Citation Nr: 21004621 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 13-24 122 DATE: January 27, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), schizophrenia, or bipolar disorder is denied. Entitlement to service connection for a vision disorder is denied. FINDINGS OF FACT 1. The Veteran’s acquired psychiatric disorder clearly and unmistakably preexisted his active service and clearly and unmistakably was not aggravated during active service. 2. At no time during the pendency of the claim does the Veteran have a diagnosis of PTSD, and the record does not contain a recent diagnosis of such disability prior to the Veteran’s filing of a claim. 3. At no time during the pendency of the claim does the Veteran have a diagnosis of a vision disorder, and the record does not contain a recent diagnosis of such disability prior to the Veteran’s filing of a claim. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1111, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. 2. The criteria for service connection for a vision disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1980 to June 1987, and June 2001 to September 2003. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a November 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. Jurisdiction of this appeal is currently with the RO in St. Louis, Missouri. This case was most recently before the Board in July 2018, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. Specifically, the claims were remanded to obtain the Veteran’s Social Security records, provide proper notice for PTSD claims to include claims based on personal assaults, obtain the Veteran’s Reserves or National Guard records, and obtain an etiology opinion with regards to the Veteran’s claimed acquired psychiatric disorder. The Veteran’s Social Security Administration records and Reserves records have been obtained and he was provided notice with regards to claims for PTSD in April 2019. In addition, an etiology opinion was obtained in August 2020. The Board determines that there has been substantial compliance with the Board’s prior remand. See Stegall v. West, 11 Vet. App. 268 (1998). The case has now been returned to the Board for appellate action. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are considered as “noted.” 38 C.F.R. § 3.304(b). When determining whether a defect, infirmity, or disorder is “noted” at entrance into service, supporting medical evidence is needed. Crowe v. Brown, 7 Vet. App. 238 (1994). VA’s General Counsel has held that to rebut the presumption of sound condition under 38 U.S.C. § 1111, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. The Board notes that the Court of Appeals for Veterans Claims (Court) has held that the presumption of aggravation under 38 U.S.C. § 1153 only applies in cases where a preexisting disability was noted at the service entrance examination. See Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). Otherwise, the matter goes to the analysis of the presumption of soundness. The veteran is not required to show that the disease or injury increased in severity during service before VA’s duty under the second prong of this rebuttal standard attaches. VAOPGCPREC 3-2003; see Horn, 25 Vet. App. at 234-35 (holding that the burden of proof in presumption of soundness cases rests with VA); see also Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). Generally, as a matter of law, the presumption of soundness may be rebutted by clear and unmistakable evidence consisting of a veteran’s own admissions during clinical evaluations of a pre-service history of symptoms. Thus, in the absence of any contention that the appellant never made the statements attributed to him (reporting pre-existing symptoms), those statements alone may rebut the preexistence prong of the presumption of soundness. Horn v. Shinseki, 25 Vet. App. 231, 237-38 (2012) (citing Doran v. Brown, 6 Vet. App. 283, 286 (1994)). Likewise, a later medical opinion based on statements made by the veteran about the pre-service history of his condition may be sufficient to rebut the preexistence prong of the presumption of soundness, notwithstanding the lack of contemporaneous clinical evidence or recorded history. Harris v. West, 203 F.3d 1347, 1349 (Fed. Cir. 2000); Horn, 25 Vet. App. at 237-38. The Court has held that lay statements by a veteran concerning a preexisting condition are not sufficient to rebut the presumption of soundness. See Paulson v. Brown, 7 Vet. App. 466, 470 (1995) (stating that a lay person’s account of what a physician may or may not have diagnosed is insufficient to support a conclusion that a disability preexisted service); Crowe, 7 Vet. App. at 246 (1994) (finding that supporting medical evidence is needed to establish the presence of a preexisting condition). A pre-existing injury or disease will be considered to have been aggravated by active service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). Temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted to symptoms, is worsened. Jenson v. Brown, 4 Vet. App. 304, 306-307 (1993) (citing Hunt v. Derwinski, 1 Vet. App. 292 (1991)). However, if an increase in disability is shown, clear and unmistakable evidence is required to rebut the presumption of aggravation. 38 C.F.R. § 3.306(b). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that §§ 1110 and 1131’s requirement of the existence of a present disability for VA compensation purposes cannot be considered arbitrary); see also McClain v. Nicholson, 21 Vet. App. 319, 323 (2007) (holding that the requirement of a current disability is met when a claimant has a disability at the time a claim for VA compensation is filed or during the pendency of that claim). Consequently, the evidence of record must show that the Veteran currently has the disability for which benefits are being claimed. 1. Acquired Psychiatric Disorder The Veteran asserts that his acquired psychiatric disorder is etiologically related to his active service. Specifically, his representative argues that such disorder was aggravated beyond its natural progression by his active service. See Appellate Brief, October 29, 2020. Moreover, the Veteran asserts that his acquired psychiatric disorder was caused by certain stressors he experienced during active service, to include seeing someone being smashed under equipment, lack of sleep, service in Desert Storm, witnessing another soldiers’ suicides, the stressor of service, See e.g. VA Form 21-0781, Statement in Support of Claim, January 9, 2020; see Notice of Disagreement, June 26, 2017; see e.g. VA Form 9, August 22, 2013; See e.g. VA Form 21-4142, August 20, 2013; see e.g. VA Form 21-4138 Statement in Support of Claim, May 7, 2012; see e.g. VA Form 21-0781a, Statement in Support of Claim, February 27, 2012; see e.g. VA Form 21-0781, Statement in Support of Claim, February 20, 2102; see also VA Form 21-4138 Statement in Support of Claim, February 20, 2102; and see also VA Form 21-4138 Statement in Support of Claim, October 13, 2011. Additionally, the Veteran asserts that he told his recruiter he had prior psychiatric history, and his enlistment was not “fraudulent.” See Service Treatment Record (STR), September 10, 2003. Moreover, the Veteran seems to assert that he sustained a traumatic brain injury during his service in Germany, resulting in his acquired psychiatric disorder. See VA Form 21-0781a, Statement in Support of Claim, December 13, 2019. Turning to the evidence of record, of record are October 1999 and December 1999 private psychiatric hospitalization records. At these times, the Veteran was diagnosed with schizophrenia, paranoid type. At a February 2000 enlistment examination for National Guard service, the Veteran denied any psychiatric history, and indicated “no” for nervous trouble of any sort. The Board notes that the Veteran’s service treatment records indicate that he had an acquired psychiatric disorder, namely schizophrenia, that preexisted service. Specifically, a June 2003 medical evaluation board proceedings record indicates the Veteran had a diagnosis of schizophrenia that preexisted service, and was not permanently aggravated by service. A medical board consult conducted by Dr. J.C. indicates that the Veteran first developed psychiatric symptoms in September 1993, had six hospitalizations between 1993 and 2000, was diagnosed with schizophrenia in 1999, and was psychiatrically unfit for active military service. Dr. J.C. found that the Veteran’s psychiatric history was consistent with the development of psychotic symptoms primarily and at the outset, before he experienced mood symptoms and diagnosed undifferentiated schizophrenia, and found him unfit to continue military service. A September 2003 service treatment record indicates the Veteran was treated for undifferentiated schizophrenia during active service by Dr. J.C. The Veteran spoke at length about his desire to stay in the military and countered the assertion by his command that his enlistment had been fraudulent. Specifically, the Veteran spoke at length about his disclosure to his recruiter of his psychiatric history, how he believed that the recruiter should be held responsible and stated he was receptive to going to JAG and Army personnel to pursue this avenue. Dr. J.C. again recommended the Veteran’s separation from military service. Service treatment records from the Veteran’s first period of active service are negative for any complaint of, treatment of, or diagnoses of any acquired psychiatric disorder. An October 1987 examination, two months after his separation from the first period of active service, the Veteran indicated “yes” to “nervous trouble of any sort,” and referred to an easy startle response. In a February 2012 VA Form 21-4138 Statement in Support of Claim, the Veteran asserted that he was stationed in Germany next to a unit that had six soldiers die by suicide via hanging and during his active service was aware of another soldier die by suicide via gunshot. Of record is a February 2012 lay statement submitted by the Veteran’s friend, V.C., a fellow veteran. In her statement, she stated that she experienced similar experiences during her active service, and “witnessed tragedies through [her] 20 years in the U.S. Army” to include deaths, suicides, accidental deaths, and the Persian Gulf War. She stated she remembered similar incidents while in Germany, and that she observed his struggles and sympathized with the Veteran. Notably, she stated she wanted to ask the Veteran about certain incidents but did not because she understood “those are things you want to forget about.” In a February 2012 VA Form 21-0781 Statement in Support of Claim, the Veteran asserted the incident regarding six soldiers dying by suicide occurred in July 1985, that the soldiers hung themselves and again indicated that another soldier died by suicide via gunshot. He also indicated that a stressor included being on “high alert” and being ready to go to war but that he did not go to Desert Storm. Then, in a separate February 2012 VA Form 21-0781a, Statement in Support of Claim, the Veteran asserts such incidents occurred in May 1982. In a May 2012 VA Form 21-4138 Statement in Support of Claim, the Veteran asserted he had an acquired psychiatric disorder as a result of anxiety and stress level experienced in active service. A June 2012 VA Memorandum indicates a formal finding of a lack of information required to verify stressors associated with a claim for entitlement to service connection for PTSD. Specifically, the Memorandum found insufficient evidence to verify stressful events described by the Veteran to include six soldiers hanging themselves in Germany in July 1985. In an August 2013 VA Form 21-4142 Authorization for Release of Information, the Veteran reported he witnessed a soldier jumping out of a window. In his August 2013 VA Form 9, the Veteran reports that he was in action during Desert Storm, and that he had served in a “PTSD era.” In a May 2017 Notice of Disagreement, the Veteran reported that his PTSD was due to a lack of sleep. In a December 2019 VA Form 21-0781a, Statement in Support of Claim, the Veteran asserted that his acquired psychiatric disorder was as a result of a soldier being smashed under a piece of equipment and vividly seeing their “brains on the concrete floor”; and falling on ice and being pinned and knocked unconscious during his service in Germany, resulting in a traumatic brain injury (TBI), and that such TBI led to his mental health condition. The Veteran was afforded a VA psychiatric examination in August 2020. At that time, the examiner diagnosed schizoaffective disorder, cannabis use disorder (now in sustained remission) and stimulant use disorder (now in sustained remission). The examiner also found the Veteran did not have a diagnosis of posttraumatic stress disorder (PTSD) nor TBI. With regard to his diagnosis of schizoaffective disorder, the examiner noted that the DSM-V diagnosis criteria of schizoaffective disorder best fit and represented the Veteran’s history of mood and psychotic symptoms over his lifetime since 1992. Specifically, the examiner noted that the Veteran’s discharge diagnosis of his first mood or psychotic episode on record, with hospitalization was in 1993 and that a diagnosis of schizoaffective disorder was evidenced as a form diagnosis as recently as 2013 with continued pharmacotherapy. The examiner found the Veteran did not meet the criteria for a diagnosis of PTSD and the examiner noted that the Veteran was asked about any stressful or traumatic events in his life. The examiner noted that the Veteran responded “[I] would say nothing, Sir,” and when asked about any specific military events or experiences, the Veteran stated “[I] had no fear of my life, but have been through some very traumatic experiences when I was on active duty,” and recounted four stressors. The examiner noted that those stressors included a soldier being crushed during his second period of active service while “overseas,” in maybe 1983 or 1984, several soldiers hanging themselves in “maybe 1983 or 1984,” and witnessing the soldiers hanging dead and witnessing mental institution patients in Pueblo die due to overmedication, which was noted to be between his periods of active service. The examiner noted that the Veteran was asked about any other lifetime stressors or traumas and stated he had no other issues, and was “waiting on my rating increase to 100 percent so I can buy my own house.” The examiner noted that all current mental health symptoms noted for the Veteran were viewed as components of his long-standing schizoaffective disorder. With regard to a diagnosis of TBI, the examiner noted that the Veteran’s service treatment records and medical evidence was silent to support the claim of any head injury, event, or loss of consciousness and that no records of trauma were found. After examination of the Veteran, the August 2020 VA examiner opined that the Veteran’s acquired psychiatric disorder clearly and unmistakably existed prior to service and was not aggravated beyond its natural progression by an in-service event, injury, or illness. In this regard, the examiner noted that the Veteran had well-documented episodes of highly severe and debilitating psychiatric symptoms well before the period of active service from June 2001 to September 2003 that included legal intervention, involuntary psychiatric treatment, and multiple psychiatric hospitalizations. The examiner noted there were also periods of highly severe and debilitating psychiatric symptoms after the above period of active service, that there were well-documented multiple periods of severe and debilitating mood and psychotic symptoms that did not develop until approximately five years after the Veteran’s first period of active service, and then continued with improved control up to and including during the Veteran’s second period of active service (until his “fraudulent enlistment” was detected in 2003, leading to his separation in 2003) and then beyond that period, including apparent at least partial remission of symptoms and discontinuation of all psychotropic medications in late 2018 and continuing to the present. The examiner noted that the natural progression of his schizoaffective disorder includes his current presentation upon examination today and that his current presentation is such that his substance use disorders are in sustained remission and is devoid evidence of a major mood disturbances, but involved the residual symptoms of disorganized thinking and speech. The examiner noted that the Veteran had been weaned off of all psychotropic medications in an outpatient setting between May to November 2018 and did not have a return of symptoms of a severity that necessitated hospitalization. Thus, it was the opinion of the examiner that the Veteran’s denial of current mental health problems, or psychotic symptoms, or mood complaints, and the medical evidence of record that the Veteran appeared to be functioning somewhat better than that time (albeit with grossly disorganized thinking or speech, with logic difficult to follow at times, and other symptoms as noted), compared to multiple times in his history. Therefore, permanent increase in severity was not present. The examiner noted that the natural course of schizoaffective disorder involved psychotic and mood symptoms that vary across the individual’s lifespan, as was the case for the Veteran. The August 2020 VA examiner also opined that the acquired psychiatric disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In this regard, the examiner noted that psychosis that was revealed in service was not likely related to an in-service injury, event, or disease in service and rather it was evidenced to have been present as early as September 1992. Also, it was the opinion of the examiner that aggravation or permanent increase in severity beyond the natural course of the disease for the Veteran’s pre-existing acquired psychiatric disorder was not evidenced. The examiner noted that the only mental health diagnoses found within the Veteran’s period of service from June 2001 to September 2003, or within a year pot-service, were variants of schizophrenia and a “rule out” diagnosis of bipolar disorder. Evidence detailed showed that the Veteran’s acquired psychiatric disorder clearly and unmistakably existed prior to his second period of military service, as shown by his hospitalizations beginning in the 1990s. The examiner also found that there was clear and unmistakable evidence that the Veteran’s mental health conditions existed prior to his second period of active service, to include his substance abuse disorders. There was no evidence to indicate a presence of any diagnosed mental health condition prior to the Veteran’s first period of active service. Again, the examiner noted the Veteran appeared to be functioning somewhat better that compared to multiple times in his history, and therefore a permanent increase in severity was not present. The August 2020 VA examiner also opined that the Veteran’s acquired psychiatric disorder was less likely than not incurred in or caused by the claimed in-service injury, event or illness. Specifically, the examiner again noted the Veteran did not have a diagnosis of PTSD as required by the DSM-V. Specifically, the examiner noted that the described in-service events would have occurred approximately 10 years prior to his first documented mental health diagnosis and that it would necessitate speculation to definitely say whether the described in-service stressors “actually occurred, as opposed to a delusion or an otherwise non-occurrence (such as due to lability) related to the Veteran’s diagnosed disorder.” In this regard, the examiner noted that one can only say that information contained in the available records did not speak to the history reported by the Veteran and was no evidenced in the available records reviewed. Therefore, it was beyond the scope of the examiner’s practice to determine whether a specific event occurred during a Veteran’s active military service and noted the question about whether there was sufficient evidence to substantiate the claim that an incident occurred is a legal question, and not a clinical one. The examiner then noted that the Veteran did not indicate at the examination that any kind of assault, military sexual trauma, or in-service stressor related to fear of hostile military or terrorist activity and the examiner evaluated the Veteran as a poor historian with marginal insight at best. Here, the Board finds that the overwhelming medical evidence shows that the Veteran’s acquired psychiatric disorder preexisted his second period of active service and was diagnosed approximately five years after his separation from his first period of active service. In this regard, the Board notes that the Veteran himself asserted he had only an increased startle response in October 1987 and the medical evidence indicates the Veteran was first hospitalized and diagnosed with an acquired psychiatric disorder in the 1990s. Specifically, the Veteran was diagnosed with schizophrenia in 1992 and was hospitalized several times between his two periods of active service. Thus, there is clear and unmistakable evidence that the Veteran was not sound upon entry of service for his second period of active service, and as such, the presumption of soundness does not apply. The acquired psychiatric disorder therefore preexisted service and the evidence must show that there was an increase in the disability during service to trigger the presumption of aggravation. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Turning to the question of whether there the Veteran’s preexisting acquired psychiatric disorder was aggravated by service, the Board notes that the August 2020 VA opinion is highly probative. In this regard, the examiner determined that the Veteran’s acquired psychiatric disorder clearly and unmistakably existed prior to service and was not aggravated beyond its natural progression by an in-service event, injury, or illness and that the natural course of schizoaffective disorder involved psychotic and mood symptoms that vary across the individual’s lifespan, as was the case for the Veteran. The Board that the VA examiner offered an etiological opinion as to the claimed disorder and based his conclusion on a review of the record, to include an interview with the Veteran and a full examination. Moreover, such opinion offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, supra; Stefl v. Nicholson, supra. This opinion is afforded great probative weight. There is no contrary opinion of record. The Board acknowledges the Court’s holding in Saunders but does not find a basis for determining that there is functional impairment related to a diagnosis of PTSD. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The August 2020 VA examiner specifically found that the Veteran did not meet the diagnostic criteria for PTSD as there were no findings, signs and/or symptoms to support a diagnosis. The August 2020 VA examination report and current clinical records do not support a diagnosis of a PTSD that confirms with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as is required for compensation for psychiatric disabilities. See Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); see Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Therefore, as the evidence of record shows that the Veteran does not have a current diagnosis of PTSD, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) (“A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.”); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection). The Board notes that the Veteran has contended that his acquired psychiatric disorder is the result service, and points to several accounts of unverified stressors occurring during active service. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to” and a mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question regarding the potential relationship between the Veteran’s acquired psychiatric disorder and any instance of his service to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, while the Veteran is competent to describe his current psychiatric symptoms, however, the Board accords his statements regarding the etiology of such a disorder little probative value as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, and requires the administration and interpretation of diagnostic testing. In the instant case, there is no suggestion that the Veteran has any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinions of the Veteran is nonprobative evidence. As discussed, to the extent that the Veteran contends that the acquired psychiatric disorder existed or was caused by his first period of active service, the Board finds that contemporaneous medical evidence showing no diagnosis of an acquired psychiatric disorder at separation at his first period of active service to be of greater probative value. Additionally, the Board notes that the Veteran has provided many contradicting accounts of in-service stressors and has been consistently evaluated to be a poor historian. In this regard, the Veteran reported stressors occurred in 1982, 1983, 1984, 1985 or that he was not sure. Further, the Veteran’s provided many different accounts of alleged stressors to include witnessing a soldier being crushed, seeing hanging bodies, injuring his head, and simply experienced heightened stress during service. The Board accepts that the Veteran is competent to report his psychiatric symptoms. See Layno v. Brown, supra. However, to the extent that he suggests that his symptoms started in service or within the one-year presumptive period after service, the Board finds that he is not credible. He denied having any psychiatric symptoms, aside from an increased startle response during his first period of active service, head injury on separation from service and asserted himself that he told his recruiter about psychiatric history upon reenlistment in 2003. Essentially, the Veteran’s own statements are incongruous with his having had onset of an acquired psychiatric disorder in service or within the applicable presumptive period, or as the result of any in-service stressor. Consequently, the Board finds that the Veteran’s statements have diminished probative value. Moreover, the Board notes the lay statement submitted by V.C. In that statement, V.C. did not confirm nor corroborate any stressor as claimed by the Veteran; rather, she simply stated that she experienced similar stressors during her period of service, and notably noted that she did not verify any of the Veteran’s statements or stressors. In sum, the weight of the competent and credible evidence demonstrates that the currently diagnosed acquired psychiatric disorder clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated by service. Accordingly, for the foregoing reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for an acquired psychiatric disorder and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Vision Disorder The Veteran contends that he has a vision disorder that is related to his active service. Specifically, he asserts that developed a vision disorder as a result of a fall sustained during active service. See VA Form 21-4138 Statement in Support of Claim, May 7, 2012. Additionally, his representative argues that such vision disorder was aggravated beyond its natural progression by active service. See Appellate Brief, October 29, 2020. Service treatment records and post service treatment records are silent for complaints of, treatment for, or diagnosis of a vision disorder. No post-service clinical records have been submitted related to any such diagnosis for a vision disorder. The Board notes that the Veteran has extensive VA treatment records, which are silent for complaints of, treatment for, or diagnosis of a vision disorder. In consideration of evidence of record, the Board finds no current diagnosis of a vision disorder is present. The Board notes a current disability is always required in order to establish service connection. See Brammer v. Derwinski, supra. With regard to the claimed vision disorder there is not sufficient evidence to show that the Veteran has had a vision disorder during the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The Board acknowledges the United States Court of Appeals for Veterans Claims (Court’s) holding in Saunders but does not find a basis for determining that there is functional impairment related to a diagnosis of a vision disorder. See Saunders v. Wilkie, supra. In addition, the Veteran has not alleged manifestations of similar severity, frequency and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 2020 U.S. App. Vet. Claims LEXIS 1609. The Board notes that the Veteran has not been afforded a VA examination addressing his claimed vision disorder. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained with respect to a Veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the Veteran’s service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and the veteran’s service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The service treatment records are otherwise negative for complaints, treatments or diagnoses related to any vision disorder. Further, the evidence does not indicate that the Veteran has a current diagnosis of a vision disorder. See McLendon, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide this claim. In summary, the controlling question in this case is answered in the negative. In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (stating that service connection presupposes a current diagnosis of the condition claimed, to at least confirm the veteran has it; without this minimum level of proof, there can be no valid claim). Therefore, as the evidence of record shows that the Veteran does not have a vision disorder, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) (“A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.”); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection). Accordingly, the Board finds that the preponderance of the evidence is against the claim and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.