Citation Nr: 21010094 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 13-24 259 DATE: February 24, 2021 ORDER Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), is denied. Entitlement to service connection for erectile dysfunction is denied. FINDINGS OF FACT 1. The electronic claims file lacks credible supporting evidence that the Veteran’s reported military sexual assault occurred; the Veteran did not experience psychiatric symptoms during service; and the most probative evidence of record fails to establish that the Veteran’s current acquired psychiatric disability, excluding PTSD, was incurred in or is otherwise etiologically related to his active duty service. 2. The most probative evidence establishes that the Veteran’s erectile dysfunction was not incurred in and is not otherwise etiologically related to the Veteran’s active duty service. While the Veteran’s erectile dysfunction has been causally linked to his acquired psychiatric disability, the Veteran is not service connected for an acquired psychiatric disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an acquired psychiatric disability, to include PTSD, have not been met. 38 U.S.C. § 1112,1131; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for erectile dysfunction have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1979 to April 1984. These matters come before the Board of Veterans’ Appeals (Board) on appeal from August 2010 and February 2011 rating decisions issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). In the August 2013 and September 2013 VA form 9s, the Veteran requested a Travel Board hearing. In correspondence received in December 2016, the Veteran withdrew his hearing request. See 38 C.F.R. § 20.603 (formerly 20.704). Accordingly, the Veteran’s hearing request has been withdrawn. The undersigned Veterans Law Judge has been assigned to adjudicate these matters pursuant to 38 C.F.R. § 20.106(a) (formerly 19.3(a)). These matters were previously before the Board in June 2017, May 2019, and October 2020. A review of the record demonstrates that the RO has substantially complied with the Board’s past remand directives, and neither the Veteran nor his attorney has alleged otherwise. See Stegall v. West, 11 Vet. App. 268 (1998); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Thus, the Board may proceed with its appellate review. As to the matters adjudicated below, neither the Veteran nor his attorney has raised any issues with VA’s duty to notify or VA’s duty to assist in obtaining documentary evidence, such as medical records. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); see also Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Thus, the Board need not discuss any potential issues in this regard. Under 38 U.S.C. § 7104, Board decisions must be based on the entire record, with consideration of all the evidence. The law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra. Service Connection 1. Entitlement to service connection for an acquired psychiatric disability, to include PTSD, is denied. The Veteran initially filed a claim seeking entitlement to service connection for only PTSD. However, the medical evidence of record reflects that the Veteran has also carried other psychiatric diagnoses during the appellate period. The United States Court of Appeals for Veterans Claims (Court) has held that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the Veteran’s description of the claim, reported symptoms, and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Thus, the June 2017 Board decision correctly recharacterized and broadened the claim to afford the Veteran every possible consideration. Generally, to establish service connection, a veteran must show: (1) a current disability; (2) an in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred during service, the so-called “nexus” requirement. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). All elements must be satisfied before service connection may be achieved. For claims specific to PTSD, there must be: (1) medical evidence establishing a diagnosis of the disorder; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) a link established by medical evidence, between current symptoms and an in-service stressor. See 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128, 139 (1997). As this matter was initially certified to the Board in May 2014, the PTSD diagnosis must be made in accordance with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). See 38 C.F.R. § 4.125; 79 Fed. Reg. 45,093, 45,094-096 (Aug. 4, 2014) (interim final rule); 80 Fed. Reg. 14,308 (Mar. 19, 2015) (final rule) (providing that for claims that were initially certified for appeal to the Board, the Court, or the U.S. Court of Appeals for the Federal Circuit prior to August 4, 2014, DSM-IV will apply. For all applications for benefits received by VA or pending before the agency of original jurisdiction on or after August 4, 2014, DSM-5 will apply). Typically, outside of enumerated exceptions irrelevant to the current claim, a veteran’s lay testimony, alone, is not sufficient to establish that a stressor occurred. See 38 C.F.R. § 3.304(f)(1-4). Nevertheless, if a PTSD claim is based on in-service personal assault, a variety of evidence sources may be used to corroborate the Veteran’s account of the stressor incident, to include corroborating statements from fellow servicemembers. See 38 C.F.R. § 3.304(f)(5). The Veteran seeks entitlement to service connection for an acquired psychiatric disability, to include PTSD, based on the allegation that his current mental health disabilities are the result of an in-service sexual assault. Specifically, the Veteran asserted that he was drugged and raped by a Mess Sergeant during service. See April 2009 Statement in Support of Claim; see also July 2013 VA examination. The Veteran was afforded a VA psychiatric examination in June 2013. The VA examiner conducted a thorough interview with the Veteran, reviewed the available record evidence, conducted a mental status examination, performed psychometric testing, and issued conclusions regarding the nature of the Veteran’s claimed disability. She conducted 45 minutes of psychological testing and interviewed the Veteran for one hour and 45 minutes. In general, the VA examiner found the Veteran to be an unreliable historian, and she noted several inconsistencies between the Veteran’s self-reported statements and other evidence of record. Additionally, psychometric testing resulted in invalid profiles due to inconsistent, unreliable, and over-endorsed responses. Regarding the Veteran’s developmental and family history, the VA examiner highlighted inconsistencies between the Veteran’s self-reports at the interview and the other evidence of record. For instance, while the Veteran reported that his parents were alcoholic and abusive towards one another, he denied any childhood physical, emotional, or sexual abuse; yet elsewhere in the record he reported childhood abuse, to include a sexual assault by his uncle’s friend. The VA examiner also noted inconsistencies regarding the severity and frequency of the Veteran’s reported psychiatric symptoms. Regarding the Veteran’s reported auditory and visual hallucinations pertaining his alleged in-service sexual assault, the VA examiner cited the varying reports documented in the medical records over time, and stated, “what is notable about these varying reports of his auditory and visual hallucinations is not only their inconsistency as far as onset, content, origin, etc., but also how the content of the hallucinations does not conform to our current understanding in the field of mental health of these phenomena.” During mental status examination, the Veteran was reported as polite and cooperative. He agreed to complete two psychological assessment measures prior to the interview, although he expressed irritation with doing so. He stated he felt violated by the VA male reproductive examination conducted the same day. He completed the psychological testing in 45 minutes, which was quite fast (as most people take more than 2 hours to complete the two measures). His mood was anxious with restricted range of affect. His thoughts were linear and free of delusional content. He was preoccupied with obtaining VA service-connected benefits—”[h]e mentioned no less than 20 or 30 times during the course of the interview that he “deserve[d]” compensation and that he hope[d] th[e] examiner [would] help him get what he deserves[d].” His memory, concentration, and insight were good; judgment and impulse control were intact; and he denied suicidal/homicidal thought, intent, plan, or means. The Veteran was administered the Trauma Symptom Index (TSI-2) which measures acute and chronic symptoms resulting from a wide range of traumatic experiences. A review of the validity scales showed that the Veteran overendorsed trauma-related symptoms that others, even with significant posttraumatic symptomatology, rarely endorse to any major extent. The VA examiner explained that reasons for overendorsement can include general overendorsement of all items, specific overendorsement of PTSD items, or random responding. The recommended cutoff score for an invalid profile on the TSI-2 is 15, and the Veteran’s score was 17, thus, resulting in an invalid profile that could not be interpreted. The Veteran was also administered the Minnesota Multiphasic Personality Inventory (MMPI-2) which is an objective self-report instrument that provides a measure of the examinee’s personality and clinical syndromes. Validity indexes are also measured to evaluate accuracy and consistency of reporting. A review of the Veteran’s validity scales showed another invalid profile. The Veteran omitted more items than is typical—which alone renders the validity questionable; he endorsed items inconsistently; he produced a profile indicating that he tended to endorse items versus denying them; and he endorsed highly unusual symptoms that are rarely endorsed with any significance. The VA examiner explained that individuals who endorse these unusual symptoms are usually floridly psychotic, which would have been readily apparent in the in-person interview, if present. Visual inspection of the Veteran’s MMPI-2 answer sheet revealed that he answered all “true” and all “false” for entire rows of answers. The Veteran’s MMPI-2 was invalid and could not be interpreted. The VA examiner opined that the Veteran gave suboptimal motivation and effort during the testing, which could have resulted from a variety of factors, to include impaired sleep or boredom, heightened or acute psychiatric distress, a desire to have perceived deficits identified, secondary gain, or other reasons. The June 2013 VA examiner declined to issue a formal psychiatric diagnosis due to the conflicting historical information and psychometric data. The VA examiner reiterated that her examination revealed “notable inconsistencies in the Veteran’s self-report of his history, which calls into question the reliability of this information.” She also noted the Veteran’s invalid performance on psychological testing, which suggested suspect effort/impression management. She stated that on psychological testing, the Veteran reported highly improbable symptoms, occurring in patterns that are not seen amongst those with known mental/cognitive ailments. The June 2013 VA examiner is not the only mental health practitioner of record that questioned the Veteran’s reliability. VA mental health treatment records from 2009 to 2010 consistently document that the Veteran is a “difficult historian.” In July 2015, the Veteran sought entrance into the Trauma Recovery Program (TRP) at the Atlanta VA Medical Center. A mental health intake assessment was conducted. The examiner noted that the Veteran’s report of symptoms was stilted and absent of distressed affect. The Veteran reported irritability and “snappishness,” however, the Veteran was unable to provide details about what situations cause him to “snap.” The examiner also noted inconsistencies in the record regarding the Veteran’s reports of nightmares. At varying times, he has stated he could and could not remember the content of his nightmares. The examiner stated that the Veteran did not have PTSD, as there was no indication of avoidance or distress in discussing symptoms/trauma history. The Veteran was preoccupied with VA examinations for PTSD. Objective testing was performed, and while certain tests were within normal limits, the negative distortion scale was moderately elevated, and the second highest coefficient of fitness was “fake bad” profile.” The examiner assessed that Veteran (based on DSM-5 criteria as opposed to DSM-IV criteria) as malingering due to a combination of symptom exaggeration/fabrication and false attribution of symptoms. The examiner stated that the records documented inconsistency in reports of disciplinary and work history and inconsistency in his reports of trauma. The Veteran also exhibited a preoccupation with obtaining service connection for PTSD and the VA examination process. Scores on some of the malingering tests were consistent with malingering, whereas some were consistent with forthrightness. The examiner stated that the Veteran’s stilted/rehearsed and vague symptom reports were also consistent with malingering, as was the inconsistency between his cheerful in-session affect and the serious symptoms he reported. The examiner noted that the Veteran may have experienced some mood, anxiety, and personality pathology related to childhood chaotic experiences, but he was currently exaggerating his symptoms and attributing them falsely to an alleged in-service sexual trauma. A panel of interdisciplinary experts determined that the Veteran was without a symptom profile indicative of trauma focused therapy, and he was not enrolled into the TRP program. As the Veteran was not engaged in combat, lay statements alone are insufficient to establish the occurrence of his claimed in-service stressor. See Moreau v. Brown, 9 Vet. App. 389 (1996). Further negating the credibility of his assertions are the numerous mental health professionals of record (highlighted above) who have indicated that the Veteran is an unreliable historian who inconsistently reported his past experiences and tended to exaggerate his symptoms. The most persuasive evidence on this point is the report of the June 2013 VA examiner, who concluded that the Veteran’s reports of his military sexual trauma were inconsistent and unreliable, stating that Veteran’s military sexual trauma varied in important details across the various iterations reported. The VA examiner explained in pertinent part: There are several notable differences in [the] various versions of the [military sexual trauma] stressor [as reported by the Veteran in various sources of record]. First, there is the date of the alleged rape, which was variously reported as occurring either in June 1982 or June 1983. Second, there is the difference in whether the Veteran was intoxicated prior to the rape: some versions state that he was intoxicated, other state that he was not intoxicated but rather had only one drink before he blacked out and was definitely not drunk. Third, there is the relationship of the Veteran to [the Sergeant]. The Veteran states that [Sergeant] was a Mess Sergeant and that he did not work with him. Previous versions state that [the Sergeant] was his direct supervisor. Fourth, there is the circumstance of how he came to arrive in the presence of his alleged perpetrator, [the Sergeant]. Some versions state that he was invited to [the Sergeant’s] house by his friend T, and the rape occurred there, whereas in other versions he was ordered to report to the Mess Sergeant’s quarters with no mention of T, and that the rape occurred there. Some versions include pornographic movies immediately upon entering [the Sergeant’s] house, whereas other versions mention the movies in the bedroom after awaking from the rape. These notable inconsistencies cause considerable difficulty in drawing any reliable conclusions about the Veteran’s claim for [military sexual trauma]. The Board has independently reviewed the evidence of record and agrees with the June 2013 VA examiner’s conclusions; as her concerns were completely supported by record evidence. As noted, there is inconsistency in the record as to when the Veteran’s alleged rape actually occurred. The Veteran first reported that his assault occurred in June 1982, but he later reported that it occurred in June 1983. He told the June 2013 VA examiner that he thought it occurred in 1983, but this equivocal language demonstrated uncertainty. Additionally, the presence of the Veteran’s friend T changes in the various reports, and the circumstances regarding the Veteran’s presence at the Mess Sergeant’s house are also inconsistent. The VA examiner is correct that in the April 2009 stressor statement, the Veteran indicated he was “ordered to report to the Mess Sergeant’s quarters” whereas later iterations of the story indicate that the Veteran was invited over to the Sergeant’s house socially, and he attended willingly as opposed to attending in response to a superior’s direct orders. See e.g. November 2010 statement. These are merely some examples of the inconsistencies in the Veteran’s self-reports of his alleged in-service sexual assault in the record. His changing story and the indefiniteness of his lay reports over time severely undercut the credibility of his assertions. See Caluza v. Brown, 7 Vet. App. 478, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). The Veteran’s service personnel records are negative for explicit reports of military sexual trauma or related psychological symptomatology. While the Veteran’s previous attorney argued that the Veteran’s service personnel records documented behavioral changes following the claimed assault, the Board does not agree. See e.g. January 2011 correspondence. In fact, the June 2013 VA examiner evaluated the Veteran’s military records and noted that the Veteran’s personnel records did not document a significant change in his behavior following his alleged in-service sexual trauma. The Veteran’s service personnel records document that the Veteran had three promotions early in his military career, and then in July 1981, he received his first demotion. Thereafter, the Veteran received several more demotions and promotions. The first demotion in rank occurred prior to the alleged rape (regardless of whether it is considered to have allegedly occurred in June 1982 or June 1983), and while the record notes a pattern of promotions and demotions from July 1981 through the end of the Veteran’s military service, this pattern was already established prior to his alleged assault. Even after the date of his alleged assault, the Veteran remained capable of moving to a higher rank, as evidenced by his October 1983 promotion. Based on this same reasoning, the June 2013 VA examiner concluded that the pattern of promotions and demotions in the record was not a reliable marker for military sexual trauma and based on the Board’s independent review of the evidence, the undersigned agrees. Regarding the Veteran’s disciplinary actions, the record reflects that he had three major infractions prior to his alleged in-service assault using the June 1982 date, and seven major infractions prior to his alleged in-service assault using the June 1983 date. A notice from July 1982 stated that the Veteran was ineligible for a Good Conduct medal due to a conviction for possession of marijuana and trespass. While it does not indicate when these actions occurred, they likely occurred prior to June 1982 given the prolonged nature of the justice system (and the obtainment of a conviction by July 1982), and thus, they would have likely occurred prior to the Veteran’s alleged assault, using either reported date. The Veteran had demonstrated a pattern of disobeying authority before his claimed assault—regardless of which date is used—and the continuance of this behavior after the alleged assault does not serve as credible supporting evidence that the claimed military sexual trauma occurred. The Board notes that the record contains a notice from February 1983 (after the June 1982 date, but before the June 1983 date) stating that the Veteran was not favorably considered for oversea service. The notice does not give an explanation, and given the inconsistency in the date of the alleged in-service assault, it is unclear if this notice occurred prior to or after the assault. Thus, its probative value is limited. The Veteran’s service treatment records also document a history of interpersonal violence and personal problems prior to the alleged in-service sexual assault. Service treatment records from January 1981 demonstrate that the Veteran sought medical care for aches and pains secondary to being in a fight. In February 1981, he was seen by a social worker due to unspecified “personal problems.” The June 2013 VA examiner correctly concluded that the record lacked evidence of significant behavioral change to support the occurrence of a military sexual trauma, either in June 1982 or June 1983. The VA examiner stated, “prior to both dates provided by the Veteran as to when the rape occurred (June 1982 or June 1983), the Veteran had an established pattern of disciplinary problems, reductions in rank, and seeking medical care for interpersonal violence and personal problems.” The Board has independently reviewed the record and finds that the June 2013 VA examiner’s assessments are supported by record evidence. As such, the Veteran’s service department records do not contain evidence of significant behavioral changes following the claimed assault that may be used to corroborate his allegations. The Veteran has submitted a private psychological opinion from September 2016 diagnosing the Veteran with PTSD, among other psychiatric diagnoses, (using the DSM-5 criteria as opposed to the DSM-IV criteria) and opining that this disability is the direct result of his alleged in-service sexual assault. The Board is cognizant that medical opinion evidence may be submitted for use in determining whether the occurrence of a stressor is corroborated. 38 C.F.R. § 3.304(f)(5); see Menegassi v. Shinseki, 683 F.3d 1379, 1382 (Fed. Cir. 2011). However, the Board does not find the opinion of the September 2016 private psychologist to be fully informed. First, there is no indication in the report of how the private psychologist conducted her evaluation (in-person, telephonically, via video); nor does the examiner specifically indicate what evidence was considered. The Veteran’s private attorney indicated that he provided the psychologist with “pertinent portions of the Veteran’s VA claims file, including the complete military file;” thus, suggesting that the psychologist did not review the complete record available at the time of the assessment. Second, unlike the June 2013 VA examiner, the private psychologist did not discuss the glaring discrepancies in the record, such as the Veteran’s varying self-reports of his alleged in-service assault and his varying reports of symptoms, or the numerous VA mental health providers who determined the Veteran to be unreliable. Lastly, the private psychologist’s statement regarding in-service behavioral changes following the Veteran’s alleged sexual assault is not probative. In pertinent part, the private psychologist stated: Review of the military personnel records show negative items before and after his sexual assault. However, prior to the assault, the infractions did not appear to affect his job performance; he received glowing reviews of his work as well as promotion. After the assault, the infractions culminated in a bar to reenlistment certificate and eventual release from active duty. All of the infractions listed on the bar to reenlistment fall after the date of the assault. This change in the [the Veteran’s] ability to function is a clear trauma marker. The private psychologist’s opinion demonstrates an inaccurate and overly simplistic assessment of the Veteran’s service personnel records. Initially, the private psychologist’s opinion regarding the Veteran’s in-service behavioral markers ignored the evidence, discussed supra, documenting a pattern of insubordination and disobedience well before June 1982. Moreover, it is unclear which date the private psychologist is using as the date of the alleged assault. At the beginning of the report she simply stated that the Veteran reported his sexual assault as occurring in 1983—without an identified month or date. Thus, it is unclear what specific date that the private psychologist was using to form her opinion when assessing in-service behavioral changes. For instance, she alleged that “all of the infractions listed on the bar to reenlistment fall after the date of the assault,” but a review of that document demonstrates that the Veteran’s superiors considered infractions from January 1983, February 1983, March 1983, and January 1984. In all other sources beside the private psychologist’s report, the Veteran placed his in-service assault as occurring in June 1982 or June 1983. Consequently, the private psychologist’s assessment would be accurate if she were using the June 1982 date; however, a plain review of her report suggests that she was generally using 1983—without reference to a specific date or month—to form her opinion. Furthermore, if the Board were to assume that the Veteran’s assault occurred in June 1983—as previously alleged by the Veteran—many of the infractions listed in the bar to reenlistment certificate predated the Veteran’s assault, thus rendering the private psychologist’s opinion inaccurate. The Board’s conclusion that the September 2016 private medical opinion lacks probative value is further bolstered by the opinion of the December 2020 VA examiner who correctly noted that the September 2016 private psychologist did not address conflicting evidence. The December 2020 VA examiner stated: [The September 2016 private psychologist did not ] address [the June 2013 VA examiner’s] seemingly well-founded claim that it is impossible to differentiate reliable reporting from the Veteran from inconsistent reporting due to invalid assessments and inconsistent reporting in a number of domains (account of assault, psychotic symptoms, etc.) as well as long-standing issues in behavior/disciplinary actions [during service] undermining the assumption [that] those items are ‘in service stressor markers’ and not simply consistent behavior by Veteran [during service] unrelated to [his] alleged assault. The Board finds the June 2013 VA medical opinion to be the most probative evidence of record. The VA examiner conducted an unparalleled assessment of the record, evaluated competing information, and conducted a remarkably thorough interview, in-person examination, and psychometric testing. Her opinions were fully articulated, factually accurate, and supported by adequate explanatory rationale. On the contrary, as articulated above, the September 2016 private psychologist’s opinion was rife with vagueness, inaccuracies, and gave no consideration to the conflicting evidence of record, especially regarding the Veteran’s various reports of his alleged sexual assaults, and his inconsistent reporting of psychological symptoms. Likewise, the Board affords minimal weight to the VA treatment records diagnosing the Veteran with PTSD based on in-service sexual assault, as they did not sufficiently analyze the conflicting evidence regarding the Veteran’s allegations. The June 2013 VA medical opinion is the superior evidence in this determination due to its comprehensive nature. In the September 2013 VA form 9, the Veteran’s prior attorney stated that the June 2013 VA examination was inadequate, but he gave no reasoning or explanation to support his opinion. As stated above, the Board finds the June 2013 VA examination to be of highest probative value in this appeal based on the comprehensiveness and thoroughness of the examination and the accompanying medical report. The Board finds no merit to the attorney’s baseless allegation. In August 2015, the Veteran’s prior attorney argued that the Veteran was not forthright at the June 2013 VA examination, because he underwent a rectal exam immediately prior to psychological testing, and this “negatively affected the Veteran’s ability to respond appropriately during [the June 2013 VA psychological examination].” The attorney further stated, “[t]his is understandable, given that the claim for PTSD is based on [military sexual trauma].” While it is true that the Veteran underwent a male reproductive VA examination, including a prostate examination, immediately prior his June 2013 VA psychiatric examination, there is no evidence to suggest this timeline impacted his ability to responded to the VA psychiatric examiner. In fact, the June 2013 VA examiner documented the Veteran’s reports of feeling “violated” by the VA examiner who conducted the male reproductive examination, but she did not suggest this had impact in the Veteran’s ability to be assessed or answer her questions. To the contrary, she reported that the Veteran was calm and cooperative, although he expressed irritation with undergoing psychometric testing. The prior attorney’s statements are purely speculative, and as a lay person without any medical training in the area of psychology/psychiatry, he is not competent to opine that the Veteran’s rectal examination negatively impacted the Veteran’s later VA psychiatric examination. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran has submitted a private medical opinion from November 2016 opining that the Veteran’s traumatic symptoms were due to his reported in-service sexual assault. This nexus opinion was conclusory and unsupported by an explanatory rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical opinion that contains only data and conclusions without any supporting analysis is accorded no weight). Moreover, the author did not address the many inconsistencies in the record, as highlighted throughout this opinion. Accordingly, the November 2016 private opinion is not entitled to probative value in this appeal. The record also contains a VA medical statement from February 2012 documenting a diagnosis of PTSD and delusional disorder. This statement did not discuss the Veteran’s alleged in-service sexual assault. To the extent that the Veteran has indicated his subjective belief that he experiences PTSD due to his alleged military sexual trauma, as a lay person, he is without the medical training to opine on complex medical matters such as the diagnosis or etiology of psychiatric disabilities. Jandreau, 492 F.3d at. 1377. The Board has also considered the buddy statements submitted by the Veteran’s family members. In a May 2009 lay statement, the Veteran’s brother indicated that the Veteran became a totally different person after he left the military. It is well-documented that the Veteran began using drugs and alcohol in the years following his service and had difficulty maintaining long-term employment. This lay statement, while credible and competent, does not prove that the Veteran’s in-service sexual assault actually occurred and is not probative in this appeal. In a May 2009 lay statement, the Veteran’s sister indicated that “the last time we saw [the Veteran] was after he got out of the army, he was in very bad shape, he seemed so cold and distant.” She further stated, “for many years [the Veteran] has been acting weird[;] he wakes up in the middle of the night crying and screaming” and when he is drunk, he would say things like “the Army raped me.” The Board finds this lay report to be internally inconsistent. It remains unclear how the Veteran’s sister is familiar with or observed the Veteran’s actions and symptoms for the many years following service, when she stated that she last saw the Veteran when he got out of service. As such, the Board does not find this lay report to be probative in this appeal. In sum, the Veteran’s appeal seeking service connection for PTSD must be denied because the evidence of record fails to contain credible supporting evidence that the Veteran’s claimed in-service sexual assault actually occurred. The most probative evidence of record is the June 2013 VA medical opinion which highlighted the many inconsistencies and unreliability in the Veteran’s lay reporting and psychiatric symptomatology, which did not support the occurrence of his claimed in-service stressor. The private medical opinions and buddy statements received in support of the Veteran’s appeal have been determined to be not probative in this determination. The Veteran has not submitted any other probative evidence, to include from the sources set forth in 38 C.F.R. § 3.304(f)(5), which credibly supports that his alleged in-service sexual assault actually occurred. As this central element of a service connection claim for PTSD has not been met, the Veteran’s appeal seeking entitlement to service connection for PTSD must be denied. Notwithstanding the above, the Veteran may still achieve service connection for his other acquired psychiatric disabilities aside from PTSD, so long as the elements for service connection are sufficiently satisfied. Here, the evidence establishes the presence of various psychiatric diagnoses within the appellate period, to include paranoid disorder; depressive disorder, drug-induced psychotic disorder with hallucinations, cocaine dependence, alcoholism, schizophrenia, schizoaffective disorder; and substance-induced mood disorder, among others. Despite the presence of an acquired psychiatric disability besides PTSD within the appellate period, there is no probative evidence of in-service incurrence of a psychiatric disability. The Board has already determined that the Veteran’s reports of in-service sexual assault lack credible supporting evidence for the purposes of achieving service connection for PTSD. Outside of the context of PTSD claims, lay evidence may, in certain circumstances, support an underlying service connection claim. 38 C.F.R. § 3.159(a)(2). However, the Board does not find the Veteran’s lay reports of an in-service sexual assault to be credible for the same reasons discussed above. Mainly, several VA mental health practitioners have determined the Veteran to be an inconsistent and unreliable historian, preoccupied with achieving service-connected benefits. Additionally, the Board has reviewed the Veteran’s service treatment records and they are silent for complaints of psychiatric symptoms or psychiatric diagnoses. There is a vague treatment note documenting a February 1981 social work visit for personal problems, but no related psychiatric symptomatology. There is no compelling evidence proving that the Veteran experienced a psychiatric disability during service, and as such, the in-service element of a service connection claim has not been met. In the absence of the in-service incurrence element, there is no need to assess the nexus element of a direct service connection claim. Nevertheless, the Board notes that the record contains a February 2020 VA medical opinion diagnosing the Veteran with alcohol use disorder and stimulant use disorder (under the DSM-5 criteria as opposed to the DSM-IV criteria) and noting that the Veteran’s addiction issues did not arise until after service. While the VA examiner relied on the DSM-5 criteria in diagnosing these disabilities, the Board finds this to be harmless error, as the record otherwise establishes that the Veteran carried similar DSM-IV diagnoses within the appellate period. Moreover, the VA examiner was correct in his explanation that the Veteran’s service treatment records are negative for psychiatric complaints and the Veteran did not begin using drugs or alcohol until after service. Indeed, while an April 1986 medical record noted the Veteran’s 8-year history of drinking alcohol, this was the first time the Veteran was formally diagnosed with clinically significant alcohol abuse, nearly two years after the Veteran’s separation from service. For these reasons, the Board finds the February 2020 VA examination probative. The RO also obtained a VA addendum opinion in December 2020 addressing the etiology of the Veteran’s psychiatric disabilities. The VA examiner noted that the more recent VA mental health records from 2019 documented symptoms of depression and anxiety that were due to psychosocial stressors. The VA examiner further questioned the psychiatric diagnoses rendered by the September 2016 private psychologist, as she did not address the inconsistencies and unreliability of the Veteran’s lay reports and psychometric testing as discussed by the June 2013 VA examiner. Indeed, the September 2016 private psychologist issued several psychiatric diagnoses beyond PTSD (using the DSM-5 criteria as opposed to the DSM-IV criteria) and argued they were due to the Veteran’s reported in-service sexual assault. The December 2020 VA examiner is accurate that the September 2016 private psychologist’s medical opinion was not fully informed, as argued in depth above. The record lacks probative medical evidence indicating that the Veteran’s acquired psychiatric disability aside from PTSD, was incurred in service or is otherwise etiologically related to his active duty service. The Veteran’s reports of in-service sexual assault have been deemed to lack credibility based on the current evidentiary record, and his service treatment records are otherwise negative for psychiatric complaints or diagnoses. For these reasons, the Veteran’s appeal seeking service connection for an acquired psychiatric disability aside from PTSD must also be denied. The Veteran’s acquired psychiatric disability has been variably diagnosed within the appellate period, to include diagnoses that could be interpreted as psychoses, warranting consideration under the presumptive service connection provisions of 38 C.F.R. §§ 3.303(b), 3.307(a)(3), and 3.309(a) as an eligible “chronic disease.” See Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). A review of the record demonstrates that the Veteran did not experience psychoses during service or within one year of his separation from service; thus, there is no basis upon which to engage in a continuity of symptomatology analysis. Entitlement to presumptive service connection for psychoses under the chronic disease regulations is also denied. 2. Entitlement to service connection for erectile dysfunction is denied. The Veteran has alleged entitlement to service connection for erectile dysfunction as secondary to his current acquired psychiatric disability. The Board acknowledges the competent medical opinions of record affirmatively linking the Veteran’s erectile dysfunction to his psychiatric disability. See e.g. September 2016 private psychologist’s opinion (without supporting rationale); March 2020 VA medical opinion. However, the Board has denied entitlement to service connection for an acquired psychiatric disorder, to include PTSD, above, and thus; the Veteran’s allegation of secondary service connection is precluded. The Veteran’s VA treatment records document the presence of erectile dysfunction during the appellate period. Thus, the current disability element of a service connection claim has been satisfied. The Board has reviewed the Veteran’s service treatment records, and despite several reports of hernia, groin, and testicle pain, there is no evidence that the Veteran suffered from erectile dysfunction during service. In June 2013, the Veteran underwent a VA medical reproductive examination which confirmed a diagnosis of erectile dysfunction. The VA examiner cited several of the Veteran’s risk factors for erectile dysfunction, but only partially issued an opinion regarding secondary service connection, which is now irrelevant. In the June 2017 and May 2019 Board remand decisions, the matter was remanded for a direct service connection opinion. In March 2020, following a complete review of the record, a VA examiner issued a negative nexus opinion declining to link the Veteran’s erectile dysfunction to his active duty service. The VA examiner noted the Veteran’s documented in-service diagnoses of epididymitis and right inguinal hernia, but opined that there were no longitudinal patterns or recurrent complaints suggestive of medical nexus. Indeed, the Veteran’s service treatment records are silent for erectile dysfunction and he was not formally diagnosed with the disability until many years following service. The Board finds this VA medical opinion to be sufficiently informed and supported by an explanatory rationale. As such, it is entitled to significant evidentiary value. At the March 2020 VA examination, the Veteran reported initial onset of erectile dysfunction in 1984 secondary to his alleged in-service sexual assault. The Board finds no credible evidence that the Veteran suffered erectile dysfunction during service, aside from the Veteran’s lay reports, and the most probative VA mental health professionals have already determined Veteran to be a poor and unreliable historian. Moreover, the Board has already deemed the Veteran’s reports of in-service sexual assault to be unreliable under the current evidentiary record. As such, his lay reports are entitled to little probative value in this appeal. [Continued on Next Page]   In sum, the evidence preponderates against the allegation that the Veteran’s erectile dysfunction was incurred in or is otherwise etiologically related to his active duty service. As the evidence weighs against the claim, the Veteran’s appeal seeking service connection for erectile dysfunction is denied. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Galante 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.