Citation Nr: 1324036 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 10-06 029 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for bilateral hearing loss, for accrued benefits purposes. 2. Entitlement to service connection for tinnitus, for accrued benefits purposes. 3. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) (claimed as lung condition and difficulty breathing) as a result of exposure to herbicides, for accrued benefits purposes. 4. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), depressive disorder, and anxiety, for accrued benefits purposes. REPRESENTATION Appellant represented by: Tennessee Department of Veterans Affairs ATTORNEY FOR THE BOARD Catherine Cykowski, Counsel INTRODUCTION The Veteran had active duty service from April 1967 to October 1968 and reserve service from November 1965 to April 1967. The Veteran died in February 2010. The appellant is the surviving spouse of the Veteran, has substituted for the Veteran, and is pursuing his claims as an accrued benefits claimant. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The appellant resides in the jurisdiction of the Nashville, Tennessee, RO. Although the Veteran's November 2008 claim specifically claimed only service connection for PTSD, other psychiatric disorders have been raised by the record. In Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) held that the scope of a mental health disability claim includes any mental disorder that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record. In consideration of this holding and the other diagnoses of record (anxiety and depressive disorder), the Board has recharacterized the claim as reflected on the title page. On April 23, 2010, the appellant filed a motion to substitute for the deceased Veteran's claim, which motion was within one year of his death. In an April 2012 letter, the RO advised the appellant that the appeal would be processed with her as the substitute claimant (38 U.S.C.A. § 5121A) for the Veteran's appeal. The Board finds that the appellant's motion to substitute and the RO's handling of the claim were proper and that the appellant is an accrued benefits claimant pursuing those benefits that the Veteran had been seeking at the time of his death in February 2010. The issues of entitlement to service connection for bilateral hearing loss and service connection for tinnitus are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran did not sustain an injury or disease of the lungs in service. 2. The Veteran's COPD was not causally or etiologically related to service. 3. The Veteran did not sustain a psychiatric injury or disease during service. 4. The Veteran did not have PTSD. 5. During his lifetime, the Veteran was diagnosed with depressive disorder and anxiety. 6. Depressive disorder and anxiety were not related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for COPD, for accrued benefits purposes, have not been met. 38 U.S.C.A. §§ 1101, 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 2. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, an anxiety disorder, and depressive disorder, for accrued benefits purposes, have not been met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.9 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.326(a) (2012). The notice requirements of VCAA require VA to notify the claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. The Board notes that a "fourth element" of the notice requirement requesting the claimant to provide any evidence in the claimant's possession that pertains to the claim was removed from the language of 38 C.F.R. § 3.159(b)(1) . See 73 Fed. Reg. 23,353-356 (April 30, 2008). The United States Court of Appeals for Veterans Claims (Court) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. A November 2008 letter provided notice of the evidence required to substantiate the claims for service connection for PTSD and difficulty breathing. This letter notified the Veteran of what information and evidence must be submitted by the Veteran, and what evidence VA would obtain. The November 2008 letter included provisions for disability ratings and effective dates. A November 2011 letter advised the appellant of the information and evidence required to substantiate a claim for service connection for accrued benefits purposes, and advised her what information and evidence must be submitted by the appellant, and what evidence VA would obtain. Because this is a case in which the appellant substituted for the Veteran, the valid VCAA notice was only required to be provided to the Veteran for the issues that are on appeal. See VBA Fast Letter 10-30 (Aug. 10, 2010) (Veterans Benefit Administration (VBA) has indicated that a new VCAA notice letter will not be provided to an individual requesting substitution if an adequate VCAA notice letter was previously sent to the original claimant). The notice included provisions for disability ratings and for the effective date of the claims. With regard to the duty to assist, the Board is also satisfied VA has made reasonable efforts to obtain relevant records and evidence, and has provided VA examinations. The information and evidence that has been associated with the claims file includes the Veteran's service treatment records, post-service VA treatment records and private treatment records, and the Veteran's statements. A VA medical opinion regarding acquired psychiatric disorders was obtained in June 2012. To that end, 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 VA medical opinion considered all the pertinent evidence of record, including a review of the claims file and the Veteran's medical history. A VA medical opinion is not necessary to decide the claims for service connection for COPD. The weight of the evidence demonstrates that the Veteran did not sustain a lung injury or disease in service or otherwise show in-service symptoms of a respiratory disorder. A VA examination is not required as there is no reasonable possibility that a VA examination or opinion could aid in substantiating the claim for service connection for COPD. See 38 U.S.C.A. § 5103A(d). See also Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010) (holding that where the evidence has failed to establish an in-service injury, disease, or event, VA is not obligated to provide a medical examination). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination with respect to the issues on appeal has been met. 38 C.F.R. § 3.159(c)(4). For these reasons, the Board finds that VA has fulfilled the duties to notify and assist. Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship of nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). COPD and PTSD are not "chronic diseases" listed under § 3.309(a); therefore, 38 C.F.R. § 3.303(b) does not apply to the claims for service connection for COPD, and PTSD. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In rendering a decision on appeal the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." See Layno, 6 Vet. App. at 469; 38 C.F.R. § 3.159(a)(2). The Court has emphasized that 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, 21 Vet. App. 303; Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Service Connection for COPD The appellant asserts that the Veteran visited Vietnam during service and was exposed to Agent Orange. The appellant asserts that the Veteran's COPD was related to Agent Orange exposure. VA treatment records reflect that the Veteran contended that COPD was related to chemicals that were onboard the USS Mauna Loa. The Veteran did not specify what chemicals were carried aboard the USS Mauna Loa. After reviewing all the lay and medical evidence, including the Veteran's and appellant's statements and testimony asserting service in Vietnam and exposure to herbicides in service, the Board finds that the weight of the evidence demonstrates that the Veteran did not have confirmed duty or visitation in the Republic of Vietnam or confirmed exposure to an herbicide agent in service. The DD Form 214 shows that the Veteran served in the Navy aboard the USS Mauna Loa, was a seaman, and was trained in cargo handling. The Veteran's awards included the National Defense Service Medal, Vietnam Service Medal with one Bronze Star, and the Republic of Vietnam Campaign Medal. In a memorandum dated in November 2012, the RO noted that the information required to corroborate Agent Orange exposure described by the Veteran was insufficient to send to the U.S. Army and Joint Services Records Research Center (JSRRC) and/or insufficient to allow for meaningful research of Marine Corps of National Archives and Records Administration. The memo noted that the JSRRC Agent Orange website was reviewed and showed that the ship the Veteran was attached to was not listed as a ship to which Agent Orange exposure had been conceded. The memorandum indicated that JSRRC determined that the USS Mauna Loa was in the official waters of the Republic of Vietnam during multiple periods from November 1967 through April 1968. The memo indicated that the Mauna Loa performed fleet supply duties, and there was no evidence that the ship ever docked in Vietnam. The record does not show that the Veteran's service involved duty or visitation in the Republic of Vietnam. See 38 C.F.R. § 3.307(a)(6)(iii)(2012); Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008). Therefore, based upon the information of record, the Board finds that the Veteran's exposure to herbicides may not be presumed. See 38 C.F.R. § 3.307(a)(6)(iii) (2012) (a veteran who served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent). Accordingly, the Board finds that it is not necessary to consider whether the Veteran's COPD was related to Agent Orange exposure. Therefore, the Board will consider the claim only on a direct basis to service. The Board finds that the weight of the evidence demonstrates that the Veteran did not sustain an injury or disease of the lungs in service. The record does not support a finding that the Veteran was exposed to chemicals during service. There is no documentation of exposure to hazardous chemicals, in personnel records or elsewhere. The Veteran's contentions of chemical exposure, absent any supporting evidence, are not sufficient to establish that such exposure occurred. Bardwell, 24 Vet. App. at 40 (holding that a layperson's assertions indicating exposure to gases or chemicals during service are not sufficient evidence alone to establish that such an event actually occurred during service). Accordingly, the Board concludes that an event of chemical exposure is not demonstrated. The report of the reserve enlistment examination, dated in November 1965, reflects that the Veteran reported a history childhood asthma and bronchitis. A November 1965 statement from a physician at the Naval Reserve Training Center indicated that the Veteran had a history of childhood asthma but had no evidence of asthma on examination. An October 1966 report of medical history reflects that the Veteran reported a history of hay fever. Service treatment records dated from April 1967 to September 1968 do not reflect any complaints, findings, or diagnoses of a lung disorder. The service separation examination, dated in September 1968, noted a normal clinical evaluation of the lungs and chest. The Board finds that COPD was not incurred in service, but had its onset decades after service separation in 2001, and has not been related by competent opinion to service. A post-service diagnosis of COPD is initially shown in private medical records dated in 2001. The post-service treatment (medical) records do not provide any medical opinions linking COPD to service. Additionally, because the record does not show respiratory injury, disease, or even symptoms of COPD or a breathing disorder in service, there is no factual basis for the Board to seek an additional nexus opinion, or upon which a medical professional could relate the Veteran's post-service COPD to service. Bardwell at 40. Accordingly, direct service connection for COPD is not established. The Board has considered the appellant's lay statements, in which she has asserted that the Veteran's COPD was related to service, including Agent Orange exposure in service. The appellant does not contend that the Veteran had COPD in service or that COPD was related to any event of service other than the alleged Agent Orange exposure. Based on the evidence of record, the weight of the competent and credible evidence demonstrates no relationship between the Veteran's COPD and active military service. For these reasons, the Board finds that a preponderance of the evidence is against the claim for service connection for COPD, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Service Connection for PTSD Service connection for PTSD requires: medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (2012) (conforming to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)); 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. 38 C.F.R. § 3.304(f) (2012). The applicable regulation requires that the in-service stressor or traumatic event involve actual or threatened death, serious injury, or a threat to the physical integrity of self or others and the person's response involve intense fear, helplessness, or horror. See DSM-IV § 309.81 (4th ed. 1994). In adjudicating a claim for service connection for PTSD, the evidence necessary to establish the incurrence of a stressor during service to support a claim of entitlement to service connection for PTSD will vary depending on whether or not the Veteran was "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60, 66 (1993). If it is determined through military citation or other supportive evidence that a veteran engaged in combat with the enemy, and the claimed stressors are related to combat, a veteran's lay testimony regarding the reported stressor must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary, provided that the testimony is found to be satisfactory, that is, not contradicted by service records, and "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C.A. § 1154(b) (West 2002); 38 C.F.R. § 3.304(d),(f); Doran v. Brown, 6 Vet. App. 283, 289 (1994). To gain the benefit of a relaxed standard for proof of service incurrence of an injury or disease, 38 U.S.C.A. § 1154(b) requires that a veteran have actually participated in combat with the enemy. See VAOPGCPREC 12-99. If it is determined that a veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, a veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. In such cases, the record must contain service records or other corroborative evidence which substantiates or verifies a veteran's testimony or statements as to the occurrence of the claimed stressor. See Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). Effective July 13, 2010, VA amended 38 C.F.R. § 3.304(f) by liberalizing, in certain circumstances, the evidentiary standards for establishing the occurrence of an in-service stressor for non-combat Veterans. See 75 Fed. Reg. 39,843 -39,852 (effective July 13, 2010). Previously, VA was required to undertake extensive development to determine whether a non-combat Veteran actually experienced the claimed in-service stressor and lay testimony, by itself, was not sufficient to establish the occurrence of the alleged stressor. Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). Instead, credible supporting evidence of a corroborated in-service stressor was required. Credible supporting evidence was not limited to service department records, but could be from any source. See YR v. West, 11 Vet. App. 393, 397 (1998); see also Moreau v. Brown, 9 Vet. App. 389, 395 (1996). Further, credible supporting evidence of the actual occurrence of an in-service stressor could not consist solely of after-the-fact medical nexus evidence. See Moreau, 9 Vet. App. at 396. The amended version of 38 C.F.R. § 3.304(f)(3) (2012) eliminated the need for stressor corroboration in circumstances in which the service member's claimed in-service stressor is related to "fear of hostile military or terrorist activity." Specifically, the amended version of 38 C.F.R. § 3.304(f)(3) states: 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 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. During his lifetime, the Veteran asserted that PTSD was related to a surgery he had during service when something was removed from his foot without anesthesia and to being onboard a ship that carried ammunition. In this case, the Veteran did not specifically allege that he engaged in combat, and there is no objective evidence that the Veteran engaged in combat with the enemy. The Veteran is not shown to be in receipt of any military citations indicative of combat service nor otherwise shown through available service records to have had combat service as contemplated by 38 U.S.C.A. § 1154(b). For these reasons, the Board concludes that the presumption afforded combat veterans under 38 U.S.C.A. § 1154(b) is not applicable. The Board finds that the weight of the evidence does not establish a diagnosis of PTSD. VA treatment records dated in November 2008 reflect a diagnosis of PTSD. The November 2008 treatment record reflects that the Veteran reported recurrent, intrusive recollections of war trauma resulting in both psychological and physiological reactivity. The Veteran reported that he was aboard a ship which hauled ammunition to various parts of Vietnam. The Veteran reported that he realized he was sitting on a "floating powder keg." The Veteran also reported a trauma which occurred when he had something removed from his foot without anesthesia. The Veteran reported flashbacks of being on an operating table. A VA counselor diagnosed PTSD and depression, not otherwise specified. The diagnosis of PTSD in November 2008 does not meet the criteria for a diagnosis according to DSM-IV, as the VA counselor did not explain what symptoms reported by the Veteran met each category of criteria and did not explain how the Veteran's symptoms met the criteria for a PTSD diagnosis. A March 2009 VA outpatient treatment record reflects a diagnosis of PTSD. The March 2009 VA diagnosis does not satisfy the criteria for a PTSD diagnosis under DSM-IV, as the psychiatrist did not identify the stressor upon which the diagnosis of PTSD was based, did not indicate what criteria were met in each category for a diagnosis of PTSD, and did not explain how the Veteran's symptoms met the criteria for a PTSD diagnosis. The Board finds that the November 2008 VA and March 2009 treatment records do not establish a diagnosis of PTSD in accordance with the DSM-IV criteria. The Board acknowledges that, if a veteran has received a diagnosis of PTSD from a competent medical professional, VA must assume that the diagnosis was made in accordance with the appropriate psychiatric criteria in regard to the adequacy of the symptomatology and the sufficiency of the stressor. Cohen v. Brown, 10 Vet. App. 128, 153 (1997). VA can only reject such a diagnosis on a finding that the preponderance of the evidence is against (1) the PTSD diagnosis, (2) the occurrence of the in-service stressor, or (3) the connection of the current condition to the in-service stressor. The adequacy of a stressor, sufficiency of symptomatology, and diagnosis are all medical determinations. Cohen, 10 Vet. App. at 143-44. The preponderance of the evidence is against a finding of currently diagnosed disability of PTSD because the diagnoses did not meet DSM-IV criteria. The preponderance of the evidence is against the adequacy of the reported stressors of having an object removed from the foot and being aboard a ship that delivered ammunition. In June 2012, a VA medical psychologist opined that those stressors were not sufficient to support a diagnosis of PTSD. The evidence weighing against a diagnosis of PTSD includes a report of a June 2012 VA medical opinion. The June 2012 VA examiner indicated that the Veteran's psychotherapy notes did not indicate concerns with PTSD symptoms but indicated more day to day concerns, such as marital problems, financial stress, and medical concerns. The VA examiner indicated that, even if the Veteran had a confirmed stressor, it does not appear that the symptoms were the cause of his anxiety and depression. The VA examiner opined that the evidence suggests that, while war is a life-changing experience, it does not appear that his reported symptoms were of the intensity of frequency that would suggest an active PTSD diagnosis. The VA examiner opined that his symptoms were more likely related to his ongoing marital problems, the death of his grandson, financial distress, and life-threatening medical problems. The June 2012 VA examiner opined that the stressor of having something removed from his foot without anesthesia is not sufficient for a PTSD diagnosis. The VA examiner opined that being on a ship that delivered ammunition is also insufficient to support a PTSD diagnosis. The VA examiner opined that it is also unlikely that either or both of these would cause any anxiety lasting 40 years. The VA examiner explained that, even those with severe PTSD symptoms usually report some remittance in symptoms after many years. In this case, there are conflicting medical opinions as to whether the Veteran had PTSD. The Board finds the report of the June 2012 VA examiner to be more probative than the VA outpatient treatment records with regard to whether the Veteran had PTSD. The June 2012 VA examination considered the Veteran's entire treatment history and a review of the claims folder and medical records in concluding that the Veteran's reported stressors were not sufficient to support a diagnosis of PTSD. Accordingly, the Board finds the June 2012 VA medical opinion to be the most probative evidence of record because it included a review of the accurate history as obtained from the claims file and the Veteran's medical history and provided a rationale explaining why the Veteran's reported stressors were not sufficient to establish a diagnosis of PTSD. The November 2008 and March 2009 VA treatment records did not include a review of the Veteran's treatment records and medical history. The November 2008 and March 2009 VA treatment records also did not address how the Veteran symptoms met the criteria for a diagnosis of PTSD. As such, the Board finds that the weight of probative evidence is against finding that the Veteran has a diagnosed psychiatric disorder of PTSD. The threshold requirement for service connection to be granted is competent medical evidence of the current existence of the claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Therefore, without a current disability of PTSD, there may be no service connection for the claimed PTSD. As such, the weight of the competent and credible evidence of record does not satisfy the elements of a PTSD claim under the criteria of 38 C.F.R. § 3.304(f) because it shows that the Veteran did not have PTSD. For these reasons, the Board finds that a preponderance of the evidence is against the claim for service connection for PTSD, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Service Connection for an Acquired Psychiatric Disorder In statements in support of his claim, the Veteran alleged that he had anxiety since service when he underwent a procedure to remove something from his foot. After reviewing all the evidence, the Board finds with regard to current disability that VA treatment records show that the Veteran was diagnosed with depressive disorder NOS and anxiety. The Board will consider whether depressive disorder and anxiety were related to service. See Clemons, 23 Vet. App. 1 (finding that a claim for benefits for one psychiatric disability also encompassed benefits based on other psychiatric diagnoses and should be considered by the Board to be within the scope of the filed claim). The Board next finds that the weight of the evidence demonstrates no psychiatric injury or disease during service, and that depressive disorder and anxiety were not present during service, that is, that symptoms of these disorders did not have in-service onset. Service treatment records are negative for any complaints of depressive disorder or anxiety. A normal psychiatric evaluation was noted on the Veteran's reserve enlistment examination in November 1965. The report of the service separation examination dated in September 1968 noted a normal psychiatric evaluation. Post-service treatment records reflect diagnoses of depressive disorder NOS and anxiety. Post-service treatment records reflect that the Veteran was initially treated for depression in 2005. The Board finds that the weight of the evidence is against a finding that the Veteran's anxiety and depressive disorder were related to service. The medical evidence of record links the Veteran's anxiety and depressive disorder to post-service life stressors. A report of a VA neuropsychology consultation dated in July 2007 reflects that a VA psychologist opined that the Veteran was depressed and anxious due to stressors taking place in his life at that time. In June 2012, a VA psychologist opined that the procedure which was performed on the Veteran's foot in service was unlikely to cause anxiety lasting 40 years. For these reasons, the Board finds that a preponderance of the evidence is against the claim for service connection for an acquired psychiatric disorder, to include PTSD, anxiety disorder, and depressive disorder NOS, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for COPD is denied. Service connection for an acquired psychiatric disorder, to include PTSD, depressive disorder, and anxiety, is denied. REMAND The Veteran asserted that bilateral hearing loss and tinnitus were related to noise exposure during service. The DD Form 214 reflects that the Veteran's service occupation was seaman. The Veteran's military occupational specialty (MOS) has been identified as an occupation where there was a moderate probability of noise exposure. See Duty MOS Noise Spreadsheets, Veterans Benefits Administration Fast Letter 10-35 (Dep't of Veterans Affairs, September 2, 2010). Accordingly, the Board recognizes that the Veteran was exposed to some loud noises (acoustic trauma) during service. In cases involving service connection for hearing loss, impaired hearing will be considered to be a disease when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2012). A VA audiology evaluation dated in October 2009 reflects a diagnosis of mild to severe mixed hearing loss in the left ear and mild high frequency sensorineural hearing loss in the right ear. The speech recognition scores of less than 94 percent met the criteria for hearing loss "disability" under 38 C.F.R. § 3.385. The October 2009 VA audiological evaluation reflects that the Veteran reported tinnitus. Tinnitus is a disability which laypersons are competent to identify. Charles v. Principi, 16 Vet. App. 370 (2002). A VA medical opinion was obtained from an audiologist in December 2012, and an addendum was obtained in February 2013. The December 2012 and February 2013 medical opinions adequately addressed the relationship between a ruptured tympanic membrane in service and the claimed hearing loss, including the question of whether loud noise exposure could cause the tympanic membrane rupture; however, the opinions did not address whether bilateral hearing loss and tinnitus were directly related to acoustic trauma during service. The Board finds that a remand is warranted to obtain a VA medical opinion on the question of whether, notwithstanding post-service onset of symptoms of current hearing loss disability and tinnitus, the hearing loss and tinnitus were caused by the noise exposure in service. Accordingly, the claims for service connection for bilateral hearing loss and tinnitus are REMANDED for the following action: 1. Forward the claims file to a VA audiologist for medical opinions regarding the etiology of bilateral hearing loss and tinnitus. 2. Following a review of the relevant documents in the claims file, the VA examiner should provide medical opinions regarding the following: a. Is it as likely as not (50 percent or greater likelihood) that the Veteran's sensorineural hearing loss was related to acoustic trauma in service? In answering this question, please note and discuss the loud noise exposure from his shipboard duties as a seaman aboard the USS Mauna Loa, and the post-service onset of symptoms of hearing loss in about 1999. b. Is it as likely as not (50 percent or greater likelihood) that the Veteran's tinnitus was related to acoustic trauma in service? In answering this question, please note and discuss the loud noise exposure from his shipboard duties as a seaman aboard the USS Mauna Loa, and the post-service onset of symptoms of hearing loss in about 1999. c. If it is the VA examiner's opinion that sensorineural hearing loss and tinnitus were not related to noise exposure in service, what is the most likely cause(s) of the hearing loss and tinnitus? The examiner should provide a detailed rationale for the opinions. 3. Thereafter, the claims for service connection for bilateral hearing loss, for accrued benefits purposes and tinnitus, for accrued benefits purposes, should be readjudicated. If any benefit sought on appeal is not granted, the appellant and her representative should be provided with a supplemental statement of the case. An appropriate period of time should then be allowed for a response before the record is returned to the Board for further review. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ J. PARKER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs