Citation Nr: 1323812 Decision Date: 07/25/13 Archive Date: 08/06/13 DOCKET NO. 05-11 856 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Virginia Girard-Brady, Attorney ATTORNEY FOR THE BOARD Timothy D. Rudy, Counsel INTRODUCTION The Veteran served on active duty from October 1975 to May 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2004 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma, which denied the Veteran's claim for a nervous disorder because no new and material evidence had been received to reopen the previously denied claim. The Veteran appealed this decision. In a July 2007 decision, the Board denied the claim for service connection for a psychiatric disability for lack of new and material evidence. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In September 2008, the Court remanded the claim to the Board pursuant to a Joint Motion for Partial Remand. In a May 2009 decision, the Board reopened the Veteran's claim for service connection for a psychiatric disorder and then remanded the claim in May 2009 and February 2011 for further evidentiary development. The following determination is based on review of the Veteran's claims file in addition to his Virtual VA "eFolder." FINDINGS OF FACT 1. The evidence on file includes a diagnosis of PTSD. 2. The evidence of record does not indicate that the Veteran's PTSD stressors have been corroborated to support his claim that he has PTSD related to his active military service. 3. The evidence of record does not show that any acquired psychiatric disorder other than PTSD, diagnosed as depression, was caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a psychiatric disorder, to include PTSD, have not been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310, 4.125 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION VCAA Before addressing the merits of the issue on appeal, the Board notes that VA has a duty to notify and a duty to assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. §§ 3.159, 3.326(a). Proper notice from VA must inform the claimant and his representative, if any, prior to the initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ) of any information and any medical or lay 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. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183, (2002). These notice requirements apply to all five elements of a service-connection claim (veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability). Dingess v. Nicholson, 19 Vet. App. 473 (2006). Information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded must be included. Id. Neither the Veteran nor his attorney has alleged prejudice with respect to notice, as is required. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009); Goodwin v. Peake, 22 Vet. App. 128 (2008); Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). None is found by the Board. Indeed, VA's duty to notify has been more than satisfied. The Veteran was notified via letters dated in February 2004, September 2009, and May 2012 of the criteria for establishing service connection for a psychiatric disorder, the evidence required in this regard, and his and VA's respective duties for obtaining evidence. He also was notified in the May 2012 letter of how VA determines disability ratings and effective dates, if service connection is awarded. That letter also notified the Veteran of the criteria for establishing service connection for PTSD due to personal trauma, the evidence required in this regard, and his and VA's respective duties for obtaining evidence. The Board notes that the Veteran did not receive complete VCAA notice before the initial adjudication by the AOJ of his claim in June 2004. Ideally, VCAA notice should be provided prior to an initial unfavorable decision on a claim by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II). If, however, for whatever reason it was not, or the notice provided was inadequate, this timing error can be effectively "cured" by providing any necessary VCAA notice and then going back and readjudicating the claim - such as in a statement of the case (SOC) or supplemental SOC (SSOC), such that the intended purpose of the notice is not frustrated and the veteran is given an opportunity to participate effectively in the adjudication of the claim. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007) (Mayfield IV); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). Such was done in this case. After all notices were sent to the Veteran, his claim currently on appeal was readjudicated in the SSOC dated in May 2013. As for the duty to assist, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. The Veteran's service treatment records as well as post-service VA treatment records have been obtained and considered. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. Also associated with the claims file were additional service personnel records, Social Security Administration (SSA) disability records, and written statements in support of his claim. The Veteran has not identified any additional, outstanding records that have not been requested or obtained. Neither the Veteran nor his attorney has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Further, a specific VA examination and opinion was obtained in August 2009 regarding the Veteran's claim for a psychiatric disorder, to include PTSD. 38 C.F.R. § 3.159(c) (4). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA examination and opinion obtained in this case is more than adequate, as it is predicated on a reading of the Veteran's claims file. The VA examiner considered all of the pertinent evidence of record, and provided a detailed rationale for the opinion stated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to this issue on appeal has been met. 38 C.F.R. § 3.159(c) (4). Additionally, the Board finds there has been substantial compliance with its March 2012 remand directives. The Board notes that the Court recently noted that "only substantial compliance with the terms of the Board's engagement letter would be required, not strict compliance." See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268) violation when the examiner made the ultimate determination required by the Board's remand). The record indicates that the Appeals Management Center (AMC) was directed in the remand to provide the Veteran with VA Form 21-0781a (Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Trauma) and such was marked as an enclosure with the May 2012 VCAA letter sent the Veteran. The Board notes that the Veteran and his attorney responded one month later with notice they had no further evidence or information to provide. In addition, an earlier remand had requested that the Veteran provide information to assist in determining the identity of two privates who witnessed one of his alleged in-service stressors. The Veteran attempted to do so in March 2011, but the U. S. Army and Joint Services Records Research Center (JSRRC) was unable to verify the incident. The Board notes that the RO has made repeated but unsuccessful efforts to attempt to corroborate the Veteran's two alleged in-service stressors and that in May 2013 the RO issued a formal finding of a lack of information required to corroborate the stressors associated with the Veteran's PTSD claim. The record indicates, however, that VA made reasonable efforts to obtain evidence from the Veteran regarding his alleged stressors and that such evidence was insufficient. The Court has held that VA's "duty to assist is not always a one-way street." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Based on the foregoing, the Board finds that the AMC substantially complied with the mandates of its remands. See Stegall, 11 Vet. App. 268 (finding that a remand by the Board confers on the Veteran the right to compliance with its remand orders). The Board concludes that all available records and medical evidence have been obtained in order to make an adequate determination as to this claim. Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Therefore, the Board finds that VA has complied with the duty-to-assist requirements. 38 U.S.C.A. § 5103A. Service Connection - Laws and Regulations Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in line of duty or for aggravation of preexisting injury suffered or disease contracted in line of duty. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303 (2012). VA regulations provide that where a veteran served 90 days or more of continuous, active military service during a period of war or after January 1, 1947, and certain chronic diseases, including a psychosis, become manifest to a degree of 10 percent within one year from date of termination of service, such disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309. In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). In this case, psychoses are a chronic disease listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a chronic disease in service or continuity of symptoms after service, the disease shall be presumed to have been incurred in service. For the showing of chronic disease in service, there are required a combination of manifestations sufficient to identify a 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). Generally, in order to prevail on the issue of service connection on the merits, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). The United States Court of Appeals for the Federal Circuit has held that a veteran seeking disability benefits must establish the existence of a disability and a connection between service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). Entitlement to service connection for PTSD also 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. The law provides that secondary service connection shall be awarded when a disability is "proximately due to or the result of a service-connected disease or injury." 38 C.F.R. § 3.310(a). See Libertine v. Brown, 9 Vet. App. 521, 522 (1996); Harder v. Brown, 5 Vet. App. 183, 187 (1993). Additional disability resulting from the aggravation of a non-service-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(a). Allen v. Brown, 7 Vet. App. 439, 448 (en banc). Establishing service connection on a secondary basis therefore requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service connected disability. When a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. Factual Background and Analysis The Veteran claims he has a psychiatric disorder to include PTSD as the result of service. He has been diagnosed with depression and anxiety in VA treatment records. As to the PTSD, in his written submissions he has offered two stressor events. He stated that one stressor event occurred in 1976 or 1977 when he and some others were in a bar near Fort Ord, California, and he witnessed the shooting of another patron there who was shot in the head. The Veteran said he was standing only a few feet away from the man who was shot. He stated that some of the victim's blood and skin splashed on him. He also stated that on another occasion in July 1976 he was beaten in the barracks at Fort Ord after being attacked by another soldier to whom he owed money and one of attacker's friends. The Veteran reported that he had to remain in his barracks for three days after he was beaten. The diagnostic criteria, including those related to stressors, set forth in the DSM-IV for mental disorders have been adopted by VA. 38 C.F.R. § 4.125. The DSM-IV provides two requirements to support a diagnosis of PTSD: (1) A person must have been "exposed to a traumatic event" in which "the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;" and (2) "the person's response [must have] involved intense fear, helplessness, or horror." DSM-IV at 209. See also Cohen v. Brown, 10 Vet. App. 128 (1997). These criteria are no longer based solely on usual experience and response but are individualized (geared to the specific individual's actual experience and response). The sufficiency of a stressor is a medical determination and is presumed by a medical diagnosis of PTSD. Id. The evidence necessary to establish the occurrence of a stressor during service to support a diagnosis of PTSD will vary depending upon whether the veteran engaged in "combat with the enemy" as established by official records. If VA determines that the veteran engaged in combat with the enemy and an alleged stressor is combat-related, then the veteran's lay testimony or statement is accepted as conclusive evidence of the stressor's occurrence and no further development or corroborative evidence is required providing that such testimony is found to be "satisfactory," i.e., credible, and "consistent with the circumstances, conditions, or hardships of service." See 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f); Dizoglio v. Brown, 9 Vet. App. 163, 164 (1996); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). For stressors unrelated to combat, credible supporting evidence is necessary in order to grant service connection. "Credible supporting evidence" of a noncombat stressor may be obtained from service records or other sources. Moreau v. Brown, 9 Vet. App. 389 (1996). The Court has held that the regulatory requirement for "credible supporting evidence" means that "the appellant's testimony, by itself, cannot, as a matter of law, establish the occurrence of a noncombat stressor." Dizoglio v. Brown, 9 Vet. App. 163 (1996). Until recently, a non-combat veteran's lay testimony, by itself, was typically not enough to establish the occurrence of a reported stressor. However, a recent regulatory change has eliminated the requirement for corroboration of a claimed in-service stressor if it is related to the veteran's fear of hostile military or terrorist activity. It is necessary that 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, provided that the claimed stressor is consistent with the places, types, and circumstances of the veteran's service. See 75 Fed. Reg. 39,843-39,852 (July 13, 2010). However, in this case there is no claim of fear of hostile military or terrorist activity or that the Veteran ever participated in combat. With respect to the Veteran's allegations of personal assault or trauma, the Board notes that there are special considerations for PTSD claims predicated on a personal assault. The pertinent regulation, 38 C.F.R. § 3.304(f)(5), provides that PTSD based on a personal assault in service permits evidence from sources other than the veteran's service records which may corroborate his or her account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. 38 C.F.R. § 3.304(f)(5) (2012). The M21-1MR also identifies alternative sources for developing evidence of personal assault, including private medical records, civilian police reports, reports from crisis intervention centers, testimonial statements from confidants such as family members, roommates, fellow service members, or clergy, and personal diaries or journals. M21-1MR, Part IV, Subpart ii, 1.D.17.g. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance, substance abuse, episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(5). VA will not deny a PTSD claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. In addition, VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f)(5). As previously noted in the VCAA section of this opinion, the Veteran received notice regarding a PTSD claim based on personal trauma in May 2012, but both he and his attorney reported they had no further evidence to provide. The Veteran's DD Form 214 reflects that he worked as a cannon crewman while in the Army, had no foreign or sea service, and received no medals or decorations suggesting participation in combat. Service personnel records show that the Veteran served at Fort Ord, after completing boot camp and advanced