Citation Nr: 21013612 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 16-49 536 DATE: March 10, 2021 ORDER Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a sleep disability, claimed as insomnia, is denied. Entitlement to service connection for depression is denied. FINDINGS OF FACT 1. A current cervical spine disability was not incurred during any period of active duty service, did not manifest within a year of service separation, and has not been chronic and continuous since service separation. 2. A current left knee disability was not incurred during any period of active duty service, did not manifest within a year of service separation, and has not been chronic and continuous since service separation. 3. A current right knee disability was not incurred during any period of active duty service, did not manifest within a year of service separation, and has not been chronic and continuous since service separation. 4. A current left ankle disability was not incurred during any period of active duty service, did not manifest within a year of service separation, and has not been chronic and continuous since service separation. 5. The Veteran does not have a current sleep disability for which service connection may be awarded. 6. The Veteran does not have a current diagnosis of depression. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2019). 2. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 4. The criteria for entitlement to service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 5. The criteria for entitlement to service connection for a sleep disability, claimed as insomnia, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 6. The criteria for entitlement to service connection for depression have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 2001 to March 2002, and from June 2004 to June 2005. He was awarded the Combat Action Ribbon. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In February 2019, the Veteran testified before the undersigned Veterans Law Judge. A transcript of this hearing has been added to the claims file. In July 2019, these issues were remanded by the Board for additional development. Also remanded was the issue of entitlement to service connection for posttraumatic stress disorder (PTSD). Service connection for PTSD was subsequently granted by the RO in a September 2020 rating decision. Thus, this issue is no longer on appeal before the Board. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). The Board also notes the Veteran initiated an appeal of the noncompensable initial rating assigned his service-connected headaches in a July 2020 rating decision. As this appeal is under the modernized review system, also known as the Appeals Modernization Act (AMA), it will be the subject of a separate Board action. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. The Board also notes the Veteran has been awarded the Combat Action Ribbon, indicative of combat exposure. Pursuant to 38 U.S.C. § 1154(b), with respect to combat veterans, “[VA] shall accept as sufficient proof of service- connection . . . satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions and hardships of such service . . . Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary.” See also 38 C.F.R. § 3.304(d). 38 U.S.C. § 1154(b), however, can be used only to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disorder etiologically to the current disorder. See Libertine v. Brown, 9 Vet. App. 521, 522- 23 (1996). 38 U.S.C. § 1154(b) does not establish service connection for a combat veteran; it aids him or her by relaxing the adjudicative evidentiary requirements for determining what happened in service. See Wade v. West, 11 Vet. App. 302, 305 (1998) (holding that “a combat veteran who has successfully established the in-service occurrence or aggravation of an injury pursuant to § 1154(b), must still submit sufficient evidence of a causal nexus between that in-service event and his or her current disability”). A veteran (or in this case, the appellant) must still generally establish the claim by competent medical evidence tending to show a current disability and a nexus between that disability and those service events. See Gregory v. Brown, 8 Vet. App. 563, 567 (1996). Finally, the Board notes that also within the July 2019 remand order, the RO was requested to obtain private medical records from two additional private physicians, Drs. D.F. and G.W., who had treated the Veteran for his claimed disabilities. A VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs, was received from the Veteran in October 2020; however, this form was incomplete and additional records were not requested by the VA. Regarding Dr. D.F., the Veteran reported that this doctor died in February 2019 and he had no knowledge of where any of the doctor’s records might be located. Thus, the Board finds any additional attempts to obtain these records would be futile and serve no useful purpose. Regarding Dr. G.W., the Veteran reported he only saw this doctor for his headaches, a disability for which service connection was subsequently awarded by VA, and no other issues currently before the Board. As such, the Board finds substantial compliance with the July 2019 remand orders, and adjudication of the issues currently on appeal is proper. 1. Entitlement to service connection for a cervical spine disability The Veteran seeks service connection for a disability of the cervical spine. He asserts this disability had its onset during or results from service, and service connection is therefore warranted. The Board initially notes that while the Veteran was awarded the combat action badge, he has not alleged that his ankle, knees, or cervical spine disability is the result of combat. Instead, during the hearing the Veteran testified that he began experiencing pain over time after climbing up and down off the truck. Considering first the service treatment records, these are negative for any diagnosis of or treatment for a disability of the cervical spine. A December 2005 periodic physical examination was negative for any diseases, injuries, or other abnormalities of the cervical spine. On a concurrent report of medical history, the Veteran denied any history of back or neck trouble. At his February 2019 hearing, the Veteran testified that he first injured his neck and upper back in approximately 2004 or 2005, while deployed in Iraq. He stated that he “can’t really specify a specific time” but that he was on a truck and that “over time” his neck started hurting. He stated he did not go on sick call or otherwise seek treatment for this disability, however. Thus, based on this evidence, the Board must conclude that a current cervical spine disability was not incurred during any period of active duty service, did not manifest within a year of service separation, and has not been chronic and continuous since service separation. The Board has considered the Veteran’s statements, but he was without any noted abnormalities of the cervical spine on a December 2005 periodic physical examination and denied any history of the same on a concurrent medical report. The Board finds this contemporaneous evidence to be highly probative. Post-service, the evidence of record is negative for any diagnosis of or treatment for a cervical spine or neck disability immediately following service. The Veteran was afforded a VA medical examination and opinion in November 2019. His claims file was reviewed in conjunction with the examination. The Veteran reported a history of a cervical spine injury after jumping from a truck during service while carrying heavy equipment. Upon examination of the Veteran, the VA examiner diagnosed a cervical strain. A December 2019 x-ray of the cervical spine was negative for fracture, subluxation, or prevertebral soft tissue swelling. Straightening of the cervical lordosis, which can be seen with strain or other soft tissue injury, was observed, however. Thus, based on the above, service connection for a cervical spine disability must be denied, as such a disability was not incurred during any period of active duty service, did not manifest within a year of service separation, and has not been chronic and continuous since service separation. The Veteran has testified that he did not seek treatment in service in Iraq when he first injured his neck. However, as noted, the service treatment records document that he denied having, or ever experiencing painful joints or “recurrent back pain or any back problem.” He was also examined and no neck or cervical spine disabilities were identified. Moreover, no competent evidence has been submitted linking a current cervical spine disability to an in-service disease, injury, or other incident of service. In the absence of such evidence, service connection for a cervical spine disability must be denied. The Veteran himself asserts a current cervical spine disability is related to an in-service disease or injury. As a layperson, however, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id; see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. In conclusion, the preponderance of the evidence is against the award of service connection for a cervical spine disability, and service connection must be denied. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). 2. Entitlement to service connection for a left knee disability The Veteran seeks service connection for a left knee disability. He asserts this disability had its onset during or results from service, and service connection is therefore warranted. Considering first the service treatment records, these are negative for any diagnosis of or treatment for a disability of the left knee. A December 2005 periodic physical examination was negative for any diseases, injuries, or other abnormalities of the left knee. On a concurrent report of medical history, the Veteran denied any history of knee trouble. At his February 2019 hearing, the Veteran testified that he first injured his knees in approximately 2004 or 2005, while deployed in Iraq. He stated he did not go on sick call or otherwise seek treatment for this disability, however. Post-service, the Veteran did not seek treatment for and was not diagnosed with a left knee disability for many years, until left knee arthropathy was diagnosed on VA examination in November 2019. Post-service treatment records document complaints of pain in other joints, but not in his left knee. In fact, private treatment records from October 2011 document complaints of right knee pain but did not mention any left knee issues. If ongoing left knee pain had existed, it is reasonable to assume that it would have been reported when seeking treatment for the opposite joint. Thus, his first post-service diagnosis of a left knee disability dates to more than 10 years after his last period of active duty service. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology, and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). The Veteran was afforded a VA medical examination and opinion in November 2019. His claims file was reviewed in conjunction with the examination. The Veteran reported a history of a bilateral knee injury after jumping from a truck during service. Upon examining the Veteran, the VA examiner determined the Veteran had arthropathy of the left knee. A December 2019 x-ray of the left knee was negative for fracture, dislocation, or acute bony abnormality. No significant arthropathy was observed. The Veteran himself asserts a current left knee disability is related to an in-service disease or injury. As a layperson, however, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id; see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Even if the Board were to accept the Veteran’s report of knee pain while serving in Iraq, he was without any knee disability on periodic examination in December 2005, and he denied any history of the same. As such, service connection for a left knee disability must be denied, as a current knee disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to an in-service disease, injury, or other incident of service. There is no competent evidence of record suggesting a link between a current disability and an in-service injury. In conclusion, the preponderance of the evidence is against the award of service connection for a left knee disability, and service connection must be denied. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 3. Entitlement to service connection for a right knee disability The Veteran seeks service connection for a right knee disability. He asserts this disability had its onset during or results from service, and service connection is therefore warranted. Considering first the service treatment records, these are negative for any diagnosis of or treatment for a disability of the right knee. A December 2005 periodic physical examination was negative for any diseases, injuries, or other abnormalities of the right knee. On a concurrent report of medical history, the Veteran denied any history of knee trouble. At his February 2019 hearing, the Veteran testified that he first injured his knees in approximately 2004 or 2005, while deployed in Iraq. He stated he did not go on sick call or otherwise seek treatment for this disability, however. Post-service, the Veteran sought private treatment in October 2011 for pain of the right knee. He stated he was walking and felt the knee “pop,” followed by constant pain. The initial impression was of knee pain, and a knee brace was provided. Thus, his first post-service diagnosis of a right knee disability dates to more than 5 years after his last period of active duty service. Significantly, the post-service treatment record does not indicate that the Veteran had been experiencing ongoing pain since service but that the Veteran’s condition onset while walking recently. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Additionally, the Veteran’s October 2011 diagnosis was attributed to a post-service cause, and the private examiner did not otherwise suggest a nexus with service. The Veteran was afforded a VA medical examination and opinion in November 2019. His claims file was reviewed in conjunction with the examination. The Veteran reported a history of a bilateral knee injury after jumping from a truck during service. Upon examining the Veteran, the VA examiner determined the Veteran had no right knee problems on the day of the examination. The right knee was described as normal by the examiner and no diagnosis was rendered. The record indicates that the Veteran does not have any functional impairment of his knee. The Veteran himself asserts a current right knee disability is related to an in-service disease or injury. As a layperson, however, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id; see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. Even if the Board were to accept the Veteran’s assertions of in-service knee pain while serving in Iraq, service connection for a right knee disability must be denied, as a current knee disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to an in-service disease, injury, or other incident of service. The record does not include competent and credible evidence suggesting a link between the Veteran’s complaints and service. In conclusion, the preponderance of the evidence is against the award of service connection for a right knee disability, and service connection must be denied. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 4. Entitlement to service connection for a left ankle disability The Veteran seeks service connection for a left ankle disability. He asserts this disability had its onset during or results from service, and service connection is therefore warranted. Considering first the service treatment records, these are negative for any diagnosis of or treatment for a disability of the left ankle. A December 2005 periodic physical examination was negative for any diseases, injuries, or other abnormalities of the left ankle. On a concurrent report of medical history, the Veteran denied any history of swollen or painful joints. At his February 2019 hearing, the Veteran testified that he first injured his ankle in approximately 2004 or 2005, while deployed in Iraq. He stated he did not go on sick call or otherwise seek treatment for this disability, however. Post-service, the Veteran sought private treatment in March 2012 for a left ankle injury sustained the previous day playing basketball. No prior history of a left ankle injury was noted. A left ankle sprain was diagnosed by the private examiner and the Veteran was prescribed rest and pain medication. The Veteran has also testified during his February 2019 hearing that following his return from Iraq, he sought private treatment for his left ankle, and was diagnosed with tendonitis. He reported he was given medication; he could not, however, locate records of this treatment. He further stated that he currently “[doesn’t] have a whole lot of trouble” with his left ankle. The Veteran was afforded a VA medical examination and opinion in November 2019. His claims file was reviewed in conjunction with the examination. A history of left ankle pain following jumping from a truck in service was noted; however, the Veteran denied any current pain or other symptoms of the left ankle. On physical examination, the Veteran’s left ankle was without pain, limitation of motion, or other impairment. The examiner opined that the in-service left ankle injury was resolved, and the Veteran had no current disability of the left ankle. No diagnosis was rendered by the examiner, and the left ankle was described as normal. As such, service connection for a left ankle disability must be denied, as a current ankle disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to an in-service disease, injury, or other incident of service. While the Board accepts the Veteran’s assertions that he experienced pain of the left ankle while serving in Iraq, such an injury appears to have been acute and transitory in nature, as he was without any disability of the left ankle on periodic examination in December 2005, and he denied any history of the same. As such, service connection for a left ankle disability must be denied, as a current ankle disability was not incurred in service, has not been chronic or continuous since service separation, did not manifest to a compensable degree within a year of service separation, and is not due to an in-service disease, injury, or other incident of service. The Veteran himself asserts a current left ankle disability is related to an in-service disease or injury. As a layperson, however, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id; see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, orthopedic disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. In conclusion, the preponderance of the evidence is against the award of service connection for a left ankle disability, and service connection must be denied. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 5. Entitlement to service connection for a sleep disability, claimed as insomnia, The Veteran seeks service connection for a sleep disorder. He asserts this disability had its onset during or results from service, and service connection is therefore warranted. Considering first the service treatment records, these are negative for any diagnosis of or treatment for a sleep-related disability. A December 2005 periodic physical examination was negative for any sleep-related abnormalities. On a concurrent report of medical history, the Veteran denied any history of frequent trouble sleeping. Post-service, the Veteran sought treatment in April 2012 for “bad insomnia.” He described himself as very stressed due to his father dying. He was prescribed medication to aid his sleep. He again sought private treatment in November 2014 for insomnia. He asserted these were related to his migraine headaches, which occasionally woke him up at night. He was again given medication. The Veteran was afforded a VA medical examination and opinion in November 2019. His claims file was reviewed in conjunction with the examination. Upon examination of the Veteran and review of the claims file, the examiner noted the Veteran displayed symptoms of sleep problems, but noted these were part of a formal diagnosis of PTSD due to combat exposure during military service. The examiner did not find an independent diagnosis of a sleep disability as a separate disability was warranted. Thus, based on the above, the Board must conclude that a current sleep disorder was not incurred in service, manifested within a year of service separation, or has been chronic or continuous since service separation. While the Veteran was treated on at least two occasions for sleep problems following service, a sleep disorder was not noted to have been incurred in service or otherwise related to a disease, injury, or other incident of service. Furthermore, while the Veteran’s sleep problems were noted by a VA examiner in November 2019, the examiner found these were symptoms of his PTSD, a disability for which service connection has already been established. The examiner did not find a separate diagnosis of a sleep disorder was warranted. Likewise, a private examiner noted in 2014 that the Veteran’s headaches, another service-connected disability, resulted in occasional sleep disruption, but did not otherwise diagnosis of a separate sleep disability. As such, the Board must conclude service connection for a sleep disorder as a separate disability is not warranted. As the lay and medical evidence of record does not establish that the Veteran has a current diagnosis of a sleep disability, his claim must be denied, and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R.§ 3.102; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). 6. Entitlement to service connection for depression The Veteran seeks service connection for depression. He asserts this disability had its onset during or results from service, and service connection is therefore warranted. Considering first the service treatment records, these are negative for any diagnosis of or treatment for a psychiatric disability, to include depression. A December 2005 periodic physical examination was negative for any psychiatric abnormalities. On a concurrent report of medical history, the Veteran denied any history of depression or excessive worry. Post-service, a VA psychiatric examination was afforded the Veteran in August 2013, at which time the examiner determined a diagnosis of depression was not warranted. The Veteran was afforded another VA medical examination and opinion in November 2019. His claims file was reviewed in conjunction with the examination. Upon examination of the Veteran and review of the claims file, the examiner noted the Veteran displayed symptoms of depression and sleep problems, but noted these were part of a formal diagnosis of PTSD due to combat exposure during military service. The examiner did not find an independent diagnosis of depression as a separate disability was warranted; rather, the examiner stated the Veteran’s depression symptoms were subsumed by the PTSD diagnosis. Thus, based on the above, the Board must conclude that depression was not incurred in service, manifested within a year of service separation, or has been chronic or continuous since service separation. While depression was noted by a VA examiner in November 2019, the examiner found the Veteran’s depression was a symptom of his PTSD, a disability for which service connection has already been established. The examiner did not find a separate diagnosis of depression was warranted, as any such disability was subsumed by the PTSD diagnosis. As such, the Board must conclude service connection for depression as a separate disability is not warranted. As the lay and medical evidence of record does not establish that the Veteran has a current diagnosis of depression, his claim must be denied, and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R.§ 3.102; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Thomas D. Jones, 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.