Citation Nr: 21068457 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-31 374 DATE: November 10, 2021 ORDER Service connection for bilateral pes planus, claimed as right and left foot disabilities, is granted. Service connection for a cervical spine disability is denied. Service connection for a lumbar spine disability is denied. Service connection for a right elbow/arm disability is denied. Service connection for a left elbow/arm disability is denied. Service connection for a right hip disability is denied. Service connection for a left hip disability is denied. Service connection for a right knee disability is denied. Service connection for a left knee disability is denied. Service connection for an acquired psychiatric disorder is denied. REMANDED Entitlement to service connection for a bilateral foot disability other than pes planus is remanded. FINDINGS OF FACT 1. The Veteran has a diagnosis of bilateral pes planus, and the evidence is in equipoise on whether it is related to service. 2. The preponderance of the evidence is against finding that any current cervical spine diagnosis began during active service, or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that any current lumbar spine diagnosis began during active service, or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that any current right elbow/arm diagnosis began during active service, or is otherwise related to an in-service injury or disease. 5. The preponderance of the evidence is against finding that any current left elbow/arm diagnosis began during active service, or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence is against finding that any current right hip diagnosis began during active service, or is otherwise related to an in-service injury or disease. 7. The preponderance of the evidence is against finding that any current left hip diagnosis began during active service, or is otherwise related to an in-service injury or disease. 8. The preponderance of the evidence is against finding that any current right knee diagnosis began during active service, or is otherwise related to an in-service injury or disease. 9. The preponderance of the evidence is against finding that any current left knee diagnosis began during active service, or is otherwise related to an in-service injury or disease. 10. The preponderance of the evidence is against finding that the Veteran has a diagnosis of PTSD, and that any other acquired psychiatric disorder, to include depressive disorder, is due to a disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral pes planus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a cervical spine disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a lumbar spine disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a right elbow/arm disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a left elbow/arm disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a right hip disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for a left hip disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for an acquired psychiatric disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from January 1979 to January 1983. In August 2018, the Board determined that new and material evidence had not been received to reopen service connection for a bilateral foot disability or an acquired psychiatric disorder, and denied service connection for the claimed cervical spine, lumbar spine, bilateral elbow/arm, bilateral hip, and bilateral knee disabilities. The Veteran appealed the issues to the United States Court of Appeals for Veterans Claims (Court), and in April 2019, the Court granted a Joint Motion for Partial Remand (JMPR), vacating and remanding the issues. In January 2020, the Board determined that new and material evidence had been received to reopen service connection for a bilateral foot disability and an acquired psychiatric disorder, and remanded the claims for service connection for further development. In April 2021, the Board remanded the claims for service connection again for further development, including obtaining medical opinions on the etiology of the claimed conditions. The Veteran subsequently had a series of VA examinations in May 2021 and the examination reports, including medical opinions, are associated with the claims file. The Board therefore finds there has been substantial compliance with the remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Stegall v. West, 11 Vet. App. 268 (1998). Service Connection The Veteran contends that the claimed cervical spine, lumbar spine, bilateral elbow/arm, bilateral hip, bilateral knee, and bilateral foot disabilities are due to the rigors of military service, including playing in football and softball games, training exercises, and daily activities. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). Certain disease, including arthritis, are listed among the "chronic diseases" under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258, 271 (2015). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 1. Service connection for bilateral pes planus. Medical treatment records indicate that the Veteran has current diagnoses of bilateral feet degenerative arthritis, bilateral pes planus, bilateral hallux valgus, and bilateral plantar fasciitis. See the March 2020 and May 2021 VA examination reports. Thus, the current disability requirement for service connection a bilateral foot disability is satisfied. The question for the Board is whether the Veteran's current diagnoses either began during active service, or are etiologically related to service. The Board finds that the evidence is in equipoise on whether the bilateral pes planus is etiologically related to the Veteran's active service. Service treatment records (STRs) indicate that in a November 1978 enlistment examination, the Veteran's feet were found to be clinically normal, and he denied having a history of broken bones except a right wrist and denied a history of foot trouble. In a July 1982 flight physical, no clinical abnormalities were noted regarding the Veteran's feet. In a November 1982 separation examination, the Veteran's feet were again found to be clinically normal, and he denied having a history of broken bones or foot trouble. A May 1983 post-service treatment record indicates that the Veteran was found to have bilateral mild to moderate pes planus. In June 2016, a medical assessment by a private physician, Dr. C.M., was submitted. Dr. C.M. diagnosed the Veteran with degenerative joint disease of the feet. Dr. C.M. opined that the musculoskeletal disorders were more probable than not secondary to the Veteran's military service performance, and noted that the medical conditions should be carefully re-evaluated to determine veteran benefits. The Veteran had a whole body bone scan in March 2017. He noted that he had fractured his left ankle in 2000 and right wrist in 1970. Results of the scan showed arthritic/degenerative joint disease in the feet. Private treatment records dated in March 2020 indicate that the Veteran reported having bilateral heel pain, which started some days to week ago. He was assessed as having moderate plantar fasciitis bilaterally and an antalgic gait. X-rays showed mild diffuse osteopenia in both feet. In a May 2021 VA examination, the Veteran reported that his bilateral foot pain existed since service. He used arch supports, which did not relieve the symptoms. On examination, the Veteran had pain in manipulation of the feet, decreased longitudinal arch height on weight bearing bilaterally, objective evidence of marked deformity of both feet, and marked pronation bilaterally. The examiner diagnosed bilateral flat foot (pes planus), plantar fasciitis, and hallux valgus. The examiner opined that the bilateral pes planus was at least as likely as not incurred in service, as bilateral pes planus was diagnosed in the 1983 examination. The condition was most likely subclinical (asymptomatic), and evolved to a clinical (symptomatic) condition thereafter. The Board finds that the VA examiner's opinion has at least some probative value, as it was based on review of the entire record and physical examination of the Veteran. The examiner also provided a rationale for his opinion. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight to be attached to medical opinions are within the province of the Board). There can be no doubt that further medical inquiry could be undertaken with a view towards development of the claim. Specifically, the Board notes that the VA examiner misconstrued the 1983 treatment record to be a service separation examination. As such, the Board considered whether another remand was appropriate to clarify; however, in this case, a remand would only unnecessarily delay adjudication, as the VA examiner's opinion is of at least some probative value, and the 1983 examination was conducted less than one year after the Veteran's separation from service. Under the "benefit-of-the- doubt" rule, where there exists "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue. Ashley v. Brown, 6 Vet. App. 52, 59 (1993). In this case, the Board finds that there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter." As such, this is a situation where the benefit of the doubt rule applies. Ashley, 6 Vet. App. at 59; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In resolving all reasonable doubt in the Veteran's favor, the Board finds that service connection for bilateral pes planus is warranted. 2. Service connection for a cervical spine disability. 3. Service connection for a lumbar spine disability. 4. Service connection for a right elbow/arm disability. 5. Service connection for a left elbow/arm disability. 6. Service connection for a right hip disability. 7. Service connection for a left hip disability. 8. Service connection for a right knee disability. 9. Service connection for a left knee disability. Medical treatment records indicate that the Veteran has current diagnoses of cervical spondylosis (osteoarthritis) of the neck, lumbar spondylosis and lumbar strain, bilateral elbow osteoarthritis, bilateral hip osteoarthritis, bilateral knee osteoarthritis, and history of right knee meniscal tear. See the March 2020 and May 2021 VA examination reports. Thus, the current disability requirement for service connection for a cervical spine, lumbar spine, bilateral elbow/arm, bilateral hip, and bilateral knee disability is satisfied. The question for the Board is whether the Veteran's current diagnoses either began during active service, or are etiologically related to service. The Board finds that probative evidence of record does not establish that any cervical spine, lumbar spine, elbow/arm, hip, or knee diagnosis is etiologically related to the Veteran's active service. Service treatment records (STRs) indicate that in a November 1978 enlistment examination, the Veteran's neck, spine, upper extremities, and lower extremities were found to be clinically normal, and he denied a history of painful or "trick" shoulder or elbow, recurrent back pain, or "trick" or locked knee and denied having a history of broken bones, except a right wrist. In December 1979, the Veteran reported having right leg pain for three days. He was noted to have possible sciatic nerve damage. In a July 1982 flight physical, no clinical abnormalities were noted regarding the Veteran's neck, spine, upper extremities, or lower extremities. In a November 1982 separation examination, the Veteran's neck, spine, upper extremities, and lower extremities were again found to be clinically normal, and he denied having a history of broken bones, painful or "trick" shoulder or elbow, recurrent back pain, or "trick" or locked knee. A May 1983 post-service VA treatment record indicates that the Veteran was found to have a history of a right wrist fracture with no apparent objective residuals, left lower extremity strain, and low back syndrome. Private treatment records indicate that in November 2010 imaging, the bilateral knees showed small patellar spurs bilaterally and mild patellofemoral joint space narrowing. In February 2011 private imaging of the knees, the bone and joint structures appeared normal. In August 2011, a left knee MRI showed a medial meniscal tear. In September 2011, the Veteran reported having generalized pain associated with numbness for more than two weeks, which was worse by repetitive movements, bending, reaching above the shoulders, and was more muscular than on joints. He was assessed as having osteoarthritis. December 2011 imaging of the cervical spine and lumbar spine showed minimal spondylosis involving C6, and osteopenia and minimal spondylosis in the lower lumbosacral segments. In January 2012, the Veteran reported to his private physician that he was having right elbow pain for 2-3 weeks. He was assessed as having generalized osteoarthritis and bicipital tenosynovitis. A sonogram showed mild common extensor tendinopathy without associated tendon tear. Private imaging done in February 2013 of the bilateral knees showed mild osteoarthritic changes and a right knee medial meniscal tear. In June 2013, the Veteran reported having bilateral elbow pain. He was assessed as having osteoarthritis. In February 2014, the Veteran reported having pain in the bilateral elbows. A left elbow ultrasound showed a small calcification in the distal triceps tendon and a small amount of fluid in the joint space. In May 2014, the Veteran reported having pain in his right elbow for 2-3 weeks. In a February 2015 private treatment record, the Veteran reported having pain in his right elbow for 2-3 weeks. He was assessed as having osteoarthritis. In November 2015, the Veteran reported having generalized pain, which was worse with repetitive movement, bending, reaching above the shoulders, and was more muscular than on joints. A May 2016 right knee MRI showed a medial meniscal tear and degenerative changes. In June 2016, a medical assessment by a private physician, Dr. C.M., was submitted. The Veteran reported having neck and high back pain with stiffness, numbness, tingling, sensorial loss, cramps, and weakness of para-cervical spine muscles, radiating to shoulders, arms, elbows, and wrists. He also had low back pain with para-lumbar spine muscle stiffness, numbness, tingling, sensorial loss, cramps, weakness, and instability radiating to hips, knees, and ankles. Dr. C.M. diagnosed the Veteran with chronic cervical spine pain; degenerative joint disease of the shoulders, elbows, and wrists; chronic myositis para-cervical spine muscles; chronic low back pain, lumbago; degenerative joint disease of the hips, knees, and ankles; and chronic myositis of the para-lumbar spine muscles. Dr. C.M. opined that the musculoskeletal disorders were more probable than not secondary to the Veteran's military service performance, and noted that the medical conditions should be carefully re-evaluated to determine veteran benefits. The Veteran had a whole body bone scan in March 2017. He noted that he had fractured his left ankle in 2000 and right wrist in 1970. Results of the scan showed arthritic/degenerative joint disease in the shoulders, elbows, wrists, hands, hips, knees, and ankles, without evidence of active inflammation in the shoulders or thoracic spine, and degenerative joint disease through the vertebral column. A May 2019 left knee MRI showed apparent post-meniscectomy changes at the medial meniscus, osteoarthritis with chondromalacia, and mild free edge degeneration at the lateral meniscal body. In a series of March 2020 VA examinations of the neck, back, elbows, hips, and knees, the Veteran reported that his musculoskeletal pain was dull, worse after repetitive movement and during cold weather, and similar at all body joints. He was on pain medication, which provided a fair response. He had a right knee arthroscopy in 2010. On examination, the Veteran's neck, back, hips, and knees had reduced ranges of motion, and the elbows had normal ranges of motion. The examiners diagnosed cervical spondylosis, lumbar spondylosis, bilateral elbow osteoarthritis, bilateral hip osteoarthritis, bilateral knee osteoarthritis, and right meniscal tear. The VA examiner who conducted the neck, back, and elbow examinations opined that the claimed conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness, and the conditions were related to normal, atraumatic changes of the aging process. The examiner also noted that the November 1982 separation examination was negative for a neck, back, or elbow condition. The VA examiner who conducted the hips and knees examinations opined that that the claimed conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness, as STRs were silent for any hip or knee condition during service. There was also no evidence of treatment of any hip or knee condition within one year of separation from service. The examiner noted that the bilateral hip and knee conditions dated to recent years. In a series of May 2021 VA examinations of the neck, back, elbows, hips, and knees, the Veteran reported that his neck condition was due to service, although he never went to sick call due to neck pain. He also stated that his lumbar spine, bilateral elbow, and bilateral hip pain was deep and dull, and worse with cold weather; and his knee pain was deep and sharp, mostly with repetitive use over time. The Veteran was using topical antiinflammatory medication and oral NSAIDS with fair response. On examination, the Veteran had neck, elbow, hip, and knee pain, and reduced ranges of motion of the neck, back, elbows, and hips. The examiners diagnosed degenerative arthritis of the neck, lumbar strain, bilateral knee osteoarthritis, right knee meniscal tear, bilateral elbow myositis, and bilateral hip degenerative joint disease. The neck examiner opined that the neck condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. There was no evidence of any sick calls, diagnosis, or treatment for any cervical spine condition until many years later in the private sector, and was due to the aging process. The back and knees examiner opined that the back and bilateral knee conditions were less likely than not incurred in or caused by the Veteran's military service. The examiner noted that the 1983 treatment record noted "low back syndrome," which was a transitory condition. The 1979 STR noting right leg pain was also considered, but there was no evidence on examination of any sciatic nerve damage. The bilateral knee condition was due to the "normal aging process" and correlated with the natural slow but steady process of atraumatic degenerative joint disease, and there was no medical evidence of a bilateral knee condition until 30 years after separation from service. Finally, the elbow and hip examiner opined that the elbow and hip conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. STRs were silent for mention of any symptoms or diagnosis of any elbow myositis, there was no manifestation or diagnosis of elbow myositis within a year after separation, and the recent diagnosis occurred 38 years after being released from active service. STRs were also silent for mention of any symptoms or diagnosis of any hip condition, there was no manifestation or diagnosis of hip DJD within a year after separation from service, the risk of osteoarthritis increases with age, and the recent diagnosis was 38 years after separation from active service. The Board finds the March 2020 and May 2021 VA medical opinions to be of at least some probative value. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The opinions were rendered after reviewing the Veteran's STRs and other medical records, soliciting a medical history from the Veteran, and physical examination of the Veteran. See Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing the probative value of a medical opinion include the examiner's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion). The opining examiners provided the facts and rationale on which their opinions were based, and the May 2021 examiner expressly considered and discussed the 1979 STR and the 1983 post-service treatment record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board also finds that there is little probative value in the June 2016 evaluation from Dr. C.M. with regard to establishing service connection for the neck, back, elbows, hips, and knees. The evaluation contains diagnoses, which appear to be based almost entirely on the Veteran's verbal reports, and notes that the medical conditions must be carefully reevaluated in order to determine veteran benefits. There is no evidence of any clinical tests, imaging reports, or any other explanation provided for the diagnoses rendered. There is also no explanation or rationale provided for the conclusion the doctor reached that the relevant conditions were related to service. See Black v. Brown, 5 Vet. App. 177, 180 (1993) (finding medical opinions inadequate when they are not supported by medical evidence); Swann v. Brown, 5 Vet. App. 229, 232 (1993) (noting that the weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated). In addition, although the Veteran can describe observable symptoms including pain, his statements cannot be used to determine whether a neck, back, elbow, hip, or knee condition is related service or to an in-service injury. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (explaining in footnote 4 that a Veteran may be competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). There is no evidence that the Veteran has the medical education and training required to make competent clinical diagnosis, or to attribute such a diagnosis to specific events or injuries. As such, the Board finds the Veteran's statements probative with regard to establishing his current symptoms, but finds little probative value with regard to establishing service connection. In any case, their probative value is outweighed by the probative value assigned to an evaluation conducted by a person who has expertise and training pertinent musculoskeletal diagnoses. Finally, the earliest evidence of complaints or treatment for any of these claimed conditions was in 2010, which was 27 years after the Veteran's separation from service. This lengthy period of time without diagnosis or treatment weighs against the finding that any current neck, back, elbow, hip, or knee diagnosis has existed since service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). As noted above, STRs are silent for any relevant complaints, diagnosis, or treatment other than a single note of right leg pain; there is no medical evidence showing relevant symptoms or a diagnosis of a chronic disability within one year from service separation other than "low back syndrome," which has been noted to be a transitory condition; and the competent and credible evidence does not establish chronic and continuous symptoms of neck, back, elbow, hip, or knee condition. As such, service connection on a presumptive basis under 38 C.F.R. § 3.303 (a) or (b) is not warranted. In sum, the weight of the competent and credible evidence of record weighs against the claims for service connection for a neck, back, bilateral elbow, bilateral hip, and bilateral knee condition. As the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 10. Service connection for an acquired psychiatric disorder. The Veteran contends that he has anxiety, depression, nervousness, and/or PTSD due to service. He states that he had to stay on alert at all times, battle-ready, for a year due to the Iran Hostage Crisis. He was in the field every week practicing war games. He alleges that all of his mental health symptoms come from that time, including interrupted rest, nervousness, anxiety, looking all around him, avoiding crowds, and putting his back against a wall to let people pass him if he is in a crowd. When the Veteran is driving, he hits the breaks and does not know why, he cannot stand sitting or waiting around, and he always looks for exits wherever he goes. See the December 2016 statement (translated in May 2018). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a probative diagnosis of PTSD, and that his diagnosis of depressive disorder is not shown to be etiologically related to his active service. STRs are silent for mention of any complaints, diagnosis, or treatment for any mental health condition. In a November 1978 enlistment examination, the Veteran was found to be psychiatrically normal, and he denied having a history of frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. In a November 1982 separation examination, the Veteran was again found to be psychiatrically normal, and he denied having a history of frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. In a May 1983 post-service VA examination, the Veteran was found to be psychiatrically normal. VA treatment records dated in May 2007, November 2007, March 2008, July 2008, October 2008, January 2009, April 2012, October 2012, May 2013, September 2013, May 2014, October 2014, January 2015, and February 2016 indicate that neuropsychiatric screenings, including depression and memory changes, were negative. Starting in September 2013, however, he was noted to be followed by a private psychiatrist for depression. Private treatment records indicate that that the Veteran was seen for an initial visit by Dr. M.O., in September 2010. He was found to have moderate depression. In October 2010, he was noted to have severe major depression; he was also noted to have had a recent knee surgery. He continued to be seen by Dr. M.O. through at least October 2019. The treatment records do not indicate a reason that the Veteran first sought treatment. In March 2016, the Veteran was seen by a VA social worker after reporting to a primary care doctor that he felt down, sad, and anxious because his mother was hospitalized, and his father had been bedridden for several years. He endorsed good and motivated mood, good eating patterns, good energy levels, and good concentration, and denied nightmares and perceptual disturbances. The Veteran reported having difficulties with sleep patterns since more than five years ago, but was using Zolpidem, prescribed by a private psychiatrist, who he had been seeing since 2011. The social worker indicated that, per the Veteran's reported symptoms and screening instrument scores, he had low levels of depressive symptoms that did not meet the criteria for a diagnosis of depressive disorder. He also had mild anxiety symptoms last month due to his parents' situations, but his mother had been discharged and he felt better, less stressed, less anxious, and with a good mood. The Veteran verbalized being emotionally stable and only using medication for insomnia when needed, which was 1-2 times per week. In a June 2016 private medical assessment, the Veteran reported symptoms of nervousness, anxiety, irritability, difficulty in adapting to stressful circumstances, in ability to establish and maintain effective work and social relationships, disturbances of motivation and mood, depressed mood, little interest or pleasure in doing things, feeling down, hopelessness, isolation episodes, easily crying, and insomnia with nightmares and flashbacks of his traumatic experiences during active duty. He also had poor frustration tolerance, suspiciousness, memory loss and poor concentration. Dr. C.M. diagnosed generalized anxiety disorder, major depression disease, and PTSD. He was noted to be taking Paxil. Dr. C.M. opined that the psychiatric diagnoses were more probable than not due to the Veteran's military service performance. He also noted that the Veteran's medical conditions should be carefully re-evaluated in order to determine veteran benefits. In February 2020, a statement from F.A., who served with the Veteran, was received. F.A. indicated that he had known the Veteran for over 40 years and had noticed a change in the way the Veteran interacted with others and the way he looked at life. He could not be active due to pains and ailments, and he did not want to socialize with anyone. In a March 2020 VA PTSD examination, the Veteran reported that he was stationed in Germany for one month twice and knew of the diplomats hostage situation. He had been seen by a private psychiatrist since 2010. The examiner noted that the Veteran arrived to the appointment appropriately dressed with adequate hygiene. He was alert, oriented, cooperative, spontaneous, and established eye contact with the examiner. His mood was relaxed, appropriate affect, and memory for recent and remote events was preserved. The examining psychiatrist diagnosed unspecified depressive disorder with symptoms of depressed mood, chronic sleep impairment, and disturbances of motivation and mood. Although the reported stressor was adequate to support a diagnosis of PTSD (Criterion A), the Veteran did not have any symptoms that met the remaining criteria (Criterion B through I) for a diagnosis of PTSD. Specifically, he did not have any intrusion symptoms associated with the traumatic event, persistent avoidance of stimuli associated with the traumatic event, negative alterations in cognitions and mood associated with the traumatic event, or marked alterations in arousal and reactivity associated with the traumatic events. The examiner noted that the military trauma had not resulted in impairment in marital relationship, parenting performance, social functioning, or occupational functioning, as the Veteran was in a successful marriage, his sons were independent adults, and he had been a fulltime postal carrier since 1999. The examiner also opined that the depressive disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran first sought mental health treatment in 2010, almost 31 years after the traumatic event, and there was no relation between the Veteran's service and the mental condition found in 2010. In a May 2021 VA PTSD examination, the Veteran reported that he continued to see Dr. M.O. and also continued to take zolpidem (Ambien) for sleep. He also reported that he was still married to his wife, had two children with whom he had good relationships, and continued to be employed by the U.S. Postal Service. The examiner noted that the Veteran arrived to the appointment appropriately dressed with adequate hygiene. He was alert, oriented, cooperative, spontaneous, and established eye contact with the examiner. His mood was relaxed, appropriate affect, and memory for recent and remote events was preserved. The examining psychiatrist diagnosed unspecified depressive disorder with symptoms of chronic sleep impairment and disturbances of motivation and mood. Although the reported stressor in Germany was adequate to support a diagnosis of PTSD (Criterion A), the Veteran did not have any symptoms that met the remaining criteria (Criterion B through I) for a diagnosis of PTSD. Specifically, he did not have any intrusion symptoms associated with the traumatic event, persistent avoidance of stimuli associated with the traumatic event, negative alterations in cognitions and mood associated with the traumatic event, or marked alterations in arousal and reactivity associated with the traumatic events. The Veteran was also living a "very successful" social and occupational life, including working fulltime for the Postal Service. The examiner also opined that the depressive disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran first sought mental health treatment in 2010, which was more than 27 years after the traumatic event, he was taking medication only for sleep, and there was mention by Dr. M.O. in his treatment records that the Veteran's depression was related to or aggravated by his military service. The examiner also noted that the 2016 opinion by Dr. C.M. lacked the basic mental health information needed to reach any mental diagnosis, such as a mental health history, or any clinical testing of mental functioning. Dr. C.M.'s evaluation also lacked a specific stressor that caused the PTSD. Finally, the examiner noted that the Veteran's lay assertions regarding having a nervous condition since November 1983 were not supported by his social or occupational history, as he had maintained his marriage, worked fulltime, and did not seek mental health treatment for 27 years after separation from service. The Board finds the March 2020 and the May 2021 VA examiners' opinions to be competent and credible, and as such, entitled to significant probative weight. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The opinions were rendered after reviewing the Veteran's medical records and STRs, soliciting a medical history from the Veteran, and conducting an interview and administering clinical tests to Veteran. See Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing the probative value of a medical opinion include the examiner's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion). The examiners provided facts and rationale on which the opinions were based, pointing to specific medical treatment records as support for the opinions and explaining the DSM criteria that had not been met for a diagnosis of PTSD. Finally, the probative value of the VA examiners' opinions are further bolstered by their consistency with the other medical evidence in the file, which shows that although the Veteran has a diagnosis of depressive disorder, a diagnosis of PTSD has never been rendered, including nearly 10 years' worth of private mental health treatment records. As discussed above, the Board also finds that the 2016 opinion from Dr. C.M. has no probative value with regard to establishing service connection for an acquired psychiatric disorder. There is no evidence of any clinical tests or any other explanation provided for the psychiatric diagnoses rendered. There is also discussion of a PTSD stressor, and no explanation or rationale provided for the conclusion the doctor reached that the relevant conditions were related to service. Rather, the diagnoses appear to be based entirely on the Veteran's verbal reports, and notes that the medical conditions must be carefully reevaluated in order to determine veteran benefits. See Black v. Brown, 5 Vet. App. 177, 180 (1993) (finding medical opinions inadequate when they are not supported by medical evidence); Swann v. Brown, 5 Vet. App. 229, 232 (1993) (noting that the weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated). Also as discussed above, the Board finds that although the Veteran and F.A. are competent to describe observable symptoms including impaired sleep and depressed mood, they are not competent to diagnose a psychiatric disorder. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (explaining in footnote 4 that a Veteran may be competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions); See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) ("It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant"). There is no evidence that the Veteran or F.A. has the medical education and training required to make competent clinical diagnoses or to attribute symptoms to such diagnoses. As such, the Board finds the Veteran's statements and F.A.'s statement probative with regard to current symptoms, but finds little probative value with regard to establishing a diagnosis of PTSD or any other psychiatric disorder. In sum, the weight of the competent and credible evidence shows that the Veteran does not have a current diagnosis of PTSD. Without competent evidence of a diagnosed disorder, service connection for the disorder cannot be awarded. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("In the absence of proof of a present disability, there can be no valid claim."); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004) (holding that service connection requires a showing of current disability). The Board also concludes that the Veteran's depressive disorder diagnosis is not related to service. As noted above, the March 2020 and May 2021 VA examiners concluded that the diagnosis was less likely than not related to service; Dr. M.O.'s treatment records do not contain any indication of the origin of the depression other than noting a knee surgery; and Dr. C.M.'s opinion is not probative. As such, the weight of the competent and credible evidence of record weighs against the claims for service connection for an acquired psychiatric disorder. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a bilateral foot disability other than pes planus is remanded. As discussed above, the Veteran has been found to have diagnoses of bilateral degenerative joint disease, bilateral plantar fasciitis, and hallux valgus. The May 2021 VA examiner opined that the that the bilateral pes planus was at least as likely as not incurred in service, and the Board granted service connection for pes planus herein. However, the examiner did not comment on the etiology of the other diagnoses. As such, remand for a medical opinion addendum is necessary. The matter is REMANDED for the following action: Send the claims file to an appropriate VA examiner and ask the examiner to review the record and prepare a medical opinion on the etiology of the claimed bilateral foot disability other than pes planus. After reviewing the entire record, the examiner should note any current relevant diagnosis, to include bilateral degenerative joint disease, bilateral plantar fasciitis, and hallux valgus. The examiner should then opine on whether it is at least as likely as not (50 percent or greater probability) that any foot diagnosis had its origin during, or is in some way the result of, the Veteran's periods of active military service. All opinions and conclusions expressed must be supported by a complete rationale in a report. If the VA examiner determines that an examination is necessary in order to render the requested medical opinion(s), the AOJ should schedule the Veteran for such an examination. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Nelson 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.