Citation Nr: 21068407 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 12-17 752 DATE: November 10, 2021 ORDER Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), is denied. REMAND Entitlement to service connection for a thoracolumbar spine disability is remanded. FINDING OF FACT The evidence of record is against finding that the Veteran's acquired psychiatric disability, to include PTSD, occurred in, or is the result of, his period of active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disability, to include PTSD, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.304(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1973 to October 1976 and in the Mississippi Army National Guard from March 1983 to March 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2008 Rating Decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. These issues have been remanded by Board several times and each subject to separate appeals to the United States Court of Appeals for Veterans Claims (CAVC). Their pertinent, respective procedural history will be discussed in each section. The psychiatric claim first was remanded in a September 2016 Decision. There, the Board instructed the agency of original jurisdiction (AOJ) to make additional attempts to obtain the Veteran's service treatment records (STRs) and military personnel records (MPRs), as well outstanding records from the Social Security Administration (SSA). The AOJ further was instructed to obtain updated VA medical center (VAMC) records and to afford the Veteran a psychiatric examination and etiological opinion. Over the course of the next six months, the AOJ confirmed the unavailability of the Veteran's active duty STRs and MPRs, obtained his SSA and updated VAMC records, and obtained an etiological opinion (discussed more fully below). In June 2018, the Board again remanded this claim, finding as necessary additional attempts to verify the Veteran's alleged in-service stressors for PTSD (those theories will be addressed below). Depending on the produced development, the AOJ was to secure an addendum opinion. A January 2020 Response to VA Request for Information indicated that the Veteran's alleged stressors could not be confirmed. In an April 2020 Decision, the Board denied this issue. The Veteran appealed that determination to the CAVC. The Veteran and the Office of the General Counsel for VA (collectively referred to as "the Parties") resolved that appeal by way of a May 20, 2021, Joint Motion for Partial Remand (JMPR). The Parties agreed that the Board issued its April 2020 Decision prematurely. Specifically, the JMPR details that Counsel for the Veteran received a response to a previously filed Privacy Act Request, informing him that he was being provided with the Veteran's records on a compact disc (CD). The Parties agree that, on January 8, 2020, Counsel contacted the named Privacy Officer assigned to Counsel's request to inform him that the disc was unreadable. On January 28th, Counsel again contacted the Privacy Officer and asked him if the CD should be returned, to which the Privacy Officer replied yes. The record, however, does not indicate whether Counsel ever received a viable CD; thus, the Board erred in issuing its April 2020 Decision before confirming whether Counsel received this information. By a June 1, 2021, Order, the CAVC adopted the Parties' JMPR and vacated the Board's April 2020 Decision with respect to this issue, remanding it back for appellate consideration. In October 2020six months after the Board's latest Decision on this issueVA notified Counsel that it was fulfilling his earlier June 1, 2020, Freedom of Information Act (FOIA)/Privacy request by providing him with a CD containing the Veteran's complete claims file. Counsel's previous, unfulfilled request, which was the subject of the JMPR, was the catalyst for his filing, prior to seeking relief in the CAVC, two motions to vacate, both of which the Board denied. See July 27, 2020, Second Motion to Vacate BVA Decision April 15, 2020; May 7, 2020, Motion to Vacate BVA Decision April 15, 2020. It has been more than one year since Counsel has been afforded a new CD containing the Veteran's claims. He has not alleged defect in that CD, and there are no other outstanding FOIA/Privacy Act requests. Thus, the Board is satisfied that the Veteran has been afforded substantial compliance with all prior Board and CVAC remands, permitting the Board to readjudicate this issue. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). Although the Veteran originally filed for and continues to seek entitlement to service connection for PTSD, his claim encompasses entitlement to service connection for any acquired psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Veteran has asserted several theories as to the cause of his psychiatric disabilities. He states that he almost drove off a cliff at night; at Fort Carlson, Colorado, witnessed a fellow service member get cut in half by a tank that became loose and rolled away; and that he was scared by a fellow service member's prank involving a rattlesnake. See, e.g., Jan. 16, 2019, Correspondence; Mar. 14, 2007. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009). For disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. § 1110. To establish service connection, there must exist medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); 38 C.F.R. § 3.303(a). To establish entitlement to service connection for PTSD, there must be: (1) medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a), which requires a diagnosis in accordance with the Diagnostic and Statistical Manual, Fifth Edition (DSM-5); (2) credible supporting evidence that the claimed, in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). With respect to the second element for PTSD, where the claimed stressor is unrelated to combat, lay testimony alone generally is not sufficient to establish that an in-service stressor occurred; it must be corroborated by credible supporting, evidence. Cohen v. Brown, 10 Vet. App. 128, 142 (1997). Lay testimony alone may be sufficient where (1) a veteran was diagnosed with PTSD during service with a stressor related to that service; (2) a veteran qualifies as a combat veteran under 38 U.S.C. § 1154 with a stressor related to that service; (3) there exists a stressor related to fear of hostile military or terrorist activity; and (4) where the veteran was a prisoner of war under 38 C.F.R. § 3.1(y) with a stressor related to that prisoner-of-war experience. 38 C.F.R. § 3.304(f)(1)(4). In rendering a decision on appeal, the Board must analyze the competency, credibility, and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Buchanan v. Nicholson, 451 F.3d 1331, 133537 (Fed. Cir. 2006). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102. The majority of the Veteran's STRs are unavailable for review, as all efforts to obtain them from all potential sources have been unsuccessful. The National Personnel Records Center (NPRC) has conducted an extensive and thorough search of the records among their holdings and reported they were unable to locate the Veteran's records. They ultimately concluded that all further efforts to locate the records at NPRC would be futile. See, e.g., Nov. 17, 2009, VA Memorandum. When service department records are missingas is the case herethere is a heightened duty on the Board to explain its findings. Dixon v. Derwinski, 3 Vet. App. 261, 26364 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991); 38 C.F.R. § 3.159(e). Case law, however, does not establish a heightened "benefit of the doubt," only a heightened duty of the Board to consider the applicability of the benefit of the doubt, to assist the claimant in developing a claim, and to explain its decision when a veteran's medical records have been lost. Ussery v. Brown, 8 Vet. App. 64, 68 (1995). Case law similarly does not lower the legal standard for proving a claim for service connection but rather increases the Board's obligation to evaluate and discuss all the evidence that may be favorable to a claimant. Russo v. Brown, 9 Vet. App. 46, 5051 (1996). The Veteran's March 1983 enlistment examination for the Mississippi National Guard did not identify any abnormal psychological findings. On the corresponding report of medical history (RMH), the Veteran denied any trouble sleeping, depression or excessive worry, loss of memory, and nervous trouble of any sort. Overall, he stated that he was in good health and taking no medication. In late April 1996, the Veteran was admitted to a VA hospital for polysubstance abuse. A May 8th entry shows that he sleeps throughout the night without any problems. He expressed concerns about the challenges that sobriety offered. The following day he stated he was feeling well without any complaints. A May 13th discharge note states that he attended classes on alternative coping skills for assertive communication, anger management, and stress management. He had good verbal participation in group discussions. VAMC records reveal an August 2001 negative depression screening and the Veteran's denial in June 2002 of any depression; although, there was a May 2002 positive depression screening. A July 2006 entry reveals another negative depression screening. In his April 2008 Notice of Disagreement (NOD), the Veteran states that, while in service, he was unaware what PTSD was and, as a result, failed to secure treatment. After learning about PTSD, however, it is his belief that he has such a diagnosis due to his alleged in-service events. Private psychiatric treatment notes in January 2009 reveal that the Veteran began receiving routine treatment from Dr. D.A. At the first session, it was noted that, in August 2008, the Veteran was working as a bus driver for a casino. He was involved in an accident whereby the bus hydroplaned and crashed, killing three passengers. The Veteran expressed feeling responsible for the incident despite realizing that it was an accident. The Veteran complained of a "low mood" on and off. Dr. D.A. indicated that the Veteran had not received any psychiatric treatment in the past but that he has "always been irritable but worse now." These treatment notes reflect that the Veteran "did not see combat but witnessed a co-worker killed in an accident." Overall, Dr. D.A. noted that the Veteran did not meet the criteria for major depression at that time but did have many symptoms. He was diagnosed with acute stress disorder. The Veteran underwent routine treatment through 2011. In June 2012 the Veteran had a VA neuropsychology consultation. Under the "psychosocial history," the examiner noted that the Veteran's military service and 2008 motor vehicle accident, but there was no mention of any psychiatric trauma during service. Under the "impressions" section, the examiner noted that, psychiatrically, the Veteran is in the midst of a major depressive episode that began following his 2008 MVA. While this incident was certainly traumatic for the veteran and continues to weigh heavily in his thoughts, he does not meet diagnostic criteria for PTSD at present. Positively, he returned to work in the last year and reported that he is able to perform his job reasonably well. He has experienced heightened anxiety when boarding buses in the "motor pool" at work; however, this anxiety appears circumscribed a limit number of circumstances which are easily avoided as such duties are not part of his standard work responsibilities. In a January 2014 VA Form 21-4138, the Veteran admitted that, after his release form service, he "did a lot of drinking and cocaine." He alleges that he was not aware how severely his military experiences had affected him, which still bother him to this day. In a June 2015 VA psychology consultation, the Veteran stated that he had PTSD, but was vague about symptoms. He endorsed symptoms when directly asked, but he did not spontaneously report them. A July 2015 VA mental health consultation indicates that the Veteran endorsed significant trauma due to a deployment in Vietnam, as well as witnessing "a boy run over by a truck." PTSD again was ruled out. March 2016 VAMC records reveal that the Veteran underwent a psychiatric examination. The examiner diagnosed the Veteran with depression, anxiety disorder, and specifically ruled out PTSD. A December 2016 VA medical opinion noted that the Veteran did not meet the criteria for PTSD but did have a diagnosis of other specified trauma and stressor related disorder, which, in the examiner's opinion, was related to the Veteran's reported stressors. The examiner also noted that the Veteran appears to have "characterological traits that may contribute to some of his behavior." A December 2017 letter from Dr. D.A. indicates that he has been treating the Veteran since January 2009 for PTSD and possibly mild vascular dementia. Routine VAMC treatment notes throughout 2018 and updated treatment records from Dr. D.A. in 2019 indicate that the Veteran was treated for PTSD. In February 2019, VA received a written statement form the Veteran's wifeP.W. She acknowledges that she did not know the Veteran during his time in service but that he has told her various stories from that time. P.W. recounts the Veteran's allegation of witnessing another soldier being run over by a tank and almost driving off a cliff but also stated that the Veteran told her he witnessed another soldier die during a shooting drill. In a March 2019 VA Form 27-0820, the Veteran informed a VA employee that he could not remember the details of his alleged stressor vis-à-vis the tank incident; he stated that occurred sometime between 1973 and 1976. An August 2019 National Archives and Records Administration letter indicates that, after reviewing the (1) Records of the U.S. Army Material Command (Record Group 544); (2) Records of U.S. Continental Army Command (Record Group 546) and (3) Records of U.S. Army Training and Doctrine Command (Record Group 553, it was unable to locate any unit records for Army units stationed at Fort Carson, Co during 1973 (including [the Veteran's] unit of interest). Searches for morning reports also yielded unfavorable results. A January 2020 Joint Services Records Research Center Claims Automated Processing System response stated the following: We have coordinated our research with the National Archives and Records Administration in College Park, Maryland. They were unable to locate copies of unit records submitted by the 1st Squadron, 10th Cavalry for the January December 1973 time period. Also, we researched the historical and casualty information available to this office. We are unable to locate documentation verifying an incident in which a soldier was crushed by a tank at Fort Carson, Colorado in 1973. An August 2020 statement from P.W. indicates that she met the Veteran in 1982a year before the Veteran entered the National Guard. She reports that, at the time, he had anger problems and would get upset easily. She also noticed that he lacked social engagement and suffered from sleeping problems and nightmares. She continued: Back then mental health issues weren't talked about. He just had anger problems is all that I knew and wasn't social. We didn't know ha had PTSD. He was like that when I met him, so I just thought it was his personality. I didn't know him prior to his active duty time but I've been told by others that he wasn't always this angry. The remainder of her statement addresses the current severity of the Veteran's psychiatric symptoms. The Veteran also wrote his own statement in August 2020. He reiterated his two alleged stressors of the cliff and tank incident. He indicated that, when he joined the National Guard, he kept his mental issues "to [him]self." The Veteran noted that he began seeing Dr. D.A. for back pain after his 2008 motor vehicle accident and that he ultimately was diagnosed with PTSD. He adds, however, that "other doctors" in the past told him he "may have PTSD," but he "didn't take further action with it because [he] didn't think anything was wrong . . . ." A friend and fellow service member of the VeteranA.B.also submitted an August 2020 statement. A.B. alleges that he served on the same base as the Veteran but not in the same unit. In pertinent part, he stated: "I recall one morning a tank got lose and [the Veteran] watched a guy get cut in half. [The Veteran] was really freaked out about that for 5 months." In a private September 2020 medical opinion, Dr. K.B. stated that the Veteran "encountered several stressful and traumatic situations that impacted his mental health. He presents with symptoms consistent with a diagnosis of specified other trauma and stressor-related disorder. This mental health disorder more likely than not started during his service." The Board acknowledges that the evidence shows both a diagnosis of PTSD as well as other non-PTSD psychiatric diagnoses. Thus, the first element of service connection for both PTSD and non-PTSD psychiatric disabilities have been met. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a), 3.304(f). Moving to the second element, the Board recognizes that a claim for PTSD and one for any other psychiatric disability requires different standards. "If Congress has explicitly left a gap for the agency to fill, there is an express delegation of authority to the agency to elucidate a specific provision of the statute by regulation. Such legislative regulations are given controlling weight unless they are arbitrary, capricious, or manifestly contrary to the statute." Chevron, U.S.A., Inc. v. Nat. Res. Def. Council, Inc., 467 U.S. 837, 84344 (1984) (footnote omitted). Here, Congress has delegated VA broad rule-making authority for regulations covering "the nature and extent of proof and evidence and the method of taking and furnishing them in order to establish the right to benefits under [VA compensation] laws." 38 U.S.C. § 501(a)(1). Congress also has not enacted any legislation prescribing the requirements for a claim of PTSD, and VA's own regulations prescribing different evidentiary standards for PTSD and non-PTSD psychiatric disabilities is not arbitrary, capricious, or manifestly contrary to the authorizing statute. Compare 38 C.F.R. § 3.304(f) (requirements for service connection for PTSD), with 38 C.F.R. § 3.303(a) (requirements for service connection generally). Thus, the Board must analyze separately PTSD and any other non-PTSD diagnoses. As to PTSD, the Board finds that evidence does not satisfy the second element. As noted above, because the Veteran's alleged stressors are unrelated to combat, lay evidence alone is not sufficient; it must be corroborated by credible, supporting evidence. See Cohen, 10 Vet. App. at 142. That is all the Board has in this case. The only pieces of evidence regarding the Veteran's stressors of almost driving off a cliff and witnessing a fellow soldier being run over by a tank are the Veteran's lay statements asserting that those events occurred and the essential hearsay statements from P.W. and A.B. that they occurred. Because the vast majority of the Veteran's STRs and MPRs were unavailable for review, VAas directed by the Board on more than one occasionconducted widespread and thorough research via multiple entities to verify the Veteran's alleged stressors, all to no avail. Thus, the Board is satisfied that it has fulfilled its heightened duty ot assist the Veteran where his military records are unavailable for review. See O'Hare, 1 Vet. App. at 367. Therefore, the Board is left with no alternative to find that the second element for service connection for PTSD has not been met. See 38 C.F.R. § 3.304(f)(1)(4). As to all the other non-PTSD psychiatric diagnoses of record, the evidence weighs against finding that the second element of service connection has been established. The Board reaches this conclusion because, after weighing several pieces of evidence and viewing the record in its totality, it does not find as credible the Veteran's assertions. To start, the Veteran has not been truthful to his medical providers about his military service. Specifically, in a June 2015 VAMC entry, the Veteran reported that he experienced significant trauma because he was "deployed in [Vietnam]" and that he saw "a boy run over by a truck." As to the first point, the Board concedes that the Veteran served during the Vietnam War era, which ended in May 1975, but the Veteran himself never was deployed overseas. Indeed, his DD-214 reflects that he had no foreign service. To the latter statement, it deviates from the Veteran's consistent statements that he has made throughout this entire appeal. As relayed to VA adjudicators, he always has maintained that he witnessed a fellow service member get run over by a tank. To this provider, he indicated that it was a "boy" run over by a "truck." Next, the Board will address the evidence concerning the allegation that the Veteran manifested psychiatric symptoms since service into the present. The Board concedes that individuals are competent to attest to their lay observations. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The overarching, reported symptom from the Veteran, P.W., and A.B. was that the Veteran had issues dealing with his anger. But Dr. D.A. indicated in his January 2009 notes that the Veteran "always [has] been irritable but worse now." Thus, this adequately explains the various reports of the Veteran's problems with his temper even shortly after service. Upon his entrance into the Mississippi National Guard, the Veteran was found to be psychiatrically normal, and he denied any psychiatric complaints, noting that he was in good health. The Veteran and P.W. attempt to explain this away by stating that mental health was an issue back then that one simply did not address. The Board is not persuaded by this argument and affords the Veteran's contemporaneous reports of his overall mental wellbeing at the time he entered the National Guard more probative value than the lay statements made for purposes of seeking compensation. See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board permitted to use hospital records that included lay history that was made for treatment purposes in assessing the credibility of a veteran's statements made for compensation purposes). Consider another inconsistency of this type: The Veteran reported to Dr. D.A. that he had no prior psychiatric treatment before seeing him; however, in his August 2020 statement, the Veteran indicates that he did have psychiatric care before Dr. D.A. but that he never took further action because he did not believe anything was wrong with him. Again, the Board does not find that statement credible given that he reported to Dr. D.A. that there was no such prior treatment. See ibid. This also does not explain why the Veteran failed to bring to VA or the Board's attention, prior to August 2020, the existence of any additional records. After both remands for the PTSD issue, the Board afforded the Veteran the opportunity to submit additional evidence and was sent the necessary forms to identify outstanding private treatment records. He only ever requested the assistance of VA to obtain updated records from Dr. D.A., which the VA did in September 2019. The Veteran never has provided VA with the name of any facility or treating doctor before he began seeing Dr. D.A. Thus, the Board does not find credible his assertion that he sought treatment before seeing Dr. D.A. and, assuming he did, that VA's duty to assist the Veteran is fulfilled because it has asked himon more than one occasionfor information, and the Veteran otherwise has been silent regarding treatment other than Dr. D.A. See 38 C.F.R. § 3.159(c)(1)(i). Psychiatric treatment with Dr. D.A. also coincidentally began after the Veteran's involvement in the August 2008 motor vehicle accident. While the Board cannot say with absolute certainty that the accident is what prompted the Veteran to seek psychiatric care, it notes that the June 2012 VA neuropsychology consultation revealed that the Veteran was in the midst of a "major depressive episode that began following his 2008 [motor vehicle accident]," which was "certainly traumatic" for the Veteran. This is strong, probative evidence that the reason the Veteran began receiving psychiatric care was because of the accident. Even considering the May 2002 VA positive depression screening, it is sandwiched between an August 2001 negative screening and the Veteran's denial in June 2002 of depressive symptoms. Another July 2006 negative screening confirms this. At no point during these times does the record reflect that the Veteran was receiving treatment. Thus, the credible evidence supports that the Veteran sought psychiatric treatment only as early as January 2009. Considering the Veteran left active duty in 1976, the Board considers this large temporal gap especially probative of the fact that the Veteran did not endure any of his alleged, in-service events and experienced psychiatric symptoms since then into the present. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim). The Board also cannot ignore the Veteran's narrative switch. For the first thirteen years of his appeal, the Veteran maintained that the alleged incident regarding the tank and the servicemember occurred in 1973 at Fort Carlson, Colorado. In March 2019, however, he switches his statement to a VA representative, and informs him that the incident occurred anywhere from 19731976. Informing the VA that his alleged in-service incident occurred on any particular day during his entire active duty service is anything but helpful to his claim. Perhaps the Veteran's statements lack credibility, or perhaps they are the manifestation of something else. As Dr. D.A. indicated in his December 2017 letter, he has been treating the Veteran since January 2009 for PTSD and possible "vascular dementia." Thus, there is a very real possibility that the Veteran's statements are the product of a separate medical condition and, therefore, also lacking credibility on that basis. Lastly, consider P.W.'s February 2019 statement. There, for the first time in the entire evidentiary record, she indicates that the Veteran witnessed a second service member die during a shooting drill. Oddly enough, the Veteran never makes any mention of this incident and does not allege it as a basis for his current psychiatric disabilities. It is interesting that, if he truly did witness multiple service members die, the Veteran would discuss one fatality but not another as the basis for his claim. No one piece of evidence discussed is dispositive; however, when viewed collectively as a whole, the Board finds the Veteran's statements lacking credibility and ultimately that the second element of service connection for a non-PTSD psychiatric disability has not been established. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). The Board, of course, recognizes that both a VA examiner and Dr. K.B. positively have linked the Veteran's diagnosis of other specified trauma and stressor-related disorder to his alleged in-service experiences. While that diagnosis sounds like a synonym for PTSD, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), specifically is incorporated into VA regulations, and it recognizes the two as separate diagnoses. 38 C.F.R. § 4.125(a). The Board acknowledges that, "in non-PTSD cases, a physician's opinion can sometimes provide evidence both of service incurrence or aggravation and of a causal nexus between a current condition and service." Moreau v. Brown, 9 Vet. App. 389, 397 (1996). To be sure, the Board cannot reject Dr. K.B.'s (or the VA's) medical opinion simply because it is based on the Veteran's self-reported history. See Kowalski v. Nicholson, 19 Vet. App. 171, 17980 (2005). Rather, an opinion based on an accurate, credible, self-reported history is worth full probative weight. Id. at 179. But accepting that maxim, the inverse must also be true: The Board need not afford probative value to a medical opinion based on non-credible assertions from a veteran. Where the Board otherwise has found that in-service events or injuries have not occurred, such an opinion would be based on an inaccurate factual premise, and that has long been held to be worthy of no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) ("An opinion based on an inaccurate factual premise has no probative value."). Thus, the Board does not find that the opinions of either the VA examiner or Dr. K.B. serve as an adequate basis for proving the in-service element for direct service connection for a non-PTSD diagnosis. As a last point, the Board notes that Dr. K.B.'s opinion also mentions other "significant trauma" that the Veteran endured in service either only fleetingly mentioned by himself or altogether omitted. The first is the "rattlesnake incident" mentioned in the early portion of this Decision. Dr. K.B. notes that the Veteran sustained a snakebite; the Veteran, however, never endorsed or conveyed being bit by a snake, only that one was near him. Second, the Veteran apparently reported to Dr. K.B. that he was being "subjected to significant racial tensions." This allegation wholly is omitted from any of the Veteran's filings. He never seriously has pursued the former theory and his one-time mention of that alleged event differs from Dr. K.B.'s recitation; he has never once mentioned the latter theory in the almost-fifteen years that this claim has remained pending. Therefore, the Board does not find these statements credible and affords them no probative value. See Gardin v. Shinseki, 613 F.3d 1374, 1380 (Fed. Cir. 2010) (upholding Board finding that vague and inconsistent lay statements were not credible because they were in direct contradiction to the more credible, competent, reliable, and clearly documented medical evidence); Cromer v. Nicholson, 19 Vet. App. 215, 216 (2005) (upholding Board's denial of service connection and finding that a veteran's recent post-service account of in-service events was not credible because the veteran had previously given other histories and theories that did not mention the alleged in-service event and first "came up with the story" years after service and in connection with the compensation claim). The Board is satisfied that it adequately has explained its reasons and bases, even considering its heightened duty in this case. All reasonable assistance has been afforded the Veteran in the procurement of evidence to substantiate his claim; and it has conducted an in-depth analysis of the relevant evidence of record. See Ussery, 8 Vet. App. at 68. As noted, however, the heightened duty to assist, does not lower the legal standard for the Veteran's claim, and the Board otherwise finds that such evidence falls short. See Russo, 9 Vet. App. at 5051. Because the evidence of record does not support the Veteran's claim for entitlement to service connection for an acquired psychiatric disability, to include PTSD, his appeal is denied. The Board is unable to find an approximate balance of the positive and negative evidence submitted to warrant for the Veteran a favorable decision. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53; 38 C.F.R. §§ 3.102, 3.303(a), 3.304(f)(1)(4). REASONS FOR REMAND In an October 2020 Decision, the Board denied the Veteran's claim for a thoracolumbar spine disability. The Veteran also appealed that determination to the CAVC, and the Parties resolved the appeal by way of a July 9, 2020, JMR. The Parties agreed that remand is warranted for two reasons. First, the Board erred in relying on an inadequate June 2020 VA opinion. In a February 2017 VA examination, the report indicates a diagnosis of a lumbosacral strain, radiculopathy, and degenerative arthritis. The June 2020 examiner, however, provided an opinion only to the Veteran's degenerative condition and did not address either the lumbosacral strain or radiculopathy and whether either were present in or related to service. Thus, remand is warranted to obtain an addendum opinion. JMR at 23. Second, the Board again prematurely issued that Decision. A July 22, 2020, docketing letter informed the Veteran that he had ninety days to submit additional evidence. On July 29th, Counsel requested the Board wait the full ninety days before adjudicating the appeal. The Board's Decision, however, was issued on October 8, 2020, prior to the expiration of the ninety days. Four days later, Counsel submitted additional evidence and argument concerning this issue. Thus, remand is required so that the Board adequately also can consider the new evidence. Thus, the Board finds that remand is warranted so that the Board can comply with the terms of the JMR and secure an addendum opinion. See Stegall, 11 Vet. App. at 271. The matters are REMANDED for the following action: 1. Obtain any ongoing VA treatment records. Should they exist, associate them with the claims file. 2. Obtain an addendum to the June 2020 VA back opinion. The addendum shall answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran's diagnosis of lumbosacral strain and/or radiculopathy occurred in, or is the result of, his period of active duty service to include heavy lifting that he would have engaged in during service? Note: The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. A detailed rationale supporting the examiner's opinions must be provided. The Veteran's active duty service treatment records are unavailable for review in this case, but the examiner should assume that the Veteran, as a member of the Motor Pool, would have engaged in the lifting of heavy materials. If an opinion cannot be made without resort to speculation, the examiner should so state and provide reasoning as to why a conclusion would be so outside the norm that such an opinion is not possible. 3. Conduct any other development deemed necessary and then readjudicate the Veteran's claim. The Veteran has the right to submit additional evidence and argument on the matter that the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded for additional development or other appropriate action by the Board or the CAVC must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Trevor T. Bernard, 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.