Citation Nr: 21016147 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 18-50 858 DATE: March 19, 2021 ORDER Service connection for posttraumatic stress disorder (PTSD) is denied. Service connection for an acquired psychiatric disorder other than PTSD is denied. Service connection for tremors of the left hand is denied. Service connection for tremors of the right hand is denied. FINDINGS OF FACT 1. The Veteran did not engage in combat with an enemy, and his stressors are not related to fear of hostile military or terrorist activity; the Veteran’s stressors have not been corroborated. 2. Posttraumatic stress disorder (PTSD) was not manifest in service and is not attributable to service. 3. An acquired psychiatric disorder other than PTSD was not manifest in service and is not attributable to service. 4. The Veteran was stationed at Camp LeJeune, North Carolina and is presumed to have been exposed to contaminated water. 5. Tremors of the left hand did not manifest in service and are unrelated to service to include exposure to volatile organic compounds at Camp LeJeune. 6. Tremors of the right hand did not manifest in service and are unrelated to service to include exposure to volatile organic compounds at Camp LeJeune. CONCLUSIONS OF LAW 1. Posttraumatic stress disorder (PTSD) was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131, 5107 (b); 38 C.F.R.§§ 3.102, 3.159, 3.303, 3.304, 4.125. 2. An acquired psychiatric disorder other than PTSD was not incurred in or aggravated by service. 38 U.S.C. § 1110, 1131; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. Tremors of the left hand were not incurred in or aggravated by service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. 4. Tremors of the right hand were not incurred in or aggravated by service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1975 to June 1997. He appeals September and October 2017 rating decisions that denied these claims. In December 2018 the Board remanded these matters to obtain VA examinations and opinions, which were obtained in October 2020. The Board’s prior remand instructions have been substantially complied with. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service or for aggravation of a preexisting injury suffered or disease contracted in line of duty. 38 U.S.C. §§ 1110 (peacetime), 1131 (wartime). Generally, 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d). 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) (providing that a Veteran is competent to report on that of which he or she has personal knowledge). 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. See 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). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Posttraumatic stress disorder. The Veteran seeks service connection for multiple psychiatric disorders, including posttraumatic stress disorder (PTSD). The Veteran’s other psychiatric diagnoses will be addressed in a separate section below. He asserts that his PTSD is due to in-service events that distressed him. There are particular requirements for establishing PTSD that are separate from the general requirements for those for establishing service connection. Service connection for PTSD requires (i) medical evidence diagnosing the condition, (ii) a link established by medical evaluation between current symptoms and an in-service stressor; and (iii) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. §§ 3.304 (f), 4.125 (a). The provisions of 38 C.F.R. sections 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. As will be discussed below, service connection for PTSD is being denied due to the absence credible supporting evidence that the claimed in-service stressors occurred. 38 C.F.R. § 3.304 (f). Service treatment records contain no complaints, treatments, or diagnoses related to PTSD. Reenlistment examinations dated September 1979, January 1982, and October 1987 show clinically normal psychiatric evaluations. The February 1997 separation examination shows a normal psychiatric clinical evaluation. The Veteran reported that he was in good health in the February 1997 report of medical history and denied any history of frequent trouble sleeping, depression or excessive worry, or nervous trouble. The Veteran filed this claim in March 2017. A February 2017 report from Dr. Y., a private chiropractor, contains his opinion that the Veteran has PTSD related to service. Dr. Y. also provided that the Veteran will be evaluated for PTSD by the appropriate mental health professional for PTSD and offered that his expertise insofar as PTSD is concerned is the recognition of PTSD for the purposes of referral to an appropriate specialist. A subsequent February 2017 Disability Benefits Questionnaire (DBQ) completed by W.J.A., Psy.D. shows that the Veteran did not have a diagnosis of PTSD, but rather had other psychiatric diagnoses which the Board will address later in this decision. No nexus opinion was provided with the DBQ. The Veteran provided a statement regarding his claimed PTSD stressors in June 2017. First, he reported that in July 1976 he was on a Mediterranean cruise on the USS Harlan County and was required to perform late night duties carrying a full pack of supplies and climb down ropes, causing increased fear and anxiety. Second, in May 1979 at Camp LeJeune he was completing a floating bridge training and obstacle course where he witnessed what appeared to be a fellow Marine being crushed by the bridge, although the Marine was not harmed. He reported the wonder of and likelihood of that occurring continued to provoke negative and ongoing stressful thoughts. Third, in September 1991 he was informed to prepare himself and his family for deployment to Kuwait during the Gulf War, and the fear of being deployed caused prominent and significant terror that has never subsided. He was not ultimately deployed. The Veteran was afforded a VA examination in October 2020. The examiner diagnosed posttraumatic stress disorder, chronic, generalized anxiety disorder, unspecified bipolar and related disorder, and unspecified neurocognitive disorder, and noted that the symptoms of the diagnosed conditions overlapped, and it was not possible to differentiate what symptoms are attributable to each diagnosis. The Veteran reported self-medicating depression during service by drinking, and that he was scared of losing respect of others if he sought professional help. He reported sleep interruptions and that he wakes up in the middle of the night to check doors and the property, which he had done since he was discharged from the service. He reported nightmares and his wife reported he talks in his sleep about military-related incidents. She noted the Veteran gets depressed, angry, and does not want to be bothered. He reported anhedonia, fatigue, worthlessness, and guild, as well as periods of heightened energy with racing thoughts and pressured speech. He reported feeling anxious most of the time and that he is easily apprehensive, worries, and finds difficult to control his worry. As noted, service connection for PTSD requires: (i) medical evidence diagnosing the condition; (ii) a link established by medical evaluation between current symptoms and an in-service stressor; and (iii) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. §§ 3.304 (f), 4.125 (a). Here, the Veteran was diagnosed with PTSD by the October 2020 examiner. However, a link established by medical evaluation between the Veteran’s current symptoms and an in-service stressor has not been shown, and there is to no credible supporting evidence that the claimed in-service stressors occurred. Regarding a link between the Veteran’s current symptoms and his reported in-service stressors, the Board finds there is no probative medical evaluation establishing such a link. The February 2017 report from Dr. Y., a private chiropractor, contains his opinion that the Veteran has PTSD related to service. However, Dr. Y. also provided that the Veteran will be evaluated for PTSD by the appropriate mental health professional for PTSD and offered that his expertise insofar as PTSD is concerned is the recognition of PTSD for the purposes of referral to an appropriate specialist. The Board does not find that Dr. Y.’s assessment of PTSD was an actual diagnosis of PTSD conforming with the DSM-5. It is clear that Dr. Y. is a chiropractor, and his initial assessment was essentially a referral to an appropriate mental health care provider for an opinion, as explained in his report. The February 2017 DBQ did not diagnose PTSD or provide any positive nexus or link between the Veteran’s symptoms and the reported in-service stressors. There is otherwise no medical evidence of record establishing a link between the Veteran’s service and his symptoms. The only probative opinion or finding of record is the October 2020 nexus opinion, in which the VA examiner determined that the conditions diagnosed related to the Veteran’s PTSD were less likely than not related to the claimed in-service stressors due to a lack of supporting evidence, explaining that the medical records showed no evidence of in-service mental health treatment or complaint of mental health condition. Regarding credible supporting evidence that the in-service stressors occurred, we note that the only evidence supporting the in-service stressors are the Veteran’s own lay statements. Service treatment records contain no indication of PTSD. The Veteran denied all relevant symptoms at separation. Reenlistment examinations dated September 1979, January 1982, and October 1987 show clinically normal psychiatric evaluations, and the February 1997 separation examination shows a normal psychiatric clinical evaluation. Furthermore, development was taken to verify the Veteran’s reported stressors. The Veteran was requested to provide further detail to assist with verification. A September 2017 VA administrative decision determined that the information required to corroborate the stressful events described by the Veteran were insufficient to send to the Joint Service Record Research Center and insufficient to allow for meaningful research of the National Archives and Records Administration. The Veteran’s accounts of what happened are not supported by any actual evidence of record. Specifically, no corroborating evidence has been able to be found in support of his contentions. As the Veteran’s lay statements alone are not sufficient to verify his claimed stressors, the claim for PTSD must be denied. In reaching this conclusion, we acknowledge that the October 2020 VA examiner determined the Veteran’s reported stressors were all related to fear of hostile military or terrorist activity and confirmed that each stressor is adequate to support the diagnosis of PTSD. Pursuant to 38 C.F.R. § 3.304 (f)(3), if a stressor claimed by a veteran is related to the veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of posttraumatic stress disorder and that the veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. However, none of the Veteran’s reported stressors meet the definition for “fear of hostile military or terrorist activity” contained in 38 C.F.R. § 3.304 (f)(3). For the purposes of section 3.304 (f)(3), “fear of hostile military or terrorist activity” means that “a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.” As noted above, the Veteran has reported three relevant stressors. First, the Veteran reported a July 1976 incident when he had to perform night duties onboard the USS Harlan County which included climbing down a rope with a heavy pack which caused increased anxiety. Second, the Veteran reported an incident in May 1979 at Camp LeJeune during a training exercise where he witnessed a marine being what he thought was crushed. Third, in the fall of 1991 he was informed to prepare himself and his family for an impending deployment to Kuwait during the Gulf War. These claimed stressors do not involve any fear of hostile military or terrorist activity within the meaning of section 3.304 (f)(3). Specifically, there is no evidence the Veteran experienced, witnessed, or was confronted with any hostile military or terrorist activity as required by 3.304 (f)(3). In this regard, the Veteran is not shown to have engaged in combat or to have been exposed to similar circumstances during his service. Determining that the Veteran’s stressors are related to fear of hostile military or terrorist activity is simply inconsistent with the places, types, and circumstances of his service. The 1976 incident onboard the USS Harlan County and the 1979 incident at Camp LeJeune involved no hostile military or terrorist activity. The Veteran did not experience, witness, or confront an event or circumstance that involved actual death or injury or the integrity of another within the meaning of the regulation. Although the 1991 incident involved the Veteran’s subjective fear of being deployed to Kuwait during the Gulf War, he was never deployed and did not experience, witness, or confront an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of himself or others. There was no actual threat to himself or others of injury or death due to hostile military or terrorist activity and he has provided nothing credible in this regard. See Hall v. Shinseki, 717 F.3d 1369 (2013). As such, his lay testimony alone is insufficient to establish the occurrence of the in-service stressors, despite the inaccurate findings recorded in the October 2020 examination report. As noted above, entitlement to service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a), a confirmed stressor event, and medical evidence linking the stressor event to the Veteran’s PTSD. Here, there is no confirmed stressor event in service. With regard to the exception for fear of hostile military activity in 38 C.F.R. § 3.304 (f)(3), the Veteran did not experience, witness or confront an event or circumstance that involved actual death or injury or the integrity of another within the meaning of the regulation. Given the lack of supporting evidence, the Board finds the weight of the evidence is against a finding that PTSD is related to a confirmed in-service stressor. There is no evidence in the record of the Veteran having any other acquired psychiatric disability. As such, the Board finds that service connection for an acquired psychiatric disability, to include PTSD is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. The claim for service connection for PTSD is denied. 2. Acquired psychiatric disorder other than PTSD. The Veteran also seeks service connection for other acquired psychiatric disorders. He primarily contends that each disorder was caused by service, specifically the three stressors that he reported had caused PTSD. Service treatment records contain no complaints, treatments, or diagnoses related to an acquired psychiatric disorder. Reenlistment examinations dated September 1979, January 1982, and October 1987 show clinically normal psychiatric evaluations. The February 1997 separation examination shows a normal psychiatric clinical evaluation. The Veteran reported that he was in good health in the February 1997 report of medical history and denied any history of frequent trouble sleeping, depression or excessive worry, or nervous trouble. A February 2017 Disability Benefits Questionnaire (DBQ) completed by W.J.A., Psy.D. shows diagnoses of generalized anxiety disorder, unspecified bipolar and related disorder, and unspecified neurocognitive disorder. He reported that he self-isolated after marriage when he was in the Marine Corps to avoid disciplinary problems and to avoid feeding various family members. He noted that his self-isolation intensified after discharge, and that he would drink and have suicidal thoughts. He reported that his first wife had died two years prior to the assessment and that he had not been the same since. He reported three in-service events and stressors. First, shifting from the USS Harlan County in the Mediterranean Sea to a smaller boat, noting fear related to potential for falling in the water. Second, witnessing an event in which he believed another Marine was crushed by a bridge. Third, preparing for a potential deployment to Kuwait, although he was not ultimately deployed. No nexus opinion was provided. The Veteran was afforded a VA examination in October 2020. The examiner diagnosed posttraumatic stress disorder, chronic, generalized anxiety disorder, unspecified bipolar and related disorder, and unspecified neurocognitive disorder, and noted that the symptoms of the diagnosed conditions overlapped, and it was not possible to differentiate what symptoms are attributable to each diagnosis. The Veteran reported self-medicating depression during service by drinking, and that he was scared of losing respect of others if he sought professional help. He reported sleep interruptions and that he wakes up in the middle of the night to check doors and the property, which he had done since he was discharged from the service. He reported nightmares and his wife reported he talks in his sleep about military-related incidents. She noted the Veteran gets depressed, angry, and does not want to be bothered. He reported anhedonia, fatigue, worthlessness, and guild, as well as periods of heightened energy with racing thoughts and pressured speech. He reported feeling anxious most of the time and that he is easily apprehensive, worries, and finds difficult to control his worry. The examiner determined that the conditions diagnosed related to the Veteran’s psychiatric disorders were less likely than not incurred in or caused by the claimed in-service events. The examiner noted that the medical records showed no evidence of in-service mental health treatments or complaints. Given the lack of supportive evidence, the Veteran’s diagnosed conditions were less likely than not the result of active duty, less likely than not related to the claimed in service stressors and were less likely than not a result of an in-service stressor related event. For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) be the product of reliable principles and methods; and (3) be the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). The Board finds the VA opinion persuasive. The provided rationale is consistent with the record and based on the facts of the case. Service treatment records show no relevant complaints or treatments, and the Veteran denied any psychiatric problems on the February 1997 report of medical history provided for separation purposes. There are no other nexus opinions of record. Although Dr. Y. provided a positive opinion for PTSD in February 2017, Dr. Y. also provided that the Veteran will be evaluated for PTSD by the appropriate mental health professional and offered that his expertise insofar as PTSD is concerned is the recognition of PTSD for the purposes of referral to an appropriate specialist. As explained above, this initial assessment was essentially a referral to an appropriate mental health care provider for an opinion, rather than a probative opinion in and of itself. The February 2017 private DBQ does not contain a nexus opinion, or any other statement positively attributing the Veteran’s symptoms to service or to in-service events and stressors. Therefore, the VA opinion has more probative weight, as it is well-supported, relied upon a diagnostic testing, and is based on a review of the record. The Board has also considered the Veteran’s statements noting his history of psychiatric symptoms to the effect that an acquired psychiatric disorder originated in service. The Veteran is competent to testify as to their observations, but this testimony must be weighed against the other evidence of record. See Jandreau, 492 F.3d at 1376-77; Buchanan, 451 F.3d at 1336. The Veteran is competent to report the existence of psychiatric symptoms and when these symptoms started. However, competence and credibility are different matters. In this case, the Veteran’s statements are outweighed by the other evidence of record. The service treatment records indicate normal mental health findings throughout service, including multiple reenlistment examinations and on the February 1997 separation examination. Normal findings are not consistent with the Veteran’s after-the-fact reports of in-service symptoms and psychiatric disorders. The contemporaneous evidence shows normal psychiatric evaluations, and that the Veteran denied any history of relevant psychiatric symptoms on the February 1997 report of medical history. We also note that the Veteran denied using alcohol on the separation report of medical history, contrary to his more recent assertions that he self-medicated by drinking during service. We find the Veteran’s post-service assertions are inconsistent with the contemporaneous history noted at the time of his period of service. The Veteran's assertion of psychiatric symptoms since service is contradicted by other evidence. See Caluza v. Brown, 7 Vet. App. 498 (1995) (In assessing credibility, the Board may consider interest, bias, inconsistent statements, bad character, internal inconsistencies, factual plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness). The Veteran's report of an in-service onset of acquired pathology is inconsistent with the more probative record and is not credible. The most probative evidence establishes the Veteran’s current psychiatric disorders were not incurred during his service. Despite the Veteran’s statements to the contrary, his psychiatric disorders appear to have had an onset many years after separation. At separation, the psychiatric evaluation was normal, and he denied the pertinent history. The only probative nexus opinion is negative. As such, the preponderance of the evidence is against the claim and the benefit of the doubt rule does not apply. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Service connection for an acquired psychiatric disorder other than PTSD is denied. 3. Left hand tremors. 4. Right hand tremors. The Veteran seeks service connection for bilateral hand tremors. He primarily contends that he has a disability manifest by tremors in both hands which is due to exposure to contaminated water at Camp LeJeune. A veteran who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service. 38 C.F.R. § 3.307 (a)(7). If a veteran was exposed to contaminants in the water supply at Camp Lejeune during military service and the exposure meets the requirements of Section 3.307 (a)(7), the following eight diseases shall be service-connected even if there is no record of such disease during service: kidney cancer; liver cancer; non-Hodgkin’s lymphoma; adult leukemia; multiple myeloma; Parkinson’s disease; aplastic anemia and other myelodysplastic syndromes; and bladder cancer. 38 C.F.R. § 3.309 (f). For the purposes of 38 C.F.R. § 3.307, “contaminants in the water supply” means the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride, that were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period beginning on August 1, 1953, and ending on December 31, 1987. 38 C.F.R. § 3.307 (a)(7). Here, the Veteran’s service personnel records confirm he served at Camp LeJeune from June 1977 to October 1980, then from November 1981 to May 1985, and again from August 1988 to September 1990. He is presumed to have been exposed to the contaminants in the water supply. However, the record reflects that the Veteran does not have any of the diseases listed in 38 C.F.R. § 3.309 (f) associated with exposure to contaminants in the water supply at Camp LeJeune. He does not contend otherwise; his claim is for hand tremors. As such, the Veteran’s hand tremors are not presumed to be related to his exposure to contaminated water at Camp Lejeune. The absence of a disease from the presumptive list does not preclude a veteran from otherwise proving that his disability resulted from exposure to contaminated water at Camp Lejeune. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Accordingly, the Board will still consider whether entitlement to service connection can be granted on another basis, to include whether the hand tremors are directly related to exposures at Camp Lejeune. After considering the evidence, the Board concludes that service connection for bilateral hand tremors is not warranted. Service treatment records contain no complaints, treatments, or diagnoses related to any hand tremors or any relevant disease or injury. Reenlistment examinations dated September 1979, January 1982, and October 1987 show clinically normal neurologic evaluations and that the extremities were normal. The February 1997 separation examination also shows a normal neurologic and extremity clinical evaluation. The Veteran reported that he was in good health in the February 1997 report of medical history and denied any history of relevant symptoms. The Veteran submitted a private nexus opinion dated February 2017 from Dr. Y., a private chiropractor. Dr. Y. stated that the Veteran had progressive tremors of the left and right hands since his service at Camp LeJeune, and that the tremors were visible and become worse with pressure against the hands. Dr. Y. diagnosed tremors of the left and right hand and determined that it is as likely as not that the tremors were directly and causally related to contaminated ground water at Camp LeJeune. He was provided a VA examination for central nervous system and neuromuscular diseases in October 2020. The Veteran stated the tremors were episodic and come and go and involved a nervous sensation. Palliating factors were described as calming down or relaxing. He reported that his bilateral hand tremors started about nine to ten years prior to the examination, and that he is unsure what may have caused the tremor. He had not been evaluated or formally diagnosed for the tremors but described the tremors as an “anxiety like” reaction. Neurologic examination was normal. The examiner determined the Veteran did not have a central nervous system or neuromuscular disorder, and noted the Veteran has anxiety and does not have a bilateral tremor consistent with familial or essential tremor. The examiner concluded the Veteran’s bilateral hand tremors were less likely than not incurred in or caused by his exposure to contaminants in the drinking water at Camp LeJeune. The examiner explained that while direct exposure to contaminated drinking water during service to Camp Lejeune was likely, a direct link to bilateral hand tremor is unlikely. He noted that a hand tremor due to contaminated water exposure should not resolve with calming down or self-soothing as reported during the examination. Although the examiner noted that the Veteran’s mental health was outside the scope of the examination, the examiner explained that the Veteran’s mental health was germane to the discussion of bilateral hand tremor and concluded the mood related disorders, including depression and anxiety, better explained the tremors. 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. Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). The probative value of a medical opinion primarily comes from its reasoning; threshold considerations are whether a person opining is suitably qualified and sufficiently informed. Id. at 304. The Board finds the February 2017 private opinion to be of no probative value. Although Dr. Y. determined the Veteran had experienced hand tremors since service at Camp LeJeune, such is not shown by the service treatment records, which show no relevant complaints or treatments. Pertinently, examination reports dated January 1982, October 1987, and February 1997 show normal clinical evaluations for the upper extremities and neurologic systems, and the Veteran denied any relevant problems on the February 1997 separation report of medical history. Furthermore, Dr. Y.’s determination is contrary to the Veteran’s own assertions recorded during the October 2020 examination, where he reported that the tremors in his hand had started 9 to 10 years prior to the examination, well after the Veteran’s last period of service at Camp LeJeune. An opinion based upon an inaccurate factual premise has no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Finally, Dr. Y.’s opinion is supported by no identifiable rationale and is merely a conclusion that the Veteran’s tremors are as likely directly and causally related to contaminated ground water at Camp LeJeune and the Veteran’s service. See Nieves-Rodriquez, 22 Vet. App. at 304. As such, the February 2017 opinion is of no probative value. We accept the October 2020 VA nexus opinion as highly probative medical evidence on the issue of whether the Veteran has a hand tremor disability due to exposure to contaminants in the drinking water during his service at Camp Lejeune. The examiner rendered the negative opinion after reviewing the claims file and after interviewing the Veteran and his wife regarding the hand tremors and noted the Veteran’s pertinent history and lay statements. The opinion is fully articulated and includes sound reasoning for the conclusion that the Veteran’s bilateral hand tremors were less likely than not incurred in or caused by exposure to contaminants in the drinking water at Camp LeJeune. We acknowledge that the October 2020 VA examiner determined the Veteran’s bilateral hand tremors were better explained by a mood disorder such as depression or anxiety. However, the Board as denied service connection for the Veteran’s acquired psychiatric disorders. As such service connection for bilateral hand tremors as secondary to an acquired psychiatric disorder is not warranted. We have also considered the Veteran’s lay statements. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (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. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. Layno v. Brown, 6 Vet. App. 465, 469 (1994) (distinguishing between competency as “a legal concept determining whether testimony may be heard and considered” and credibility as “a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). Here, the Veteran is competent to report that Dr. Y. told him his hand tremors were due to exposure to contaminated water. However, as explained above Dr. Y.’s opinion is of no probative weight. As such, we do not find Dr. Y.’s opinion, or the Veteran’s subsequent report of the diagnosis and opinion, to be credible. There is otherwise no evidence that any other medical professional has related the Veteran’s tremors to exposures at Camp LeJeune. Furthermore, while the Veteran is competent to testify as to his symptoms, he alone is not competent to address whether his hand tremors are etiologically related to his exposures at Camp LeJeune. Making such a connection would require specialized education, training, or experience that the Veteran does not possess. 38 C.F.R. § 3.159 (a)(2); Jandreau, 492 F.3d at 1377.   In sum, the most probative evidence establishes the Veteran’s bilateral hand tremors were not incurred in and are otherwise unrelated to his service, to include his exposure to contaminated drinking water at Camp LeJeune. Notably, the most probative evidence suggests the Veteran’s hand tremors are related only to his psychiatric disorders, which are not service connected. In addition, the evidence establishes that he does not have an organic disease of the nervous system. The preponderance of the evidence is against the claim for service connection and the benefit of the doubt rule does not apply. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morse 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.