Citation Nr: 21001217 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 15-20 229 DATE: January 7, 2021 ORDER Entitlement to a compensable disability evaluation for bilateral hearing loss is denied. Entitlement to service connection for an acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), is denied. FINDINGS OF FACT 1. At worst, the Veteran manifested Level III hearing loss in his right ear and Level II hearing loss in his left ear during the period on appeal. 2. An acquired psychiatric condition, to include PTSD, has not been diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased disability rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.85, Diagnostic Code 6100. 2. The criteria for entitlement to service connection for an acquired psychiatric disability, to include PTSD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.326. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1951 to February 1954. He was awarded the Purple Heart Medal and the Combat Infantryman Badge. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. These claims have been before the Board twice previously. First, the Board remanded these claims for additional development in June 2017. In that decision, the Board instructed the RO to (1) obtain a VA examination in connection with the nature and etiology of his claimed acquired psychiatric disorder, (2) obtain a contemporaneous VA examination to evaluate the severity of his service-connected bilateral hearing loss, and (3) obtain and associate with the claims file outstanding disability benefit questionnaires (DBQs) in connection with his claims, including a June 7, 2013, DBQ on hearing loss. Thereafter, the RO issued a supplemental statement of the case in November 2017 but failed to obtain the outstanding DBQs or schedule a new VA examination for hearing loss. In November 2018, the Board remanded the matters once again so that this development could be completed, as well as for a new VA mental disorders examination to be obtained. A careful review of the claims file reflects that in February 2020 the RO obtained and associated with the claims file the outstanding June 2013 DBQs. The record also contains various DBQs from other years, including DBQs from 2012 and 2014. Additionally, in March 2020 the Veteran was afforded a new VA examination for hearing loss. Last, the Veteran was afforded a new VA examination with respect to his claimed acquired psychiatric disorder. As such, there has been substantial compliance with the Board’s remand directives, and additional remand is not warranted. See D’Aries v. Peake, 22 Vet. App. 97 (2008). The Board also notes that VA’s duty to assist has been satisfied with respect to its efforts to identify and obtain other relevant treatment records in support of his claims. For instance, VA sent the Veteran numerous notification letters requesting copies of treatment records related to his claimed conditions. The notification letters also included copies of VA Form 21-4142, Authorization and Consent to Release Information, which VA said it would use to obtain records of treatment related to his claimed disabilities if he wished for VA to obtain them on his behalf. See, e.g., October 2014 Notification Letter; June 2014 Notification Letter; January 2014 Notification Letter; June 2013 Notification Letter; May 2013 Notification Letter. However, the Veteran never executed and returned any of these forms. The duty to assist is not a one-way street, and the claimant has a responsibility to provide information that is essential to his claim. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (if a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence). As such, the Board will proceed to evaluate the merits of his claims. This matter has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.800(c). Increased Rating Throughout the period on appeal, the Veteran has asserted that he is entitled to a compensable disability rating for his service-connected bilateral hearing loss. Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. All reasonable doubt regarding a degree of disability will be resolved in favor of the appellant. 38 C.F.R. § 4.3. Where entitlement to compensation already has been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Therefore, although the Board has thoroughly reviewed all the evidence of record, the more critical evidence consists of the evidence generated during the appeal period. The Veteran’s service-connected bilateral hearing loss is currently rated at 0 percent disabling under 38 C.F.R. § 4.85, Diagnostic Code 6100. The ratings for disability compensation for hearing loss are determined by the mechanical, nondiscretionary application of the criteria in Table VI and Table VII. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Evaluations of defective hearing range from 0 to 100 percent. This is based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by pure tone audiometric tests at the frequencies of 1000, 2000, 3000, and 4000 Hertz. To evaluate the degree of disability from service-connected hearing loss, the rating schedule establishes 11 auditory acuity levels ranging from numeric I, for essentially normal acuity, through numeric XI, for profound deafness. See 38 C.F.R. § 4.85, Tables VI and VII, Diagnostic Code 6100. Table VI in 38 C.F.R. § 4.85 is used to determine the numeric designation of hearing impairment based on the pure tone threshold average from the speech audiometry test and the results of the speech discrimination test. The vertical line in Table VI represents nine categories of the percentage of discrimination based on the controlled speech discrimination test. The horizontal row in Table VI represent nine categories of decibel loss based on the pure tone audiometry test. See id. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by finding the intersection of the vertical line corresponding to the percentage of discrimination and the horizontal row corresponding to pure tone decibel loss. The percentage evaluation is then derived by using Table VII in 38 C.F.R. § 4.85 by intersecting the vertical line corresponding to the numeric designation for the ear having better hearing acuity (as determined using Table VI) and the horizontal row corresponding to the numeric designation level for the ear having the poorer hearing acuity (as determined using Table VI). For example, if the better ear has a numeric designation level of “V” and the poorer ear has a numeric designation level of “VII,” the percentage evaluation is 30 percent disabling. The Board has carefully considered the evidence from the appeal period, including audiology data from June 2013, December 2014, and March 2020 VA audiology DBQs. Based on this evidence, however, the Board finds that the preponderance of the evidence weighs against awarding a compensable disability rating during the period on appeal. After filing his claim, the Veteran was afforded a VA examination in June 2013. According to the DBQ submitted in connection with that examination, pure tone thresholds, in decibels, were as follows at these frequencies: Ear 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz Right 35 55 70 75 Left 20 40 55 50 The pure tone threshold average from the speech audiometry test is 59 in the right ear and 41 in the left ear. Speech audiometry revealed speech recognition ability of 96 percent in both ears. Utilizing 38 C.F.R. § 4.85, Table VI, this corresponds to a hearing level II in the right ear and level I in the left ear. A comparison between these levels and 38 C.F.R. § 4.85, Table VII, yields a 0 percent evaluation, consistent with the currently assigned rating. Afterwards, the Veteran was afforded another VA audiology examination in December 2014. In the DBQ accompanying that examination report, pure tone thresholds, in decibels, were as follows as these frequencies: Ear 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz Right 35 50 65 75 Left 20 35 45 45 The pure tone threshold average from the speech audiometry test is 56 in the right ear and 36 in the left ear. Speech audiometry revealed speech recognition ability of 88 percent and 96 percent in the right and left ears, respectively. The Board also notes that a separate December 2014 VA examination in connection with other ear conditions reflects identical pure tone thresholds and speech audiometry data. Once more, utilizing 38 C.F.R. § 4.85, Table VI, this corresponds to a hearing level II in the right ear and level I in the left ear. Comparing these levels using 38 C.F.R. § 4.85, Table VII, yields a 0 percent evaluation, consistent with the currently assigned rating. Finally, in March 2020 the Veteran underwent another VA examination in connection with his claim for a higher disability rating for his bilateral hearing loss. According to the DBQ completed during that examination, pure tone thresholds, in decibels, were as follows at these frequencies: Ear 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz Right 45 60 70 80 Left 30 45 55 60 The pure tone threshold average from the speech audiometry test is 64 in the right ear and 48 in the left ear. Speech audiometry revealed speech recognition ability of 88 percent in both ears. The results on the March 2020 reveal slight worsening of the Veteran’s hearing acuity. Nonetheless, using 38 C.F.R. § 4.85, Table VI, this corresponds to a hearing level III in the right ear and level II in the left ear. Comparing these levels using 38 C.F.R. § 4.85, Table VII, still yields a 0 percent evaluation, consistent with the currently assigned rating. In sum, although the Board acknowledges the Veteran’s contentions that he is entitled to a higher disability rating due to the severity of his hearing loss, there is no evidence during the relevant period on appeal that suggests a higher disability rating for hearing loss is warranted under the criteria in 38 C.F.R. § 4.85. In evaluating the Veteran’s claim for a higher disability rating, the Board has also considered whether he is entitled to a greater level of compensation on an extraschedular basis. Ordinarily, the VA Schedule will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). According to the regulation, an extraschedular disability rating is warranted based upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. See 38 C.F.R. § 3.321(b)(1). An exceptional case is said to include such factors as marked interference with employment or frequent periods of hospitalization as to render impracticable the application of the regular schedular standards. See Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet. App. 111 (2008), aff’d sub. nom. Thun v. Shinseki, 573 F.3d 1366 (Fed Cir. 2009), there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. First, the Board must first determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the claimant’s level of disability and symptomatology and is found inadequate, the Board must determine whether the claimant’s disability picture exhibits other related factors such as those provided by the regulation as “governing norms.” Third, if the rating schedule is inadequate to evaluate a veteran’s disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the veteran’s disability picture requires the assignment of an extraschedular rating. With respect to the first prong of Thun, the evidence in this case does not show such an exceptional disability picture that the available schedular evaluation for the service-connected disability is inadequate. Moreover, the rating criteria adequately addresses the Veteran’s symptoms of bilateral hearing loss. Even if the Board were to find that step one of Thun had been satisfied, however, extraschedular referral would still not be warranted because the Board also finds that Thun step two is not satisfied. See Johnson v. Shinseki, 26 Vet. App. 237, 247 (2013) (en banc) (error in Thun step one analysis is harmless where the Board makes an adequate finding that Thun step two is not satisfied). The Veteran’s hearing loss does not present an exceptional disability picture with related factors such as marked interference with employment or frequent hospitalization. 38 C.F.R. § 3.321(b)(1). Although the Veteran has indicated that his hearing loss impacts his ability to function under the ordinary conditions of daily life by making it difficult to hear and understand conversational speech when there is background noise, he has neither been hospitalized for this condition nor indicated that his hearing loss has impeded his employability. Thus, even if his disability picture was exceptional or unusual, referral would not be warranted. Further, 38 C.F.R. § 4.1 specifically sets out that “[g]enerally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability.” Factors such as requiring periodic medical attention are clearly contemplated in the Schedule and provided for in the evaluations assigned herein. What the evidence does not demonstrate in this case is that the manifestations of the Veteran’s service-connected disabilities have resulted in unusual disability or impairment that has rendered the criteria and/or degrees of disability contemplated in the Schedule impractical or inadequate. Accordingly, consideration of 38 C.F.R. § 3.321(b)(1) is not warranted in this case. Service Connection The Veteran also asserts that he is entitled to service connection for an acquired psychiatric disorder, claimed as PTSD, due to his combat service in the Korean War. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Proof of a current disability is a threshold to establishing service-connection for an acquired psychiatric disorder, to include PTSD. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). To be a present as a current disability, there must be evidence of the condition at some time during the appeals period. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). In general, establishing service connection for PTSD requires specific findings. These are: (1) a current medical diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and, (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. See 38 C.F.R. § 3.304(f). The Board notes that, effective March 19, 2015, VA amended the portion of the Rating Schedule dealing with mental disorders so as to replace outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), with references to the DSM-V. See 79 Fed. Reg. 149, 45,094 (Aug. 4, 2014). VA directed that the changes be applied only to applications for benefits received by VA or pending before the agency of original jurisdiction on or after August 4, 2014, but not to claims certified to, or pending before, the Board, the Court of Appeals for Veterans Claims, or the United States Court of Appeals for the Federal Circuit on or before August 4, 2014. As the Veteran’s original PTSD claim was made on March 7, 2013, but first certified to the Board after August 4, 2014, the DSM-V applies. As such, diagnoses must conform to the DSM-V. The first element of service connection for an acquired psychiatric disorder, including PTSD, is medical evidence establishing a diagnosis under 38 C.F.R. § 4.125(a). Diagnoses of PTSD and other psychiatric disorders by health care professionals are presumed to be in accordance with applicable governing medical criteria. See Cohen v. Brown, 10 Vet. App. 128, 139-40 (1997). Since the Veteran’s stressor pertains to fear of hostile military or terrorist activity, a VA psychiatrist or psychologist or one contracted with VA must furnish the PTSD diagnosis. 38 C.F.R. § 3.304(f)(3). Here, the Veteran has reported symptoms of flashbacks, nightmares, and memory loss, and says that he has been diagnosed with PTSD and major depression. See December 2015 VA 21-4138, Statement in Support of Claim. However, the preponderance of the evidence weighs against finding that the Veteran has a current diagnosis of PTSD or any other mental health disorder that conforms to DSM-V criteria. For instance, on VA examination in June 2013, the VA examiner found that the Veteran had no current diagnosis of PTSD that conformed with the DSM-IV criteria or any other mental health disorder. The Board notes that the VA examiner conducted the examination in accordance with the DSM-IV diagnostic criteria instead of the DSM-V diagnostic criteria, and, as such, the probative value of the June 2013 VA examination is limited. Nevertheless, the Board finds that the June 2013 VA examination is useful as it provides a description of his psychiatric symptomatology. To that end, the June 2013 VA examiner noted that the Veteran had a service-connected traumatic brain injury (TBI), and that residuals of that TBI included difficulty following conversations and finding words, as well as difficulty remembering names. Nonetheless, the Veteran had no symptoms associated with a mental health disorder, as opposed to a TBI. The VA examiner acknowledged the Veteran’s combat service, but ultimately opined that he did not have the requisite response to in-service stressors to warrant a diagnosis of PTSD or any other mental disorder. For instance, although the Veteran had experienced an event that involved actual or threatened death or serious injury, as well as recurrent and distressing recollections of the event, he did not persistently avoid stimuli associated with the trauma, and had no persistent symptoms of increased arousal. Moreover, the examiner stated that no other mental condition was found on examination. In May 2014, the Veteran submitted a private medical opinion from Dr. Q., an internal medicine doctor. The opinion stated that he had complained of nervousness, anxiety, impaired impulse control, difficulty in adapting to stressful circumstances, difficulty in establishing and maintaining effective work and social relationships, disturbances of motivation and mood, a depressed mood, episodes of isolation with easy crying and insomnia, nightmares, and flashbacks to his traumatic experiences in Korea. Dr. Q. ultimately diagnosed the Veteran with generalized anxiety disorder, major depressive disorder, and PTSD, and opined that these disorders were more likely than not related to his military service. The Board acknowledges that Dr. Q. is a medical professional and thus is competent to offer opinions on complex medical questions, such as the etiology of injuries and diseases. However, Dr. Q.’s letterhead indicates that he is an internal medicine doctor, not a psychiatrist or a psychologist. He therefore does not have the requisite expertise or training to provide a formal psychiatric or psychological diagnosis. See 38 C.F.R. § 3.159(a)(1). As such, his diagnoses have little, if any, probative value. Moreover, even if Dr. Q. were a psychologist or a psychiatrist, it does not appear that Dr. Q. considered all the relevant evidence of record prior to providing his diagnoses. To that end, Dr. Q. does not appear to have considered pertinent VA treatment records and examination reports in connection with the Veteran’s service-connected TBI. These records reflect residual TBI symptoms such as mild memory loss, difficulty making complex decisions, occasional disorientation to one of the four aspects of orientation, becoming disoriented in unfamiliar places, increased irritability, impulsivity, and a lack of motivation. See, e.g., September 2017 VA TBI Examination; December 2014 VA TBI Examination; March 2012 VA TBI Examination. Essentially, other examiners have linked numerous purported PTSD symptoms, such as his lack of motivation, irritability, and impulsivity, to his TBI instead of to a mental health disorder. This evidence consistently indicates that such symptoms are facets of his TBI. Nonetheless, Dr. Q. does not appear to have addressed such relevant evidence with his own medical opinion or diagnoses. His opinion is thus inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board also notes that the Veteran previously submitted a February 1994 letter from an internal medicine doctor, which stated that the Veteran was under continuous treatment from March 9, 1987, to February 1, 1994, for high blood pressure, angina pectoris, chronic obstructive pulmonary disease with small airway obstruction, hyperlipidemia, severe degenerative joint disease, lumbar muscle spasms, sinusitis, and anxiety. See January 2017 Certified Translation. As with Dr. Q.’s opinion, this letter is from an internal medicine doctor, not a psychiatrist or psychologist. Moreover, the letter does not provide any other details regarding the diagnosis of anxiety. As such, this letter has limited probative value to the extent that it reflects a diagnosis of an anxiety disorder. More significantly, the letter is from February 1994, nearly 20 years prior to when the instant claim was filed. Absent other competent and credible evidence of record that would support a continuous diagnosis of anxiety or some other mental health disorder, this letter describing a diagnosis of anxiety in February 1994 fails to establish that the Veteran has a current diagnosis of anxiety. To that end, the post-service treatment records available in the record do not indicate that the Veteran suffers from symptoms such as nightmares, flashbacks, frequent crying spells, anxiety, or nervousness. Although a February 2020 VA Community Care-GEC Nonskilled Homemaker/Health Aide note states that he has been diagnosed with depression, this is inconsistent with his other recent treatment records. Indeed, the Veteran’s other post-service VA treatment records are otherwise conspicuously absent for any notes on mental health treatment or currently diagnosed mental health disorders. See, e.g., January 2020 VA Primary Care Follow Up Note (negative screening for neuropsychiatry problems, including memory changes and depression); April 2018 VA Primary Care Follow Up Note (same); January 2017 VA Primary Care Follow Up Note (same); August 2015 VA Primary Care Follow Up Note (same); November 2014 VA Primary Care Follow Up Note (same); November 2013 VA Primary Care Follow Up Note (same); January 2012 VA Primary Care Follow Up Note (same); April 2010 VA Primary Care Follow Up Note (same). The Veteran has also received negative scores on various PTSD and depression screenings. See, e.g., April 2019 VA Primary Care Note (negative depression screening score); March 2019 VA Primary Care Clinic Nursing Note (endorsing nightmares and avoiding thinking about stressful events or avoiding situations that remind him of the event, but no other symptoms); April 2018 VA Preventative Medicine Education Note (endorsing feeling down, depressed, or hopeless for several days but no other depression symptoms). Additionally, his VA treatment records reflect a diagnosis of non-service-connected obstructive sleep apnea. See February 2020 VA Pulmonary Note. Indeed, his most recent VA examinations from September 2017 and March 2020 indicate that he does not have any currently diagnosed mental health disorder. The Boards finds the findings from the September 2017 and March 2020 VA examination reports to be highly probative. In the September 2017 VA examination, for instance, the Veteran indicated that he had not been in private or government psychiatric evaluation or treatment and had no referrals or personal requests for behavioral health services. Although the September 2017 VA examiner acknowledged that he had experienced a stressor related to fear of hostile military or terrorist activity, adequate to support a diagnosis of PTSD, he did not satisfy the other criteria necessary to establish a diagnosis of PTSD. Moreover, the September 2017 VA examiner did not find any other symptoms of a mental health disorder were present. Likewise, the March 2020 VA examiner indicated that the Veteran had no history of psychiatric complaints, findings, or treatments from the San Juan VA Medical Center or any other mental health institution, and no history of hospitalizations or emotional crisis. The March 2020 VA examiner also indicated that while he satisfied one of the criteria for a PTSD diagnosis, related to experiencing a stressor, he did not satisfy any other criteria consistent with a DSM-V diagnosis. In addition, the March 2020 VA examiner noted that the Veteran behaved properly during the interview, was well-developed and well-nourished, was spontaneous and alert with reality, and had coherent and logical thought processes, normal patterns of speech, no signs of delusions, hallucinations, phobias, obsessions, panic attacks, or self-harm ideas. His memory for recent, remote, and immediate events was preserved and his judgment and insight were good and adequate. With respect to PTSD, the March 2020 VA examiner noted that he did not satisfy the full criteria for PTSD, such as re-experiencing the traumatic event, avoiding reminders of the trauma, or the symptoms for increased anxiety and emotional arousal. He also noted that his military service and the exposure to trauma did not cause impairment in his marriage, parenting performance, or social, occupational, or other areas of functioning. As a result, no diagnosis of PTSD was found. Additionally, the March 2020 VA examiner stated that there were no other mental disorders or conditions, as his mental status examination was normal, and his clinical history and psychosocial course were negative for a mental condition. The March 2020 VA examiner also stated that Dr. Q. did not appear to be a trained mental health professional and, as such, his diagnoses were improper and beyond his expertise and qualifications. The Board notes that the September 2017 and March 2020 VA examiners, unlike the June 2013 VA examiner, did not state that the Veteran has or has had a TBI. As set forth above, this is incorrect, as the Veteran is entitled to service connection for a TBI. This specific finding somewhat diminishes the probative value of their examination reports, as it is inconsistent with the other medical evidence of record. This is also one of the reasons that the Board remanded this matter in its previous November 2018 decision. Nonetheless, this inaccuracy does not render the September 2017 or March 2020 examination reports entirely without probative value, and the Board finds that additional remand is unnecessary. To that end, it would only have been necessary to note a diagnosis of a TBI to the extent that it would have been necessary to distinguish symptoms attributable to the TBI from symptoms attributable to a mental health disorder. Here, however, there were no diagnosed mental health disorders and distinguishing symptoms would therefore not have been necessary in the first place. Indeed, the September 2017 and March 2020 VA examiners’ findings regarding mental health diagnoses are otherwise supported by the weight of the most competent, credible evidence of record, including the June 2013 VA examination report and the Veteran’s most recent post-service VA treatment records. This evidence is absent for any currently diagnosed mental health disorder. Moreover, his previous VA TBI examinations indicate that various symptoms, such as mild memory loss and irritability, are attributable to his TBI, as opposed to attributable to a separate mental health disorder. As such, a remand on the basis that the March 2020 VA examiner failed to note the Veteran’s TBI diagnosis would constitute a waste of resources with no benefit to the Veteran. See, e.g., Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands that would only result in imposing additional burdens on VA, with no benefit flowing to the claimant, are to be avoided). For this reason, additional remand is unwarranted. Ultimately, the Board finds the June 2013, September 2017, and March 2020 VA examinations, which do not indicate that the Veteran has a current diagnosis of PTSD or any other mental health disorder, are the most persuasive medical evidence of record. They are supported by competent medical evidence and contain clear rationales. In so finding, the Board has also considered the statements the Veteran provided in support of his claim that he is entitled to service connection for an acquired psychiatric disorder. Although the Veteran is competent to provide statements relating to symptoms, facts, or events that he has observed and within the realm of his personal knowledge, he is not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465 (1994). When considering whether lay evidence is competent, the Board must determine whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent on the issues of diagnosis and medical causation. Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). In this case, however, the issues are outside the realm of common knowledge of a layperson. See Jandreau v. Shinseki, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The record does not demonstrate, and the Veteran has not contended, that he has specialized training, education, or experience that would qualify him to render a medical diagnosis related to PTSD. Moreover, no medical professional with the requisite specialized training, education, or experience has diagnosed him as having had an acquired psychiatric disorder during the pendency of this appeal. To the extent that he has mentioned symptoms such as irritability, impulsivity, and memory loss, he is already entitled to service connection for a TBI, and such symptoms are contemplated in the rating assigned for this disability, which is not on appeal here. Accordingly, these reports of symptomatology do not provide a basis to grant service connection for an acquired psychiatric disorder. See 38 C.F.R. § 4.14 (evaluation of the same disability under various diagnoses is to be avoided). In sum, the evidence of record reflects that the Veteran does not have PTSD or any other mental health disorder. The Board reiterates that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See, e.g., 38 U.S.C. § 1110. Accordingly, where, as here, competent evidence indicates that the Veteran does not have the disability for which service connection is sought, there can be no valid claim for service connection for the disability. See Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. Without persuasive evidence of a current diagnosis of mental health disorder that comports with the DSM-V, there is no basis upon which to award service connection. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Rademacher, Associate 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.