Citation Nr: 21004617 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 10-25 640 DATE: January 27, 2021 ORDER Service connection for an acquired psychiatric disorder, to include anxiety, is denied. FINDING OF FACT The Veteran does not have a current diagnosis of PTSD or a mood disorder, and his current anxiety disorder cannot be linked to his military service without resorting to mere speculation. CONCLUSION OF LAW The criteria to establish service connection for an acquired psychiatric disorder, to include anxiety, have not been satisfied. 38 U.S.C. §§ 1131, 5107 (b) (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from May 1984 to September 1985. This matter was last before the Board in June 2018. The Board remanded the matter to more fully develop the Veteran’s claim in accordance with a September 2017 directive by the Court of Appeals for Veterans Claims (Court). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection for PTSD requires (1) a PTSD diagnosis conforming to the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5); 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. § 4.125. The Veteran’s claim that he has PTSD related to an in-service assault falls within the category of situations in which it is not unusual for there to be an absence of service records documenting the events which the veteran alleges. See, e.g., Patton v. West, 12 Vet. App. 272, 281 (1999). The pertinent regulation, 38 C.F.R. § 3.304 (f) (5), reflects a recognition that service records may not contain evidence of personal assault, and that alternative sources, including testimonial statements from confidants such as family members, roommates, fellow service members, or clergy, may provide credible evidence of an in-service stressor premised on personal assault. See YR v. West, 11 Vet. App. 393, 399 (1998). If a PTSD claim is based on in-service personal assault, evidence from sources other than the veteran’s service records may corroborate the veteran’s account of the stressor incident. Examples of such evidence include, but are not limited to records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases, and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.304 (f) (5). Alcoholism or alcohol abuse is not a disability for the purposes of VA compensation. VA law and regulations preclude compensation for primary substance abuse disabilities and secondary disabilities that result from primary substance abuse as this is deemed to constitute willful misconduct on the part of the claimant. See 38 U.S.C. § 105 (a) (West 2014); 38 C.F.R. §§ 3.1 (m), 3.301(d) (2019); see also Allen v. Principi, 237 F.3d 1368, 1381 (Fed. Cir. 2001) (“the legislative history is quite clear that Congress intended to... preclude recovery for a primary alcohol abuse disability...”). Therefore, service connection for an alcohol abuse disability as a primary disability related to active duty service must be denied as a matter of law as service connection is not permissible for that type of disability. However, the United States Court of Appeals for the Federal Circuit has held that service connection is warranted for an alcohol abuse disability acquired as secondary to, or as a symptom of, a veteran’s service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran contends his post-service alcohol and substance abuse was a way of coping with the personal assaults he experienced during a training exercise at Fort Irwin, California. In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for an acquired psychiatric disorder to include PTSD, mood disorder and anxiety Service personnel records indicate that in June 1982 the Veteran was ordered to inactive duty for training (INACDUTRA). On his June 1982 report of medical history, the Veteran denied psychiatric symptoms. In July 1982 his INACDUTRA was cancelled, and in November 1982 the Veteran was discharged with a characterization of service under Other Than Honorable conditions due to excessive absences. In May 1984 the Veteran reenlisted. His May 1984 report of medical history at enlistment indicates he denied frequent trouble sleeping, depressive or excessive worry, or nervous trouble of any sort. His clinical psychiatric evaluation was normal. There are no complaints, diagnoses, or treatments for any psychiatric symptoms during service. The Veteran contends that in January 1985 he was ordered to attend combat training at Fort Irwin, California, for one month. The Veteran, whose military occupational specialty was a cook, alleges that during the training, he was physically assaulted, treated as if he were a prisoner of war during an insurrection or coup, and that he generally feared for his life. Personnel records also indicate the Veteran was recommended for administrative discharge under the provisions of Army Regulation 635-200, Chapter 13 due to unsatisfactory duty performance. He was discharged under honorable conditions in September 1985. Significantly as it bears on his allegation, as well as those of his wife’s of the Veteran having had symptoms of mental distress since January 1985, the Veteran’s August 1985 report of medical history prior to separation, indicates his specific denial of frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. His clinical psychiatric evaluation at separation was normal. In January 2008, over 20 years after his release from active duty, the Veteran hit his head on his truck’s steering wheel. Although there were no witnesses to the accident, coworkers noticed the Veteran acting strangely, and the Veteran was eventually transported to an emergency department for evaluation. An examination indicated the Veteran had no acute head trauma or bleeding, but that the Veteran had no memory of place, time, who he was, where he worked, or any other aspect of his life. He was assessed with an altered mental status with associated amnesia. Again suggestive of his lack of credibility, the discharge notes indicate the examiner assessed the Veteran’s symptoms as “somewhat out of proportion” to the stated injury; that the Veteran’s brain MRI was unremarkable, and that on discharge the Veteran’s diagnoses were severe cognitive deficiency with associated amnesia and a closed head injury. In a February 2008 follow up consultation, Dr M.T. noted during the evaluation that the Veteran alleged he could not remember the current president’s name, count from 1 to 10, or identify the days of the week or the months of a year. The examiner assessed the Veteran with memory loss and noted “I have never seen a patient with such complete and total loss of apparent memory.” The examiner noted the Veteran’s medical findings did not indicate a physiologic causation but rather a psychological etiology and that the examiner would be interested in a neuropsychologist’s impression. In March 2008 Dr. J.B, a neuropsychologist, noted the Veteran reported becoming very anxious, feeling “scared” around people, feeling threatened around others, and being startled if people approach him. The Veteran also reported nightmares since the January 2008 post-military service accident, and the Veteran’s spouse voiced her concern that the Veteran may be having flashbacks of his military service during the nightmares. The examiner noted possible sources of past difficulties included the Veteran’s account of being adopted at age 2 with a history of abuse; the Veteran’s allegation as to his military service including a stressful month of training referred to as “war games,” and a recent robbery. The Veteran reported being in the military for 1.5 years but being discharged because he had difficulty adjusting to military life; that he had severe anxiety during the month of “war games;” and that he and his wife had recently been robbed. The examiner also noted the Veteran reported a head injury 25 years previously, and the Veteran’s spouse reported she learned after the Veteran’s work-related head injury that the Veteran had a head injury the week before the January 2008 incident. The examiner noted the Veteran’s responses were variable and quite inconsistent. Her diagnostic impressions were memory loss, with other deficits; and severe psychiatric presentation, with features of PTSD and severe anxiety. The examiner was most concerned about the Veteran’s severe psychiatric disturbance, noting the Veteran referred to childhood and military trauma, anxiety about safety and being around other people, and sleep impairment. The examiner recommended psychiatric intervention. In an April 2008 evaluation conducted again by Dr. J.B., the examiner noted significant improvement in the Veteran’s cognitive functioning and that the Veteran had begun psychiatric treatment. The Veteran endorsed moderate anxiety, frequent nightmares, minimal depression, difficulty with sustained attention, and memory loss for personal remote history. The examiner noted the Veteran was eager to return to work. In a July 2008 followup neurological consultation, Dr. L.K. indicated she had not seen such severe anxiety and the onset of PTSD erupt from a head injury in her practice. She noted that the Veteran needed a psychiatric opinion on his PTSD because she stated she was “skeptical” his PTSD was trigged by his head injury. At his initial psychiatric evaluation in August 2008 with Dr. S.T., the Veteran reported that he sustained a head injury in January 2008; that he did not lose consciousness, and that he continued to work for over an hour after it happened before he was taken to the hospital, although he did not recall the events. The Veteran then reported presenting symptoms of PTSD in late January 2008 such as becoming afraid that someone would kill him and that did not want anyone unfamiliar near him. However, he alleged the onset of memories of military service, and asserted that he was trained with the understanding that he could be killed. He stated he remembered “everything” from the Fort Irwin training, that he developed nightmares occurring 5-7 times every night, and that he had refused taking any further psychiatric medication because his initial experience with the medication was that it made his symptoms worse. However, he also admitted he could not remember anything about his life before the accident until about three weeks prior to this evaluation, which he credited to his wife’s herbal juice. The Veteran denied reliving his military experiences but endorsed nightmares of military service, to include exposure to hand grenades and gunfire. He denied irritability, stated that his nightmares no longer involved the military, denied feeling “low” or any suicidal ideation, but endorsed continued isolative behavior. He avoided stimulation that might remind him of his military trauma, endorsed decreased participation, that he felt detached, and that he had a decreased affect, problems falling asleep, poor concentration, hypervigilance, an elevated startle response, and that he avoided noises such as fireworks. He reported he had “no stressors in his life,” that he was always “laid back” and that he had a good marriage, and that his paranoia was improving. The Veteran reported occasional alcohol intake, and that in the remote past he used cocaine once on occasion and that he also used LSD when he was in the military. The examiner opined the Veteran met the criteria for PTSD because his combat training would be “markedly” distressing to almost anyone; that he re-experienced his military trauma by having recurrent and intrusive recollections of combat training; had recurring distressing dreams of events; avoided situations that would arouse recollections of the trauma; that he felt detached and demonstrated a restricted affect; and that he had persistent symptoms of increased arousal, difficulty falling asleep, poor concentration, hypervigilance, increased startled response and avoided noises such as fireworks. The examiner was concerned the Veteran also experienced a psychotic episode, and advised the Veteran to obtain counseling for PTSD through VA. He noted that in order to make a better determination of the etiology of his symptoms, he would need to interview the Veteran’s spouse and review the Veteran’s service records. The examiner diagnosed the Veteran with rule/out PTSD, rule/out psychotic episode, r/o catatonic episode, r/o malingering, and r/o fictious disorder. The Veteran received treatment from Dr. S. T. until January 2010. In October 2008 Dr. L.K. noted that neurologically the Veteran was able to return to work and that the Veteran reported that since taking a fruit juice concoction his memory had improved almost to “normal.” In a November 2008 statement, the Veteran reiterated his allegation that his unit was sent to Fort Irwin, California, for combat training, that they trained by defending themselves in nighttime ambushes with live ammunition, and that as a cook he did not have prior combat training so therefore he feared for his life. He also endorsed flashbacks and nightmares of the combat training. In a June 2009 statement, the Veteran’s spouse reported that the Veteran traveled to Fort Irwin for approximately 4 weeks, and that when he returned he “was not the same person.” She reported that he began abusing drugs and alcohol and did not discuss what happened during the training until after his January 2008 head injury. These lay statements are competent regarding their observations of the Veteran’s behavior during and after service, and to establish the presence of observable symptomatology, including frequency. See Caluza v. Brown, 7 Vet. App. 498 (1995); see also Barr v. Nicholson, 21 Vet. App. 303, 307-8 (2007). However, these observations are not competent to diagnosis the Veteran with a psychiatric disorder or link any psychiatric symptoms to his service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). In December 2009 Dr. S.T. stated that he had diagnosed the Veteran with PTSD and mood disorder not otherwise specified (NOS) but that he could not say definitively that his January 2008 accident caused his symptoms since he did not start treating him until approximately four months after the accident occurred. In January 2010 the Veteran reported to his treating psychiatrist that he had a panic attack at work while backing up his truck. He reported that he had then resigned. He also reported that generally his mood was good but that certain things triggered his anxiety. In an April 2010 statement, the Veteran’s spouse again reported that in January 1985 the Veteran went to California for a month and that he returned a different person than before he left. She reported that the Veteran did not inform her why he was discharged, but that she noticed he spent many late nights out without telling her where he was going and that he abused alcohol and drugs and was discharged from two of three alcohol treatment centers because he was not being honest. She reported he had many nightmares but that he did not confide in her what they were about until after the January 2008 head injury. She reported the Veteran reported constant nightmares about his Fort Irwin, California, training experiences of war training exercises. At the June 2012 Board hearing, the Veteran reported that he and other members of his unit were exposed to live ammunition fire at night that felt like war training, and that at least three times he and his unit were captured in their tents, marched to another location like prisoners, and pushed around. The Veteran endorsed having nightmares of the incident, that he did not like having people stand behind him, that he had startled responses to gunfire or similar-sounding noises, and that he had flashbacks. The Veteran also testified that he did not seek any psychiatric treatment for the incident until his head injury in January 2008 triggered his recollections. At the July 2014 VA medical examination, the examiner conducted a thorough evaluation, spending almost 2 hours with the Veteran. He opined the Veteran’s current psychiatric condition was less likely than not incurred in service because the Veteran did not meet the diagnostic criteria for any acquired psychiatric disorder, to include PTSD, mood disorder or anxiety. The examiner explained the Veteran’s predominant mood was euthymia (stable), that his present psychological testing results contraindicated the presence of a clinical level of depression, and that the Veteran did not evidence or report a predominantly depressed mood, manic mood, hallucinations, delusions, feeling of worthlessness, excessive or inappropriate guilt, feelings of hopelessness, difficulty concentrating, difficulty making decisions, anhedonia, or suicidal ideation. The examiner noted the Veteran endorsed difficulty falling and staying asleep, along with the resulting frequent fatigue, but that these symptoms alone were insufficient for establishing a mood disorder. Regarding the Veteran’s anxiety, the examiner noted again that the Veteran’s predominant mood was euthymia, the Veteran denied a history of panic attacks, that his present psychological testing results contraindicated the presence of a clinical level of anxiety, and that he did not evidence or report prominent anxiety, tension, worries or restlessness. Regarding the Veteran’s asserted PTSD, the examiner noted the Veteran reported symptoms characteristic of a trauma- and stressor-induced disorder that caused him clinically significant distress and social functioning impairment, but that the symptoms did not meet the full criteria for any trauma- or stressor-related disorder, including PTSD. The examiner then went into detail about the contradictory, improbable or incredible nature of the Veteran’s reported symptoms. As to the Veteran’s contradictory assertions, the examiner noted that at the June 2012 Board hearing, the Veteran testified that he and other members of his unit were “pushed around.” However, at the current VA examination, the Veteran reported he was beaten to unconsciousness with rifle stocks. The examiner also noted that at the June 2012 Board hearing the Veteran reported that he lost his memory for approximately 6 months. The examiner noted that notes from his initial evaluation in August 2008 by Dr. S.T. confirm that the Veteran reported the onslaught of memories from his military service came back to him only recently. However, at the current VA medical examination, the Veteran reported that the memories of his traumatic military experience in Fort Irwin, California, returned to him the same day that the head injury occurred. The examiner also noted that the Veteran had repeatedly stated that he had no psychiatric symptoms prior to the January 2008 head injury but also noted that the Veteran’s spouse submitted a statement that the Veteran had constant nightmares when he returned from Fort Irwin, California, during service in 1985. Finally, the Veteran reported at the VA medical examination that he did not speak after the incident, although the examiner noted that observation reports indicate the Veteran answered questions appropriately soon after the incident. As for the improbability of the Veteran’s account, the examiner noted January 2008 neurologist notes from Dr. M.T. that indicated the Veteran was thoroughly evaluated; that his head CT and brain MRI were normal; that he appeared well-nourished; and that his speech was clear and easily intelligible. However, the Veteran was unable to identify the current president; unable to count to 10; unable to say the days of the week or the months of the year; and was unable to name common objects in the room. Secondary, the examiner noted the psychological consultation with Dr. M.C. where the Veteran denied having any knowledge of his past, where he was born, who his parents were, what his name was, or how to spell “cat.” The examiner also noted several factors as to the Veteran’s lack of credibility. The examiner noted the Veteran’s belief that he was a prisoner of war while also being aware that it was 1985; that he was not deployed to a combat zone; that he alleged US soldiers were taking him prisoner for several hours while staging a coup and attempting to overthrow the American government; that these same soldiers would repeatedly return the Veteran and his unit to their tents after a few hours; that he would persist in such a belief after seeing those soldiers in the meal line the next day; that he would persist in such a belief after being “captured” and “returned” three times, and that although he alleged he was beaten to unconsciousness with rifle stocks, he reported that upon returning to his tent no one in his unit or elsewhere at Fort Irwin noted and treated his injuries. The examiner explained that the evidence contraindicates the hypothesis that the Veteran’s contradictory, improbable and incredible report of symptoms was due to genuine delusional beliefs, as several mental health evaluations and treatment have not rendered any psychosis diagnoses. The examiner stated that the Veteran did not present any psychotic indicators during the interview and that his current psychological testing results contraindicated the presence of psychosis. At the September 2019 VA medical examination, the Veteran reported no psychiatric treatment since 2010; that he did not take prescription psychiatric medication and that he struggled with sleep maintenance, anxiety and that he did not like having people stand behind him. The Veteran also reported his stressor was the training at Fort Irwin, California, where he was taken prisoner the first three nights of war training, and that he alleged that he was beaten unconscious with a rifle stock. The examiner noted the Veteran’s stressor met the criteria for a support of a PTSD diagnosis but that the stressor was not related to the Veteran’s fear of hostile military or terrorist activity nor to an in-service personal assault. The examiner noted the Veteran’s symptoms did not meet the diagnostic criteria for PTSD and diagnosed the Veteran with unspecified anxiety disorder. The examiner opined the Veteran’s current anxiety diagnosis was less likely than not incurred in service because there was no evidence that his anxiety was related to his military service because there was no report of mental health issues during service, and there was no consistent report of ongoing mental health problems since service. In an August 2020 addendum, the same examiner reviewed the Veteran’s claims file and noted the Veteran’s extensive medical records after his head injury. For example, she noted that the Veteran’s hospital admission report indicated the Veteran’s symptoms were out of proportion to his reported injury and therefore the etiology of his symptomatology was unknown. She also noted the neuropsychologist evaluation from March 2008 where the examiner also provided no concrete mental health diagnosis and noted concern of malingering and factitious disorder. The examiner then opined that although the Veteran currently demonstrated symptoms of anxiety, she could not determine the etiology of the Veteran’s symptoms without resorting to mere speculation and that therefore a nexus between his military service and his current diagnosis could not be made. The examiner also opined that after a thorough review of the medical records, it was unclear if the Veteran had a diagnosis of a head injury. The examiner noted medical records from the Veteran’s initial hospitalization did not indicate an acute injury pattern or intracranial hemorrhage. Furthermore, the Veteran’s significant memory loss could not be accounted for by any of the examiners. She opined that since the medical records were not clear that the Veteran had a head injury, she could not provide a nexus indicating the Veteran’s current anxiety diagnosis was caused by his January 2008 head injury and his subsequent experience of recalling repressed memories. Finally the examiner opined that the etiology of the Veteran’s head injury, present mental health, and current anxiety disorder were all unclear and that determining the etiology of the Veteran’s current anxiety disorder would require resorting to mere speculation. The preponderance of the evidence is against finding service connection for an acquired psychiatric disorder. The Veteran does not have a current diagnosis of PTSD or a mood disorder, and his current anxiety disorder cannot be linked to his military service without resorting to mere speculation. The August 2020 addendum opinion is highly probative. The examiner noted that the Veteran’s head injury and subsequent report of symptoms have baffled neurologists, neuropsychologists and psychiatrists alike. The Veteran’s contention is essentially that he believed himself to be a prisoner during an attempted insurrection, but upon realizing that it was an intense combat training exercise, continued to fear for life, indulged in drug and alcohol abuse to avoid the memories of it upon his return to civilian life, repressed the entire experience for over 20 years, and is now experiencing anxiety from his military experience even though he understands he mischaracterized the entire experience in the first place. As no competent experienced examiner has been able to determine the etiology of the Veteran’s symptomatology since his head injury, the Board cannot grant service connection for his current anxiety disorder based on mere speculation. The record is replete with inconsistent statements regarding the onset of symptoms and the diagnosis and treatment of psychiatric diagnoses that minimize the probative weight of the Veteran’s observations of symptoms. Caluza v. Brown, 7 Vet. App. 498 (1995) (holding the Board has a duty to ascertain the credibility of testimony put before it and may consider self-interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of witness when weighing credibility.). As noted in the July 2014 VA medical examination report and opinion, the Veteran’s contradictory, improbable and incredible reports of events and psychiatric symptomatology dissuaded experienced examiners to diagnose the Veteran with a clinical mental disorder. There are no military records that corroborate the Veteran’s allegation that he experienced injuries such as beatings with a rifle until he lost consciousness. Given the Veteran’s admittance to the use of hallucinogenic drugs such as acid during service, his inconsistent statements about the force with which he was treated during his unsubstantiated Fort Irwin training, and his incredible spontaneous recollection of repressed memories after 20 years of no reported psychiatric stressors, the Veteran’s statements regarding the relationship of his psychiatric symptoms to his service do not merit probative weight. (Continued on the next page)   The Veteran has continuously asserted throughout the appeal that his current psychiatric disorder is a result of his unsubstantiated combat training experience in Fort Irwin, California. The Veteran is competent to report observable symptomatology of his condition and to relate a contemporaneous medical diagnosis. See Layno, 6 Vet. App. 465, 469; see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, while the Veteran has attempted to establish a nexus through his own lay assertions, and those of other lay individuals, the Veteran is not competent to offer opinions as to the etiology of his current anxiety disorder. See Jandreau, 492 F.3d 1372, 1377 n.4; Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Acquired psychiatric disorders require specialized training for determinations as to diagnosis and causation, and are therefore not susceptible to lay opinions on etiology. Thus, the Veteran is not competent to render such a nexus opinion or attempt to present lay assertions to establish a nexus between his current anxiety diagnosis and its relationship to his service. Since the Veteran’s current anxiety disorder was not incurred in service, the claim for service connection is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Anwar, Attorney-Advisor The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.