Citation Nr: 21040415 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 17-62 612 DATE: July 3, 2021 ORDER As new and material evidence has been received, the petition to reopen the claim for service connection for an acquired psychiatric disorder, including depression, is granted. Entitlement to service connection for respiratory disability, to include asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD), is denied. Entitlement to service connection for cardiac disability, including congestive heart failure, to include as secondary to respiratory disability, is denied. Entitlement to service connection for an acquired psychiatric disorder, including depression, to include as secondary to respiratory disability, is denied. FINDINGS OF FACT 1. In an unappealed February 1968 rating decision, the RO denied service connection for nervous condition. 2. Evidence received since the February 1968 denial relates to an unestablished fact necessary to substantiate the claim and raises a reasonable possibility of substantiating the claim now characterized as entitlement to service connection for an acquired psychiatric disorder, including depression. 3. Asthma pre-existed service and is not shown to have been aggravated by service and the appellant's current asthma is not shown to be otherwise related to service. 4. Respiratory disability other than asthma, including emphysema, chronic bronchitis, and chronic obstructive pulmonary disease (COPD), were not shown in service or for many years thereafter and are not shown to related to service. 5. Congestive heart failure was not shown in service or for many years thereafter and is not shown to be related to service. 6. During service, the appellant was shown to have an emotional instability, a personality disorder, which pre-existed service and was not aggravated during service; an acquired psychiatric disability, including depression was not shown in service and any current acquired psychiatric disability, including depression, is not shown to be related to service. CONCLUSIONS OF LAW 1. The February 1968 rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. 2. The criteria for reopening the claim for service connection for an acquired psychiatric disorder, to include depression, have been met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.156(a), 20.1103. 3. The criteria for entitlement to service connection for respiratory disability, to include asthma, chronic bronchitis, emphysema, and COPD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for cardiac disability, including congestive heart failure, to include as secondary to respiratory disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include depression, including as secondary to respiratory disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant served on active duty for training from June 29, 1967 to July 25, 1967. This matter is on appeal before the Board of Veterans Appeals (Board) from a September 2016 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2020, a Board hearing was held before the undersigned; a transcript of the hearing is of record. Petition to Reopen In a February 1968 rating decision, the RO denied service connection for "nervous condition." The basis for this denial was that the service treatment records showed that the claimed nervous condition constituted a constitutional or developmental abnormality (i.e. a personality disorder), which was not subject to service-connected compensation. The appellant did not submit a valid notice of disagreement with this decision. Moreover, no new and material evidence was received by the VA within one year of the decision. As such, the rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.1103; see also Bond v. Shinseki, 659 F.3d 1362, 13676 (Fed. Cir. 2011). In order to reopen a claim which has been denied by a final decision, the claimant must present new and material evidence. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to VA. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992) (in determining whether evidence is new and material, the "credibility" of newly presented evidence is to be presumed unless the evidence is inherently incredible or beyond the competence of the witness). The language of 38 C.F.R. § 3.156(a) creates a low threshold for finding new and material evidence and views the phrase "raises a reasonable possibility of substantiating the claim" as "enabling rather than precluding reopening." Evidence "raises a reasonable possibility of substantiating the claim," if it would trigger VA's duty to provide an examination in adjudicating a non-final claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). In June 2016, the appellant filed a claim to reopen the previously denied claim for service connection for nervous condition, which is now characterized as a claim for an acquired psychiatric disorder, including depression. Since the February 1968 rating decision, evidence added to the record includes the appellant's October 2020 Board hearing testimony where he asserted that he was currently under treatment for depression and that he had been depressed since service. This evidence is new because it was not of record at the time of the final February 1968 rating decision. It also tends to indicate the presence of a current psychiatric disability manifested by depression and tends to indicate that depression was present since service. Thus, it related to unestablished facts necessary to substantiate the claim (the presence of current disability and a potential medical nexus) and, under the low standard of Shade, raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156; Shade, 24 Vet. App. 110. Accordingly, this evidence is new and material and the claim for service connection for an acquired psychiatric disability, including depression, is reopened. 38 C.F.R. § 3.156; Shade, 24 Vet. App. 110. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Establishing entitlement to direct service connection generally requires: (1) competent and credible evidence confirming the appellant has the claimed disability or, at the very least, showing he has at some point since the filing of his claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or an injury; and (3) competent and credible evidence of a relationship or correlation between the disease or injury in service and the currently claimed disability - which is the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. 38 C.F.R. § 3.310. Certain evidentiary presumptions - such as the presumption of sound condition at entrance to service, the presumption of aggravation during service of preexisting diseases or injuries which undergo an increase in severity during service, and the presumption of service incurrence for certain diseases which manifest themselves to a degree of disability of 10 percent or more within a specified time after separation from service are generally provided by law to assist veterans in establishing service connection for their disabilities. 38 U.S.C. §§ 101, 1112; 38 C.F.R. § 3.304(b), 3.306, 3.307, 3.309. The term active military service includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 C.F.R. § 3.6(a). ACDUTRA includes full-time duty in the Armed Forces performed by Reserves for training purposes, while INACDUTRA includes duty (other than full-time duty) prescribed for Reserves, as well as duty (other than full-time duty) performed by a member of the National Guard of any State. 38 C.F.R. § 3.6(c), (d). Claims based on a sole period of ACDUTRA or INACDUTRA are never entitled to the presumption of service connection outlined in 38 C.F.R. § 3.307 and § 3.309 or the presumption of sound condition at entry into service outlined in 38 C.F.R. § 3.304. See Smith v. Shinseki, 24 Vet. App. 40 (2010). For claims based on aggravation of a pre-existing condition during a period of ACDUTRA or INACDUTRA, the appellant must generally show that the condition worsened beyond its natural progression during the period of training and that the worsening was caused by the training. Smith, 24 Vet. App. 40 (2010). Personality disorders are considered congenital or developmental defects. 38 C.F.R. §§ 3.303(c), 4.9; Winn v. Brown, 8 Vet. App. 510, 516 (1996). Congenital or development defects are not diseases or injuries within the meaning of the applicable legislation and are not subject to service-connection. Id. However, service connection may be granted, in limited circumstances, for disability due to disease or injury superimposed onto a personality disorder. See VAOPGCPREC 82-90, 55 Fed. Reg. 45,711 (1990); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993); and VAOPGCPREC82-90. The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See also 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Entitlement to service connection for respiratory disability, to include asthma, bronchitis, emphysema, and COPD. The appellant alleges that his current asthma began during his period of active duty for training. He also appears to allege that he has current bronchitis, which either began during active duty for training or was aggravated by active duty for training. Additionally, his representative appears to assert that the appellant's asthma is directly related to service, and his bronchitis, emphysema and COPD are secondary to the asthma. The appellant's service treatment records show that at his June 3, 1967 enlistment examination, his lungs and chest were found to be normal. A July 1, 1967 chest X-ray showed that the chest, heart, and lungs were within normal limits. At a July 21, 1967 medical visit, the appellant reported a head cold for the past 5 days. He noted head congestion and a nonproductive cough. Physical examination revealed that his throat was slightly inflamed, and wheezing was heard throughout. The diagnostic impression was bronchitis. At a July 1967 neuropsychiatric visit, the appellant reported a past history of asthma, bronchitis, and high blood pressure. Post-service private medical records show that the appellant was seen for respiratory problems in May 2015. It was noted that he had a history of asthma as a child. He reported respiratory symptoms with coughing and wheezing in the spring and fall. A sample of Symbicort was provided to him. He was advised to use Allegra (antihistamine) for rhinitis. At a subsequent December 2015 visit, the appellant reported problems with coughing for the past week. It was noted that he was a former smoker who had smoked for 40 years. He was found to have a mild asthma exacerbation, which was treated with Zithromax and Symbicort. Other pertinent historical conditions included COPD, unspecified, upper respiratory tract hypersensitivity reaction, site unspecified, and other disorders of the lung. At a May 2019 private medical visit, the appellant was noted to have a history of chronic bronchitis and pneumonia. VA treatment records include June 2018 and March 2019 progress notes indicating that the appellant's COPD was stable and that he was being followed for it by a private physician. In a September 2016 notice of disagreement, the appellant indicated that he felt he had asthma before he went into service and that it was aggravated by the physical activity he was forced to perform. He also felt that his other respiratory conditions, including COPD and emphysema, were aggravated by him having asthma. More broadly, he felt that all his current conditions were aggravated by basic training. At a March 2018 Decision Review Officer (DRO) hearing, the appellant's representative argued that the appellant should not have been taken into service in the first place because he did have a history of asthma at the time of entry. In April 2018 argument, the appellant's representative indicated that the appellant clearly stated that he did have asthma prior to service but was taken into service anyway where the physical activity of training aggravated his condition. The representative commented that it was also rational that the appellant's bronchitis, lung condition and emphysema were related to the exacerbation of his asthma. At the October 2020 Board hearing, the appellant testified that his asthma began during basic training. He indicated that he had to train on ground that was wet and flooded, including doing pushups on the flooded ground. As a result, he got sent to the hospital during service for treatment of asthma. He testified that he thought that he did have a pre-service history of bronchitis but not of asthma but that he did not remember this too well and noted that he was not sure of the history. However, he reported that he did not have issues with breathing prior to service. Then, he had problems in training following the push-ups on saturated ground and his breathing problems continued after service. He noted that eventually he went to see a private physician; Dr. A, 10 to 15 years previously. At that time, tests were performed, and he was diagnosed with a number of different things. He appeared to report that he first noticed breathing problems during service, including wheezing, coughing and tightness in the chest. He also appeared to report that he was treated with a nebulizer and inhalers. Additionally, the appellant reported that he had respiratory symptoms ever since service. He indicated that about the time he started seeing Dr. A, he was diagnosed with emphysema. In a December 2020 letter, private treating physician Dr. A indicated that the appellant currently had mild intermittent asthma. The physician noted that asthma was usually lifelong and non-curable. The physician commented that it was very likely the asthma started when the appellant was young. However, the physician did not know the appellant when he was in military service and had been seeing him for approximately 10 years. The above summarized evidence indicates that the appellant's asthma pre-existed his period of ACDUTRA. In this regard, at the July 1967 neuropsychiatric visit, the appellant specifically reported a prior history of asthma (and also bronchitis). Similarly, at the May 2015 private medical visit, it was noted that the appellant had a history of asthma as a child. Additionally, in the September 2016 notice of disagreement, the appellant indicated that he felt he had asthma before he entered service and at the March 2018 DRO hearing and in the April 2018 argument, the appellant's representative emphasized that the appellant had asthma prior to entry into service. Notably, at the October 2020 Board hearing, the appellant testified that he thought he did not have asthma prior to service but he was not sure. This testimony is directly contradictory to his earlier assertion made in September 2016 and the assertions of his representative made in March and April 2018 that the asthma did pre-exist service. It is also contradictory to the appellant's report of pre-existing asthma made during the July 1967 neuropsychiatric visit. Given the appellant's expressed uncertainty at the October 2020 hearing concerning pre-existence and given all the earlier evidence indicative of pre-existence, the Board is not able to credit the October 2020 testimony and must instead credit the multiple pieces of evidence indicating that the appellant's asthma pre-existed his military service. Accordingly, the evidence shows that the appellant's asthma pre-existed his military service and the relevant determination pertaining to his service-connection claim is whether this pre-existing asthma was aggravated by service beyond the natural progression of the disease. Smith, 24 Vet. App. 40 (2010). Notably, there is no medical evidence tending to indicate that the appellant's pre-existing asthma was aggravated by his 27 days of ACDUTRA. In the December 2020 letter, the private treating physician indicated that it was very likely that the appellant's asthma started when he was young but did not provide any opinion concerning aggravation of the pre-existing asthma by service, noting he did not know the appellant when he was in service and indicating that he had only been seeing the appellant for approximately 10 years. Also, there are no other medical opinions of record that even suggest that the pre-existing asthma was aggravated by service. The appellant has also asserted that his asthma was aggravated by service. Notably, the he is competent to report symptoms he experienced, including asthma/respiratory symptoms incurred while training in wet conditions. However, as a layperson without any demonstrated expertise concerning the nature and etiology of asthma, he is not competent to opine that his asthma was actually aggravated (increased in severity beyond natural progression) by service. Accordingly, the appellant's assertion may not be afforded any probative value. In sum, the weight of the evidence is against a finding that the appellant's pre-existing asthma was aggravated by service. Accordingly, the preponderance of the evidence is against this claim and it must be denied. Alemany, 9 Vet. App. 518 (1996). Regarding the other claimed respiratory disabilities, including bronchitis, emphysema, and COPD, the appellant has generally alleged that these disabilities have been caused or aggravated by his underlying asthma. However, as the appellant's claim for service connection for asthma is being denied, there is no basis for awarding service connection for these disabilities on a secondary basis. 38 C.F.R. § 3.310. Notably, at the July 1967 neuropsychiatric visit, the appellant did report bronchitis that pre-existed service and at the July 21, 1967 medical visit during service, the appellant was found to have bronchitis. However, there is no medical evidence of record even suggesting that any pre-existing bronchitis was aggravated by service and the appellant has not specifically alleged any such aggravation. Similarly, there is no medical evidence indicating that any current chronic bronchitis (or other respiratory disability, to include COPD and emphysema) is directly related to service and the appellant has not specifically alleged any such direct connection. Additionally, although the appellant appeared to allege in his September 2016 NOD that service aggravated all his respiratory disabilities, there is no indication that COPD or emphysema pre-existed service or was aggravated by service. Accordingly, there is no basis for awarding service connection for respiratory disability other than asthma, to include bronchitis, emphysema, or COPD, on either a direct or secondary basis. 38 C.F.R. §§ 3.303, 3.310; Alemany, 9 Vet. App. 518 (1996). Finally, the Board has considered whether a VA medical examination is necessary in relation to any of the appellant's claims for respiratory disability. However, the medical evidence does not even suggest that the appellant's current asthma was aggravated by his period of ACDUTRA and does not even suggest that any of the other current respiratory disabilities were caused or aggravated by his period of ACDUTRA. Instead, the evidence simply includes the appellant's bare assertion that the asthma was aggravated by service and that the other respiratory conditions are secondary to the asthma. Accordingly, a VA examination is not necessary in this case. 38 C.F.R. § 3.159(c)(4); see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (indicating that a bare assertion concerning a nexus to service, standing alone, does not suffice to trigger VA's duty to obtain an examination and opinion). Entitlement to service connection for cardiac disability, including congestive heart failure, to include as secondary to respiratory disability. The appellant essentially alleges that his cardiac disability resulted from his respiratory disability. The appellant's service treatment records do not show any findings of congestive heart failure or other cardiac problems. At a December 2015 private medical visit, the appellant was noted to have a history of chronic systolic (congestive) heart failure. A June 2016 VA progress note listed congestive heart failure as an active medical problem. In his September 2016 notice of disagreement, the appellant appeared to contend that his congestive heart failure had been aggravated by his respiratory disability, including asthma. He also contended that all his current conditions were aggravated by basic training. At the October 2020 Board hearing, the appellant testified that he did currently have a defibrillator pacemaker. He indicated that he thought his breathing problems led to his heart failure. He noted that he was diagnosed with heart failure approximately 10 years previously. In a December 2020 letter, a private treating physician indicated that the appellant had heart conditions, including coronary stent placement and defibrillator placement that may have been associated with his years of service. The appellant has essentially alleged that his cardiac disability has been caused or aggravated by his asthma/respiratory disability. However, as service connection for asthma/respiratory disability has been denied in the decision above, there is no basis to award service connection on this secondary basis. 38 C.F.R. § 3.310. There is also no specific allegation or evidence to suggest that the cardiac disability is directly related to service. 38 C.F.R. § 3.303. The appellant did appear to indicate in his September 2016 notice of disagreement that his cardiac disability was aggravated by service; however, as this condition is not shown to have pre-existed service, it could not have been aggravated by service. The Board notes that the December 2020 private treating physician did indicate that the appellant's heart conditions may have been associated with his "years of service." However, as alluded to above, the appellant only served on ACDUTRA for 27 days; not for a period of years. Also, the physician did not provide any rationale for his conclusion. Consequently, given the inaccurate factual premise on which the opinion was based and the lack of any rationale, the Board is not able to attach any probative value to this opinion. The Board also notes that even if the opinion were found to be probative, it is too indefinite to support an award of service connection. Additionally, as there is no basis to award service connection for cardiac disability on a secondary basis and as there is no probative evidence which even suggests that current cardiac disability is directly related to service, a VA examination was not necessary in this case. 38 C.F.R. § 3.159(c)(4). Accordingly, the preponderance of the evidence is against this claim and it must be denied. Alemany, 9 Vet. App. 518 (1996). Entitlement to service connection for an acquired psychiatric disorder, to include depression. The appellant appears to allege that he has a current acquired psychiatric disability that is related to service and/or has been caused or aggravated by his respiratory disability. The appellant's service treatment records show that he was seen in July 1967 by the neuropsychiatric section of the medical detachment. It was noted that he was shaky, tearful, and agitated. His affect was noted to be quite labile. He reported symptoms of tension and tremulousness over the past 4 to 5 years but that he had never been treated by a doctor for "nerves as such." He noted that he used to have a bad temper but had calmed down in the last few years. It was noted that he seemed to have very close ties to his home and that he felt too anxious to continue with service. The appellant was admitted to the inpatient psychiatric ward for further evaluation. At a July 20, 1967 Medical Board neuropsychiatric evaluation, it was noted that the appellant arrived for duty on June 30, 1967 at Parris Island. On July 6, 1967 he was referred to the neuropsychiatric section because of episodes of nervousness occurring whenever he was talked to. These were characterized by shaking and crying and inability to speak. He was then admitted to the neuropsychiatric ward for further evaluation. He reported that he had been nervous for approximately the past 5 years. He indicated that at that time he started shaking and if he got extremely upset his whole body became very tremulous. During these times he would cry and stutter and if extremely upset, he would also be unable to speak. He noted that these things seemed to happen when people bothered him, hollered at him, or acted in a similar manner. He also noted that he was always a little nervous. He reported that on one pre-service occasion he had seen his family physician who had simply told him to calm down or he might get an ulcer and have to be put on tranquilizers. The appellant indicated that in his early life he bit his fingernails, had a bad temper, and had nightmares. During the past 5 years he had been bothered by some queasy feelings in his stomach, which his doctor simply told him were nerves. He indicated that during high school he did not have any friends and frequently stayed in the house watching t.v. He indicated that his temper used to be quite bad but that he had calmed down in the past few years. He had wanted to join the NYPD but elected to come to the Marines instead. Mental status examination showed that the appellant became markedly tremulous and stuttered quite noticeably. He was also tearful. His affect seemed to be quite labile and at times he giggled not entirely appropriately. There were no abnormal mental trends indicative of psychosis. He was well oriented and thought to be of average intelligence. After an adequate period of evaluation and a conference of psychiatrists and psychologists, the diagnosis was emotionally unstable personality, existing prior to entry into service, manifested by markedly increased psychomotor activity, poor hostility control, tearfulness, neuropathic traits of childhood, and stuttering. The appellant was noted to have a severe predisposition. His condition was found to have clearly existed prior to his entry into service. His impairment was severe for military service, but it was felt he should be able to resume his prior level of adjustment following discharge. In summary, the evaluating mental health professional found that the appellant suffered from a personality disorder which rendered him unsuitable for further service. This was found to have existed prior to enlistment and had progressed at no more than the usual rate for such disorders and hence was considered not aggravated by service. There was no disability which was the result of an incident in service. The appellant was considered to be fully competent to be discharged into his own custody, did not constitute a menace to himself or others and was no more likely to become a public charge than he was prior to entry into service. The appellant was noted to have a non-acceptable defect. He was also noted to have been informed of the findings of the Medical Board and to not desire to submit a statement in rebuttal. In his September 2016 notice of disagreement, the appellant reported that he felt that his other conditions were aggravated by him having asthma and that this in turn caused his depression, which had made him suffer many years later. He indicated that he was presently seeing a psychiatrist and taking medication. He also felt that all his current conditions (presumably to include depression) were aggravated by his basic training. In April 2018 argument, the appellant's representative indicated that it was rational that the appellant's current depression was related to the exacerbation of his asthma by his military service. At the October 2020 Board hearing, the appellant testified that he had problems with depression during service. He also indicated that he was currently taking medication for depression and that he had been depressed since service. He noted that when he was discharged in one way he was happy to go home but in another way he was unhappy to do so. He reported that in any case, he had to go home because he was suffering from depression and asthma. The appellant reported that after service he would get agitated and argumentative, asking himself how his life would have been different if he was still in service. He noted that he had planned to make the service his career. He also noted that he first saw a psychiatrist after service around 1979 in Mercer County. He reported that the doctor in Mercer County put him on Mellaril, which he could not tolerate so then he was placed on Valium. He indicated that he did not remember the name of the psychiatrist who he saw. The above summarized evidence indicates that during service, the appellant suffered from a personality disorder, which pre-existed service and was not aggravated by service. To the extent that the appellant has any current personality disorder, as alluded to above, personality disorders are considered congenital or developmental defects, which are not subject to service-connected compensation. 38 C.F.R. §§ 3.303(c), 4.9; Winn v. Brown, 8 Vet. App. 510, 516 (1996). Also, there is no indication that the appellant has any disorder, which has been superimposed on his personality disorder, nor has he specifically alleged that this is the case. The appellant has reported that he currently has depression. He has also reported that he was depressed in service and has been depressed since service. Notably, the neuropsychiatric evaluation performed in service indicates that the emotional symptoms the appellant experienced in service, including symptoms that could be compatible with depression (e.g. crying, tearfulness), were specifically attributed to personality disorder and there is no other medical evidence of record indicating that any of these symptoms were attributable to an acquired psychiatric disorder, such as depressive disorder. Also, the record does not contain any medical evidence that the appellant's reported depressive symptomatology post-service has been the result of an acquired psychiatric disability such as depressive disorder, as opposed to the personality disorder shown in service, which is not subject to service connection. Additionally, the record does not contain any medical evidence tending to indicate that any current acquired psychiatric disorder, to include a disorder manifested by symptoms of depression, is related to the personality disorder with associated symptoms shown in service. Notably, the appellant is competent to report symptoms he experienced, including having symptoms of depression in service and since service. However, as a layperson without any demonstrated expertise concerning the nature and etiology of psychiatric disorder, he is not competent to opine that such symptoms were/are a result of an acquired psychiatric disorder (as opposed to a personality disorder) and is not competent to opine on whether there is a medical nexus between any current acquired psychiatric disorder that might be present and the personality disorder shown during service. Moreover, even assuming that the appellant's emotional problems in service did include a component of an acquired psychiatric disorder, the neuropsychiatric evaluation performed during service clearly concluded that the disorder that was present pre-existed the appellant's 27 days of ACDUTRA and was not aggravated by it. Further, there is no medical opinion of record to the contrary (i.e. an opinion tending to indicate that the appellant's in-service psychiatric symptomatology was aggravated by his 27 days of ACDUTRA). Additionally, a VA examination is not necessary in this case because the evidence does not establish that any event, disease, or injury occurred in service. See 38 C.F.R. § 3.159(c)(4). In this regard, as explained above, the emotional symptoms experienced by the appellant in service were all attributed to a personality disorder, which may not be subject to service connection. Thus, the presence of these symptoms and the diagnosis of this underlying disorder do not qualify as qualifying event, injury or disease occurring in service according to 38 C.F.R. § 3.159(c)(4), making a VA examination unnecessary in this case. In sum because the appellant is shown to have experienced a personality disorder during service and not an acquired psychiatric disorder; because the appellant's reported post-service symptoms are not shown to have been the result of an acquired psychiatric disorder (as opposed to a personality disorder) and because any current acquired psychiatric disorder is not otherwise shown to be related to service, the preponderance of the evidence is against this claim and it must be denied. Alemany, 9 Vet. App. 518 (1996). S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dan Brook, 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.