Citation Nr: 21074051 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 18-50 189A DATE: December 14, 2021 ORDER Entitlement to service connection for erectile dysfunction is dismissed. Entitlement to service connection for peripheral neuropathy left upper extremity is denied. Entitlement to service connection for peripheral neuropathy right upper extremity is denied. Entitlement to service connection for peripheral neuropathy left lower extremity is denied. Entitlement to service connection for peripheral neuropathy right lower extremity is denied. Entitlement to service connection for an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD) and unspecified anxiety disorder is denied. FINDINGS OF FACT 1. At the June 9, 2021 Board hearing and in a written signed document dated that same day, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran that a withdrawal of this appeal is requested as to the issue of entitlement to service connection for erectile dysfunction. 2. Peripheral neuropathy of the right upper extremity did not manifest in service and is unrelated to service, to include exposure to herbicide agents, and an organic disease of the nervous system did not manifest within one year of discharge from service. 3. Peripheral neuropathy of the left upper extremity did not manifest in service and is unrelated to service, to include exposure to herbicide agents, and an organic disease of the nervous system did not manifest within one year of discharge from service. 4. Peripheral neuropathy of the right lower extremity did not manifest in service and is unrelated to service, to include exposure to herbicide agents, and an organic disease of the nervous system did not manifest within one year of discharge from service. 5. Peripheral neuropathy of the left lower extremity did not manifest in service and is unrelated to service, to include exposure to herbicide agents, and an organic disease of the nervous system did not manifest within one year of discharge from service. 6. The probative evidence of record reflects that the Veteran does not have PTSD; the currently diagnosed acquired psychiatric disability other than PTSD, unspecified anxiety disorder, was not manifest in service and is not attributable to service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of an appeal by the appellant have been met as to the issue of service connection for erectile dysfunction. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. Peripheral neuropathy of the right upper extremity was not incurred in or aggravated by service, nor can an organic disease of the nervous system or early-onset peripheral neuropathy be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. Peripheral neuropathy of the left upper extremity was not incurred in or aggravated by service, nor can an organic disease of the nervous system or early-onset peripheral neuropathy be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. Peripheral neuropathy of the right lower extremity was not incurred in or aggravated by service, nor can an organic disease of the nervous system or early-onset peripheral neuropathy be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. Peripheral neuropathy of the left lower extremity was not incurred in or aggravated by service, nor can an organic disease of the nervous system or early-onset peripheral neuropathy be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 6. The criteria for service connection for an acquired psychiatric disability, to include PTSD and unspecified anxiety disorder, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304 (f), 4.125. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1967 to August 1969 to include service as a crew chief in Vietnam for approximately 20 months. He appeals a November 2018 rating decision. He and his wife testified before the undersigned Veterans Law Judge (VLJ) in June 2021. The VLJ clarified the issues on appeal; clarified the concept of service connection; identified potential evidentiary defects; clarified the type of evidence that would support the Veteran's claims, inquired as to the existence of potential outstanding records and granted the Veteran's motion to hold the record open 90 days to allow for the submission of evidence. The undersigned also discussed the potential for the Veteran to file other claims of service connection for hypothyroidism and Parkinson's disease or Parkinsonism. The actions of the VLJ comply with 38 C.F.R. § 3.103. DISMISSAL The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 19.55. In the present case, the appellant has withdrawn the appeal as to the issue of entitlement to service connection for erectile dysfunction, having articulated his intent to withdraw this issue at the June 2021 hearing and then submitting a signed written withdrawal of the issue on the same day. Hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeal and it is dismissed as to the issue of entitlement to service connection for erectile dysfunction. Service Connection Veterans are entitled to compensation from VA if they develop a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish a right to compensation for a present disability, a veteran 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 between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain enumerated chronic diseases including other organic diseases of the nervous system (which would include peripheral neuropathy) will be presumed related to service if they manifested to a compensable degree within a presumptive period following separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). The Veteran's service records confirm that he served in Vietnam and his exposure to herbicide agents is thus presumed. 38 C.F.R. § 3.307 (e)(6)(iii). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected even though there is no record of such disease during service. 38 C.F.R. § 3.309 (e). Early-onset peripheral neuropathy is a disease listed under section 3.309 (e). However, 38 C.F.R. § 3.307 (a)(6)(ii) requires that it "shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service." The availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a Veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis if (1) the medical issue is within the competence of a layperson, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). The Veteran is not precluded from proving entitlement to service connection on a direct basis for the presumptive diseases. See Combee v. Brown, 5 Vet. App. 248 (1993). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to service connection for peripheral neuropathy left upper extremity is denied. 2. Entitlement to service connection for peripheral neuropathy right upper extremity is denied. 3. Entitlement to service connection for peripheral neuropathy left lower extremity is denied. 4. Entitlement to service connection for peripheral neuropathy right lower extremity is denied The Veteran is presumed exposed to herbicide agents by virtue of his service in Vietnam. He seeks service connection for peripheral neuropathies under all available theories, including that that they were caused by exposure to herbicide agents in Vietnam. The Veteran urges that he has had bilateral upper and lower extremity peripheral neuropathy since service separation. See, e.g., March 2021 wife's statement, June 2021, December 2016 and March 2016 Veteran's statements, hearing testimony, generally. He clarified in his testimony that he believes the neuropathy is not due to hypothyroidism. Service treatment records (STRs) are negative for complaints or findings of peripheral neuropathy. At his August 1969 class III flight physical the same month he separated from service, he denied neuritis, depression and nervous trouble. He reported a history of leg cramps when working in the past but nothing else about the extremities. The clinical examination reflected normal findings as to neurologic, upper and lower extremities, and psychiatric system. The Veteran and his wife urge that they did not know what peripheral neuropathy was for many years following the Veteran's service separation. However, they now believe it has been present since that time. They acknowledge that he started complaining about the condition at VA when they moved to Florida in 2008, but that he was never offered a name for it. Finally, they found chiropractor Dr. Scott Coletti in 2015 who diagnosed the problem. He thereafter went back to VA where a VA physician treated him in February 2016 and reportedly recommended filing a claim. He feels that the condition is related to Agent Orange exposure in Vietnam. He cites to the fact that his wife had twins and one was stillborn and the other was born with disabling issues in further support of his assertion that there were effects of his Agent Orange exposure. Non-VA treatment records dated in 2006 reflect a review of systems in July 2006 that does not note neuropathies or psychiatric problems. He had presented on multiple occasions for prostatitis related pain. He did note some back and leg pain that usually disappears once he is treated for prostatitis. In August 2006, lumbar radiculopathy was noted. In October 2006, there was a finding of normal reflexes of the lower extremities. In February 2008, there was a constitutional assessment that included no findings or complaints of neuropathy; he denied headaches, seizures and vertigo, heat/cold intolerance, polydipsia or depression, anxiety or mood disorders. Neuro cognitive was noted as normal. A February 2009 review of systems at VA revealed that as to neurological, he denied relevant history. As to mood disorder he denied a history of depression or anxiety and as to extremities there was no edema or any related findings. August 2010, February 2011 and 2012, January 2013, 2014 and 2015 evaluations reflected extremities showed no cyanosis or edema. Dr. Coletti's November 2015 Neuropathy Severity Evaluation reflects lower extremity neuropathy. In the June 2016 VA Initial PTSD examination, the Veteran reported he usually falls asleep quickly, but the neuropathy is so bad he asks himself is it worth it. He described pain with neuropathy all over, on average 5-6. VA treatment records dated from 2016 into 2018 reflect the finding of neuropathy for which he is prescribed Gabapentin. Non-VA treatment records dated in 2016 through 2021 reflect the ongoing diagnosis of polyneuropathy for which he takes Gabapentin. We note that extremities and neurological systems review were repeatedly noted to be normal with three visits (1 in 2018 and 2 in 2020) showing diminished sensation. At the hearing, the Veteran and his wife testified and he reported he began feeling numbness and tingling in his arms and legs during his 20 months in Vietnam. There was no doctor or sick call available. He did not seek treatment initially after service because he did not know there would be any connection to his symptoms and Agent Orange. Again, his wife started to figure it out around 2008 when he went to VA in Florida, then Dr. Coletti diagnosed it in 2015. His wife testified that she noted his numbness in arms and legs after they married in 1965. The Veteran feels he has early onset peripheral neuropathy due to his 20 months of exposure to Agent Orange. The question for the Board is whether the Veteran's bilateral upper and lower extremity peripheral neuropathy was incurred in or aggravated by service, manifested within a presumptive period from service, or is otherwise related to service. As to direct and presumptive theories of service connection, the preponderance of the evidence is against the claims. Here, not only are the STRs negative, he actually denied the presence of symptoms in August 1969 at the time of service separation. Moreover, though the Veteran and his wife urge in connection with this claim that he had such symptoms in the years following service prior to, say 2008, he indeed denied the presence of relevant symptoms in the aforementioned intervening medical encounters. These intervening denials and findings of no symptoms outweigh the more recent assertions as to ongoing signs and symptoms since his time in Vietnam. We refer to the medical records dated between 2006 and January 2015 in support of this conclusion. Thus, we find the preponderance of the evidence is against finding that there were any such symptoms during service or that he has had continuity of symptoms since his active service. There was no relevant chronic disease manifested or diagnosed within one year of separation from service or within one year of his exposure to herbicides. There is no evidence that early-onset peripheral neuropathy was manifest to a degree consistent with 38 C.F.R. § 3.307 (a) (6) (ii) within one year of the last exposure to herbicide agents. While we acknowledge the assertions to the contrary, the weight of the evidence shows that neuropathy had its onset many years after he last served in Vietnam. Lay persons are not competent to provide an opinion that his neuropathy is directly due to herbicide exposure as that requires medical testing and expertise that is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Furthermore, there is no proof of a presumptive neuropathy within the applicable period. In addition, neuropathy was not "noted" during service or within one year of separation, within the meaning of section 3.303(b). The Board finds that the STRs do not show a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. Rather, service records disclosed that the extremities and neurological system were normal. Furthermore, the evidence does not establish that neuropathy was manifest to a compensable degree within one year of separation, as previously explained. Service connection on a presumptive basis is not warranted. There is no reliable evidence linking the Veteran's neuropathy to service, to include exposure to herbicide agents. Relevant symptoms, complaints, treatment, or diagnoses were not noted in service. The contemporaneous records establish that the relevant systems were normal at separation. The more probative evidence establishes that he did not have characteristic manifestations during service or within one year of separation sufficient to identify the disease entity, it was not manifest to a degree of 10 percent within the last date of herbicide exposure, and that his current disorder is not related to any event in service. The evidence establishes that the remote onset of peripheral neuropathy decades after separation is unrelated to service. As such, service connection is not warranted for the Veteran's neuropathies on a direct or presumptive basis, to include as due to herbicide exposure. Further, the preponderance of the evidence is against finding that a nexus otherwise exists between the Veteran's bilateral upper and lower peripheral neuropathy and service. 38 U.S.C. § 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Again, we find that the neuropathy began years after service and have not been related to service by any competent evidence. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Again, we have negative clinical examinations and no complaints, indeed denial of problems, in service, initial recorded complaints and treatment not for decades, and diagnoses not before the 2000's. As we mentioned at the hearing, we have looked into the treatment records in the 2000's and cannot find that they link the neuropathy to service via any reported history. The lack of identification of complaints or findings in the post service treatment record for multiple decades following service is highly persuasive evidence against finding current bilateral upper and lower peripheral neuropathy related to service. Ultimately, the Board gives more probative weight to the credible medical evidence, most notably the treatment records which show that the disorders first manifested decades after service and are unrelated to service. The multi-year gap between discharge from active duty service and evidence of the condition decades later is viewed as a factor weighing against this claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Horn v. Shinseki, 25 Vet. App. 231, 240 n.7 (2012). The Board finds the negative record prior to at least the 2000's and no diagnosis until 2015 to be most probative as they record the Veteran's complaints. The lay assertions of on-going symptoms since service are not credible in view of the multiple denials and negative findings. The preponderance of the evidence is against the claims. Finally, we note there was no examination for these claims, but none was required. VA is required to provide a claimant with a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see 38 C.F.R. § 3.159 (c)(4). In this case, the evidence collectively fails to present an indication that the current disability may be associated with the Veteran's service (to include herbicide agents exposure) or with another service-connected disability. STRs and decades of post service records were negative for the neuropathies. The entirety of the evidence in support of nexus consists of the lay statements and testimony dating from 2016 onward. Such are insufficient to trigger VA's duty to assist by providing a medical examination. 38 C.F.R. § 3.159 (c)(4); McLendon, 20 Vet. App. at 81; see Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). 5. Entitlement to service connection for an acquired psychiatric disorder to include PTSD and unspecified anxiety disorder is denied. The Veteran seeks service connection for an acquired psychiatric disorder, specifically PTSD. He claims PTSD due to wartime-related stressors in Vietnam. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); 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 provisions of 38 C.F.R. §§ 3.384, 4.125, 4.126, 4.127, and 4.130 were updated via a final rule, effective August 4, 2014, in part to substitute references to the DSM-IV for the DSM-5. The changes are applied to applications for benefits received by VA or pending before the AOJ on or after August 4, 2014, but not to claims certified to or pending before the Board, the United States Court of Appeals for Veterans Claims, or the United States Court of Appeals for the Federal Circuit. The Board notes that the appellant's case was certified to the Board after the effective date of the final rule. Thus, the Board will refer to the DSM-5 criteria herein. For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) the product of reliable principles and methods; and (3) the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). As will be discussed below, service connection for PTSD is being denied due to the absence of a diagnosis of PTSD. The missing element is competent evidence of a current disability as to PTSD. 38 C.F.R. § 3.304 (f). As to the acquired psychiatric disorder claim other than PTSD, the claim is being denied because the preponderance of the evidence is against finding that there is a nexus between the currently-diagnosed unspecified anxiety disorder and service. Indeed, a VA examiner opined in the negative. The Veteran filed this claim in March 2016. We note that service personnel records reflect that he participated in multiple Vietnam campaigns and was awarded medals and decorations to include the Vietnam Campaign Medal with Device, Vietnam Service Medal, three overseas bars, Good Conduct Medal, Aircraft Crewman Badge and National Defense Service Medal. He participated in Vietnam Counter Offensives III, IV and V. The Veteran's stressors in Vietnam are conceded. Here, we note that he has reported and testified regarding the circumstances of his service during the TET offensives. He reported he and his crew were the only ones dumped on the perimeter for several weeks. They were mortared almost all the time. The first TET offensive was in March 1968 and they were on the perimeter all spread out all night long. He became afraid of the dark. An additional stressor was that the same thing happened in 1969 during the second TET. Also at that time, he killed cobras and Bamboo Vipers on guard duty that had approached him in the jungle to keep warm. With regard to the Veteran's stressors, the Board notes and accepts the events stated by the Veteran. Service treatment records, however, reflect no psychiatric abnormalities. In the August 1969 Report of Medical History, the Veteran denied depression or excessive worry and nervous trouble of any sort. In the accompanying service separation examination, psychiatric evaluation was normal. There is no diagnosis of PTSD in the record. Indeed, the June 2016 VA Initial Examination for PTSD reflects no PTSD but instead notes subclinial PTSD symptoms. The Veteran described/endorsed symptoms associated with anxiety to include nervousness, restlessness, being on edge, easily fatigued, having excessive worrying and irritability (impulse control problems). Here, the examiner diagnosed instead Unspecified Anxiety Disorder. The examiner found that the reported stressors were adequate to support a diagnosis of PTSD, but still found no diagnosis of PTSD. The examiner noted that PTSD was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness. They explained that the Veteran's STR and treatment records do not support his claim. In addition, the Veteran did not endorse the necessary symptoms to meet criteria according to the DSM5. In order for a diagnosis of PTSD to be made, the disorder must be the primary causal factor of significant impairment in social and occupational functioning. Many individuals experience traumatic events in their lives and have subsequently met one or more of the PTSD criteria (i.e., Criterion B, C, D, and E) but they are still able to function reasonably well in social and occupational settings. Thus, if an individual has symptoms of PTSD that do not significantly interfere with social and occupational functioning, that individual would not meet the threshold specified in DSM-V for the diagnosis of PTSD even though various symptoms of PTSD may be present. They cited the following: Morel, K., 2010 and Solomon, Z & Horesh, D, 2007. They observed that the Veteran did not report significant impairment in his social, interpersonal or occupational functioning. As to the Veteran's anxiety disorder, the examiner found it less as likely as not incurred in or caused by his military service. The rationale was that the separation physical is negative for any psychiatric symptoms and the Veteran has never been diagnosed or treated for a mental disorder. They stated there does not exist any documented evidence to provide a nexus of his mental disorder to his military service. The lay assertions that there is PTSD are outweighed by the uncontroverted medical opinion that there is no PTSD. The Veteran is not competent to diagnose PTSD, this is a medically complex issue beyond the scope of a lay person. There has been no later diagnosis by a medical professional. As to the unspecified anxiety disorder, we note that non-VA review of systems from 2006 to 2021 were negative as to psychiatric problems. The Veteran and his wife testified and have stated that he had nightmares since Vietnam. He testified that he had not been treated for a psychiatric condition. He also testified as to the traumatic events that he experienced in Vietnam. He noted that they were aircraft mechanics not trained infantry soldiers and the experience being mortared, being on the perimeter during TET and having to defend against dangerous snakes in the jungle was terrifying. He did not seek treatment because he wanted to get on with his life. He still has nightmares. The 2016 VA opinion is well-supported and thoroughly explained. See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wray v. Brown, 7 Vet. App. 488 (1995) The Board finds this the most probative evidence as to whether there is current PTSD or other mental health disorder related to service. Therefore, we conclude there is no diagnosis of PTSD in accordance with 38 C.F.R. § 4.125 (a) at any time during the appeal or proximate to the service connection claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 321 (2013). While invited to submit additional medical opinion evidence, the Veteran has not done so. As stated above, the existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich, 104 F. 3d at 1328. In the absence of evidence of a present disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. Evidence must show that the Veteran currently has the disability for which benefits are being claimed. There is no evidence of a reliable diagnosis of PTSD as explained herein. 38 C.F.R. §§ 3.304 (f); 4.125. As to the remaining current acquired psychiatric disorder, characterized by the 2016 VA examiner as unspecified anxiety disorder, the question for the Board is whether it manifested in service or is otherwise related to service. We find it did not manifest in service or for years following service. Again, the STR reflects normal psychiatric findings. The psychiatric evaluation was normal at separation and he denied pertinent pathology at that time. Moreover, there are no treatment records showing complaints of depression or anxiety for decades following service. Routine mental health screenings were negative. Lastly, a medical professional, who thoroughly reviewed the entire record and examined the Veteran, determined that there was no relationship to service. The preponderance of the evidence is against finding that a nexus exists between the remaining acquired psychiatric disorder, unspecified anxiety disorder, and service. 38 U.S.C. § 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Not only did complaints and findings begin years after service, it has not been related to service by the most probative evidence. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The VA examiner's opinion is well-supported and thoroughly explained, and the examiner fairly considered the material evidence of record. The opinion is wholly against the claim. Again, the Veteran is competent to attest to lay-observable symptomatology but he is not competent to state that his unspecified anxiety disorder, first noted in the record many years following service, is related to service. This is a complex medical question. The Board finds the rationale provided by the 2016 VA examiner to be more persuasive as to this complex medical question. As the preponderance of the evidence is against the claim for an acquired psychiatric disorder to include PTSD, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Rippel, 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.