Citation Nr: 1329580 Decision Date: 09/16/13 Archive Date: 09/20/13 DOCKET NO. 07-32 059 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD), a not otherwise specified depressive disorder, and a depressive mood disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL The Veteran ATTORNEY FOR THE BOARD Christine C. Kung, Counsel INTRODUCTION The Veteran had active service from January 1960 to August 1963 and from November 1963 to October 1967. This matter came before the Board of Veterans' Appeals (Board) on appeal from a January 2005 rating decision of the Phoenix, Arizona, Regional Office (RO) which determined that new and material evidence had not been received to reopen the Veteran's claim of entitlement to service connection for PTSD. In 2008, the Veteran moved to Texas. His record was subsequently transferred to the Waco, Texas, Regional Office (RO). In April 2010, the Veteran was afforded a hearing before the undersigned Acting Veterans Law Judge sitting at the RO. A hearing transcript was prepared and incorporated into the record. In June 2010, the Board determined that new and material evidence had been received to reopen the Veteran's claim and remanded the issue of service connection for an acquired psychiatric disorder to include PTSD and depression to the RO for further development. In February 2013, the Board requested an opinion from a Veterans Health Administration (VHA) medical expert in psychiatry. In April 2013, the requested VHA opinion was incorporated into the record. In May 2013, the Veteran and his accredited representative were provided with a copy of the VHA opinion. In July 2013, the accredited representative submitted additional argument. The Board has reviewed both the physical claims files and the "Virtual VA" file so as to insure a total review of the evidence. The Board has reframed the issue of service connection for an acquired psychiatric disorder to include PTSD and depression as entitlement to service connection for an acquired psychiatric disorder to include PTSD, a not otherwise specified depressive disorder, and a depressive mood disorder in accordance with the United States Court of Appeals for Veterans Claims' (Court) decision in Clemons v. Shinseki, 23 Vet. App. 1 (2009) (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). FINDINGS OF FACT 1. The Veteran is not a former prisoner of war. 2. An acquired psychiatric disorder was not manifested during active service or for many years thereafter. 3. The Veteran has been found not to meet the diagnostic criteria for PTSD on multiple evaluations. 4. The Veteran's not otherwise specified depressive disorder and depressive mood disorder have not been shown to have originated during or otherwise related to active service. CONCLUSION OF LAW An acquired psychiatric disorder to include PTSD, a not otherwise specified depressive disorder, and a depressive mood disorder was not incurred in or aggravated during active service. 38 U.S.C.A. §§ 101(32), 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.326(a) (2013). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on the Department of Veterans Affairs (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). 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, VA will attempt to obtain. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the Court 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. VA has issued several VCAA notices to the Veteran including an October 2004 notice which informed him of the evidence generally needed to support an application to reopen a claim of entitlement to service connection; what actions he needed to undertake; and how VA would assist him in developing his claim. The October 2004 VCAA notice was issued to the Veteran prior to the January 2005 rating decision from which the instant appeal arises. In June 2010, the Board reopened the Veteran's claim for service connection and remanded it to the RO for de novo adjudication. The issue was subsequently adjudicated on the merits in May 2011. In the May 2011 supplemental statement of the case (SSOC), the Veteran was informed of the evidence generally needed to support a claim of entitlement to service connection; what actions he needed to undertake; and how VA would assist him in developing his claim. Therefore, there was no defect with respect to timing of the VCAA notice. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). Regarding the duty to assist in this case, VA has secured or attempted to secure all relevant documentation required by the VCAA. Social Security Administration (SSA) records were obtained and incorporated into the record. A review of relevant ship logs was conducted and the report thereof incorporated into the record. The Veteran was afforded multiple VA examinations for compensation purposes. The examination reports are of record. He was afforded hearings before both a VA Decision Review Officer (DRO) and the undersigned Acting Veterans Law Judge sitting at the RO. The hearing transcripts are of record. The Board requested a VHA psychiatric opinion. The opinion was incorporated into the record and provided to the Veteran. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The April 2013 VHA opinion examination report reflects that all relevant records were reviewed and opinion requested was advanced. All identified and available relevant documentation has been secured and all relevant facts have been developed. There remains no question as to the substantial completeness of the claim. 38 U.S.C.A. §§ 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.159, 3.326(a). For these reasons, the Board finds that the VCAA duties to notify and to assist have been met. II. Service Connections Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The claimed disorder is not a "chronic disease" enumerated under 38 C.F.R. § 3.309(a); therefore, the provisions of 38 C.F.R. § 3.303(b) are not for application. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). During the pendency of the instant appeal, the Secretary of VA amended the provisions of 38 C.F.R. § 3.304 applicable to PTSD claims. This amendment is expressly applicable to all claims pending before the Board on July 13, 2010. The amended regulation directs, in pertinent part, that: (f) Posttraumatic stress disorder. Service connection for posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. The following provisions apply to claims for service connection for posttraumatic stress disorder diagnosed during service or based on the specific type of claimed stressor: (1) If the evidence establishes a diagnosis of posttraumatic stress disorder during service and the claimed stressor is related to that service, 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. (2) 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. (3) 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 posttraumatic stress disorder 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). In the case of any veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war, campaign, or expedition, the Secretary shall accept as sufficient proof of service connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran. Service connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. The reasons for granting or denying service-connection in each case shall be recorded in full. 38 U.S.C.A. § 1154(b) (West 2002). In adjudicating a claim for service connection for PTSD, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence. Hayes v. Brown, 5 Vet. App. 60, 66 (1993);38 U.S.C.A. § 1154(a) (West 2002); 38 C.F.R. § 3.304(f). The evidence necessary to establish the occurrence of an in-service stressor for PTSD will vary depending on whether or not the veteran "engaged in combat with the enemy." Id. If VA determines that a veteran engaged in combat with the enemy and that the alleged stressor is related to combat, then the veteran's lay testimony or statements are accepted as conclusive evidence of the occurrence of the claimed stressor. 38 U.S.C.A. § 1154(b) (West 2002); 38 C.F.R. § 3.304(f). No further development or corroborative evidence is required, provided that the claimed stressor is "consistent with the circumstances, conditions, or hardships of the veteran's service." Id. If, however, VA determines that the veteran did not engage in combat with the enemy or that the alleged stressor is not related to combat, the veteran's lay testimony by itself is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain service records or other evidence to corroborate the veteran's testimony or statements. See Moreau v. Brown, 9 Vet. App. 389, 394 (1996). The question of whether a veteran was exposed to a stressor in service is a factual one, and VA adjudicators are not bound to accept uncorroborated accounts of stressors or medical opinions based upon such accounts. Wood v. Derwinski, 1 Vet. App. 190 (1991), aff'd on reconsideration, 1 Vet. App. 406 (1991). Hence, whether a stressor was of sufficient gravity to cause or support a diagnosis of PTSD is a question of fact for medical professionals and whether the evidence establishes the occurrence of stressors is a question of fact for adjudicators. The law provides that, if a PTSD claim is based on in- service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Gallegos v. Peake, 22 Vet. App. 329 (2008). Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304(f)(3). Additionally, VA can submit any evidence, including alternate source evidence, to a medical or mental health professional for interpretation. Bradford v. Nicholson, 20 Vet. App. 200 (2006). Most significantly, for claims involving an in-service personal assault, after-the- fact medical evidence can be used to establish a stressor. See Bradford v. Nicholson, 20 Vet. App. 200 (2006); Patton v. West, 12 Vet. App. 272, 278 (1999). The term "former prisoner of war" means a person who, while serving in the active military, naval or air service, was forcibly detained or interned in line of duty by an enemy government or its agents, or a hostile force, during a period of war; or by a foreign government or its agents, or a hostile force, under circumstances which the Secretary of VA finds to have been comparable to the circumstances under which persons have generally been forcibly detained or interned by enemy governments during periods of war. 38 U.S.C.A. § 101(32). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1154(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also 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). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran contends that service connection for PTSD is warranted as the claimed disability was precipitated by his in-service Vietnam War-related traumatic experiences which included witnessing the arrival of body bags aboard the U.S.S. Valley Forge; watching napalm attacks against enemy coast line targets; harassment by his superior officers, and being kept as a virtual "prisoner of war" while serving aboard the U.S.S. Valley Forge. Initially, the Board observes that the record does not establish and the Veteran does not allege that he was forcibly detained or interned by either an enemy government or its agents or a hostile force; or a foreign government or its agents during active service. Therefore, the Board finds that the Veteran is not a former prisoner of war for VA purposes. 38 U.S.C.A. § 101(32). The Veteran's service treatment records do not refer to an acquired psychiatric disorder. His service personnel records indicate that he served aboard the U.S.S. Estes, the U.S.S. Tulare, and the U.S.S. Valley Forge as a boiler tender. The Veteran received multiple non-judicial punishments for incidents including being absent from his post and other duty-related activities. The Veteran served aboard the U.S.S. Valley Forge from May 1964 to March 1967. An Internet reference notes that the U.S.S. Valley Forge and her Marine helicopter contingent were involved in combat operations against the enemy including providing logistic and medical support for the operations. The ship's activities included air evacuation of casualties to the ship. An October 1988 psychiatric evaluation from T. Robertson, M.D., states that the Veteran complained of right arm pain. He was noted to be "blandly preoccupied with chronic pain in the right arm" and to feel that "he is unable to do things and is dependent upon others for support." The Veteran was diagnosed with a somatoform pain disorder and a mixed personality disorder with passive-aggressive, inadequate, and schizoid features. In his October 1988 Veteran's Application for Compensation or Pension (VA Form 21-526), the Veteran sought service connection for PTSD. A July 1989 psychological evaluation from C. Base, Ph.D., notes that the Veteran had been previously diagnosed with a somatoform pain disorder, probable psychogenic pain disorder, and PTSD. The Veteran was diagnosed with a dysthymic disorder, a somatoform pain disorder, and "[ruleout] histrionic personality disorder with dependent and schizoid features." An April 1999 psychiatric evaluation from L. Flowers, M.D., notes that the Veteran was diagnosed with a mood disorder secondary to chronic pain and psychoactive substance abuse and alcohol abuse in remission. A September 2000 Vet Center intake evaluation states that the Veteran was diagnosed with an emotional disorder. The treating psychologist commented that the Veteran "presented with many of the symptoms of PTSD, but without a traumatic event specific to the Vietnam or any other war" and "his 'trauma' relates to reports of harassment and deprivation of advancement in rank over his second 4 year tour of duty in the U.S. Navy ostensibly by a chief and division officer." In his December 2000 Veteran's Application for Compensation or Pension (VA Form 21-526), the Veteran advanced that service connection for PTSD was warranted as the disorder had been initially manifested in 1967 by nightmares, intrusive thoughts, anger, guilt, depression, isolation, emotional numbing, hypervigilance, and anxiety. He stated that he had been treated for PTSD at the San Diego Vet Center. In his July 2001 application to reopen his claim of entitlement to service connection, the Veteran conveyed that he witnessed the unloading and handling of body bags and watched "as our jets napalmed on shore" while aboard the U.S.S. Valley Forge. At a December 2001 VA psychiatric examination, the Veteran was diagnosed with a not otherwise specified depressive disorder. The examiner determined that the Veteran did not meet the PTSD diagnostic criteria involving threatened death, serious injury, or a threat to his physical integrity and intense fear, helplessness, or horror in the presence of that event. The examiner clarified that the Veteran exhibited chronic depressive symptoms "which have affected the way which he functioned throughout life." An August 2004 VA social work letter states that the Veteran had been referred for assessment of "military-related PTSD." VA clinical documentation dated in December 2004 report that assessments of severe PTSD and depression were advanced. VA social work documentation dated in February 2005 and March 2005 conveys that the Veteran reported having been restricted to his ship during active service and was found to PTSD as a consequence. A March 2005 VA treatment record states that the Veteran was diagnosed with PTSD and not otherwise specified depression. No specific findings as to whether the Veteran met the diagnostic criteria for PTSD were advanced. In an undated written statement received in September 2005, the Veteran indicated that he had experienced several stressful in-service events including one occasion wherein he was "forced to go ashore" as he did not have duty; went to a bar; passed out; was shaken awake by his division officer; and yelled at to go to work. The Veteran stated that he had kicked and threatened his division officer as a result of the harassment. An August 2006 VA treatment record relates that the Veteran complained of "worsening PTSD and depression." Assessments of PTSD and a not otherwise specified depressive disorder were advanced. A December 2006 VA mental health clinic treatment record states that the Veteran was diagnosed with PTSD, depression, and alcohol and marijuana abuse. In his undated Appeal to the Board (VA Form 9) received in October 2007, the Veteran advanced that certain facts had been overlooked "which led to PTSD during Vietnam War that led and held me a prisoner to this very day." At the December 2007 DRO hearing, the Veteran testified that he had witnessed the handling of body bags and on shore napalm attacks while aboard the U.S.S. Valley Forge. He stated further that he had been unfairly punished for minor military infractions including failing to get a haircut; harassed by his military superiors about his duties; had been required to work for 38 hours straight on one occasion; and went absent without leave (AWOL) to escape his ship. At the April 2010 hearing before the undersigned Acting Veterans Law Judge, the Veteran testified that: he had been a boiler tender aboard the U.S.S. Valley Forge; had witnessed helicopters bringing casualties in body bags to the ship and napalm attacks on the Vietnamese coastline; and had been required by his chief to teach a new shipmate everything he knew which took 12 straight hours of training nonstop. He stated that his PTSD had been linked by treating medical personnel solely to his combat-related traumatic experiences. At an April 2011 VA examination for compensation purposes, the examiner determined that "PTSD not found." He commented that: I did not find any evidence whatsoever from today's examination suggesting the diagnosis of PTSD. The Veteran's presentation was completely unremarkable. Reviewing his C-file, I note that he has received a diagnosis of PTSD, but I did not find any evidence from today's examination that would warrant that diagnosis. Similarly, there was no evidence from today's examination of any other psychiatric diagnosis acquired or otherwise that he reported in today's examination. The April 2013 VHA states that the Veteran's records were thoroughly reviewed. The physician opined that: 1. In the absence of any clear or documented traumatic event or events during his active service "that involved actual or threatened death or serious injury," Criterion A, which is the basic premise of the diagnosis of PTSD based on the DSM-IV - is not fulfilled. Other non-specific symptoms that [the Veteran] has reported over the years which include - nightmares, hypervigilance, getting easily startled, while distressing - are not enough to warrant a PTSD diagnosis. Therefore, in my opinion, there is very little evidence that supports a diagnosis of PTSD in this veteran. 2. The Veteran's records show evidence for a chronic mood disorder, on the depressive spectrum. 3. There is no evidence to suggest that this depressive disorder had its onset during active service, or is related in any way to the Veteran's service aboard the U.S.S. Valley Forge. The Veteran asserts that service connection for an acquired psychiatric disorder to include PTSD is warranted secondary to his in-service traumatic experiences which included witnessing both casualties being brought aboard his ship and on shore napalm attacks against enemy targets and having been harassed by his military superiors to the extent that he felt like a prisoner aboard his own ship. The Veteran served aboard the U.S.S. Valley Forge while the vessel was supporting combat operations against enemy targets by sending helicopters on missions and subsequently receiving dead and wounded Marines by helicopter. He reported having observed both the returning helicopters and napalm attacks against enemy targets on shore while aboard ship. While he has submitted testimony about inservice harassment by his military superiors, the Veteran acknowledged at the April 2010 hearing before the undersigned Acting Veterans Law Judge that his claimed PTSD had been related by treating medical personnel solely to his combat-related traumatic experiences. In determining whether a veteran participated in combat, the veteran's testimony will be weighed together with the other evidence of record. Cohen v. Brown, 10 Vet. App. 128, 146 (1997). The Board finds that the Veteran engaged in combat with the enemy as a crewman aboard the U.S.S. Valley Forge and his claimed stressors are combat-related. His credible lay statements are accepted as conclusive evidence of the stressors occurrence. No further development or corroborative evidence is required. Zarycki v. Brown, 6 Vet. 91, 98 (1993). T It is next necessary to determine whether the claimed acquired psychiatric disability is related to active service including the Veteran's combat experiences. The Board has reviewed the probative evidence of record including the Veteran's testimony and written statements on appeal. The service treatment records make no reference to an acquired psychiatric disorder. The first documentation of record of the onset of an acquired psychiatric disorder in the October1988 diagnosis of a somatoform pain disorder and a mixed personality disorder with passive-aggressive, inadequate, and schizoid features, some 21 years after service separation. The record is in conflict as to the nature and etiology of the Veteran's acquired psychiatric disorder. While VA social work and treatment records dated between 2004 and 2006 reflect that the Veteran was diagnosed with PTSD and a not otherwise specified dysthymic disorder, both the reports of the December 2001 and the April 2011 VA examinations and the April 2013 VHA opinion convey that the Veteran has a not otherwise specified depressive disorder and a depressive mood disorder and specifically did not meet the diagnostic criteria for PTSD. The VA social work and treatment records reflecting a diagnosis of PTSD do not indicate whether the Veteran met the diagnostic criteria for PTSD or reflect any specific basis for the PTSD diagnoses. The December 2001 VA examination report and the VHA opinion note that the clinical evidence had been thoroughly examined; discussed the prior PTSD diagnoses; and found that the Veteran did not meet "Criterion A, which is the basic premise of the diagnosis of PTSD based on the DSM-IV." The VHA opinion further concluded that the record contained no evidence establishing that the Veteran's depressive mood disorder originated during or was otherwise etiologically related to his period of naval service. Given that the VA examiners' opinions and the VHA opinion are supported by the examiners' specific findings that the Veteran did not meet the relevant criteria for PTSD and the VA social workers and treating medical personnel advanced no findings as the criteria necessary for a PTSD diagnosis, the Board finds that the December 2001 and April 2011 VA examination reports and the April 2013 VHA opinion are more persuasive than the VA treatment records as to the adequacy of the PTSD diagnoses of record. The Veteran testified on appeal that he has PTSD related to his naval service. The Veteran is competent to state that he has nightmares, intrusive thoughts, depression, and other psychiatric symptoms. However, to the extent that the Veteran asserts that such symptoms are manifestations of PTSD and that such disability is related to his active service, the Board finds that the Veteran's lay statements do not constitute competent evidence. The Veteran is not a physician, a psychiatrist, or a psychologist. He has not offered any medical qualifications. As a layman, the Veteran is not competent to offer a diagnosis of PTSD or to offer an opinion regarding the etiology of his psychiatric disability including its relationship to active service. The diagnosis of PTSD and other psychiatric disabilities and their relationship to active service is too complex to be addressed by a layperson. The etiology of psychiatric disabilities is the subject of extensive research by medical professionals and would require specific clinical observation. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran's diagnosed not otherwise specified depressive disorder and depressive mood disorder have not been shown to have been manifested during active service or for many years thereafter. No competent medical professional has concluded that the disabilities originated during or are otherwise related to active service. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. Therefore, the claim must be denied. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for an acquired psychiatric disorder to include PTSD, a not otherwise specified depressive disorder, and a depressive mood disorder is denied. ____________________________________________ J. T. HUTCHESON Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs