Citation Nr: 21027015 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 13-35 525 DATE: May 4, 2021 ORDER Service connection for a thoracolumbar spine disability is denied. Service connection for a psychiatric disorder is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that a current thoracolumbar spine disability was incurred in or caused by service or caused or aggravated by a service-connected disability. 2. The preponderance of the evidence is against a finding that a current psychiatric disorder was incurred in or caused by service or caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a thoracolumbar spine disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 2. The criteria for establishing entitlement to service connection for a psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304(f), 3.307, 3.309, 4.125 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1967 to February 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In November 2020, the Veteran was scheduled for another hearing before the Board. However, during the pre-hearing conference, the Veteran's attorney withdrew the request for another hearing. This matter was previously before the Board in September 2016 and December 2019 and was remanded for further development. The requested development was completed, and the case has been returned to the Board for further appellate action. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). A disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). Where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and certain chronic disease, including arthritis and psychoses, becomes manifest to a degree of 10 percent within one year from date of termination of 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. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Additionally, service connection for posttraumatic stress disorder (PTSD) requires a medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). 1. Entitlement to service connection for a thoracolumbar spine disability The Veteran asserts that a current thoracolumbar spine disability was incurred during service, or alternatively, was caused or aggravated by his service-connected status post right sternoclavicular dislocation with right ulnar sensory neuropathy. During the April 2016 Board hearing, the Veteran testified that he began having thoracic spine pain about two months after his in-service collarbone injury. The Veteran has indicated that he injured his lower back after service, which he asserts did not heal properly due to instability in his spine caused by his in-service collarbone injury. Upon review of the record, the Board finds that the preponderance of the evidences against a finding that a current thoracolumbar spine disability was incurred in or caused by service or caused or aggravated by a service-connected disability. Although the Veteran has recently claimed to have had continued back pain since service, his assertions are not consistent with the evidence of record. Service treatment records show that in October 1967, the Veteran fell and hurt is back the day before, hitting it against an iron bar. The assessment was a bruise secondary to trauma to the left buttocks, and the treatment provider recommended heat and aspirin. In January 1968, the Veteran dislocated his right sternoclavicular joint after being thrown to the mat while wrestling, and he was placed on light duty. In October 1968, the Veteran reported continued pain at the sternoclavicular joint, popping, and subluxation, and there was anesthesia to pin prick along the ulnar aspect of the right arm from the elbow to the right wrist. The Veteran was subsequently referred to the Medical Board. Later that month, the Veteran reported pain in the mid back beneath the scapula, and a physical examination revealed tenderness to palpation over the paraspinous muscles. The impression was possible muscle pain etiology. In November 1968, the Medical Board found the Veteran unfit for duty due to his dislocated right sternoclavicular joint, and he was medically discharged in February 1969. In February 1970, the Veteran underwent a VA examination pursuant to a claim for service connection for his dislocated sternoclavicular joint. During that examination, the only musculoskeletal symptom reported by the Veteran was right sternoclavicular joint pain. He did not report any symptoms of back pain. The examiner indicated that the Veteran exhibited good gait and posture and moved about actively. X-rays were normal, and a physical examination of the chest, right sternoclavicular joint, and upper extremities revealed no apparent deformities, good function, and no restriction of motion. Thereafter, the record shows no complaints of or treatment for a spine condition until 1981. In a December 1988 written statement, the Veteran indicated that he received a whiplash injury in 1981 and a spine injury in 1983, both of which he asserted would not heal due to his prior right sternoclavicular joint dislocation. The earliest treatment record associated with the claims file is a December 1988 letter from a private chiropractor, which indicates that the Veteran had "spinal pain related to a work-related injury in June of 1985," and that he has experienced spinal instability and discomfort for the past three years. During a May 1989 VA examination, the Veteran reported spinal problems since 1981. The Veteran stated that he sustained a neck injury in August 1981 and a spinal injury in June 1985, when he fell off the roof of a two-story house. The Board finds the statements made prior to the denial of the Veteran's service connection claim for a spine disability and those made for purposes of seeking treatment to be more credible and probative than subsequent statements made to VA for purposes of seeking compensation. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). In December 1988, the Veteran submitted a letter from a private chiropractor, Dr. Shaw, who indicated that he felt "there is a possibility [that Veteran's] right sterno-clavicular injury may relate to some of the spinal instability and discomfort he has experienced over the last three years, although most of that certainly relates to the 1985 work-related injury." During a November 1995 VA examination, the Veteran reported that his lower back pain began after he fell off of a house, and his neck pain began after he was rolled over by an earth compactor. He stated that he also experienced middle back pain when he felt pain in his neck and lower back. X-rays revealed minimal degenerative joint disease in the mid-thoracic and lumbar spine. In August 1996, the Veteran submitted another letter from Dr. Shaw, which indicates that the Veteran was diagnosed with a cervical sprain/strain and whiplash after the 1981 work injury in which he was pitched off an earth compactor, which subsequently rolled over him. It was noted that the Veteran also sustained a back injury in June 1985, when he fell off the roof of a house onto a pile of lumber. The chiropractor indicated that x-rays taken between 1988 and 1990 showed structural instabilities of the cervico-thoracic spine, notably a left scoliosis with the apex at T3 and right scoliosis with the apex at C5, which resulted in the head translated to the right of the center of the chest by about 20 millimeters. The chiropractor indicated that "[i]t is my opinion that the scoliosis and head translation structures discussed above are consistent with and probably caused by the wrestling injury to the right shoulder in 1968," and "these biomechanical imbalances caused other reactive imbalances and instabilities throughout the spinal column, which probably impeded the recovery of the subsequent injuries." During a September 1996 VA examination, the Veteran reported injuring his neck in a 1981 accident involving the earth compactor and injuring his back in June 1985 when he fell off a roof. The examiner opined that the Veteran's thoracic and lumbar spine problems were caused by his post-service work injuries and not caused by his service-connected sternoclavicular joint disability. The Board notes that the examiner indicated that x-rays obtained by VA in November 1985 showed minimal degenerative joint disease in the mid-thoracic and lumbar spine at L3-4 and a normal cervical spine. However, the x-rays included with that VA examination report were from the November 1995 VA examination, which showed findings identical to those quoted by the VA examiner. As the evidence of record does not show x-rays taken by VA in November 1985, it appears that the September 1996 VA examiner was referring to the November 1995 x-rays. During an August 1997 VA neurological examination, the Veteran reported that his neck problems began in 1981, his lumbosacral problems began in 1985, and his thoracic spine problems have been present since his discharge from service in 1969. He also reported symptoms of numbness in his right upper extremity from the right and little fingers up to the region just below the elbow. It was noted that service treatment records showed decreased pinprick testing in the right forearm region about six months after the Veteran's in-service sternoclavicular joint injury. The examiner indicated that the Veteran's symptoms were consistent with lower brachial plexus dysfunction and opined that it was related to the Veteran's in-service sternoclavicular injury. However, the examiner indicated that the Veteran's particular type of neuropathy and the nerve roots affected were not consistent with an injury to the lower back or thoracic spine. During a June 2003 VA examination, the Veteran reported dislocating his right sternoclavicular joint during service and injuring his back in December 2002, when he was hit by a motor vehicle, and again in February 2003, when he slipped on ice. The examiner agreed with the 1996 VA examiner's opinion that the Veteran's thoracic and lumbar spine problems were caused by his post-service work injuries and not caused by his service-connected sternoclavicular joint disability. During a July 2012 VA examination, the Veteran reported receiving treatment for back pain for many years and did not recall any specific injury or date of onset, but stated that he believed it may be related to his in-service sternoclavicular dislocation. The examiner reviewed the evidence of record and opined that it was less likely than not that the Veteran's spine problems were caused by his service-connected right sternoclavicular joint dislocation. In support of this, the examiner explained that the Veteran has had several injuries since 1981, which could have caused and worsened his back problems, including being thrown from an earth compactor, falling off a roof, being hit by a motor vehicle, and slipping on ice. The examiner concluded that it is more likely than not that the Veteran's back problems were caused by his post-service injuries. During a November 2018 VA examination, the Veteran reported developing cramp-like pain and a ball in his lower thoracic spine muscles about two to three months after his in-service wrestling injury. He stated that it lasted about four to five days before the area suddenly popped, and the pain was considerably relieved. The Veteran stated that he did not have any lower thoracic pain until after service. He also reported several post-service accidents affecting his back, including the accident with the earth compactor in 1981, falling off a roof twice in the mid-1980's, being hit by a car in 2003, and subsequently slipping on ice. The examiner opined that it was less likely than not that the Veteran's current thoracic and lumbar spine disabilities were aggravated by his service-connected status post right sterno-clavicular dislocation with right ulnar sensory neuropathy. In support of this, the examiner indicated that while the Veteran's sternoclavicular joint dislocation was a significant injury with the potential for serious consequences, a detailed review of the medical records and a discussion with the Veteran did not reveal any indications that the Veteran's spinal conditions were affected by his service-connected conditions. The examiner also acknowledged the opinion of the Veteran's private chiropractor, Dr. Shaw, who concluded that the spinal curvatures observed on his x-rays in the late 1980's were caused by the Veteran's right sternoclavicular dislocation and were preventing the post-service spine injuries from healing because the chiropractic alignments would not hold. However, the VA examiner indicated that she did not agree with the conclusion that the cervical and thoracic curvatures found on chiropractic x-rays in the late 1980's were caused by the Veteran's service-connected status post right sternoclavicular dislocation with right ulnar sensory neuropathy. In support of this, the examiner explained that the record shows no evidence of symptoms or findings related to cervical, thoracic, or lumbar spine sufficient to produce a permanent change in the spinal curvature, such as pain, spasm, or bony injuries, at the time of the in-service wrestling injury or during the year thereafter. The examiner further explained that it is highly unlikely that a sprain/strain injury would alter the spinal curvature without producing other detectable abnormalities. Moreover, the examiner noted that the degenerative change in the thoracic and lumbar spinal regions did not become symptomatic until traumatic incidents occurred more than 10 years after the in-service wrestling injury. The examiner explained that if there had been damage to the spinal column which, even though asymptomatic at the time, triggered a degenerative process, it would not be expected to have taken 10 years or more to develop symptoms. Finally, the examiner indicated that a review of medical literature revealed no information to support a relationship between acute or chronic conditions of the sternoclavicular joint or shoulder and aggravation or acceleration of spinal conditions. In June 2019, the Veteran submitted an opinion from a private physician who opined that "it is at least as likely as not that the Veteran's thoracic and lumbosacral spine pain and difficulty are service connected." In support of this, the physician reasoned that the Veteran "sustained a fall and traumatized his back by a collision with an iron bar," and "[h]e suffered from prolonged mid and lower back pain related to this injury," and was subsequently diagnosed with degenerative joint disease of the lumbosacral and thoracic spines. The Veteran underwent another VA examination in February 2020, during which he reported developing lower back pain after the in-service wrestling injury. The Veteran was diagnosed with degenerative disc disease of the thoracic and lumbar spine, and the examiner opined that it was less likely than not incurred in or caused by service. In support of this, the examiner explained that although the Veteran was seen in 1967 and 1968 for complaints of back pain, there is no evidence of an ongoing back condition for the next 12 years (between separation and the work related injury in 1981). The examiner indicated that the record did not reflect any traumatic degenerative changes or fractures during service and noted that the Veteran had no back complaints during his February 1970 VA examination, and x-rays were normal. With respect to direct service connection, the Board had reviewed and considered the June 2019 private opinion and the February 2020 VA examiner's opinion. The Board assigns little probative value to the June 2019 private opinion, as it is based on the assertion that the Veteran suffered from prolonged mid and lower back pain ever since the October 1967 back injury. However, as found above, the Veteran's assertion of continued back pain since service lacks credibility. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that "[a]n opinion based on an inaccurate factual premise has no probative value"). Additionally, the June 2019 private opinion indicates that the Veteran was subsequently diagnosed with degenerative joint disease after the October 1967 back injury; however, it does not mention the fact that the diagnosis was many years after service and after two post-service injuries to the spine. See id. Conversely, the Board finds the February 2020 opinion of the VA examiner to be significantly more probative and persuasive, as it is supported with a reasoned medical explanation that is consistent with the credible evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). With respect to secondary service connection, the Board assigns no probative value to the December 1988 opinion from Dr. Shaw, as it is speculative in nature, utilizing language that "there is a possibility" that some of the Veteran's spinal instability and discomfort is related to his right sternoclavicular joint injury. See Polovick v. Shinseki, 23 Vet. App. 48, 54 (2009) (holding that a doctor's statement that a veteran's brain tumor "may well be" connected to Agent Orange exposure was speculative); Bloom v. West, 12 Vet. App. 185, 187 (1999) (noting that the use of the term "could," without other rationale or supporting data, is speculative). The Board also assigns little probative value to the August 1996 opinion from Dr. Shaw because it does not contain a rationale to support the conclusion that the that the scoliosis and head translation structures found on x-rays in the late 1980's were caused by the 1968 wrestling injury, which was the basis for the opinion that the in-service sternoclavicular injury impeded the Veteran's recovery from his post-service back injuries. See Stefl, 21 Vet. App. at 124. Conversely, the Board finds the opinions of the July 2012 and November 2018 VA examiners to be significantly more probative and persuasive because as they are supported by reasoned medical explanations that are consistent with the credible evidence of record. Moreover, the November 2018 VA examiner provided a detailed rationale explaining why it is unlikely that the 1968 sternoclavicular injury would cause scoliosis and head translation structures. See id. In sum, the most probative evidence shows that a current thoracic or lumbar spine disability was not incurred in or caused by service or a service-connected disability. In reaching this decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for a psychiatric disorder The Veteran asserts that a current psychiatric disorder was caused by stressful incidents that occurred during service or alternatively, was caused or aggravated by his status post right sternoclavicular dislocation with right ulnar sensory neuropathy and/or his disabilities of the spine. Specifically, the Veteran asserts that while he was recovering from his in-service sternoclavicular joint injury, he worked in a Naval hospital where he saw severely injured soldiers who recently returned from Vietnam and heard their stories of combat. VA treatment records also show that the Veteran reported having PTSD from his own combat service in Vietnam. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that a current psychiatric disorder was incurred in or caused by service or caused or aggravated by a service-connected disability. The record shows that the Veteran was assigned to the staff of the U.S. Naval Hospital in Oakland, California for a six-month temporary duty after his in-service sternoclavicular joint injury. However, the record does not show that the Veteran served in combat or in Vietnam. Indeed, personnel records show that the Veteran was stationed in the United States, and he did not have any foreign or sea service. Service treatment records shows no complaints of, treatment for, or diagnosis of a mental condition during service. A February 1970 VA examination report indicates that the Veteran exhibited no significant psychiatric or personality abnormalities about a year after his discharge from active duty. The earliest record of treatment for a psychiatric condition in the claims file is dated June 1991. At that time, the Veteran sought mental health treatment due to concerns about his drinking and suicidal ideation. He also stated that he had nerve trouble in service, but was never treated for it. The Veteran was noted to exhibit symptoms of bipolar disorder and paranoid delusional disorder. The assessment was rule out bipolar disorder, rule out paranoid disorder, alcohol dependence, and marijuana abuse. The Veteran stated that his only prior psychiatric treatment consisted of a three-day hospitalization in 1981 following an overdose due to getting into a fight with his wife. The Veteran later reported that the hospitalization for an overdose occurred in 1979. Subsequent VA treatment records from July and August 1991 show that the Veteran reported working as a CIA operative in Afghanistan, which the treatment provider opined most likely represented a fixed delusion. The impressions initially included bipolar disorder versus psychotic depression verses schizophrenia. In August 1991, it was noted that the Veteran did not fully meet the criteria for bipolar disorder and schizophrenia, and he most likely had delusional disorder, persecutory type. Subsequent VA treatment records show that the Veteran reported problems with anger and alcohol abuse in 1994, and he reported having a history of PTSD in 1995. In May 1997, the Veteran submitted a written statement from an acquaintance who has a master's degree in counseling and a PhD in pastoral counseling. The acquaintance indicated that the Veteran could not work due to his back injury, and she opined that the Veteran's mental problems were aggravated by his physical problems and inability to work. A January 2003 VA psychiatric treatment record shows that the Veteran reported serving in Vietnam, and he denied having bipolar disorder. A February 2003 VA psychiatric treatment record shows that the Veteran reported having PTSD; however, after an interview with the Veteran, the treatment provider indicated that it appeared unlikely that the Veteran was suffering from PTSD. In March 2003, the Veteran told a VA mental health treatment provider that he feigned symptoms of bipolar disorder during prior psychiatric interviews. It was noted that the Veteran was insistent that he had PTSD from exposure to severely injured Vietnam veterans while he resided in a hospital in Oakland, California. The treatment provider indicated that the Veteran's mood was generally stable, and his symptoms were not consistent with PTSD. In April 2003, it was noted that the Veteran had a past history of depression, but his mood was euthymic at that time. The assessment was major depression, recurrent. In May 2003, it was noted that the Veteran became quite angry as he indicated that he wanted an evaluation for PTSD. In June 2003, the Veteran reported having depression, and he talked about traumatic experiences in Vietnam. However, the treatment provider noted that the Veteran did not seem to be distressed as he spoke. A July 2003 VA mental health treatment record shows that the Veteran reported having trauma from serving in combat as a medical corpsman in Vietnam from 1968 to 1969, but that it was not recorded. He also reported working for NSA and the CIA and stated that he believed they were continuing to monitor him. The treatment provider indicated that the Veteran exhibited delusional ideation consistent with that noted in 1991. The diagnoses included delusional disorder with persecutory traits and depression. In December 2003, the Veteran told a treatment provider that he was never directly involved in combat, but indicated that he was exposed to soldiers in a hospital who were badly burned and wounded in Vietnam. The treatment provider noted that although the Veteran described symptoms consistent with PTSD, the validity of his responses was uncertain due to his recent strong push to have his outpatient psychiatrist diagnose him with PTSD for disability purposes. A July 2004 VA mental health treatment record notes that the Veteran remained focused on attaining a diagnosis of PTSD and receiving compensation for it. The treatment provider indicated that the Veteran did not exhibit symptomatology that would meet the criteria for a diagnosis of PTSD. A March 2005 VA mental health treatment record likewise notes that from the outset, the Veteran was most concerned with obtaining a diagnosis of PTSD so as to obtain a 100 percent service-connected disability rating. The Veteran underwent a VA mental health examination in February 2006, during which he reported exposure to badly injured soldiers who recently returned from Vietnam while he was recovering from a shoulder injury. It was noted that the Veteran also reported being followed by people who worked for NSA as a form of retaliation related to a mission in Cambodia. The examiner indicated that the Veteran's statements appeared to be consistent with ongoing delusions. The examiner indicated that the Veteran did not have a diagnosis of PTSD, but he did have delusions with paranoid features, which were not related to his military service. An April 2007 VA mental health treatment record shows that a treatment provider indicated that the Veteran did have some symptoms of PTSD, but that they appeared to be related to other factors he experienced in his life. A January 2011 VA mental health treatment record shows that the Veteran acknowledged lying to treatment providers about serving in Vietnam. His mood was euthymic, and the diagnosis was depressive disorder, by history. A March 2012 VA mental health treatment record shows that the reported that he was having increased back pain, which was making him depressed. However, the treatment provider noted that the Veteran did not report any acuity of depressive symptoms or any significant decrease in his baseline level of functioning. The Veteran underwent another VA mental health examination in July 2012, during which the examiner indicated that the Veteran appeared angry and bitter about the way he was treated by VA, but he was not clinically depressed due to his in-service wrestling injury. Depression screens performed in March 2014, March 2015, January 2016, May 2017, August 2018, and October 2019 were negative. In June 2019, the Veteran submitted an opinion from a private physician who reviewed the evidence of record and indicated that the Veteran "was stationed at a hospital where he assisted severely injured service members, many of whom expired," and "[s]oon thereafter, he was diagnosed with both depression and anxiety." The physician opined that "it is much more likely than not that the Veteran's depression and anxiety are service connected." In support of this, he explained that the Veteran's exposure to severely wounded patients caused him severe anxiety and other psychological trauma, and he suffered from nightmares, stress, and feelings of agitation and depression related to his work in the hospitals. The Veteran underwent another VA mental health examination in November 2018, during which he reported that his depressive symptoms began around the mid-1980's, when he realized he was unable to work due to his spinal problems. Additionally, the Veteran reported a history of a suicide attempt via overdose in 1979. He also reported having PTSD from childhood trauma and exposure to injured soldiers at the Naval hospital. The examiner noted that there was no evidence of depressive disorder at that time, and the Veteran appeared to have an agenda to obtain a diagnosis of PTSD, which was routinely documented in his treatment records. The VA examiner also indicated that there were many discrepancies in the facts reported by the Veteran, and he had a history of delusional thought content, noting that the Veteran reported working for NSA and being personally involved in the fall of the USSR. The examiner indicated that it appears that the Veteran's mental health symptoms first appeared around 1979, 10 years after his discharge from ative duty, and there is no indication that the Veteran's current symptoms are related to or caused by his military service. The examiner also opined that it was less likely than not that the depression diagnosed during the course of the Veteran's claim was caused or aggravated by his service-connected status post right sternoclavicular dislocation with right ulnar sensory neuropathy. In support of this, the examiner explained that the Veteran did not credibly report depressive symptoms during the VA examination. It was further noted that although the Veteran reported depressive symptoms in the past, and some providers have diagnosed a depressive condition, multiple treatment providers over multiple years documented that the Veteran has been dishonest about his emotional symptoms in an effort to obtain financial compensation. Moreover, the examiner cited to various treatment records noting that the Veteran did not present as depressed or reported depressive symptoms related to things other than his service-connected right sternoclavicular dislocation with right ulnar sensory neuropathy. To the extent that the Veteran claims to have had psychiatric symptoms since service and/or claims to have depression secondary to his status post right sternoclavicular dislocation with right ulnar sensory neuropathy, the Board finds that the Veteran's assertions lack credibility. As noted above, the Veteran reported during the November 2018 VA examination that his depressive symptoms began around the mid-1980's, after his back injuries. See Caluza, 7 Vet. App. at 511 (finding that in weighing credibility, VA may consider inconsistent statements, internal inconsistency, and consistency with other evidence of record). Additionally, he has reported serving in combat in Vietnam on multiple occasions, which he later acknowledged was not true, and treatment providers have indicated that the Veteran has repeatedly attempted to obtain a diagnosis of PTSD for purposes of receiving disability compensation. See id.; see also Cartright, 2 Vet. App. at 25 (VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence). Moreover, mental health treatment records note that the Veteran has stated that he was depressed at times when he did not appear to endorse symptoms of depression, and he has reported feigning psychiatric symptoms at times. Given this and the Veteran's documented history of delusional thought content, the Bord finds that the Veteran's assertions regarding the nature and onset of his claimed mental health symptoms are not credible. Additionally, although the Veteran's treatment records note a diagnosis of PTSD at times, those diagnoses appear to be based on the Veteran's report of having PTSD. See LaShore v. Brown, 8 Vet. App. 406 (1995) (holding that a lay history is not transformed into competent evidence merely because it was transcribed by a medical professional). The medical evidence of record does not show a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a) based on a credible in-service stressor. See 38 C.F.R. § 3.304(f). The Board has reviewed and considered the May 1997 opinion of the Veteran's acquaintance which indicates that the Veteran's mental problems are aggravated by his physical problems and inability to work. However, even assuming that the acquaintance has the requisite education and training to offer medical opinions, the Board assigns no probative value to this opinion, as the only physical disability mentioned in the opinion is the Veteran's back injury, which is not service-connected. The Board likewise assigns little probative value to the June 2019 opinion of the private physician, as it indicates that the Veteran was diagnosed with anxiety and depression shortly after his in-service exposure to wounded soldiers, which is not consistent with the evidence of record. See Reonal, 5 Vet. App. at 461. As noted above, the earliest evidence of record showing a diagnosis of a psychiatric disorder is dated June 1991, over 22 years after the Veteran's discharge from active duty. The earliest the Veteran reported receiving psychiatric treatment is around 1979 or 1981, which is at least 10 years after the Veteran's discharge from active duty. Furthermore, the Veteran reported during the November 2018 VA examination that his depressive symptoms began around the mid-1980's, when he realized he was unable to work due to his spinal problems. See id. Conversely, the Board finds the opinion of the November 2018 VA examiner to be significantly more probative and persuasive, as it is based on a clinical evaluation of the Veteran and is supported by a reasoned medical explanation that is consistent with the Veteran's mental health treatment records. See Nieves-Rodriguez, 22 Vet. App. at 302-04. In sum, the most probative evidence shows that a current psychiatric disorder was not incurred in or caused by service or caused or aggravated by a service-connected disability. In reaching this decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. See Gilbert, 1 Vet. App. at 56. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Banister, 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.