Citation Nr: 1306458 Decision Date: 02/25/13 Archive Date: 03/01/13 DOCKET NO. 07-04 997 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUE Entitlement to service connection for an acquired psychiatric disability, to include depressive disorder and posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J.M. Seay, Associate Counsel INTRODUCTION The Veteran served on active duty from September 1962 to July 1966. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision dated in October 2006 by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. The record shows that the Veteran initially requested a Board hearing in connection with his appeal. However, in a December 2007 statement, the Veteran withdrew his request for a hearing. The Board remanded this case in December 2009, March 2011, and June 2012. The case has been returned to the Board for review. FINDINGS OF FACT 1. The most competent and probative medical evidence of record is against a finding that the Veteran has PTSD in accordance with the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). 2. The most probative medical evidence of record is against a finding that the Veteran has an acquired psychiatric disability that had its onset in active service or is otherwise causally related to active service. CONCLUSION OF LAW An acquired psychiatric disorder, to include a depressive disorder and PTSD, was not incurred in or aggravated by active service, nor may a psychosis be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1101, 1131, 1112, 1113, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). Duty to Notify Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2012); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and 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. VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). In March 2006, the United States Court of Appeals for Veterans Claims (Court) issued its decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Court in Dingess/Hartman held that the VCAA notice requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a "service connection" claim. As previously defined by the courts, those five elements include: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Upon receipt of an application for "service connection," therefore, VA is required to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. This includes notice that a disability rating and/or an effective date will be assigned if service connection is awarded. In VA correspondence to the Veteran in April 2006, VA informed him of what evidence was required to substantiate the claim and of his and VA's respective duties for obtaining evidence. The notice also informed the Veteran as to the law pertaining to the assignment of a disability rating and effective date as the Court required in Dingess/Hartman in the event that service connection was granted. In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the Court held that compliance with 38 U.S.C.A. § 5103 required that VCAA notice be provided prior to an initial unfavorable agency of original jurisdiction decision. Because the VCAA notice was completed prior to the initial AOJ adjudication denying the claim, the timing of the notice does comply with the express requirements of the law as found by the Court in Pelegrini. The VCAA requires that the duty to notify is satisfied, and that claimants are given the opportunity to submit information and evidence in support of their claims. Once this has been accomplished, all due process concerns have been satisfied. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996). The Board finds the VCAA notice requirements have been met in this case. Duty to assist With regard to the duty to assist, the claims file contains the Veteran's service treatment records (STRs), service personnel records, VA examination and treatment records, private treatment records and letters from Dr. F.B., lay statements from A.M.K, the Veteran's spouse, and C.K., and the statements of the Veteran in support of his claim. The Board has carefully reviewed the statements and concludes that there has been no identification of further available evidence not already of record for which VA has a duty to obtain. The April 2011 VA examination report shows that the Veteran reported that he receives Social Security Administration (SSA) retirement benefits. There is no indication that the Veteran ever applied for disability benefits and a search for SSA records is not necessary in this case. In a VA Form 21-4142, authorization and consent to release information, received in April 2006, the Veteran reported receiving treatment for mental illness at the Mayo Clinic from 1966 through April 2006. The claims file contains records from the Mayo Clinic which appear to have been submitted by the Veteran. The AOJ did not appear to request the Mayo Clinic records. In December 2009, the Board remanded the Veteran's case to request and obtain the Veteran's complete Mayo Clinic treatment records. In January 2010 correspondence, the Veteran was asked to complete a VA Form 21-4142 for Dr. F.B., but was not asked to submit a VA Form 21-4142 for