Citation Nr: 21072802 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 17-06 142 DATE: December 6, 2021 ORDER Service connection for a seizure disorder is denied. Service connection for claustrophobia, previously claimed as a nervous condition, is denied. Service connection for major depressive disorder and posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. The most credible and competent evidence does not support the conclusion that a seizure disorder had its onset in service or within one year of service separation, or that current seizure disorder is related to active military service. 2. The preponderance of the evidence is against a finding that the Veteran's claustrophobia, major depressive disorder, or PTSD manifested in service or is otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for seizure disorder are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 2. The criteria for service connection for claustrophobia, previously claimed as nervous condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for major depressive disorder and PTSD are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1989 to November 1989. In November 2019, the Veteran testified before the undersigned Veterans Law Judge in a videoconference hearing. A hearing transcript is of record. The Board of Veterans' Appeals (Board) issued a January 2020 decision which found new and material evidence had been received to reopen the claims for service connection for a seizure disorder as well as for claustrophobia, previously claimed as a nervous condition. The Board then remanded the underlying service connection claims along with the claim for service connection for major depressive disorder and PTSD for further development. Additional evidence has been added to the claims file since the last Agency of Original Jurisdiction (AOJ) review of the evidence. In June 2021, the Veteran's representative submitted arguments along with a waiver of AOJ consideration of this newly submitted evidence. Therefore, this evidence is considered herein. Service Connection Service connection may be established for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, the evidence must show (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the current disability and the in-service disease or injury (or in-service aggravation). Holton v. Shinseki, 557 F.3d 1362, 1355 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as epilepsies (seizure disorders). See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Entitlement to service connection for a seizure disorder The Veteran contends he suffers from a seizure disorder because of his military service. Specifically, at the November 2019 Board hearing, the Veteran testified he developed seizures while he was in the Army. He testified he suffered a head trauma from a beating with his sergeant, was taken by base ambulance to the base hospital, and two or three months after separation from service, a seizure disorder was diagnosed. See Hearing Transcript. Service treatment records (STRs) show the Veteran had his wisdom teeth removed June 22, 1989. The next day, the Veteran reported shaking, dizziness, and weakness upon waking. He was diagnosed with a viral syndrome and given medication for the symptoms. Subsequent progress treatment records show the Veteran had a fear he was suffering from a seizure disorder and was monitored over the course of several days. The records from this monitoring show the Veteran did not suffer from any seizures but he did experience anxiety related to his concern about suffering seizures. In November 1989 the Veteran indicated he did not wish to undergo a separation medical examination. Post service private treatment records show the Veteran has reported on various occasions of having a history of seizure disorder. Specifically, a record dated April 1992 shows that during a psychiatric history and physical, the Veteran reported having recently sought treatment for a seizure. It was noted the Veteran had a history of seizures grand mal type. The Veteran reported experiencing seizures for the past 3 years and claimed they were not related to alcohol or cocaine, but instead related to a past head injury. Under the Medical History section of that treatment note, the doctor indicated, "apparently, 3 years ago, he had a head injury resulting into seizure disorder". Moreover, the medical impressions included in the treatment note stated "history of seizure disorder". He was observed on seizure precautions and took anti-seizure medication. Thereafter, in an October 1992 psychiatric history and physical, it was stated that the Veteran's medical history revealed he had been diagnosed to have a seizure disorder about one to one and a half years ago. The treating physician indicated the seizures may have been related to alcohol withdrawal, although the Veteran also admitted to having had a head injury about one and one half years ago. See Medical Treatment Record, received January 2017. The March 2020 VA examination confirmed a diagnosis of seizure disorder. In January 2020, and based on the testimony that the Veteran provided at the November 2019 hearing, the Board remanded the Veteran's claim for a VA examination to evaluate the nature and etiology of any seizure disorder. As noted, the March 2020 VA examination diagnosed seizures (possibly grand mal) with a date of diagnosis in 1991. Historically, the Veteran reported he had had some teeth removed during service and then within three to four days he was told by others that he passed out and started shaking. He also reported that an ambulance took him to the hospital for an evaluation and upon discharge from the Army, the Veteran claims he was told he had seizures. He also reported being hit in the head/jaw around the same time as he teeth removal. Following service, he started having seizures and went to a private hospital. After examining the Veteran and a thorough and detailed review his records, the VA examiner concluded it was less likely than not that the Veteran's claimed condition was caused by his service. The examiner explained the nature of impacted wisdom teeth, including pericoronitis which is the inflammation and infection of the soft tissues around a partially erupted tooth. Furthermore, the examiner pointed out that the the most common injury to the face was a mouth injury because the jaw is the lower, long bone that makes up the chin and connects towards the side of the face near the ears. The examiner explained that a fracture to the jaw can occur anywhere along the bone and can occur directly or indirectly. The examiner then noted that in the Board hearing transcript, the Veteran had said his wisdom teeth were pointing backwards because of trauma to the jaw. However, literature did not support this. The examiner explained that trauma to the face involved fracturing of the mandible, not the tooth, and stated that the Veteran had no evidence in his records of fractured mandible or a supposed traumatic event. The examiner observed that the dental appointment in June 1989 was silent for any mention of trauma to the jaw or head, and there were no physical exam findings to indicate such. It was also noted that in his initial dental appointment in June 1989, the Veteran complained of something sticking out of the gym which was typical of an impacted wisdom tooth. The examiner highlighted this was not due to trauma. Because the Veteran's STRs did not document a trauma to the head or jaw (complaint, physical examination, findings, or imaging studies) the examiner found there was no connection between his service and his seizure disorder. See March 2020 VA examination. Based on a review of the evidence, the Board finds that service connection for a seizure disorder is not warranted. Although the Veteran has been diagnosed post-service with a seizure disorder (possibly grand mal), the evidence fails to show that it is related to his military service. Significantly, the history that the Veteran has relayed throughout the course of his claim and to his treatment providers throughout the years is not supported by the record. While the Veteran's STRs show he experienced weakness and numbness of his extremities, and document his reports that he felt like he had suffered from a seizure, his records do not confirm seizure activity. They also do not show that he was ever diagnosed with a seizure disorder in service, as he has claimed. On the contrary, the records show he was closely monitored for seizures, but no such activity was found. Based on the foregoing, the evidence does not indicate that the Veteran was diagnosed with a seizure disorder in service or within one year of leaving active duty in so as to warrant service connection on a presumptive basis under 38 C.F.R. §§ 3.307 and 3.309. Notably, the Veteran did not desire a separation medical examination which would have evaluated his neurologic system. Moreover, the STRs are silent for witnessing an actual seizure or assault resulting in a facial injury during service. A seizure disorder was not diagnosed until 1991. In so finding, the Board acknowledges the April 1992 and October 1992 private treatment records which reference a history of seizure disorder for three years prior. While that history raises a question as to whether the Veteran had a seizure disorder within the presumptive period following his military service, it is based on the Veteran's reported history and recollection of events, and not his actual medical treatment records. As previously discussed, the Veteran's STRs do not confirm that he suffered a seizure disorder during service. Moreover, the treatment notations from 1992 used the terminology "apparently" when discussing the Veteran's history of seizure disorder for the past 3 years, which is not confirmation of a seizure disorder. Lastly, both treatment records reference the Veteran's history of drug and alcohol abuse, with the possibility that the reported seizures may have been related to alcohol withdrawal. As noted above, following a review of the Veteran's medical records and examination, the March 2020 VA examiner reported the Veteran's seizure disorder was diagnosed in 1991 and was treated with medication, which is outside the presumptive period in order to warrant service connection on that basis. Regarding service connection on a direct basis, the March 2020 VA examiner's opinion found no nexus between service and the Veteran's current seizure disorder. The examiner thoroughly reviewed the claims file and explained the STRs are more supportive of an impacted wisdom tooth which is an age-appropriate medical issue with no evidence of a connection to seizures. The examiner's opinion is supported by sound medical rationale. It also provides compelling evidence against the Veteran's claim. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (indicating "[i]t is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion"). Consideration has also been given to the arguments made by the Veteran. In particular, the Board acknowledges in an August 2020 statement, he reported evidence was missing from his claims file at the time of his March 2020 VA examinations and his examinations were not complete. See August 2020 Correspondence. However, a review of the March 2020 VA examination report does not suggest that the examiner's opinion was based on a review of a less than complete claims file. In the December 2020 appellate brief, the Veteran's representative also argued that the March 2020 VA examiner failed to address whether the medication the Veteran was provided in association with his dental treatment resulted in the falling out, loss of consciousness, and shaking that the Veteran experienced during active service. Further, it was argued the examiner failed to address whether the diagnosed viral syndrome was causally related to the Veteran's current seizure disability. Lastly, it was argued the examiner relied on the absence of evidence in rendering an opinion, which was an inadequate and improper rationale for a medical opinion. See December 2020 Appellate Brief. The Board disagrees with representative's contentions and finds the March 2020 VA examination to be adequate. The VA examiner adequately evaluated the available medical records and provided a complete medical opinion to support the negative nexus rendered. Furthermore, regarding any possible connection with the medication the Veteran was provided in association with his dental treatment, the fact the Veteran lost consciousness and was shaking during service was apparently told to the Veteran by others and not witnessed by a medical professional or documented in the STRs. Moreover, while the March 2020 VA examiner may not have specifically addressed the Veteran's medication taken following his dental surgery or his diagnosed viral syndrome during service in connection with his seizure disorder, the examiner did a thorough review of the STRs, including a personal interview with the Veteran. There is no suggestion the examiner did not adequately evaluate every possible connection between the Veteran's current seizure disorder and his military service in rendering his medical opinion. In making the above findings, the Board acknowledges that, generally, lay evidence is competent regarding identification of a disease with unique and readily identifiable features which are capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). A lay person may also speak to etiology in some limited circumstances in which nexus is obvious merely through observation. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, a lay person, such as the Veteran, is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Therefore, although the Veteran may believe he has a seizure disorder related to his military service, his lay statements are not competent regarding the etiology of that disability. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). In sum, the competent and probative evidence of record fails to indicate that the Veteran's seizure disorder had its onset in, within one year of service separation, or is otherwise related to service. As the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply, and service connection for a seizure disorder must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56. 2. Service connection for claustrophobia, previously claimed as nervous condition and service connection for major depressive disorder and PTSD The Veteran is seeking service connection for an acquired psychiatric condition, including claustrophobia, major depression, and PTSD. He argues he began to feel anxiety and depression during active service after several incidents with fellow service members. At the November 2019 Board hearing, the Veteran testified to experiencing a personal trauma during his military service, stemming from his discovery of his serial number being changed on his weapon, which he contends is responsible for his present seizure disorder as well as his claustrophobia, depression, and PTSD. He testified that he did not report the attack for fear of retribution, but relayed that he was attacked and beaten, and suffered physical injuries as well as possible seizure. He also indicated experiencing problems with severe anxiety, depression, and forms of PTSD, because of that in-service attack. See Hearing Transcript. The record shows the Veteran has been diagnosed with anxiety, PTSD, major depressive disorder, and borderline personality disorder throughout the period at issue as evidenced by medical examinations as well as private treatment records. See Private Treatment Records. Notably, while his diagnosis of personality disorder is noted in post military treatment records as well as on active duty, personality disorder is not a service connectable disorder. The Veteran's STRs show he experienced anxiety due to the fear of possible convulsions or seizure activity. He also experienced anxiety related to the lack of acknowledgment concerning seizure activity. However, in November 1989 the Veteran indicated he did not wish to undergo a separation medical examination. Military personnel records show the Veteran had disciplinary problems and advised that he would rather kill himself than stay in the Army. He also reported he would "do whatever it takes to get out of the Army". The records reported the Veteran had an immature personality deemed inappropriate for miliary service. It was recommended he be separated from service due to a personality disorder. See Military Personnel Record. Lay statements were received in support of his claim. An October 2011 statement from the Veteran's sister reported witnessing his physiological issues as well as medical issues. She reported his first seizure in the Army happened at Ft. Jackson hospital. She also stated his life had taken a spiral turn for the worse since his service in the Army. He experienced paranoid episodes where he thought people were out to get him constantly and had high levels of anxiety and depression which kept him away from others. Additionally, she noted he was claustrophobic which did not allow him to be in small quarters, otherwise he would start to have severe debilitating anxiety/irritability and rage. See October 2011 Lay statement. The Veteran's stepfather submitted a statement in October 2012. He also reported the Veteran was very depressed with anxiety and paranoia, and noted that the Veteran could not hold a job or have a successful relationship with women. The Veteran's stepfather stated the Veteran blamed every else for his problems. See October 2012 Lay statement. Additionally, the Veteran submitted his own statement in December 2018. He reported his experiences during his basic training and military service in which he was threatened and traumatized. He stated he began to have anxiety and depression which he had never had until his experiences in basic training. Additionally, he reported needing his wisdom teeth surgically removed, requiring him to be on light duty because of medication. He "fell out onto the floor of the barracks" and needed to be hospitalized to determine whether he suffered from a seizure. Lastly, he reported an incident with his weapon during training. He discovered his serial number had been changed. He later heard that weapons had been taken off base and sold and he feared for his safety and his family's safety when he tried to report it. See December 2018 lay statement. The record includes several VA examiners' opinions as well as a private medical opinion which provide contradictory opinions regarding the nature and etiology of the condition. At the outset, the Veteran's representative acknowledges the record includes a diagnosis of personality disorder, which is not eligible for service connection. However, his representative argues the evidence demonstrates that the Veteran experiences a comorbid acquired psychiatric disorder and that it would be erroneous to attribute all mental health issues to a personality disorder. See June 2021 Appellate Brief. In a November 2019 statement from Dr. S.M., she reported the Veteran suffered from anxiety and PTSD. It was her opinion that it was medically necessary for him to always keep his chihuahua dog with him as a medical service dog to keep his symptoms under control. She characterized his symptoms as severe and including flashbacks, panic attacks, and terrible anxiety related to PTSD from trauma that occurred while he was serving in the military. See Medical Statement Record. However, this statement attributing the Veteran's psychiatric symptoms to service is conclusory in nature and therefore, probative weight cannot be assigned without supporting explanation. In March 2020, a VA medical examination and corresponding opinion was obtained. The examiner did not find the Veteran had a diagnosis of PTSD but did find that he had an unspecified personality disorder. It was the examiner's opinion that it was less likely as not that the Veteran's diagnoses were due to any events in his six months in service. The examiner stated that, as had been previously noted, the Veteran was discharged with a personality disorder that was not service connectable and led to an inability to adapt to the military lifestyle. The examiner pointed out the Veteran's acting out and failure to follow orders as well as comments led to his discharge, and there were no markers in the STRs that supported the claim of assault. Additionally, and based on review of the records, the examiner also noted there seemed to be contradictory statements and a discrepancy in the Veteran's personal history report. The examiner pointed out the Veteran's report at the 2020 examination was at times guarded and evasive therefore, not held to be totally reliable particularly when it came to his history of pre-military and then post-military behaviors and symptom reporting. The examiner noted that the Veteran minimized or would not answer questions regarding the use of alcohol and drugs and was not forth coming about his youth or adulthood experiences/behaviors. Additionally, his psychological testing was indicative of extreme overreporting. Therefore, as in his testing, the Veteran's report of symptoms was elevated and not deemed to be reliable. The examiner further reported that claustrophobia was not indicated in the records in service. The examiner also stated that while the Veteran was now claiming PTSD due to assaults, there were no STRs that indicated or supported this claim. The examiner highlighted how the Veteran's post military records seemed to start with civilian documentation in 1992 and then in 2015 with anxiety and depression noted. The examiner also pointed out that the later diagnosis of "PTSD" by the Veteran's primary care physician was not accompanied by a formal evaluation nor any identified stressor incidents, and the examiner found it notable that although the Veteran had requested a prescription for Diazepem his primary care treatment providers had refused to continue the medication as it was highly addictive, and the Veteran left treatment. Regarding the Veteran's previous diagnosis of PTSD, the VA examiner further noted this was conferred in a clinical context where different diagnostic guidelines applied, appeared to have been based predominately on the Veteran's subjectively reported symptoms with no objective assessment of response style and was therefore, inapplicable to the current examination. The examiner found the validity of the Veteran's previous diagnosis of PTSD to be inadequately assessed and therefore, unknown. The examiner also stated that although the Veteran received treatment for PTSD, the fact that he received treatment was not a diagnostic criterion for PTSD, nor was there evidence in the published empirical literature that a diagnosis of PTSD was at least as likely as not to be valid because one received treatment associated with it. Lastly, the examiner noted concerns with the validity of the examination performed in that the Veteran's responses included both an unusual combination and high number of somatic, cognitive, and neurological symptoms as compared to other veterans who had genuine severe psychological, neurological, and/or medical diagnoses based on reported credible symptoms. The examiner explained that this pattern of responding might occur for a variety of unconscious or conscious reasons, none of which could be ruled in or out at the time of the examination; however, this rendered the Veteran's clinical and substantive scales to be incapable of being reliably interpreted. See March 2020 VA examination and medical opinion. Additional records have been added to the Veteran's claims file following the March 2020 VA examination. An April 2021 Outpatient Mental Health Interpretive Report indicated the Veteran had an extremely elevated F score and relatively low VRIN scale score which suggested that his endorsement of extreme items was the result of a careful item responding rather than an inconsistent response pattern. It was explained that one possibility for such a result was exaggerated symptoms to gain attention or service. Another possibility was that the Veteran's extreme responding resulted from unusually severe psychological problems. The Veteran's approach to the MMPI-2 items was noted to be somewhat inconsistent and he endorsed items false regardless of their content which showed carelessness or inattention to content. See Medical Treatment Record. An April 2021 private Disability Benefits Questionnaire (DBQ) diagnosed the Veteran with major depressive disorder, recurrent, severe (specifiers include anxious distress, PTSD and psychotic features and seizure disorder), and polysubstance use disorder, in sustained remission since around 1991 (which the private examiner opined was at least as likely as not developed secondary as a form of self-medication in the military). The private examiner also opined the Veteran's psychiatric/medical disorder and secondary polysubstance self-medication had intermingling symptoms and were not possible to separate from each other. Based on the private examiner's overall psychological examination dated April 28, 2021, it was his clinical opinion that the Veteran at least as likely as not had developed an acquired psychiatric disorder, to include major depressive disorder with anxiety, PTSD and psychotic features as well as secondary polysubstance use disorder as a form of self-medication which at least as likely as not developed in mutual aggravation and exacerbation to his acquired psychiatric disorder in the military which had continued uninterrupted to the present. See April 2021 DBQ. In June 2021, the Veteran's represented arranged for him to be examined by Dr. A.I., a psychiatrist, who reviewed the Veteran's medical and psychiatric records and opined it was at least as likely as not that the Veteran's major depressive disorder, recurrent, with psychotic features, was related to his military service, as it had its onset during his period of active duty. In support of that opinion, Dr. A.I. indicated that the Veteran's symptoms of a personality disorder were so noticeable and severe that such a condition would and should have been noticed upon entrance. For that reason, Dr. A.I. found the Veteran's separation was not the result of a preexisting personality disorder problem but the result of the Veteran developing in service psychiatric symptoms primarily in the domain of depressive symptomatology and quite possibly superimposed development of psychiatric symptoms related to PTSD. Further, Dr. A.I. indicated it was reasonable to consider that the Veteran also developed neuropsychiatric problems such as development of seizure disorder versus the possibility that he developed pseudo-stressors that his brain was not able to handle, and consequently clinical presentation includes the presence of psychosomatic symptomatology, more specifically pseudo-seizures. See June 2021 Dr. A.I. Medical Statement. Also in support of the claim, the Veteran's representative submitted in June 2021 an article entitled Anxiety and posttraumatic stress symptoms following wisdom tooth removal. See June 2021 Correspondence. After carefully weighing the competing medical opinions and other competent evidence, as outlined above, the Board finds that the March 2020 negative nexus opinion is more probative than the opinions provided by the private physicians. In this regard, the Board highlights the possibility of exaggerated symptoms to gain attention or service, which was noted in the March 2020 VA examinations as well as the April 2021 Outpatient Mental Health Interpretive Report. Furthermore, the March 2020 VA examiner thoroughly addressed the diagnosis of PTSD included in the record and explained that no actual objective testing had been performed to support such a diagnosis and that treatment for PTSD itself does not confirm an actual diagnosis. The March 2020 VA examiner's medical opinion is also more consistent with the Veteran's STRs which do not show that he suffered from the personal assault he has described in detail throughout the record, nor do they include a diagnosis of a psychiatric condition. As for the positive nexus opinions, as highlighted by the March 2020 VA examiner, they rely heavily on the Veteran's historical report of experiences as well as the acceptance of the Veteran's report regarding the severity of his symptomatology which has been questioned in both VA examination reports as well as in the Veteran's STRs. Furthermore, it is noted that Dr. A.I. used speculative terminology such as "possibly" and "reasonable" in providing a medical opinion that was based largely on the Veteran's own historical reports and does not acknowledge the lack of supportive evidence in the Veteran's STRs. For that reasons, the Board finds Dr. A.I.'s medical opinion to be speculative and not probative. The Board acknowledges that, generally, lay evidence is competent regarding identification of a disease with unique and readily identifiable features which are capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). A lay person may also speak to etiology in some limited circumstances in which nexus is obvious merely through observation. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, a lay person, such as the Veteran, is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Therefore, although the Veteran may believe he has psychiatric disability related to his military service, his lay statements are not competent regarding the diagnosis and etiology of that disability. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Board also acknowledges that in an August 2020 statement, the Veteran claimed evidence was missing from his claims file at the time of his March 2020 VA examinations and his examinations were therefore not complete. See August 2020 Correspondence. In a December 2020 Appellate Brief, the Veteran's representative also argued the March 2020 VA examination was inadequate because the examiner relied on the absence of evidence in rendering an opinion, which he pointed out was an inadequate and improper rationale for a medical opinion. See December 2020 Appellate Brief. However, the Board has carefully reviewed the March 2020 VA examination report and does not find any reasoning to find that the March 2020 VA examiner reviewed an incomplete claims file or that the medical opinion relied on an absence of evidence to form the basis for the negative opinion. In fact, the examiner thoroughly evaluated the Veteran's claims file and explained in detail the reasoning for providing an unfavorable nexus opinion. (Continued on the next page) In sum, the competent and probative evidence of record fails to indicate that the Veteran's claustrophobia, previously claimed as nervous condition, as well as major depressive disorder and PTSD had its onset in or are otherwise related to service. As the preponderance of the evidence is against the claims, the benefit of the doubt rule does not apply, and service connection for claustrophobia, previously claimed as nervous condition, and for major depressive disorder and PTSD must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Churchwell, 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.