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Citation Nr: 1340434
Decision Date: 12/06/13    Archive Date: 12/20/13

DOCKET NO.  08-01 829	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Montgomery, Alabama

THE ISSUE

Entitlement to service connection for an acquired psychiatric disorder, including posttraumatic stress disorder (PTSD), to include as secondary to service-connected residuals of frostbite.

REPRESENTATION

Appellant represented by:	The American Legion

ATTORNEY FOR THE BOARD

David Gratz, Counsel

INTRODUCTION

The Veteran had active service from January 2, 1977 to June 28, 1977.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama.

The Veteran was scheduled to present testimony before a Veterans Law Judge at the RO in Montgomery, Alabama, in June 2010.  However, the Veteran cancelled the request for the hearing.

In November 2011, the Board remanded this case for further development.  The case has returned to the Board for appellate review.

The issues of entitlement to service connection for degenerative arthritis of the feet, and entitlement to a temporary total disability rating for left great toe surgery, were remanded in November 2011 along with the claim currently on appeal.  Following development conducted pursuant to the Board's November 2011 remand, the AOJ granted service connection and a temporary total disability rating, respectively, for those disorders in a March 2013 rating decision.  As such are complete grants of the benefits sought on appeal, those issues are no longer before the Board.  Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997).

FINDING OF FACT

The most probative evidence fails to link the Veteran's claimed acquired psychiatric disorder, including PTSD, to active service or to his service-connected residuals of frostbite.

CONCLUSION OF LAW

The criteria for service connection for an acquired psychiatric disorder, including PTSD, to include as secondary to service-connected residuals of frostbite, have not been met.  38 U.S.C.A. §§ 1101, 1112, 1131, 1154, 5103, 5103A, 5107 (West 2002 & Supp. 2013); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310 (2013).

REASONS AND BASES FOR FINDING AND CONCLUSION

Duties to Notify and Assist

Under applicable criteria, VA has certain notice and assistance obligations to claimants.  See 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a).

Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim.  38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b).  Proper notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide in accordance with 38 C.F.R. § 3.159(b)(1).  Pelegrini v. Principi, 18 Vet. App. 112, 120-121 (2004).  This notice should be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ).  Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004).

VA's notice requirements were satisfied by a September 2012 letter which advised the Veteran of the criteria for establishing service connection and provided him with notice regarding the assignment of disability ratings and effective dates.  The letter was sent prior to the most recent adjudication of the Veteran's claim in March 2013.  Although the letter did not provide the Veteran with notice as to service connection on a secondary basis, he is not prejudiced thereby because he demonstrated actual knowledge of the availability of secondary service connection in his written statements of record.

Next, VA has a duty to assist the Veteran in the development of his claim.  This duty includes assisting him in the procurement of pertinent medical records and providing an examination when necessary.  38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159.  In this case, the RO has obtained and associated with the claims file the Veteran's service treatment and personnel records, and records of his post-service VA and private treatment.

The Veteran has asserted that additional federal records could corroborate his stressor and otherwise support his claim.  Consequently, as outlined in a February 2013 Formal Finding, the RO requested information from the Joint Services Records Research Center (JSRRC) and the US Army Crime Records Center; however, those sources provided negative responses for the requested date range.  Similarly, the Social Security Administration (SSA) issued a negative response in September 2012.  Thus, the Board finds that VA has fulfilled its duty to assist the Veteran in obtaining available federal records.  38 C.F.R. § 3.159(c)(2).

The Veteran was afforded an independent medical opinion germane to his claimed disorder on appeal in March 2013.  The examination report is adequate because the clinician based her opinions upon consideration of the Veteran's prior medical history, described the Veteran's symptoms in sufficient detail so that the Board's evaluation of the claimed disability would be fully informed, and supported all conclusions with analyses that the Board could consider and weigh against any contrary opinions.  Additionally, the independent medical clinician fully described any functional effects caused by the Veteran's claimed disorder.  Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007).

For the foregoing reasons, the Board concludes that VA made all reasonable efforts to obtain evidence necessary to substantiate the Veteran's claim.  Therefore, no further assistance to the Veteran with the development of evidence is required.

Service Connection

In seeking VA disability compensation, a veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131.  "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with active service in the Armed Forces, or if preexisting such service, was aggravated therein.

Establishing direct service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability.  See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table).

Service connection may also be established for disability that is proximately due to or the result of a service-connected disability.  38 C.F.R. § 3.310(a) (2012).  Further, 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 (2012); Allen v. Brown, 7 Vet. App. 439 (1995).

Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred, unless the stressor is related to a Veteran's fear of hostile military or terrorist activity.  38 C.F.R. § 3.304(f).

The Veteran contends that his psychiatric disorder was caused by service, or by his service-connected residuals of frostbite.  Specifically, in his September 2007 claim, the Veteran asserts that he never experienced mental issues before service, but "became easily irritated and alarmed during service and it has never diminished."

In his October 2007 stressor statement, the Veteran listed four stressors.  First, he stated that "I witness[ed] Pvt. [name omitted] trying to kill [an] instructor by drawing his weapon on [an] instructor."  Second, he asserted that "I witness[ed] in Ft. Rucker a group of Privates force bathing another Private with a steel brush."  Third, he wrote that "I witness[ed] a group of Privates giving [a] Private a G.I. Party.  (Blanket Party)....If I had turned them in then I could have been next!"  Fourth, he averred that "At Ft. Jackson, [South Carolina] during Basic, one of the trainees dropped a live grenade in the bunker.  This drill sergeant/Instructor jumped on it and was killed."  The Veteran concluded that those stressors made it "hard for me to concentrate on my studies as a Tower Operator.  And that's why I failed the course."  In February 2008, the Veteran added that "I did receive stress counseling in service at Ft. Rucker as I was failing my course."

In his October 2009 substantive appeal, the Veteran added that "my frostbite residuals...cause me much anxiety and frustration."

After reviewing the record, the Board finds that the most probative evidence is against a finding of in-service incurrence or aggravation of an acquired psychiatric disorder, including PTSD; there is no credible supporting evidence that any claimed in-service stressor occurred; and the most probative evidence demonstrates that the Veteran's service-connected residuals of frostbite did not cause or aggravate an acquired psychiatric disorder, including PTSD.

As a finder of fact, when considering whether lay evidence is credible, the Board may properly consider the internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran.  See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996).

Here, the multiple contradictions in the Veteran's evidence lead the Board to conclude that the alleged incidents and stressors did not occur.  First, the Veteran expressly denied experiencing psychiatric symptoms in service in his April 1977 and May 1977 Reports of Medical History, wherein he checked boxes indicating that he did not have, and had never had, depression or excessive worry, loss of memory or amnesia, or nervous trouble of any sort.  See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than subsequently reported history).  Second, in April 1977 and May 1977 Reports of Medical Examination, clinicians found that the Veteran was psychiatrically normal.  See Buczynski v. Shinseki, 24 Vet.App. 221, 224 (2011) (noting that where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the condition or symptoms did not exist).  Third, the Veteran's counseling records were for academics, not stress-as the Veteran inaccurately asserted in a February 2008 letter to VA.  For example, in a June 1977 service personnel record a counselor opined that:

I have personally interviewed this SM and found him to have a good attitude towards the Army.  However, he has a serious academic problem.  His ability to read and comprehend the material in his AIT course is extremely poor, and his exam grades indicated that he will develop[] into a marginal soldier at best.  Recommendation: I don't feel that this SM can obtain an MOS and recommend he be discharged.

Similarly, the Veteran's own contemporaneous assessment reflected academic, rather than psychiatric, concerns, as described by an in-service supervisor in his service personnel records:

He says that he doesn't know what the problem is but guesses [that the test is] too hard.  I agree with him-it is too hard for him and he should not be in a service organization where his and other persons' lives may depend upon his ability to respond logically and rapidly to requirements.  He tried the Active Army and could not pass the tests.