individual training, until his early discharge for alcohol/drug abuse. Service treatment records do not show complaints of, or treatment for, any psychiatric disorder. In fact, the Veteran was given a mental status evaluation in February 1977, shortly before his discharge, and the mental status evaluation showed normal results. His February 1977 discharge examination showed no psychiatric abnormalities. According to a September 1997 VA medical record, while the Veteran was being treated for substance abuse he denied a history of psychiatric or mental health treatment. He reported, however, that he attempted suicide once in the past by jumping off a highway bridge onto a travelled road but was not injured. He also said that he had been actively thinking about suicide if his current situation did not improve. However, the VA staff psychologist noted that the Veteran was otherwise oriented toward the future and listed an impression of a current alcohol and cocaine problem. Treatment for substance abuse in a residential/inpatient program was recommended. VA treatment records for the next several years reflect treatment for substance abuse, but do not reflect a PTSD diagnosis. A January 1998 VA medical record noted that the Veteran related he had been treated for depression and now was off his medication. Another January 1998 VA medical record indicated that the Veteran had earlier screened in the severe range of a depression test but that follow-up testing revealed a score well within normal limits and consistent with the absence of depressive symptomatology. The VA staff psychologist stated that no further formal assessment of depression was indicated and that abstinence was strongly recommended as the best way to prevent a relapse to depression. An April 2003 VA screening test for depression was normal. According to a January 2005 VA medical record the Veteran had a positive screening test for PTSD. A March 2006 VA mental health clinic record indicated that the Veteran's score on a test placed him on the lower end of the severe range of reported symptoms for depression. At that time he began attending depression management skills classes at VA. Records from the Social Security Administration (SSA) showed that an administrative law judge approved the Veteran's receipt of SSA disability benefits in a September 2006 decision for, in part, affective or mood disorders, an anxiety related disorder, and substance addiction as well as for several physical disorders. A November 2005 psychiatric review undertaken for SSA indicated that the Veteran had affective disorders, anxiety-related disorders, and substance abuse disorders. Anxiety was listed as the predominant disturbance, which included recurrent and intrusive recollections of a traumatic experience that was the source of marked distress. The consultant noted that the Veteran had a history of substance abuse in 1995 and had no history of mental health treatment. It was noted that mental health treatments now indicated mild depression, social avoidance and PTSD symptoms with no significant functional limitations. According to a March 2008 VA medical record the Veteran denied ever being treated or diagnosed with PTSD or hospitalized for treatment of a psychiatric or emotional problem. However, he admitted that he had had an experience so frightening, horrible, or upsetting that in the past month he had nightmares about it, tried hard not to think about it, and was easily startled. In May 2009, VA received typewritten correspondence from the Veteran's oldest brother. He stated that sometime during the Veteran's enlistment there appeared to be a change in the Veteran's demeanor and his physical and mental state. He stated that the person who enlisted in the service and who was later discharged were two different people. The Veteran was frequently sick and the family had to endure many challenges while the Veteran attempted to adjust from military to civilian life. The brother wrote that the Veteran appeared to suffer through some form of adjustment disorder after his discharge. He noted that after constant treatment and therapy the Veteran has made some adjustments that make him more functional and a family member once again. The Veteran underwent a VA mental examination in August 2009. He told the examiner that he began having polysubstance abuse problems following an incident in service when he witnessed a man at a bar being shot and killed. The Veteran claimed that he was sitting next to the man and reported having blood and brain matter sprayed on him. He also recalled being terrified that he also might be killed. Subsequently, he developed intrusive thoughts and nightmares about this traumatic event and began drinking excessively. His commanding officer then ordered him for treatment, but when it failed he was discharged. He admitted having problems functioning in the service which led to his alcohol/drug treatment. He said that since service he continued to have intrusive thoughts and dreams about the event. On mental status examination, the Veteran was diagnosed with PTSD, alcohol dependence in full remission, and polysubstance abuse dependence in full remission. The VA psychologist-examiner noted that the Veteran presented with a number of symptoms consistent with DSM-IV diagnostic criteria for PTSD and that the diagnosis was supported by the examination findings. She noted that the Veteran had been exposed to a traumatic event in which a man was shot and killed and blood and brain matter were sprayed on the Veteran while he was sitting next to the victim. She found it was more likely than not that the Veteran's PTSD was related to the bar shooting incident stressor and that his alcohol and polysubstance dependency was more likely than not secondary to the PTSD. The VA examiner also noted a long history of depression that was secondary to his PTSD symptoms and the consequences of his alcohol and drug dependence. No other mental disorders were found. A June 2010 VA medical record, as well as others, noted the Veteran had a past medical history of anxiety and depression. The problem list of the Veteran's medical disorders found in recent VA treatment records lists a recurrent, unspecified major depressive disorder as the only mental illness. June 2012 and September 2012 VA psychiatric records noted both a recurrent major depressive disorder and PTSD like symptoms as Axis I diagnoses. An August 2012 VA mental health record noted that the Veteran began group therapy for depression management. In November 2011, the JSRRC reported that it had researched the available Army historical records and was unable to document the Veteran's bar shooting stressor. JSRRC also reported that it was unable to provide full identification of a Private W. or a Private B., whom the Veteran had claimed in a March 2011 statement were witnesses to the bar shooting near Fort Ord. Later in November 2011, the JSRRC reported that it had researched the available Army historical records and was unable to document the barracks brawl stressor incident in which the Veteran claimed that he was assaulted by a Private Ivy. However, JSRRC indicated that there could be a criminal investigation filed on the incident and referred the RO to another records center. Subsequently, December 2011 correspondence from the United States Army Crimes Records Center stated there were no records of the July 1976 personal assault in the barracks at Fort Ord. Based upon the evidence of record, the Board finds that the preponderance of the evidence weighs against the claim for service connection for a psychiatric disorder, to include PTSD. It appears that the threshold requirement of a DSM-IV diagnosis of PTSD has been met in the August 2009 VA mental examination. The remaining question, therefore, is whether there is a corroborated inservice stressor or credible evidence the stressor occurred. Since the Board finds that there are no service department records indicating that the Veteran engaged in combat with the enemy, there must be credible supporting evidence of record that the alleged stressors actually occurred in order to warrant service connection. With regard to the question of a stressor, the Veteran's stressor statements and history as reported to medical professionals have been detailed herein, as noted above. There is no evidence in the case before the Board to confirm either of the Veteran's alleged in-service stressors. Even though the JSRRC attempted to corroborate both stressors, each is fundamentally vague and difficult to verify as the Veteran provided insufficient information about dates, individual identities or other information relating to his involvement with these reported stressors. See VBA's Adjudication Procedure Manual, M21-1MR (hereinafter "M21-MR"), Part IV.ii.1.D.15.a (attempt at corroboration not required where stressors are not capable of being documented), and 14.d. (noting that claimants must provide, at a minimum, a stressor that can be documented). Indeed, the claimant must provide, at a minimum, a stressor that can be documented, the location of where the incident occurred, the approximate date, and the unit of assignment. M21-1MR, Part IV.ii.1.D.14.d. Despite several efforts to verify the Veteran's reported two stressors, such verification has been unsuccessful. In addition, the file contains several memoranda by the RO constituting formal findings of lack of sufficiently detailed information to verify the Veteran's reported PTSD stressors. The May 2013 memorandum sets forth a brief history of these failed attempts. The medical diagnosis of PTSD on file, which appears in the August 2009 VA examination and is linked to one of the Veteran's claimed in-service stressors, does not corroborate that this bar shooting stressor actually occurred. The VA examiner failed to address the lack of corroborating medical or historical evidence of the Veteran's proximity to an off base bar shooting. The diagnosis found in the August 2009 VA examination is based solely on the Veteran's unsubstantiated assertions regarding what occurred in service. While the VA examiner, a VA psychologist, had access to the claims file, the Court has held on a number of occasions that a medical opinion premised upon an unsubstantiated account of a claimant is of no probative value. Swann v. Brown, 5 Vet. App. 229, 233 (1993) (generally observing that a medical opinion premised upon an unsubstantiated account is of no probative value, and does not serve to verify the occurrences described); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (the Board is not bound to accept a physician's opinion when it is based exclusively on the recitations of a claimant). See also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when there is factually accurate, fully articulated, and sound reasoning for the conclusion, not the mere fact that the claims file was reviewed). The Board is not bound to accept the Veteran's uncorroborated account of his experiences. Wood v. Derwinski, 1 Vet. App. 190 (1992); Swann, supra. The question of whether a specific event reported by a veteran as a stressor actually occurred is a question of fact for the Board to decide, involving, as it does, factors as much historical as psychological. Wilson v. Derwinski, 2 Vet. App. 614 (1992). In this case, as noted above, the available evidence simply does not corroborate the Veteran's claimed stressors, and thus does not support his claim. In the absence of a showing of combat with the enemy or evidence of a verifiable stressor, the Board concludes that the Veteran has failed to satisfy the criteria for service connection for PTSD. As the Veteran bases his claim on the reported stressors, service connection cannot be granted without corroboration of one of them, regardless of a current diagnosis of PTSD. The Board also notes that the Veteran completed and dated his PTSD stressor statement in July 2009, but that such was not received at VA until October 2009, or after the Veteran's August 2009 VA mental examination. According to the report of the August 2009 VA examination, the Veteran at no time mentioned his second stressor - the attack in the barracks by a fellow soldier to whom he owed money. As the JSRRC also has attempted without success to corroborate the barracks brawl, the Board finds that it would be unnecessary and futile to see whether the VA examiner now could tie the Veteran's diagnosed PTSD to this second stressor. The Veteran's attorney contends that this second personal assault stressor can be corroborated through the May 2009 correspondence of the Veteran's brother because the Veteran's brother documented the Veteran's personality changes after service. However, a review of the Veteran's brother's letter in question lacks any specifics, such as references to the Veteran's substance abuse or mental illness in service or in the immediate post-discharge period. It does not provide us with information on how the Veteran's mental state changed or what the nature was of his adjustment disorder to civilian life. Therefore, the Board finds that the brother's correspondence of May 2009 is much too vague, especially in view of the medical evidence of record showing the Veteran's substance abuse after service, to corroborate a personal assault in service. A fair reading of the letter supports the view that the Veteran's brother wrote the letter as a plea that disability assistance be granted his brother. A review of the service treatment records and service personnel records also fails to corroborate the Veteran's assertions that he was beaten while in service and had to remain in barracks for three days. Next, the Board notes that the available post-service treatment records indicate that the Veteran did not seek treatment for a psychiatric disorder for many years after service, and then when he did so he did not refer to an in-service assault. The barracks brawl is not found in the claims file until he completed his July 2009 PTSD questionnaire. The Board finds this weighs against the Veteran's credibility as such information would have been important in evaluating and treating his condition. Put another way, had an assault truly occurred, it would have benefited the Veteran to report such to his physician. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). Indeed, despite treatment for substance abuse and anxiety and depression before 2009, the Veteran did not mention the alleged attack in his barracks until the summer of 2009 and then failed to mention this personal trauma even to the August 2009 VA examiner. Further, the Board finds it incredible that if the Veteran had been assaulted as he claims he was during his period of active duty service, such would not have been mentioned to anyone until 2009, more than 30 years following service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (noting that it was proper to consider the veteran's entire medical history, including the lengthy period of absence of complaint with respect to the condition now raised). Moreover, weighing against the credibility of the Veteran's contentions is the fact that he applied for service connection for a nervous condition in 1997 and made no mention of any in-service beating at that time. Crucially, the Veteran was made aware that he could submit evidence in support of his personal trauma claim with such things as: police reports or medical treatment records for assault or rape, additional statements from individuals with whom he may have discussed the incident, or copies of correspondence he may have sent to close friends or relatives in which he related information about the incident. See May 2012 VCAA letter; see also 38 C.F.R. § 3.304(f)(5). The Board notes that the Veteran has not submitted any corroborating evidence outlined above. See 38 U.S.C.A. § 5107(a) (West 2002) (it is a claimant's responsibility to support a claim for VA benefits). Accordingly, the Board finds that, aside from evidence that the Veteran was discharged early from service for substance abuse, which may or may not be related to any beating the Veteran underwent in service, the existing evidence of record (both medical and historical) does not corroborate the Veteran's account of the claimed in-service assault. However, as noted above, the VA examiner tied the Veteran's PTSD to his bar shooting stressor and not to his barracks brawl stressor. Therefore, any further effort to corroborate the barracks brawl stressor or to tie the PTSD diagnosis to this stressor appears futile. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application and service connection for PTSD must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In addition, service connection for any other psychiatric diagnosis (other than PTSD) is not warranted in this case. As noted above, during post-service mental examinations and evaluations the Veteran was often diagnosed with some psychiatric disorder other than PTSD, such as depression or anxiety, although neither was listed on Axis I as a psychiatric diagnosis in the August 2009 VA examination. A review of the evidence of record does not demonstrate that the Veteran had a psychiatric disorder in service or that any psychiatric disorders other than PTSD are related to the Veteran's period of active service. His available service treatment records do not show any psychiatric problems in service and at that time of discharge in 1977 his psychiatric condition was found to be normal. The Veteran is competent to say that he felt depressed while in service and thereafter, but under the circumstances of this case such assertions are not competent or credible to show that he had a diagnosis of a psychiatric disability at such time when the medical evidence of record shows that he was not diagnosed at the earliest until the middle or late 1990s. Although the Board acknowledges that starting in 1998 VA medical records indicate that the Veteran was diagnosed with possible depression, this diagnosis was rendered more than 20 years after his separation from active service. Evidence of a prolonged period without medical complaint and the amount of time that elapsed since military service, can be considered as evidence against a claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board reiterates that the fact that the Veteran may have felt depressed in the intervening years does not indicate that he suffered from a chronic and clinically defined psychiatric disorder. Moreover, the Veteran has not submitted any competent medical evidence that any diagnosed psychiatric disorder is related to his military service or that he currently has been diagnosed with a psychiatric disorder that is related to military service. See Wray v. Brown, 7 Vet. App. 488, 492-93 (1995). A review of the competent evidence of record does not show that service connection is warranted in this case for any other psychiatric disorder. In order for the Veteran to be granted service connection for depression as secondary to PTSD, there must be evidence of a present disability. However, as explained in the discussion above, service connection is not warranted in this case for PTSD. Therefore, secondary service connection for depression as due to PTSD is not available in this case. 38 C.F.R. § 3.310(a); see Libertine v. Brown, 9 Vet. App. 521 (1996); Harder v. Brown, 5 Vet. App. 183 (1993). In sum, there is no competent or credible lay or medical evidence of psychiatric symptoms until many years after service. While the Veteran is competent to report symptomatology during service or in the interim, he does not have the requisite special medical knowledge necessary to render an opinion as to medical causation, or as to whether any feelings of depression represented a clinical psychiatric disorder. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). There is also no indication that the Veteran had a diagnosis of a psychiatric disorder based on some psychosis which had become manifested to a compensable degree during the first year following his discharge from service in 1977. Accordingly, entitlement to service connection for a psychiatric disorder other than PTSD on a presumptive basis also is not warranted in this case. See 38 C.F.R. §§ 3.307, 3.309 (2012). Given the absence of competent evidence in support of the Veteran's claim for service connection for a psychiatric disorder other than PTSD, for the Board to conclude that the Veteran has a psychiatric disorder other than PTSD that was incurred as a result of his period of active service would be speculation, and the law provides that service connection may not be based on a resort to speculation or remote possibility. 38 C.F.R. § 3.102; Obert v. Brown, 5 Vet. App. 30, 33 (1993). The Board has also carefully considered the benefit of the doubt rule, but as the preponderance of the evidence is against the claim, the evidence is not in equipoise, and there is no basis to apply it. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. ORDER Service connection for a psychiatric disorder, to include PTSD, is denied. ____________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs