Citation Nr: 1324211 Decision Date: 07/30/13 Archive Date: 08/07/13 DOCKET NO. 07-17 614 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Georgia Department of Veterans Services WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD K. R. Fletcher, Counsel INTRODUCTION The Veteran served on active duty from July 1970 to January 1972. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2005 rating decision of the Atlanta, Georgia, Department of Veterans Affairs (VA) Regional Office (RO), which found that new and material evidence had not been submitted to reopen the claim for service connection for PTSD. The Veteran disagreed with the findings, and the current appeal ensued. In December 2009, the Veteran and his spouse testified at a Travel Board hearing before the undersigned. A transcript of that hearing is of record. In March 2010, the Board reopened the claim for service connection for PTSD, and remanded the claim for further development. The Board recharacterized the Veteran's claim at that time as entitlement to service connection for an acquired psychiatric disorder, to include PTSD. In so doing, the Board noted Clemons v. Shinseki, 23 Vet. App. 1 (2009), wherein the Court found that an appellant's claim for service connection for PTSD should have been construed more broadly by VA as a claim for service connection for any mental disability. As is discussed in more detail below, the medical evidence of record in this case indicates that the Veteran has been diagnosed with various mental health disorders, including PTSD and depressive disorder, during the period of the appeal. The matter was Remanded a second time in September 2011. In addition to the paper claims file, there is a Virtual VA (VVA) electronic claims file associated with the Veteran's claim. Both the Board and originating agency (see December 2012 Supplemental Statement of the Case) have reviewed the VVA file, which includes VA treatment records and examination reports dated from October 2011 to December 2012. The other documents in the VVA file are either duplicative of the evidence in the paper claims file or are irrelevant to the issue on appeal. FINDINGS OF FACT 1. The Veteran has not presented competent and credible evidence of a combat stressor, his active service would not have subjected him to hostile military or terrorist activity, and his remaining alleged stressors could not be verified. 2. The preponderance of the evidence fails to support a diagnosis of PTSD in accordance with VA regulations. 3. A chronic psychiatric disorder was not noted in service or for many years after service; and, the Veteran's diagnosed depressive disorder is not related to service. CONCLUSION OF LAW The criteria for the establishment of service connection for an acquired psychiatric disorder, to include PTSD, are not met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist 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. 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). 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 representative has alleged prejudice with respect to notice, as is required. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009). None is found by the Board. Indeed, VA's duty to notify has been more than satisfied. The Veteran was notified via letter in April 2010 of the criteria for establishing service connection, the evidence required in this regard, and his and VA's respective duties for obtaining evidence. He also was notified of how VA determines disability ratings and effective dates if service connection is awarded. This letter accordingly addressed all notice elements. Nothing more was required. Although the Veteran was not provided complete notice until after the initial adjudication of the claim, the Board finds that there is no prejudice to him in proceeding with the issuance of a final decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). In this regard, the Board notes that following the provision of the required notice and the completion of all indicated development of the record, the originating agency readjudicated the Veteran's claim. See December 2012 Supplemental Statement of the Case. There is no indication in the record or reason to believe that any ultimate decision of the originating agency on the merits of the claim would have been different had complete VCAA notice been provided at an earlier time. See Overton v. Nicholson, 20 Vet. App. 427, 437 (2006) (A timing error may be cured by a new VCAA notification followed by a readjudication of the claim). The Board also finds VA has complied with its duty to assist the Veteran in the development of his claim. Service treatment records (STRs), service personnel records, records from the Social Security Administration (SSA), and identified post-service treatment records were obtained. Neither the Veteran nor his representative has identified any outstanding evidence that could be obtained to substantiate the claim; the Board is also unaware of any such evidence. The Veteran has also been afforded appropriate VA examination to determine the nature and etiology of his claimed disability. The examination was adequate, as it was predicated on a full reading of the Veteran's medical records in the claims file, interview of the Veteran, and psychiatric examination with appropriate testing. All of the pertinent evidence of record was considered, to include the statements of the Veteran, and the examiner provided a rationale for the opinion stated, relying on and citing to the records reviewed. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As noted, this case was before the Board in September 2011 when it was remanded for additional action, including obtaining up-to-date VA treatment records, submitting the Veteran's stressor statements to the U.S. Army and Joint Services Records Research Center (JSRRC) for verification, and affording the Veteran a VA examination to ascertain the current nature and etiology of his claimed acquired psychiatric disorder. As will be discussed in more detail below, VA treatment records were obtained in November 2012, the Veteran's stressor statements were sent to JSRRC in March 2012 and the Veteran was afforded a VA examination in November. The March 2012 examination report reflects that the Veteran's records were reviewed and contains the requested opinion. The Board finds that there has been substantial compliance with its remand instructions and additional remand is not required. D'Aries v. Peake, 22 Vet. App. 97 (2008) (noting that substantial rather than strict compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)). Service Connection Law and Regulations Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may 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). To establish service connection for PTSD there must be medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) [i.e., a diagnosis under DSM-IV]; a link, established by medical evidence, between current symptoms and a stressor event in service; and credible supporting evidence that the claimed stressor event in service occurred. 38 C.F.R. § 3.304(f). Where the veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, the veteran's testimony alone is not sufficient to establish the occurrence of the stressor, and it must be corroborated by credible supporting evidence. Cohen v. Brown, 10 Vet. App. 128 (1997). The sufficiency of a stressor is a medical determination and is presumed by a medical diagnosis of PTSD. Id. On July 13, 2010, VA published a final rule that amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the required in-service stressor. 75 Fed. Reg. 39843 (July 13, 2010); see also 75 Fed. Reg. 41092 (July 15, 2010) (correcting effective and applicability dates). The revised rule provides: 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. 38 C.F.R. § 3.304(f)(3). The Board is not required to accept an appellant's uncorroborated account of his active service experiences. See Swann v. Brown, 5 Vet. App. 229, 233 (1993) and Wood v. Derwinski, 1 Vet. App. 190, 192 (1991); however, a stressor need not be corroborated in every detail. Suozzi v. Brown, 10 Vet. App. 307, 311 (1997). See also, Pentecost v. Principi, 16 Vet. App. 124 (2002). Just because a physician or other health professional accepted an appellant's description of his experiences as credible and diagnosed appellant as suffering from PTSD does not mean the Board is required to grant service connection for PTSD. Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). With disability compensation claims, VA adjudicators are directed to assess both medical and lay evidence. As a general matter, a layperson is not capable of opining on matters requiring medical knowledge. See 38 C.F.R. § 3.159(a)(2); see also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). In certain circumstances, however, lay evidence may be sufficient to establish a medical diagnosis or nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In addressing lay evidence and determining its probative value, if any, attention is directed to both competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In terms of competency, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). That notwithstanding, a veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See generally Caluza, supra. The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006); but see Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Factual Background and Analysis The Board notes that it has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. The Veteran recalls numerous stressors which he contends caused his claimed PTSD, including the deaths of fellow soldiers during his period of advanced infantry training from September 28, 1970 to November 13, 1970 and his period of airborne training from November 15, 1970 to December 1970. He also asserts that he was deployed to Washington D.C. to quell the riots taking place there during his period of military service, and that he served in combat operations in Vietnam. Specifically, the Veteran alleged that while assigned to an advanced training brigade at Ft. Sill, Oklahoma, from September 1970 to November 1970, a serviceman in his group was struck in the head by the recoil of a 155mm Howitzer cannon which crushed his skull. The Veteran did not know the name of this serviceman or the exact date of this incident. See December 2009 Board hearing transcript, pages 3-4; November 2009 VA Statement in Support of Claim for Service Connection for PTSD. While assigned to an airborne training brigade at Ft. Benning, Georgia, between November 1970 and December 1970, a fellow serviceman's parachute and back-up parachute failed to open during a jump exercise from an aircraft, causing him to plunge to his death. Again, the name of the serviceman was not known to the Veteran. See December 2009 Board hearing transcript, pages 4-5, 10-11; November 2009 VA Statement in Support of Claim for Service Connection for PTSD. The Veteran additionally identified a December or January 1971 parachute jump injury as an in-service stressor. See December 2009 Board hearing transcript, pages 5-6. Finally, the Veteran maintains that he served in combat during the Vietnam War and was shot and received medical treatment. See March 2000 VA Annual Health Care Questionnaire; July 2004 statement from the Veteran; December 2009 Board hearing transcript, pages 9-10. The Veteran's DD Form 214 shows that he served on active duty in the United States Army from July 1970 to January 1972. He was a recipient of the National Defense Service Medal and the Parachute Badge. Both his DD Form 214 and service personnel records confirm that he had no foreign service, including no service in the Republic of Vietnam. Service personnel records show that the Veteran served at Ft. Jackson, Ft. Benning and Ft. Bragg, but not in Washington, D.C. The Veteran's STRs document that he was seen with complaints of a right shoulder injury in June 1971 as a result of a parachute jump. X-ray studies revealed no significant abnormality. The Veteran was given a prescription and prohibited from heavy lifting for two days. STRs, including a January 1972 separation examination report, are negative for complaints or findings related to psychiatric disability. Following service, in a March 2000 VA Annual Health Care Questionnaire, the Veteran reported that he had been in combat, had seen someone badly injured or killed, and had been attacked or threatened with a weapon. VA treatment records dated from March 2001 to June 2004 document diagnoses of PTSD, major depression and alcohol dependence. In particular, a June 2004 social work progress note shows that the Veteran reported experiencing flashbacks about combat in Vietnam. The Veteran "acknowledges being exposed to many casualties and injured soldiers in his capacity as a paratrooper with the 82nd Airborne Division." The assessment included untreated emotional disorder associated with combat experience. A June 2004 primary care record notes an assessment of depression/PTSD. In a July 2004 statement, the Veteran indicated that he was "transferred to [the] 3rd brigade [in the] Republic of Vietnam in January 1968." He further stated that he was shot during his combat duty and was "taken to [a] hospital in Saigon where I spent four months with lead and scrap metal in my chest and back. After I was released from the hospital, I returned to Vietnam serving a total of twenty-two months." He reported seeing his fellow soldiers die in front of him while in Vietnam. A July 2004 VA general psychiatric record notes the Veteran's complaints of depression, hyperarousal, nightmares, anxiety and flashbacks; he reportedly burned his house down a few years earlier. Impression was chronic and severe PTSD. A subsequent July 2004 VA general psychiatric record notes the Veteran's report of nightmares of people getting killed or killing themselves during his military service; the assessment was major depression, rule out PTSD. A July 2004 Social Security Administration (SSA) psychological evaluation from Dr. WBF notes that the Veteran reported a history of combat in Vietnam and current symptoms of memory loss, nightmares related to Vietnam, and problems sleeping. On examination mood was anxious and thought process was logical. The Veteran denied suicidal or homicidal ideation, delusions, or hallucinations. Insight and judgment were fair. Impulse control was good. The diagnostic impression included rule out PTSD. Dr. WBF noted that although the Veteran's symptomatology was consistent with PTSD, more documentation was needed to fully assign a diagnosis of PTSD. In August 2004, SSA found the Veteran to be disabled since June 2003 with a primary diagnosis of affective and mood disorders. In February 2006 and April 2010 statements, VA psychologist Dr. R.G. opined that the Veteran's PTSD is linked to his military service. However, the opinion specifically links the Veteran's PTSD to his claimed combat service in Vietnam, "where his unit sustained heavy casualties" and many were "seriously wounded." He also noted that the Veteran has witnessed the death of several buddies. In September 2010 the U.S. Army Crime Records Center reported that it had no record of a soldier being killed by a Howitzer cannon at Fort Sill between September 1970 and November 1970 or of a soldier being killed during a parachute jump at Fort Benning between November 1970 and December 1970. A January 2011 VA examination report notes that the Veteran reported the following stressors: being deployed to D.C. during the May Day riots in 1971; seeing another soldier's face smashed in after he was hit in the head by a Howitzer at Ft. Sill; and witnessing a soldier die when his parachute failed to open during a jump at Ft. Benning. After interviewing the Veteran and reviewing the claims file, the examiner stated that the Veteran did not meet the criteria for a diagnosis of PTSD. The examiner stated that the Veteran does report experiencing symptoms typically associated with PTSD; however, his re-experiencing symptoms are not related to his in-service injury. In fact, [the Veteran] spent little time elaborating on any injury or "close calls" he may have had during the military and was more focused on his account of the other accidents listed above. Of note, there are no other reports of [the Veteran's] in-service jump injury mentioned in the mental health treatment records, and no indications that this injury incident was a source of distress for him. In addition, when given the opportunity to discuss it, [the Veteran] minimized it and chose to focus on the other incidents that he detailed, along with his Vietnam service. As such, it is difficult to not question the veracity of his claims given the number of inconsistencies between his reported military service and experiences and what is reflected in his records and other self-reports. Therefore, . . . given the lack of related symptoms, and [the Veteran's] own report that his injury was not as significant to him as other self-reported incidents, [the Veteran] does not meet the criteria for PTSD diagnosis related to an in-service injury. The diagnosis was depression NOS. In May 2012 JSRRC reported that after researching the Army historical records, it was unable to verify the alleged stressor incidents from Fort Sill and Fort Benning. A review of the Morning Reports was recommended. In November 2012 the National Personnel Records Center reported that a search of the applicable Morning Reports revealed no mention of the alleged stressor incidents. The Veteran was informed of these findings in November 2012. A November 2012 VA examination report notes that the Veteran reported the following stressor: witnessing death and destruction in Vietnam. After examining the Veteran and reviewing the claims file the examiner stated that the Veteran reported some symptoms of PTSD (hypervigilance, sleep disturbance, irritability, avoiding thoughts about the stressors) but not other symptoms required for a diagnosis of PTSD (re-experiencing the traumatic stressor). The examiner also noted that the Veteran's alleged stressor had not been verified. Therefore, the Veteran did not meet the DSM-IV criteria for a diagnosis of PTSD. The diagnosis was depressive disorder NOS, which the examiner opined was less likely than not incurred in or caused by service. Instead, this diagnosis is more likely than not related to the Veteran's chronic (non-service connected) medical problems and further exacerbated by memory disturbance, marital problems and the death of a sibling. The examiner acknowledged that the Veteran's VA treatment records indicate that his emotional problems are associated with his combat experiences. The examiner stated that while it is possible that some of the Veteran's depression is attributable to these combat experiences, no evidence has been presented to confirm such combat. Also of record are numerous statements from the Veteran and his wife maintaining that the Veteran suffers from PTSD related to his combat in Vietnam. In addition, the Veteran submitted copies of photographs which he maintains were taken during his service in Vietnam. The outcome of the Veteran's claim for service connected for PTSD turns on whether there is credible evidence of an in-service stressor. Several of the diagnoses and provisional diagnoses of PTSD are based on the Veteran in engaging in combat while stationed in Vietnam. However, as indicated, the Veteran is not shown to have served in the Republic of Vietnam or, for that matter, had any foreign service. Indeed, other than his own personal statements and photographs that he alleges were taken by him in Vietnam, the Veteran has not provided a scintilla of credible evidence to support his claim of being in Vietnam, to include engaging in combat at that time. Such assertions are not credible. Any diagnosis of PTSD based on the Veteran's allegation of being in combat is thereby flawed and carries no probative value. Coburn v. Nicholson, 19 Vet. App. 427, 432 (2006) (reliance on veteran's statement renders a medical report incredible only if the Board rejects the statement of the veteran). There is similarly no credible evidence demonstrating that the Veteran's service placed him in a situation that would have placed him in a situation where he would have feared hostile or military activity. He was stationed in the United States throughout his military service. Moreover, the Board stresses that, while the amended regulations provide for a way to establish PTSD without supporting evidence, the lower evidentiary standard applies only of a VA psychologist or psychiatrist (or a psychiatrist or psychologist with whom VA has contracted) confirms the claimed stressor which supports the diagnosis. Indeed, the comments associated with the proposal of the amended regulations indicate the intent that the VA examiner's diagnosis must be within the context of a Compensation and Pension examination. As was noted very recently by the U.S. Court of Appeals for the Federal Circuit, the reasons for this were several: (1) VA practitioners are given specific instruction on how to conduct PTSD examinations, including guidance materials and a certification process. (2) The VA reviews the quality of its practitioners' examinations, including taking steps to address identifiable problems with feedback and training. (3) The VA provides VA associated practitioners with the veterans' claims folders in connection with all mental-disorder examinations, including PTSD examinations, who are instructed that a PTSD diagnosis cannot occur without a review of the folder. (4) The VA noted that limiting the rule to VA associated practitioners, accompanied by periodic review of these examinations, would ensure standardization and consistency. Nat'l Org. of Veterans' Advocates, Inc. v. Sec. Of Veterans Affairs, 669 F.3d 1340 (Fed. Cir. 2012) (citing 75 Fed.Reg. 39,843, 39,847-48 (July 13, 2010)). Consequently, while the Veteran may have been diagnosed as having PTSD, and notwithstanding the lack of credibility to the Veteran's claims, these assessments are not sufficient to warrant service connection under the amended regulations. There is also no credible evidence of the alleged stressors pertaining to the parachuting or Howitzer accidents. Those incidents were researched and were not documented in any of the available service department records. Put another way, the stressors could not be verified. In light of the foregoing, the Board finds that the preponderance of the evidence does not support a diagnosis of PTSD. The diagnosis of PTSD made by the Veteran's VA treatment providers (as noted in treatment records beginning in 2004) has been duly considered. However, this diagnosis was based on an unverified stressor, combat service in Vietnam. Moreover, and of significant import, there was no testing data that supported this diagnosis. Therefore, such findings of PTSD do not constitute medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) [i.e., a diagnosis under DSM-IV]; a link, established by medical evidence, between current symptoms and a stressor event in service; and credible supporting evidence that the claimed stressor event in service occurred so as to warrant service connection under 38 C.F.R. § 3.304(f). Conversely, the 2011 and 2012 VA psychiatric examinations were focused, in part, on determining whether the Veteran has PTSD and examination findings did not support a diagnosis of PTSD. A detailed explanation was provided as to why the criteria to support a diagnosis of PTSD had not been met. Specifically, the Veteran did not re-experience a verified traumatic stressor event. Further, the 2011 VA examiner noted the only verified stressor was the Veteran's in-service parachuting injury, but the Veteran minimized this event and again, did not "re-experience" this event such that this verified event would support a diagnosis of PTSD. In short, the 2011 and 2012 VA examination reports provided clinical data and an articulated rationale for its negative conclusions that was not included in the VA treatment records. The Board thereby affords greater weight to the findings by the 2011 and 2012 VA examiners in that the opinions were based on a full interview of the Veteran, a review of the file, and a discussion of why the Veteran failed to meet the criteria for a diagnosis of PTSD. See Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994); see also Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Consideration has also been given to the assertions of the Veteran and his wife that he suffers from PTSD. A lay person is competent to provide testimony regarding factual matters of which he has first-hand knowledge, including reports of what occurred during service. Washington v. Nicholson, 19 Vet. App. 362, 367-68 (2005). There is no categorical rule that medical evidence is required when the determinative issue is either medical etiology or a medical nexus. Davidson, supra. Lay evidence can be competent and sufficient to establish a diagnosis where the layperson is competent to identify the medical condition, is reporting a contemporaneous medical diagnosis, or describes symptoms that support a later diagnosis by a medical professional. Jandreau, supra. However, while lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case of an acquired psychiatric disorder, it is noted that such falls outside the realm of common knowledge of a lay person. Id. The diagnosing of a psychiatric disorder is well beyond the competence of the Veteran and his wife. Such requires a level of training and education, to include clinical testing, that the Veteran and his wife fail to possesses. Their opinions that the Veteran has PTSD therefore carry no probative value. Turning to the question of service connection for an acquired psychiatric disorder, other than PTSD, the Veteran's STRs are absent of any notations regarding treatment or complaints related to a psychiatric disorder. Therefore the evidence does not demonstrate a psychiatric disorder had its onset during his active service. The earliest indication of a psychiatric disorder (depressive disorder) in the record was not until 2001, nearly 30 years following his discharge from active duty. Such a long interval between service and the initial diagnosis is, of itself, a factor against a finding that depression is service-related, providing more limited evidence against this claim. See Maxson, supra. There is also no competent and credible lay or medical evidence in the record of a nexus between the Veteran's currently diagnosed acquired psychiatric disorder (depressive disorder) and the his active service. There are no medical opinions relating the Veteran's current psychiatric disorder, diagnosed as depressive disorder, to his active service. To the contrary, the 2012 VA examiner opined that the Veteran's depressive disorder was less likely than not incurred in or caused by service. The examiner instead related the Veteran's psychiatric disorder to his non-service connected physical disabilities. The examiner acknowledged that the Veteran's VA treatment records indicate that his emotional problems are associated with his combat experiences, but noted once again that no evidence has been presented to confirm such combat. Consideration has again been given to lay assertions of the Veteran and his wife that his psychiatric disorder is related to service, to include his in-service stressor experiences. The Board again acknowledges that lay persons are competent to provide opinion on some medical issues. However, an opinion on the etiology of the Veteran's depressive disorder is the type of opinion that falls outside the realm of common knowledge of a lay person. See Jandreau, supra. Finally, as relevant to the Veteran's diagnosis of alcohol dependence, with respect to claims filed after October 31, 1990, service connection may not be granted for substance abuse on the basis of service incurrence or aggravation. 38 U.S.C.A. §§ 105, 1110; 38 C.F.R. § 3.301(a); VAOPGCPREC 2-98. The law does not preclude a Veteran from receiving compensation for an alcohol or drug abuse disability acquired as secondary to, or as a symptom of, a Veteran's service-connected disability. However, in this case, has no service connected disabilities. Moreover, as the Board has determined that service connection is not warranted for an acquired psychiatric disorder, service connection for alcohol dependence is also not warranted. In reaching the conclusion above the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Gilbert, supra. ORDER Service connection for an acquired psychiatric disorder, to include PTSD, is denied. ____________________________________________ MICHAEL A. HERMAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs