Citation Nr: 1323205 Decision Date: 07/19/13 Archive Date: 07/24/13 DOCKET NO. 99-22 368A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for an acquired psychiatric disorder other than mood disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The Veteran and his wife ATTORNEY FOR THE BOARD C. Fleming, Counsel INTRODUCTION The Veteran served on active duty from April 1970 to February 1972, including service in the Republic of Vietnam. This matter initially came before the Board of Veterans' Appeals (Board) from a May 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Little Rock, Arkansas. In that decision, the RO denied entitlement to service connection for PTSD. The RO in Waco, Texas, currently has jurisdiction over the Veteran's claim. The Board denied the Veteran's appeal most recently in a July 2012 decision. The Veteran appealed the Board's 2012 decision to the United States Court of Appeals for Veterans Claims (Court). In a December 2012 joint motion for remand (Joint Motion), the Court vacated the Board's decision and remanded the claim for re-adjudication. The Board subsequently remanded the case in March 2013 for further evidentiary development and adjudication. The agency of original jurisdiction (AOJ) obtained the identified VA treatment records and associated them with the claims file. The Veteran was then provided a supplemental statement of the case (SSOC) in April 2013, in which the AOJ again denied the Veteran's service connection claim. Thus, there has been compliance with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting that where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). In November 1999, the Veteran and his wife testified at a hearing before a decision review officer at a hearing held at the RO. A transcript of that hearing has been associated with his claims folder. In addition to the paper claims file, there is a Virtual VA paperless claims file associated with the Veteran's claim. The documents in this file have been reviewed and considered as part of this appeal. FINDING OF FACT An acquired psychiatric disorder other than mood disorder, to include PTSD, did not have its clinical onset in service and is not otherwise related to active duty; such a disorder was not exhibited within the first post-service year. CONCLUSION OF LAW An acquired psychiatric disorder other than mood disorder, to include PTSD, was not incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Under the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107 and 5126; see also 38 C.F.R. §§ 3.102, 3.156(a), and 3.326(a), VA has a duty to notify the claimant of any information and evidence needed to substantiate and complete a claim, and of what part of that evidence is to be provided by the claimant and what part VA will attempt to obtain for the claimant. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The United States Court of Appeals for Veteran Claims' (Court's) decision in Pelegrini v. Principi, 17 Vet. App. 412 (2004), held, in part, that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. This decision has since been replaced by Pelegrini v. Principi, 18 Vet. App. 112 (2004), in which the Court continued to recognize that typically a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. In this case, VA satisfied its duties to the Veteran in VCAA letters issued in April 2004 and January 2008. See id. The VCAA letters notified the Veteran of what information and evidence is needed to substantiate his claim of service connection, what information and evidence must be submitted by the claimant, what information and evidence will be obtained by VA, and the types of evidence necessary to establish a disability rating and effective date. Id.; but see VA O.G.C. Prec. Op. No. 1-2004 (Feb. 24, 2004); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of his claim, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). In any event, the Veteran has not demonstrated any prejudice with regard to the content of any notice. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination.) See also Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). The Board also finds that VA has complied with all assistance provisions of VCAA, to include compliance with the December 2012 Joint Motion and the March 2013 remand. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The evidence of record contains the Veteran's service treatment records and lay statements of the Veteran, as well as post-service treatment from both private and VA treatment providers. The evidence of record contains examination requested by VA performed in May 2001, July 2001, January 2005, April 2008, and April 2011. The Board finds that the VA examination reports are thorough and contain sufficient information to decide the issue on appeal. McLendon v. Nicholson, 20 Vet. App. 79 (2006). For all the foregoing reasons, the Board concludes that VA's duties to the Veteran have been fulfilled with respect to the issues on appeal. Criteria & Analysis Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in the line of duty or for aggravation of a pre-existing injury or disease in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. 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). If a psychosis becomes manifest to a degree of 10 percent or more during the one-year period following a Veteran's separation from active service, the condition may be presumed to have been incurred in service, notwithstanding that there is no in-service record of the disorder. 38 U.S.C.A. §§ 1101, 1112 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.307, 3.309 (2012). Where the Board is presented with conflicting medical evidence, it is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995). In this regard, the Board notes that the Federal Circuit and the Court have both specifically rejected the "treating physician rule." See White v. Principi, 243 F.3d 1378 (Fed. Cir. 2001); Guerrieri v. Brown, 4 Vet. App. 467 (1993). Instead, the Court has held that the Board must determine how much weight is to be attached to each medical opinion of record. See Guerrieri v. Brown, 4 Vet. App. 467 (1993). Greater weight may be placed on one medical professional's opinion over another, depending on factors such as reasoning employed by the medical professionals and whether or not, and the extent to which, they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994); see also Wensch v. Principi, 15 Vet. App. 362, 367 (2001) (it is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons and bases). Adequate reasons and bases, in short, must be presented if the Board adopts one medical opinion over another. In assessing evidence such as medical opinions, the failure of the physician to provide a basis for his 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 file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. 444, 448-49 (2000). In some cases, the physician's special qualifications or expertise in the relevant medical specialty or lack thereof may be a factor. In every case, the Board must support its conclusion with an adequate statement of its reasoning of why it found one medical opinion more persuasive than the other. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); 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. 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 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 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f)(2). 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. 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. See 38 C.F.R. § 3.304(f)(3) (2012); 75 Fed. Reg. 39,843-39,852 (July 13, 2010). The provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform to the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). The Veteran contends that his experiences in service, including experiences that induced fear of hostile military activity, have caused his current acquired psychiatric disorder, which he identifies as PTSD. The Veteran lists the following events as his stressors: while stationed in Tuy Hoa, observing five crew members burn after an aircraft blew up on landing; having his compound go on red alert one evening and having to leave the barracks for his worksite; watching his friend get stabbed in the barracks; experiencing grenades being thrown in the enlisted men's club after a fight between rangers and infantry troops; witnessing a unit member shooting up the barracks with an M-16; and learning that two men who took over his position were killed. He contends that ever since service, he has experienced recurring nightmares and memories of these events, causing his PTSD. At the outset, the Board notes that the Veteran is already in receipt of service connection for a "mood disorder, claimed as anxiety, depression and stress," which has been rated as 30 percent disabling. As this grant of service connection necessarily includes the Veteran's diagnoses of a mood disorder, anxiety disorder, and depressive disorder, the Board finds that the Veteran is already compensated for those psychiatric disabilities, and they are thus not on appeal at this time. The Veteran served in the Republic of Vietnam from October 1970 to October 1971, and his military occupational specialty was radio message router. However, there is no indication, through medals or awards, that the Veteran participated in combat. Service treatment records do not reflect the presence of a chronic psychiatric disability. Private post-service treatment records reflect that in August 1996, the Veteran was diagnosed with "subclinical" PTSD. In the report, the Veteran was assessed to have developed survivor's guilt over the men who were killed who were in the position he had earlier occupied. Mental status examination revealed that he had occasional nightmares and would occasionally startle easily. He had occasional short term memory loss, along with recurrent and intrusive memories of the helicopter explosion and the men who died while guarding the perimeter. These thoughts were triggered by watching war movies or talking about Vietnam. Otherwise, his mental functioning was normal. The treatment provider noted that the Veteran experienced "little guilt about his actions in the military." A January 1998 treatment note documents that the same treatment provider, a social worker, diagnosed the Veteran with "PTSD, mild." His service stressors were once again listed, and no other basis for that diagnosis was listed. Similarly, in February 1998, a private psychiatrist diagnosed the Veteran with "chronic and moderate" PTSD. The Veteran reported multiple stressors while in Vietnam, including the reported helicopter accident, the two peers whose throats were cut while on guard duty, and the soldier who went berserk and shot an M-16 rifle around the camp. After 30 years, the Veteran stated that he still remembered these instances and harbored survivor's guilt. He stated that he tried to get along with everyone around him and had a good relationship with his wife and son. His most noteworthy symptom was having nightmares related to his experiences and having disturbing memories when watching Vietnam movies. His memories and bad dreams were assessed as moderate, with viable and occasional disruption to his general level of functioning. The Veteran has undergone VA examinations on five separate occasions, in May 2001, July 2001, January 2005, April 2008, and April 2011. Report of the May 2001 VA examination reflects that the Veteran reported having difficulty sleeping, including having dreams and night sweats. He reported a similar stressor of having witnessed a fatal helicopter accident. Psychological testing on the MMPI scale was of questionable validity, possibly due to inconsistent performance. Similarly, Mississippi Scale testing resulted in a low score of 95, below the generally accepted cut off score of 107 for the presence of PTSD. Similarly, traumatic symptom inventory did not reflect any PTSD symptoms at an appreciably significant clinical level. Rather, the examiner noted that testing was positive for a severe personality disorder. The examiner further found that the majority of the Veteran's complaints were more physically/medically based than psychiatrically based. It was further noted that there did not appear to be a stressor evidenced through psychodiagnostic testing or mental status evaluation. The examiner diagnosed the Veteran only with personality disorder not otherwise specified with prominent schizoid traits; no Axis I diagnosis was assigned. The examiner concluded that there was no sound basis for a PTSD diagnosis based upon the clinical opinion and diagnostic evaluation. In July 2001, the Veteran again underwent VA examination with a different VA examiner, at which time he reported that he had suffered intermittently in the past from anxiety symptoms related to his service in Vietnam, consisting of subjective symptoms of uneasiness, arousal, and fear. He denied any other significant psychological history. Mental status examination showed a restricted affect and some sadness. The Veteran was noted to display some mild vegetative symptoms, including decreased sleep and concentration, as well as loss of memory, energy, and libido. However, he did not show anxiety, even when speaking in detail about his service experiences and trauma. His wife stated that he had displayed symptoms of being easily startled in his sleep and, in the 1970s, would sometimes wander at night and was easily distractible. She denied observing any previous panic or anxiety attacks. The examiner diagnosed the Veteran with "possible posttraumatic stress disorder, mild, resolved," and probable schizoid personality traits. The examiner opined that the Veteran may have had a very mild form of PTSD in the past, but his current symptoms were attributable not to PTSD but to "his personality style and his social circumstances." The Veteran was again provided VA examination in January 2005. At that time, the Veteran reported the stressor of the helicopter crash, although at this examination he stated that he did not actually witness the crash or the death of any service members. He reported, rather, that he saw the dead bodies "being brought in." He stated that after this experience, he had thought of the men and their families for a few days but that there were no long term effects. Similarly, he reported that he heard about two guards who were killed on duty but denied any lasting effects from that incident. He reported that he tended to avoid crowds and fireworks and experienced occasional nightmares but that they were not a re-experiencing of the events that occurred in Vietnam. He was noted to have had recent memory loss problems, which the examiner thought were not related to his previous military service due to the recent onset. The examiner acknowledged the prior diagnoses of PTSD, both "subclinical" and mild/moderate PTSD; however, mental status examination did not support the presence of PTSD. Rather, the examiner found the Veteran to display schizoid and avoidant personality traits. In addition, the Veteran was administered a variety of tests to determine the presence of PTSD. That testing strongly indicated that PTSD was not present. Thus, the examiner found that the Veteran did not meet the diagnostic criteria for PTSD. The examiner explained that the reported stressors had not had sufficient psychological impact to render a diagnosis of PTSD and, further, that the Veteran's own report of symptoms did not meet the diagnostic criteria for PTSD. The examiner further clarified that the Veteran showed evidence of a personality disorder associated with anxiety and depression. The nature of the personality disorder most likely existed prior to entry into service and was not related to service. The examiner diagnosed the Veteran only with personality disorder not otherwise specified, with schizoid and avoidant features; no Axis I diagnosis was assigned. In January 2008, the Veteran's spouse submitted a statement attesting that prior to entering service, the Veteran was easy-going and very personable. Following separation from service and over the past 35 years, she stated, he had had trouble concentrating on work around the house, was easily angered over trivial things, had trouble sleeping, and recently had trouble with his memory. Shortly after leaving service, he would sleepwalk into furniture due to nightmares. Once she woke up to him choking her. He had withdrawn socially and did not like to be around crowds. In January 2008, the Veteran also submitted a statement in which he contended that he suffered from a sleep disorder that he believed was related to his experiences in Vietnam. The Veteran subsequently underwent additional VA examination in April 2008. At that time, the Veteran and his wife reported that following separation from service, the Veteran became socially isolated. He first sought psychiatric help when his supervisor ordered him to do so due to social isolation in 2001. He reported having trouble sleeping at night and stated that he would kick and jerk in his sleep. He stated that sirens bothered him and complained of feeling tense in his job and getting angry over little things. Psychological testing showed that he had chronic severe anxiety, as evidenced by restlessness, fatigue, insomnia, feeling on edge, bad daydreams, and fears of loss. He had moderate panic symptoms and severe depression, as evidenced by severe indecision, health worries, excessive eating, and loss of motivation. He had moderate frustration and occasional mild suicidal ideation. The examiner determined that the Veteran did not meet the criteria for a diagnosis of PTSD on two grounds. First, the examiner found that it did not appear that the Veteran's identified stressors had had a sufficient psychological impact to create that disorder. Secondly, the examiner observed that the Veteran's own symptom report indicated that he did not meet the diagnostic criteria for a diagnosis of PTSD, regardless of whether the stressors were sufficient. The examiner found instead that there was evidence of a personality disorder with associated anxiety and depression likely generated largely by interaction with others and perfectionism. The examiner found that the Veteran displayed insufficient symptoms to diagnose anxiety and depression separately and assigned a diagnosis of mood disorder with panic disorder due to the events experienced in service and to his diabetes. The examiner also diagnosed the Veteran with personality disorder, not otherwise specified, with avoidant and negativistic traits. The examiner stated that the Veteran's diagnoses are "interactive and cannot be separated." VA treatment records reflect that the Veteran has sought psychiatric treatment since at least April 2008, at which time he was found to test positive for a diagnosis of PTSD, showing symptoms of exposure to a traumatic event, a response of intense fear, recurrent and intrusive distressing recollections and dreams of the event, and intense psychological distress at exposure to cues. He reported persistent avoidance of stimuli, thoughts, feeling, places, and activities related to the event and an inability to recall important aspects of the trauma. He complained of feeling detachment from others and of experiencing persistent symptoms of increased arousal manifested by difficulty falling asleep, irritability, difficulty concentrating, and an exaggerated startle response. The same diagnosis was continued in treatment notes from May and June 2008. Similarly, in September 2008, the Veteran reported that he was sleeping better but still having nightmares. He was again assigned a diagnosis of PTSD. In October 2009, the Veteran was again seen for psychiatric treatment; at that time, his diagnosis was PTSD and depression not otherwise specified. Those diagnoses have continued from that time to his most recent VA treatment visit in March 2013. To address the conflicting diagnoses assigned by the Veteran's VA treatment provider and his multiple VA examiners, the Veteran was again provided VA examination in April 2011. At that time, the Veteran reported that while in service, he did not have any direct combat experiences; however, he knew of people who had been killed. In particular, concerning his claimed stressor, the Veteran reported that he did not witness the earlier-identified helicopter crash or its aftermath but instead merely "read about it later." He stated that following separation from service, his general personality and interpersonal relationships changed in that he became much less social, less animated, and appeared distracted and withdrawn. He also stated that he had become uncomfortable in social situations, though he was able to maintain employment until he retired in 2008. The examiner noted symptoms of trauma such as nightmares, exaggerated startle response, autonomic hyperactivity, intrusive memories, nightmares, and other recollections. After conducting mental status examination and reviewing the previous VA examination and VA treatment records evidencing various psychiatric diagnoses and psychiatric testing, including the VA diagnosis of PTSD, the examiner found evidence of a persistent mental disorder. However, the examiner found that his history and current symptomatology were not consistent with PTSD, except the existence of possible emotional numbness and social isolation. However, those symptoms could also be the result of a mood disorder or consequences of a personality disorder with avoidant traits. The examiner concluded that it was not possible to say that it was more likely than not that those symptoms were the result of PTSD; therefore, the examiner could not conclude that the Veteran met the criteria for a diagnosis of PTSD. Rather, the examiner found that he met the criteria for diagnoses of depressive disorder, anxiety disorder, and a personality disorder. Although it was apparent that the Veteran's personality changed following separation from service, the examiner concluded this alteration could have been due to the development of a depressive disorder or to personality factors. Upon careful review of the record, the Board finds that the competent and probative evidence of record weighs against a finding that the Veteran has a diagnosis of an acquired psychiatric disorder other than mood disorder, to include PTSD. In so finding, the Board notes that an evaluation of the probative value of medical evidence is based on the medical expert's personal examination of the patient, the examiner's knowledge and skill in analyzing the data, and the medical conclusion reached. The credibility and weight to be attached to such opinions are within the province of the Board as adjudicators. Guerrieri v. Brown, 4 Vet. App. 467 (1993). The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. Sklar v. Brown, 5 Vet. App. 140 (1993). In this case, the Board places the greatest probative weight on the five independent VA examinations finding that the Veteran did not meet the criteria for a diagnosis of PTSD, rather than on the 1996 and 1998 diagnoses of subclinical PTSD and mild to moderate PTSD. Similarly, the Board places greater probative weight on the five VA examinations than on the VA psychiatric treatment records dated in from 2008 to 2013 that demonstrate an ongoing diagnosis of PTSD. In so finding, the Board notes first that all five VA examinations contain clear conclusions with supporting data as well as a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a "medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Specifically, the VA examiners in this case each conducted thorough psychological testing and mental status examination when concluding that the Veteran's psychiatric history and symptom presentation simply did not meet the criteria for a diagnosis of PTSD, but rather resulted in diagnoses of a personality disorder and/or a mood disorder with anxiety and depression. The Board finds it to be highly significant and probative that all VA examiners were in agreement in this respect, and that each examiner came to the same determination after independently reviewing the Veteran's claims file and conducting the necessary psychiatric testing. The examiners were in agreement that the Veteran's reported stressors were not of an adequate severity to result in a diagnosis of PTSD, even assuming their veracity. Further, the examiners all concluded that the Veteran's reactions to the stressors following service and during the course of the appeal had not resulted in symptoms that met the necessary criteria for a diagnosis of PTSD. Although it is clear that the Veteran does in fact suffer from a mood disorder that is most likely related to his service-for which he is currently in receipt of service connection-all of the VA examiners found, upon extensive record review, examination, and testing, that the Veteran simply does not suffer from symptoms to result in a clinical diagnosis of PTSD. In finding that the VA examiners' negative opinions are more probative than the diagnoses of PTSD assigned to the Veteran at various points during the appeal, the Board acknowledges that the July 2001 VA examiner offered the opinion that it was possible the Veteran had had PTSD. However, that examiner went on to state that it appeared that any previous PTSD had resolved and that it therefore was more probable that he currently had a mental disorder other than PTSD. That conclusion does not establish that the Veteran had or ever had PTSD, only that it was possible that he once had it in the past, prior to the appeal period. This finding does not even indicate a probability that PTSD was present in the past, only the possibility, and when viewed with the overall record, does not establish the presence of the disability at any time during the appeal period. Similarly, when reviewing the 1996 and 1998 records, the Board finds that those reports of evaluation inadequately describe the symptoms upon which the diagnoses were based. For example, in August 1996, the Veteran stated only