Citation Nr: 21063379 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 11-24 568 DATE: October 14, 2021 ORDER Entitlement to a compensable rating for scar residuals, back, is denied. Entitlement to service connection for an acquired psychiatric disorder, including posttraumatic stress disorder, is denied. FINDINGS OF FACT 1. The Veteran's back scar is not deep or nonlinear, painful, or unstable, and there are no other disabling effects. The scar is not associated with underlying soft tissue damage. 2. An acquired psychiatric disorder, to include PTSD, was not manifest in service and is unrelated to service. 3. Personality disorders and substance abuse disorders have been identified. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for scar residuals, back, are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.118, Diagnostic Code 7805. 2. An acquired psychiatric disability, to include PTSD, was not incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.304, 4.125. 3. Personality disorders are not considered a disease or injury for purposes of VA compensation. 38 C.F.R. §§ 3.303, 4.9, 4.127. 4. A substance abuse disorder is not secondary to, or caused by, a service-connected disease or injury. 38 C.F.R. §§ 3.301, 3.310 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1982 to September 1985. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2016 and July 2017 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a Board hearing in April 2018. A transcript is of record. With respect to the Board hearing, the undersigned Veterans Law Judge clarified the issues on appeal, identified potential evidentiary deficits, clarified the type of evidence that would support the Veteran's claims, and elicited relevant testimony from the Veteran. These actions complied with any duties owed during a hearing. 38 C.F.R. § 3.103. In an August 2018 decision, the Board denied service connection for a psychiatric disorder, to include PTSD. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court). In a June 2019 Order, the Court granted the parties' Joint Motion for Partial Remand, vacated the Board's August 2018 decision, and remanded the matter for action consistent with the terms of the Joint Motion. In an April 2020 decision, the again Board denied the Veteran's claim of service connection for a psychiatric disorder, to include PTSD. The Veteran appealed the Board's denial. In a March 2021 Order, the Court granted a second Joint Motion for Partial Remand vacating the Board's April 2020 decision and remanded the matter for action consistent with the terms of the Joint Motion. Following the Court's March 2021 Order, the appeal streams for service connection for PTSD and for a compensable rating for a back scar were merged into a single appeal. The Veteran had sought entitlement a total disability rating based on individual unemployability (TDIU) as part of the instant appeals. However, a TDIU was granted in a January 2021 rating decision. This represented a full grant of the benefit originally sought, and the issue of entitlement to a TDIU is not before the Board. 1. Increased rating for scar residuals, back. The Veteran seeks a compensable rating for his service-connected back scar. Disability evaluations are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C. § 1155. Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from such disease or injury and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Here, the Veteran's scar residuals, back, is currently evaluated as noncompensable under Diagnostic Code 7805. He has challenged this evaluation, and generally contends a compensable rating is warranted because the scar is painful. VA amended the criteria for rating skin disabilities while the Veteran's claim was pending. The amendments became effective August 13, 2018, and changes were made to the diagnostic codes applicable to scars. The old version of Diagnostic Code 7805 in effect prior to August 13, 2018 applied to "scars, other (including linear scars) and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, and 7804" and instructed that disabling effects of scars not considered in a rating provided under diagnostic codes 7800 through 7804 are to be rated under an appropriate diagnostic code. The new version of Diagnostic Code 7805 pertains to "scars, other; and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804" and also instructs that any disabling effects of scars not considered in a rating provided under diagnostic codes 7800-7804 are to be rated under an appropriate diagnostic code. Neither the new nor old version of Diagnostic Code 7805 is more beneficial to the Veteran, as both instruct to rate disabling effects of scars under Diagnostic Codes 7800 through 7804 unless the scars cause disabling effects not considered in a rating provided under those codes. We note that service connection for the Veteran's back scar residuals was granted in a September 2014 rating decision. The scar was evaluated as a "linear scar" under the old version of Diagnostic Code 7805 and assigned a noncompensable rating under. The noncompensable rating was assigned pursuant to 38 C.F.R. § 4.31, which provides that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. After reviewing the evidence, the Board concludes that a compensable rating is not warranted. The preponderance of the credible evidence is against finding that the scar is painful or unstable, the scars are not deep or nonlinear, and the scar causes no disabling effects. The Veteran was provided a VA scars examination in September 2015. The scar was located on the left side of the Veteran's lower back at waist level and measured .1 centimeters wide by 2 centimeters long. The scar was noted as barely discernable with no elevation, depression, keloid, adhesion, inflammation, or breakdown. There was no pain or tenderness of the scar and the scar was not unstable, although the Veteran did report tenderness on palpation of the lower back. The scar was noted on a November 2015 VA back examination, and the examiner determined the scar was not painful or unstable and did not have an area equal to or greater than 39 square cm (6 square inches). He was provided another VA scars examination in March 2017. The Veteran reported that he was seen by his primary care provider who told him that he probably had "scar tissue knotting up" the nerves in his lower back, and that he believed his back pain is due to an internal scar from a stab wound. Physical examination showed the scar measured 2 centimeters long and was well healed with no elevation, depression, adhesion, keloid, inflammation, or break down. Light palpation of the Veteran's lower back showed generalized tenderness of the lower back with no pain or tenderness specific to the scar. The examiner noted that a February 2017 MRI did not reveal any signs of internal scar tissue and confirmed that the Veteran has degenerative disc disease with degenerative arthritic changes of his lumbar spine. The examiner determined the Veteran's back pain is directly related to the multilevel degenerative disease as described by the MRI and noted there is no evidence to support the notion that the Veteran's back pain is due to an external or an internal scar. The Veteran was provided another VA scars examination in June 2019. The examiner noted the scar left of the spine was well-healed, non-keloid, 2 centimeters long by .1 centimeters wide, and that the Veteran had mildly tender lumbar muscles. The scar itself was not tender or painful, was not unstable, and was not associated with underlying soft tissue damage. Here, the credible evidence establishes that the Veteran's service-connected back scar causes no disabling effect, to include any disabling effect that would not otherwise be compensated by rating under Diagnostic Codes 7800 through 7804. A compensable rating is not warranted under either the old or new versions of Diagnostic Code 7805 itself is not warranted. Furthermore, Diagnostic Codes 7800 through 7804 would not provide a compensable evaluation for the Veteran's service-connected back scar. Diagnostic Code 7800 is inapplicable as it relates specifically to scars of the head, face, or neck. Diagnostic Code 7801 is also inapplicable, as the scar is not deep, is not associated with underlying soft tissue damage, did not cause limited motion, and does not cover an area exceeding 39 square centimeters. Diagnostic Code 7802 would not allow a compensable rating. Diagnostic Code 7802, which refers to burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. VA amended the criteria for rating skin disabilities, effective August 13, 2018. Prior to the August 2018 amendments, regulations described these scars as superficial (not associated with underlying soft tissue damage) and nonlinear; the rating criteria in the Code was otherwise unchanged. The Veteran's back scar is not associated with underlying soft tissue damage. However, the scar covers approximately .2 square centimeters total, well below the threshold for a compensable rating under Diagnostic Code 7802. As such, he is only be entitled to a zero percent rating under Diagnostic Code 7802. See 38 C.F.R. § 4.31. Pursuant to Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent rating; three or four scars that are unstable or painful warrant a 20 percent rating; and five or more scars that are unstable or painful warrant a 30 percent rating. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. 38 C.F.R. § 4.118, Diagnostic Code 7804. Here, the most credible evidence establishes the Veteran's back scar is not painful or unstable as required for a compensable rating under Diagnostic Code 7804. Although the Veteran has reported that the scar is painful, VA physical examinations have regularly shown the scar is not painful. Rather, VA examiners have attributed the Veteran's back pain to his service-connected lumbar spine muscle strain with degenerative disc disease. The Veteran is competent to report symptoms such as pain. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, we find the VA examinations of the scar, which reveals the scar is not painful and attribute the Veteran's back pain to his service-connected lumbar spine disabilities, to be far more probative than his lay assertion that the scar is painful. The Veteran has reported that a doctor told him that increasing pain was due to scar tissue building up in his back. Veterans are competent to report what medical professionals have told them. Jandreau, 492 F.3d at 1377. However, the Veteran's assertion is not credible. Review of the medical evidence of record suggests no medical professional has ever told the Veteran that increasing pain was due to scar tissue building up in his back. As noted by the March 2017 VA examiner, February 2017 MRIs did not reveal any signs of internal scar tissues and showed that the Veteran had degenerative disc disease and degenerative arthritic changes of his lumbar spine that caused his back pain. The examiner concluded there was no evidence to support the notion that the Veteran's back pain is due to an external or an internal scar. No subsequent evidence shows painful back scarring, either internal or external. The Board acknowledges that lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan, 451 F.3d at 1336-37. However, the lack of contemporaneous medical evidence can be considered and weighed against lay statements. Id. In addition, when weighing evidence, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). The Veteran's assertions that his back scar is painful and that doctors have told him that increasing pain was due to scar tissue building up in his back are inconsistent with the medical evidence of record, which shows the Veteran's back scar is not painful and contains no evidence of painful scar tissue building up in his back. In sum, the preponderance of the evidence is against the claim and there is no doubt to be resolved. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; Gilbert, 1 Vet. App. at 55-56. Entitlement to a compensable rating for scar residuals, back, is denied. 2. Service connection for an acquired psychiatric disorder, including PTSD. The Veteran contends he has posttraumatic stress disorder (PTSD) due to witnessing a murder in service in 1985. Service connection may be established for disability resulting from personal injury or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110 (wartime service), 1131 (peacetime service). To establish service connection a Veteran must generally 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." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d). 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); 38 C.F.R. § 4.125. The United States Court of Appeals for Veterans Claims (Court) has held that the scope of a mental health disability claim includes any psychiatric disability that may reasonably be encompassed by a veteran's description of the claim, reported symptoms, and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). After reviewing the evidence, the Board finds the preponderance of the evidence is against the Veteran's claim. The Veteran has submitted a police report, dated in May 1985, which shows he reported being awoken at night by gunfire and witnessed a fellow servicemember being shot and killed. A service treatment records dated in January 1984 show a diagnosis of adjustment disorder with depressed mood related to a spouse abuse incident and marital problems. The August 1985 separation examination report showed a clinically normal psychiatric evaluation. On the August 1985 report of medical history, the Veteran reported a history of depression. The examiner explained referred to marital problems and the Veteran reported the depression had been resolved without treatment. There was no indication of PTSD or another psychiatric disorder. There are notes from when the Veteran first established treatment with the VA in 2007 of numerous active problems, mainly due to cocaine abuse or dependency. The first VA mental health treatment records are dated in March 2008 and show a diagnosis of cocaine abuse and substance-induced mood disorder. Over the next several years, the Veteran had psychiatric hospitalizations different times for cocaine abuse. The VA treatment record show numerous PTSD screens, with most screens being negative. As part of a claim for Social Security Disability, a state agency requested a psychological examination of the Veteran, which occurred in March 2008. The examiner reported that the Veteran had polysubstance dependency in early remission and personality disorder with passive-aggressive and antisocial features. The examiner noted the only trauma during active service was when he was hospitalized after his girlfriend stabbed him in the back and he feared never being able to walk again. The Veteran reported witnessing the murder at a September 2010 VA substance abuse treatment session, stating that he had frozen in shock and disbelief when he witnessed the event. He had a VA mental health intake interview in October 2010, where he reported experiencing horror at the time of the murder. The interviewing psychologist diagnosed the Veteran with adjustment disorder with mixed emotional features, cocaine dependence in early full remission, alcohol abuse in early full remission, and personality disorder not otherwise specified with antisocial and borderline features. The psychologist declined to diagnose PTSD. A December 2011 mental health HUD/VASH assessment from a licensed clinical social worker noted the Veteran reported he had PTSD but found such a statement did not support a diagnosis of PTSD during her assessment. After taking a detailed history and interview of the Veteran, the social worker diagnosed cocaine dependency in early remission and personality disorder, not otherwise specified. In July 2012, the Veteran had an examination for purposes of determining eligibility for Social Security Disability. The examining psychologist noted the Veteran had witnessed a homicide during service, and the Veteran reported he had flashbacks regarding the trauma and that loud noises upset him. The Veteran also reported that he had avoidance behavior, insomnia, irritability, and was jumpy and easily startled. He reported he was not often angry and did not often lose his temper. He reported taking anxiety medication. The examiner diagnosed adjustment disorder with anxiety and cocaine and marijuana use by history. The same psychologist provided an additional examination in September 2013 and noted cocaine and marijuana abuse by history and PTSD. The psychologist reported that the Veteran claimed he had PTSD and reported two VA doctors saw the Veteran for PTSD related to violence in the military. The Veteran reported a variety of stressors including being robbed at gunpoint, witnessing murders by gangs in California, being attacked by a gang, seeing someone murdered in service, and testifying in court regarding the murder. The examiner stated the Veteran had avoidance behavior, problems sleeping, irritability, and fear of crowds. The examiner noted that VA treatment records indicated cocaine abuse and adjustment disorder. The examiner also noted some inconsistencies in the Veteran's reports, including that the Veteran reported hallucinations and reported not getting along with people, neither of where present in the prior July 2012 examination. At the time of the September 2013 examination, the Veteran's VA treatment records showed diagnoses of anxiety disorder and cocaine dependency. PTSD was not listed as an ongoing problem. However, there were repeated notations of differential diagnosis, to include PTSD, Bipolar II illness, and intermittent explosive disorder. VA treatment notes report the only clear diagnosis was substance dependency. An April 2015 decision regarding PTSD from the Office of Disability Adjudication and Review found that the examiner relied heavily on the subjective report of symptoms and limitations provided by the claimant and accepted most of what the claimant reported. The decision found that "there exists good reasons for questioning the reliability of the claimants [sic] subjective complaints." The Veteran had a VA examination in November 2016, signed in December 2016. The November 2016 VA examination found the murder the Veteran had witnessed met the criteria for a PTSD-type stressor in service. However, personality assessment testing results and self-report of symptoms were determined not reliable and could not be considered as supporting a diagnosis of PTSD. Based on the Veteran's history of inpatient treatment for drug abuse, over-endorsement or exaggeration of symptoms, and lack of report of significant intrusive recollections or avoidance behaviors, no diagnosis of PTSD could be given. The examiner, based on an evaluation and a review of the evidence of record, determined that history and presentation were consistent with current diagnoses of antisocial personality disorder, cocaine use disorder in remission, and cannabis use disorder in remission. The examiner noted that he Veteran's occupational and social impairment was more likely due to cocaine use disorder and unspecified personality disorder, which caused relationship problems, unemployment, homelessness, and legal problems, including imprisonment. After psychometric testing, the examiner could not render a diagnosis for PTSD based on unusually high number of infrequent or implausible symptoms. Likewise, the examiner found the September 2013 opinion speculative and not supported by the medical evidence. A new VA examination was obtained in November 2017. On the November 2017 VA examination report, the examiner stated he reviewed the evidence of record and discussed the prior November 2016 VA examination. The examiner reported at length the Veteran's medical history including the murder in 1985. The examiner noted prior mental health evaluations found that the Veteran did not meet the criteria for PTSD. The examiner determined that, in these prior evaluations, the Veteran grossly over-endorsed infrequent and improbable symptoms, giving an invalid result. The examiner stated no valid diagnosis of PTSD had ever been given. In terms of whether the Veteran has a diagnosis of PTSD that is at least as likely as not (50 percent or greater probability) related to the claimed in-service event, the 2017 VA examiner agreed with the 2016 VA examiner, that the Veteran's current report of symptoms and clinical presentation were not consistent with a PTSD diagnosis. The examiner stated the most recent VA treatment records for the most part only referenced cocaine use disorder in remission. The examiner noted the April 2017 VA record that reported other trauma related disorder, prominent irritability, with differential diagnosis of complex PTSD, bipolar II illness, and intermittent explosive disorder due to imprisonment and other life situation. The VA examiner stated that this note was a working or provisional diagnosis, and that the diagnoses were offered after a superficial process with no direct review for each symptom via interview for the diagnosis, less consideration of alternative diagnosis to explain the Veteran's behavior, and no valid testing regarding the Veteran's reliability. The examiner noted the Veteran had history of drug abuse, including multiple psychiatric hospitalizations, with annual screening for PTSD being highly inconsistent with no pattern overtime. In both the 2016 and 2017 VA examinations, the examiners found that testing of the Veteran results that were not sufficiently reliable to be considered alongside his presentation and past treatment. The examiner found the Veteran was considered a poor historian. The examiner diagnosed antisocial personality disorder and stimulant (cocaine) use disorder, in sustained remission. In support of his claim, the Veteran has submitted a private mental health evaluation report dated November 2019 from E.Z., Psy.D. Dr. E.Z. documented the Veteran's medical history and after evaluation of the Veteran and consideration of his medical history rendered a diagnosis of PTSD. Her rationale was based largely on finding that the Veteran met the diagnostic criteria for a diagnosis of PTSD. Specifically, she reported Criterion A was met as the Veteran witnessed, in person, the murder of a fellow service member. Criterion B was met as intrusion symptoms were noted following the incident. Criterion C was met as the Veteran avoided thinking about the incident based on him leaving the Air Force early due to the murder trial and that he drank heavily. His cluster of symptoms related to increase in violent behavior, withdrawal from relationships, difficulty feeling pleasure or happiness without using controlled substances, and feeling of guilt and shame satisfied Criterion D. Criterion E was met as there was evidence of irritable behavior and angry outbursts, self-destructive behavior, paranoia, suspiciousness, sleep disturbance, and problems with concentration. Dr. E.Z. explicitly excluded the diagnosed antisocial personality disorder because there was no evidence of a conduct disorder or antisocial traits prior to the age of 15. Regarding the November 2017 VA examination, Dr. E.Z. noted the evidence used to support the antisocial personality disorder was impulsive behavior, irritability, aggressiveness, and lack of remorse. The examiner cited evidence suggesting the Veteran is not impulsive or fails to plain ahead, noted that irritability and aggressiveness can be used to support a diagnosis of antisocial personality disorder, Bipolar II, or PTSD and is also consistent with stimulant intoxication and withdrawal. She also cited multiple instances in VA treatment records where the Veteran disclosed feelings of shame, guilt, and remorse. Dr. E.Z. also noted that a diagnosis of a personality disorder was most frequently offered when the Veteran was using controlled substances, and that since he became sober a personality disorder diagnosis was only offered during VA C&P examinations. She concluded that treatment providers inconsistently offered the diagnosis of a personality disorder, were frequently unable to offer a specific diagnosis, and when a specific diagnosis of a personality disorder was made the consequences of his addiction were discounted and DSM criteria were ignored. Dr. E.Z. also determined that Criteria F, G, and H for PTSD were met because the Veteran's symptoms exceeded one month, caused distress, and were not better accounted for by either a personality disorder or by the physiological effects of a controlled substance, noting that the Veteran's symptoms had continued after he attained sobriety in 2011. Dr. E.Z. noted the November 2016 and November 2017 VA examiners' comments on the Veteran's credibility and the invalid MMPI-2-RF results, and based on her interview with the Veteran, determined his reports were consistent with the available documentation and found no reason to doubt the Veteran's veracity. Dr. E.Z. concluded that there were no other events other than witnessing the murder in 1985 that would better account for his current symptoms, and that it is at least as likely as not that the Veteran's PTSD is due to witnessing the murder. Dr. E.Z. also concluded that it was at least as likely as not that the Veteran's dependence on alcohol and cocaine developed secondary to the PTSD, determining that the Veteran's substance use initially was a form of self-medication for his emerging and worsening psychiatric symptoms following the murder. Subsequent VA treatment records show the Veteran was assessed with PTSD by a nurse practitioner in July 2020 based on reports of trauma-related symptoms including depression, hypervigilance, avoidance, and intrusive thoughts. The Veteran continued to have individual therapy sessions as part of the VA SARRTP/SATC program, and the treating psychologist noted a diagnosis of cocaine use disorder in remission. For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) the product of reliable principles and methods; and (3) the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion. Id. Here, we find the September 2013 medical opinion that the Veteran had PTSD accepted the Veteran's reported history, which contradicted the pertinent medical evidence of his treatment history. The September 2013 opinion found a PTSD diagnosis based, at least partially, on the Veteran's statements that he already had been diagnosed and treated with PTSD by the VA. The Veteran had not been diagnosed with PTSD by his VA physicians and the Veteran's statements regarding his claimed symptoms were contradicted by the lengthy and detailed VA treatment records. A medical opinion based on an inaccurate factual premise is not probative. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The November 2016 and November 2017 VA examinations and opinions are probative evidence showing that the Veteran does not have PTSD, and instead has only personality disorders and substance abuse disorders. The examiners based their negative opinions on a thorough review of the Veteran's medical history and interviews with the Veteran where he reported his history and symptoms. The November 2016 examiner determined PTSD could not be diagnosed because the MMPI-2-RF testing indicated the Veteran was over-reporting or exaggerating complaints and that the Veteran had endorsed an unusually high number of infrequent or implausible symptoms, and PTSD could not be diagnosed because the overall profile was considered invalid. The November 2017 examiner reached a similar conclusion, explaining that the Veteran's self-report was unreliable for the process of identifying his current psychiatric symptoms, and the sum of his treatment records indicated the presence of psychiatric symptoms that are due to this inservice event is unlikely. However, Dr. E.Z.'s November 2019 examination and opinion are probative evidence showing the Veteran has PTSD that is related to his service. Dr. E.Z. rendered her opinions after a thorough review of the Veteran's medical history and an interview with the Veteran where he reported his history and symptoms. Dr. E.Z. addressed the Veteran's history of multiple diagnoses, determined he did not have a personality disorder, and addressed the Veteran's history of substance abuse disorders and being an unreliable historian. Dr. E.Z.'s opinion is fully articulated and includes sound reasoning for her conclusions. Dr. E.Z. considered all the prior evidence of record in arriving at her conclusions, including the 2016 and 2017 VA examinations and the personality disorder diagnoses in both. The Board is presented with conflicting evidence regarding whether the Veteran has PTSD and whether PTSD or any other psychiatric disorder is related to his service. As explained above, service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a), a link stablished by medical evidence between current symptoms and an in-service stressor, and credible supporting evidence that the claimed in-service stressor occurred. Here, the Veteran has been diagnosed with PTSD. Dr. E.Z. is a private psychologist and PTSD was diagnosed pursuant to the DSM-5 criteria following an interview with the Veteran and review of the record. Dr. E.Z. provided a medical nexus opinion linking the Veteran's PTSD to an in-service stressor, specifically a murder he witnessed in May 1985. Finally, the Veteran has submitted a copy of the police report he provided in May 1985 following the murder, which we find is credible supporting evidence that the stressor occurred. The Veteran has been diagnosed with different psychiatric disorders at various times throughout the appeals period. During the period on appeal his most prominent diagnoses have been cocaine use disorder and cannabis use disorder in full remission and other specified personality disorder as diagnosed by the November 2016 VA examiner; antisocial personality disorder and cocaine use disorder in sustained remission as diagnosed by the November 2017 VA examiner; and PTSD with alcohol and stimulant disorder in remission as diagnosed by Dr. E.Z. in November 2019. VA treatment records show diagnoses of personality disorder not otherwise specified, adjustment disorder with mixed disturbance of emotions and conduct, and related cocaine dependency in remission. In April 2017, a DSM-V diagnostic impression showed the Veteran had unspecified trauma-related disorder and cocaine use disorder in remission. The Board has considered the Veteran's lay statements. In adjudicating a claim, the Board must fully assess the competence and credibility of the Veteran. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006); Washington v. Nicholson, 19 Vet. App. 362 (2005). Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). Here, the Veteran is competent to report what he experienced, including the in-service murder and his symptoms. The occurrence of the stressor is supported by the contemporaneous police report. However, the Veteran's after-the-fact assertions that his psychiatric symptoms are all attributable to the in-service stressor are inconsistent with his contemporaneous statements made during service and at separation from service regarding psychiatric symptoms. During service the Veteran was assessed with adjustment disorder with depression due to marital problems and violence, although this incident and diagnosis occurred before the May 1985 stressor. However, at separation in August 1985, the Veteran reported only a history of depression related to marital problems that had resolved without treatment. The separation examination and medical history were completed months after the May 1985 murder occurred. The Veteran reported no relevant symptoms or history of symptoms related to the stressor. Depression was related only to the Veteran's marriage and had resolved. Most importantly, there was no indication of PTSD or any other psychiatric disorder related to the May 1985 murder. The psychiatric evaluation was also clinically normal at separation, suggesting no psychiatric disorder was present at separation in August 1985. The first documented reference to psychiatric symptoms caused by the murder appears in a September 2010 VA substance abuse treatment program note. The Veteran also reported witnessing the murder during the October 2010 mental health intake interview. However, the examining psychologist determined the Veteran was an unreliable historian because several of his reports were inconsistent with information contained in his file. The psychologist also determined that the personality assessment inventory was invalid to due gross over-endorsement, and determined the Veteran appeared to be having mild anxiety and depression related to his conflicted relationship with his girlfriend. Notably, the psychologist determined the Veteran did not have PTSD, and instead diagnosed adjustment disorder with mixed emotional features, cocaine dependence in early, full remission, alcohol abuse in early, full remission, and personality disorder NOS with antisocial and borderline features. The Veteran reported being treated for PTSD due to the in-service murder in the July 2012 Social Security psychiatric examination. Although the Veteran reported being treated by a VA psychiatrist for PTSD at the time, review of the relevant VA records show he was treated for cocaine abuse, adjustment disorder, and anxiety. Notably, neither the adjustment nor anxiety disorders were attributed to his service by VA psychologists and psychiatrists. The Board assigns high probative value to the Veteran's service treatment records. Although the Veteran had depression and was assessed with an adjustment disorder during service, these were attributed to his marriage and he reported the symptoms had resolved at separation. The psychiatric evaluation at separation, which occurred after the in-service murder, was clinically normal. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant). The Board also assigns high probative value to the many years intervening service and the first documented findings or complaints of mental health problems relating to the in-service murder. See Buchanan, 451 F.3d at 1337; Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that the Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disorder at issue). The Board acknowledges that Dr. E.Z. concluded there was no reason to doubt the Veteran's veracity regarding the onset and nature of his symptoms. However, the VA examiners reached the opposite conclusions following similar interviews with the Veteran and reviews of the record. The November 2016 VA examiner determined the Veteran's psychiatric profile was invalid because the Veteran endorsed an unusually high number of infrequent or implausible symptoms when administered the MMPI-2-RF test to assess his psychological and emotional functioning. The November 2017 VA examiner found the Veteran's self-report was not sufficiently reliable to be considered alongside his presentation and past treatment records for the purpose of identifying PTSD. As discussed above, evidence of record shows that the Veteran has not been a reliable historian. Service treatment records show adjustment disorder with depressed mood attributed to marital discord and domestic violence, and at separation from service in August 1985 the Veteran reported that his symptoms had resolved. There was no indication that PTSD or another psychiatric disorder attributable to the May 1985 murder was present when the Veteran separated from service. Multiple medical professionals have noted inconsistencies in the Veteran reports and have questioned the Veteran's reliability and credibility. Although the Veteran was diagnosed with PTSD by a psychologist in September 2013, the diagnosis was based on the Veteran's statements which included that he already been diagnosed and treated for PTSD by the VA, which he had not. At the time of the September 2013 examination, the Veteran's VA treatment records showed diagnoses of anxiety and cocaine dependency. Although differential diagnoses included PTSD, contemporaneous VA notes report the only clear diagnosis was substance abuse, and PTSD was not listed as an ongoing problem at the time of the September 2013 opinion. The September 2013 opinion itself noted that the Veteran endorsed symptoms such as hallucinations and inability to get along with people that he had previously denied and the Veteran reported a variety of symptoms of PTSD which were not documented in VA treatment records, which record a detailed history of ongoing treatment. Furthermore, an April 2015 decision regarding PTSD from the Office of Disability Adjudication and Review found that the examiner had relied heavily on the subjective report of symptoms and limitations provided by the claimant and accepted most of what the claimant reported and found that there were good reasons to question the reliability of the Veteran's subjective complaints. Both the November 2016 and November 2017 VA examiners determined the Veteran's statements regarding his symptoms were unreliable because his self-reports were inconsistent with information contained in his medical record and because results of a personality assessment inventory were invalid due to over-endorsement or exaggeration of symptoms. Given the foregoing, the Board finds the Veteran's history of not being a credible historian and over-endorsing symptoms renders his lay statements less credible than the medical evidence of record, including the November 2016 and November 2017 VA examinations and opinions, the service treatment records, and VA treatment records. As a result, the November 2019 examination and opinion from Dr. E.Z. is less probative than the VA examinations and opinions due to its reliance on the Veteran's lay statements. The Board acknowledges that Dr. E.Z. addressed the Veteran's credibility and the 2016 and 2017 examiners' findings regarding reliability and found no reason to doubt the Veteran's veracity. However, the Veteran has a well-documented history of not being a credible historian and over-endorsing symptoms. We also note that the Veteran still has not been diagnosed with PTSD by his VA physicians and psychologists. Dr. E.Z.'s November 2019 examination and opinion alone does not outweigh the remainder of the evidence or establish an equal balance of evidence. As discussed, the Veteran's lay reporting of his symptoms and diagnosis has been inconsistent, and multiple medical professionals have questioned his credibility. Any impressions in the VA treatment records of PTSD were provisional or based upon the Veteran's own inconsistent lay reporting of his symptoms or diagnosis. Although a nurse practitioner diagnosed PTSD as recently as July 2020, the diagnosis was rendered based on a short phone conversation and there is no indication the diagnosis was made pursuant to the DSM. His treating VA psychologist has not diagnosed PTSD. The evidence in support of the Veteran's claim is Dr. E.Z.'s private assessment, which while probative, is outweighed by the remainder of the evidence of record. The evidence is not in approximate equipoise, and the preponderance of the evidence is against the Veteran's claim for service connection for PTSD. As to the numerous other mental health disorders diagnosed in VA treatment records, to the extent the Veteran has a mental health disorder besides a personality disorder or a substance abuse disorder, these VA treatment records are less probative then the VA examiners' opinions for the reasons already discussed above. The Veteran has a history of not being a credible historian and over-endorsing symptoms. As a result, the VA examiners found only substance abuse and personality disorders. In addition, most of the recent VA treatment records only list substance use disorders. The Board finds this medical evidence probative on the matter. The Veteran has been diagnosed with personality disorders and drug and alcohol abuse disorders in remission. Personality disorders are not diseases or injuries within the meaning of the law. 38 C.F.R. §§ 3.303, 4.9, 4.127. VA disability compensation benefits may not be awarded for disability related to the abuse of alcohol or drugs on the basis of service incurrence or aggravation. 38 U.S.C. §§ 105, 1131; 38 C.F.R. § 3.301. There is no evidence of record that the Veteran's alcohol and drug abuse disorders are secondary to, or caused by, a service-connected disability. 38 C.F.R. §§ 3.301, 3.310; Allen v. Principi, 237 F.3d 1368, 1381 (Fed. Cir. 2001). As such, compensation cannot be award for these disorders by law. The claim for an acquired psychiatric disorder, to include PTSD, is denied. The preponderance of the evidence is against the claim, and the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Morse 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.