Citation Nr: 21072635 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 18-25 480 DATE: December 3, 2021 ORDER New and material evidence having been received, the application to reopen the previously denied claim of entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. New and material evidence having been received, the application to reopen the previously denied claim of entitlement to service connection for a nervous disorder is granted. Service connection for PTSD is denied. REMANDED The issue of service connection for major depressive disorder, also claimed as anxiety, is remanded. The issue of a total disability rating based on individual unemployability (TDIU) due to service-connected disability is remanded. FINDINGS OF FACT 1. In an unappealed May 1985 decision, the Board denied service connection for PTSD or other chronic psychiatric impairment, to include a nervous disorder and depression. 2. In a November 2002 rating decision, a Department of Veterans Affairs (VA) regional office (RO) denied reopening the previously denied claim of service connection for PTSD or a nervous disorder; although notified of the decision and his appellate rights in a November 2002 letter, the Veteran did not initiate an appeal or submit new and material evidence within one year of the notification. 3. The preponderance of the evidence of record is against finding that the Veteran has been diagnosed with PTSD in conformance with the applicable diagnostic criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at any time during the pendency of the claim. CONCLUSIONS OF LAW 1. The May 1985 Board decision denying service connection for PTSD or other chronic psychiatric impairment, to include a nervous disorder and depression, is final. 38 U.S.C. § 7104; 38 C.F.R. §§ 3.104, 20.1100. 2. The November 2002 rating decision declining to reopen the claim for service connection for PTSD or a nervous disorder is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 20.302, 20.1103. 3. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1963 to July 1967. This matter comes before the Board of Veterans' Appeals (Board) from a June 2015 rating decision. In November 2020, the Veteran testified at a Board telehearing; a transcript of the hearing is associated with the claims file. 1. Whether new and material evidence has been received to reopen the previously denied claim of service connection for PTSD 2. Whether new and material evidence has been received to reopen the previously denied claim of service connection for a nervous disorder In general, decisions of the RO and the Board that are not appealed in the prescribed time period are final. 38 U.S.C. §§ 7104, 7105(c); 38 C.F.R. §§ 3.104, 20.1100, 20.1103. Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156. To reopen a previously disallowed claim, new and material evidence must be presented or secured since the last final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim since a prior final disallowance. Evans v. Brown, 9 Vet. App. 273, 285 (1996). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992) (in determining whether evidence is new and material, the credibility of newly presented evidence is to be presumed unless evidence is inherently incredible or beyond competence of witness). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, to include by triggering the Secretary's duty to assist. Id. at 118. In a May 1985 decision, the Board denied the Veteran's original claim for service connection for PTSD and a nervous disorder, finding that the evidence of record did not reflect a current PTSD disability, any chronic psychiatric impairment in service, or that the depression diagnosed on VA examination was related to military service. The Board decision is final on the date stamped on the face of the decision. 38 C.F.R. § 20.1100(a). In April 2002, the Veteran sought to reopen the claim for service for PTSD. A November 2002 RO decision declined to reopen the claim for service connection for PTSD or a nervous disorder because new and material evidence had not been received. The Veteran was notified of the decision the same month and did not appeal or submit new and material evidence within the time period allowed. The November 2002 RO decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. The Veteran now seeks to reopen the previously denied claims; in August 2014, VA received his claim seeking service connection for PTSD, depression, and anxiety. As noted above, despite the finality of a prior adverse decision, a claim will be reopened and the former disposition reviewed if new and material evidence is presented or secured with respect to the claim that has been disallowed. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Having compared the new evidence received since the last final Board decision that denied service connection for psychiatric impairment diagnosed as depression and since the last final RO decision that denied reopening the claim for service connection for PTSD and a nervous disorder, the Board finds that new and material evidence had been received sufficient to review the claims. Notably, a January 2017 private psychological evaluation report diagnosed PTSD, major depressive disorder, and unspecified anxiety disorder. The private psychologist indicated the Veteran may have been hit with shrapnel in a 1966 mortar attack, and the Veteran reported that his depression began in the military when he felt unable to keep up with physical demands and was accused of not exerting maximum effort. The Veteran also reported ongoing, intermittent symptoms related to PTSD, depression, and anxiety since separation from service. Presuming this new evidence to be credible, the Veteran's statements regarding a continuity of symptoms and the private psychological opinion suggesting current psychiatric disorders are related to events during military service are new and material because they relate to previously unestablished facts necessary to substantiate the claims. Accordingly, the standards under 38 C.F.R. § 3.156(a) have been met and the claims are reopened. 3. Service connection for PTSD At various times after separation from service, the Veteran reported that he was hit by shrapnel in the forehead, both arms, both legs, and the left hand below the little finger in the Fall of 1966 while in Dong Ha, Vietnam. He has asserted that he has a piece of retained shrapnel in his right forearm. On one occasion, he reported having retained shrapnel in his right leg. In an Authorization for Release of Information received in June 2002, he reported he received a "Purple Heart in country (NOT ON DD214)" for "long hours [spent in] close combat off of south ridge [where he was] hit with shrapnel." (Emphasis in original). An August 2002 progress note reflects that he told his private therapist, A. Scott, Ed.D., that he was in Vietnam and received the Purple Heart. In January 2015 correspondence, he stated that he was hit with shrapnel and received treatment but "was never awarded the Purple Heart because no medical records were ever found." In November 2020, he testified that he did not receive the Purple Heart for shrapnel wounds because "we had a CO that didn't believe in giving Purple Hearts unless you were taken out in a bag." Establishing service connection for PTSD requires medical evidence diagnosing the condition in accordance with §4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The diagnosis of a mental disorder must conform to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published in 2013 by the American Psychiatric Association. 38 C.F.R. § 4.125(a). In the case of veterans who engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(2). Similarly, if a stressor claimed by a veteran is related to his fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3). The Veteran's service personnel records document two deployments. His first deployment from February 1964 to February 1965 included service in Okinawa, Japan; Taiwan; the Philippines; and in Vietnam from August 1964 to October 1964. His second deployment involved service in Vietnam from December 1965 to January 1967. Awards and decorations received are not indicative of participation in combat. The Veteran's service treatment records reflect he underwent psychiatric observation for a period of 17 days, but he neither endorsed nor was found to have any chronic psychiatric impairment or disorder at that time or during the remainder of his military service. In an enlistment report of medical history, he denied any history of frequent trouble sleeping, frequent or terrifying nightmares, depression or excessive worry, loss of memory or amnesia, or nervous trouble of any sort. On enlistment examination the same day, his psychiatric function was reported as normal. The only abnormality noted on evaluation was a vaccination scar on his left arm, which was not considered disabling. In June 1965, the Veteran was admitted to the neuropsychiatric service at the U.S. Naval Hospital in Bethesda, Maryland from the Post psychiatrist at Quantico, Virginia. The records show he had complained of an inability to move his legs for two consecutive days after they began to hurt while on guard duty and later gave out during a PRT test. When his symptoms began, he was seen by the medical officer, unable to move his toes, received an injection, borrowed crutches, and was returned to his barracks. The next day, his legs ached and again he was unable to perform his duties; he was seen by the medical officer followed by the Post psychiatrist. On admission to the Naval Hospital, he was able to walk but with pain. On examination, he was friendly, cooperative and intelligent; oriented to time and place; there was no dyscalculia; he was not depressed or overly angry; he quietly rejected the suggestion that his symptoms were due to an emotional problem; his fingernails were chewed off; and he was not manipulative or psychotic. The admission diagnosis was "conversion reaction (tired, angry Marine); [rule out] neurologic disease if he doesn't improve with rest." A July 1965 narrative summary of his hospitalization detailed that physical, neurological, and indicated laboratory examinations had been normal. He was fully cooperative and of above-average intelligence. He complained of pain in the back of his legs and he "knew that that was thought to be psychogenic." He was mildly angry and fully oriented; he was not depressed; and there was no evidence of neurotic or psychotic ideation. He was treated with rest and allowed to ambulate as he saw fit. His leg pain soon abated and he was able to get around without any difficulty. He continued to show no evidence of a neurosis or psychosis and expressed his wish to return to duty. "After an adequate period of observation, a conference of staff psychiatrists reviewed [his] case. The diagnosis was established as Observation, Psychiatric, No disease found." He was returned to full duty. Subsequent service treatment records are silent for complaints, diagnosis, or treatment related to psychiatric problems. Similarly, the records are silent for any reports, diagnosis, or treatment related to any shrapnel or other combat-related wounds or injuries. In a July 1967 separation report of medical examination, his psychiatric function, face, upper extremities, lower extremities, and neurologic function were reported as normal on clinical evaluation. Again, the only abnormality noted was identifying body marks, scars, or tattoos, which the examiner identified as a vaccination scar on the upper left arm. In July 1970, VA received the Veteran's first claim for VA compensation benefits in which he sought service connection for a skin disorder. During a September 1970 VA general medical examination, he reported having a rash over his shoulders, neck, and arms since January 1967 when he was in Vietnam. Examination of his skin revealed a typical spread of maculopapular squamous eruption with depigmentation over his chest, back, and arms. His head, face, and neck were reported as normal. He had no varicose veins. Examination of his musculoskeletal system, to include identification and evaluation of any injuries (such as gunshot wounds and other injuries on skin and underlying structures) and any scars or burns, was reported as normal. Examination of his psychiatric function, including behavior, comprehension, coherence of response, emotional reaction, orientation, memory, signs of tension, and status as to social and industrial capacity, was reported as normal. The diagnosis was tinea versicolor. An October 1971 rating decision granted service connection for tinea versicolor and assigned a 10 percent rating. The decision indicated that re-examination would be scheduled in two years because improvement was expected. During an August 1972 VA general medical examination, he described his history and symptoms of tinea versicolor. He reported currently working as an assembler for an automobile company. On examination, he had no scars, no injuries on the skin, no musculoskeletal or neurological impairment, and no psychiatric impairment. Private treatment records from J. Coupland, D.O., dated from November 1976 to September 1979 (and received in May 1984) are silent for complaints, diagnosis, or treatment relating to mental health problems. In July 1983, the Veteran presented to a VA medical center with complaints of stomach cramps, nausea, bloating, occasional vomiting, dry heaves, diarrhea, and epigastric pain. The diagnosis was cholecystitis, hiatus/hernia, gastric ulcer. He was admitted for hospitalization. The discharge diagnosis six days later included depression associated with chronic abdominal discomfort. During his hospitalization for gastrointestinal symptoms, he filed an informal claim for an increased rating for tinea versicolor; service connection for a stomach/abdominal disorder and tendonitis of the posterior upper left leg and posterior lower right leg; and service connection for PTSD and a nervous disorder. He asserted that he was in combat and life-threatening situations in Vietnam and had nervous problems caused by a "night attack in 1966, which caused nightmares." He stated that he was first treated for a nervous disorder and delayed stress at the Bethesda Naval Hospital in 1966. He indicated that his nightmares diminished in 1971 but he continued to have problems with his nerves, which caused trouble sleeping. He reported that he had "made numerous outpatient visits for sleeping pills," and two doctors, Dr. Coupland and Dr. Joseph, had prescribed Valium for him. Later in July 1983, he saw a VA social worker and reported that he was undergoing "delayed stress." He stated that no one seemed to understand that he was having difficulty hanging onto his job because of his medical problems. He was concerned that due to his "tendonitis, nerves, and diarrhea," he would lose his job and be unable to care for his wife and child and that his application for an increase in his service-connected disability was taking too long. An August 1983 psychiatric assessment from J. Blank., M.D., reflects the Veteran was referred by the VA hospital following his hospitalization for gastrointestinal problems. He indicated that tests with his family doctor and VA had always been negative. He related that his private physician, Dr. Joseph, believed that "since [he] was in Vietnam that this is delayed stress syndrome." The diagnosis was physical problem associated with nervous disorder; spastic colitis. During an initial visit with a therapist, S. Gibson, M.S., the Veteran reported having trouble sleeping and gastrointestinal problems. He expressed his belief that his problems were a result of "something that may have happened in [Vietnam] and they are psychological in nature." However, he stated that his Vietnam experience was "unclear to him and he [did] not remember a lot." During a September 1983 therapy session, he again stated that many of his problems were related to his Vietnam service but "not so much the actual duty as with the runaround the government has given him." In September 1983, the Veteran was afforded a VA psychiatric examination. He reported serving two 13-month tours in Vietnam, developing tendonitis between his first and second tour, and being put in a straitjacket and admitted to a psychiatric ward. On questioning about his nerves, he indicated he had recurrent nightmares "that he is in a hole in Vietnam, the Vietnamese were throwing fish heads and monkey meat at him, and he is unable to do anything because his is in a straitjacket." He reported having this dream almost nightly since leaving Vietnam and presently having this dream two to three times per week. He stated he was seeing a psychiatrist and had been going to counseling for two and one half years. Current psychiatric medications included Sinequan, Tofranil, and Halcion. On mental status examination, the Veteran described feeling nervous with his hands feeling numb; he described "depression as that he just cannot motivate himself." He denied experiencing flashbacks. The psychiatrist indicated that at present there was not a definite psychiatric diagnosis possible. The psychiatrist also referred the Veteran for a "Social Service survey" and requested to review his current records, noting that his "history suggests a diagnosis of depression; however, he does have recurrent nightmares about his service experience." One week later, the Veteran presented for a social service assessment (accompanied by his spouse) by a VA social worker. He stated that he served two 13-month tours in Vietnam. He described three stressful military events. First, he reported that "during his first tour in 1964, he was hospitalized for two weeks with gastritis" and was "placed on a ward with many veterans who had suffered combat injuries." He indicated it was the first time in his life that he had witnessed so much pain and traumatic injury and that he had coped by trying not to think about it after he returned to his unit. Second, he stated that he was frequently assigned the detail of delivering mail between three separate locations in Vietnam and the trip was dangerous because of snipers and possible ambush. He related that he "came close to death numerous times during these runs, and it served to create a great amount of anxiety and fear in him." Finally, he indicated that during his second tour in Vietnam, a battalion of Sea Bees was established approximately two thousand yards away from his unit. At night, each unit would suspect enemy movement through the area between the two units and as a result, there were "numerous 'friendly fire casualties,'" which "created great levels of anxiety for the troops nearly every night." The Veteran stated that during one of these incidents he was "injured by shrapnel from an exploding mortar round as he lay in his bed." He reported being sent to a field hospital for three weeks and then returning to the field to resume his duties. He explained that his current anxiety and nervousness related "directly to this recurring situation." He described his post-service work history and stated he had "never had a problem relating to co-workers or his supervisors," elaborating that when he had left jobs, it was almost always due to business conditions or his medical condition and not a result of emotional instability on his part. The interviewing social worker observed that although the Veteran claimed that his medical problems were his greatest difficulty, all of the medical tests performed to date had been negative, and it appeared that his gastritis may have been psychosomatic in nature and stress-induced. The social worker believed that further psychiatric evaluation may be appropriate before a final diagnosis is determined because although the Veteran exhibited numerous symptoms related to PTSD, his symptoms also closely paralleled depression. The social worker concluded it was "possible that [the Veteran's] current stress management problems and emotional isolation are a result of military service." In a September 1983 addendum, the examining psychiatrist indicated he had reviewed the Social Service survey and his diagnosis of no definite psychiatric diagnosis was continued. Later in September 1983, the Veteran's private physician, A. Joseph, M.D., indicated he had treated him since November 1979, including for a rash that began during military service in Vietnam. Dr. Joseph did not identify any problems or treatment related to mental health problems. A November 1983 individual therapy record from S. Gibson, M.S., reflects the Veteran's report that he was quite upset that Dr. Blank was unable to determine him incapable of working. He had "brought in copies from the [Physician's Desk Reference], which describe his medication and has symptoms underlined." The therapist noted that the Veteran had been telling his employer that he is unable to work due to his medication, but Dr. Blank had indicated that the Veteran is able work under his current medication regimen. In a February 1984 substantive appeal, the Veteran again asserted he was placed in a straitjacket for a day in June 1965 and then hospitalized for about three weeks before being released. He stated he was currently being treated by a local psychiatrist for a stress disorder, which he believed was connected to his service. In his April 2002 application to reopen the claim for PTSD, the Veteran asserted he had residuals of combat wounds in his "forehead, left hand, right forearm, left ankle area, and right shin." In June 2002 correspondence, he suggested that he had been hospitalized at the Bethesda Naval Hospital during military service because he "could not handle the stress level" of military service; he was humiliated and defamed; and he had fallen out of a physical readiness test but about a month later was well enough to be sent back to Vietnam for a second tour even though he "could not handle the first tour." In support of his claim, the Veteran submitted a May 2001 psychological report prepared by a private psychologist, A. Scott, Ed.D., at the request of an attorney who had been representing him in a Worker's Compensation case but had backed out (after all of the testing had been completed) because he believed that the Veteran's "total problems were due to long-term psychiatric issues." The report details that he had been working at his job of more than 15 years as head of maintenance at a school when he fell from a scaffold in August 1999. He indicated he had been treated for depression with Zoloft in the past, but identified the factor leading up to recent therapy as the August 1999 workplace injury. He described feeling extremely angry at the medical and legal systems in addition to problems with anxiety, nervousness, depression, fatigue, agitation, flashbacks, insomnia, physical problems, and paranoia. Dr. Scott reviewed evaluation reports by other treatment providers. An April 2000 psychiatric evaluation by A. Clark, M.D., indicated that the Veteran had suffered from a major depressive episode, moderate, in partial remission. Dr. Clark had recommended the Veteran attend individual counseling to help with stressors related to finances and his Worker's Compensation claim. A November 2000 report from another private psychiatrist, L. Bernstein, M.D., indicated that a preexisting psychological history was a factor in the Veteran's current psychiatric presentation. Dr. Bernstein also noted there were multiple iatrogenic reasons for his mild cognitive impairment and depressive symptomatology. Following his own evaluation and psychological testing, Dr. Scott summarized that the Veteran "had a long-term psychiatric problem; however, the work injury added a PTSD problem." Subsequent therapy records dated from December 2001 to September 2002 indicate that the Veteran told Dr. Scott had had received a Purple Heart related to his service in Vietnam and that he had constant nightmares and flashbacks that "go back to Vietnam." Among treatment records from the Butler VAMC dating from December 2002 to July 2019, routine screening for depression and PTSD was generally negative except for a positive depression screen in November 2007 and May 2014 and a positive PTSD screen in December 2005 and December 2017. During the December 2005 visit with a primary care physician, the Veteran's reported concerns were limited to back pain and problems for which he was seeing a private cardiologist. Similarly, in November 2007, the Veteran's primary care physician acknowledged the positive depression screen but indicated that additional assessment revealed he did not meet the criteria for major depressive disorder and he had no psychiatric symptoms that required additional intervention. In connection with the May 2014 depression screening, the Veteran told his primary care provider that "this time of year with Memorial Day is a constant reminder of everything he went through in Vietnam." He stated that he had been put in inpatient psychiatric treatment for two months and was subsequently sent for a second tour in Vietnam. He reported that he had "shrapnel [in his] right leg that [was a] constant reminder of everything he went through." He endorsed experiencing current symptoms of depression, flashbacks, and nightmares. Examination of his psychiatric function revealed a slightly flat affect. The assessment was PTSD/depression and the examiner ordered a cognitive behavioral health (CBH) consult. During a June 2014 CBH consultation with a VA psychologist, the Veteran reported he had had problems over the years with PTSD but had "never got any satisfaction on it." The psychologist observed that the primary care physician had entered a diagnosis of PTSD on the Veteran's problem list and ordered a consultation, indicating he had been experiencing flashbacks and nightmares. However, when the consulting psychologist asked about traumatic events, the Veteran was unable to identify any. After multiple attempts to clarify the definition of a traumatic event and to help the Veteran identify the experiences he had thought would qualify as traumatic and potentially lead to PTSD, he initially provided examples of his medical problems. With continued attempts at clarification, he eventually explained that he had combat exposure to mortar attacks and one small arms fire event during his service in Vietnam, which he reported as consisting of two 13-month tours. He also reported he did fire upon the enemy and mentioned an incident in which he was "'lost' out in the field and was considered to be 'missing in action' for a time." He disclosed that he sustained multiple injuries in a 1999 construction accident but denied having any emotional or psychological symptoms related to that experience. Regarding any pertinent psychiatric history, the Veteran reported that he was psychiatrically hospitalized for a total of two months at the Bethesda Naval Hospital in 1965 or 1966 following his first tour in Vietnam, with two or three of those weeks being on lockdown. He explained that his legs gave out on him and he fell out of a physical readiness test, but his commander believed he had been faking an impairment. Other than his legs giving out, he was unable to identify what emotional or psychological issues he was having at the time that required his psychiatric hospitalization for a two-month period. He stated that other than being prescribed Zoloft at one point, he had not received any other mental health treatment. Following a mental status examination, the diagnosis was unspecified anxiety disorder and recurrent major depressive disorder. The psychologist summarized that the Veteran did not appear to meet criteria for a diagnosis of PTSD and explained this fact to him. A June 2014 addendum note detailed that members of the PTSD Treatment Team had met and agreed that the Veteran's symptoms did not meet the criteria for a diagnosis of PTSD at this time. Finally, a December 2017 primary care note details that the provider reviewed the results of the positive PTSD screen and evaluated the Veteran, including for any suicide risk. During a review of systems, the Veteran denied any personal, family, or mental or emotional problems; any depression; any suicidal ideation; or things that made it hard for him to take care of his own health. On examination, he appeared alert and oriented and his mood and affect were reported as normal. The assessment included PTSD/depression. The physician assistant indicated the Veteran had declined further evaluation or treatment by CBH providers and declined starting any medications for depression. Treatment records from the Pittsburgh VAMC dated from July 2013 to July 2019 identify a psychiatric history of depression with "no issues" and "no admissions." The records do not reflect complaints or treatment related to current mental health problems. Meanwhile, in March 2015, the Veteran was afforded a VA examination to evaluate his claimed psychiatric disability. He reported experiencing a traumatic stressor midway through his second tour when stationed at Dong Ha, Vietnam. He stated that he was standing near a radio van when the camp received mortar fire and hand grenades. He immediately jumped into a nearby bunker and landed on another individual's rifle, causing a back injury. He stated he was also hit with shrapnel in the head, leg, finger, and arm but continued fighting until the next morning. At that point, he reported going to the field hospital and receiving stitches in his hand. The examiner remarked that having reviewed the Veteran's electronic claims file, there was "no evidence of this visit in his service records." He described a generally stable post-service work history until he fell off some scaffolding in 1999 and received Worker's Compensation for his injuries. In 2008, he returned to the workforce, working part-time for a car auction company until 2013 when he quit his job due to physical health limitations. Regarding the June 1965 diagnosis of conversion disorder and hospitalization, he described collapsing and being unable to move his legs because he "was suffering from malnutrition and tendonitis," but others believed he was faking an injury. He reported spending a month at the Bethesda Naval Hospital and being released back to duty and stated, "They dealt with me afterwards by sending me back to Vietnam a second time." The examiner remarked that during the present interview, the Veteran had "framed this episode as purely physical and as evidence that he was being mistreated" but in a 1983 statement, he "used this hospitalization as an example of his 'nervous condition and delayed stress.'" The examiner observed that the June 1965 hospitalization occurred at least one year prior to the Veteran's reported traumatic event involving being hit by incoming mortar rounds. The Veteran endorsed current symptoms such as depressed mood, anxiety with nail-biting, infrequent flashbacks over the past 40 years, nightmares every four or five months related to his reported military stressor, fatigue, anhedonia, insomnia, and psychomotor retardation. Following a review of the claims file and examination, the diagnosis was major depressive disorder with anxious distress. The examiner explained that although the reported stressor of experiencing incoming mortar rounds during military service in Vietnam was related to fear of hostile military activity and was sufficient to meet Criterion A (a traumatic stressor) for a diagnosis of PTSD, the Veteran's symptoms did not meet other criteria for a diagnosis of PTSD. For example, the examiner commented that the Veteran appeared in no apparent distress during the interview and denied experiencing distress even when talking about his reported stressor, discussing symptoms of "nerves" and "stress...mostly in association with his physical health." In fact, he stated, "I feel better after talking to you about it." Also, he "often provided very vague descriptions that required clarification" and "presented with an overall pattern that the military is responsible for most things that have gone wrong in his life." In April 2015, VA received medical records associated with the Veteran's disability claims file from the Social Security Administration (SSA). Private treatment records, which appear to be from Dr. DeJulia, reflect that the Veteran presented as a new patient in June 1996 with complaints that included difficulty sleeping, family stressors, and feeling anxious. He also reported a past medical history that involved a gunshot wound to the right lower leg during the Vietnam war. The assessment was anxiety. Subsequent records showed diagnosis and treatment for depression. In March 2017, the Veteran submitted the report of a private psychological evaluation completed in January 2017 by M. Meyer, Ph.D., and J. Uran, Ph.D. The Veteran described a mental health history involving PTSD "diagnosed in 1966 relating to 'shell shock' or conversion reaction with two Vietnam experiences (2 tours)." He stated he was also involved in a mortar attack in 1966 during which he jumped into a sandbag and landed on a rifle, injuring his wrist, back, and left leg. He indicated he "may have also been hit with shrapnel." He described having mood swings with irritability and intense anger that were worse in the past; near-constant anxiety involving nail-biting and tremors; poor focus and poor recall for instructions; and insomnia with night waking, being unable to sleep more than four hours nightly due to flashback experiences. Reported clinical observations included the following: well-bitten fingernails; typically lacked eye contact and wore glasses; and presented as stiff, evidenced poor handwriting, and had a bilateral hand tremor. Other mental status examination findings or behavioral observations by either examining psychologist were not reported. Following a review of at least some of the records from the Veteran's VA claims file and psychological testing, the diagnosis was PTSD; recurrent, mild major depressive disorder; unspecified anxiety disorder. The private psychologists summarized that the Veteran "may have had experiences in Vietnam. . . and appears to suffer some ongoing correlates of PTSD." In a March 2017 PTSD Disability Benefits Questionnaire (DBQ) (VA Form 21-0960P-3) completed in March 2017, M. Meyer, Ph.D., listed the same diagnoses as the January 2017 psychological evaluation. However, in Section VI of the DBQ, Dr. Meyer indicated Criterion C for a diagnosis of PTSD was not met because the Veteran had no persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness. A December 2017 VA examination report reflects the Veteran's report that he was injured with shrapnel during military service and his insistence that all problems he has are PTSD-related. Following a review of the electronic claims file, including the private psychological reports from earlier in 2017, and examination, the diagnosis was moderate major depressive disorder with anxiety. The examining clinical and forensic psychologist detailed in the examination report that the criteria for a diagnosis of PTSD were not met. Instead, only criteria A and B were met. The examiner opined "within a reasonable degree of scientific-psychological certainty that this Veteran's psychological profile, history, and symptoms-pattern are not consistent with PTSD." In support of the conclusion, the examiner detailed that the Veteran's alleged PTSD does not include symptoms in multiple PTSD categories, and his psychological issues on active duty were not logically related to PTSD issues. In a May 2018 addendum report addressed to the Veteran's attorney, Dr. Meyer indicated that the diagnosis of PTSD was based on symptoms from [the DSM-5] Criteria A, B, and D. Regarding category C-related PTSD symptoms, Dr. Meyer indicated that because the "trauma occurred in Vietnam, there is no proximity to presenting stimuli or triggers, although it is clear that he does suffer prolonged distress involving experiences of flashbacks and night terrors, at which time he has vivid recall of presenting stimuli such as 'sensations of explosions or being stabbed.'" Dr. Meyer noted that a review of the Veteran's military records indicated "that he experienced incoming mortars and hand grenades and was hit with shrapnel" and that his "stressor statement indicates live fire and accompanying wounds from shrapnel." He concluded that it could not be ruled out that the Veteran's "symptoms that are typically associated with PTSD have a causal relationship to his military experiences" and that it was at least as likely as not that "these symptoms associating with PTSD are related to his military experiences in Vietnam." Having considered the medical and lay evidence of record, the Board concludes that the preponderance of the evidence is against an award of service connection for PTSD. To the extent the Veteran contends that he has PTSD, he is not competent to provide such a diagnosis. See Young v. McDonald, 766 F.3d 1348, 1353 (Fed. Cir. 2014) (holding that PTSD is not the type of medical condition that lay evidence, standing alone, is competent and sufficient to identify); see also Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) (2009) ("It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant."). However, he is competent to describe events he experienced during military service, to identify many psychiatric symptoms, and to report the onset and continuity of many symptoms associated with psychiatric impairment. See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (holding that non-expert witnesses are competent to report that which they have observed with their own senses). In this regard, although the Veteran is competent to report being struck and injured by shrapnel on multiple body parts in 1966 during his second tour in Vietnam, this reported stressor is not credible. First and foremost, contemporaneous service treatment records document that at separation examination, the Veteran had no additional scars or identifying body marks other than the vaccination scar on his left upper arm that was present on entrance examination. Similarly, detailed examination of his skin and musculoskeletal system during September 1970 and August 1972 VA examinations documented that he did not have scars or injuries on his skin or underlying structures. Moreover, as detailed above, his account of being injured by shrapnel changed over time. For example, in September 1983, he told a VA examiner he was injured by shrapnel from friendly fire but when he sought to reopen his service connection claim for PTSD in April 2002, he described having residuals of combat wounds on his forehead, left hand, right forearm, left ankle, and right shin. In summary, the Veteran's reported military stressor involving injury by shrapnel in 1966 is not credible because it is unsupported and contradicted by contemporaneous in-service and post-service medical evidence of record and because the Veteran's various reports describing this event are internally inconsistent. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (holding that the credibility of a witness can be impeached by a showing of interest, bias, inconsistent statements, or, to a certain extent, bad character). Regarding the military stressors he described on VA examination in September 1983 involving seeing others injured while he was hospitalized in service for gastrointestinal problems and coming "close to death" on multiple occasions while delivering mail during military service, each of these reported stressors is vague and uncorroborated by either credible supporting lay evidence or competent medical evidence. Also, neither contemporaneous service treatment or personnel records nor post-service medical evidence supports the conclusion that the Veteran had come close to death multiple times during active duty service. Furthermore, to the extent that either of these reported military stressors occurred as described, neither appears to be clinically significant because the evidence of record indicates the Veteran did not mention either event again outside of the September 1983 VA examination to VA or private treatment providers or to subsequent examiners. To the extent the Veteran may have experienced incoming artillery, rocket, or mortar fire during either period of service in Vietnam, the March 2015 VA examiner acknowledged that this sort of stressor related to fear of hostile military activity and would be adequate to support a diagnosis of PTSD. However, following a review of the claims file and examination, the psychologist concluded the Veteran's symptoms did not meet the full criteria for a diagnosis of PTSD. Finally, service connection for PTSD must be denied because the preponderance of the evidence indicates the Veteran does not have a current PTSD disability that conforms to the diagnostic criteria set forth in the DSM-5. For example, a May 2014 VA primary care provider diagnosed PTSD after a limited examination of the Veteran's psychiatric function that was significant for slightly flat affect but no other observed psychiatric impairment was recorded. Upon referral for psychological consultation the next month, a VA team of psychologists concluded the Veteran did not meet the criteria for a diagnosis of PTSD. Similarly, although the private psychological assessment from January 2017 indicates that the diagnosis included PTSD related to experiences he "may have had" in Vietnam, including possibly being hit with shrapnel, that report included only minimal clinical observations and did not demonstrate how the criteria for a diagnosis of PTSD were met. In comparison, the March 2017 PTSD DBQ report authored by Dr. Meyer identified the Veteran's psychiatric symptoms and addressed each diagnostic criterion outlined by the DSM-5 pertinent to a diagnosis of PTSD. Here, Dr. Meyer clearly indicated that Criterion C was not met because the Veteran had no persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness. As a result, the diagnosis of PTSD rendered in the January 2017 private psychological assessment and in the March 2017 DBQ by Dr. Meyer did not conform to the diagnostic criteria set forth in the DSM-5 and may not be accepted as a valid diagnosis of PTSD. The Board also observes that A. Scott, Ed.D., diagnosed PTSD in May 2001; however, the diagnosis was made based on the underlying stressor related to the August 1999 on-the-job injury and not to any in-service traumatic event. As the preponderance of the evidence is against the Veteran's claim for service connection for PTSD, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. The issue of service connection for major depressive disorder, also claimed as anxiety, is remanded. Competent medical evidence of record reflects that the Veteran has a current diagnosis of major depressive disorder with anxious distress. Although he was previously afforded VA examinations in March 2015 and December 2017 to evaluate the nature and etiology of his claimed psychiatric disability, neither examiner included a medical opinion as to whether the current major depressive disorder with anxiety had its onset in service or is otherwise related to military service, to include the episode of conversion reaction for which he was hospitalized for psychiatric observation for 17 days beginning in June 1965. The AOJ should arrange for an examination to obtain necessary opinion evidence. 2. The issue of a TDIU due to service-connected disability is remanded. The Veteran contends that he is unable to obtain or maintain substantially gainful employment due to service-connected disability, particularly his ischemic heart disease. By way of background, an October 2012 rating decision granted service connection for ischemic heart disease and assigned a 60 percent disability rating effective November 21, 2010. Later in October 2012, the Veteran filed a claim for an increased rating for ischemic heart disease. While his claim was pending, he filed an application for a TDIU due to service-connected heart disease in July 2013. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (holding that a claim for a TDIU, either expressly raised by the veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability or disabilities, either as part of the initial adjudication of a claim or as part of a claim for an increased rating). The June 2015 rating decision on appeal denied entitlement to a TDIU. A July 2017 rating decision increased the assigned rating for ischemic heart disease to 100 percent effective July 5, 2017. Therefore, the issue on appeal is whether a TDIU is warranted at any time since October 29, 2012 but prior to July 5, 2017. Since receipt of the claim for an increased rating for ischemic heart disease on October 29, 2012 and prior to July 5, 2017, service connection has been in effect for ischemic heart disease (rated 60 percent disabling), type II diabetes mellitus (rated 20 percent disabling), tinea versicolor (rated 10 percent disabling), and hypertension (rated noncompensably disabling). The combined evaluation for compensation was 70 percent effective October 29, 2012. The Veteran meets the threshold schedular criteria for entitlement to a TDIU pursuant to 38 C.F.R. 4.16(a). The issue of entitlement to a TDIU is dependent, in part, on the outcome of the service connection claim for major depressive disorder, also claimed as anxiety. Because the TDIU claim is inextricably intertwined with the psychiatric disorder issue, it also must be remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with a psychologist or psychiatrist to obtain an opinion regarding the nature and etiology of the current depressive disorder with anxiety. Provide the Veteran's electronic claims file to the designated examiner for review. Following a review of the claims file and examination, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that a current depressive disorder with anxiety had its onset during military service or is otherwise etiologically related to disease or injury during service, to include the episode of conversion reaction for which the Veteran was hospitalized for psychiatric observation for 17 days beginning in June 1965. A detailed medical rationale must be provided for all opinions expressed. K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Laura Kirscher Strauss 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.