Citation Nr: 18158100 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 09-10 617 DATE: December 14, 2018 ORDER Entitlement to an increased disability rating in excess of 10 percent for a skin disorder is denied. Entitlement to service connection for acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), is denied. Entitlement to service connection for sleep disorder is denied. FINDINGS OF FACT 1. The objective medical evidence shows that at no time did follicular eczema exhibit symptoms covering 20 to 40 percent or more than 40 percent of the entire body, or 20 to 40 percent or more than 40 percent of exposed areas affected; nor was the prescribing of systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, or constant or near-constant such systemic therapy, required during a prior 12-month period. 2. The objective medical evidence shows that an acquired psychiatric disorder, to include PTSD, was not caused by or etiologically related to an event, injury or illness during active service. 3. The objective medical evidence does not show competent evidence of the existence of a current disability of a sleep disorder. CONCLUSIONS OF LAW 1. The criteria for an increased disability rating in excess of 10 percent for a skin disorder have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.7, 4.118, Diagnostic Code 7806 (2002 and 2008). 2. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2017). 3. The criteria for entitlement to service connection for a sleep disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has active service in the United States Army from October 2001 to March 2002 and from January 2004 to March 2005. The Veteran testified at a September 2013 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. 1. Entitlement to an increased disability rating in excess of 10 percent for a skin disorder. Increased Schedular Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service connected disorder. 38 U.S.C. § 1155. The evaluation of a service-connected disorder requires a review of a veteran’s entire medical history regarding that disorder. 38 U.S.C. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Additionally, it is possible for a veteran to be awarded separate percentage evaluations for separate periods (staged ratings), based on the facts. See Fenderson v. West, 12 Vet. App. 119, 126–27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where an increase in the disability rating is at issue, the present level of the veteran’s disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). A September 2007 rating decision granted service connection for the Veteran’s skin disorder at a noncompensable rating, effective March 9, 2005, the day after the Veteran’s separation from active service, as he had actively pursued his claim from that date. An October 2016 rating decision increased the Veteran’s disability rating to 10 percent, also effective March 9, 2005. The Veteran is currently rated for follicular eczema under Diagnostic Code 7806. VA recently published a final rule amending its regulations on skin disabilities, effective August 13, 2018. The amendment, in pertinent part, added a General Rating Formula for the Skin (General Rating Formula) for Diagnostic Code 7806, as well as other related or analogous diagnostic codes, and it amended still other diagnostic codes. See 83 Fed. Reg. 32,592 (July 13, 2018). The claims pending prior to the August 2018 effective date will be considered under both old and new rating criteria, and whichever criteria is more favorable to the Veteran will be applied. Under the rating criteria in effect for Diagnostic Code 7806 at the time when the Veteran filed his claim in December 2005, as well as those applicable when the Veteran’s disability rating was increased to 10 percent in October 2016, Diagnostic Code 7806 provided a 10 percent evaluation if at least 5 percent, but less than 20 percent of the entire body, or at least 5 percent, but less than 20 percent of exposed areas affected, or; when intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs is required for a total duration of less than six weeks during the past 12-month period. A 30 percent evaluation would be warranted if the skin condition covers 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; when systemic therapy such as corticosteroids or other immunosuppressive drugs is required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent evaluation was available if the skin condition covers more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806 (2002 and 2008). Under the new regulations, effective August 13, 2018, the rating criteria for Diagnostic Code 7806 will now be found in the new General Rating Formula, under which a 10 percent rating will be assigned if the disability meets at least one of the following: Characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA [psoralen, with long-wave ultraviolet-A light], or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is provided for at least one of the following: Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating would be warranted for at least one of the following: Characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806 and the General Rating Formula for the Skin (2018). Evidence Looking to the record from the March 9, 2005 effective date of the 10 percent disability onward, a VA initial evaluation note in November 2005 notes that the Veteran reported he was using no medications for treatment of his skin. The treatment provider found on examination dry areas, antecubital spaces, as well as posterior patella large area about 5 inches in diameter of discolored, scaly area appreciated. Also, a “fine” rash noted over upper leg and areas of the back. In a VA dermatology consult note in December 2005, the treatment provider noted the Veteran’s reports of daily moisturizing with Eckerd-brand lotion, but no other medications and being bothered by his disorder on and off since February 2004. Upon examination, the treatment provider found diffusely dry, scaly skin; 1 cm slightly hyperpigmented spot on the abdomen and a similar spot on right upper arm; bilateral antecubital fossa with pinpoint red papules; on the Veteran’s back small (0.2 mm) spots diffusely of hypopigmentation; and laboratory analysis of a scraped hypopigmented lesion of the back showed no yeast under microscopic examination. The December 2005 treatment provider assessed the Veteran with likely atopic diathesis (susceptibility to bleeding), with diffuse dry skin and dry, scaly rash moving from antecubital and popliteal fossa to extensor surfaces of thigh and upper arm consistent with follicular eczema. He prescribed Keri lotion and hydrocortisone cream (1 percent) applied as needed for 5 of 7 days of the week. A December 2006 VA General Medical examination included the Veteran’s reports of the disorder bothering him off and on since February 2004. Upon examination, the December 2006 VA examiner found one small area at the right antecubital fossa, very small, less than 0.1 mm hyperpigmented spot, otherwise no other areas. She diagnosed the Veteran with “[f]ollicular eczema diagnosed per Dermatology. Zero percent exposed, less than 1 percent involved.” In September 2007, the Veteran was diagnosed with atopic dermatitis and prescribed Clotrimazole (one percent) cream. By October 2007, an examination of the Veteran’s skin showed no current rash, entirely intact skin, without excoriations or abnormal pigmentation or erythema; however, the Veteran reported persistent itchiness. Additionally, notes show that the Veteran was taking one capsule of hydroxyzine pamoate once a day for itchy skin. In December 2007, the Veteran presented to a VA emergency department, at which the treatment provider noted a scaly rash, dry skin and bleeding easily on the anterior thigh, but without blisters and now healing. The Veteran’s medications during September 2013 included Hydrocerin (Hydrophilic) cream and hydrocortisone (1 percent) ointment. In the September 2016 VA examination for skin diseases, the VA examiner stated the Veteran’s 2005 diagnosis of follicular eczema. Using an excerpt of the December 2005 VA dermatology consult, she set forth the history of the Veteran’s skin disorder. The September 2016 VA examiner found no scarring (regardless of location) or disfigurement of the head, face or neck. She noted that the Veteran had been treated with the oral medication Atarax p.r.n. [to be used as the occasion requires] and the topical medication of hydrocortisone p.r.n., both in the past 12 months, but for a total duration of less than 6 weeks. The September 2016 VA examiner further found the Veteran had no treatments or procedures in the past 12 months for exfoliative dermatitis or papulosquamous disorders, other than systemic or topical medications; he had had no debilitating episodes in the past 12 months due to urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis; and he had had no non-debilitating episodes of urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis in the past 12 months. The September 2016 VA examiner found the Veteran’s eczema affected a total body area of from 5 percent to less than 20 percent. She found the exposed area to be less than 5 percent. She concluded the eczema did not impact the Veteran’s ability to work. As shown above, the 2002 and 2008 rating criteria for Diagnostic Code 7806, as well as those of the 2018 General Rating Formula, do not greatly differ. In each revised version, to attain more than a 10 percent rating, a greater extent of the entire body or exposed areas must be affected; between 20 and 40 percent for a 30 percent rating and over 40 percent for the maximum evaluation of 60 percent. In the alternative there must be systemic therapy ongoing in the prior 12-month period for a total duration of 6 weeks or more for a 30 percent rating and “constant or near-constant” systemic therapy for the highest rating. The foregoing summary of the treatment record does not show such findings. For example, the December 2006 VA examiner found “[z]ero percent exposed and less than 1 percent involved.” The September 2016 VA examiner found eczema affected a total body area of from 5 percent to less than 20 percent and the exposed area to be less than 5 percent. The Veteran’s own reports to the December 2005 VA dermatology consultant identified usual affected areas as left thigh, back, upper right arm, bilateral antecubital fossa, and bilateral popliteal fossa, but nonetheless, treatment providers and VA examiners found the actual percentage to the total body affected to be no more than less than 20 percent. The Veteran’s reports would seem to indicate there is nothing of his exposed person affected. As it is, the actual findings of the December 2005 dermatology consultant of affected areas are in terms of centimeters and millimeters. Moreover, consistent with the Board’s February 2016 remand, the September 2016 VA examination was requested specifically to be conducted at a time when the Veteran’s skin disorder was in an active phase and, if not, the Veteran was to inform VA and the Regional Office would reschedule an examination on another date. The record does not contain any such communications and the Board will presume the September 2016 VA examination findings reflect the Veteran’s disorder in its active phase. From the medical evidence, the Board concludes that none of the revised versions of the rating criteria for Diagnostic Code 7806 is more favorable to the Veteran than any other. Therefore, in applying the rating criteria of the identical versions applicable when the Veteran filed his claim in December 2005 and when he received an increased rating to 10 percent in October 2016, and based on the objective medical evidence, the Board finds that at no time did follicular eczema exhibit symptoms covering 20 to 40 percent or more than 40 percent of the entire body, or 20 to 40 percent or more than 40 percent of exposed areas affected; nor was the prescribing of systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, or constant or near-constant such systemic therapy, required during a prior 12-month period. Consequently, a disability rating in excess of 10 percent is not warranted. Service Connection Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection 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). See also Hickson v. West, 12 Vet. App. 47, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). 2. Entitlement to service connection for acquired psychiatric disorder, to include PTSD. The record does not provide psychiatric or medical evidence to establish service connection for an acquired psychiatric disorder, to include PTSD. The Veteran’s service treatment records (STRs) show, with one exception, no complaints of anxiety, nervousness, depression, or other symptoms associated with various psychiatric disorders. In his January 2005 Post-Deployment Health Assessment, the Veteran reported seeing persons killed and wounded, being in or inspecting destroyed military vehicles and experiencing feelings of being in danger of being killed. He also reported nightmares and intrusive thoughts related to the above; he avoided situations which reminded him the events; he was constantly on guard watchful, or easily startled; and he felt numb or detached from others, from activities or from his surroundings. The Veteran further reported that, in the prior two weeks, he was much bothered by having little interest or pleasure in doing things; feeling down, depressed or hopeless and having thoughts of being better off dead or of hurting himself. A November 2005 VA treatment note states the Veteran’s PTSD screening was negative. In August 2007, the Joint Services Records Research Center verified Veteran’s reported PTSD stressor of mortar attacks and a VA examination was scheduled. In August 2007, the Veteran presented for a VA examination for PTSD. In his assessment of PTSD, the August 2007 VA examiner stated: Although he describes his events in Iraq as distressing it is this examiner’s opinion that they would not fulfill [sic] the DSM – IV stressor criterion [sic]. When asked about other symptoms that are often associated with PTSD he indicated that about once a week he will have dreams where he wakes up in Iraq sitting on his cot or walking. He did not describe this as particularly distressing. He denies having any upsetting or distressing dreams related to his experiences in Iraq. He denies any intrusive thoughts related to his experiences in Iraq. He denies any avoidance. In summary, the events he described do not meet DSM – IV stressor criterion [sic], nor does he have the constellation of symptoms required for a diagnosis of PTSD. The August 2007 administered various psychometric tests and diagnosed the Veteran with adjustment disorder with mixed anxiety and depressed mood. In his summary, the August 2007 VA examiner stated: [The Veteran’s symptoms] of irritability and trouble sleeping… appear to be linked to a number of events including the upcoming separation from his girlfriend who will be leaving the city to go to another town for college as well as ongoing stress associated with working and going to school. When asked whether he believed that his symptoms were severe enough that he wanted to be seen for any type of further evaluation or treatment he declined. In a September 2007 VA mental health note, the treatment provider stated: “On today’s evaluation I was unable to find criteria consistent with any mood disorder or anxiety disorder, to include PTSD.” The treatment provider further stated: “In my opinion, [the Veteran’s] reports of peristent daytime drowsiness and his nighttime myoclonic jerks seem to [a]ffect his daytime mood, and I am not convinced he meets criteria for and adjustment disorder.” In an October 2007 VA addendum note, although he noted the Veteran’s reports of symptoms, the treatment provider characterized these as only “potential PTSD symptoms.” He further noted that it was unclear if the Veteran had experienced a significant Criterion A stressor. In both October and December 2007 treatment sessions, he diagnosed the Veteran with adjustment disorder with mixed depression and anxiety and added, “Rule out PTSD,” indicating his uncertainty and the need for more evidence. A VA psychiatry resident in October 2007, after testing and examination, stated the Veteran’s diagnosis as dyssomnia NOS [difficulty initiating and maintaining sleep, NOS (not otherwise specified); R/O (rule out) adjustment disorder, unspecified. In the period of May 2012 to July 2015, VA psychiatry and psychotherapy notes show that the Veteran consistently reported symptoms of depression and anxiety. In her May 2012 through May 2013 VA progress notes, the Veteran’s treatment provider, having noted that certain PTSD criteria have been met, concluded “PTSD diagnosis is suggested.” She initially assessed the Veteran with major depressive episode, with symptoms consistent with PTSD. Later, she assessed the Veteran with PTSD, chronic and depression NOS. In September 2013 progress notes, the Veteran’s VA treatment provider notes that he continues to have PTSD symptoms, including passive suicidal ideation in the prior month. However, in her assessment, she refers to “PTSD by history” and comments that “depression is prominent and is [a] priority for treatment at this time.” A July 2015 VA mental health progress notes note shows that the Veteran’s PTSD screening test was negative. In September 2016, the Veteran underwent a VA examination for PTSD, in which at the outset the September 2016 VA examiner found the Veteran did not have a diagnosis of PTSD which conforms to the criteria DSM – V, based on that day’s evaluation. Rather, based on symptoms detected on examination, she identified the sole, current diagnosis of unspecified depressive disorder with panic attacks. The September 2016 VA examiner was requested to render an opinion as to whether it is at least as likely as not that PTSD or other mental disorder, to include sleep disorder, is related in any way to the Veteran’s active duty service, to include symptoms documented during service, specifically on the January 2005 Post-Deployment Health Assessment. She opined that such disorder was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. She explained: Rationale: Veteran is diagnosed with Depressive Disorder with panic attacks upon examination today. (He is not diagnosed with PTSD.) This was not diagnosed in service or within one year of discharge. Previous VA exam in 2007 diagnosed only Adjustment disorder related to current stressors and no symptoms related to military service. That evaluation failed to comment specifically on the [V]eteran’s report of symptoms on his 1/05 Post Deployment health assessment, so I am asked to comment specifically on that piece of information. I reviewed the [V]eteran’s report of symptoms on that self-assessment. It did not result in any formal evaluation or diagnosis of a mental disorder in the military or within one year of discharge. The Post Deployment health assessment is simply a self-report measure in which a service member can mark check boxes to indicate if they feel they are having any symptoms. A checked box is not evidence of a mental disorder and is not the same as a review of symptoms made by a qualified medical professional or a diagnosis made by a qualified medical professional. Therefore the [V]eteran’s report of symptoms on the Post Deployment Health assessment is not indicative that he suffered from a mental disorder or condition at the time he completed the measure. In 2006 he had no diagnosis when evaluated by a VA psychologist, indicating that any symptoms he may have reported in 2005 were not of a chronic nature. In 2007 VA C&P examination, he had only adjustment problems related to current stressors and no problems related to service, again indicating no symptoms from the service of a chronic nature. In 2007 through 2009 notes he reported only sleep disturbance. There is no evidence of a mental disorder at the time of discharge or in the early years after service. Later notes in 2013 indicate depression but by that time the [V]eteran was also drinking 4 alcoholic beverage[s] almost daily and his depressive symptoms were likely attributable to his level of alcohol use. It is unclear at this time how much the [V]eteran is drinking, so current symptoms of depression could also be caused by or complicated by undisclosed alcohol use. Given all this information, the Veteran’s currently diagnosed depression is less likely than not related to his military service and to the symptoms he reported in service on the Post deployment health assessment in 2005. The Veteran has submitted an October 2018 private treatment Disability Benefits Questionnaire (DBQ) for PTSD, completed by Dr. J.A., in which he states the Veteran’s current diagnosis as PTSD, adding “[t]o include Secondary Adjustment Disorder with Major Depressive Disorder, Anxiety Disorder, paranoid personality traits as part of PTSD syndrome and from the same traumatic events.” In a section he entitles “Clinical Findings,” Dr. J.A. notes that the August 2007 VA examiner found the events on deployment reported by the Veteran do satisfy diagnostic criteria for PTSD. Dr. J.A. then declares “as far as I’m concerned that is a blatant untruth.” He provides no further comment. He states the August 2007 VA examiner opined that the reports do not satisfy the DSM – V stressor criteria. He adds that this “is obviously not the truth.” Dr. J.A. provides no further comment. After noting that the August 2007 VA examiner did not perform a clinician-based PTSD scale (CAPS) protocol, he remarks that the August 2007 VA examiner “cynically stated” that the Veteran served on deployment in the non-combat role of prison guard and, although he did experience some distressing events, there are no events which would typically qualify for DSM – V stressor criteria. Dr. J.A. then declares “in point of fact they do qualify.” He offers no further explanation. Dr. J.A next moves to the August 2007 VA examiner’s diagnosis of adjustment disorder with mixed anxiety and depressed mood, about which he asserts that the August 2007 VA examiner ascribed the reason for this diagnosis as based on the Veteran’s girlfriend leaving for school in another town, as well as the Veteran’s stresses associated with work and school. Dr. J.A. further asserts the following: The problem I have is not that the C&P examination was dishonest—which many of them are—but that the VA would allow this to go through without taking any corrective action. The are 4 techniques the examiners use to deny people PTSD benefits. The first being denial—where they just deny that any stressor event ever took place. The next one is deflection where they attempt to deflect any symptoms off on to other areas like your childhood, your work, your health, your relationships, etc. The third one is dissembling where they outright lie on reports and the last one is dismissal where they say that something did happen but the person doesn’t have any symptoms from it or impairments. The 4 techniques that very many complaints of examiners use to deny benefits, this examiner used 3 out of the 4 [sic]. In the face of such glaring inaccuracies it is felt that this C&P examination should not be used to determine PTSD and should be give no weight. In his findings for PTSD criteria, Dr. J.A. finds the Veteran satisfies all criteria, A through H, with almost all of the numerous sub-categories checked off. Although Dr. J.A. contends that the August 2007 VA examiner’s conclusions regarding criteria amount to “a blatant untruth,” are “obviously not the truth” and the reports “do qualify,” he fails to provide reasons why and otherwise implies that the reports standing alone, in and of themselves, satisfy the respective criteria. Yet, Dr. J.A. perhaps failed to notice—certainly failed to mention---that the August 2007 VA examiner specifically supported his conclusions by noting that, when asked about symptoms often associated with PTSD, although having dreams in which he wakes up in Iraq sitting on his cot or walking, the Veteran did not describe this as particularly distressing. Moreover, the Veteran denied having any upsetting or distressing dreams whatsoever related to his experiences in Iraq. He further denied having any intrusive thoughts related to his experiences in Iraq, nor did he report engaging in avoidance measures to prevent reminders of distressing events. In other words, the very post-traumatic symptoms associated with post-traumatic stress disorder, by the Veteran’s own reports, were not in evidence after the reported occurrence of distressing events. The Board has noted Dr. J.A.’s “theory” that VA examiners, in employing deliberate techniques to thwart awards of benefits, will “outright lie on reports,” as did the August 2007 VA examiner, being “dishonest,” “as many of them are” and so on. Although Dr. J.A. advises the Board to give no weight to the August 2007 VA examination findings and opinions based on his assertions, the Board has concluded that it is Dr. J.A.’s DBQ findings and “opinions” to which it will give no probative weight and the Board will give as reasons its observations as stated above. Whereas Dr. J.A. has given no cogent, persuasive or clinically-based reasons why the August 2007 findings and opinions are “obviously untrue,” the August 2007 VA examiner set forth his findings that the Veteran did not admit to characteristic and typical post-traumatic symptoms, for which those findings and opinions are assigned substantial probative weight. The Board so finds. The Veteran has also submitted Dr. C.S.’s November 2018 medical statement, originally produced, it appears, for the Veteran’s employer. The statement briefly addresses the Veteran’s current mental health disorder by stating the Veteran’s endorses significant anxiety (e.g., panic attacks) since returning from deployment and is undergoing psychiatric treatment. The Board recognizes the statement’s purpose in giving a summary of treatment and history for the employer and stating the Veteran difficulties in working, but it does not speak to the issue of service connection, other than to state without reference to medical evidence and clinical findings that the Veteran has had a psychiatric disorder since deployment. This alone does not establish a causal connection. The evidence of record shows that the Veteran’s November 2005 VA PTSD screening was negative. Not until the August 2007 VA examination, already discussed at very great length above, was a diagnosis of adjustment disorder, with mixed anxiety and depressed mood made. Without more, the statement of Dr. C.S. does not support the claim of service connection and is of limited probative weight. As it is, the Board ascribes to the September 2016 VA examination significant and determinative probative weight. The September 2016 VA examiner directly addressed the January 2005 Post-Deployment Health Assessment, the only in-service document reflecting the possibility of an in-service psychiatric disorder. She explained that the assessment with the Veteran’s reports is not indicative that he suffered from a mental disorder or condition at the time he completed it. She added that in 2006 he had no diagnosis when evaluated by a VA psychologist, indicating that any symptoms he may have reported in 2005 were not of a chronic nature. Additionally, the September 2016 VA examiner notes that the record does not provide evidence of a mental disorder at the time of discharge or in the early years after service and the record, as summarized above, bears this out. Furthermore, she views as significant the Veteran’s lifestyle choices pertaining to alcohol, as his depressive symptoms “were likely attributable” to his level of alcohol use, as reported or otherwise unknown and, as such, possibly producing further complications for depression in the intervening years since separation from active service. For the foregoing reasons and based on the objective medical evidence, the Board finds that an acquired psychiatric disorder, to include PTSD, was not caused by or etiologically related to an event, injury or illness during active service. 2. Entitlement to service connection for sleep disorder. The record does not provide medical evidence which establishes the existence of a current disability of a sleep disorder. The Veteran’s service treatment records (STRs) show in his January 2005 Post-Deployment Health Assessment, the Veteran reported since deployment still feeling tired after sleeping. An April 2006 examination, conducted after the Veteran’s separation from active duty, indicates the Veteran’s affirmative response to “frequent trouble sleeping” and his reports of “jumping out of my sleep after I got back from Iraq” and so noted down by the examiner. In the December 2006 VA examination for General Medical, the Veteran reported that he has a condition since returning from Iraq, due to which, his muscles will jerk strongly and awaken him. The December 2006 VA examiner noted that the Veteran denies any night sweats or hypersomnolence and further denies any treatment or any evaluation for this claimed disorder. The December 2006 VA examiner diagnosed the Veteran with “Sleep Disorder -- Not Found-- by Veteran’s report only—complaints of jerking awake, does not meet diagnostic criteria for any Sleep Disorder.” In the August 2007 VA examination for PTSD, the Veteran described his symptoms as primarily a sleep disorder. He stated he jumps out of his sleep like someone has slapped him. As already set forth above, in his summary, the August 2007 VA examiner stated: [The Veteran’s symptoms] of irritability and trouble sleeping… appear to be linked to a number of events including the upcoming separation from his girlfriend who will be leaving the city to go to another town for college as well as ongoing stress associated with working and going to school. When asked whether he believed that his symptoms were severe enough that he wanted to be seen for any type of further evaluation or treatment he declined. In October 2007, the Veteran underwent sleep testing at VA. The results revealed: “1. confusional arousal, no evidence of somnambulism. 2. Poor sleep hygiene.” In November 2007, a VA physician, Dr. P.K., produced a medical statement to be presented to Allegheny Count’s Department of Resources, in which he states the Veteran has been diagnosed with a sleep disorder and that his work schedule should only be daytime hours. On or near the same date, in his treatment notes, Dr. P.K. notes that, with medication, the Veteran is now sleeping eight hours a day and “[a]s a result, he has experienced complete resolution of confusion arousals. He was reassured that continued attention to sleep hygiene will prevent return of symptoms. He was advised to taper temazepam over two weeks by using it [every other day], then [as needed].” In December 2007, the Veteran presented a VA emergency department during which the Veteran also complained of sleep maintenance problems. In the period of May 2012 to May 2016, the Veteran reported to his VA treatment provider symptoms of sudden awakening from sleep, difficulties falling asleep afterward and daytime somnolence. In May 2012, upon discharge from the VA emergency department, the Veteran received a diagnosis of sleep disturbance, NOS. However, between December 2013 and May 2014, assessments in VA psychiatry notes state the Veteran’s sleep disturbance symptoms were part of a “long-standing history of vague symptoms” and they add that the Veteran has as well a “long-standing history of poor adherence to treatment recommendations.” Nonetheless, the treatment provider diagnosed the Veteran with sleep disorder, unspecified. In her summary, the September 2016 VA examiner further noted the Veteran’s complaints after service of a sleep disorder. She states: The Veteran “does not meet separate criteria for a sleep disorder, as symptoms of sleep difficulty are part of the symptoms of depression. They are not evidence of a separate distinct disorder.” Dr. C.S.’s November 2018 medical statement addresses the Veteran’s current treatment for chronic insomnia, the Veteran’s reports of waking from nightmares and difficulty falling back to sleep, as well as the Veteran experiencing insomnia since returning from deployment. In addressing Dr. C.S.’s statement first, as stated above in regard to the claim for a psychiatric disorder, the Board acknowledges the purpose of the statement to alert the employer to the claimed disorder and its impact on the Veteran’s work, but once again it does not speak to the issue of service connection, other than to state without reference to medical evidence and clinical findings that the Veteran has had insomnia since deployment. Without more, the Board views the statement as being of limited probative weight. Turning to Dr. P.K.’s November 2007 medical statement, although simply stating the Veteran has been diagnosed with a sleep disorder, it does not address specific symptomatic criteria which would establish the existence of a disorder. In contrast, the December 2006 VA examiner, in finding the Veteran’s reports did not meet the diagnostic criteria for a sleep disorder, specifically addressed the lack of night sweats or hypersomnolence, as well as the Veteran having had no treatment or evaluation. The August 2007 VA examiner in turn directly attributed sleep difficulties to the Veteran’s specific personal and emotional preoccupations, to include his work, school and his girlfriend’s imminent departure. Moreover, Dr. P.K.’s own treatment note from the same month as his statement mentions that medication has been effective and the Veteran has experienced “complete resolution of confusion arousals,” without the prospect of a return of symptoms if the Veteran adheres to correct sleep hygiene. For these reasons, the Board finds Dr. P.K.’s statement of limited probative value and the findings of the December 2006 and August 2007 VA examiners to be of significant probative weight. Although receiving diagnoses of either sleep disturbance or sleep disorder between May 2012 and May 2014, as already stated, the October 2007 sleep study made no findings of a sleep disorder, but of “confusional arousal.” By November 2007, Dr. P.K. states confusional arousal is now completely resolved. Moreover, the diagnoses between May 2012 and May 2014, unlike the sleep study, were not based on clinical observations during testing, but on reports by the Veteran and whether they were deemed to match criteria associated with sleep disorders. Service connection requires a showing of a current disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A current disability is shown if the claimed condition is demonstrated at the time of the claim or while the claim is pending. McClain v. Nicholson, 21 Vet. App. 319 (2007). As it is, the September 2016 VA examiner did not find the Veteran exhibited criteria indicating a sleep disorder and in fact assessed his symptoms as other symptoms of depression and “not evidence of a separate distinct disorder.” For the above reasons and based on the absence of a diagnosis of a sleep disorder in the October 2007 sleep study and the findings of the September 2016 VA examiner, the Board finds the medical evidence does not show competent evidence of the existence of a current disability of a sleep disorder. Therefore, service connection for such a disorder cannot be established. Conclusion The Board has reviewed and carefully considered the Veteran’s testimony in the September 2013 Board hearing; the statement accompanying his December 2005 Application for Compensation or Pension; his April 2006 Statement in Support of Claim; his two July 2007 Statements in Support of Claim; the statement accompanying his September 2007 Authorization for Release of Information; his September 2007 Statement in Support of Claim; the statement accompanying his September 2007 Notice of Disagreement; the statement accompanying his March 2009 VA Appeals Form 9; and the statement accompanying his November 2016 Notice of Disagreement, as well as his reports to treatment providers, as they have appeared throughout the record. These have helped the Board in understanding better the nature and development of the Veteran’s disorders and how they have affected him. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. However, the Board must emphasize that the Veteran is not competent to diagnose dermatological, psychiatric or vascular, respiratory or possibly neurological disorders or interpret accurately clinical findings pertaining them, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Moreover, the Board cannot render its own independent medical judgments; it does not have the expertise. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board must look to the medical evidence when there are contradictory findings or statements inconsistent with the record and it must rely on clinical findings and opinions to establish the connection of current disabilities to service-related events, injuries or illnesses or determine their current level of severity. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Based on the evidence of record as it now stands, the Board has made its findings as stated above.   The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claims, the doctrine is not applicable and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Franke, Associate Counsel