-IV criteria. See August 2012 addendum report. The VA examiner alternatively found that the Veteran suffered from recurrent and severe MDD, Anxiety Disorder NOS, and Alcohol Dependence on Axis I. In providing rationale for the medical conclusion, the June 2012 VA examiner opined that the Veteran presented with a significant psychiatric disorder but that the symptoms were not consistent with the typical natural course and progression of PTSD, and were unlikely to be PTSD. The examiner indicated that the claims file was reviewed and the Veteran was interviewed. The service treatment records include a June 1973 entry that shows that the Veteran complained of sleepwalking for 10 days. He stated that he hated to get yelled at and that he was scared of doing something wrong. He indicated that he was not a junior man and that he felt that he hadn't advanced in rate like he should or could have. He indicated that he stayed off the beach as much as possible and stuck mostly around the shop. It was noted that he was advised to get away from work and go off and do something out of the ordinary. The treatment note includes the statement of examiner who indicated the he felt that the Veteran's main problem was that he took his work too seriously and he needed to get away and relax. No diagnosis was noted on that entry and the examiner asked "What do you advise". The June 20121 VA examiner considered the in-service complaint of sleep walking. The examiner indicated that there was a diagnosis of chronic anxiety in June 1973, which was treated with Librium. The VA examiner wrote that there was only one evaluation on that date and no follow-up visits, which suggested that the symptoms were not severe. While a diagnosis of chronic anxiety and a prescription for Librium are not noted on the June 1973 service treatment record or on any other service treatment record in the claims file, the June 2012 VA examiner noted on his report that he both reviewed the claims file and interviewed the Veteran and apparently his comments are based on a combination of the records review and the interview with the Veteran. The VA examiner also noted that there was no mention of specific traumatic events, and the anxiety disorder was diagnosed before any of the traumatic events were to have occurred. The VA examiner then noted that, according to the Veteran, there were no other encounters with mental health services or even psychiatric symptoms until 1992, when he was having psychiatric problems at the workplace for which he was retired early and considered disabled after having worked uneventfully from 1979 to 1992 (i.e., about 13 years). The VA examiner further noted the Veteran's numerous psychiatric hospitalizations from 1992 to 1995, which included a noted diagnosis of PTSD, in addition to MDD and delusional disorder, and the majority of his symptoms were related to the Veteran's suicidal ideation regarding his difficulty dealing with a divorce and custody battle, concern that his sons were being sexually molested, and delusions that the telephone company was bugging his phones, following him, and wanting to cause him harm. The VA examiner noted that there was only scant mention of any symptoms related to PTSD, except a rare noting of a "flashback" or "intrusive thoughts," which included no specific mention of Vietnam. The VA examiner noted that, although PTSD was a recorded diagnosis, there was very little in the medical record to support the diagnosis. The VA examiner additionally noted that, while the Veteran was hospitalized from October 1992 to November 1992, the PTSD diagnosis was discontinued secondary to the fact that the Veteran had never been in combat and his symptomatology seemed to be more of a delusional persecutory subtype rather than PTSD despite his consistent complaints of PTSD symptoms. The VA examiner also noted that the Veteran had an intake at the PTSD clinic in July 1995, and it was noted at that time that he did not appear to have PTSD and, instead, was delusional and suffered from polysubstance related disorder, major depression, and delusional disorder. The VA examiner further noted that it was even hypothesized in 1992 that the Veteran's reported PTSD symptoms were part of the delusional diagnosis. The June 2012 VA examiner then wrote that, as far as he could determine, the Veteran began to experience psychiatric symptoms around the time that he applied for VA benefits in 1995. The June 2012 VA examiner noted that the typical time course of PTSD is usually such that after deployment, there is difficulty with readjustment to civilian life and PTSD symptoms are present from the start and wax and wane over time but are always present to some extent. The June 2012 VA examiner wrote that the psychiatric symptoms as reported by the Veteran and as evidenced in the medical record showed a lack of psychiatric symptoms, and rather evidenced high functioning in that he was able to maintain stable performance at the same phone company until his rapid psychiatric decline in 1992, characterized by depression, marital discord, and delusions. The June 2012 VA examiner commented that during the time of psychiatric decompensation from 1992 to 1996, there were 11 psychiatric hospitalizations but a notable lack of symptoms reported regarding PTSD, except for providers recording the diagnosis itself. The June 2012 VA examiner then reiterated that two different providers noted that PTSD was probably not among the Veteran's psychiatric diagnoses during the period. The June 2012 VA examiner noted that there is a lack of psychiatric notes from 1996 to 2000; however, in 2000, the notes start to document symptoms that are consistent with PTSD. The June 2012 VA examiner later wrote that the shift in the reporting of symptomatology (from depressions and delusions during the period from 1992 to 1996 to PTSD symptoms beginning in 2000) was unusual in the typical progression of PTSD. The June 2012 VA examiner noted that the Veteran has been on numerous psychiatric medications and a variety of antipsychotics, which was a less typical medication regime than that of a typical veteran who has PTSD. The June 2012 VA examiner also considered the Veteran's reported current symptomatology, treatment records showing that the Veteran's current psychiatrist had diagnosed him with PTSD, and reported in-service stressor events; however, the June 2012 VA examiner ultimately concluded that the anxiety symptoms demonstrated by the Veteran described the diagnosis of anxiety disorder NOS, as opposed to PTSD. The June 2012 VA examiner has medical training in the area of mental disorders and had adequate data on which to base the medical opinion. Indeed, the June 2012 VA examining psychiatrist's opinion was based on a thorough clinical interview and evaluation of the Veteran, as well as consideration of the Veteran's past and current psychiatric symptoms, diagnoses, and treatment as documented in the record. The June 2012 VA examiner's description of the Veteran's psychiatric symptoms, diagnosis, and treatment during and after service is consistent with the Board's review. The June 2012 VA examiner provided a sound and thorough rationale for the medical opinion that the Veteran does not suffer from PTSD. For these reasons, the Board finds the medical opinion to be of great probative value. The Board recognizes that the Veteran had previously undergone a VA mental disorders examination in September 2004 and the September 2004 VA examiner diagnosed the Veteran with PTSD on Axis I; however, the September 2004 VA medical opinion is of lesser probative value than the medical opinion of the June 2012 VA examiner for the following reasons. When rendering the medical opinion, the September 2004 VA examiner acknowledged that it was "difficult to fully assess the [Veteran's] underlying condition on examination while he [was] medicated." The June 2012 VA examiner, on the other hand, did not identify the Veteran being medicated as a barrier to being able to assess fully the Veteran's psychiatric condition. The June 2012 VA examiner specifically noted that the Veteran was on a very low dose of antipsychotic medication at that time. Additionally, the September 2004 VA examiner opined that the Veteran was suffering from a personality disorder with borderline features, which could account for the varied diagnoses that the Veteran has received in the past, but did not articulate why he believed that the Veteran had an Axis I PTSD diagnosis but no other Axis I psychiatric diagnoses, particularly in light of the earlier statement in the report that depressive symptoms were not uncommon in patients with PTSD, borderline personality, and other psychiatric conditions and may be co-incident with or the result of the comorbid psychiatric conditions. The June 2012 VA examiner, on the other hand, thoroughly explained the basis for the opinion that the Veteran did not suffer from PTSD in accordance with DSM-IV, specifically delineated the criteria that was not met for a PTSD diagnosis, and cited to other evidence in the record to support the opinion. Furthermore, the September 2004 VA examiner assumed for the purposes of providing the opinion that the Veteran's stressors were true; however, none have been sufficiently corroborated by credible supporting evidence. The Board also notes that the Veteran has been diagnosed with PTSD by several mental health providers throughout the course of the appeal. For example, when the Veteran was admitted to a VA hospital for psychiatric treatment in August 1995, PTSD was included among the Axis I psychiatric diagnoses. Also, in a September 2008 letter, the Veteran's treating VA psychiatrist noted that the Veteran suffered from chronic PTSD on Axis I. More recently, the Veteran's current treating VA psychiatrist wrote, in a January 2012 VA mental health note, that the Veteran had chronic PTSD. However, the Board finds the June 2012 VA medical opinion to be of greater probative value because the examiner considered the prior and current diagnoses of PTSD, as well as the progression of the Veteran's psychiatric symptoms, as shown in the record and provided a thorough explanation as to why the Veteran does not have PTSD. The VA mental health providers have only considered the Veteran's account of in-service stressor events, and symptomatology as reported by the Veteran, which have varied over the course of the appeal as described by the June 2012 VA examiner in the examination report; therefore, the Board finds that the VA mental health providers, unlike the June 2012 VA examiner, did not have adequate facts and data on which to base their PTSD diagnosis. In March 2008 and January 2011 letters, the Veteran's attorney asserted that service connection for the Veteran's PTSD claim is warranted based on consistent testimony, a diagnosis which linked current PTSD with an in-service personal assault, and some evidence of corroboration; however, the assertion is not supported by the record. Indeed, there has not been sufficient corroboration of the Veteran's claimed in-service stressor events, to include the claimed personal assaults. The service treatment records and service personnel records include no mention of any of the Veteran's claimed stressor events. In a June 1998 letter, the Director of USACRUR wrote that the deck logs for the U.S.S. Prairie were researched for the period from January to July 1975 in an attempt to corroborate the Veteran's claimed stressor events; however, the documents, which included mention of occurrences of assaults such as fist fights and reports of men overboard, included no mention of a bus incident involving the Veteran and other men or corroborative evidence that the ship was sabotaged or that the Veteran was almost run over. In light of the types of incidents that were documented in the deck log, it is likely that one of the Veteran's claimed stressor events would have been supported by the record and the fact that there was no such corroboration weighs against the Veteran's credibility. Also, the description of the participation of service personnel from the U.S.S. Prairie in giving aid to Vietnamese and Cambodian refugees, which was submitted by the attorney, only indicates that the Veteran was likely a participant in the aid mission; however, it does not provide credible support for any of the stressor events that allegedly occurred during that time. Pursuant to the Board Remand orders, the Veteran has repeatedly been asked over the course of this appeal to submit additional information regarding his claimed stressor events and has repeatedly failed to do so. The Board observes that the Veteran told the September 2004 VA examiner that the individuals that could offer corroboration were either dead or he did not know how to reach them. He similarly told the June 2012 VA examiner that those who were able to verify the events were not available to make buddy statements for him because they were either dead or he was not able to find them. The Board further notes that the Veteran's testimony has not been consistent regarding the alleged stressor events. For example, as stated above, when the Veteran originally filed the claim in June 1995, he wrote that the most terrifying stressors involved armed combat or enemy action, bombed booby traps, and other actions that threatened his life; however, he later stated, in an undated handwritten statement, that he was never in armed combat action or exposed to bombed booby traps, which was in direct contradiction to the earlier statement. Moreover, as discussed above, the Board recognizes that the Veteran was noted to be diagnosed with PTSD by mental health providers during the time relevant to the claim, and a treating VA psychiatrist noted, in a September 2008 letter, that the Veteran suffered from chronic PTSD due to a personal assault. The September 2004 VA examiner also opined that the Veteran had PTSD that was at least as likely as not related to service; however, the June 2012 VA examiner alternatively opined that the Veteran did not suffer from PTSD based on a thorough evaluation of the Veteran and review of the record and provided a thorough explanation for the medical opinion. The Board finds that the June 2012 medical opinion outweighs the prior diagnoses of PTSD included in the record, which provided inadequate explanation for the diagnosis and was not based on adequate data (e.g., based on the Veteran's reported stressor events, which have not been corroborated by credible supporting evidence). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). The Board recognizes that the Court has held that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). However, where, as here, the overall evidence of record fails to support a diagnosis of PTSD, that holding is of no advantage. As the weight of the evidence demonstrates that the Veteran does not have PTSD, the preponderance of the evidence is against the claim for service connection for PTSD, and the claim must be denied. In reaching the conclusion, the Board notes that under the provisions of 38 U.S.C.A. § 5107(b), 38 C.F.R. § 3.102, a reasonable doubt is to be resolved in the claimant's favor in cases where there is an approximate balance of positive and negative evidence in regard to a material issue; however, because the preponderance of the evidence is against the Veteran's claim for service connection for PTSD, that doctrine is not applicable. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service Connection Analysis for Psychiatric Disorders other than PTSD As noted above, the June 2012 VA examiner diagnosed the Veteran with MDD and Anxiety Disorder NOS on Axis I; however, after reviewing the lay and medical evidence of record, the Board does not find that the psychiatric disabilities had their onset during service or in the first post-service year, or that they are otherwise related to service. As discussed above, the service treatment records document his complaint of sleepwalking for ten days in June 1973. At the time, the Veteran complained that he did not feel that he was advancing at the rate he should be and made no mention of any other factors or events contributing to his mental distress. The Veteran had previously reported on the February 1972 service report of medical history that he had a history of childhood sleepwalking. As discussed above, the June 2012 VA examiner indicated that the claims file was reviewed and that he interviewed the Veteran and indicated that during service in June 1973 there was a diagnosis of chronic anxiety and that Librium was prescribed. See June 2012 VA examination report, page 4. There remaining service treatment records do not show complaints or treatment for psychiatric problems for the remainder of the Veteran's period of active service, which was a period of approximately two-and-a-half years. The service personnel records show no behavioral or performance problems, which may be indicative of mental distress. At the February 1976 service separation examination, the Veteran was psychiatrically evaluated as normal. At the June 2012 VA examination, the Veteran specifically told the VA examiner that there were no other encounters with mental health services or even psychiatric symptoms until 1992. Thus, the service treatment records demonstrated that other than the June 1973 treatment report, there were not treatment records demonstrating psychiatric symptoms or treatment for psychiatric symptoms for approximately 19 years. This evidence weighs against finding that the Veteran had a chronic psychiatric disorder manifested by psychosis during service or manifested to a compensable degree within one year of discharge, or that there was a continuity of symptomatology of a chronic psychiatric disorder manifested by psychosis from service until the present time. The medical opinion evidence also weighs against finding that the Veteran's current psychiatric disorders had their onset during service or are otherwise causally related to service. Regarding the diagnosis of MDD, the June 2012 VA examiner noted that the Veteran reported at the examination that the onset of the depressive symptoms occurred in 1992 or 1993, within the context of separation from his wife, her remarrying, his worrying that the man would be sexually molesting his sons, and a custody battle over their two sons. The June 2012 VA examiner noted the Veteran's report that depression in general was not an issue before that time. The June 2012 VA examiner noted that the medical records showed that most of the Veteran's difficulties began in 1992, and that much of his symptoms at that time were depression surrounding the divorce, custody battle, and difficulties with delusions. The June 2012 VA examiner noted the Veteran's treatment for anxiety symptoms with sleepwalking in service but noted that there was no evidence of a mood disorder or delusional or psychiatric symptoms during service. The June 2012 VA examiner opined that, given the significant time between service and the time when the symptoms reportedly began, it was unlikely and less than a 50 percent probability that the diagnosed depressive disorder was first manifested in service, pre-existed and was aggravated during service, or was otherwise causally related to service. Because the VA examiner provided a sound rationale for the conclusion, and there is no medical opinion to the contrary of record, it is of great probative value. Regarding the diagnosis of Anxiety Disorder NOS, the June 2012 VA examiner opined that, given that there was a span of over 20 years from the June 1973 diagnosis of chronic anxiety in the service until the emergence of psychiatric symptoms in 1992 of depression and delusions, with no reported psychiatric symptoms in the interim, there was less than a 50 percent probability that the two disorders were related. The VA examiner added that the Veteran was functioning and working at the phone company adequately for over 12 years until the emergence of psychiatric symptoms resulting in the numerous psychiatric hospitalizations, which suggests that there was a development of an independent psychiatric disorder. Because the VA examiner provided a sound rationale for the conclusion, and there is no medical opinion to the contrary of record, it is of great probative value. The miscalculation of the length of time between the diagnosis of chronic anxiety in service until the first evidence of psychiatric symptoms in 1992 does not render the medical opinion inadequate as it still indicates a nearly two decade span of time between service and onset of symptomatology. Although the Board notes that the June 2012 VA examiner diagnosed alcohol dependence on Axis I, in addition to MDD and anxiety disorder NOS, service connection for alcohol abuse on a direct basis is precluded by law; therefore, no further discussion of the merits of the claim is required. 38 C.F.R. § 3.301. As the weight of the evidence demonstrates that the Veteran does not suffer from a psychiatric disorder other than PTSD manifested during service, the first post-service year, or a psychiatric disorder otherwise due to service, the preponderance of the evidence is against the claim for service connection, and the claim must be denied. In reaching the conclusion, the Board notes that under the provisions of 38 U.S.C.A. § 5107(b), 38 C.F.R. § 3.102, a reasonable doubt is to be resolved in the claimant's favor in cases where there is an approximate balance of positive and negative evidence in regard to a material issue; however, because the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. (CONTINUED ON NEXT PAGE) ORDER Service connection for an acquired psychiatric disorder, to include PTSD, is denied. ____________________________________________ K. J. ALIBRANDO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs