Citation Nr: 18151413 Decision Date: 11/19/18 Archive Date: 11/16/18 DOCKET NO. 14-14 644 DATE: November 19, 2018 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for a heart disability, claimed as a congestive heart problem is denied. Entitlement to service connection for hypertension, claimed as high blood pressure is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for a psychiatric disability, claimed as posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. Despite the Veteran’s exposure to a hazardous noise environment during service, the preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of bilateral hearing loss disability for VA purposes. 2. The Veteran’s heart disability, claimed as a congestive heart problem, did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 3. The Veteran’s hypertension, claimed as a high blood pressure, did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 4. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a headache disability. 5. The Veteran did not engage in combat with the enemy and the claimed stressor event is not related to fear of hostile military or terrorist activity. The Veteran is not diagnosed with posttraumatic stress disorder (PTSD) as the record does not otherwise contain credible supporting evidence sufficient to corroborate the Veteran’s claimed in-service stressor events. 6. The Veteran is currently diagnosed with depressive disorder related to medical conditions. 7. The preponderance of the evidence is against finding that the Veteran has psychiatric disability due to a disease or injury in service, to include specific in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria to establish service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2018). 2. The criteria to establish service connection for left ear hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2018). 3. The criteria to establish service connection for a heart disability, claimed as a congestive heart problem have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 4. The criteria to establish service connection for hypertension, claimed as high blood pressure have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 5. The criteria to establish service connection for headaches have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 6. The criteria to establish service connection for a psychiatric disability, claimed as posttraumatic stress disorder (PTSD) have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, had service from September 1986 to September 1995. In April 2016, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file. The Board previously considered this appeal in September 2016, and remanded these issues for additional development. After the development was completed, the case returned to the Board for further appellate review. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2018). 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Organic diseases of the nervous system, including sensorineural hearing loss and headaches, as well as cardiovascular-renal diseases and hypertension are considered “chronic diseases” under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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. In order to show a “chronic” disease in service, the record must reflect a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. Where a chronic disease has been incurred in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required in order to establish entitlement to service connection. 38 C.F.R. § 3.303(b). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases to a degree of 10 percent or more within one year of separation from service, such diseases may be presumed to have been incurred in 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. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. While the disease need not be diagnosed within the presumptive period, it must be shown—by acceptable lay or medical evidence—that there were characteristic manifestations of the disease to the required degree during that time. 1. Entitlement to service connection for right and left ear hearing loss. The Veteran asserts that he was exposed to hazardous loud noises during service, specifically exposure to sounds associated with a ship engine room, including heavy equipment, air compressors, generators, and evaporators. His DD Form 214 shows that his occupation was “Machinist Mate.” As such, the Board finds his account of in-service noise exposure to be consistent with his occupation during service. However, exposure to acoustic trauma alone does not mandate that service connection be granted. Rather the noise exposure must be shown to have caused his current hearing loss disability, or to have caused chronic or continuous symptoms. Otherwise, the Veteran’s hearing loss must be evaluated to have been compensably disabling within one year of service to be presumed as incurred in-service. See 38 C.F.R. §§ 3.307, 3.309. The threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Service treatment records indicate that the Veteran’s hearing was normal upon entry, and maintained essentially normal findings throughout his entire service period. Service treatment records note that the Veteran affirmatively denied any hearing loss or tinnitus upon entry and separation from service. The Veteran testified before the undersigned in April 2016. He endorsed hazardous noise exposure associated with working in a ship engine room. He did not recall being put on physical profile or receiving any treatment related to hearing loss, but did recall being issued ear plugs. He described declining hearing loss since service as not being able to distinguish when certain people are talking and asking others to repeat themselves whenever he cannot understand them. The Veteran said he did not report any hearing issues during service because he was “young and [did] not [know] any better.” The evidence on file does not contain any private treatment records that address the Veteran’s hearing loss claim. On the VA authorized audiological evaluation in January 2011, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 Average RIGHT 25 25 25 15 10 19 LEFT 20 25 15 10 10 15 Speech audiometry revealed speech recognition ability of 94 percent in the right ear and 96 percent in the left ear. The Veteran endorsed military noise exposure from ship engine rooms and a history of occupational noise exposure from train engines after service separation when he worked as a railroad engineer. He also reported a history of occasional recreational noise exposure due to lawnmowers, power tools, and motorcycles. The Veteran did not endorse symptoms of tinnitus at this time. Based on these results, the VA examiner opined that the Veteran’s hearing was within normal limits, bilaterally. On the authorized audiological evaluation in November 2016, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 Average RIGHT 25 25 25 25 15 23 LEFT 20 30 25 30 20 26 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and of 100 percent in the left ear. The examiner diagnosed normal hearing in the right ear and hearing loss at a level that is not considered to be a disability for VA purposes in the left ear. The examiner opined that the Veteran’s right ear hearing loss was not at least as likely as not caused by or a result of service. The examiner pointed out that the Veteran’s right ear hearing was within normal range on this VA examination. The examiner also noted service treatment records showed multiple audiological tests between 1986 and 1996. Specifically, the examiner highlighted a January 1989 audiogram that indicated a decrease in right ear hearing; however, testing on the next day and all subsequent testing indicated a return to normal thresholds and did not show a shift according to the examiner. As a result, the examiner found that the change was likely a “one time temporary threshold shift.” The examiner also opined that the Veteran’s left ear hearing loss was not at least as likely as not caused by or a result of service. The examiner pointed out a 1990 audiogram that showed a decrease at one relevant frequency in the left ear to 30 decibels. However, the examiner noted that all subsequent testing indicated a return to normal range with no noted shift. The examiner also reported that following service separation the Veteran had occupational noise exposure while working at Southern Railroad. Lastly, the examiner commented that the Veteran’s hearing loss did not impact ordinary conditions of daily life, including his ability to work. Accordingly, the Board finds that the Veteran does not have a current hearing loss disability for VA purposes. The Board also finds this medical opinion highly probative of the Veteran’s current condition because it not only contains a clear conclusion with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board has considered the Veteran’s statements of record that service connection is warranted for bilateral hearing loss. The Board notes that, while lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, they are not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). As such, even if the lay statements of record were credible, there is no evidence that the Veteran has the requisite medical expertise to opine as to the etiology of his hearing loss, or when his disability met the criteria for hearing loss under VA regulations. 38 C.F.R. § 3.385. While the Veteran can attest to subjective hearing loss, the Veteran is not competent to provide an objective determination of the level of hearing loss, as required under 38 C.F.R. § 3.385. Therefore, his opinion as to his bilateral hearing loss and its relationship to his service are entitled to no probative value. See Cromley v. Brown, 7 Vet. App. 376, 379 (1995). Most critically, the Veteran’s essential contention of a nexus between the in-service noise exposure and his current symptoms has been fully investigated as mandated by the Court’s decision in Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A necessary element for establishing entitlement to service connection is the existence of a current disability; it is the cornerstone of a claim for VA disability compensation. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). For VA purposes, a current disability exists when a claimant has a disability at the time a claim is filed or at some point during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). At no time during the appellate period has the Veteran’s level of hearing loss for either ear risen to the level of a disability for VA purposes under 38 C.F.R. § 3.385. After a full review of the record, the Board finds that the weight of the evidence demonstrates that the Veteran does not have a current diagnosis for a bilateral hearing loss disability for VA purposes for the reasons discussed above. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlements to service connection for a heart disability and hypertension, claimed as a congestive heart problems and high blood pressure. The Veteran contends that he had a heart disability, including hypertension, in-service that is related to his current heart disability. He has current diagnoses for hypertension, congestive heart failure, coronary artery disease, cardiomyopathy, paroxysmal ventricular tachycardia, paroxysmal supraventricular tachycardia, and postsurgical status of automatic implantable cardiac defibrillator. The question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has various cardiovascular diseases and hypertension, which are considered chronic diseases under 38 U.S.C. § 1101(3) and 38 C.F.R. § 3.309(a), they were not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Private treatment records show the Veteran was not diagnosed with any heart-related disability until June 2008, over a decade after his separation from service and over a decade outside of the applicable presumptive period. These treatment records noted no significant past medical history and new onset of congestive heart failure, hypertension, and chest pain. His social history included smoking, and recently quitting drinking alcohol. His family history noted early-age coronary artery disease in his grandfather. However, an October 2008 private treatment record noted that the Veteran was seeing a cardiologist for the last two to three years, but these records were not included in the record despite notice to the Veteran and record requests made by VA to all private treatment providers identified in the record. Nonetheless, the purported treatment still occurred over a decade after service, at the earliest. The Board notes that VA’s duty to assist in developing the facts and evidence pertinent to a veteran’s claim is not a one-way street, and it is the responsibility of veterans to cooperate with VA with regard to development. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). This is especially true in matters relating to private records, to which VA has no access or knowledge without the Veteran’s cooperation. Given the Veteran’s actions, and VA’s offers to assist him in developing the claim, the Board finds that VA has no additional duty with regard to request for private treatment records concerning any heart disability. See Caffrey v. Brown, 6 Vet. App. 377, 383 (1994); Olson v. Principi, 3 Vet. App. 480, 483 (1992). The Veteran testified before the undersigned in April 2016. He initially endorsed having chest pains during service and receiving treatment in October 1986. He expressed his belief that his service treatment for chest pain was an early phase of subsequently diagnosed congestive heart failure. He said that he experienced the same symptoms intermittently since service. The Veteran stated that he received treatment for heart issues periodically after service that he said was mainly for hypertension and later found it to be congestive heart failure. He also said he started seeking treatment for his heart shortly after service, but recalled being diagnosed with hypertension and congestive heart failure around the year 2000. On VA examination in November 2016, the Veteran endorsed onset of hypertension around 2009 and vaguely reported treatment before then. He recalled onset of cardiac problems many years ago and referred to his service treatment records as well as possibly alcohol consumption over the years as contributing to his issues. The examiner noted the service treatment record from October 1986 where the Veteran presented with complaints of chest pain and was diagnosed with costochondritis, which the examiner remarked was non-cardiac in origin. The examiner pointed out that medical records were silent regarding cardiac conditions, including hypertension, over the years following service. The examiner noted that the Veteran was diagnosed with malignant hypertension several years after service and had a history of medication noncompliance for his cardiac issues. The examiner reported that the Veteran has cardiomyopathy that is hypertensive in origin as well as a strong family history of this disease, which indicates a “likelihood of a genetic component” that was “perhaps unescapable.” The examiner opined that the aforementioned factors most likely attributed to years of elevated blood pressure. In addition, the examiner noted that the Veteran’s non-adherence to medications to control his blood pressure was also likely a factor, which was preventable. The Veteran’s history was also notable for alcohol and tobacco abuse. The November 2016 VA examiner noted that medical records indicate ischemic heart disease is not predominant and that the focus of pathology was congestive heart failure, which probably stemmed from cardiomyopathy due to years of poorly controlled hypertension. The examiner found that it was not until well over a decade after service that the evidence indicated development of hypertension. The examiner stated, “Given his strong family history of [cardiomyopathy], genetic predisposition to etiology of cardiac symptoms is most likely. This was not manifest in the military. Military service had and has no relationship to said conditions.” Furthermore, the examiner opined that the Veteran’s degree of hypertension “is much more severe than the common population, and his family history suggests the roots are genetic in origin.” In conclusion, the examiner found the evidence fails to show that the Veteran’s heart disabilities are related to service on a direct or secondary basis. The Board finds this medical opinion highly probative of a negative nexus between the Veteran’s current conditions and service because it not only contains a clear conclusion with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). While the Veteran is competent to report having experienced symptoms of chest pain consistently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of hypertension or any other chronic heart-related disability. The Veteran affirmatively denied any heart symptoms on entrance and separation reports of medical history. The entrance and separation examinations also did not reveal any heart abnormalities. Further, while the Veteran asserts that the reported symptoms were manifestations of hypertension or any other chronic heart-related disability, he is not competent to make this determination. The issue is medically complex, as it requires specialized medical education, knowledge of the interaction between multiple organ systems in the body, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Service connection for a heart-related disability may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s heart disabilities and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The November 2016 VA examiner opined that the Veteran’s claimed heart disability is less likely as not related to an in-service injury, event, or disease. The rationale was that the Veteran blood pressure readings during service were within a good range without the use of medication. According to the examiner, at some point approximately ten years after service, the Veteran was shown to have poor control of blood pressure, as evidenced by noncompliance with taking the appropriately prescribed medication, which the examiner believes eventually led to the Veteran’s cardiomyopathy and congestive heart failure. The Veteran also had a notable family history of cardiomyopathy that was strongly suggestive that the etiology is genetic. Furthermore, the examiner stated that the Veteran was healthy upon entrance and separation from service and subsequent medical evidence otherwise failed to indicate that his heart problems were “tethered to military service.” The examiner acknowledged the Veteran’s statements that stress during service caused elevated blood pressure, but noted that stress only causes transient elevated levels and not to the degree shown in the Veteran. In a December 2017 addendum opinion, the examiner further stated that the Veteran’s strong family history of hypertension and his history of smoking are most likely the cause of his cardiac problems. The Board finds this medical opinion highly probative of a negative nexus between the Veteran’s current condition and service because it not only contains a clear conclusion with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez, 22 Vet. App. at 301. While the Veteran believes his hypertension and other heart-related disabilities are related to an in-service injury, event, or disease, including treatment for chest pain, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education, knowledge of the interaction between multiple organ systems in the body, and the ability to interpret complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377, 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence. After a full review of the record, the weight of the evidence demonstrates that the current hypertension and other heart-related disabilities did not have onset in service, were not manifest to a compensable degree within one year of separation from service, and are not otherwise related to service for the reasons discussed above. As the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to service connection for headaches. The Veteran contends that he developed a headache disability due to a head injury that occurred during service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of headaches and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran testified before the undersigned in April 2016. He said that he was assaulted in June 1993 and was hit in the head. He expressed continuous headache symptoms since then as well as his belief that his current headaches are related to this in-service incident. He said he started to receive treatment for headaches within two months of separation from service. The Veteran said that a partial skull fracture was revealed after a subsequent CT scan was performed by a private hospital. He stated that the private doctors told him the fracture had “been there for a while” and that the headaches were related to the assault in-service. The November 2016 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms of right-sided head pain, he did not have a diagnosis of a headache disability. Further, despite the Veteran’s endorsement of continuous symptoms since service, VA and private treatment records do not contain a diagnosis of headaches. These records also show that the Veteran either did not endorse any headache symptoms or at most endorsed occasional headaches. The VA examiner noted the service treatment record for a head injury due to an assault, but pointed out that the Veteran did not endorse any headaches or other head trauma-related symptoms as noted at the time. The examiner commented that the subsequent CT scan revealed a right-side skull fracture, but that it was “not possible for area Veteran was hit in the head in the military to have caused the fracture [shown on CT scan over 20 years later].” The VA examiner also opined that the Veteran has a headache condition based on his lay reports, but that it is not chronic and did not impact his ability to work. Cf. Saunders v. Wilkie, 2017-1466, 2018 U.S. App. LEXIS 8467, at *21 (Fed. Cir. Apr. 3, 2018) (holding that pain alone can constitute a disability if it causes functional impairment). In a December 2017 addendum opinion, the VA examiner commented that the Veteran’s headaches do not amount to a diagnosed chronic headache disorder,” such as migraines, cluster, tension, etc.” The examiner noted that occasional headaches, such as those endorsed by the Veteran, are not uncommon and resolve with or without treatment. Furthermore, the examiner noted that for a person with risk factors such as obesity, history of dangerously elevated blood pressure, smoking, and sleep apnea, are apt to have headaches present. The examiner remarked that the “confounding variables and risk factors for [the Veteran] getting headaches are better explained by such conditions, that it makes there being a military nexus improbable.” The Board finds these medical opinions highly probative of a lack of a diagnosed headache disability as well as a negative nexus between any subjective symptoms endorsed by the Veteran and service because they not only contain a clear conclusion with supporting data, but also reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). While the Veteran believes he has a current headache disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education, knowledge of the interaction between multiple organ systems in the body, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. After a full review of the record, the weight of the evidence demonstrates that the Veteran does not have a headache disability for the reasons discussed above. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Entitlement to service connection for a psychiatric disability, claimed as posttraumatic stress disorder (PTSD) The Veteran asserts that he acquired posttraumatic stress disorder due to service. The evidence shows a current diagnosis for depressive disorder. A claim for service connection for a mental disability may encompass claims for service connection of any mental disability that may reasonably be encompassed by several factors, including the claimant’s description of the claim, the symptoms the claimant describes and the information the claimant submits or that the Secretary obtains in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Accordingly, the Board has taken an expansive view of the Veteran’s claim pursuant to Clemons. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of depression, and evidence shows that certain in-service events occurred, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis began during service or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service connection for PTSD requires the presence of three elements: (1) a current medical diagnosis of PTSD; (2) medical evidence of a causal nexus between current symptomatology and a claimed in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. 38 C.F.R. § 3.304(f). With respect to the third element, if the evidence shows that a veteran engaged in combat and the veteran is claiming a combat-related stressor, no credible supporting evidence is required. Id.; see also Doran v. Brown, 6 Vet. App. 283 (1994). In order to grant service connection for PTSD to a non-combat veteran, there must be credible evidence to support the veteran’s assertion that the stressful event occurred. A stressor need not be corroborated in every detail. Suozzi v. Brown, 10 Vet. App. 307, 311 (1997). Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. Cohen v. Brown, 10 Vet. App. 128, 142 (1997); Moreau v. Brown, 9 Vet. App. 389, 395-396 (1996). For the purposes of establishing service connection, medical evidence diagnosing PTSD must be in accordance with 38 C.F.R. § 4.125(a), which refers to the American Psychiatric Association Diagnostic and Statistical Manual for Mental Disorders, 5th ed. (DSM-5) as the source of criteria for the diagnosis of claimed psychiatric disorders. DSM-5 provides that a valid diagnosis of PTSD requires that a person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of himself or others, and (2) the person’s response involved intense fear, helplessness, or horror. A veteran’s testimony, by itself, can establish the occurrence of an in-service stressor event if the requirements of 38 C.F.R. § 3.304(f)(3) are met. The revised 38 C.F.R. § 3.304(f)(3) reduces the evidentiary burden of establishing a stressor when it is related to a fear of hostile military or terrorist activity. See 75 Fed. Reg. 39843 through 39852 (July 13, 2010). However, and as further detailed below in this decision, this provision is inapplicable here because although the Veteran may be claiming that his stressors are related to hostile military or terrorist activity, a VA psychiatrist or psychologist (or psychiatrist or psychologist with whom VA has contracted) has not confirmed that the claimed stressor is adequate to support a diagnosis for PTSD and that the Veteran’s symptoms are related to the claimed stressor. Furthermore, there is clear and convincing evidence contrary to the Veteran’s statements regarding the claimed stressors. Lastly, the evidence does not establish that the Veteran’s claimed stressors involve “fear of hostile military or terrorist activity,” which means that the Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3). Service treatment records are silent for any symptoms or diagnoses, and at enlistment and separation from service, the Veteran affirmatively denied any psychiatric disorders acquired before or during service. On VA examination in January 2011, the Veteran was examined for a possible psychiatric diagnosis. He endorsed current symptoms of irritation and a quick temperament. He also said he had “depression,” which the examiner noted he did not describe actual feelings or behaviors that are indicative of actual clinical depression. The Veteran described his experiences in the Gulf War, and said it was a top-secret mission. He expressed a fear of hostile military activities, but the examiner found it was “questionable as to whether or not he actually experienced any events that would meet the criteria for traumatic as noted in the DSM-IV.” The Veteran said he was informed of two different incidents where a sailor committed suicide on his ship. The examiner noted that the Veteran had knowledge of certain incidents during service “by information only and nothing that he experienced or witnessed.” The Veteran said that it was “very stressful weaving through waters where he knew that missiles were pointed at the ship,” but the examiner commented that “there was no actual event or life threatening circumstance.” The Veteran told the examiner that he drank heavily during the service and continued this behavior until approximately one-year ago in 2010. He said that he now attends church regularly on Sundays, but has reduced his other activities due to congestive heart failure. Ultimately, the examiner diagnosed alcohol abuse in full sustained remission. The VA examiner opined that the Veteran does not have symptoms meeting the criteria for a mental health diagnosis, including PTSD. The examiner said, “Although the [Veteran] expressed some problems associated with irritability and temperament this condition is not such that he has ever sought treatment nor does it appear that it has interfered vocationally or socially.” An April 2011 VA Memorandum made a formal finding of a lack of information required to corroborate stressors associated with the Veteran’s claim for service connection for PTSD. VA requested specific details from the Veteran concerning his stressful events needed to process his claim, but he did not respond. The VA Memorandum also noted that the Veteran did not receive any combat related medals or awards, nor was there evidence that he was involved in combat or served in a combat environment. Subsequent VA treatment records and statements from the Veteran indicate various stressor-events related to service. The Veteran described stressful events during service within his August 2011 Notice of Disagreement. He said that he was involved in several special operations in the Gulf War around Iran and Iraq. He described one event where he went on ship watch for the night and returned in the morning to find out that a shipmate that slept below his bunk committed suicide. He also said that a month later there was a ship that came in for maintenance where a pressure valve malfunctioned and killed 8 crew members on this other ship. VA treatment records from August 2012 indicate initial diagnoses for PTSD and depression were made by a VA psychiatrist. The Veteran complained of nightmares and flashbacks about “some terrible things [he] witnessed when [he] was in the Navy.” He described watching a F-14 pilot crash into a ship, but after he was rescued the Veteran said he could smell the pilot’s flesh and see a bone protruding from his uniform. He detailed another traumatic incident where several Marines riding in a helicopter crashed into a sister ship and fell into the water and they never found the bodies. He said another incident involved an officer that hung himself after distress from marital problems and the Veteran said he saw the body after it was taken down. The Veteran said he was involved in a top-secret mission that was a “very nerve wracking experience” because there were shore missiles point at his ship. He also said that a buddy in service died from a heart attack and that it bothers him because he now has congestive heart failure, which makes him think it might happen to him. VA treatment records from December 2013 note the Veteran also endorsed witnessing the murders of civilians by locals during service while he was in the Philippines. A VA psychiatrist continued the diagnoses for PTSD and depressive disorder, not otherwise specified. The Veteran testified before the undersigned in April 2016. He described an incident in-service where he relieved a shipmate from watch duty at night and then found out the next morning that the man had died of a heart attack. He said the part that affected him most was seeing the body in an ambulance with a “toe tag on him” because the door was left open. He next detailed an incident on a different ship where he learned of a sailor aboard that committed suicide after he was embarrassed by the public viewing of a video tape he received from his wife that showed her engaging in intimate acts with another man. The Veteran said he saw a helicopter crash on the landing pad of a different Navy ship and killed fellow servicemen aboard. He also reiterated the incident he met another ship’s machinist crew while they were both docked and after returning to their respective ships he learned that these other servicemen died after a pressure valve malfunctioned. He said this greatly affected him more than other incidents because he learned from others specific details of their deaths and he worried that this may happen to him since he worked in the same type of environment. The Veteran said that his VA psychiatrists were told of these same incidents and arrived at a diagnosis for PTSD. He also testified that after all of these incidents he should have sought medical treatment because they greatly bothered him, and while not documented, said he later attempted suicide while in service. He then said he was treated for depression aboard the USS Lincoln and at a Naval base in Alameda, California. The Veteran explained that he talked to the medical officer and they phoned his mother to have her try to calm him down. He explained that he has difficulty whenever he thinks back on these incidents in-service and cause him to feel demoralized “like it just the air out of [him].” A May 2016 statement from the Veteran’s mother described talking to the Veteran after two of these traumatic incidents occurred (the two sailors that died due to heart attack and suicide). She remembered receiving a phone call from a shipmate who described the Veteran as depressed and wanted to commit suicide, so she called him every day to make sure he was okay. She stated that she “even contacted his commanding officer to beg him to keep a close eye on [her] only child.” The Veteran received another VA examination in November 2016. The examiner noted that the Veteran only has a diagnosis for depressive disorder due to medical conditions. The Veteran detailed several stressor-incidents to the examiner. The Veteran told the examiner that an officer committed suicide after receiving a “Dear John” letter and that he saw the body, which was then kept in a freezer. He described an incident where learned that a different ship’s crew died from a steam leak accident. The Veteran added that he was involved in a “horrific car accident” in Japan where he incurred a head injury as a passenger after the driver crashed into a tree. He detailed vivid memories of an event where he learned of a fellow shipmate that died from a massive heart attack and he then saw the “toe tag” on the body after the ambulance’s door was left open. The Veteran reported seeing a helicopter crash and bounce off the deck of another ship into shark-infested waters. A recovery team with divers and “missing man formation” tried to rescue the crew, but the Veteran was told that there were no survivors from the helicopter crew and that sharks were eating the deceased. He also told the VA examiner he saw a F-14 pilot crash into his ship, the USS Abraham Lincoln, and that he saw the pilot’s body was burned. The Veteran reported depressive symptoms (but denied any homicidal or suicidal ideation) that were tethered to his medical conditions. The November 2016 VA examiner opined that there is no evidence to substantiate the Veteran’s previous diagnosis for PTSD rendered by a VA psychiatrist because it was only based on lay reports without proper verification of such incidents. The examiner commented that the Veteran “has given inconsistent narratives of stressors—in some instances self-contradictory.” The examiner pointed out that an attempt to formally verify stressors via Department of Defense records did not yield any results. The examiner found the Veteran’s credibility to be poor regarding his reported stressors and “likely nonsense.” The examiner noted that the Veteran’s military occupational specialty (MOS), Machinist Mate, made it “very improbable that he would witness all that he claimed.” The examiner stated that the Veteran’s MOS would be below deck on a ship and, unless he was off duty, which was not reported as such by the Veteran, he would not have seen the helicopter or F-14 plane crashes firsthand and certainly would not have stood around to watch the aftermath. The examiner pointed out that the record showed the Veteran previously reported being told secondhand about the one sailor’s suicide as well as the other’s heart attack, but in later statements had said he saw the bodies first-hand. In particular, the examiner found the “toe tag” incident was not possible because emergency medical technicians do not put them on bodies and was thus “utter nonsense and fiction.” The examiner also explained that the Veteran’s firsthand account of seeing the heart-attack victim turn “blue” was improbable given the short amount of time he reported it took for the sailor’s skin color to change. The examiner explained that hypoxia, the lack of oxygen that causes the skin color to turn “blue,” takes much longer than as reported by the Veteran’s sequence of events. After thoroughly examining the Veteran’s statements of record regarding his various PTSD-stressors, the examiner found “some instances self-contradictory, outright nonsense in an account, not likely for him to have been central and so on.” The examiner opined, “No evidence suggests that PTSD, or any other mental health condition was present in, or due to military service.” Instead, the examiner reiterated that the Veteran has “depression consistent with having suffered from medical conditions, but this is not considered related to military.” An October 2017 VA Memorandum detailed another formal finding that the Veteran’s PTSD-stressors could not be conceded. The memorandum stated that the evidence did not show that the Veteran was exposed to a qualifying PTSD stressor related to the different incidents that involved the deaths of two sailors, one from suicide and the other from a heart attack. The helicopter crash on a sister ship was verified, but the memorandum found, after extensive review, that the relevant Ship Commander’s History Reports did not mention any injuries or loss of life despite the ship being part of the search and rescue operation. In a December 2017 addendum opinion, the VA examiner continued to find the Veteran’s reported stressors were not supported by the evidence of record, but stated that “fortunately such is not a barrier to him getting care for [his] conditions.” The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In conjunction with the VA examiner’s findings, the Board agrees that the medical evidence does not show the Veteran has a valid PTSD diagnosis based on a confirmed stressor. While the Veteran is competent to report having experienced symptoms of mental health symptoms since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of PTSD. The issue is medically complex, as it requires diagnosis by a psychiatrist or psychologist as well as evidence of a confirmed valid stressor. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran’s depressive disorder has also not been linked to service by a competent medical professional. The record contains conflicting medical opinions regarding whether the Veteran has a valid PTSD diagnosis. While the Veteran was initially diagnosed with PTSD, the Board agrees with the VA examiner that the initial PTSD diagnosis is not probative because it was not based on confirmed stressor. There is no indication that initial diagnosis was made after the VA psychiatrist reviewed pertinent medical evidence or other relevant records in the claims file to corroborate the claimed stressors. Instead, the opinion appears to be based on the Veteran’s self-reported medical history, which, as previously explained, is inconsistent with VA and service treatment records, military personnel records, as well as the formal findings made by the Joint Services Records Research Center. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Consequently, the Board gives more probative weight to the November 2016 and December 2017 VA examiner’s opinions. While the Veteran and his mother believes the Veteran’s mental health symptoms are related to an in-service injury, event, or disease, including the aforementioned stressors, they are not competent to provide a nexus opinion in this case as this issue is also medically complex. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiner’s opinions made in November 2016 and December 2017. Even if the Board were to consider that the Veteran has a diagnosis of PTSD, the Veteran’s claim fails the third element of 38 C.F.R. § 3.304(f), which requires “credible supporting evidence that the claimed in-service stressor actually occurred.” His DD Form 214 shows that he was a Machinist Mate and it does not document that he was awarded any individual combat medals. Because his official service record does not show combat service awards, and his military occupational specialty is not consistent with combat exposure, the Board finds that his stressor statements alone are of no probative value to corroborate the occurrence of the events that he claims are related to PTSD. See 38 C.F.R. § 3.304(f)(1)-(2). The October 2017 VA Memorandum also did not concede any claimed stressors. As previously stated, if the Veteran did not engage in combat with the enemy, or the claimed stressors are not related to combat, and the stressor is not related to “fear of hostile military or terrorist activity,” then the Veteran’s testimony alone is not sufficient to establish the occurrence of any claimed stressors and his testimony must be corroborated by credible supporting evidence. See Cohen v. Brown, 10 Vet. App. 128 (1997); Dizoglio v. Brown, 9 Vet. App. 163 (1996); Moreau v. Brown, 9 Vet. App. 389 (1996). Furthermore, service department records must support, and not contradict, the Veteran’s testimony regarding non-combat stressors. Doran v. Brown, 6 Vet. App. 283 (1994). As such, the Veteran’s claim of entitlement to service connection for PTSD cannot be granted, as it fails to establish the third criterion set forth in 38 C.F.R. § 3.304(f) -independent corroboration of his non-combat stressor. Here, the record does not reflect a credible, verified in-service stressor, and in turn does not warrant a diagnosis for PTSD based on a verified in-service stressor (i.e. causal nexus). Nevertheless, the only evidence of record which indicates that the Veteran’s claimed stressors occurred consists of his statements regarding the stressful events, which could not be verified through VA’s several attempts to assist the Veteran. The Board finds that the Veteran has not provided credible evidence of an in-service stressor upon which a valid diagnosis of PTSD may be based. Therefore, service connection for PTSD is not warranted. As previously discussed, the Veteran’s diagnosed depressive disorder has also not been linked to service by the November 2016 VA examiner’s opinion, which the Board finds highly probative. Nieves-Rodriguez, 22 Vet. App. at 301. After a full review of the record, the weight of the evidence demonstrates that a psychiatric disability did not have its onset in service and is not otherwise related to service for the reasons discussed above. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Connally, Counsel