the Mayo Clinic records. Again, in March 2011, the Board remanded the Veteran's case to secure any necessary authorization or releases to obtain the Veteran's complete Mayo Clinic treatment records. The Veteran was sent VA correspondence in April 2011, requesting that he complete and return a VA Form 21-4142 for the Mayo Clinic records. In May 2011, the Veteran was sent a second VA correspondence letter requesting that he complete and return a VA Form 21-4142 for the Mayo Clinic records. In June 2011, the Veteran submitted a private authorization to release information by the Mayo Clinic. The signed June 21, 2011 form shows that the authorization would terminate in one year. In June 2012, the Board again remanded the Veteran's case because there was no evidence that the AOJ attempted to obtain the Mayo Clinic records after receipt of the private release form. The Veteran was sent correspondence in June 2012 and was asked to complete and return a VA Form 21-4142 for the Mayo Clinic records. The Veteran did not respond. The Board recognizes the Veteran's representative's argument in the January 2012 post-remand brief. The Veteran's representative stated that the case should be remanded again because the June 2011 private authorization form was not used to obtain the Mayo Clinic records and that the Veteran was simply requested to submit another VA Form 21-4142. However, the Board finds that another remand is not required in this case. A remand by the Board confers on a veteran or other claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998). An appellant has the right to substantial, but not strict, compliance with that order. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). As noted above, the June 2011 private authorization form has since expired and cannot be used to obtain the Mayo Clinic records. The Veteran has been given an opportunity to submit another VA Form 21-4142 for the identified Mayo Clinic records, but has not responded. In Wood v. Derwinski, 1 Vet. App 190 (1991), the United States Court of Appeals for Veterans Claims noted that "[t]he duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." In light of the Veteran's failure to provide the requested information, the Board finds the VA has met its duty to assist. Thus, the Board finds that VA does not have a further duty to obtain records and there has been substantial compliance with the Board's remand. D'Aries, 22 Vet. App. at 105 (2008); Stegall, 11 Vet. App. at 271. In addition, the Board's December 2009 remand requested that the Veteran's records from Dr. F.B. be obtained and associated with the claims file. The record shows that the records were obtained and associated with the claims file. Therefore, the Board's December 2009 remand directive was completed. Stegall, 11 Vet. App. at 271. VA examinations were obtained in April 2007, September 2010, and April 2011. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the examinations and opinions are more than adequate. The reports reflect that the examiners reviewed the claims file, interviewed the Veteran regarding his symptoms and history, and examined the Veteran to include diagnostic testing. The examiners also provided opinions with supporting rationale. In addition, the April 2011 VA examiner had access to all the evidence in the claims file including records from Dr. F.B. The Board notes that the April 2011 VA examiner did not provide a nexus opinion in terms of probability. The examiner opined that the Veteran's depression was not secondary to any military experiences. The examiner provided an unequivocal opinion as to the etiology of the Veteran's depressive disorder and explained the opinion with a supporting rationale. Therefore, the Board finds that the opinion is adequate and there has been substantial compliance with the Board's remand. D'Aries, 22 Vet. App. at 105 (2008); Stegall, 11 Vet. App. at 271. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c) (4). Legal criteria Service connection is warranted if it is shown that a Veteran has a disability resulting from an injury incurred or a disease contracted in active service or for aggravation of a pre-existing injury or disease in active military service. 38 U.S.C.A. §§ 1110, 1131(West 2002); 38 C.F.R. § 3.303 (2012). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). Where a veteran served 90 days or more during a period of war, and a psychosis becomes manifest to a degree of 10 percent or more within one year from date of termination of such service, such disease shall be presumed to have been incurred in or aggravated by service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In Robinson v. Shinseki, 312 Fed. Appx. 336 (2009), the Court held that, in some cases, lay evidence will be competent and credible evidence of etiology. Whether lay evidence is competent in a particular case is a question of fact to be decided by the Board in the first instance. The Court set forth a two-step analysis to evaluate the competency of lay evidence. First, Board must first determine whether the disability is the type of injury for which lay evidence is competent evidence. If so, the Board must weigh that evidence against the other evidence of record to determine whether to grant service connection. The Board observes that this Federal Circuit decision is nonprecedential. However, see Bethea v. Derwinski, 2 Vet. App 252, 254 (1992) [a non-precedential Court decision may be cited "for any persuasiveness or reasoning it contains"]. The Board believes that if Bethea applies to the utility of Court decisions, it surely applies to the utility of decisions of a superior tribunal, the Federal Circuit. Service connection for PTSD Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and an in-service stressor. 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. 38 C.F.R. § 3.304(f). 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. Otherwise, the law requires verification of a claimed stressor. § 3.304(f)(3) is limited to stressors arising from hostile military or terrorist acts toward the U.S. military committed by individuals or entities, rather than acts of one service member directed at another service member. Hostile criminal actions, such as the harassment and personal assault stressors alleged by a Veteran are contemplated under the provisions of § 3.304(f)(5), which addresses evidentiary considerations where PTSD is alleged to have resulted from an in-service personal assault. Acevedo v. Shinseki, No. 10-3402 (U.S. Vet. App. July 9, 2012) VA is required to evaluate the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the official history of each organization in which the Veteran served, the Veteran's military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a). Analysis The Board has reviewed all of the evidence in the claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, 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 claims. The Veteran contends that he is entitled to service connection for a psychiatric disability. The first element of a claim for service connection is evidence of a current disability. The Veteran avers that he has PTSD; however, the most competent and probative evidence of record is against such a finding. Instead, the evidence shows that the Veteran has been diagnosed with major depressive disorder. For purposes of clarity, the Board will first address PTSD. The VA treatment records do not reveal an Axis I diagnosis of PTSD. Instead, the VA treatment records note diagnoses of major depressive disorder. The March 2002 PTSD screen was negative - the Veteran denied feeling distant or cut off from people, denied having repeated, disturbing memories, thoughts, or images of any stressful events he experienced. The Veteran had negative PTSD screens in May 2005 and January 2006. VA treatment records dated in May 2006, after he filed for service connection, show that the Veteran complained of PTSD symptoms, but was not diagnosed with PTSD. The Veteran was provided a VA examination in April 2007. The VA examiner noted that the Veteran's military occupational specialty (MOS) was freight traffic specialist. He did not spend any time in a war zone, although he claimed in his stressor statement that his unit handled the remains of persons killed in a plane crash as well as shipping remains of deceased to dependents in the U.S. With respect to PTSD, when asked to describe the traumatic events to which he was exposed in the military, he gave vague and unusual descriptions. He stated that he was involved in graves registration and salvaging human remains the "entire time he was there." With direct questioning, he stated that he had one incident of exposure to human remains. Shortly after his arrival in Greece, his entire unit was called to help clean up after a plane crash and sent to recover aircraft parts and human remains. He reported that his unit took children's bodies to the flight line. However, the Veteran admitted that he did not see any bodies, but his unit handled bodies enclosed in caskets. He reported feeling upset and emotional about this. The examiner indicated that if the facts were accurate, the events would meet Criterion A for a diagnosis of PTSD. However, the material in the claims file indicated that there was no evidence that the events occurred as described. The Veteran's reported symptoms met Criterion B, C, and D. The examiner noted that the Veteran's self-report of symptoms met the criteria for a diagnosis of PTSD. However, psychological testing and medical reports dispute the diagnosis. The examiner noted that the Veteran's MMPI-2 test results showed the Veteran to be responding in a non-credible manner and likely to be feigning a psychiatric disorder. His F scale raw score was 44, T score above 120, and his Fp raw score was 11, and t-score above 120. The scores showed the Veteran to be endorsing symptoms and experiences seldom endorsed by bonafide psychiatric patients. Other validity indices showed that the Veteran was not responding randomly, as might be expected if dementia were the cause. In summary, the Veteran's testing results pointed to a strong possibility of deliberate over-endorsing of symptoms. The examiner found that the Veteran's self-report of PTSD symptoms in the CAPS scale was brought into question. The examiner stated that the findings of the evaluation were that the Veteran did not have PTSD. The Veteran was provided a VA examination in September 2010. The examiner reviewed the claims file. On Axis I, a diagnosis of major depressive disorder, recurrent, in full remission, was listed. The Veteran was provided a VA examination in April 2011. The examiner reviewed the claims file. The Veteran reported that the most traumatic thing that happened during military service was having to unload bodies off of a plane, put them on a pallet, and drive them with a forklift to an unspecified location. He reported that he did this for all branches of the service and that deceased's dependents would pick up the bodies. He stated that he did this two or three times a month. He reported that it did not bother him at all until the 1990s. The examiner stated that in all probability, criterion A was not met for this event. The Veteran also reported a stressful event when a C130 crashed into the side of a mountain in Greece in 1964. He reported that he had to salvage the bodies and that his emotional response was that he threw up and he became terrified in the 1990s. Again, the examiner noted that criterion A does not appear to be met for the event. He reported intrusive memories of the crash ten times per month, has nightmares, and denied flashbacks. The examiner indicated that according to the Veteran's self-report, criteria B, C, D, and F were met. However, the examiner noted that the self-report suggested that there was a significant delay in the onset of his symptoms since they first began in the 1990s. The examiner noted that the MMPI-2 profile generated by the Veteran was invalid for interpretation. There were strong indications that the Veteran was highly inconsistent in his responding. The profile indicated significant over endorsement of items. The inconsistency would be indicative of the Veteran's cognitive decline indicated in his previous neuropsychological testing and the MOCA screening instrument that suggests the likelihood of some cognitive impairment. The examiner explained that the Veteran reported two stressful events that most likely did not meet criterion A for PTSD. A review of related symptoms found that the Veteran endorsed a significant number of symptoms in very extreme ways. Additionally, the Veteran almost robotically reported the onset of his symptoms as beginning in the 1990s. It was also noted that the MMPI-2 profile was invalid for interpretation, which was consistent with the invalid profile generated during the VA examination in 2007. The current profile suggested significant inconsistent responding. It was not believed to be due to intentional or manipulative intent, but rather a reflection of poor insight secondary to cognitive deficits. The examiner opined that given the numerous amounts of documentation between the Mayo Clinic and VA records, the Veteran's self-report was simply unreliable. The examiner noted that the Veteran's presentation during the current interview may have been significantly impaired due to his diagnosed subcortical dementia. The examiner further stated that, regardless, the Veteran underwent three VA examinations and none of them has he been able to provide a nexus between his symptoms and military experiences. The Veteran was not diagnosed with PTSD. The Veteran's private physician, Dr. F.B., submitted letters dated in August 2006 and January 2008. The August 2006 letter noted that the Veteran did a tour of duty with the United States Air Force and that his duties included the shipping of human remains. Since that time, he was depressed and claimed to have PTSD. He stated that his nightmares first began while doing this activity. Dr. F.B. noted that it was his impression that the Veteran had long standing depression with PTSD, which was service connected. In a January 2008 letter, Dr. F.B. stated that the Veteran reported that he had to handle human remains (corpses) during his service in Greece and at that time, he had frightening dreams and night sweats. He continued to have difficulty with the same dreams and night sweats. Dr. F.B. stated that, in his opinion, the Veteran had PTSD, which was long standing and clearly related to his employment by the United States Air Force. The accompanying private records from Dr. F.B. show that the Veteran was diagnosed with PTSD and depression, noting the Veteran's nightmares and that his stressor involved the handling of human remains. In a December 2006 lay statement from A.M.K., it was noted that the Veteran clearly had PTSD and that his nightmares and sweats seem related to his service in the United States Air Force. A.M.K. noted review of the Veteran's case with Dr. F.B. (above), an internist. In a lay statement received in November 2006, C.K. stated that he served with the Veteran in the United States Air Force from January 1965 to July 1966 and was assigned to the 7206th Support Group, Transportation/Traffic Management Office. C.K. stated that the Veteran's duties included packaging, crating, boxing, receiving materials, and cargo. The Veteran's duties also included the packing of deceased personnel property and supporting the recovery of crashed aircraft. C.K. explained that a USAF C-130 Cargo Aircraft crashed in the northern mountains of Greece during this period and the freight section was called to provide and assist in the recovery of salvageable cargo and removing and processing of the crash victims. In an April 2006 statement, the Veteran's spouse indicated that the Veteran had varying degrees of depression for a long time and that he did not talk about shipping human remains when they were in Greece because he thought it would go away. Here, the Board finds that the April 2011 VA examiner's opinion is more probative than Dr. F.B.'s opinion. The probative value of medical opinions is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion). There is no requirement that additional evidentiary weight be given to the opinion of a medical provider who treats a veteran; courts have repeatedly declined to adopt the "treating physician rule." See White v. Principi, 243 F.3d 1378, 1381 (Fed. Cir. 2001); Van Slack v. Brown, 5 Vet. App. 499, 502 (1993). The Board finds that Dr. F.B.'s opinions are entitled to little, if any, probative value, and far less probative value than the opinions of the April 2011 VA examiner. First, it does not appear that Dr. F.B. is a psychiatrist or psychologist. In the letters and private medical records, Dr. F.B. stated that the Veteran met the criteria for PTSD. However, in determining this, Dr. F.B. noted that the Veteran reported experiencing nightmares and sweats during active service and since that time. As will be explained in more detail below, the Veteran has provided inconsistent statements regarding the onset of his symptoms. During the April 2011 VA examination, he stated that his symptoms with respect to his reported stressors occurred in the 1990s. The report of medical history completed upon separation from active service shows that the Veteran denied experiencing depression/excessive worry, denied frequent trouble sleeping, and denied frequent or terrifying nightmares. This is in conflict with the basis for Dr. F.B.'s opinion that the Veteran has PTSD. In addition, the records and letters from Dr. F.B. do not include psychiatric testing or an Axis I diagnosis of PTSD. This omission weighs against the probative value of these records in showing a current PTSD diagnosis. 38 C.F.R. § 4.125. In contrast, the Board finds that the April 2011 VA examiner's opinion is the most competent and probative evidence of record as to whether the Veteran has a diagnosis of PTSD. The examiner reviewed the claims file, examined the Veteran, provided an analysis of the DSM-IV criteria, and determined that the Veteran did not meet the criteria for PTSD. See Guerrieri v. Brown, 4 Vet. App. 467, 470 (1993); see also Owens v. Brown, 7 Vet. App. 429, 433 (1995) (holding that VA may favor the opinion of one competent medical expert over that of another when VA gives an adequate statement of reasons and bases). In determining that the Veteran did not have a diagnosis of PTSD, the examiner noted the VA examination report from September 2007 regarding the validity of the MMPI-2 profile and the over endorsement of symptoms. The April 2011 VA examiner indicated that a possibility of the over-endorsement of symptoms was due to a diagnosis of dementia. However, the examiner still explained that, in all probability, criterion A was not met. In support for this conclusion, the examiner noted that the Veteran reported that his stressors did not bother him until the 1990s. In addition, the examiner explained that the Veteran reported a significant number of symptoms in very extreme ways and that the Veteran's self-report was simply unreliable. The examiner opined that the Veteran did not meet nor did he appear to have ever met the criteria for PTSD that was related to his military experiences. Therefore, the Board finds that the most probative and competent evidence indicates that the Veteran does not have PTSD. The Board acknowledges the Veteran's statement and A.M.K.'s statement that he has PTSD. Under certain circumstances, a layperson is competent to identify a simple medical condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (noting, in a footnote, that sometimes a layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer). In a claim of service connection for PTSD, there is a specific legal requirement that the diagnosis of PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125, that is, a diagnosis that conforms to the DSM-IV. 38 C.F.R. § 3.304(f). PTSD is not a simple medical condition that the Veteran and A.M.K., as lay persons, can perceive based on mere personal observation, that is, by visual observation or by any other of the senses. Thus, the Veteran and A.M.K. are not competent to declare that he has PTSD or to offer an opinion that PTSD is related to service, as PTSD is not a simple medical condition. It has not been established that the Veteran or A.M.K. are otherwise qualified through specialized education, training, or experience to state that the Veteran has PTSD or to offer a medical diagnosis or an opinion on medical causation. Accordingly, to the extent that the Veteran's statements and those of A.M.K. are offered as evidence of a diagnosis, the statements are not competent evidence. Again, in order to establish service connection for PTSD, there must be evidence of a valid medical diagnosis of PTSD under the DSM-IV criteria, as well as link between current PTSD and the in-service stressor. See 38 C.F.R. § 3.304(f). Absent competent evidence of the existence of a disability, service connection cannot be granted. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Board notes that the records from Dr. F.B. and his statements note impressions of PTSD. However, the records do not contain a diagnosis of PTSD under the DSM-IV and the most probative and competent evidence indicates that the Veteran does not have a diagnosis of PTSD. Therefore, service connection is not warranted. In sum, the Board finds that the preponderance of the evidence is against a grant of service connection and thus, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). The Board has also considered whether the Veteran is entitled to service connection for an acquired psychiatric disability other than PTSD but finds that he is not. The medical evidence shows that the Veteran is diagnosed with major depressive disorder. The private medical records, VA treatment records, and VA examination reports include diagnoses of major depressive disorder and depression. However, the STRs are absent for any notation, documentation, or diagnosis of psychiatric problems or depression. The separation report of medical examination shows that the Veteran's psychiatric condition was clinically evaluated as normal. The report of medical history shows that the Veteran denied depression/excessive worry, denied frequent trouble sleeping, denied nervous trouble of any sort, and denied frequent or terrifying nightmares. Following separation from active service, the private medical records indicate that the Veteran was first diagnosed with depression in 1990. In a November 2003 VA treatment record, it was noted that the Veteran had a 13 year history of depression. The April 2006 private medical record shows that the Veteran was first formally diagnosed with depression in 1990 but he believed that there may have been periods in his life where he suffered with depressive symptoms which went untreated. In a January 2004 VA treatment record, the Veteran reported that he was diagnosed with major depressive disorder in 1990 and denied being significantly depressed prior to this. The Veteran was provided a VA examination in April 2007. The claims file was reviewed. The Veteran reported that he has been treated for depression since 1990, although he felt that he had bouts of depression much earlier. On Axis I, a diagnosis of major depressive disorder, recurrent, was listed. The examiner opined that there was no evidence that the Veteran's major depressive disorder, beginning in 1990, was caused by or aggravated by his military service nearly 30 years earlier. The Veteran was provided a VA examination in September 2010. The examiner reviewed the claims file. The Veteran reported that he initially received treatment for depression in 1990, at which time he was hospitalized for several days. He attributed the onset of his depression at that time to not having a job, lack of interest in things, and that he slept a lot. On Axis I, a diagnosis of major depressive disorder, recurrent, in full remission, was listed. The examiner opined that the Veteran's major depressive disorder was not caused by or a result of his military service. The examiner stated that the Veteran reported the onset of depression in 1990 (more than 20 years after discharge), which he attributed to his unemployment and lack of interest in doing things. There was no strong evidence in his self-report or treatment records to establish a nexus between his depression and military service. It was noted by the examiner that the depression was not aggravated by military service, as evidenced by the depression being in full remission. The Veteran was provided a VA examination in April 2011. The examiner reviewed the claims file. It was noted that the service treatment records did not indicate that the Veteran endorsed the presence of psychiatric symptoms during his military service. The examiner noted review of VA treatment records and private treatment records. The examiner stated that the records indicated that the Veteran reported onset of symptoms in 1990; however, the reason for onset was varied at times. A November 2003 note indicated that the Veteran reported the onset of depression in 1990 and that his parents had both passed away in 1987 which he believed was the trigger for his depression. On Axis I, diagnoses of subcortical dementia by history and major depressive disorder by history were listed. Based on review of the numerous records from VA, Mayo clinic, and the accumulation of previous examinations, the examiner opined that the Veteran's depression was not secondary to any military experiences. The Veteran's private physician, Dr. F.B., stated that the Veteran's depression began during service and continued since that time. However, the Board finds that Dr. F.B.'s opinion is entitled to little probative value. The separation report of medical history shows that the Veteran denied experiencing depression or excessive worry. In addition, the Veteran has provided inconsistent statements with respect to the onset of his symptoms. In private and VA treatment records and the VA examination reports, the Veteran stated that his symptoms began in the 1990s. However, in other records, the Veteran expressed his belief that he had bouts of depression before his formal diagnosis of depressive disorder in 1990 that went undiagnosed. Thus, Dr. F.B.'s opinion is based on inconsistent statements of the Veteran and Dr. F.B. does not appear to have reviewed the service treatment records or other medical records included in the claims file. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In contrast, the VA examiners examined the Veteran, noted his reported history and symptoms, reviewed the claims file, and opined that the Veteran's depression was not related to active service. The Board finds that the VA examiner's opinions are probative as they noted the Veteran's reported symptoms, reviewed the records, included detailed examination findings, and provided opinions with supporting rationale, citing to the records reviewed. Thus, the most competent and probative evidence does not relate the Veteran's depressive disorder to active service and service connection is not warranted. The Board is aware that service connection may be warranted on the basis of continuity of symptomatology. The Veteran is competent to describe his symptoms such as being depressed. However, the Board finds that the Veteran is not credible with respect to his reports of continuity of symptomatology. The Veteran's statements regarding the onset of his depression have been inconsistent. In private and VA treatment records, the Veteran reported that his problems with depression began in 1990. In a November 2003 record, the Veteran reported the onset of depression in 1990 and that his parents had both passed away in 1987 which he believed was the trigger for his depression. In other records, the Veteran reported that he believed he had bouts of depression before he was diagnosed in 1990. During the September 2010 examination, the Veteran attributed the onset of his depression in 1990 to not having a job, lack of interest in things, and that he slept a lot. On the other hand, the Veteran appears to have told Dr. F.B. that his depression began during active service. In addition, the Veteran's spouse indicated that he had chronic depression although she did not state that it began during active service. The separation report of medical history shows that the Veteran denied experiencing depression or excessive worry. As such, the Board finds that the Veteran is less than credible due to the inconsistencies of his statements. The Board finds his statements to be less than credible not only due to the lack of supporting evidence, but due to inconsistencies. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (finding that, while the Board may not ignore a veteran's testimony simply because he or she is an interested party and stands to gain monetary benefits, personal interest may affect the credibility of the evidence); see also Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995) (credibility can be generally evaluated by a showing of interest, bias, or inconsistent statements, and the demeanor of the witness, facial plausibility of the testimony, and the consistency of the testimony). The Board acknowledges the Veteran's statement and his spouse's statement that his depression is related to active service. Neither the Veteran nor his spouse has been shown to possess medical training or expertise necessary to render a competent diagnosis or etiology finding. The question of causation, in this case, involves a complex medical question that the Veteran and his spouse are not competent to address. Jandreau, 492 F.3d at 1372. Moreover, the Board attributes more probative value to the VA examiners who examined the Veteran, reviewed the claims file, took into account the Veteran's statements, and provided negative nexus opinions with supporting rationale. In sum, the Board finds that the preponderance of the competent and probative evidence weighs against a finding that any acquired psychiatric disability, including depressive disorder and PTSD, had its onset in service or is otherwise causally related to the Veteran's active service. In addition, the evidence does not show that any psychosis manifested to a compensable degree within one year following his separation from service. 38 C.F.R. §§ 3.307, 3.309. The Board finds that the preponderance of the evidence is against a grant of service connection and thus, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). (CONTINUED ON NEXT PAGE) ORDER Entitlement to service connection for an acquired psychiatric disability, to include depression and PTSD, is denied. ____________________________________________ U.R. POWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs