Citation Nr: 20030353 Decision Date: 04/30/20 Archive Date: 04/30/20 DOCKET NO. 15-37 509 DATE: April 30, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for a low back disability is denied. REMANDED Entitlement to service connection for hepatitis C is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran’s acquired psychiatric disorder to include PTSD is related to his active duty service. 2. The preponderance of the evidence is against a finding that the Veteran’s low back disability is related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for acquired psychiatric disorder to include PTSD, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 2. The criteria for service connection for a low back disability, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in active duty service with the Marine Corps from August 1975 to December 1975 to include service in the Marine Corps Reserve. Review of the Veteran’s military personnel record shows in August 1975 the Veteran enlisted in the Marine Corps Reserve for 6 years and that he was to serve at least 6 months in active duty. The records also indicate he was discharged in October 1978 and received an honorable discharge certificate in August 1981. This matter is on appeal from a December 2011 rating decision. The Veteran was afforded a hearing in March 2005 and another hearing in January 2019 with the undersigned Judge in January 2019. A transcript of the hearing has been associated with the record. The Board remanded this appeal in May 2019 for additional development. As an initial matter, the Board notes that the scope of a disability claim includes any disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and other information of record. See Clemons v. Shinseki 23 Vet. App. 1 (2009). In September 1984 the Veteran filed a claim for service connection for manic depressive illness. In January 2003 the Veteran submitted a statement to amend his claim to include PTSD, and review of his medical treatment record includes complaints, treatment and diagnoses to include depression and PTSD. In light of the rule in Clemons, the Board has recharacterized the issue on appeal as a claim of service connection for an acquired psychiatric disorder to include PTSD. Service Connection Service connection is granted on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 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). However, VA laws are different as to the Reserve service. The Reserve service includes active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). ACDUTRA is full time duty performed under 32 U.S.C. §§ 316, 502, 503, 504, or 505. See 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). For VA purposes, ACDUTRA covers the annual training that Reservists perform each year and, if applicable, the initial period of training. INACDUTRA is duty, other than full-time duty, performed pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101 ; 38 C.F.R. § 3.6 (d). While service connection may be granted for disability resulting from either a “disease” or an “injury” incurred during ACDUTRA, it may only be granted based on “injuries” suffered during INACDUTRA. 38 U.S.C. §§ 101 (24), 106. “Active military, naval, or air service” includes active duty and any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; or any period of inactive duty training (INACDUTRA) in which the individual concerned was disabled or died from an injury, though not also disease, incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). Presumptive service connection does not apply to claims predicated on ACDUTRA and INACDUTRA service, but only for active duty. Biggins v. Derwinski, 1 Vet. App. 474 (1991); Smith v. Shinseki, 24 Vet. App. 40 (2010). Reserve and National Guard service generally means ACDUTRA and inactive duty for training (INACDUTRA). ACDUTRA is full time duty for training purposes performed by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). That usually includes two weeks of annual training and/or an initial period of training. INACDUTRA includes duty, other than full-time duty, performed for training purposes by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.A. § 101(23); 38 C.F.R. § 3.6 (d). That usually indicates weekend drills or training. The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. See Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In relevant part, 38 U.S.C. § 1154 (a) requires that the VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim to disability. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. 38 U.S.C. § 5107(b); see Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Acquired psychiatric disorder to include PTSD The Veteran asserts that his acquired psychiatric disorder to include PTSD is related to or caused by his active duty service. Where a PTSD claim is based on an in-service personal assault, evidence from sources other than the Veteran’s service records may corroborate the Veteran’s account of the stressor incident. Examples of potentially useful evidence may include records from law enforcement, rape crisis centers, mental health counseling centers, hospitals, statements from family members, roommates, clergy, or other similar sources. Evidence of behavior changes following the claimed assault is also one type of relevant evidence that may be found from these sources. 38 C.F.R. § 3.304 (f)(5). Examples of behavior changes that may constitute credible evidence of the stressor include but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. Id. It is also important to note that for personal assault PTSD claims, an after-the-fact medical opinion may serve as the credible supporting evidence of the reported stressor. Patton v. West, 12 Vet. App. 272, 280 (1999). Review of the medical treatment record shows treatment for PTSD or PTSD-related symptoms. The July 2019 VA examiner diagnosed the Veteran with PTSD. Accordingly, the Board finds the Veteran with a current disability. Review of the Veteran’s STRs do not show any complaints, treatment or diagnoses for an acquired psychiatric disorder to include PTSD. The Veteran’s December 1975 separation examination did not find or report any acquired psychiatric disorder to include PTSD. The Veteran submitted a November 1977 newspaper article titled “Gun Horseplay Ends in Death.” The article documented the death of the Veteran’s “girlfriend” on November 10, 1977 when “a gun [the Veteran] was holding accidently fired as she sprawled across him on a waterbed in their bedroom.” The investigating detective reported that “she came over to him and sprawled on top of him…it was just a bit of horseplay. But her sudden weight caused a kind of wave and the gun fired.” The detective noted the Veteran’s account of the shooting was still being investigated but no charges were filed. In a December 1977 private psychologist letter, the treating psychologist reported interviewing the Veteran in relation to the accidental shooting of his girlfriend. The Veteran reported that because of the traumatic incident related to weapons and killing, the Veteran “planned to do everything he could to withdraw from his obligation to the Marines.” The psychologist found the Veteran with depression and anger over the incident and warned “given [the Veteran’s] short temper … at the very worst, harm might also come to those around him in the Marines if he is forced to remain active against his will.” Review of the Veteran’s military personnel record shows the Veteran missed attending monthly drills starting November 1977 through April 1978. In September 1978 the Veteran’s inspector-instructor recommended the Veteran be administratively discharged by reason of misconduct due to shirking. The inspector-instructor noted the Veteran accumulated unauthorized absences from scheduled drills and annual training duty. It was noted that this action had been delayed in “compassion felt towards [the Veteran] when it became known that he accidentally shot and killed his wife in November 1977.” The inspector-instructor noted the Veteran reported in July 1978 to address his absences and was offered the opportunity to make up to regain his satisfactory participation status, however the Veteran refused and stated that he only wanted to be discharged. The Veteran refused to make a written statement and completed acknowledgement of his notification of the intent to recommend discharge by reason of misconduct. The inspector-instructor noted the Veteran was absent for drills in July and August 1978 and found the Veteran intended to avoid all responsibilities of his military obligation, regular or reserve, and that the Veteran was notified and acknowledged the action. In October 1978 the Veteran was discharged. Review of the Veteran’s reserve STRs notes the October 1978 discharge for non-attendance of drills and that the Veteran was not available for physical exam. The documenting physician found that no injury or illness was noted at this time. In a June 2001 private physician letter, the physician noted that he had been taking care of the Veteran since October 1999. The physician stated that at the time the Veteran was happy and active but has since followed a persistent “downhill course.” The physician noted that the Veteran has been forced to sell his business, his wife left him, and suffered from weight loss and decreased appetite caused by severe depression. In a submitted April 2002 lay statements from the Veteran’s friends and family, the stated that the Veteran has suffered problems with depression for many years. In an August 2002 VA medical center (VAMC) pain clinic note, the Veteran reported felling very depressed and frustrated. The treating physician assessed the Veteran with depression with suicidal ideation. In a follow up visit, the treating physician noted the Veteran reported “turning in some claims for disability and has been rejected secondary to obscure reasons.” The physician noted the Veteran had suffered some traumatic events in the past and has an abnormal PTSD examination result but never properly evaluated for PTSD. The physician diagnosed the Veteran with multi-factorial depression and referred the Veteran for PTSD evaluation. In an August 2002 discharge form, the Veteran was given a primary diagnosis of a mood disorder with secondary diagnoses for “poor coping skills, difficulty to control anger.” It was noted that during his stay, the Veteran stated his belief that he was suffering from PTSD; when informed that the Veteran would need to be clean of drugs due to an earlier positive drug test for cocaine before admission for PTSD treatment, the Veteran became angry and punched the wall before threatening to leave. In February 2003 discharge report, the Veteran was admitted in October 2002 with an admitting diagnosis of recurrent major depressive disorder, PTSD, and cocaine abuse in remission. The Veteran’s chief complaint was noted to center around multiple mentions of “killing my first wife for no reason” which has caused him to be “unable to be happy” and following a self-destructive path. The Veteran reported that after his basic training he joined the Reserve as “the best way to go to combat.” The Veteran stated that “one day for no apparent reason in circumstances he does not remember he shot his wife.” The Veteran stated that an early injury in basic training caused him to be slower than other recruits and he got tired of “having my ass kicked” and became “aggressive all the time.” The Veteran reported that following the death of his wife he became afraid of carrying or firing a weapon. It was noted that the Veteran reported service in the Marines from August 1975 to December 1975. The Veteran was noted to repeatedly state that he “did not want to talk about certain issues whose discussion could be detrimental to him.” The Veteran reported symptoms of PTSD and mentioned stressors from boot camp, the shooting death of his wife, and the death of his 10-year-old child in a car accident. The Veteran was given a discharge diagnosis of recurrent major depressive disorder, PTSD, and cocaine abuse in remission, and was released with a finding that he was psychologically stable. In a submitted February 2003 PTSD questionnaire, the Veteran reported that in December 1975 he was beaten up 3 times during boot camp. The Veteran stated that after the third beating he began sleeping with a loaded magazine; and although the beatings stopped, the Veteran stated that he could not sleep for fears that “they would get me.” The Veteran noted that he never reported these beatings. In a separate February 2003 statement, the Veteran stated that he suffered an injury to his back which he claimed was misdiagnosed as a pulled muscle and as a result caused him to be unable to keep up with his platoon and squad. The Veteran stated that he was beaten three times and after the third time he began sleeping with a loaded magazine to ensure he would never be beat up again. In an April 2003 psychology note, the Veteran was seen for consultation on psychosocial impairment. The Veteran reported that he “stayed 102 days” for a complete psychosocial history but was told that he did not meet the criteria for PTSD. The evaluating psychologist noted the Veteran had a long history of impulse control problems; verbal and physical aggression; legal consequences from a history of fighting; poor quality sleep due to “thrashing around and punching people in my sleep”; a history of heavy cocaine and substance abuse; depression; interpersonal and occupation dysfunction; and several “divorces”. The Veteran’s primary complaints concerned very poor-quality sleep, depression, irritability and anger, and “unhappy” with his current situation in life and not knowing what to do about it. The Veteran submitted an August 2003 statement noting he was taking medication for PTSD and asked his file to be reviewed again. In an October 2003 statement, the Veteran stated that because of his claimed back injury in boot camp, this caused him to be dragged out of his bed and be beaten on three different occasions. The Veteran stated that one particular beating lasted 10 minutes and resulted in a broken nose and a cut over his left eye. The Veteran stated that after the last beating he stole some bullets and slept with a loaded magazine “waiting for them to come night after night.” The Veteran stated that as a result of his beatings he suffers from nightmares and fights in his sleep every night. The Veteran stated that he was married to his first wife for only three months when one night she tried to wake him up while he was having a nightmare and he “pulled the pistol from under my pillow and just shot one time”, killing her instantly and that she “died in [the Veteran’s] arms.” The Veteran reiterates that “this is all from being beating up in boot camp. This is where it all has started.” The Veteran stated that he has been married three other times and did not sleep with his spouses because of swinging and kicking in his sleep. The Board notes that the Veteran’s July 1975 enlistment examination noted the Veteran with a simple fracture of the nasal bone. The Veteran’s STRs show in September 1975 the Veteran reported a that his nose had been broke two times while practicing karate. In a March 2004 buddy statement, the Veteran’s friend stated that when he first met the Veteran, the friend noticed the Veteran was “stand-offish and not very friendly…suffered from mood swings and would turn aggressive to the point of violence over the smallest thing,” and personally witness the Veteran go into a rage over a small scratch on his motorcycle. The friend stated that basic training turned civilians into a trained soldier where they were taught to “turn fear into anger and aggression … when the spirit of the bayonet is to kill” and stated the Veteran’s suffering from PTSD. In a March 2005 private physician statement, the physician opined the Veteran was suffering from recurrent major depressive disorder and PTSD. The physician noted the Veteran was able to cite “potential causes for his PTSD related to his experiences in boot camp and the shooting of his wife.” This opinion did not reference records that would support the finding nor definitely indicate if either “potential cause” was the actual cause of the Veteran’s claimed PTSD. At the Veteran’s March 2005 hearing, the Veteran reported that he was in good physical shape at the time of basic training with a brown belt in karate. The Veteran testified that his back injury in boot camp held him back and caused his platoon and squad to do extra exercise or duty. The Veteran stated that afterwards he was dragged out of bed and beaten up to 20 minutes at a time. The Veteran stated that he slept with a loaded magazine and informed others that “if you work me up and I got to a rifle, I was gonna end that.” The Veteran testified that the major thing he took away from the beatings in boot camp was the memory of the beatings and suffering from nightmares of being beaten. The Veteran stated that in 1977, “two years after [the Veteran’s] discharge from the military” that he has always had sleep problems with exaggerated startle response upon awakening. The Veteran then discussed the death of his first wife in 1977. The Veteran stated that they had only been married for three months. The Veteran testified “I guess I was dreaming; I don’t know why she woke me up. I was dreaming or fighting or doing something. And she went to wake me up. And I sleep with a gun since then and pulled the pistol and shot and killed her.” The Veteran stated that some of the psychiatrists that treated him determined that based on his provided history to them that the onset of his PTSD was back to the basic training. The Veteran asserts that the beatings during his boot camp were the cause of his current complaints and symptoms relating to PTSD. The Board remanded this appeal in April 2005 for additional development. In October 2005 the Veteran had a positive screening for PTSD and was noted to be currently receiving treatment for PTSD. In a January 2006 private physician letter, the physician stated that they had been taking care of the Veteran since August 2005 for PTSD treatment. In a March 2006 Board decision, the Board noted the Veteran’s claimed beating from fellow service members went unreported and no formal complaint was documented. The Board found that review of the Veteran’s inservice medical and personnel report did not report an assault or show treatments for appropriate injuries relating to the claimed beating. As such, the Board decision did not find any record to support the Veteran’s claimed in-service stressor. The Board decision found “give the more obvious non-service-related stressors, his killing of his wife and the death of his son, [the Veteran’s] more recent assertions of brutal beatings in service are not credible.” In May 2011 the Veteran filed a claim to reopen his claim for service-connection for an acquired psychiatric disorder to include PTSD. In a June 2011 statement the Veteran stated that he was still in the military when he accidently shot and killed his wife “after 2 weeks of marriage” and that he would provide records of the incident that gave him PTSD. In a submitted July 2011 statement, the Veteran stated that on November 10,1977 “while still in the marine corps” the Veteran accidently shot and killed his wife. The Veteran stated, “if killing somebody that you don’t know in combat creates PTSD what would killing someone you love create, maybe severe PTSD.” The Veteran asserts that his Social Security Statement showing that he was unable to hold a job as proof that he has PTSD; the Veteran also noted that he has submitted doctor notes and newspaper clippings in support of his claim. In a May 2012 private physician statement, the physician stated that the Veteran had many deficits that would keep the Veteran from being employed in the competitive business community to include depression, standing for long periods, bending, stooping and lifting. In a submitted June 2012 statement, the Veteran stated that he would “try to connect the dots for you.” The Veteran stated that in boot camp he was often woken up in the middle of the night and beaten for things “I couldn’t control.” The Veteran stated that it got the point where he was always in a hyper alert state and on guard at all times. The Veteran stated that after “8 or 9 beatings” by the end of the second month, the Veteran took a few bullets from the firing range and began sleeping with a loaded magazine. The Veteran stated that to this day he continues to sleep with a loaded weapon. The Veteran next stated that he “was still in the Marine Corps” when he was married to his first wife. The Veteran stated that two weeks after the marriage he was suffering from a nightmare about being beaten in boot camp and when his wife woke him up by shaking him, he “swung around and shot my wife in the heart. She died in my arms. This add to my PTSD.” The Veteran stated that he blamed the bootcamp and the Marine Corps for his PTSD as “that is where it all started.” In a November 2012 NOD, the Veteran stated that after his back injury in boot camp training exercises, the Veteran was physically unable to keep up with his class and “that is where the hazing started.” The Veteran asserted the random beatings and night raids in part led to him suffering from PTSD, and in turn lead to the accidental death of his wife. The Veteran stated that he has submitted letters to support his claim that his PTSD began from the trauma he experienced in boot camp. In a July 2013 psychiatrist statement, the psychiatrist noted that they had been taking care of the Veteran every two months since the beginning of February 2013; the psychiatrist noted the Veteran with diagnoses of anxiety, attention deficit hyperactivity disorder (ADHD), and a history of substance abuse in remission. The psychiatrist noted the Veteran accidently killed his wife but did not mention the Veteran’s reported beatings in boot camp or offer an etiology opinion. In a September 2013 private physician letter, the physician noted that he spoke with the Veteran over the past two years concerning their military experiences. The physician stated that based on the Veteran’s conversations, he is led to believe that the Veteran’s boot camp experiences has had long-term consequences on his life. The physician stated the Veteran’s reported symptoms were consistent with others counseled that had PTSD. The physician did not provide any other details to support how the Veteran met the criteria for PTSD or clarification on how the stressor would support this finding. In a separate September 2013 initial psychiatric evaluation, the Veteran wanted to see if there was anything more to be done for his PTSD. The Veteran reported that his symptoms referred to his tenure in boot camp as a marine where he was hazed and beaten as part of his boot camp experience. The Veteran then stated that when he was recently married his wife “came into the bedroom and surprised him and he pulled out a weapon and shot her accidently, killing her.” In a submitted March 2014 PTSD disability benefit questionnaire (PTSD) completed by a private psychologist, the Veteran was diagnosed with chronic PTSD and recurrent major depressive disorder. The evaluating psychologist noted that no records were reviewed and no opinion regarding the nature and etiology of the Veteran’s PTSD was provided. In an October 2014 assessment the Veteran was given a provisional diagnosis of PTSD and ADHD. The Veteran stated that his PTSD diagnosis stemmed from an occurrence in the military that he “initially did not desire to discuss” but later disclosed that he accidently shot his wife “who made some noise from her movement on a waterbed.” The Veteran stated that his action was the direct reaction or result of his military training and that he was hyper-vigilant. At the Veteran’s January 2019 hearing, the Veteran testified that his PTSD would be attributed to his time in boot camp. The Veteran stated that he would be beaten two to three times a week because he would be unable to complete running exercises and causing other to do extra exercises. The Veteran stated that when he complained about the beatings, “the drill instructor put a metal bucket on my head and beat it with a broom stick or mop.” The Veteran stated that the beatings continued for two months until one day he took several bullets from the firing range and told the other service members “the next time you guys put your sorry hands on me, I’m going to kill [you]…all ‘ve got to do is get my hands on a magazine and a rifle and we’re going to have a problem.” The Veteran stated that the beatings stopped after that and he since then always slept with a gun out of habit. The Veteran stated that he had sleeping problems as a result of his beatings during boot camp and that he would be easily startled. The Veteran testified that he had been married to his first wife for only three weeks when one night “she came in and startled me and [the Veteran] shot her and killed her.” The Board remanded this appeal in May 2019 for additional development. The Veteran was afforded a July 2019 VA examination. The VA examiner diagnosed the Veteran with PTSD. The Veteran reported that his first marriage lasted three weeks and ended due to her accidental shooting death. The Veteran noted that his second marriage lasted 10 years and he had a son who was hit by a car and killed at the age of 10. The Veteran reported that in boot camp he suffered a fall and hurt his back which caused him to fall behind his squad or platoon members because of back pain. The Veteran stated that he was getting beaten 2 to 3 times a week for falling behind. The Veteran stated that when he complained to the drill instructor, the instructor “put [the Veteran] in front of the whole squad and put a bucket over my head.” The Veterans stated that he started sleeping with a gun and then he was never beaten since. The Veteran stated that because he was sleeping a gun, this led to the incident with his first wife where “she startled me when she sat on the water bed, so I grabbed my pistol and just shot,” killing her. The Veteran stated from 1977 to 1981 “I didn’t have anything to do with the Marine Corps.” The examiner reviewed the Veteran’s claimed stressors. The Veteran first claimed a stressor from the Veteran’s accidental shooting of his first wife, killing her. The examiner found this a valid stressor to support the diagnosis of PTSD but did not find this stressor related to the Veteran’s fear of hostile military or terrorist activity or related to a personal assault. The Veteran next reported a stressor from being repeatedly physically assaulted while in boot camp. The examiner found this a valid stressor to support the diagnosis of PTSD related to an in-service personal assault. However, the examiner noted while there was a reported physical assault, there was no military sexual trauma (MST) and no specific markers noted or found in the Veteran’s service treatment record. The examiner found that after review of the Veteran’s STRs, treatment records and information provided at the examination, the Veteran’s PTSD had the “index trauma being the shooting/killing of his wife which occurred during his active duty service…while there are memories of military experience that are troubling to him, [the Veteran] doesn’t have a problem of PTSD that is sufficiently linked or caused by the reports of being beat up in boot camp. His symptoms appear to be linked to the death of his wife which is supported by the treatment record.” The Board notes that the VA examiner opined that the Veteran’s shooting of his wife occurred during “active duty service”; however review of the Veteran’s military personnel record indicates the Veteran served in active duty service from August 1975 to December 1975 and served the remainder of his service to 1978 in reserve. The military personnel record also notes the Veteran in August 1977 achieved the rank of Corporal as part of the Marine Corps Reserve. As the VA examiner’s opinion was based upon inaccurate facts in erroneously adding a few years to the Veteran’s active duty service period, therefore the Board affords the opinion less probative weight. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The Board acknowledges the Veteran’s assertions that his acquired psychiatric disorder was related to his military service. Certainly, he is competent to describe experiencing symptoms. Indeed, treatment records corroborate at least to some extent the Veteran’s history of reported symptoms. Nevertheless, a lay person, the Veteran does not have the training or expertise to render a competent opinion which is more probative than the VA examiner’s opinion on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Furthermore, the Board notes that review of the claims record show several inconsistencies in the Veteran’s reported history and symptoms of his acquired psychiatric disorder. Such inconsistencies include the cause of his acquired psychiatric disorder where the Veteran stated was caused only by the beatings in boot camp conflicting with his later assertions that his beatings led to his accidental shooting of his wife and leaving him with PTSD or mainly because of the shooting of his wife; the Veteran’s accounts regarding the circumstances of the shooting of his wife where in August 2003 and March 2005 he reported or testified that he shot his wife when she tried to wake him up while he was having a nightmare conflicted with the February 2003 Veteran’s statement that “one day for no apparent reason in circumstances he does not remember, he shot his wife”, the November 1977 newspaper article which the Veteran’s wife was killed when she sprawled on the Veteran while he was holding a gun and it accidently fired, and later , and later statements and January 2019 testimony where the Veteran accidently shot his wife when she walked into the room and surprised him. Given the inconsistencies of the statements made by the Veteran compared to the medical findings in the treatment record, the Board affords the Veteran’s statements less probative weight and outweighed by VA examinations of record performed by professionals. The Board notes that for personal assault PTSD claims, an after-the-fact medical opinion can serve as the credible supporting evidence of the stressor. Menegassi, 638 F.3d 1379, 1383; Bradford v. Nicholson, 20 Vet. App. 200, 207 (2006); Patton v. West, 12 Vet. App. 272, 280 (1999). Additionally, a Veteran’s failure to report an in-service assault to military authorities may not be considered as relevant evidence tending to prove that an assault did not occur. AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013). However, the July 2019 VA examiner found that the Veteran’s PTSD was not related to his reported inservice beatings in boot camp and no markers were found after review of the Veteran’s STRs and military personnel record. The Board notes that the Veteran’s military personnel records show the Veteran was able to be promoted and achieve the rank of Corporal in August 1977 while in the reserves; and the Veteran’s subsequent absence from drills and later actions leading to his discharge occurred after the November 1977 death of his wife. Review of the records does not show that the death of the Veteran’s wife occurred during a period of active duty or while performing inactive duty training. Based on the above, the Board finds that the competent evidence on record is against a finding of service connection for the Veteran’s acquired psychiatric disorder to include PTSD. The Veteran’s STRs do not show any complaints or treatments relating to an acquired psychiatric disorder, and his December 1975 separation examination did not report or find any mental issues. Review of the Veteran’s medical treatment record shows the earliest medical documentation of the Veteran’s treatment for an acquired psychiatric disorder was in 2002, many years after separation from active duty service. The Veteran asserted an inservice personal assault during boot camp that contributed to or caused his PTSD, however review of the record does not show any markers to support a finding of a personal assault in service. Although the Veteran’s provided statements and testimony that he sleeps with a gun and is hypervigilant because of the beatings may indicate a response to recent trauma, the inconsistencies between the Veteran’s statements versus the competent evidence of record undercuts the Veteran’s credibility and the probative weight and value of his statements. The July 2019 VA examiner considered the Veteran’s report of symptoms to include his reported stressors but found no relevant markers resulted from the reported beating and provided reasoned analysis of the case to support their opinion that the Veteran’s current acquired psychiatric disorder was not related to the Veteran’s reported inservice beating. Although the examiner opined the Veteran’s acquired psychiatric disorder was related to his accidental killing of his wife, this incident happened after the Veteran’s separation from active duty service. Review of the record does not show any credible evidence or documentation to show the claimed incident occurred during a period of active duty service or a period of inactive duty training. As such, the evidence of record does not show an inservice event that relates to or caused the Veteran’s acquired psychiatric disorder to include PTSD. The Board thus finds that the weight of the competent and probative evidence is against a finding of service connection for the Veteran’s acquired psychiatric condition. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Low back disability The Veteran contends that his low back disability is related to his active duty service. Review of the Veteran’s medical treatment record shows complaints, treatment and surgery for a low back disability. In a July 2019 VA examination, the examiner diagnosed the Veteran with lumbar spondylolisthesis and degenerative disc disease (DDD) status post left sided hemilaminectomy with medial facetectomy for resection of epidural mass, synovial cyst. As such, the Board finds the Veteran with a current disability. Review of the Veteran’s STRs during his active duty service show no complaints, treatment or diagnoses for a low back disability. The Veteran’s December 1975 separation examination does not show or report any low back disability or issues. In October 1977 the Veteran was seen at the Marine Corps Reserve physician for complaints of tightness and pain in the back while doing sit-ups with pain along the left side of his middle back. The treating physician gave an impression of a muscle strain and gave the Veteran light duty for 24 hours with medication. In February 2000 the Veteran was seen with complaints of increasing severe pain in his lower back. The Veteran reported a history of a back injury during boot camp. The treating physician gave an impression of mild degenerative changes with a small disc herniation at the L4-L5 and L5-S1 producing no significant central stenosis. In a June 2001 private chiropractor letter, the chiropractor stated that they had been taking care of the Veteran since 1991. The chiropractor stated the Veteran had chronic pain to all three vertebral areas with spinal disc degenerative evidence on x-rays in all three regions. The chiropractor opined the severity of his pain are related to the extent of stress on these structures during his work and leisure activities and felt that the Veteran’s condition would only worsen in subsequent years. In a following June 2001 private physician letter, the physician stated that they had been taking care of the Veteran since October 2001. The physician noted that the Veteran was currently troubled by back pain and complications hepatitis C and fatigue have caused the Veteran to sell his business and his condition to follow a persistent “downhill course.” In a June 2001 private progress supplemental report, the Veteran was noted with an original diagnosis of lumbosacral sprain/strain and neuritis, but the report updated the diagnosis as chronic lumbosacral sprain/strain and degenerative disc disease. The Veteran reported intermittent low back pain and peripheral neuropathy in his leg. The Veteran stated that these symptoms impacted his ability to perform physical labor “through much of life” and the evaluating physician found that the Veteran’s ongoing symptoms made him unable to perform normal work responsibilities at this time. The physician was unable to give a prognosis and that the Veteran was scheduled to undergo surgery. In a July 2001 surgical history and physical note, the Veteran reported with complaints of back pain for many years. The physician gave an impression of degenerative changes of the lumbosacral spine with bulging disc at the L3-L4 and disc osteophyte complex at L4-L5 with mildly narrowing neural foramina. In August 2001 the Veteran underwent an L4-L5, L5-S1 intradiscal electrocautery thermal ablation (IDET) procedure. In September 2001 the Veteran was seen for an initial complaint of cold-like symptoms but then reported severe back pain associated with back surgery done earlier in the year. In November 2001 the Veteran presented with complaints of pain in the lower back for the past 3 months that had been worsening in the past 2 to 3 weeks. In a February 2002 pain initial assessment report, the Veteran reported a long history of back pain starting in 1974 following a fall during boot camp training. The Veteran stated that he suffered stress fractures in both arms along with coccygeale pain; the Veteran stated that he was placed on light duty for 3 days, sent to “motivation platoon” and eventually graduated from boot camp. The Veteran stated that he then developed intermittent mild low back pain and had seen a chiropractor for years with some relief. The Veteran stated that the pain had been progressive to the point of becoming constant in 1977 and increasing in severity since that time; the Veteran states that the pain is currently constant and severe that it interferes with his sleep and daily activities. The treating physician noted the Veteran underwent an IDET procedure 7 months ago with no long-term relief. The Veteran also wrote in comments stating, “I did not know the VA would take care of me until 1998 – that is why there is a long lapse from 1975 to 1998.” In a February 2002 statement, the Veteran stated that in boot camp he fell 20feet off a rope climb and landed on his tailbone and arms. The Veteran stated that he was sent to sickbay and told that he had stress fractures in his arms and bruising of his back. The Veteran stated that the treating physician gave him 3 days of light duty and indicated “check my records”. The Veteran stated that his drill instructor thought he was “a slacker and sent me to Motivation Squad where it was even tougher on my injured back.” The Veteran stated that his back was hurting but he “toughed it out and hoped it would get better.” The Veteran complained that the IDET surgery made his back worse and described it as a new procedure that “I was the guinea pig.” The Veteran submitted lay statements from his family and friends in April 2002. The Veteran’s mother stated that when she visited the Veteran while he was in the hospital, the doctor told her the Veteran had severe back problems and injured his back from a climbing exercise. The Veteran’s friend stated that he visited the Veteran at the hospital for hepatitis and a bad back. In August 2002 the Veteran complained of chronic back pain and reported this pain stems from an “accident while in the military when he fell off a roof and hurt his back.” In an August 2002 statement, the Veteran stated that he hurt his back in boot camp and asserted they misdiagnosed his injury as a pulled muscle. The Veteran stated that he has had back pain since boot camp and “have dealt with it long enough.” In an October 2002 statement the Veteran stated having fusion surgery on his L4 and L5 disc due to an injury in boot camp. The Veteran stated that his injury was incorrectly written down as a pulled muscle and that he had back pain ever since he fell off the rope climb. In an August 2003 form 9 statement, the Veteran stated that he suffered from low back pain that he was told was a pulled muscle. The Veteran stated that “I know that was the incident that caused all my back pain; it is in my record.” In a submitted August 2003 Social Security Administration (SSA), the Veteran asserted that he had been disabled since June 1999 due to a back injury, hepatitis C and liver cancer. The Veteran reported that he had been employed as a boat captain, diver and salvage master. The Veteran was noted to have undergone back surgery in August 2001 and his complaints and symptoms included joint pain, chronic lumbar pain, displaced lumbar disc and discogenic disease. The SSA administrative law judge found the Veteran met the criteria for a disability under SSA criteria. In an October 2003 statement, the Veteran stated that during bootcamp he injured his back and was sent to sickbay, was told that he pulled a muscle, and given light duty for a few days. The Veteran stated that the pain did not go away and that he had to tough it out and hope it would get better. The Veteran stated that he has been plagued with back problems ever since. At the Veteran’s March 2005 hearing, the Veteran testified that during a boot camp exercise, the Veteran fell off the rope swing and landed in a seated position. The Veteran stated that he sustained stress fractures to both arms as well as injured his back. The Veterans stated that when his back was checked out, he was told that “it was probably a pulled muscle and gave me three days light duty.” The Veteran stated that no treatment or medication was given for his injuries and after the three days of light duty he returned to regular basic training. The Veteran stated that he never had back problems before the injury in basic training and described the injury as a jolt that “shook the soul out of my body.” The Veteran stated that his back was hurting too much and it stopped him or held him back from keeping up with others during basic training. The Veteran stated that he continued to have back problems ever since and referred to his IDET surgery for his back. The Veteran testified that after he finished boot camp, he went to a private doctor for treatment several times over the course of 15 years, however the Veteran stated that the private doctor later died and none of the records during this period were available. The Board remanded this appeal in April 2005 for additional development. In a March 2006 Board decision, the Board found there was no STRs documenting the Veteran’s injury to his back during his active duty service. The Board noted the Veteran complained of back pain while in the Reserves in 1977, but there was no finding of an earlier or chronic injury to the back. In May 2011 the Veteran filed a claim to reopen his claim for a low back disability. In a July 2011 statement, the Veteran stated that in boot camp a corpsman “not a doctor” told the Veteran that he had a back sprain. The Veteran noted that “when you’re in boot camp you don’t complain.” The Veteran stated that he did not receive x-rays and that he has suffered back pain since. The Veteran noted that VA performed back surgery on him and asked, “why would [VA] operate on me if there was not something wrong … that tells me that they have accepted responsibility for this.” In a November 2012 statement, the Veteran stated that in 1975 he fell off a 25-foot rope climbing exercise and landed on his back. The Veteran stated that he was taken to the infirmary where “a medic, not a licensed Medical Doctor, or M.D., gave me a quick once over and stated that I only strained my back.” The Veteran stated that he was told that the pain would be temporary and would resolve in time, given three days of light duty and returned to his unit. The Veteran asserted that his back was injured more severely than determined and the pain was excruciating; however, the Veteran “trusted the diagnosis and continued to power through my routine, expecting to heal.” The Veteran stated that the back pain did not subside and caused him to fall behind in physical requirements and be reassigned to “motivation platoon.” The Veteran stated that he has suffered from severe back pain ever since graduating from boot camp. The Veteran stated that the Marine Corps taught him that “pain is your friend, it lets you know, when you are seriously injured, it will keep you awake at night and most importantly, it lets you know that you are alive.” The Veteran asserts that he was unaware of VA benefits until 1998 where after starting they decided to do surgery to fuse part of his spine. In April 2018 the Veteran presented for a routine followup. The Veteran reported an exacerbation of his chronic low back pain attributed to his work as a welder with 2 failed back surgeries. In September 2018 the Veteran reported in a followup for his chronic low back pain that his symptoms have started to progress in the past year to 6 months. The treating physician noted that despite the Veteran’s reported back pain and other symptoms, the Veteran continued to be active as a welder and required to lift very heavy weights at his job. At the Veteran’s January 2019 hearing, the Veteran testified that while trying to climb a 25-foot-long rope, the Veteran fell and landed on his bottom on the ground. The Veteran stated that the next day he was sent to sick bay where a corpsman put him on light duty for 3 days. The Veteran stated that afterwards the Veteran was sent to a motivation platoon where he was exercised and “brutalized and penalized for getting hurt.” When asked about the Veteran’s complaints of back pain in 1977 while doing sit ups, the Veteran testified that he “sort of remember complaining about an injury, but I don’t remember what I was doing.” When asked about his separation examination, the Veteran stated that he got out of the military two to three weeks after the death of the Veteran’s wife in 1977 where he told his commanding officer that he did not want to pick up a firearm and qualify and his commander officer “pretty much said, well you don’t need to be in the Marine Corps, see you later.” The Veteran stated that nobody contacted him or did anything and the only time he went back was in 1981 to receive a certificate of an honorable discharge. The Veteran stated that he has always had issues with his back since. The Veteran stated that he sought treatment but not through the military. The Board reopened and remanded this appeal in May 2019 for additional development. The Veteran was afforded a July 2019 VA examination. The examiner diagnosed the Veteran with lumbar spondylolisthesis and DDD status post L3-L4 left sided hemilaminectomy with medial facetectomy for resection of epidural mass, synovial cyst. The Veteran reported the onset of his symptoms as December 1975 where during a rope climbing exercise in boot camp he fell in a sitting position and hit the ground. The Veteran stated that he was diagnosed with a back strain and given 3 days of light duty before returning to full duty. The Veteran stated that he did not return for any follow up treatment. The Veteran reported suffering from back problems and daily back pain ever since. The examiner noted that the Veteran had worked as a boat captain for 15 years, but his back pain did not allow him to continue working in the rough seas and eventually stopped working as a captain in 2004. The Veteran reported that he currently works as a welder in his home working on 3 to 5 items a week “repairing metal furniture, boats, almost anything.” The Veteran stated that this work causes back pain. The VA examiner found it less likely than not that the Veteran’s claimed low back disability was related to or incurred by the Veteran’s active duty service. The examiner found that the Veteran’s STRs for active duty service from August 1975 to December 1975 were silent for a chronic lumbar condition. The Board notes that service connection may be granted on a presumptive basis for certain chronic diseases, including arthritis, if such disease is shown to be manifest to a degree of 10 percent or more within one year following the Veteran’s separation from active military service. See 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. The Veteran has stated that he had continuing back symptoms from his claimed in-service injury going through service and after separation. In this instance however, service connection for a back condition on a presumptive basis is not warranted as the record does not show evidence of degenerative disc disease of the lumbar spine arose during the Veteran’s period of active military service, or within one year of separation from active duty service. Notably, review of the medical treatment record shows the first medical evidence documenting any back related complaints was in 2000, many years after his separation from active duty. As such, the available medical evidence does not support or show that the Veteran’s back condition was present to a compensable degree within a year of the Veteran’s separation from service. Accordingly, service connection for a back disability on a presumptive basis is not warranted as a chronic disease did not manifest to a degree of 10 percent or more within one year following the Veteran’s separation from active military service. The Board notes that the only evidence linking the low back disability to service are the Veteran statements. The Board acknowledges the Veteran’s statements and assertions that low back disability are related to his military service. Certainly, he is competent to describe experiencing symptoms. To the extent that the Veteran contends that a medical relationship exists between his claimed current disability and service the Board acknowledges that the Veteran is competent to testify as to his observations. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) Nevertheless, a lay person, the Veteran does not have the training or expertise to render a competent opinion which is more probative than the VA examiner’s opinion on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Here, the VA examiner considered the Veteran’s statements and reports of symptoms. The examiner still found that it was unlikely that his reported in-service injuries were related to any current disability. The Board finds that the Veteran’s opinion is outweighed by the competent opinion of the VA examiner. See id.; see also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). As addressed above, the Board notes that review of the claims record show several inconsistencies in the Veteran’s reported history and symptoms of his claimed disabilities. The Board notes that the Veteran has stated that he suffered an injury during boot camp with assigned light duty but review of the Veteran’s STRs does not show a report that the Veteran was seen in sick bay or assigned a light profile duty for his injury. The next documented complaint of a back injury was an October 1977 back injury sustained during sit ups which occurred during the Veteran’s Reserve duty; the Veteran here was given a 24-hour light duty profile and no other followup visit for a back injury was documented. The Board notes that the Veteran in August 2002 reported that he injured his back when he fell off a roof onto his back. The Veteran has not otherwise stated that his injury occurred during active duty service or during his periods of training in reserve duty. At the July 2019 VA examination, the Veteran reported the onset of his symptoms as in December 1975. The Board notes that the Veteran separated from active duty service in December 1975 and the separation examination did not find or report any back issues or complaints. The Veteran testified in January 2019 that he left the service two to three weeks after the death of his wife in November 1977; however, review of the military personnel record shows the Veteran had reported in July 1978 and submitted acknowledgement of notice of discharge for reasons of missing scheduled drills. As addressed above, such inconsistencies undercut the credibility and probative weight given to the Veteran’s submitted statements and testimony. As such, the Board finds the Veteran’s statements to be outweighed by VA examinations of record performed by professionals. Based on the above, the Board finds that the competent evidence on record is against a finding of service connection for the Veteran’s low back disability. Review of the Veteran’s active duty STR show no complaints, treatment or diagnosis of a low back disability. Review of the medical treatment record shows the earliest competent documentation of the Veteran’s low back disability is in 2000, many years after separation from active duty service. Significantly, the only medical opinion addressing the etiology of the claimed low back disability is the July 2019 examiner’s opinion. The July 2019 VA examiner considered the Veteran’s report of symptoms but provided analysis of the case record to support their opinion that the Veteran’s current low back disability was less likely than not incurred in or caused by the Veteran’s active duty service. The Board thus finds that the weight of the competent and probative evidence is against a finding of service connection for the Veteran’s low back disability. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASONS FOR REMAND The Board finds remand is warranted for additional development before adjudication of the Veteran’s appeal. The Veteran contends that his Hepatitis C is related to his active duty service. The Veteran has submitted multiple statements and testimony regarding the etiology of his hepatitis C in relation to his service. In a June 2002 statement, the Veteran stated that while on active duty in 1975 he got a tattoo on his left arm and later got tattoos on his right arm and one on his back. The Veteran stated that one year later he got sick and then ended up in the civilian hospital with hepatitis. In a January 2003 statement, the Veteran stated that he contracted hepatitis C from exposure to blood while getting tattooed in service. The Veteran stated that he was very promiscuous and had many sexual partners and that he also had his ears pierced. The Veteran also stated that he used other service-member’s razors while in service and indicate that he was hospitalized in late 1977 or early 1978. At the Veteran’s March 2005 hearing, the Veteran testified that that he was 19 when he was diagnosed with hepatitis C and denied drug use until he was 29. The Veteran stated that the only exposure to hepatitis that he would had known of was from either “inoculations received in the Marine Corp” or from the three tattoos that he got overseas during training. In a submitted July 2011 statement, the Veteran contends that at the time of his wife’s death in 1977, she had hepatitis C. The Veteran asserts that when he shot her, “there was blood everywhere and all over me from holding her in my arms … every policeman and I had to get conglobing shots.” The Veteran stated that one month later he was in the hospital with hepatitis C and “still in the Marine Corps.” At the Veteran’s January 2019 hearing, the Veteran testified that he didn’t know that he had hepatitis C until his wife was killed. The Veteran stated that there was “blood all over me, all over the bed, the room” and that he was kept at the sheriff’s department for two days until they told him that he had hepatitis C. The Veteran stated that when he entered service he was inoculated with “air guns” shooting into the side of his arm and that it wasn’t too long afterwards that the sheriff’s department found out the Veteran had hepatitis C. The Veteran stated that he did not receive treatment during this time until 2000. Review of the Veteran’s medical treatment record and VA examination show the Veteran with a history of drug and substance abuse. The Board reopened and remanded this appeal in May 2019 for additional development. The Veteran was afforded a July 2019 VA examination. The July 2019 VA examiner found the Veteran’s claimed hepatitis C was less likely as not incurred in or caused by his active duty service, finding that the Veteran’s STRs were silent for diagnosis and treatment of this condition. However, the Board notes that the VA examiner based their opinion only on the finding that the Veteran’s STRs did not show complaints, treatments or a diagnosis for hepatitis C and did not address or discuss the Veteran’s identified possible risk factors such as air gun vaccinations, shared razors, drug use, and tattoos in relation to his hepatitis C as well as his statements that his wife had hepatitis C when she died and her blood got all over him when she was shot and killed. As such, the Board finds the opinion inadequate and remand warranted for an addendum opinion to discuss the identified risk factors in relation to the Veteran’s claimed hepatitis C. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated and outstanding treatment records. 2. Return the claims file to the VA examiner who conducted the July 2019 examination, if available, for clarification and additional opinions. If that examiner is not available, the claims file should be provided to another physician to obtain the requested opinion. After review of the claims file, the examiner is asked to respond to the following: (a.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s hepatitis C had its onset during, or is otherwise related to, his active duty service? (b.) In rendering the requested opinion, the VA examiner should consider and discuss all identified risk factors, prior to, during, and after service, including drug use, sharing razors, tattoos, and high-risk sexual behavior. Additionally, the VA examiner should identify and discuss any medical and lay evidence to include the Veteran’s statements that his first wife had hepatitis C when her blood got all over the Veteran when she was shot and killed by the Veteran, as well as to include any medical principles and literature relied upon to support the underlying medical opinion. (c.) The examiner is also advised that the Veteran is competent to report in-service events and treatment, and his symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. (d.) A complete rationale is requested for all opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, he/she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 3. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review, if in order. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Yang, Attorney-Advisor The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.