Citation Nr: 18150092 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-24 607A DATE: November 14, 2018 ORDER Entitlement to service connection for asthma is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and an adjustment disorder (hereafter referred to simply as an “acquired psychiatric disorder”), is denied. FINDINGS OF FACT 1. The Veteran’s asthma clearly and unmistakably preexisted service; and clearly and unmistakably was not aggravated thereby. 2. The evidence of record is against finding that the Veteran’s headaches are due to an in-service injury, event, or disease. 3. The evidence of record is against finding that the Veteran’s acquired psychiatric disorder is due to an in-service injury, event, or disease, including an in-service sexual assault. CONCLUSIONS OF LAW 1. The criteria for service connection for asthma are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for headaches are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for an acquired psychiatric disorder are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from May 1989 to October 1991. This case is on appeal before the Board of Veterans’ Appeals (Board) from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran initially filed a claim for service connection for PTSD. However, in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims clarified how the Board should analyze claims for PTSD and other acquired psychiatric disabilities. As emphasized in Clemons, a veteran’s claim “cannot be limited only to that diagnosis, but must rather be considered a claim for any mental disability that may be reasonably encompassed.” Id. Accordingly, the Board has re-characterized the issue as shown on the title page. In February 2017, the Veteran appeared and provided testimony before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is associated with the claims file. A review of the record reflects additional medical evidence was added subsequent to the June 2016 Statement of the Case (SOC). Although this evidence was submitted without wavier of RO consideration, the evidence provided is essentially cumulative of the information previously considered. As such, no further action is required. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). Neither the Veteran nor her representative has raised any specific issues with the duty to notify or the duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); see also Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Also, neither the Veteran nor her representative has raised any issues concerning the hearing held before the undersigned. Bryant v. Shinseki, 23 Vet. App. 488, 492 (2010). The Veteran seeks service connection for asthma, headaches, and an acquired psychiatric disorder, all of which she claims are related to active service. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Regulations provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Barr v. Nicholson, 21 Vet. App. 303 (2007); Pond v. West, 12 Vet. App. 341, 346 (1999). Where the evidence shows a chronic disease in service or continuity of symptoms after service, the disease shall be presumed to have been incurred in service. For the showing of a chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). If a condition noted during service is not shown to be chronic, then a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A veteran is considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). The presumption of soundness may be rebutted by clear and unmistakable evidence showing that a disability pre-existed service and that the disability was not aggravated by service. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). Thus, the Veteran is not required to show that a pre-existing injury or disease increased in severity during service. Rather, the burden remains with the VA to show by clear and unmistakable evidence that the pre-existing disease or injury was not aggravated by service. The VA may show a lack of aggravation if clear and unmistakable evidence establishes that there was no increase in disability during service, or that any increase in disability was due to the natural progress of the pre-existing condition. If this burden is met, then the claimant is not entitled to service connection benefits. Id. On the other hand, if the VA fails to show a lack of aggravation by clear and unmistakable evidence, then the presumption has not been rebutted. Id. at 1094 (holding that Congress intended to “convert aggravation claims to ones for service connection when the government fails to overcome the presumption of soundness under § 1111”). In that case, the claim will be considered as a normal claim for service connection and, if granted, no deduction for the degree of disability existing at the time of entrance will be made. Id. at 1096 (citing 38 C.F.R. § 3.322). In other words, the claim may not be denied, nor benefits deducted, on the basis of a finding that the disability in question pre-existed active service, if the VA has not also met its evidentiary burden by showing that the disability was not aggravated during service. In rendering a decision on appeal, the Board must analyze the credibility and probative value of all medical and lay evidence of record, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. 38 U.S.C. § 1154(a); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board must resolve reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran seeks service connection for asthma, headaches, and an acquired psychiatric disorder. Although the evidence reveals that the Veteran’s asthma clearly and unmistakably existed prior to service, it clearly and unmistakably shows that it was not aggravated beyond its natural progression by an in-service injury, event, or disease. Similarly, the preponderance of the evidence is against finding that the Veteran’s headaches and acquired psychiatric disorder are related to service. Therefore, all three appeals are denied. I. Asthma The transcript of the February 2017 Board hearing reflects that the Veteran denies having asthma prior to service. Rather, she traces her condition to her deployment to Saudi Arabia, which lasted for 30 days. The Veteran asserts that, during her time in the desert, her eyes became swollen and it became difficult for her to breathe. Due to her symptoms, she was sent back to Germany for medical attention. The Veteran states that, prior to her tour in Saudi Arabia, she could run and exercise. Now, however, she cannot do those things. The Veteran asserts that she receives treatment for her asthma, which involves the use of both inhalers and oral medication. A review of the Veteran’s service treatment records does not reveal any references to a pre-existing respiratory condition during her March 1989 entrance examination. Nonetheless, she sought treatment for shortness of breath in December 1989, when she also reported a family history of asthma. The Veteran went to the emergency room in February 1991, complaining of chest pain and asthma-like symptoms. She was diagnosed with bronchial asthma which, after receiving treatment, was characterized as being in remission. Another progress note associated with this incident confirms that the Veteran was sent back from Saudi Arabia due to a recurrence of her childhood asthma. This is also referenced in her August 1991 separation examination. A private treatment record from December 2012 indicates that the Veteran was doing well on medication without signs of wheezing or shortness of breath. Similarly, in June 2013 the Veteran stated that her asthma is quiet most of the time but flares with heat. The Veteran underwent a VA examination in May 2014. The examiner reviewed the claims file and the Veteran’s history, describing her current asthma as mild and persistent. The examination report notes the recurrence of the Veteran’s asthma during her tour in Saudi Arabia, stating that it was most likely the result of exposure to dust and allergens that temporarily worsened her condition. Once she returned from deployment, however, she improved after continued treatment. She was found to have episodes of mild persistent asthma symptoms that were treated episodically during the remainder of her tour of duty. The record also suggests that the Veteran’s asthma was well-controlled and in remission at the time of separation, with no permanent or chronic residuals due to any respiratory condition. There was also no evidence that the Veteran’s self-limited exposure to dust and allergens her during deployment altered the course of her disease or affected her current asthma condition. Based on this evidence, the examiner concluded that the Veteran’s condition is more likely than not caused by or related to shortness of breath shown in service given the evidence of a pre-existing asthma condition with exacerbations during her deployment to Saudi Arabia. Nonetheless, the examiner also opined that the Veteran’s asthma was less likely than not aggravated beyond its normal progression because there is no evidence of permanent aggravation during service. After careful consideration of the claims file, the Board concludes that the Veteran’s asthma clearly and unmistakably preexisted service, and was not aggravated beyond its natural progression during service. Despite there being no mention of the Veteran’s childhood asthma on her enlistment examination report, it is referenced in later service treatment records relating to her respiratory impairment, including her August 1991 separation examination. Furthermore, evidence dating after separation, which includes numerous statements from the Veteran herself, generally agrees on the fact that she experienced asthma-like symptoms before enlistment. The only indication to the contrary is the Veteran’s own statements during the February 2017 Board hearing, when she denied the existence of a childhood respiratory impairment. Nonetheless, the Board finds that the statements made by the Veteran during her February 2017 Board hearing lack credibility. Indeed, it is reiterated that her assertions about suffering from asthma as a child were made to medical professionals for the purpose seeking treatment. In contrast, her statements denying the existence of a childhood respiratory impairment were made to VA adjudicators with the goal of securing monetary benefits. Although the existence of a pecuniary interest does not render the Veteran’s testimony invalid as a matter of course, the Board concludes that it lessens the probative value of her recent, contradictory statements. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (monetary interest may affect the credibility of a claimant’s testimony). The Board finds that the history of childhood asthma to medical professionals for the purpose of medical treatment are more reliable. Thus, there is clear and unmistakable evidence that the Veteran’s respiratory condition existed prior to service, meaning that the presumption of soundness has been rebutted. Therefore, under the analytical framework set forth in Wagner, the burden is on the VA to demonstrate by clear and unmistakable evidence that the Veteran’s preexisting asthma was not aggravated by service. In doing so, the Board notes that the opinion provided by the May 2014 VA examiner is the only statement from a medical professional addressing the origin and development of the Veteran’s respiratory impairment. The VA examiner had the benefit of examining the Veteran and the claims file, and found that the exacerbation of her asthma in Saudi Arabia was attributable to various environmental conditions there. Indeed, the evidence of record shows that once she returned and received treatment, her asthma went into remission. As such, the exacerbation of asthma symptoms that the Veteran experienced in Saudi Arabia was an acute, transitory episode that did not aggravate her preexisting condition beyond its natural progression. Given that there is no medical opinion evidence to contradict this conclusion, the Board assigns great probative weight to the opinion of the May 2014 VA examiner, and finds that there is clear and unmistakable evidence that the Veteran’s asthma was not aggravated by service. Lastly, the Board acknowledges the statements of the Veteran, which allege that her asthma is related to service. Although lay witnesses are competent to provide evidence regarding matters that can be perceived by the senses, they are not competent to provide an opinion regarding etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (2007); see also Barr, 21 Vet. App. 303 (lay testimony is competent to establish the presence of observable symptomatology). For the reasons discussed above, however, the Board finds that the opinion provided by the VA examiner in May 2014 is more probative than the Veteran’s lay assertions. The VA examiner has expertise, education, and training that the Veteran is not shown to have. As such, that etiology opinion warrants more weight. In conclusion, the Board finds that clear and unmistakable evidence supports the existence of a preexisting respiratory impairment. The Board also finds that clear and unmistakable evidence shows that the Veteran’s asthma was not aggravated beyond its natural progression by an in-service injury, event, or disease. Although the Board recognizes the Veteran’s assertions that her asthma related to service, the majority of the evidence is inconsistent with these statements. Since the weight of the evidence is against the claim, the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. 49, 58 (1991). Thus, the Veteran’s claim for service connection for asthma is denied. II. Headaches The Veteran claims that she did not experience chronic headaches prior to joining the military. Rather, she traces her headache condition to an accident she experienced in service. According to the Veteran’s account of the incident, she missed a step while exiting a truck, hitting her head. She asserts that she has experienced headaches since then, which she treats with a daily aspirin regimen. The Veteran also denies ever having been diagnosed with a traumatic brain injury (TBI) in service, and is unsure about a prior diagnosis of tension headaches. See February 2017 Board hearing. The Veteran’s service treatment records indicate that she complained of severe headaches after hitting her head on a wall locker in June 1990. In August 1990, the Veteran reported that her headaches typically lasted two days, with pain at the site where she was struck in the temple. The Veteran indicated that her headaches occurred once per week, with pain waxing and waning in severity. The attending physician opined that the Veteran’s symptoms could possibly be tension headaches, but also stated that they could be associated with her head injury. In January 1991, the Veteran complained of a migraine headache lasting for several days. She stated that Advil brought temporary relief for a few hours before the symptoms returned. However, despite these complaints, the Veteran’s August 1991 separation examination contains no references to a chronic headache condition. There is no further evidence of any complaints or treatment related to headaches until May 2014, when the Veteran was afforded a VA examination. The examiner reviewed the claims file, noting that the Veteran has no pathology or diagnosis of a chronic headache condition or syndrome. The examiner also noted that, despite her head injury in June 1990, the Veteran was never diagnosed with a TBI or a concussion during service. The examination report recited the Veteran’s history of headaches during service, which were thought to possibly be tension-type migraine headaches. She began complaining of headaches in January 1990, which preceded her minor head injury by several months. However, any headache complaints after the head injury were self-limiting and resolved without residuals. There was also no evidence of any chronic headache condition at separation, nor is there evidence of chronicity of complaints or care for any headache condition since military service. As such, nothing in the claims file indicates that the Veteran has a current chronic headache condition. Based on these findings, the examiner concluded that the Veteran’s headaches are less likely than not caused by or related to an in-service event, injury, or disease. After careful consideration of the claims file, the Board concludes that the preponderance of the evidence is against the finding that the Veteran’s headaches are related to service. The Board notes that the opinion provided by the May 2014 VA examiner is the only medical opinion addressing the origin of the Veteran’s headaches. The VA examiner had the benefit of examining the Veteran and the claims file, provided a clear basis for his medical opinion, and made the most recent evaluation of record. The VA examiner also had the opportunity to review the Veteran’s VA medical records associated with the claims file, and found no relationship between her current headaches and her head injury in 1990. The Board thus affords the greatest probative weight to the opinion of the May 2014 VA examiner, and adopts his conclusion that the Veteran has not had a chronic headache condition since service. The Board acknowledges the statements of the Veteran, which attribute her headaches to an incident that occurred in service. Although lay witnesses are competent to provide evidence regarding matters that can be perceived by the senses, they are not competent to provide an opinion regarding etiology. See Jandreau, 492 F.3d 1372; see also Barr, 21 Vet. App. 303 (lay testimony is competent to establish the presence of observable symptomatology). For the reasons discussed above, however, the Board finds that the opinion provided by the VA examiner in May 2014 is more probative than the Veteran’s lay assertions. The VA examiner has expertise, education, and training that the Veteran is not shown to have. As such, that etiology opinion warrants more weight. In conclusion, the Board finds that the preponderance of the evidence does not support the Veteran’s contention that she has a current headache condition related to active service. Although the Board recognizes the Veteran’s assertions that she has suffered from headaches since service, the majority of the evidence is inconsistent with these statements. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. 49, 58 (1991). Thus, the Veteran’s claim for service connection for headaches is denied. III. Acquired Psychiatric Disorder The Veteran seeks service connection for an acquired psychiatric disorder, which she identifies as PTSD and claims results from a sexual assault during service in May 1991. She never reported it, but her service treatment records contain a reference to chlamydia, which the Veteran claims she contracted in the assault. The Veteran also asserts that she told a fellow female soldier about the incident, but indicates that she is no longer in contact with that person. Lastly, the Veteran alleges that she saw a therapist for three or four months in 2014, who diagnosed her with PTSD. However, these records are not associated with the claims file, and the Veteran could provide no more than the therapist’s first name. See June 2015 correspondence; see also February 2017 Board hearing. Service connection for certain identified chronic diseases, including psychoses, may be established on a presumptive basis by showing that such a disease manifested itself to a compensable degree within a prescribed period following separation from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). The term “psychosis” means any of the following disorders listed in the DSM-5: (a) Brief Psychotic Disorder; (b) Delusional Disorder; (c) Psychotic Disorder Due to Another Medical Condition; (d) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder; (e) Schizoaffective Disorder; (f) Schizophrenia; (g) Schizophreniform Disorder; and (h) Substance/Medication-Induced Psychotic Disorder. 38 C.F.R. § 3.384. However, the presumption of service connection for chronic diseases under 38 C.F.R § 3.309(a) does not apply in this case because the record does not show any diagnosis of a psychosis during service or within one year of the Veteran's separation from service. 38 U.S.C. §§ 1110, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Additionally, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a). Walker, 708 F.3d 1331. The enumerated diseases include psychoses, but do not include PTSD or other psychiatric or mental disorders that have been diagnosed in this case. As such, there is no presumption of service connection for any of the conditions at issue. Generally, service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). Depending on the circumstances, there are several avenues to document an in-service stressor: an in-service PTSD diagnosis with lay testimony; combat service with lay testimony; prisoner of war status with lay testimony; lay evidence of personal assault with appropriate corroboration; and a stressor related to a veteran's fear of hostile military or terrorist activity, with appropriate medical evidence from a VA psychiatrist or psychologist. 38 C.F.R. § 3.304(f). In PTSD claims that are not combat-related, do not pertain to the fear of hostile military or terrorist activity, nor are related to a Veteran’s status as a prisoner of war, lay testimony alone is not sufficient to establish that a stressor occurred; it must be corroborated by credible supporting evidence. 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128, 142 (1997). Under 38 C.F.R. § 3.304(f)(5), 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. 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; 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. The Veteran’s service personnel records contain several references to behavioral and disciplinary problems. In August 1980, the Veteran was counseled two separate times for failing to obey direct orders. In September 1990, the Veteran slapped another soldier across the face and pushed her with her hands. As a result, the Veteran forfeited pay, was assigned 14 days of extra duty, and was reduced in rank. In February 1991, the Veteran tested positive for chlamydia during an emergency room visit for stomach pain. The Veteran’s August 1991 separation examination contains no references to any psychiatric disorders or psychological testing. However, the following month, she received notice that she was being separated under Chapter 13. The reason for this was due to her “continuously” writing bad checks, failing to carry out her duties in a professional manner, and showing contempt toward senior military authorities. There is no record of psychiatric treatment until November 2010, when the Veteran was diagnosed with adjustment disorder with mixed anxiety and depressed mood by Dr. R.M., a psychiatrist contracted by the Social Security Administration. According to Dr. R.M., the Veteran’s psychiatric condition was brought on by occupational and financial issues, along with other health-related problems. There is no mention of an in-service sexual assault in any of these records. The Veteran underwent a VA psychological examination in July 2014. The examiner reviewed the claims file, noting the Veteran’s history and complaints. The examiner diagnosed the Veteran with an adjustment disorder with both anxiety and depressed mood, which results in occupational and social impairment due to mild or transient symptoms. However, the examiner concluded that the Veteran’s current adjustment disorder was less likely than not related to her military service. This is because she did not report symptoms and was neither diagnosed with nor treated for any psychological condition during service. Additionally, the examiner opined that the Veteran’s current mood disorder is a result of multiple psychosocial stressors, including unemployment and the incarceration of her two sons. Significantly, there was no mention of an in-service sexual assault during this examination. The first reference to an in-service sexual assault does not occur in the record until June 2015, when the Veteran filed a statement in support of as claim for PTSD secondary to sexual assault. The following month, the Veteran submitted another statement in which she described the incident. According to the Veteran’s account, she went off base one night to visit a friend. After dinner, they were watching a movie in his apartment. He kept touching her and did not stop when she asked him to quit. The Veteran attempted to leave but he would not let her. He later forced himself onto her in the bedroom. The Veteran indicated that she did not report this incident or seek treatment because she did not want to be discharged. She stated that she never told anyone and no investigation was ever conducted. The Veteran was afforded a second VA psychological examination in December 2015. The examiner reviewed the claims file and the Veteran’s complaints, diagnosing her with an adjustment disorder with mixed anxiety and depressed mood. The examination report reflects no diagnosis of PTSD comporting with the DSM-5 criteria in the claims file. Although the Veteran related her account of the in-service sexual assault, the examiner found insufficient evidence to satisfy the criterion A requirements necessary to substantiate a PTSD diagnosis. To support this conclusion, the examiner cited to evidence of behavioral issues from August and September 1990, both of which occurred well before the claimed in-service sexual assault. The Veteran was also not diagnosed with chlamydia until February 1991, which was almost 3 months before the claimed in-service sexual assault occurred. Moreover, the Veteran denied being in a relationship for the past 15 years, but the evidence shows she has had at least two romantic relationships during that time, resulting in her two sons. The examiner also pointed out that the first report of a military sexual assault came after the July 2014 examination and subsequent denial. Although the examiner could not opine as to whether an in-service sexual assault occurred without resorting to speculation, she stated that the Veteran did not display behavioral markers that would typically indicate a sexual assault occurred. Thus, the examiner concluded that the Veteran’s adjustment disorder is less likely than not related to events experienced in service, but rather developed in response to various stressors that occurred since separation, such as those referenced by the July 2014 VA examiner. After careful consideration of the claims file, the Board concludes that the preponderance of the evidence is against the finding that the Veteran’s acquired psychiatric disorder is related to service. The Board notes that the opinions provided by the July 2014 and December 2015 VA examiners are the only statements from medical professionals addressing the etiology of the Veteran’s acquired psychiatric disorder. Although the December 2015 examiner could not opine whether the alleged in-service sexual assault occurred without resorting to speculation, the Board finds that this determination is immaterial because there is no valid diagnosis of PTSD in the record. Indeed, both the July 2014 and December 2015 VA examiners, along with Dr. R.M., diagnosed the Veteran with an adjustment disorder. Although Dr. R.M. did not offer an opinion as to the etiology of this condition, both VA examiners found that it developed in response to various stressors that manifested after service. These included unemployment, financial pressures, and the incarceration of the Veteran’s two sons. Both VA examiners had the benefit of examining the Veteran and the claims file, and provided clear bases for their medical opinions. The VA examiners also had the opportunity to review the Veteran’s VA medical records associated with the claims file, and found no relationship between her current acquired psychiatric disorder and any events experienced in service, including an in-service sexual assault. The Board thus affords the greatest probative weight to the opinions of the July 2014 and December 2015 VA examiners, and adopts their conclusion that the Veteran does not have a current acquired psychiatric disorder related to service. The Board also acknowledges the Veteran’s insistence that she has PTSD resulting from an in-service sexual assault. Although lay witnesses are competent to provide evidence regarding matters that can be perceived by the senses, they are not competent to diagnose themselves with a psychiatric disorder or offer an opinion regarding its etiology. See Jandreau, 492 F.3d 1372; see also Barr, 21 Vet. App. 303 (lay testimony is competent to establish the presence of observable symptomatology). For the reasons discussed above, however, the Board finds that the opinions provided by the VA examiners in July 2014 and December 2015 are more probative than the Veteran’s lay assertions. The VA examiners have expertise, education, and training that the Veteran is not shown to have. As such, those diagnoses and etiology opinions warrant more weight. Lastly, the Board recognizes the Veteran’s contention that therapy records reflecting a diagnosis of PTSD exist but are not currently associated with the claims file. However, the Board notes that the Veteran bears the burden of proof to substantiate every element of her claim. Madden v. Gober, 125 F.3d 1477, 1480-81 (Fed. Cir. 1997). Although the VA has a duty to assist the Veteran in developing evidence, the duty to assist is not a one-way street. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Rather, if a Veteran wishes help, she cannot passively wait for it in those circumstances where her own actions are essential in obtaining the putative evidence. Hayes v. Brown, 5 Vet. App. 60, 68 (1993). Here, the Veteran has been unable to provide the VA with anything other than the therapist’s first name. As such, the Board finds that the VA has satisfied its duty to assist with regard to these records. In conclusion, the Board finds that the preponderance of the evidence does not support the Veteran’s contention that her acquired psychiatric disorder is related to active service. Although the Board recognizes the Veteran’s assertions that her psychiatric condition stems from an in-service sexual assault, the majority of the evidence is inconsistent with these statements. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. 49, 58 (1991). Thus, the Veteran’s claim for service connection for an acquired psychiatric disorder is denied. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD MJS, Associate Counsel