that he had occasional short term memory loss and had recurrent intrusive memories of the events. The 1998 reports of examination are similar in that only a few mild to moderate symptoms were reported. The Board finds these diagnoses wanting, particularly in comparison to the extensive explanations offered by each of the five VA examiners as to why the Veteran does not currently experience PTSD. Additionally, in finding that the evidence of record weighs against a finding that the Veteran currently experiences PTSD, the Board acknowledges that the Veteran has been assigned a diagnosis of PTSD by his VA treatment provider from April 2008 through the present. The computerized list of diagnoses of PTSD in the VA system spanning from 2008 through 2013 includes a check-list of symptoms necessary for a diagnosis of PTSD, but there is no accompanying report of psychiatric examination or mental status examination to adequately support such a diagnosis in comparison to the five VA examinations of record. Thus, even assuming that each such diagnosis was made in accordance with the DSM-IV, the Board finds it impossible to determine the reasoning behind the treatment provider's rationale in assigning the PTSD diagnosis. The Board finds that each diagnosis of PTSD made during the pendency of the appeal is unsupported by an adequate rationale as to how the diagnosis met the criteria under DSM-IV, and thus, those diagnoses are of little probative value to the Board. On the other hand, as explained above, the five VA examinations each included thorough mental status examination, psychological testing, and review of the record, with adequate rationale as to the Veteran's current symptom presentation and appropriate diagnosis. Even upon considering the diagnoses of PTSD, each of the five VA examiners, spanning over a decade from 2001 to 2011, consistently and independently found that it was unlikely that the Veteran's current symptoms met the criteria for a diagnosis of PTSD. Further, the Board notes that the multiple VA examinations were obtained, in part, to clarify the Veteran's diagnoses-thus, the examinations were an attempt to obtain clarification under 38 C.F.R. § 4.125 as to the rationale underlying the diagnoses of PTSD made by the Veteran's private and VA treatment providers. The fact that each VA examiner has found the Veteran not to experience PTSD, when relying on an explicit evaluation under the DSM-IV, weighs heavily against a finding that the Veteran has experienced PTSD at any time during the appellate period. The Board finds that these five VA examinations, each with a clear and thorough explanation for the finding that the Veteran does not have PTSD, outweigh the unsupported impressions of PTSD assigned by the private treatment providers in 1996 and 1998, as well as the diagnosis of PTSD assigned by his VA treatment provider beginning in 2008. Those diagnoses are simply unsupported by any explanation as to how the treatment providers arrived at their diagnosis and are heavily outweighed by the well-reasoned and thorough VA examination reports from May 2001, July 2001, January 2005, April 2008, and April 2011-each of which clearly and comprehensively explains why the Veteran does not have a DSM-IV diagnosis of PTSD. Accordingly, the Board finds that the overwhelming probative and competent evidence in this case is against a finding of service connection for an acquired psychiatric disorder other than mood disorder, to include PTSD. The Board finds that there is no competent medical evidence of any pertinent "disability"; thus, service connection cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (Court stated that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability," and held that, in "the absence of proof of a present disability[,] there can be no valid claim"); Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992); see Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001) (symptoms alone, without a finding of an underlying disorder, cannot be service-connected). In so finding, the Board notes that the Veteran is currently in receipt of service connection for a "mood disorder, claimed as anxiety, depression, and stress." The Board finds that these diagnoses cover all the acquired psychiatric disorders with which the Veteran has been diagnosed by his various VA examiners. In so finding, the Board notes that the evaluation of the same "disability," or the same "manifestations" under various diagnoses, is not allowed. See 38 C.F.R. § 4.14. A claimant may not be compensated twice for the same symptomatology, as "such a result would overcompensate the claimant for the actual impairment of his earning capacity." Brady v. Brown, 4 Vet. App. 203, 206 (1993) (interpreting 38 U.S.C.A. § 1155). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. This is important in light of the findings of the April 2008 VA examiner that the Veteran's psychiatric diagnoses are "interactive and cannot be separated." Thus, the Board finds that he is currently being compensated for the entirety of his psychiatric symptomatology. Because of this, and because the competent and probative evidence of record does not suggest that the Veteran experiences PTSD, the Board finds that the current award of service connection for a mood disorder fully contemplates the Veteran's psychiatric symptomatology. In any event, none of the five separate VA examiners have diagnosed PTSD. The Board accepts the VA examiners' diagnoses and opinions as being the most probative medical evidence on the subject, as they were each based on a review of all historical records, and each report contains a detailed rationale for the medical conclusions reached. See Boggs v. West, 11 Vet. App. 334 (1998). Given the depth of the examination reports, and the fact that each VA examiner's opinion was based on a thorough review of the applicable record-including those instances in which the Veteran was diagnosed with PTSD-the Board finds that the five VA examiners' opinions are the most probative and material to the Veteran's claim. See Owens v. Brown, 7 Vet. App. 429 (1995). Each VA examiner independently reviewed the record, including prior diagnoses of PTSD; examined the Veteran; and conducted extensive psychological testing, and each VA examiner independently arrived at the conclusion that the Veteran does not suffer from PTSD. Because the Board finds these opinions to be more probative than the evidence of record suggesting that the Veteran currently experiences PTSD, the Board finds that the Veteran's claim must be denied. The Veteran has contended on his own behalf that he has an acquired psychiatric disorder other than mood disorder, to include PTSD, that is related to his service. The Board has considered the Veteran's contention that a relationship exists between his current psychiatric disabilities and service. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368- 69 (2005). In Barr v. Nicholson, 21 Vet. App. 303 (2007), the Court emphasized that lay testimony is competent if it is limited to matters that the witness has actually observed and is within the realm of the witnesses personal knowledge. See 38 C.F.R. § 3.159(a)(2) (Competent lay evidence means any evidence not requiring that the proponent have specialized education, training or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person). However, "VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to," and a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to support a grant of service connection. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question of whether the Veteran has PTSD related to any incident(s) during his military service to be complex in nature. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Here, although the Veteran is competent to describe his experiences in service and his current symptoms, the Board accords his statements regarding the nature and etiology of his disability of little probative value, as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical diagnosis or causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). The Veteran has offered only conclusory statements regarding the relationship between his in-service experiences and a diagnosis of PTSD. In contrast, the five VA examiners, who are all mental health professionals, took into consideration all the relevant facts in providing their opinions, to include the Veteran's reported in-service stressors and the current nature of his psychiatric disorder. Importantly, the Board notes that each of the five examiners independently reached the conclusion, upon review of the record and examination of the Veteran, that he does not experience PTSD but rather has a mood disorder with anxiety and depression. Therefore, the Board accords greater probative weight to the VA examiners' opinions rather than to the Veteran's and his family members' statements on the matter. With regard to assessing the credibility and competency of the statements offered by the Veteran, while he is competent to describe his psychiatric symptoms (i.e., that is, symptoms capable of lay observation), diagnosing PTSD is not something he has demonstrated that he has the medical expertise to do. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Moreover, as discussed, none of the VA examiners have diagnosed PTSD based on his claimed assertions. The Board accepts the opinion of the May 2001, July 2001, January 2005, April 2008, and April 2011 VA examiners that the Veteran does not experience PTSD as being the most probative medical evidence on the subject, as all of these opinions were based on a thorough review of all historical records and a thorough examination, and each report contains a detailed rationale for the examiner's conclusion that the Veteran does not have PTSD. The Board finds compelling, as noted above, that each of the five VA examiners separately arrived at the same conclusion-that the Veteran does not experience PTSD, and has not at any time during the appeal period. See Boggs v. West, 11 Vet. App. 334, 343 (1998). In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for an acquired psychiatric disorder other than mood disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to service connection for an acquired psychiatric disorder other than mood disorder is denied. ____________________________________________ THOMAS J. DANNAHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs