Citation Nr: 21000135 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 13-20 957 DATE: January 4, 2021 ORDER As new and material evidence to reopen a claim of entitlement to service connection for hepatitis has not been received, the appeal as to that matter is denied. The claim of entitlement to service connection for residuals of left knee injury, to include arthritis, is denied. The claim of entitlement to service connection for residuals of back injury, to include degenerative arthritis, is denied. The claim of entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) and adjustment disorder with depression, is denied. FINDINGS OF FACT 1. Most recently, in a January 1989 rating decision, the agency of original jurisdiction (AOJ) denied the Veteran’s claim of service connection for hepatitis; the Veteran did not initiate an appeal, and no pertinent exception to finality applies. 2. New evidence associated with the record since the January 1989 denial, when considered by itself or in connection with evidence previously assembled, does not relate to an unestablished fact necessary to substantiate the service connection claim and raise a reasonable possibility of substantiating the claim. 3. Although the Veteran’s service treatment records document complaints of right knee pain (conceded as left knee pain), no chronic left knee disability was shown in service or for many years thereafter; there is no credible evidence of continuous left knee symptoms during and since service; and the only competent, probative opinion to address whether there exists a medical relationship between any current left knee disability and the Veteran’s active service weighs against the claim. 4. No chronic right back disability was shown in service or for many years thereafter; there is no credible evidence of continuous back symptoms during and since service; and the only competent, probative opinion to address whether there exists a medical relationship between any current right back disability and his active service weighs against the claim. 5. The weight of the competent, probative evidence indicates that the Veteran does not currently meet and at no point pertinent to the current claim has met the diagnostic criteria for PTSD. 6. The weight of the competent, probative evidence establishes that no diagnosed acquired psychiatric disability to include adjustment disorder with depression had its onset during service or is otherwise medically related to service. 7. Personality disorder is not a disability for compensation purposes. CONCLUSIONS OF LAW 1. The January 1989 decision in which the AOJ denied service connection for hepatitis is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 20.302, 20.1103. 2. New and material evidence to reopen the previously denied claim for service connection for hepatitis has not been received. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria for service connection for left knee disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for an acquired psychiatric disability, to include PTSD and adjustment disorder with depression, are not met. 38 U.S.C. §§ 105, 1110, 1131, 5107(b); 38 C.F.R. §§ 3.1(m), 3.102, 3.301(d); 3.303, 3.304, 4.9, 4.125. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from November 1969 to November 1971. This appeal to the Board of Veterans’ Appeals (Board) initially arose from rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO) in November 2009 and December 2009. In the November 2009 rating decision, the RO, inter alia, denied service connection for a left knee condition and a low back condition. In that decision, the RO also confirmed and continued the denial of service connection for hepatitis B on the basis that new and material evidence had not been submitted. In the December 2009 rating decision, the RO, inter alia, confirmed and continued the denial of service connection for PTSD on the basis that new and material evidence had not been submitted. The Veteran timely disagreed with, and perfected an appeal as to, the RO’s determinations. In June 2015, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge at the RO. A transcript of the hearing is associated with the claims file. In September 2015, the Board reopened the previously denied service connection claim for PTSD, expanded the reopened claim to include any acquired psychiatric disability, and remanded all claims on appeal for further development. The Board again remanded the claims on appeal in November 2017. Initially, it is noted that, regardless of the RO’s actions with respect to the hepatitis claim, as explained below, that matter is subject to a prior, final denial, and the Board has a legal duty under 38 U.S.C. §§ 5108, 7104 to address the question of whether new and material evidence has been received to reopen a previously denied claim for service connection. That matter goes to the Board’s jurisdiction to reach the underlying claim and adjudicate the claim on a de novo basis. See Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). Request to Reopen At the time of the prior denials and currently, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also 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). Historically, the Veteran’s claim for service connection for hepatitis was previously considered and denied in an August 1978 rating decision and again in January 1989. The evidence of record at the time of the most recent, January 1989 denial included service treatment records and a VA examination report. The Veteran was notified of the denial in January 1989, but did not initiate an appeal with respect to the claim. See 38 C.F.R. §§ 20.200, 20.201. Moreover, no new and material evidence was received within the one-year appeal period from the date of the notice of the denial of the claim, and no additional service records (warranting reconsideration of the claim) have been received at any time. See 38 C.F.R. § 3.156(b), (c). Therefore, the January 1989 denial of the claim is final as to the respective evidence then of record and are not subject to revision on the same factual basis. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 19.52, 20.1103. However, under pertinent legal authority, VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of the claimant. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). In July 2009, the Veteran filed an application to reopen his claim for service connection for hepatitis. For petitions to reopen filed on and after August 29, 2001, and before February 19, 2019, 38 C.F.R. § 3.156(a) defines “new” evidence as evidence not previously submitted to agency decision makers and “material” evidence as evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a); see also Shade v. Shinseki, 24 Vet. App. 110 (2010) (evidence is new if it has not been previously submitted to agency decision makers and is material if, when considered with the evidence of record, it would at least trigger VA’s duty to assist by providing a medical opinion, which might raise a reasonable possibility of substantiating the claim). In determining whether new and material evidence has been received, VA must initially decide whether evidence received since the prior final denial is, in fact, new. This analysis is undertaken by comparing the newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The provisions of 38 U.S.C. § 5108 require a review of all evidence submitted by or on behalf of a veteran since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-83 (1996). Furthermore, for purposes of the “new and material” analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-13 (1992). Pertinent new evidence received since the January 1989 rating decision includes 2009 VA treatment records which indicates the Veteran’s hepatitis B core antibody and hepatitis A antibody were positive. A November 2015 VA treatment record also notes a positive hepatitis B core antibody and that the Veteran is likely immune due to previous infection. There was mild elevated AST. Also of record is an April 2017 VA examination report indicating there is no current diagnosis of active or chronic hepatitis identified based on objective lab tests/serologies documented. The examiner explained that mildly elevated liver test is not due to prior hepatitis in 1971 and is not indicative of active or chronic hepatitis. The cause of this lab finding is not exactly known; however, this does not indicate hepatitis given serologies documented above. The examiner further explained there is no documentation of active hepatitis infection in review of records since the last examination in 2009 and review of lab results supports prior hepatitis A infection (indicated by Hep A IGG +) and prior hepatitis B infection (indicated by Hep B core antibody +). The examiner concluded that there is no evidence of ongoing hepatitis A infection, and the negative Hep A IGM indicates no acute/active infection - generally, this is an acute, self-limited condition and is not a chronic condition. The examiner explained the lab results support that the Veteran had a prior hepatitis B infection and has immunity to hep B (with hep B core antibody +), and the Veteran does not have current active Hep B disease, as the January 2016 hep B PCR is not detected, and Hep B surface antigen was negative. The new medical evidence, however, does not abrogate the deficiency noted in the prior January 1989 decision, namely, that there was no evidence that the Veteran had a current diagnosis of hepatitis or associated residuals. As such, the additional medical evidence is not “material,” as it does not pertain to an unestablished fact or provide a reasonable possibility of granting the claim for service connection. The Board also finds that the Veteran’s own assertions (to include those advanced by his representative on his behalf), provide no basis to reopen the claim. To the extent that the Veteran asserts that suffers from hepatitis that is related to the treatment for hepatitis in service, the Board finds that these statements do not provide any new information because they simply reiterate assertions previously of record. In this regard, the Board notes that that statements simply reemphasizing the position previously considered in the prior final decision are not new or sufficient to reopen the claim. See Reid v. Derwinski, 2 Vet. App. 312 (1992). The Board further notes that while the Veteran and his representative are each competent to assert matters within his own personal knowledge (to include matters experienced or observed), and may be competent to comment on some limited medical issues (to particularly include with respect to conditions capable of lay observation), neither is shown to have the medical training and expertise to comment on more complex medical matters, such as the questions of diagnosis and medical etiology at issue in this appeal. Such matters involve internal processes which are beyond the competence of a lay person. See 38 C.F.R. § 3.159(a); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, where resolution of the appeal turns upon a medical matter that cannot be established by lay evidence, unsupported lay assertions of medical diagnosis and/or nexus, alone, even if new, cannot serve as a predicate to reopen a previously disallowed claim. See Hickson v. West, 11 Vet. App. 374 (1998); Moray v. Brown, 5 Vet. App. 211, 214 (1993). Under these circumstances, the Board concludes that the criteria for reopening the service connection claim for hepatitis are not met. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156. As the Veteran has not fulfilled his threshold burden of submitting new and material evidence to reopen this finally disallowed claim, the benefit-of-the-doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). Service Connection In addition to the basic legal authority cited above, generally, to establish service connection, there must be competent evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). See also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The determination as to whether each element of a claim is are met is based on an analysis of all the evidence of record, and evaluation of its competency, credibility, and probative value. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Baldwin v. West, 13 Vet. App. 1, 8 (1999). Certain chronic diseases, such as arthritis and psychoses, shall be presumed to have been incurred in service if manifested to a compensable degree within a prescribed period post-service (10 percent and one year for arthritis and psychoses), even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. With chronic disease shown as such in service (or within the presumptive period under 38 C.F.R. § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributed to incurrent causes. Continuity of symptomatology is required only where the condition noted during service (or in the presumption period) is questioned. When the fact of chronicity is service is not adequately supported, then the showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The United States Court of Appeals for the Federal Circuit has clarified that the provisions of 38 C.F.R. § 3.303 (b) pertaining to the award of service connection of the basis of continuity of symptomatology (in lieu of a medical nexus opinion) apply to chronic diseases as defined in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). As noted, arthritis is among the diseases listed in § 3.309(a). In adjudicating a claim for VA benefits, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Back and left knee disabilities The Veteran contends continuity of back and left knee symptoms since his reported fall in which he was carrying a 165lbs. pump on his shoulder when he fell five to six feet and injured his back and left knee during service. He reported that he self-treated his symptoms. A May 1970 service treatment record (STR) notes that the Veteran reported right knee complaints and physical examination revealed no swelling or any inflammation. The treating clinician noted “no history of injury.” On evaluation four days later, it was noted notes there was “no ligamentous or meniscal damage” and that the complaints are indicative of chondromalacia patella and he was treated with a cylinder cast. The STRs did not reflect any complaints related to the back. A May 1971 diving examination and September 1971 separation examination revealed no abnormalities as to the back or left knee. Post service, a September 2009 VA treatment record references degenerative changes in the lumbar spine noted on x-ray. The x-ray showed facet hypertrophy and mild disc space narrowing. Radiology stated the sacro-iliac joints were normal. The clinician noted that mechanical back pain was probably exacerbated by his weight, and by history, osteoarthritis of the left knee, although not discernible on the examination today with the limited examination due to his pain behavior regarding his knees. A September 2009 VA treatment record notes that an x-ray revealed moderate bilateral medial joint space narrowing, spiking of intercondylar notches, consistent with moderate osteoarthritis; advanced osteoarthritis of the left patellofemoral joint, possible calcifications medial meniscus bilateral. A subsequent September 2009 VA treatment record noted modest osteoarthritis in the knees. A July 2012 radiologist reports reflects that an x-ray of his left knee revealed some arthritis which was not present on last x-ray in 2009. The June 2013 examiner provided a diagnosis of complex medial meniscus degenerative tear based on the November 2012 MRI. The examiner provided a negative opinion and explained the Veteran’s current knee condition is not the same condition he was treated for in service, as the STRs state right knee injury, no effusion, no fracture, and probable chondromalacia patella and the Veteran did not seek treatment for his knee until 2009. The report of a June 2017 VA examination reflects the Veteran had thoracolumbar spine degenerative changes. The examiner opined that the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness. The examiner stated that the STRs do not note any back-injury complaints or treatment and the November 1971 separation examination did not note any back complaints. The examiner further indicated the Veteran had been a laborer all his life with degenerative changes throughout the thoracolumbar spine, which was confirmed on x-ray. The Veteran also had psoriasis and a BMI of 41.38, both of which also can lead to thoracolumbar degenerative changes. He explained he was unable to link the current back complaints to the Veteran’s military service as there is no evidence of an injury, chronicity of condition, or nexus. Regarding the left knee disability, the Veteran underwent an additional VA examination in April 2017. The examiner explained the STRs note right knee complaints in May 1970 and that it was conceded that it could very well be his left knee. In either case, the examiner noted that physical examination of the knee in 1970 revealed no swelling or any inflammation and that it noted clearly there is “no history of injury.” The examiner also pointed out that on evaluation four days later, the treating clinician noted that there is “no ligamentous or meniscal damage” and that it further noted that the complaints are indicative of chondromalacia patella and he was treated with a cylinder cast. The examiner noted the VA treatment records reflect history by the Veteran that he had fractured his knee during military service. The examiner indicated, however, there was no evidence of that in the STRs and the fact that the Veteran was treated with a cylinder cast may be cause for the Veteran to believe that he had a fracture. The examiner noted the Veteran was noted to have knee pain in August 2009 when he was a new patient at the VA and an x-ray revealed no significant arthritis changes. The examiner also noted that a November 2012 MRI revealed extensive complex medial meniscal tear involving the posterior horn, posterior and mid body with associated para meniscal cysts, small horizontal tear involving the junction of the posterior horn and posterior body of the lateral meniscus, tricompartmental moderate cartilage disease, small joint effusion, and proximal patellar tendinopathy. The examiner concluded had the Veteran had a chronic meniscal tear over a 40-year period, there would have been many instances during active service as well as post-active service with mechanical symptoms and effusion. Additionally, the examiner explained that one would expect to see early degenerative changes on x-ray which was not found in 2009, nearly 40 years post-date of injury. Also, the examiner noted the MRI does not note degenerative meniscal tear but notes a complex medial meniscus tear involving the posterior horn, which is also not consistent with a chronic injury. The examiner opined that the medical history and objective findings do not support the claim of a chronic left knee injury associated with military service. A February 2018 addendum opinion regarding his back disability was obtained. The examiner indicated he reviewed all medical evidence and documentation, including the Veteran’s statements and recollection of injuries, treatments self-directed or otherwise, symptoms and continuity of symptomatology. The examiner explained that even though the Veteran’s contentions were not specifically addressed in the previous opinion, they were properly considered and given proper weight and consideration in the rendering of the opinion. With regard to the Veteran’s statement of a fall of 5-6 feet with 165lbs. pump on his shoulder around 1970, the examiner explained that there is no evidence of such event in the medical records and that the Report of Medical Examination for Diving Duty dated 5/13/1971 does not note any back complaints and within one month after this examination the Veteran contracted a hepatitis infection for which he was admitted to the hospital in Japan on 6/13/1971. The examiner noted that there was not one entry during his hospital stay in Japan or at St. Albans Naval Hospital between 6/13/1971 and 9/9/1971 that notes any back complaints and rounding progress notes were consistent for; the patient was doing well, sleeping all night, in good spirits, has no complaints, occupied with painting and drawing, and returning from liberty with no complaints. He further explained that at no time during the three months was the Veteran hospitalized for his hepatitis infection and the Veteran did not complain or bring up his back injury. The examiner opined that the Veteran would have had significant symptoms of pain and functional limitations given the axial loading along with any rotational forces that may or may not have occurred with a fall from a 5-6 foot level with the additional weight of a 165lbs. and that such a mechanism of injury would have caused a disc herniation, vertebral body compression fracture, a transverse process fracture and/or lower extremity radiculopathy that are more severe than what someone would be able to self-treat. The examiner further explained that if the injury occurred, then there is no medical evidence to support that the injury was significant enough to rise to the level of at least as likely as not that it was the cause of the current back condition and complaints and that the medical evidence is not consistent with such a claim nor does it support such a claim. A February 2018 addendum opinion regarding the left knee was obtained, and the examiner indicated he reviewed all medical evidence and documentation, including the Veteran’s statements and recollection of injuries, treatments self-directed or otherwise, and symptoms and continuity of symptomatology. The examiner stated that although the Veteran’s contentions were not specifically addressed in the previous opinion, they were properly considered and given proper weight and consideration in the rendering of the opinion. Regarding the Veteran’s statement of a fall of 5-6 feet with a 165lbs. pump on his shoulder around 1970, the examiner explained that there is no evidence of the injury in the medical records. He noted that the Report of Medical Examination for Diving Duty dated 5/13/1971 does not note any knee complaints. He also noted that within one month after this examination, the Veteran contracted a hepatitis infection for which he was admitted to the hospital in Japan on 6/13/1971. He was then transferred to St. Albans Naval Hospital on 7/21/1971. The examiner noted daily rounding notes are reviewed with no one entry during his hospital stay in Japan or at St. Albans Naval Hospital between 6/13/1971 and 9/9/1971 that notes any knee complaints or functional limitations with ambulation. He noted rounding progress notes were consistent for; the patient was doing well, sleeping all night, in good spirits, has no complaints, occupied with painting and drawing, and returning from liberty with no complaints. The examiner noted that at no point and time during the three months that the Veteran was hospitalized for his hepatitis infection did he complain or bring up a knee injury. The examiner opined that the Veteran would have had significant symptoms of pain and functional limitations given the axial loading along with any rotational forces that may or may not have occurred with a fall from a 5-6 foot level with the additional weight of a 165lbs and that such a mechanism of injury would have caused ligamentous, chondral bone, and/or meniscal injuries that are more severe than what someone would be able to self-treat. The examiner stated on the other hand, if the incident did truly happen then there is no medical evidence to support that a knee injury was significant enough to rise to the level of at least as likely as not that this was the cause of this Veteran’s current knee condition and complaints and that the medical evidence is not consistent with such a claim nor does it support such a claim. In a September 2019 VA addendum opinion, the examiner reiterated his June 2017 and February 2018 opinions that it is less likely as not that the Veteran’s thoracolumbar spine degenerative changes are due to his fall approximately 6 feet while carrying 165-pound pump on his shoulder. He explained that even though the Veteran was seen by chiropractic medicine dating back to 2001, there is no sound medical evidence to support such a claim. He explained the Veteran was a laborer all his life with a BMI of 41.38 and factors contributing to degenerative changes are age, type of employment and physical demands, obesity and traumatic events. The examiner explained that the Veteran’s claimed traumatic event is not in question, however, his degenerative changes are not traumatic in nature and are consistent with three of the factors noted above; age, type of employment and body habitus. The examiner explained there is also no evidence to support the claim that the thoracolumbar spine degenerative changes were manifested to a compensable degree within the first post service year and that a diagnosis of degenerative changes is based on radiographic findings not based on a clinical diagnosis. He noted the earliest documented degenerative changes noted on x-rays per review of records are in 2009 and although there potentially could be other evidence indicating degenerative changes earlier than 2009, there is no documentation of thoracolumbar spine degenerative changes being manifested within the first year post active service. Regarding the Veteran’s left knee disability, a September 2019 VA addendum opinion was obtained. The examiner reiterated his April 2017 and February 2018 opinions and further opined that is less likely than not that this Veteran’s left knee condition had onset during service to include the Veteran’s report of an in-service fall in which he was carrying 165 pound pump on his shoulder when he fell 5-6 feet and injured his left knee; or was manifested to a compensable degree within the first post service year based on the absence of sound medical evidence to support such a claim. The examiner indicated that he does not doubt the Veteran’s statement as to a traumatic event, however, his current left knee condition is not traumatic in nature. He explained that in 2012, the Veteran complained of multiyear history of left knee pain worse with cold weather which the Veteran attributed to time in active service, however, he had new onset of left knee pain for one month when he was seen in the emergency department on 3/6/2012 and orthopedics with a MRI reflected he had a meniscus tear and x-rays in July 2012 showed medial joint line narrowing with degenerative changes. The examiner explained that this is unrelated to an injury during active service, as thoroughly explained in the previous VA opinions. Regarding the September 2009 VA treatment record that noted moderate osteoarthritis of the left knee, the examiner explained it was a rheumatology consult and that the earliest evidence of degenerative changes of the left knee is documented in July 2012, which is confirmed by radiology reports. He explained that he did not doubt the Veteran’s assertions of left knee pain during active service and that he did not discount his belief that his current symptoms are due to his left knee pain during active service, however, the medical evidence does not support these assertions and therefore, it is less likely as not that the Veteran’s current left knee complaints were caused by or had its onset during service to include the Veteran’s report of an in-service fall in which he was carrying 165 pound pump on his shoulder with a fall of about 6 feet injuring his left knee. The examiner also opined there is no evidence that the current left knee was manifested to a compensable degree within the first post service year. Considering the pertinent evidence in light of the governing legal authority, the Board finds that service connection for back and left knee disabilities is not warranted. While the Veteran has current arthritis of the left knee and degenerative changes of the thoracolumbar spine, and there is documented evidence that he reported right knee pain (conceded as left knee pain) during service, the evidence of record does not support a finding that his current back and left knee disabilities began in, or is otherwise medically related to, the Veteran’s active service, to include any injury and/or symptoms therein. As indicated above, the Veteran did not complain of back symptoms during service and no chronic left knee disability, specifically arthritis, was shown in service, as his in-service medical records, to include the separation examination report, are otherwise unremarkable as to any complaint, finding or diagnosis pertaining to the left knee or the back. With regard to the left knee disability, as indicated above, the examiner conceded that the Veteran’s in-service complaint of a right knee pain could have been his left knee, however, no chronic left knee or back disability was shown in service, as his in-service medical records, to include the separation examination report, are otherwise unremarkable as to any chronic knee or back disability, finding or diagnosis pertaining to the left knee or back. Here, the first report of knee or back pain and diagnosis of a disability was in 2009. The Board also points out that the passage of years between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v. Principi, 3 Vet. App. 365 (1992). Furthermore, the only competent, probative opinions to address the medical relationship, if any, between left knee disability and back disability diagnosed many years post-service and the Veteran’s active service weighs against the claim. The examiner explicitly rendered conclusions that weighs against a finding of service connection for current left knee and back disabilities. The opinion was clearly based on the results of examination of the Veteran, and full consideration of the Veteran’s documented medical history and assertions and supported by clearly stated rationale. As such, the Board accepts these opinions as probative of the medical nexus question. See, e.g., Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Significantly, there is no contrary medical evidence or opinion of record, i.e., one that establishes a medical nexus between current left knee disability or back disability and service, and neither the Veteran nor his representative has presented or identified any such existing evidence or opinion. In fact, the only evidence that tends to support the claim consists of the Veteran’s own assertions. During his Board hearing, the Veteran asserted that he injured his back and left knee due to in-service fall in which he was carrying a 165lbs. pump on his shoulder when he fell five to six feet and his report that he self-treated his symptoms. As a lay person, the Veteran is certainly competent to report matters his own personal knowledge, such as the occurrence of an injury, and symptoms experienced. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). As noted above, however, the examiner explained that the Veteran would have had significant symptoms of pain and functional limitations given the axial loading along with any rotational forces that may or may not have occurred with a from 5-6 foot level with the additional weight of a 165lbs that would have resulted in a disc herniation, vertebral body compression fracture, a transverse process fracture and/or lower extremity radiculopathy that are more severe than what someone would be able to self-treat. Regarding the left knee disability, the examiner also explained that such an injury would have resulted in ligamentous, chondral bone, and/or meniscal injuries that are more severe than what someone would be able to self-treat. Thus, the examiner opined that the Veteran’s reported injury is inconsistent with the medical evidence. Given these inconsistencies, coupled with the documented medical findings and stark absence of any documented complaints referable to the left knee and back disabilities for many years post-service, the Board finds that any current assertions to the Veteran experiencing continuous left knee and back problems in and after active service, are not credible. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (a pecuniary interest may affect the credibility of a claimant’s testimony). See also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) (VA adjudicators may properly consider internal inconsistency, facial plausibility and consistency with other evidence submitted on behalf of the Veteran in weighing evidence). The Board also finds it noteworthy that the VA examiner considered the Veteran’s assertions, in light of the other evidence of record, and still rendered a negative etiology opinion. Moreover, as for any direct assertions by the Veteran that there exists a medical relationship between the current left knee and back disability and active service, the Board finds that such assertions do not provide persuasive evidence in support of the claim. The matter of the medical etiology of the disabilities here at issue is one within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Although lay persons are competent to provide opinions on some limited medical issues (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), here the etiology of the back and left knee disability at issue is a complex medical matter that falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377, n.4 (providing that lay persons are not competent to diagnose cancer). As the Veteran is not shown to be other than a layperson without appropriate training and expertise, he is not competent to render a probative (i.e., persuasive) opinion on the complex medical matter upon which these claims turns. Id. As, in connection with these claims, lay assertions as to the etiology of the disability for which service connection is sought have no probative value, the Board points out that the Veteran cannot counter the competent, probative medical etiology opinion of record on the basis of his lay assertions, alone. For all the foregoing reasons, the Board finds that the claim for service connection for back and left knee disability must be denied. In reaching the conclusion to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. Acquired Psychiatric Disability In addition to the basic legal authority governing service connection claims, it is also noted that service connection for PTSD requires medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125 (a); credible supporting evidence that the claimed in-service stressor occurred; and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. See 38 C.F.R. §§ 3.304 (f), 4.125. Diagnoses of PTSD must be made in accordance with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). 38 C.F.R. § 4.125. The Board notes that the Fifth Edition of the DSM (DSM-5) recently replaced the Fourth Edition (DSM-IV). Effective August 4, 2014, VA issued an interim rule amending the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations to refer to certain mental disorders in accordance with the DSM-5. The provisions of the interim final rule only apply, however, to all applications for benefits that are received by VA or that are pending before the AOJ on or after August 4, 2014. Since the Veteran’s claim was not certified to the Board until January 2019, the DSM-5 is applicable. The evidence needed to establish the occurrence of a claimed in-service stressor is typically dependent upon whether the Veteran engaged in combat with the enemy, as well as whether the claimed in-service stressor is related to such combat; or, if not, whether there is objective evidence to verify the occurrence of the claimed stressor. See Cohen v. Brown, 10 Vet. App. 128, 147 (1997); Moreau v. Brown, 9 Vet. App. 389, 395 (1996); 38 C.F.R. § 3.304 (f); see also 38 U.S.C. § 1154 (b). On July 13, 2010, VA published a final rule that amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the occurrence of in-service stressors involving “fear of hostile military or terrorist activity.” See 75 Fed. Reg. 39843 (July 13, 2010), and 75 Fed. Reg. 41092 (July 15, 2010) (correcting the effective and applicability dates from July 12, 2010, to July 13, 2010). If a stressor claimed by a Veteran is related to the Veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304 (f)(3). “Fear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304 (f)(3). The Veteran contends that he suffers from PTSD due to a traumatic incident that occurred in service, including that during a plane transport, he was with approximately 21 other soldiers -most of whom were missing body parts. As this was the only stressor with sufficient information to verify, the AOJ attempted to corroborate this stressor. The report of a November 1986 psychiatric examination conducted in connection with a child custody matter reflects the Veteran was diagnosed with mild dysthymic disorder. The clinician noted his drug-use history and that, therefore, an inquiry into whether he was still using drugs should be made. The clinician noted that the Veteran cried about his service in Vietnam and his marital status, as well as the custody issue regarding his children. The clinician noted the Veteran had great difficulty in dealing with changes and when he perceives a loss. He was also under extreme pressure working as a foreman at a construction site. The clinician provided a diagnosis of dysthymic disorder, as well as marital problem and parent-child problem. 2009 VA treatment records provide a provisional diagnosis of PTSD and note PTSD by way of history. A private mental health assessment received in October 2010 reflects a iagnosis of PTSD. The Veteran reported several traumatic incidents including an incident involving a drill instructor hitting him with a rifle in the right elbow while at Great Lakes, Illinois in January 1970. He reported he was refused entry to sick bay by the drill instructor. He also reported that in March 1971, he witnessed a woman get shot, an officer pointed a rifle in his face, and he shared a hospital room with a Marine whom was injured in the Vietnam War. The Veteran recalled how this Marine spoke to him of killing “gooks” and described how they desecrated enemy bodies by removing the ears of enemy soldiers whom were killed. He reported the Marine had his duffel bag with him and showed client a plastic bag which contained several human ears that were removed from enemy soldiers killed in action. The Veteran reported that he shared a hospital room with a Marine who died. He claims they were transferring nuclear war heads when one came out of its cradle cart and fell approximately four feet and rolled across the floor toward him, and finally, he reported he had hepatitis during service. The examiner concluded that his reported traumatic incidents included witnessing and being involved in actual death, threatened death, and serious injury, and he met the criteria for PTSD. A February 2010 VA treatment record provides a diagnosis of PTSD based on the Veteran’s report that he witnessed a policeman shoot a woman in the bar. In an October 2019 VA examination report, the examiner noted the Veteran’s enlistment exam is silent for mental health issues. His separation exam noted depression or excessive worry by self-report. The Veteran had no mental health treatment prior to or during military service but did receive a psychiatric evaluation which indicated he had an emotionally unstable personality which existed prior to service. He was deemed unsuitable for service duty and not a candidate for rehabilitation. The examiner noted that personnel records indicated he was discharged for addiction or unauthorized use or possession of habit-forming drugs or marijuana and noted that the Veteran told a licensed professional counselor in October 2012 that he lied about drug use in the military to get discharged because of traumatic stress. The examiner indicated that he did not believe the Veteran as he told one demonstrable, blatant lie to this counselor and told her his service records were maliciously destroyed by commander and included information that he had Navy Seal training, but personnel records indicate he had no such training. The examiner asked the Veteran if he had any advance training beyond his duties as a fireman/damage control specialist, and the Veteran responded no. The examiner noted he clearly lied and thought that the lie could not be discovered because he mistakenly believed his military records had been destroyed. The examiner also noted the Veteran also told another lie to another healthcare professional about his military experiences in September 1988 about his experiences in Vietnam. The examiner noted personnel records and his DD-214 do not reflect Vietnam service and the Veteran reported he never served in Vietnam but served off the waters of Vietnam. The examiner explained the instances of deception undermined his assertions that he had traumatic experiences in the military and that the stressors he reported are unconfirmed despite review of VA records by JSRRC, the Naval History and Her at age Command, VBA, and the examiner. The examiner explained that the Veteran’s previous tearful presentation of problems associated with the Vietnam service undermine other tearful presentations about stressors. The examiner noted the Veteran was treated for PTSD at Portland VA in 2010 and underwent a course of outpatient, individual therapy using cognitive processing therapy and he saw a psychiatric nurse practitioner at the same time who also diagnosed him with PTSD. The examiner noted the counselor diagnosed him with PTSD and traits of borderline personality disorder and the Veteran has not had any mental health treatment since 2010 and does not take mental health medication. The examiner noted none of the reported stressors have been confirmed, and, therefore, cannot be used as evidence for PTSD. For reasons noted above, the examiner indicated he had serious doubts that the stressors occurred based upon the Veteran’s previous difficulties with the truth. When the examiner inquired about PTSD symptoms, the examiner noted the Veteran said the traumatic events have caused him to have little sympathy for people’s complaints now compared to what he saw the military and he avoids thinking about those stressful events in the military. During the examination, the Veteran’s only real mental health issues have to do with some regret, apprehension, and sadness associated with the separation from his wife and, especially, the separation from their 2 children. The Veteran stated that he lived alone in an apartment while his wife and children live in a nice house, he and his wife purchased together, which “eats” at him. The Veteran stated he is not sure if he had a traumatic brain injury and that he hit his head against a metal bulwark while on board ship in the Navy. He has never been diagnosed with TBI. The examiner opined it is less likely than not (less than 50% probability) the Veteran’s adjustment disorder with depression is related to any established in-service events. He explained the in-service events have not been confirmed and his adjustment disorder relates to the current marital separation and other familial stressors. The examiner stated the Veteran did not know his sixth wife when he was in the military, and the children were not yet born. The examiner also stated that the Veteran did not come close to meeting DSM-5 diagnostic criteria for PTSD. In this regard, the examiner indicated that the Veteran did not meet criterion B, presence of (one or more) intrusion symptoms, criterion D, negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, and there was no corroborated stressors. Considering the above-cited evidence in light of the applicable legal authority, the Board finds that service connection PTSD is not warranted. As noted, fundamentally, an award of service connection requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). The requirement of the existence of a current disability is satisfied when a veteran has a disability shortly prior to or at the time he files his claim for service connection, or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. See Romanowsky v. Shinseki, 26 Vet. App. 289 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board finds the expert medical opinion provided by the 2019 VA examiner to be of great probative value. Indeed, the examiner considered the Veteran’s contentions, conducted extensive review of the electronic claims file, and provided detailed outline of pertinent clinical medical evidence before providing negative etiological opinions. To this point, the examiner did not diagnose PTSD and indicated that the Veteran did not come near meeting the criteria for PTSD under DSM V; opined that it was less likely than not that the Veteran has any currently diagnosed psychiatric disorder that was first manifested in service and/or was causally related to event(s) in service, as the Veteran was not credible with his history of deception and the stressors were not confirmed. The examiner’s negative opinions were supported by a medical rationale and were consistent with the verifiable facts regarding the Veteran’s contentions. By contrast, the 2010 VA opinion that the Veteran met the criteria for a PTSD was based on the Veteran’s report of an uncorroborated stressor. Notably, evidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by that examiner, does not constitute “competent medical evidence” and a bare transcription of a lay history is not transformed into “competent medical evidence” merely because the transcriber happens to be a medical professional). See LeShore v. Brown, 8 Vet. App. 406, 409 (1995). The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1110. Thus, where, as here, competent, probative evidence establishes that, fundamentally, the Veteran not have the disability for which service connection is sought, there can be no valid claim for service connection. See Brammer, supra. See also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). Notably, even if there was a current, valid diagnosis of PTSD, service connection for PTSD could still not be established because another essential criterion for establishing service connection for PTSD—credible evidence that a claimed in-service stressor occurred—has not been met. Of the Veteran’s alleged stressors, he only provided sufficient information to send to the Department of the Army U.S. Army and Joint Services Records Research Center (JSRRC) for the stressor concerning being transported with approximately 21 other soldiers (-most of whom were missing body parts), and that stressor has not been verified. The JSRRC reviewed official personnel records and found no evidence of the alleged incident and specifically indicated that transport of injured of deceased soldiers did not occur on USS Dixie or by plane, as the history and the deck logs do not indicate that the USS Dixie put Sailors on planes carrying injured and dead soldiers, as indicated in the September 2016 Memorandum. Hence, the occurrence of the claimed stressor cannot be verified, and the stressor is not one which, under these circumstances, can be attributed to fear associated with hostile military or terrorist activity. See 38 C.F.R. § 3.304(f)(3); see also Hall v. Shinseki, 717 F.3d 1369, 1372 (Fed. Cir. 2013). As there is no credible supporting evidence that a claimed in-service stressor occurred—and no further basis to develop the claim in this regard—an essential criterion for establishing service connection for PTSD, the Veteran cannot meet the requirements of 38 C.F.R. § 3.304(f). As for other psychiatric diagnoses of record, as noted above, pertinent to this claim, the Veteran had diagnosed with adjustment disorder with depression. However, the Board also finds no basis to award service connection for this diagnosis, as there is no competent medical evidence linking this psychiatric disorder to service. In fact, the October 2019 VA examiner specifically found no nexus between the psychiatric disorders and the Veteran’s service, instead, relating the Veteran psychiatric problems to post-service stressors including marital and financial problems, which also appears consistent with the September 1988 private psychiatric evaluation that the Veteran’s concerns and symptoms were related to marital and custody issues pending his divorce and wanting his children to grow up in the Mormon faith. The clinician appears to have endorsed the examiner’s conclusion by indicating the Veteran has difficulty adjusting to change and dealing with perceived loss. As these opinions were based on examination of the Veteran and consideration of his history, and is consistent with other evidence of record, the Board accepts them as opinion as probative of the medical nexus with respect to these diagnosed disabilities. See Nieves, supra. Significantly, there is no contrary medical evidence that, in fact, establishes a nexus between any of these diagnosed disorders and service, and neither the Veteran nor his representative has presented or identified any such evidence or opinion. Furthermore, the Veteran has not been diagnosed with any other psychiatric disorder that is subject to service connection. The Board notes that the personality disorder (concluded as pre-existing service) is not considered a disability for compensation purposes. See 38 C.F.R. §§ 3.303 (c), 4.9; see generally, Winn v. Brown, 8 Vet. App. 510 (1996) (upholding Secretary’s authority to exclude certain conditions from consideration as disabilities under 38 C.F.R. § 4.9). In connection, the Board notes a personality disorder would by its very nature pre-exist active service and, so, the presumptions of soundness and aggravation are not applicable to personality disorders. See Quirin v. Shinseki, 22 38 C.F.R. § [390, 394 (2009). Nevertheless, personality disorders are manifested by psychiatric symptoms and, so, the actual presence of psychiatric symptoms either prior to or during service would not be inconsistent with the Veteran’s having personality disorder, which by its very nature pre-existed and co-existed with military service. Finally, as for the Veteran’s own attempts to diagnosis or link any current psychiatric disorder to service, the Board emphasizes that, the matters diagnosis and etiology upon which this claim turns are complex medical matters that fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007) (providing that lay persons are not competent to diagnose cancer). 38 C.F.R. § 3.159. As explained above, the most persuasive evidence on these points weighs against the claim. For all the foregoing reasons, the claim for service connection for an acquired psychiatric disability, to include PTSD and adjustment disorder with depression, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine but finds that there is no doubt to be resolved in the Veteran’s favor on any point material to this determination. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. JACQUELINE E. MONROE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sarah Campbell, Counsel 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.