Citation Nr: 21004011 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 16-24 558A DATE: January 25, 2021 ORDER The application to reopen the claim of entitlement to service connection for a left wrist ganglion cyst is denied. The application to reopen the claim of entitlement to service connection for a skin condition (claimed as acne) is denied. Service connection for tinnitus is denied. Service connection for right foot toe disability is denied. Service connection for left foot toe disability is denied. Service connection for iron deficiency microcystic anemia is denied. Service connection for disability manifested by symptoms of fatigue and tiredness is denied. Service connection for an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. In an unappealed March 2002 rating decision, the RO denied service connection for left wrist ganglion cyst and a skin condition (claimed as acne). 2. Evidence received since the March 2002 rating decision is cumulative and redundant of evidence previously of record and does not relate to an unestablished fact necessary to substantiate the claims of service connection for left wrist ganglion cyst or a skin condition (claimed as acne). 3. Tinnitus is unrelated to service. 4. The probative evidence of record reflects that the appellant does not have a current right foot toe disability. 5. The probative evidence of record reflects that the appellant does not have a current left foot toe disability. 6. The anemia, iron deficiency microcystic anemia, is a congenital disease that clearly and unmistakably pre-existed service and clearly and unmistakably was not aggravated by service. Her anemia is unrelated to service. 7. The probative evidence of record reflects that the appellant does not have a disability manifested by symptoms of fatigue and tiredness; these have been medically attributed to documented anemia. 8. The probative evidence of record reflects that the appellant does not have a current acquired psychiatric disorder to include PTSD. 9. The appellant did not have active duty or active service. She is not a Veteran and she did not engage in combat. CONCLUSIONS OF LAW 1. New and material evidence has not been received to reopen the claims of service connection for left wrist ganglion cyst or a skin condition (claimed as acne), the claims are not reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. Tinnitus was not incurred in or aggravated during peacetime service. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for right foot toe disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 4. The criteria for service connection for left foot toe disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 5. The criteria for service connection for anemia, iron deficiency microcystic anemia are not met. 38 U.S.C. §§ 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306. 6. The criteria for service connection for a disability manifested by symptoms of fatigue and tiredness are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 7. The criteria for service connection for acquired psychiatric disorder to include PTSD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant had service from August 16, 1982 to April 3, 1983 (ACDUTRA) with additional subsequent National Guard service (INACDUTRA). See DD 214 for 1982-1983 active duty for training period and National Guard personnel records for subsequent service. She appeals an Agency of Original Jurisdiction (AOJ) decision dated in January 2013. In September 2020, she testified at a hearing before the undersigned Veterans Law Judge (VLJ). The VLJ identified the issues on appeal; clarified the concept of service connection claims and new and material evidence; identified potential evidentiary defects; clarified the type of evidence that would support the Veteran’s claim and inquired as to the existence of potential outstanding records. Thus, the actions of the VLJ comply with 38 C.F.R. § 3.103. An October 2011 file memorandum reflects that the service personnel records for her period of service from August 16, 1982 to April 3, 1983 are unavailable. New and Material Evidence 1. The application to reopen the claim of entitlement to service connection for a left wrist ganglion cyst is denied. 2. The application to reopen the claim of entitlement to service connection for a skin condition (claimed as acne) is denied. In general, rating decisions that are not timely appealed are final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. The Board is required to consider whether new and material evidence has been received warranting the reopening of a previously denied claim. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). New evidence is defined as evidence not previously submitted to agency decision-makers. Material evidence means existing 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 prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. See 38 C.F.R. § 3.156 (a). In determining whether evidence is new and material, the “credibility of the evidence is to be presumed.” Justus v. Principi, 3 Vet. App. 510, 513 (1992). 38 C.F.R. § 3.156 (a) creates a low threshold. Shade v. Shinseki, 24 Vet. App. 110 (2010). The regulation is designed to be consistent with 38 C.F.R. § 3.159 (c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” See id. The claims were initially denied in a February 2002 rating decision followed by a March 2002 rating decision which noted that the left ganglion cyst did not manifest during the period of active duty. Rather, it manifested in 1997 as established in the National Guard records dated after April 1983. She was not treated for acne until after her initial period of ACDUTRA ended in April 1982. The evidence showed the appellant was treated for a ganglion cyst and acne/dermatitis during periods of inactive duty for training after April 1983. Since these conditions were not shown to be caused by an injury, service connection could not be established. Additional service treatment records (STRs) were reviewed in the March 2002 rating decision, and the RO again concluded that the cyst was not treated during the period of active service but rather was treated initially in 1997 during inactive duty for training but were not due to injury at that time. There was no evidence of treatment for acne or left wrist ganglion cyst in the STRs for the duty period from August 1982 to April 1983. July 1982 and May 1983 examination reports reflect normal skin and upper extremities. Evidence considered included her January 2001 claim indicating onset of June 1997, and STRs from 1983 to 2000. The appellant was notified of this decision. No notice of disagreement or new and material evidence was submitted within one year and the decision became final. In connection with her January 2013 claim to reopen, the appellant submitted private treatment records reflecting ongoing treatment for skin conditions of the face to include rosacea and acne as well as ongoing treatment for left ganglion cyst. She also testified before the undersigned in September 2020 that she believes wearing a gas mask in service caused acne. She noted there was black powder and soot that would form in the mask and she was allergic to this substance. She stated the rash would come periodically. She admits she was diagnosed as having seborrheic dermatitis, but it is also a rash and the rash began when she wore the gas mask for many years. As to the ganglion, she feels it was due to building things and handling extremely heavy bags. She states she noticed a knot in the left wrist and was treated at Keesler Air Force Base. She first noticed the ganglion cyst in 1994 or 1995. Here, the STRs continue to document that the ganglion first manifested in about 1997, after the period of duty ended in April 1983. Similarly, acne was not noted during the duty period. It was noted in approximately 1995. The Board finds that the evidence submitted since the March 2002 denial is redundant or cumulative of the evidence of record at the time of the last prior final decision. The RO had previously considered the fact that the appellant had no documented wrist or acne/skin injury or incident in service and that there was a ganglion or skin/acne current condition. The testimony as to these claims remains general and redundant at best and there remains no new evidence that the conditions are related to service. The testimony that there was black soot in the gas masks she trained with at some unspecified point during her National Guard service is not considered new and material. Here, again, we note no indication of acne or other skin condition in the period of service. The critical facts have not changed: there is no evidence of a connection between a current left ganglion cyst or acne/skin condition and the service from August 1982 to April 1983. Here, there remains documentation in subsequent National Guard records that the initial manifestations of these conditions occurred after that period. This evidence is by definition not material. Consequently, the claims may not be reopened because no new and material evidence has been received. While 38 C.F.R. § 3.156 (a) creates a low threshold, and does not require new and material evidence as to each previously unproven element of a claim, the appellant has not presented new and material evidence with respect to any previously unproven element of the claims. The claims to reopen are denied. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service or for aggravation of a preexisting injury suffered or disease contracted in line of duty. 38 U.S.C. § 1110 (wartime), 1131 (peacetime). In the context of Reserve or National Guard service, the term "active military, naval, or air service" includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101 (21), (24); see also 38 C.F.R. § 3.6. Diseases or injuries incurred or aggravated while performing ACDUTRA are eligible for service connection. 38 U.S.C. §§ 101 (24), 106, 1110. In other words, when a claim is based on a period of Reserve or National Guard service, it must be shown that the individual concerned became disabled (or died) as a result of a disease or injury incurred or aggravated in the line of duty on Reserve ACDUTRA/INACDUTRA or during Federalized National Guard service. In general, to establish a right to compensation for a present disability, 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. 2009). Certain chronic diseases such as arthritis and organic diseases of the nervous system (including tinnitus) and primary anemia will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). If a condition is not noted upon entrance into service, then to rebut the presumption of soundness at service entrance VA must show by clear and unmistakable evidence both that there was a pre-existing condition and that it was not aggravated during or by the Veteran’s service. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); VAOPGCPREC 3-2003 (July 16, 2003). To satisfy this second-prong requirement for rebutting the presumption of soundness, the government must show by clear and unmistakable evidence either that there was no increase in disability during service or that any increase in disability was “due to the natural progression” of the condition. Joyce v. Nicholson, 443 F.3d 845 (Fed. Cir. 2006). If a pre-existing disability is noted upon entry into service, then the Veteran cannot bring a claim for service connection for that disability, only a claim for service-connected aggravation of that disability. In that case, 38 U.S.C. § 1153 applies and the burden falls on him, not VA, to establish aggravation. Wagner, 370 F.3d at 1096; Jensen v. Brown, 19 F.3d 1413 (Fed. Cir. 1994); 38 C.F.R. § 3.306. Defects are defined as “structural or inherent abnormalities or conditions which are more or less stationary in nature.” VAOPGCPREC 82-90 (July 18, 1990). Congenital or developmental “defects” automatically rebut the presumption of soundness and are therefore considered to have pre-existed service. 38 C.F.R. §§ 3.303 (c), 4.9. Service connection is generally precluded by regulation for such “defects,” because they are not “diseases” or “injuries” within the meaning of applicable legislation. 38 C.F.R. §§ 3.303 (c), 4.9, 4.127; Terry v. Principi, 340 F.3d 1378 (Fed. Cir. 2003); Palczewski v. Nicholson, 21 Vet. App. 174 (2007). VA’s Office of General Counsel has distinguished between congenital or developmental defects, for which service connection is precluded by regulation, and congenital or hereditary diseases, for which service connection may be granted, if initially manifested in or aggravated by service. VAOPGCPREC 82-90, VAOPGCPREC 67-90. The VA General Counsel draws on medical authorities and case law from other federal jurisdictions and concludes that a defect differs from a disease in that a defect is “more or less stationary in nature,” while a disease is “capable of improving or deteriorating.” VAOPGCPREC 82-90 at para. 2. For VA adjudication purposes, "disease" generally refers to a condition considered capable of improving or deteriorating, whereas "defect" generally refers to a condition not considered capable of improving or deteriorating. (As an example, VA considers sickle cell anemia as congenital "disease" for VA purposes, whereas refractive error is considered a congenital "defect.") In this regard, the presumption of soundness does not apply to congenital defects because such defects “are not diseases or injuries” within the meaning of 38 U.S.C. §§ 1110 and 1111. 38 C.F.R. § 3.303 (c); Terry, 340 F.3d at 1385-1386 (holding that the presumption of soundness does not apply to congenital defects); Winn v. Brown, 8 Vet. App. 510 (1996) (holding that a non-disease or non-injury entity such as a congenital defect is “not the type of disease- or injury-related defect to which the presumption of soundness can apply”). However, a congenital defect can still be subject to superimposed disease or injury. VAOPGCPREC 82-90. If such superimposed disease or injury does occur, service connection may be warranted for the resulting disability. Id. 3. Service connection for tinnitus is denied. There is current disability as noted in the December 2012 VA Audiological Evaluation. She also testified before the undersigned in September 2020 that she has had tinnitus since service in 1983. The appellant testified that ringing that started when she worked around the flight line. She was in a supply building on the flight line, with lots of heavy equipment and forklifts. They now ring constantly. The appellant has thus asserted that she has had ringing in her ears since noise exposure associated with her 1983 service. The DD form 214 reflects that her specialty for that period of service was inventory management specialist. We accept her assertions as to noise exposure as consistent with her service. The examiner in 2012 concluded the tinnitus was not related to service but was more likely associated with Eustachian dysfunction in the right ear. The appellant is competent to report ringing in her ear and when it started. However, we are faced with an issue of credibility. Here, tinnitus was not noted or diagnosed during serviced. Tinnitus was not identified in proximity to service. We also not the claims below that are remarkably lacking in credibility. The Board acknowledges the negative opinion of the VA examiner and finds the testimony as to noise based on her specific assignment in 1983 and continuity of tinnitus since service to be less probative as to nexus. In sum, we find the remote assertions of onset in service to be not credible. Service connection is thus denied. 4. Service connection for right foot toe disability is denied. 5. Service connection for left foot toe disability is denied. The appellant contends that she has right and left foot toe disorders related to service. The issue for the Board is whether the appellant has a current disability that began during service or is at least as likely as not related to an in-service injury or disease. The preponderance of the evidence is against finding a current toe disability for either foot. Notably, VA and non-VA treatment records fail to show a toe diagnosis, or complaints and findings related to the toes. She testified that, for whatever reason, she could never wear the shoes that were loose. Every time she was issued shoes, she would end up walking with a limp and going to get a tennis shoe waiver. Here feet and toes just hurt. They were all cramped up and she would have to special order her shoes. She does not know what is actually wrong and she does not have ‘a formal diagnosis’. The feet would just hurt all the time from all the years of trying to wear those steel-toed boots and the low-quarter boots throughout the 25 years. She has to wear tennis shoes to work. STRs show she had bilateral metatarsalgia in December 1982 with a temporary profile for bilateral forefoot strain that expired in January 1983. However, the July 1982, May 1983 and September 1984 examinations in the STRs reflect normal feet. A June 1993 report from a Dr. Gallo indicates the appellant was pregnant, due in August 1993, and had swollen feet she was unable to wear military shoes. It was requested she be allowed to wear tennis shoes. The medical evidence is inconsistent with finding a current toe disorder. There is no indication that there is any functional limitation or a disorder relevant to the toes. There is no proof of current underlying pathology. The Board concludes there is no current toe disorder. The Board notes the assertion that she has a current toe disorder due to service. The appellant is competent to attest to lay-observable symptomatology; however, her assertions are less probative than the negative medical treatment record. Moreover, she provides minimal substantive description of a current toe disorder and acknowledges there is no actual diagnosis, and the post-service medical record is negative as noted. Ultimately, her assertions are outweighed by the negative medical treatment record on the issue of whether there is a current disability due to disease or injury. The law is clear, there must be evidence of disability and such disability must be due to an identified disease or injury. Here, there is no proof of underlying pathology (disease or injury). Due to the absence of proof of a present disability due to disease or injury, there is no valid claim for service connection as to toe disorder. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Even if we accept that pain may be result in disability, there must be underlying disease or injury. 6. Service connection for iron deficiency microcystic anemia is denied. The appellant urges that her anemia is related to service. She testified that she still has anemia and takes Ferro-Sequels, an iron supplement. She had some related issues giving blood in the service. However, for the following reasons, the preponderance of the evidence is against finding that any current anemia is related to service. Rather, the condition is a congenital disease that clearly and unmistakably pre-existed active service and was not aggravated by service. There is current disability inasmuch as the July 2011 VA examination report with June 2012 addendum reflects a diagnosis of iron deficiency microcytic anemia per lab. The examiner noted that the reported date of onset was around 1982. The appellant reportedly was asked to give blood while in service in basic training, and while she informed the training instructor that she couldn't, she did give blood. After giving blood she was asked to resume training and while running, she reports she collapsed. She reported she takes B-12 injections every three to six months since late 80s or early 90s. She thinks the condition is worse because she stated that she is always tired. STRs reflect that the appellant sought emergency care as she felt dizzy on August 29, 1982 after giving blood two days earlier. The assessment/diagnosis was anemia. She was in good condition at discharge and she was instructed to take Ferro Sequels. A May 1983 request for medical consultation reflect the need for evaluation to see if she is not medically qualified for continued service. She was noted to have had multiple somatic complaints related to physical status to include anemia. A July 1983 report of medical consult reflects pre-existing congenital anemia (not acquired), otherwise normal work-up. The appellant underwent VA examination in July 2011 with an addendum medical opinion in June 2012. The examiner reviewed the record and was specifically asked to look at the following conflicting evidence: (1) STRs showing treatment for and diagnosis of anemia with symptoms of fatigue, tiredness, etc., with hemoglobin levels of 11.7 and 12.5 during service. (2) Private treatment records from Dr. Estrada from May 23, 2000 showing diagnosis and treatment for anemia with hemoglobin levels of 10.3. The examiner opined that the anemia was less likely than not (less than 50 percent probability) incurred in or caused by service. The rationale was as follows: Unequivocally, the medical evidence reviewed, as above yielded two dissimilar findings. These conflicted findings are that the veteran has an acquired anemia and congenital anemia. Based on evidence reviewed, the vet has lab results which were abnormal; some of these findings will be discussed for the purpose of the requested medical opinions. For example, she has lab result of target cells. Target cells can be found in inherited disease condition like hemoglobin C, a genetic blood disorder. In another example, the lab results also show she has rare spherochete. Hereditary spherocytosis, according to the literature, is a genetic hemolytic disorder characterized by asymptomatic to symptomatic hemolytic anemia. The results of the lab provide support for the diagnosis made by the medical officer whose diagnosis of the veteran's condition was anemia [Poss Hemoglobin C Disease]. Similarly, the 7/7/83 Report of Medical Consult, indicating that the vet's condition was that she has a pre-existing congenital anemia [not acquired], also lent support to the veteran's condition of congenital anemia. Thus, based on the evidence reviewed, the veteran's anemia is as less as likely as not (50 percent or greater probability) incurred in or caused by active military service. The examiner commented on the conflicting evidence, noting that clearly, the evidence reviewed shows two dissimilar findings: an acquired anemia and a congenital anemia. They explained that acquired anemia is a disease originating after birth due to some environmental influences and not by hereditary or developmental factors, while congenital anemia is present at birth, which may be genetically acquired, inherited and is not due to outside influences. They noted that while STRs and private medical records show treatment for and diagnosis of anemia with symptoms of fatigue, tiredness, she also has lab studies in service that were abnormal on 3/10/83. These abnormal lab findings support the diagnosis made by two individual providers, that is, one provider made a diagnosis of Poss Hemoglobin C Disease and the other shows the appellant has a pre-existing congenital anemia [not acquired]. To reconcile this difference, based on the evidence reviewed, the examiner concluded that the anemia is not acquired due to outside influences but a congenitally acquired anemia. Thus, the anemia is as less as likely as not (50 percent or greater probability) incurred in or caused by active military service. Critically, we find the VA examiner’s opinion as to the classification of the anemia as congenitally acquired to be the most probative evidence on that issue. It is well-supported and based on a thorough review of the salient and even conflicting facts, and is uncontroverted. We reasonably infer that the examiner has classified the anemia as a congenital disease. While we cannot find that there is evidence of anemia at the time of entrance into service in August 1982, the presumption of soundness has been rebutted (even if we assume that it was applicable). See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wray v. Brown, 7 Vet. App. 488 (1995) (the Board may adopt an independent medical expert's opinion for its reasons and bases where the expert has fairly considered the material evidence of record). We also note that the appellants service was not active duty, she is not service-connected for any disability and therefore, her service is not active service. Therefore, the presumption of soundness is not applicable. We also conclude that this congenital disease of anemia, that clearly and unmistakably pre-existed service was clearly and unmistakably not aggravated by service. Here, we note that the examiner’s opinion that the anemia is not incurred in or caused by military service. We also note the July 1982 and May 1983 examinations that were clinically normal. We note that the has continued to have the same level of treatment for her anemia over the years, taking Ferro-Sequels with additional periodic B-12 shots. Her complaints have remained relatively uniform, lightheadedness, weakness and headaches as recorded in the VA examination. A reasonably reading of the lengthy assessment by the VA examiner, when viewed in the context of the fact pattern presented by the lengthy non-active duty National Guard medical record, unequivocally compels the conclusion that the condition clearly and unmistakably was not aggravated by service. The appellant’s assertions are outweighed by the opinion of the VA examiner on this matter which is medically complex. Thus, service connection for anemia is denied. 7. Service connection for disability manifested by symptoms of fatigue and tiredness is denied. As to disability manifested by symptoms of fatigue and tiredness, we note there is no current separate disability. These symptoms have instead been consistently attributed to her ongoing anemia. See, STRs and July 2011 and June 2012 VA anemia examination. The Board notes the assertion that she has a current disorder manifested by fatigue and tiredness disorder due to service. The appellant is again competent to attest to lay-observable symptomatology; however, her assertions are not probative in this regard in view of the negative medical treatment record. Moreover, she actually testified that indeed she has been told this is a manifestation of her anemia. Ultimately, her assertions are outweighed by the negative medical treatment record on the issue of whether these symptoms are a disability due to a separate disease or injury rather than a manifestation of anemia. Due to the absence of proof of a present disability other than anemia, there is no valid claim for service connection as to this disorder. Service connection was separately denied and the manifestations of such disease are equally denied. Service connection for an acquired psychiatric disorder to include PTSD is denied. The appellant testified that she believes she has a current psychiatric disorder due to service. She stated that she was caring for her parents and children during the New Orleans Hurricane Katrina evacuation and one of her parents had a heart attack so she could not go to duty. Basically, the person who she had to leave her kids with had a heart attack. Her commander got very upset with her and was calling and threatening her to come in. She got upset and ultimately went to a psychiatrist. A sergeant in her unit kept calling. They tried to give her an Article 15 but it got overruled. They tried to force her to retire again but could not. She just felt really stressed and depressed. She did not report, and the whole unit verbally attacked her. Medical records from Dr. Lesser show treatment from October 2005 to November 2006 for a psychiatric disorder assessed by this physician as anxiety, depression and PTSD. These records do not identify a specific stressful event giving rise to posttraumatic stress disorder, but do note the doctor felt she was harassed at work (in the military). In August 2006, Dr. Lesser wrote that the appellant continues to improve quite a lot but continues with some issues. In November 2016, Dr. Lesser wrote that the appellant continued in her care for anxiety but had improved tremendously and was doing well. Dr. Lesser wanted to see her every three months. There are no more records. During the initial period of active duty for training was from August 1982 to April 1983, there was no record of the having any overseas deployment or any service in a zone of conflict. Her testimony is consistent with Dr. Lesser’s records to the extent that the psychiatric treatment appears to be in the aftermath of Hurricane Katrina. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f). Here, we note that there is no current diagnosis as to any psychiatric disorder, to include PTSD. The appellant has not indicated that she is receiving any current psychiatric treatment, and she has not provided any medical records relating to any psychiatric diagnosis during the appeal period. We do not find current psychiatric disorder. The appellant is competent to attest to lay-observable symptomatology; however, her assertions are outweighed by the negative medical treatment record since 2006. Due to the absence of proof of a present disability, there is no valid claim for service connection as to a psychiatric disorder. Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability at any point during the claim or appeal period. Brammer v. Derwinski, 3 Vet. App. 223 (1992). H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. RIPPEL 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.