Citation Nr: 1324029 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 12-27 849 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Anchorage, Alaska THE ISSUES 1. Entitlement to service connection for an ear disorder other than hearing loss or tinnitus. 2. Entitlement to service connection for a respiratory disorder, including as due to asbestos exposure. 3. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. Fleming, Counsel INTRODUCTION The Veteran had active military service from May 1951 to April 1955. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from an August 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Anchorage, Alaska, in which the RO denied the claims on appeal. In May 2013, the Veteran withdrew his prior request for a Board hearing, in writing. 38 C.F.R. § 20.704 (2012). The Board notes that the United States Court of Appeals for Veterans Claims (Court) has recently has held that, although an appellant's claim identified only a single diagnosed disorder, it cannot be a claim limited only to that diagnosis, but must rather be considered a claim for any disability that may reasonably be encompassed by several factors-including the claimant's description of the claim, the symptoms the claimant describes, and the information the claimant submits or that VA obtains in support of the claim. The Court reasoned that the appellant did not file a claim to receive benefits only for a particular diagnosis, but for the affliction (symptoms) his condition, however described, causes him. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Here, although the Veteran filed his claim seeking service connection for PTSD specifically, the Board notes that the Veteran has not been diagnosed with PTSD but has been assigned a diagnosis of generalized anxiety disorder. The Board thus finds that, pursuant to Clemons, supra, the Veteran's service connection claim is more accurately classified as one for any acquired psychiatric disorder, to include PTSD. See Clemons, 23 Vet. App. 1 (2009). Please note that this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The Veteran does not have a chronic ear disability other than hearing loss and tinnitus that had its clinical onset in service or is otherwise related to active duty. 2. The Veteran does not have a respiratory disability, to include asbestosis or any other asbestos-related disease that had its clinical onset in service or is otherwise related to active duty.. 3. The Veteran does not have PTSD; an acquired psychiatric disorder other than PTSD, to include generalized anxiety disorder was not manifested during service and is not otherwise related to the Veteran's active service. CONCLUSIONS OF LAW 1. An ear disorder other than hearing loss and tinnitus was not incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303 (2012). 2. A respiratory disorder was not incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303 (2012). 3. An acquired psychiatric disorder, to include PTSD, was not incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 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 March 2011 and June 2011, which predated the August 2011 rating decision. See id. The VCAA letters notified the Veteran of what information and evidence is needed to substantiate his claims 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 claims, 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. 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 also contains examinations requested by VA performed in June 2012. The Board finds that the June 2012 VA examination reports are thorough and contain sufficient information to decide the issues 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). In addition, 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). With regard to arguments raised as to asbestos exposure, there is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary promulgated any regulations in regard to such claims. However, VA has issued a circular on asbestos-related diseases. DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988) (DVB Circular), provides guidelines for considering compensation claims based on exposure to asbestos. The information and instructions from the DVB Circular have been included in a VA Adjudication Procedure Manual, M21-1MR, Part IV, Subpart ii, Chap. 1, Sec. H, Para. 29, entitled "Developing Claims for Service Connection for Asbestos-Related Diseases," and Part IV, Subpart ii, Chap. 2, Sec. C, Para. 9, entitled "Service Connection for Disabilities Resulting from Exposure to Asbestos." The Court has held that VA must analyze an appellant's claim of entitlement to service connection for asbestosis or asbestos-related disabilities under the administrative protocols under these guidelines. Ennis v. Brown, 4 Vet. App, 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). The guidelines provide that the latency period for asbestos-related diseases varies from 10-45 years or more between first exposure and development of disease. An asbestos-related disease can develop from brief exposure to asbestos or as a bystander. The guidelines identify the nature of some asbestos-related diseases. The most common disease is interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce pleural effusions and fibrosis, pleural plaques, mesotheliomas of the pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. The Court has further held that in adjudicating asbestos-related claims, it must be determined whether development procedures applicable to such claims have been followed. See Ashford v. Brown, 10 Vet. App. 120 (1997). The Manual guidelines provide, in part, that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal disease; that rating specialists are to develop any evidence of asbestos exposure before, during and after service; and that a determination must be made as to whether there is a relationship between asbestos exposure and the claimed disease, keeping in mind the latency period and exposure information. The Veteran asserts that he has an ear disorder other than hearing loss or tinnitus that is related to his time in service. He also contends that he was exposed to asbestos during service while serving aboard the USS Brush. He has stated that he was a machinist and often breathed in asbestos fibers while working on board ship. Upon review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding that the Veteran has an ear disorder other than hearing loss or tinnitus. Similarly, the Board finds that the preponderance of the evidence is against a finding that the Veteran currently experiences a respiratory disorder. In that connection, the Board notes, first, that the Veteran's service treatment records are silent as to any complaints or diagnoses of respiratory problems, although he was seen on multiple occasions for treatment for "fungus" and otitis media. However, he was noted to have normal ears and a normal respiratory system at his April 1955 separation medical examination. Post-service treatment records are silent as to any complaints of ear problems other than hearing loss and tinnitus, for which the Veteran is currently in receipt of service connection. Post-service records document that the Veteran was treated for pneumonia in January 2011 and has been seen on occasion for complaints of cough and shortness of breath, which has been diagnosed as acute bronchitis and acute flu syndrome. VA treatment records document that the Veteran underwent radiological examination of his chest in April 2001; at that time, "asbestosis (exposure in Navy)" was noted in his chart. A similar notation has remained in his treatment records since the initial April 2001 evaluation. In addition, report of a March 2004 chest x-ray showed findings of pleural density and pleural thickening. However, no diagnosis was assigned at that time. Results of a May 2009 CT scan of the Veteran's chest showed pleural plaques in his lungs that were noted to be "suspect" for asbestosis; however, no firm diagnosis was assigned at that time, and at a private chest x-ray in December 2010 revealed no lung disease. Similarly, a CT scan of the Veteran's chest conducted by VA treatment providers in December 2010 showed pleural plaques that were "suggesting asbestos related pleural disease," but no diagnosis was assigned at that time. In June 2012, the Veteran underwent VA examinations concerning his claims for ear and respiratory disorders. The ear examiner noted the Veteran's in-service treatments for "fungus" of the ears and otitis media but noted that the Veteran denied having experienced any post-service ear problems other than hearing loss and tinnitus and some occasional itching when his hearing aids were in. Physical examination was normal, and the examiner found that the Veteran did not experience any ear disorder other than hearing loss and tinnitus. The Veteran has similarly not submitted any post-service medical evidence reflecting diagnoses of an ear disability other than hearing loss and tinnitus. The Veteran also underwent VA examination in June 2012 concerning his claimed respiratory disorder. At that time, he complained of having experienced acute episodes of coughing and shortness of breath, which he attributed to spending winters living by a river in Arizona, as well as a bout of pneumonia in 2011. The examiner acknowledged the radiological and CT studies showing that the Veteran currently has pleural plaques in his lungs but noted that the plaques confirm only that the Veteran has been exposed to asbestos, not that he currently has a diagnosable disease. The examiner explained that pulmonary plaques are not a disease process but are instead merely evidence of past asbestos exposure; thus, the "suspect asbestosis" note in the Veteran's medical history is not a diagnosis but merely an "alert to the clinician that these plaques are markers/risk factors for asbestosis," should the Veteran develop an active disease process in the future. Asbestosis can be diagnosed only with a finding of pulmonary fibrosis by biopsy or CT scan, and as no such fibrosis has been shown on the Veteran's multiple CT scans, the examiner reasoned, there is no evidence of current asbestosis, nor is there compelling reason to subject him to an "invasive" procedure like biopsy. For the purposes of this decision, the Board assumes, without conceding that the Veteran was exposed to asbestos in service. However, there is no competent evidence that the Veteran has a disability manifested by asbestos exposure, to include asbestosis. As detailed above, in order for there to be a clinical diagnosis of asbestosis, one of the requirements is radiographic evidence of parenchymal disease. The Veteran, however, has not submitted any medical evidence that contains a diagnosis of a specific disease manifested by asbestos exposure. As explained by the June 2012 VA examiner, the presence of pleural plaques does not equate to a finding of asbestosis or any respiratory disease process, and no radiological or CT studies have shown active cardiopulmonary disease. The Veteran has not been diagnosed with any chronic respiratory disorder. His acute respiratory problems, including pneumonia, have not been shown to be related to service or any incident therein. The Board finds that there is no radiographic evidence of an asbestos-related disability, or any evidence that the Veteran currently experiences any respiratory or ear disorder that can be related to active service. In the absence of proof of a current ear disorder other than hearing loss and tinnitus or of a current respiratory disorder, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. Brammer, 3 Vet. App. at 225. In the absence of any competent evidence of a current ear disorder other than hearing loss and tinnitus or a current respiratory disorder, the Board must conclude the Veteran does not currently suffer from such disabilities. Without competent evidence of a current ear disorder other than hearing loss and tinnitus or of a current respiratory disorder due to disease or injury, the Board must deny the Veteran's claims. See Degmetich v. Brown, 104 F.3d 1328, 1333 (1997) (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). The Board has considered the Veteran's contention that he has an ear disorder other than hearing loss or tinnitus and a respiratory disorder due to in-service exposure to asbestos. In adjudicating these claims, 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 witness's personal knowledge. See also 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). In this capacity, the Board finds that the Veteran is competent to attest to his symptomatology associated with his ears and respiratory system, and the Board finds his assertions of having experienced occasional illnesses and problems with his breathing to be credible. The Veteran, however, is not competent to diagnose respiratory pathology, as he does not have the requisite medical expertise. As discussed, the June 2012 examination reports are negative for objective findings of chronic disabilities of the respiratory system or of the ear (other than hearing loss or tinnitus). Even assuming the Veteran's exposure to asbestos during his service on the USS Brush, the claim of service connection for a respiratory disorder still fails, as the Veteran has not submitted medical evidence of a disability manifested by asbestos exposure, to include asbestosis, or of any other chronic respiratory disorder. The Veteran's contentions of chronic disabilities are outweighed by the objective clinical findings and conclusions made by medical professionals. Further, the Board points out that the Veteran himself denied experiencing any chronic ear problems when asked to describe his complaints by the June 2012 VA examiner. Absent a showing of ear or respiratory pathology, service connection for such disability cannot be granted. Thus, the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine does not apply, and the claims of service connection for an ear disorder other than hearing loss and tinnitus and a respiratory disorder must be denied. See Gilbert v. Derwinski, 1 Vet. App 49 (1990). Turning to the Veteran's claim for service connection for an acquired psychiatric disorder, to include PTSD, the Board notes that 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. Regarding the presence of his claimed stressors, the Board notes that the Veteran served on board the USS Brush, and records confirm that the ship was fired upon on multiple occasions in 1953, while he was on board the ship. Thus, the Board finds that the Veteran experienced "fear of hostile military or terrorist activity" as considered by § 3.304(f)(3). Regarding diagnosis of the Veteran's claimed psychiatric disorder, the Board notes initially that service treatment records do not reflect the presence of a chronic psychiatric disability. VA post-service treatment records reflect that he was seen on several occasions, including in August 2009 and again in June 2011, for what has been variously identified as "social/situational stress" and generalized anxiety disorder. In addition, he returned a positive PTSD screen during an April 2011 treatment visit, but no diagnosis of PTSD has ever been assigned. Further, in connection with the instant claim, the Veteran underwent VA psychiatric examination in June 2012. At that time, the Veteran reported that he had suffered from severe dyslexia all his life. He also reported having been fired upon while on board the USS Brush, which he cited as his in-service stressor. The examiner found that this stressor would be sufficient to support a diagnosis of PTSD but concluded that the Veteran did not meet the DSM-IV criteria to warrant a diagnosis of PTSD. Rather, the examiner diagnosed the Veteran with generalized anxiety disorder, which he found less likely than not to be etiologically linked to his time in service. The generalized anxiety disorder is instead linked to the Veteran's lifelong battle with a learning disorder, the examiner concluded. Upon consideration of the above evidence, the Board finds that the preponderance of the evidence is against the Veteran's claim of service connection for an acquired psychiatric disorder, to include PTSD. The Board concedes that VA examination confirms that the Veteran currently suffers from generalized anxiety disorder. The Board concludes, however, that the greater weight of the evidence is against the claim. As an initial matter, the Board notes that the evidence establishes that the Veteran does not experience PTSD. In that connection, the Board first notes that the Veteran contends that he was exposed to an in-service stressor, in the form of his ship taking incoming fire from enemy combatants, that led to PTSD. This stressor has been verified by military records documenting that the USS Brush was fired on in May 1953, while the Veteran was on board. However, the Board notes that in order for the Veteran's claim of service connection for PTSD to be granted, the record would have to contain a clear diagnosis of PTSD. As discussed above, the June 2012 VA examiner considered the Veteran's contentions and results of psychological testing as well as the available medical evidence-including his positive PTSD screen in April 2011-in specifically concluding that it was less likely than not that the Veteran experiences PTSD. In so concluding, the examiner found that results from the Veteran's psychiatric testing did not support a diagnosis of PTSD and that his symptoms were more likely explained by a different diagnosis of generalized anxiety disorder that is not linked to service. The examiner offered a clear explanation for his opinion, relying on the Veteran's medical history and his medical expertise, as well as current medical knowledge, in concluding that the Veteran does not in fact have PTSD. There is no evidence in the record to contradict this finding; despite the Veteran's having returned a positive PTSD screen in April 2011, no diagnosis of PTSD has ever been assigned, by private or VA treatment providers. Regarding the Veteran's claim for service connection for an acquired psychiatric disorder other than PTSD, the Board notes that the Veteran's service treatment records are completely silent as to complaints of or treatment for psychiatric complaints. His April 1955 separation medical examination revealed findings of no psychiatric abnormalities. Further, the June 2012 VA examiner found no link between any current disability and military service. Furthermore, the Board finds persuasive the absence of probative medical evidence to support a finding of a nexus between the Veteran's service and his current generalized anxiety disorder. In that connection, the Board notes that the medical opinion submitted by the June 2012 VA examiner specifically addressed the question but did not attribute the Veteran's current generalized anxiety disorder to active duty. In so finding, the psychologist considered the positive PTSD screen and the Veteran's contentions but nevertheless concluded that he experiences a generalized anxiety disorder (not PTSD) that is due not to his dyslexia (not his period of service). The Board therefore gives significant weight to this opinion. The June 2012 VA examiner provided a report that considered the Veteran's history, set out his findings in detail, and contained clearly articulated reasons for his conclusions. Thus, the Board relies upon this opinion in making its determination. As discussed above, the June 2012 VA examination specifically addressed causation, clearly indicating that the Veteran's current generalized anxiety disorder is not likely related to his time in service. Additionally, the examiner offered a clear and well-reasoned explanation for his opinion that the evidence contained in the Veteran's claims file, including his own statements to the VA medical examiner and to other VA personnel, supported a conclusion that the current generalized anxiety disorder is not likely related to service, relying on the examination report and his medical expertise as well as medical knowledge in concluding that any such etiological link was doubtful. The Veteran has contended on his own behalf that he has an acquired psychiatric disorder, to include PTSD, that is related to his service. The Board has considered the Veteran's contention that a relationship exists between his psychiatric disorder 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 or any other acquired psychiatric disorder 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 VA examiner, who is a mental health professional, took into consideration all the relevant facts in providing his opinions, to include the Veteran's reported in-service stressors and the current nature of his psychiatric disorder. Importantly, the Board notes that this opinion is uncontradicted by any other medical evidence of record. Therefore, the Board accords greater probative weight to the VA examiner's opinions rather than to the Veteran's 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, or any other psychiatric disorder, 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, the VA examiner did not diagnose PTSD and found that his generalized anxiety disorder is not linked to service. The Board accepts the opinion of the VA examiner that the Veteran does not experience PTSD as being the most probative medical evidence on the subject, as the opinion is based on a thorough review of all historical records and a thorough examination, and the report contains a detailed rationale for the examiner's conclusion that the Veteran does not have PTSD and that his generalized anxiety disorder is not linked to service. The Board finds compelling, as noted above, the fact that this opinion is not contradicted by any medical evidence of record. 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. 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 ear disorder other than hearing loss or tinnitus is denied. Entitlement to service connection for a respiratory disorder, including as due to asbestos exposure, is denied. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, is denied. ____________________________________________ THOMAS J. DANNAHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs