Citation Nr: 21031613 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 15-25 823 DATE: May 24, 2021 ORDER Service connection for a bilateral knee condition is denied. Service connection for a bilateral shoulder condition is denied. Service connection for a back condition is denied. Service connection for a bladder condition, to include as a result of exposure to herbicide agents, is denied. Service connection for an acquired psychiatric condition, to include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), is denied. FINDINGS OF FACT 1. The Veteran's bilateral knee, bilateral shoulder, and low back conditions, were not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disabilities have not otherwise been etiologically linked to an in-service injury or disease. 2. It is not shown that the Veteran served in the Republic of Vietnam or in/near the Republic of Korea DMZ, and the evidence fails to show actual exposure to an herbicide agent (to include Agent Orange) during his military service. 3. Bladder cancer was not present during the Veteran's active service or manifest to a compensable degree within one year of service separation, and the record contains no competent evidence that the Veteran's post-service bladder cancer is causally related to his active service or any incident therein. 4. The weight of the evidence is against a finding that the Veteran has, or has had at any time during the appeal, a diagnosis of PTSD. 5. The weight of the evidence is against finding that major depressive disorder (MDD) began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral knee condition, a bilateral shoulder condition, and a low back condition have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for bladder cancer have not been met. 38 U.S.C. §§ 1131, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, and major depressive disorders have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1979 to November 1989. This matter is on appeal from a February 2012 rating decision. Of note, the Veteran's previous representative withdrew representation in August 2015. The Veteran was notified of the withdrawal, but has not submitted any documentation appointing another representative. The Veteran initially filed a claim to establish service connection for PTSD. The United States Court of Appeals for Veterans Claims (Court), however, has held that the scope of a claim includes any disability that may reasonably be encompassed by the Veteran's description of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). In light of this determination and the evidence of record, the Board has expanded the Veteran's claim to include all acquired psychiatric disabilities, and the issue has been re-characterized as stated on the title page. In November 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. The transcript of the hearing is associated with the claims file. This claim was previously before the Board in June 2019, at which time it was remanded for further development, to include obtaining outstanding private/VA treatment records, service treatment/personnel records, and VA examinations. The Veteran implied at the Board hearing that he had sought private treatment for his bilateral knee, bilateral shoulder, and back conditions from December 1989 to 2001, (which is after his December 1988 in-service motor vehicle accident, discussed in detail below and prior to treatment at a VA facility). As such, upon remand, the Veteran was asked by the RO to complete a VA Form 21-4142 and provide a list of private treating physicians/facilities with his authorization to obtain the records. While, the Veteran completed the VA form with VAMC treatment providers for the requested period, to date, he has not submitted any names of private physicians or facilities that he sought treatment during the requested time period post service from December 1989 to 2001. In addition, the record includes a fact-finding dated December 2019 reflecting that treatment records covering the period from December 1989 to 2001 are not available. However, the Veteran was not in active military service during that period and he testified that he did not seek medical attention at a VA facility during that period. Further, of record are VA fact finding documents dated in February 2012, and November 2019, which reflect that complete service treatment/personnel records cannot be located and therefore presumed to be unavailable. However, pertinent service treatment records with entry and a routine examination five months prior to separation from service are of record. With respect to the Veteran's missing service/personnel records, the Board observes that when records are unavailable, "VA has no duty to seek to obtain that which does not exist." Counts v. Brown, 6 Vet. App. 473, 477 (1994). The Board finds that the RO has attempted to develop the record as much as possible, and any further efforts to obtain the Veteran's service treatment and personnel records would be futile. The Board has kept this unfortunate situation in mind while addressing the Veteran's claim, and it is mindful that it has a heightened obligation both to explain its findings and conclusions and to carefully consider the benefit of the doubt doctrine. See O'Hare v. Derwinski, 1 Vet. App. 365 (1991). As such, the Board finds that VA has fulfilled its duty to assist the Veteran in obtaining the records discussed above, to include private treatment records. Moreover, the Veteran, has not alleged prejudice with regard to notice. The Board finds that nothing more is required and adjudication of the claims at this time is warranted. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for chronic disabilities, including arthritis, if such is shown to have been manifested to a compensable degree within one year after the Veteran was separated from service. 38 U.S.C. §§ 1131, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. As an alternative to the nexus requirement, service connection for this chronic disability may be established through a showing of continuity of symptomatology since service. 38 C.F.R. § 3.303 (b). The option of establishing service connection through a demonstration of continuity of symptomatology rather than through a finding of nexus is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, a Veteran who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, or in certain areas near the Demilitarized Zone (DMZ) in the Republic of Korea from September 1, 1967 to August 31, 1971 is presumed to have been exposed to certain designated herbicide agents (e.g., Agent Orange) during such service, absent affirmative evidence to the contrary. 38 U.S.C. §§ 1116(f), 1116B; 38 C.F.R. § 3.307(a)(6)(iii). In the case of such a Veteran, service connection based on herbicide agent exposure will be presumed for certain specified diseases including cancer of the bladder, that become manifest to a compensable degree. 38 U.S.C. § 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Of note, cancer of the bladder was recently added to the list of diseases subject to presumptive service connection, via the National Defense Authorization Act for Fiscal Year 2021, effective January 1, 2021. 1. Service connection for a bilateral knee condition, bilateral shoulder condition, and back condition are denied. The Veteran asserts that his current bilateral knee, bilateral shoulder (mostly left), and back disorder were caused by his active duty service, testifying that they were the result of an in-service car accident (MVA) in December 1988. During the Board hearing, he stated that he was transported by ambulance from the scene of the MVA to a VA Hospital where he was treated/released the same day and subsequently treated at another VA Hospital with physical therapy for both legs. The Veteran maintained that he didn't know he was eligible to go to a VA hospital after his 1989 separation from service until 2001. He asserted that for close to eleven years he had endured pain while seeing civilian doctors. The Veteran testified that prior to 2001 he was treated by "small" and private practice doctors. However, as noted above, the Veteran has not submitted, as requested by the RO, a list of these private treating doctors who allegedly treated him between December 1989 to 2001, which is necessary for VA to attempt to assist him with obtaining the referenced records. In addition, the Veteran testified that he was on the fast track with several promotions before the December 1988 MVA and that after the car accident he just couldn't serve anymore. However, of record in the Veteran's available military file is a personal note dated in March 1989 from the Veteran's commander congratulating him on his promotion to Sergeant First Class. In addition, he reported to the January 2020 mental health contract examiner that he was a stellar recruiter until he finished his career. As discussed in detail below, the Veteran has a current diagnosis for a bilateral knee condition, a bilateral shoulder condition, and a back condition, to include arthritis diagnoses. (See January 2020 contract examinations for leg/knee, shoulder, and lumbar back respectively). Thus, the first criteria for service-connection is met for these claimed conditions. Regarding the second element of direct service connection, the Veteran's service treatment records (STRs) include one-page emergency care and treatment record from a hospital in San Diego dated in December 1988, showing the Veteran was in a motor vehicle accident (MVA) during his period of service and treated for complaint of spinal pain and right knee pain. The Veteran was diagnosed with spinal/muscular strain status post MVA. The one-page emergency treatment document also reflects that the right patella was found otherwise unremarkable, complain of spinal pain from center of back and no complaint of cervical spine noted. The Veteran was treated and released, and light duty was recommended for three days. The Veteran was advised to follow up with a VA Medical Clinic if not resolving. The Veteran testified that both knees, shoulders and his back were injured during his MVA. Notwithstanding the absence of any clinical findings referable to either the left knee and the Veteran's bilateral shoulders in his STRs, and resolving all reasonable doubt, the Board finds that the Veteran's testimony regarding his MVA during active duty service to be consistent with the time, place, and circumstances of his service. See 38 U.S.C. § 1154 (a), and see O'Hare v. Derwinski, 1 Vet. App. 365 (1991). Thus, the Board finds that Shedden element number two (2), evidence of in-service injury, have been met for his bilateral knees, shoulders, and low back service connection claims. Regarding Shedden element number three (3), nexus to military service, there are competent negative nexus opinions against the claims for service connection for bilateral knees, shoulders, and low back conditions, on a direct basis of service connection. Of record is part of a May 1989 report of routine medical examination report (RME) (conducted about five months after the Veteran's December 1988 MVA and six months prior to his December 1989 separation from service). The May 1989 RME showed a "normal" clinical evaluation of the Veteran's spine and other musculoskeletal, lower, and upper extremities. The Veteran declined a military separation examination. VA post-service treatment records of evidence are dated from 2004 to 2021. The records show complaints of pain for knee, shoulder and back conditions beginning more than fifteen (15) years after the Veteran's separation from service. The evidence of record shows that the Veteran has been in receipt of age-related Social Security retirement benefits since 2009. Moreover, the evidence of record reflects that during the Veteran's January 2020 PTSD examination, he again reported that he was involved in a MVA while in service. However, on this occasion, he explained that he was stationed in Germany and driving 120 miles an hour, missed a deer, and hit a barrier. The Veteran reported that despite totaling his car, he was not injured, "did not suffer any bruises," and managed to call the military command to let them know what happened. The Veteran asserted to the PTSD examiner that he was not hurt during the MVA and returned to duty that same day. (See January 2020 VA mental health contract examination). Regarding service connection for bilateral knees, the January 2020 VA contract examiner diagnosed him with bilateral patellofemoral pain syndrome (diagnosed in 2010), bilateral arthritis, degenerative (diagnosed in January 2020) bilateral total knee replacements (right knee diagnosed in 2013 and left knee in 2011), and right knee meniscal tear (diagnosed in 2008). Initially, the Veteran does not meet the criteria for presumptive service connection because the record does not show that he was diagnosed with arthritis of the right or left knee during service or within a year following separation, that is, by November 1990. Based on the available record, it appears that the Veteran's bilateral arthritis of the knees was not diagnosed, yet alone manifested to a compensable degree (10 percent), until a November 2007 VA x-ray showed the presence of minimal degenerative change and narrowing of the medial compartments in the bilateral knees. Regarding service connection for bilateral knees on a direct basis, the January 2020 examiner provided a contradicting medical opinion, in which a positive nexus statement box was checked, but the rationale concluded that "a nexus is not established". Thus, the Board finds that the January 2020 medical opinion is not adequate for rating purposes. Subsequently, a June 2020 medical opinion was obtained. The June 2020 VA examiner reported that she reviewed all medical evidence including the conflicting medical evidence. The medical professional opined that it was less likely than not that the Veteran's current bilateral knee condition was either incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran's complaint of leg pain documented on active duty in 1988 from a MVA was more likely an acute event without long term sequela, since there is no sign of continuation of symptoms during service and/or after separation from active service. A 2007 VA treatment record reflects the Veteran's first report of knee condition after MVA. Further, a November 2007 VA orthopedic treatment note reflects that the Veteran reported that his right knee pain began six weeks prior without any acute event. He stated that he had recently started walking for weight loss and had walked 2 miles and the following day had increased swelling. A VA treatment note shows that the Veteran's right knee meniscal tear was diagnosed and treated in 2008 after he heard a pop in his right knee. A VA 21-527EZ pension application is of record and submitted by the Veteran, in which the Veteran asserted that his leg disabilities began in January 2004. Regarding the Veteran's bilateral shoulder claim, the January 2020 VA contract examiner diagnosed him with degenerative arthritis of the left shoulder (diagnosed in January 2020), and shoulder strain (diagnosed in January 2020). Initially, the Veteran does not meet the criteria for presumptive service connection because the record does not show that he was diagnosed with arthritis degenerative of the left shoulder during service or within a year following separation, that is, by November 1990. Based on the available record, it appears that the Veteran's degenerative arthritis of the left shoulder was not diagnosed, yet alone manifested to a compensable degree (10 percent), until many years after his separation of service. Regarding service connection for bilateral shoulders on a direct basis, the January 2020 examiner provided a contradicting medical opinion, in which a positive nexus statement box was checked, but the rationale concluded that "a nexus is not established". Thus, the Board finds that the January 2020 medical opinion is not adequate for rating purposes. Subsequently, a June 2020 medical opinion was obtained. The June 2020 examiner reported that she reviewed all the medical evidence, to include conflicting medical evidence. The medical professional opined that it was less likely than not that the Veteran's current bilateral shoulder condition was either incurred in or caused by the claimed in-service injury, event, or illness. The medical professional explained that there were no complaints of shoulders pain documented on active duty in 1988 from an MVA , furthermore there is no sign of continuation of symptoms during service and/or after separation from active service. Further, there were no complaints of pain in the cervical spine area in the available service treatment records, to include the MVA emergency treatment report. The post VA treatment record reflects 2015 bilateral shoulder pain and March 2019 VA treatment record reflects left shoulder pain diagnosis. Regarding the Veteran's lower back claim, the January 2020 VA contract examiner diagnosed him with degenerative arthritis of the spine (diagnosed in 2020), and bilateral lower extremity radiculopathy (diagnosed in January 2020). Initially, the Veteran does not meet the criteria for presumptive service connection because the record does not show that he was diagnosed with back arthritis during service or within a year following separation, that is, by November 1990. Based on the available record, it appears that the Veteran's back arthritis was not diagnosed yet alone manifested to a compensable degree (10 percent), until many years after his separation from service. Regarding the Veteran's lower back claim on a direct basis, the January 2020 examiner provided a contradicting medical opinion, in which a positive nexus statement box was checked, but the rationale concluded that "a nexus is not established". Thus, the Board finds that the January 2020 medical opinion is not adequate for rating purposes. Subsequently, a June 2020 medical opinion was obtained. The June 2020 examiner reported that she reviewed all the medical evidence, to include conflicting medical evidence. The medical professional opined that the Veteran's lumbar spine condition is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The following rationale was given: the complaint of spinal pain documented on active duty in 1988 from an MVA is more likely an acute event without longterm sequela, since there is no sign of continuation of symptoms during service and/or after separation from active service. Thus, concluding it is less likely as not that the current lower back diagnosis is incurred in or caused by the complaint and treatment for spinal condition while in military. In adjudicating the Veteran's claims for service connection of the knees, shoulders and back, the Board must assess not only competency of the Veteran's statements, but also their credibility. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Here, the Veteran has not credibly shown that his present bilateral knees, bilateral shoulders, and low back pain has continued since service for the following reasons: This statement is inconsistent with his statement to the 2020 PTSD examiner, in which he reported that he was not injured from the MVA and returned to duty the same day, which suggested that there are no additional MVA service treatment records (other than the one page emergency treatment) for VA to obtain. In addition, the Veteran has not provided the names of any private treating doctors after service from 1989 to 2004, when the records reflect he first sought treatment at a VAMC. Thus, his assertions in this regard have little probative value. To the extent that the Veteran is asserting continuity of symptomatology from service, it was specifically found in a May 1989 report of medical examination report (RME) after his MVA and about six months before separation from service that he did not have any continuing symptomatology of pain for any of his claimed conditions. Moreover, the 1989 RME showed a "normal" clinical evaluation of the Veteran's spine and other musculoskeletal, lower, and upper extremities. The record reflects that Veteran subsequently refused the opportunity to indicate the presence of any medical conditions at separation, by refusing a final examination. Another factor the Board has considered, although not wholly dispositive on its face, is that the Veteran's claims file is absent any treatment for bilateral knee problems, shoulder and low back problems for many years following service. With respect to the Veteran's claimed missing STR records, the Board observes that when records are unavailable, "VA has no duty to seek to obtain that which does not exist." Counts v. Brown, 6 Vet. App. 473, 477 (1994). When combined with the above inconsistencies in the service record, his statements offer limited evidentiary value in establishing continuity of symptomatology. Moreover, the above medical opinions from the June 2020 VA medical professional support the conclusion that the Veteran's bilateral knee, bilateral shoulder, and low back conditions are not due to military service. The medical professional provided highly probative evidence that outweighs the Veteran's inconsistent lay statements. To the extent that the Veteran attempts to relate his bilateral knee, bilateral shoulder, and low back conditions to his MVA in service in 1988, based on his own personal knowledge of medicine and his familiarity with his individual medical history, the Board notes that he is not a trained medical clinician. The records show that he has never received any formal medical training. Although lay persons may be competent to provide opinions as to some medical issues (Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), as the specific question in this case regarding the etiology of the Veteran's bilateral knee, bilateral shoulder, and low back conditions fall outside the realm of common knowledge of a lay person, he lacks the competence to provide a probative medical opinion linking his bilateral knee, bilateral shoulder, and/or low back conditions to military service. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). As discussed, the criteria for service connection for bilateral knee, bilateral shoulder, and low back conditions, have not been met, and the Veteran's claims are denied. 2. Service connection for bladder condition, to include as a result of exposure to herbicide agents is denied. The Veteran is seeking service connection for a bladder condition. Specifically, he testified that he has recurring bladder cancer that was first diagnosed in 2003 that he believes is due to exposure to toxins (herbicide agents) while stationed in Korea. The Board remanded the Veteran's claim for a VA medical opinion and additional information. VA treatment record shows that the Veteran has a history of bladder cancer and has VA follow ups to check for reoccurrence. VA treatment records show his most recent checkup in 2019. Personnel records show that the Veteran served in Korea from September 1979 to September 1982. His DD-214 reflects that his military occupation was administrative specialist and recruiter. The Board notes that there is a presumption of exposure to herbicide agents for Veterans who served in Vietnam during the Vietnam Era and for certain Veterans who served in Korea between April 1, 1968, and August 31, 1971 in areas where herbicides were known to have been applied. See 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii), (iv). The Veteran did not assert that he served in Vietnam, and there is no evidence that the Veteran served in Vietnam or during the Vietnam era. The Veteran served in Korea from 1979 to 1982, which is at least nine years after the period when the presumption of herbicide agents could be applied. Moreover, upon remand, the RO requested the Veteran provide additional details regarding his claim of exposure to herbicide agents while stationed in Korea. However, on contact with the Veteran via phone in February 2021, he subsequently recanted his Board testimony and stated that he was not exposed to herbicide agents during service. (See report of general information dated in February 2021). Therefore, as the Veteran denies exposure and he did not serve in Korea between April 1, 1968, and August 31, 1971 in areas where herbicides were known to have been applied. service connection for bladder cancer on the basis that it is secondary to herbicide agent/dioxin poison exposure is not warranted. In addition, bladder cancer is a chronic disease listed under 38 C.F.R. § 3.309(a); therefore, the presumptive service connection provisions of 38 C.F.R. § 3.309(b) based on "chronic" symptoms in service and "continuous" symptoms since service are applicable to the claims for service connection for bladder cancer. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). With a chronic disease shown 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. For the showing of a 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. 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). The Veteran's available service treatment records are silent for complaints of, treatment for, or diagnosis of a bladder condition. While the Veteran declined a military separation examination, a routine clinical evaluation of the genitourinary system in May 1989, and six months before his separation was normal. There has been no evidence submitted to show a bladder condition was incurred during the Veteran's active military service. Upon Board remand, the Veteran was afforded a VA examination. The January 2020 VA contract examiner diagnosed the Veteran with bladder cancer (2003 onset) with urinary frequency and urinary incontinence and residuals, status post multiple transurethral bladder tumor resections. Upon examination and review of the claims file, the examiner opined that it is less likely as not that the Veteran's bladder condition was incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the claims file lacks objective evidence of chemical exposure resulting in bladder cancer or treatment during service. The examiner reported that there is no record of complaints, treatment of, or diagnosis for any bladder condition during dates of active duty and a nexus is not established. The examiner concluded that there was not a link between the Veteran's medical condition and military service. Accordingly, service connection cannot be granted on a direct basis. As the medical evidence of record fails to show that the Veteran's bladder condition became compensable within one year of his discharge from active service, service connection on a presumptive basis must be denied as well. (38 C.F.R. §§ 38 C.F.R. § 3.307). In conclusion, the Board has considered the myriad of avenues through which the Veteran could establish service connection for his bladder cancer. As discussed above, there is no evidence which warrants a finding that he was exposed to herbicide agents during service. Furthermore, the Veteran has not alleged any other service injuries or events to account for his bladder cancer. There is no lay or medical evidence of this condition until decades after the Veteran's separation from service. Finally, the record does not contain any medical evidence that supports the claim. Thus, the Board concludes that the weight of the evidence is against the claim and service connection for bladder cancer is not warranted. 3. Service connection for an acquired psychiatric condition, to include PTSD and major depressive disorder is denied. The Veteran is seeking service connection for an acquired psychiatric condition, to include PTSD and MDD. He testified that he experienced in-service psychiatric symptoms, but was too ashamed to report them. He reports currently experiencing depression, suicidal ideations, argumentative behavior with others and an in-service stressor event (namely the documented motor vehicle accident). As such, a VA examination and medical opinion was obtained upon Board remand in January 2020. Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); (2) credible supporting evidence that the in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304 (f); Cohen v. Brown, 10 Vet. App. 128 (1997). Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the updated Diagnostic and Statistical Manual (Fifth Edition), the DSM-5. See 79 Fed. Reg. 45,094 (August 4, 2014). VA adopted this interim rule without change and clarified that the provisions of this rule did not apply to claims that have been certified for appeal to the Board or were pending before the Board on or before August 4, 2014. 80 Fed. Reg. 14,308 (March 19, 2015). In this case, the RO certified the Veteran's appeal with respect to his claim for service connection for an acquired psychiatric disorder, to include PTSD to the Board in December 2015, which is after August 4, 2014. Thus, the DSM-5 is applicable to the claim. First, the Board will address the first element of service connection, present diagnosis. Regarding a diagnosis of PTSD, the Board has thoroughly reviewed the evidence of record and finds that the weight of the evidence is against a finding that the Veteran has PTSD. The treatment records indicate that the Veteran has not been diagnosed with PTSD. See generally VA treatment records. In addition, the Veteran has not submitted or suggested that there are private treatment records supporting that he has been diagnosed with PTSD. Furthermore, in January 2020, a VA contract psychologist concluded, after a mental status evaluation of the Veteran, that he did not meet the criteria for a diagnosis of PTSD under DSM-5. Moreover, upon examination, the Veteran denied any mental health care while on active duty and since getting out of the military. He also denied taking any medications and having any suicide attempts or hospitalizations. (See January 2020 VA contract examination). The VA psychologist's rationale noted that when asked about traumas that bother him, the Veteran admitted that the loss of his mother and the fact that his daughter has no contact with him as things that bother him. The psychologist noted that the Veteran's loss of his mother happened pre-military and his daughter not talking to him is post military. The VA psychologist concluded that these examples do not meet criterion for PTSD (See January 2020 VA opinion). Regarding the Veteran's previous claim that his inservice stressor was due to his MVA during military service, the January 2020 examiner noted that the Veteran reported that he was not injured from the MVA and went back to duty on the same day. It is also noted that the MVA the Veteran described at his Board hearing was completely different from the MVA he described to the psychologist. The Board finds the January 2020 VA psychologist's opinion to be of high probative value in evaluating the claim. The January 2020 VA psychologist based his opinion on examination, thorough review of the record and explained how the Veteran's claimed condition did not result in support of the criteria required for a PTSD diagnosis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The VA psychologist's opinion supports a finding that the Veteran does not have PTSD. Thus, his PTSD claim cannot meet the first element for service connection. While the VA psychologist reviewed the notations of PTSD and clearly opined that it was less likely than not that the Veteran had a diagnosis of PTSD, the psychologist diagnosed the Veteran with major depressive disorder MDD, which he also determined was not likely due to his military service. Specifically, the January 2020 VA psychologist noted that the Veteran stated he has been depressed most of his life, and the psychologist found that it was less than likely than not that his time in the military made it worse. While the Veteran did report being involved in a motor vehicle accident while in service, he denied any long-term mental health problems from this event and he said he was a stellar recruiter until he finished his career. The VA psychologist further commented that the Veteran endorsed feeling sad at times because of the "state I am in" (i.e. health condition/finances), poor sleep (about five hours - is up and down all night to use the restroom), problems with concentration, feeling worthless, lack of energy, and passive suicidal ideation (on average once a week) problems with concentration, feeling worthless, lack of energy, and passive suicidal ideation. The Veteran denied any immediate plans to harm himself or others because he would not want to harm his wife. (See January 2020 VA contract examination). The VA psychologist concluded that the Veteran's current depression seems more focused on his financial and medical conditions (i.e. hypothyroidism and Myasthenia Gravis), which are not service connected at this time. Regarding the Veteran's diagnoses of MDD, the Board will deny service connection for this disorder because the weight of the evidence of record is against a finding that it is related to military service. For example, the Veteran admitted he feels depressed now because of his multiple health conditions which impact both his physical life/mental life and he stated that he gets depressed because his wife has to shoulder a lot of financial responsibility in the family. The Veteran said he gets anxious when there are bills. (See January 2020 VA contract examination). The January 2020 VA psychologist's opinion is against a finding that the Veteran's diagnosis of MDD is related to military service based on examination, a knowledge of the Veteran's medical history, well-reasoned and against the claim. Last, in making these findings, the Board is cognizant of the Veteran's lay statements that purport to either provide a diagnosis or link a psychiatric diagnosis to service. In this regard, the Board finds that his lay statements are not competent as to a nexus or diagnosis. Whether a layperson is competent to provide a medical opinion depends on the facts of the particular case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay witnesses are competent to report that which they have observed with their own senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In this case, the diagnosis of a psychiatric disorder under particular psychiatric diagnostic criteria and ascertaining any psychiatric disorder's etiology is distinguishable from ringing in the ears, a broken leg, or varicose veins, as these complex psychiatric determinations are not capable of lay observation. See Jandreau, 492 F.3d at 1377. As such, the Veteran's lay statements pertaining to these issues are not competent lay evidence. Regardless, the Veteran's assertions are outweighed by the medical evidence of record, which is more probative as it is based upon medical expertise. Accordingly, the claim is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Franklin, Associate 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.