Citation Nr: 21071393 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 15-24 497 DATE: November 30, 2021 ORDER Entitlement to a rating in excess of 20 percent prior to October 25, 2018 for right upper extremity peripheral neuropathy as secondary to the Veteran's service-connected diabetes mellitus, type II, and in excess of 40 percent from October 25, 2018 is denied. Entitlement to a rating in excess of 20 percent prior to October 25, 2018 for left upper extremity peripheral neuropathy as secondary to the Veteran's service-connected diabetes mellitus, type II, and in excess of 30 percent from October 25, 2018 is denied. Entitlement to a rating in excess of 10 percent prior to October 26, 2017 for right lower extremity peripheral neuropathy as secondary to the Veteran's service-connected diabetes mellitus, type II, and in excess of 20 percent from October 26, 2017 is denied. Entitlement to a rating in excess of 10 percent prior to October 26, 2017 for left lower extremity peripheral neuropathy as secondary to the Veteran's service-connected diabetes mellitus, type II, and in excess of 20 percent from October 26, 2017 is denied. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. Prior to October 25, 2018, the Veteran's right upper extremity peripheral neuropathy manifested as no worse than mild incomplete paralysis; from October 25, 2018, the Veteran's right upper extremity peripheral neuropathy manifested as no worse than moderate incomplete paralysis. 2. Prior to October 25, 2018, the Veteran's left upper extremity peripheral neuropathy manifested as no worse than mild incomplete paralysis; from October 25, 2018, the Veteran's left upper extremity peripheral neuropathy manifested as no worse than moderate incomplete paralysis. 3. Prior to October 26, 2017, the Veteran's right lower extremity peripheral neuropathy manifested as no worse than mild incomplete paralysis; from October 26, 2017, the Veteran's right lower extremity peripheral neuropathy manifested as no worse than moderate incomplete paralysis. 4. Prior to October 26, 2017, the Veteran's left lower extremity peripheral neuropathy manifested as no worse than mild incomplete paralysis; from October 26, 2017, the Veteran's left lower extremity peripheral neuropathy manifested as no worse than moderate incomplete paralysis. 5. The preponderance of the evidence is against finding that the Veteran has a diagnosis of PTSD. CONCLUSIONS OF LAW 1. Prior to October 25, 2018, the criteria have not been met for a rating in excess of 10 percent for right upper extremity peripheral neuropathy; from October 25, 2018, the criteria have not been met for a rating in excess of 40 percent for right upper extremity peripheral neuropathy. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.7, 4.124a Diagnostic Codes 8513, 8514. 2. Prior to October 25, 2018, the criteria have not been met for a rating in excess of 10 percent for left upper extremity peripheral neuropathy; from October 25, 2018, the criteria have not been met for a rating in excess of 30 percent for left upper extremity peripheral neuropathy. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.7, 4.124a Diagnostic Codes 8513, 8514. 3. Prior to October 26, 2017, the criteria have not been met for a rating in excess of 10 percent for right lower extremity peripheral neuropathy; from October 26, 2017, the criteria have not been met for a rating in excess of 20 percent for right lower extremity peripheral neuropathy. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.7, 4.124a Diagnostic Codes 8520, 8521. 4. Prior to October 26, 2017, the criteria have not been met for a rating in excess of 10 percent for left lower extremity peripheral neuropathy; from October 26, 2017, the criteria have not been met for a rating in excess of 20 percent for left lower extremity peripheral neuropathy. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.7, 4.124a Diagnostic Codes 8520, 8521. 5. The criteria for entitlement to service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 4.125. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 1964 to May 1967. This matter is before the Board of Veterans' Appeals (Board) on appeal from July 2014 and January 2017 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is of record. This case was before the Board in July 2021. The Veteran's claims were remanded for additional development. The case is now again before the Board for further appellate action. Increased Rating Disability evaluations are determined by comparing a Veteran's symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code (DC), the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). At the time of the assignment of an initial rating for a disability following an initial award of service connection for that disability, separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board will consider entitlement to staged ratings to account for variations in the severity of a disability over time. Id. 1. Entitlement to a rating in excess of 20 percent prior to October 25, 2018 for right upper extremity peripheral neuropathy as secondary to the Veteran's service-connected diabetes mellitus, type II, and in excess of 40 percent from October 25, 2018 is denied. 2. Entitlement to a rating in excess of 20 percent prior to October 25, 2018 for left upper extremity peripheral neuropathy as secondary to the Veteran's service-connected diabetes mellitus, type II, and in excess of 30 percent from October 25, 2018 is denied. A December 2014 rating decision granted service connection for right upper extremity peripheral neuropathy and left upper extremity peripheral neuropathy and assigned each a 20 percent rating, effective August 6, 2014. An October 2021 rating decision granted an increased rating to 40 percent for the right upper extremity peripheral neuropathy and an increased rating to 30 percent for the left upper extremity peripheral neuropathy. The effective date for these increase ratings was October 25, 2018, the date that a private nerve conduction study showed the Veteran's peripheral neuropathy of the upper extremities had worsened. The Veteran contends that he is entitled to higher ratings for his service-connected right and left upper extremity peripheral neuropathy. The Veteran's right and left upper extremity peripheral neuropathy have been rated under 38 C.F.R. §§ 4.124a, Diagnostic Code 8514 from August 6, 2014 and under 38 C.F.R. §§ 4.124a, Diagnostic Code 8599-8513 from October 25, 2018. Under Diagnostic Code 8514, impairment of the musculospiral, or radial, nerve, mild incomplete paralysis is rated as 20 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. The criteria for complete paralysis warranting a rating of 70 percent for the major extremity and 60 percent for the minor extremity include: drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; cannot extend hand at wrist, extend proximal phalanges of fingers, extend thumb, or make lateral movement of wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity. 38 C.F.R. § 4.124a, DC 8514. The term "incomplete paralysis" indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis of this nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Under Diagnostic Code 8513, impairment of all radicular groups of the hand, mild incomplete paralysis is rated as 20 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent for the major extremity and 30 percent for the minor extremity. Severe incomplete paralysis is rated as 70 percent for the major extremity and 60 percent for the minor extremity. Complete paralysis of all radicular groups of the hand warrants a rating of 90 percent for the major extremity and 80 percent for the minor extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8513. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. Here, the use of Diagnostic Codes 8599-8513 reflects that, from October 25, 2018, there is no diagnostic code specifically applicable to the Veteran's service-connected right and left upper extremity neuropathy, and that this disability has been rated by analogy to paralysis of all radicular groups under Diagnostic Code 8513. See 38 C.F.R. § 4.20 (allowing for rating of unlisted condition by analogy to closely related disease or injury). Turning to the evidence, the Veteran was provided a VA examination of his peripheral neuropathy in December 2014. The examiner reported that the Veteran's dominant hand was the right hand. An assessment of symptoms for the Veteran's right and left upper extremities reported mild intermittent pain, moderate numbness, and moderate paresthesias or dysesthesias in both extremities. The examiner stated that the nerves affected were terminal branches of peripheral nerves and cannot be assigned to specific nerves. The examiner reported that the clinical presentation was suggestive of bilateral upper and lower sensory peripheral neuropathy, which she stated was equivalent to incomplete paralysis that seems mild. The Veteran was provided another VA examination of his peripheral neuropathy in November 2016. The examiner noted that the Veteran did not report numbness or burning in his hands as he did in 2014. The Veteran reported his hands feel stiff and occasionally he has a finger "lock up" on him. An assessment of symptoms for the Veteran's right upper extremity reported the Veteran had no constant pain, intermittent pain, numbness, or paresthesias or dysesthesias. The examiner concluded the Veteran did not have upper extremity diabetic peripheral neuropathy. The Veteran was provided another VA examination of his peripheral neuropathy in December 2017. The Veteran reported having burning/stinging pain with intermittent numbness in his hands and feet for which ibuprofen "helps a little." An assessment of symptoms for the Veteran's right and left upper extremities reported severe intermittent pain, severe paresthesias or dysesthesias, and moderate numbness. The examiner characterized the right and left upper extremity neuropathy as mild incomplete paralysis of the radial nerve (musculospiral nerve). An October 2018 private medical record reported the results of an electromyography and nerve conduction study. Evaluation of the right median motor nerve showed prolonged distal onset latency, reduced amplitude, and decreased conduction velocity. Evaluation of the right median sensory nerve showed prolonged distal onset latency, reduced amplitude, and decreased conduction velocity. Evaluation of the right ulnar motor nerve showed reduced amplitude and decreased conduction velocity. Evaluation of the right ulnar sensory nerve showed no response. Evaluation of the right median/ulnar (palm) comparison nerve showed prolonged distal peak latency and prolonged distal peak latency. No evidence of electrical instability was found. The impression was moderate axonal sensory motor polyneuropathy. The Veteran was provided another VA examination of his peripheral neuropathy in September 2021. An assessment of symptoms for the Veteran's right and left upper extremity reported mild constant pain, no intermittent pain, mild numbness, and mild paresthesias or dysesthesias. The examiner characterized the right and left upper extremity neuropathy as mild incomplete paralysis of the radial nerve (musculospiral nerve). For the period prior to October 25, 2018, the Board gives great probative weight to the December 2014, November 2016, and December 2017 VA examination findings. These findings were based on in-person examinations of the Veteran's upper extremity peripheral neuropathy. Considering all the evidence, prior to October 25, 2018, the Board finds the Veteran's neuropathy symptoms of the right and left upper extremities are more consistent with mild incomplete paralysis. The evidence does not support that the Veteran's radiculopathy of the right and left upper extremities produced moderate, moderately severe, or severe incomplete paralysis to warrant a rating in excess of 10 percent. For the period from October 25, 2018, the Board gives great probative weight to the September 2021 VA examination findings. These findings were based on an in-person examination of the Veteran's upper extremity peripheral neuropathy and characterized the right and left upper extremity neuropathy as mild incomplete paralysis. The Board notes that the October 2018 private nerve conduction report resulted in an impression of moderate sensory motor polyneuropathy. Considering all the evidence, from October 26, 2017, the Board finds the Veteran's neuropathy symptoms of the right and left upper extremities are more consistent with mild to moderate incomplete paralysis. The evidence does not support that the Veteran's radiculopathy of the right and left upper extremities produced moderately severe or severe incomplete paralysis to warrant a rating in excess of 20 percent. Moreover, the regulations state that when the involvement is wholly sensory, the rating should be, at most, the moderate degree. 38 C.F.R. § 4.124a. In consideration of the above, the Board finds that the preponderance of the evidence weighs against the following: (1) a disability rating in excess of 10 percent for the period prior to October 25, 2018 for the Veteran's peripheral neuropathy of the right and left upper extremities and (2) a disability rating in excess of 40 percent for the period from October 25, 2018 for the Veteran's peripheral neuropathy of the right upper extremity (dominant), and (3) a disability rating in excess of 30 percent for the period from October 25, 2018 for the Veteran's peripheral neuropathy of the left upper extremity (non-dominant). Consequently, the benefit-of-the-doubt rule does not apply and entitlement to increased ratings as described above, is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 3. Entitlement to a rating in excess of 10 percent prior to October 26, 2017 for right lower extremity peripheral neuropathy as secondary to the Veteran's service-connected diabetes mellitus, type II, and in excess of 20 percent from October 26, 2017 is denied. 4. Entitlement to a rating in excess of 10 percent prior to October 26, 2017 for left lower extremity peripheral neuropathy as secondary to the Veteran's service-connected diabetes mellitus, type II, and in excess of 20 percent from October 26, 2017 is denied. A December 2014 rating decision granted service connection for right and left lower extremity peripheral neuropathy and assigned a 10 percent rating, effective August 6, 2014. A January 2017 rating decision denied an increased rating for both disabilities. On October 26, 2017, the Veteran filed a claim for total disability rating based on individual unemployability (TDIU), which was considered by the RO as an increased rating claim for peripheral neuropathy of the lower extremities. A January 2018 rating decision granted an increased rating to 20 percent for both disabilities, effective October 26, 2017. The Veteran contends that he is entitled to higher ratings for his service-connected right and left lower extremity peripheral neuropathy. The Veteran's right and left lower extremity peripheral neuropathy have been rated under 38 C.F.R. §§ 4.124a, Diagnostic Code 8521 from August 6, 2014, under 38 C.F.R. §§ 4.124a, Diagnostic Code 8520 from November 3, 2016, and under 38 C.F.R. §§ 4.124a, Diagnostic Code 8599-8520 from October 26, 2017. Under Diagnostic Code 8520, a 10 percent evaluation is warranted for mild incomplete paralysis of the sciatic nerve of the lower extremity. A 20 percent evaluation is warranted for moderate incomplete paralysis of the sciatic nerve of the lower extremity. A 40 percent evaluation is warranted for moderately severe incomplete paralysis of the sciatic nerve of the lower extremity. A 60 percent evaluation is warranted for severe incomplete paralysis, with marked muscular atrophy, of the sciatic nerve of the lower extremity. An 80 percent evaluation is warranted for complete paralysis of the sciatic nerve of the lower extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Complete paralysis of the sciatic nerve is indicated where the foot dangles and drops, there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term "incomplete paralysis" indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis of this nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Under Diagnostic Code 8521, a 10 percent rating is warranted for mild incomplete paralysis of the external popliteal nerve. Moderate incomplete paralysis warrants a rating of 20 percent, and severe incomplete paralysis warrants a rating of 30 percent. Under this code, a maximum evaluation of 40 percent is warranted for complete paralysis of the external popliteal nerve, which is defined as manifested by foot drop and slight drop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; and anesthesia covers entire dorsum of foot and toes. 38 C.F.R. § 4.124a, Diagnostic Code 8521. Turning to the evidence, the Veteran was provided a VA examination of his peripheral neuropathy in December 2014. An assessment of symptoms for the Veteran's lower extremities reported mild intermittent pain, moderate numbness, and severe paresthesias or dysesthesias in both extremities. The examiner stated that the nerves affected were terminal branches of peripheral nerves and cannot be assigned to specific nerves. The examiner reported that the clinical presentation was suggestive of bilateral upper and lower sensory peripheral neuropathy, which she stated was equivalent to incomplete paralysis that seems mild. The Veteran was provided another VA examination of his peripheral neuropathy in November 2016. The Veteran reported his numbness/paresthesias in his feet as mild/moderate in severity and not requiring any medications at this time. An assessment of symptoms for the Veteran's lower extremities reported the Veteran had no constant pain, mild intermittent pain, moderate numbness, and moderate paresthesias or dysesthesias. The examiner concluded the Veteran had mild incomplete paralysis of the sciatic nerve in the lower extremities. The Veteran was provided another VA examination of his peripheral neuropathy in December 2017. The Veteran reported having burning/stinging pain with intermittent numbness in his hands and feet for which ibuprofen "helps a little." An assessment of symptoms for the Veteran's lower extremities reported severe intermittent pain, severe paresthesias or dysesthesias, and moderate numbness. The examiner characterized the peripheral neuropathy in both lower extremities as moderate incomplete paralysis of the sciatic nerve. An October 2018 private medical record reported the results of an electromyography and nerve conduction study. Evaluation of the right peroneal motor nerve showed no response. The right tibial motor nerve showed prolonged distal onset latency, reduced amplitude, and decreased conduction velocity. No evidence of electrical instability was found. The impression was moderate axonal sensory motor polyneuropathy. The Veteran was provided another VA examination of his peripheral neuropathy in September 2021. The Veteran reported he had pain, numbness, and tingling around his feet and ankles. He stated it was painful to walk or stand for long periods of time. An assessment of symptoms for the Veteran's lower extremities reported moderate constant pain, no intermittent pain, moderate numbness, and moderate paresthesias or dysesthesias. The examiner characterized the peripheral neuropathy in both lower extremities as moderate incomplete paralysis of the sciatic nerve. For the period prior to October 26, 2017, the Board gives great probative weight to the December 2014 and November 2016 VA examination findings. These findings were based on in-person examinations of the Veteran's lower extremity peripheral neuropathy. Considering all the evidence, prior to October 26, 2017, the Board finds the Veteran's neuropathy symptoms of the right and left lower extremities are more consistent with mild incomplete paralysis. The evidence does not support that the Veteran's radiculopathy of the right and left lower extremities produced moderate, moderately severe, or severe incomplete paralysis to warrant a rating in excess of 10 percent. For the period from October 26, 2017, the Board gives great probative weight to the December 2017 and September 2021 VA examination findings. These findings were based on an in-person examination of the Veteran's lower extremity peripheral neuropathy. In 2019, the Veteran's representative submitted a notice of disagreement in which the representative reported that, as a result of the October 2018 private nerve conduction study, the Veteran was diagnosed with severe sensorimotor neuropathy of the lower extremities. However, the October 2018 report indicates that the nerve conduction study resulted in an impression of "[m]oderate axonal sensory motor polyneuropathy." Considering all the evidence, from October 26, 2017, the Board finds the Veteran's neuropathy symptoms of the right and left lower extremities are more consistent with moderate incomplete paralysis. The evidence does not support that the Veteran's radiculopathy of the right and left lower extremities produced moderately severe or severe incomplete paralysis to warrant a rating in excess of 20 percent. Moreover, the regulations state that when the involvement is wholly sensory, the rating should be, at most, the moderate degree. 38 C.F.R. § 4.124a. In consideration of the above, the Board finds that the preponderance of the evidence weighs against both (1) a disability rating in excess of 10 percent for the period prior to October 26, 2017 for the Veteran's peripheral neuropathy of the right and left lower extremities and (2) a disability rating in excess of 20 percent for the period from October 26, 2017 for the Veteran's peripheral neuropathy of the right and left lower extremities. Consequently, the benefit-of-the-doubt rule does not apply and entitlement to increased ratings as described above, is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 5. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. The Veteran contends that he has PTSD that is related to an in-service event, injury, or disease in service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). For cases certified to the Board on or after August 4, 2014, such as this case, the diagnosis of PTSD must be in accordance with the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5). 79 Fed. Reg. 45,093 (Aug. 4, 2014). The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran's DD Form 214 reflects that he served in the U.S. Army as a cook. The Veteran's enlisted qualification record indicates that he served in Germany from November 1964 to May 1966 and Vietnam from October 1966 to April 1967. The Veteran's service treatment records do not show any relevant symptoms, complaints, treatment, or diagnoses of an acquired psychiatric disorder, including PTSD. A May 1967 report of medical examination reported the Veteran's psychiatric system was normal. A May 1967 report of medical history documented the Veteran's report that he did not experience depression, excessive worry, or nervous trouble of any sort. A July 2013 VA primary care note reported that a PTSD screening test was negative. The Veteran was provided a VA PTSD examination in May 2014. The examiner concluded that the Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria and that the Veteran does not have a mental disorder that conforms with DSM-5 criteria. The examiner reported that the Veteran's experience in combat experience in Vietnam met Criterion A for PTSD. However, the examiner explained that he did not report negative alterations in cognition/mood and did not report enough hyper arousal symptoms. The examiner concluded that the reported symptoms "appear sub clinical at this time." An August 2017 VA primary care note reported that a PTSD screening test was negative. The Veteran's representative submitted a November 2017 medical report completed by a licensed clinical social worker. The Veteran reported having dreams about Vietnam two to three times a week. He reported that the dreams wake him and make him angry. The social worker diagnosed the Veteran with PTSD. The report did not describe whether the Veteran met the DSM-5 diagnostic criteria for PTSD. An August 2018 VA primary care note reported that a PTSD screening test was positive. A November 2019 VA primary care note reported that a PTSD screening test was negative. The Veteran was provided another VA PTSD examination in September 2021. The Veteran reported he was enjoying retirement and enjoys collecting antiques. He reported he is limited by physical issues but remained independent in all his needs. The examiner reported the Veteran's PTSD screens have all been negative except a positive screen in 2018. All PTSD screens have been negative for nightmares. The Veteran reported he still has nightmares of Vietnam but does not remember the nightmares. It was reported that he "thinks" he must be having nightmares as he does not sleep well at night. However, the Veteran reported he does not use his CPAP. The Veteran reported he can become sad when he thinks about the buddies he lost during his service; otherwise, the Veteran denied any prolong depressed mood. Veteran reported he will have down moods when he has health issues and he is worried about his prostate cancer, for which he has avoided treatment. The Veteran had soft signs of a neurocognitive disorder with poor memory for remote history and some mild confabulation. The examiner reviewed the private November 2017 medical report that included a PTSD diagnosis. She reported that the symptoms noted in the report do not indicate a PTSD diagnosis and that a full PTSD screen was not completed when the diagnosis was made. The examiner noted the main symptom of concern during the 2017 assessment was nightmares. However, the examiner reported that the Veteran's PTSD screens have all been negative for nightmares. The Veteran's non-compliance of CPAP was also not addressed in the 2017 assessment. Therefore, the Veteran is reporting disturbance in sleep while not controlling his obstructive sleep apnea. The Veteran is not reporting recalling his nightmares but thinking he had a nightmare. The Veteran also reported normal grief when recalling death of fellow soldiers. The examiner concluded that the Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria and that the Veteran does not have a mental disorder that conforms with DSM-5 criteria. While the Veteran contends that he has PTSD related to an in-service injury or disease, he is not competent to provide a nexus opinion in this case. The issue of the etiology of the Veteran's PTSD is medically complex, requiring specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Thus, the Board finds the Veteran's statements are not competent medical evidence. Consequently, the Board gives more probative weight to the September 2021 VA examination report. After reviewing the Veteran's claims folder, including the November 2017 report in which the licensed clinical social worker diagnosed the Veteran with PTSD, and conducting an in-person examination of the Veteran, the examiner, a licensed psychologist, concluded that the Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria and that the Veteran does not have a mental disorder that conforms with DSM-5 criteria. The probative medical evidence of record is against a finding that the Veteran has a current diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a). The September 2021 VA examination is highly probative evidence in this regard, as it relied on sufficient facts and data, provided a rationale for the opinion, based its reasoning on the DSM-5 criteria, and contains sound reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. (2008). As described above, the first prong of a service connection claim is a current disability. The evidence does not demonstrate that the Veteran had a diagnosis of PTSD or any other acquired psychiatric disorder during the pendency of the appeal. The U.S. Court of Appeals for Veterans Claims has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claims for service connection for PTSD. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claim for PTSD must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Moore, 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.