Fourth, the Veteran's stressor statements to VA clinicians and examiners are often unrelated to, or in direct contradiction with, his stressor statements in support of his claim.  For example, the Veteran told a treating VA psychiatrist in September 2007 that he had not seen the recruit shoot a drill sergeant, but rather had heard about it.  This conflicts with the Veteran's October 2007 stressor statement wherein he stated that "I witness[ed] Pvt. [name omitted] trying to kill [an] instructor by drawing his weapon on [an] instructor."  Additionally, the Veteran told his treating VA psychiatrist in November 2008 that he remembered one surgeon scraping another with a metal brush in service, causing bleeding in his body.  This appears to be a variant of his October 2007 assertion that "I witness[ed] in Ft. Rucker a group of Privates force bathing another Private with a steel brush."  Furthermore, the Veteran told a VA psychologist in August 2007 that he had been revolted and horrified in service by one of his superiors who kept on his desk a large jar of pickled ears from dead NVA and Vietcong soldiers; the Veteran never listed this stressor in his claim.

Based on the foregoing, the Board concludes that the Veteran's reports of in-service incidents and stressors lack credibility.

In March 2013, VA obtained a medical opinion as to the Veteran's claimed PTSD and psychiatric disorders.  The clinician opined that "It is LESS LIKELY THAN NOT that the Veteran's claimed mental health condition, to include PTSD, incurred, was caused by or proximately due to his 6 months in military service."  In support of her opinion, the clinician relied on the absence of verification of the Veteran's stressors; the in-service counseling report showing discharge due to an academic deficiency; and the absence of "medically based scientific evidence found in his service record to indicate that his short time in military service...[was] the underlying cause of his current diagnoses of PTSD and Depression."  The clinician also opined that it is less likely than not that the Veteran's mental health condition is caused by, proximately due to, or related to his service-connected bilateral lower extremity disabilities, to include peripheral neuropathy and vascular disease, because "[t]here is no current literature or scientifically based medical evidence to support such a nexus."

The Board finds that the clinician's opinion is competent because she is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  38 C.F.R. § 3.159(a)(1).  Also, the clinician's etiological opinions are credible based on their internal consistency and her duty to provide truthful opinions.  The Board further finds that the March 2013 clinician's opinion is most probative because she considered the Veteran's medical records and discussed his medical history, provided unequivocal and conclusive opinions, and offered clear reasoning for her conclusions.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Where, as here, conflicting competent opinions are of record, the Board can ascribe greater probative weight to one opinion over another, provided that a rational basis is given.  Winsett v. West, 11 Vet. App. 420 (1998), aff'd 217 F.3d 854 (Fed. Cir. 1999).  The Board is cognizant of the February 2008 VA psychologist's letter, the additional VA treatment records, and the December 2012 VA examination report linking the Veteran's PTSD to his service.  However, the Board accords those opinions less probative weight because they are based on acceptance of the Veteran's reported stressors which, as the Board demonstrated above, lack credibility.  Id.

Likewise, the Board finds that the March 2013 VA medical opinion warrants greater probative weight than the Veteran's own contentions, based on the examiner's greater knowledge and expertise, as well as her greater factual accuracy in accordance with the claims file.  See Kahana v. Shinseki, 24 Vet. App. 428 (2011).

The Board further finds that service connection for PTSD is not warranted under 38 C.F.R. § 3.304(f) because the Veteran was not diagnosed with PTSD during service, did not engage in combat with the enemy, did not experience a stressor related to fear of hostile military or terrorist activity, was not a prisoner-of-war, and did not sustain an in-service personal assault.

The most probative evidence of record shows that the Veteran's psychiatric disorders, including PTSD, are unrelated to service or to his service-connected residuals of frostbite.  Accordingly, reasonable doubt does not apply, and the Veteran's appeal of the issue of entitlement to service connection for an acquired psychiatric disorder, including PTSD, is denied.

ORDER

Service connection for an acquired psychiatric disorder, including PTSD, is denied.

____________________________________________
MICHAEL E. KILCOYNE
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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text: obtain

text: evidence

text: necessary

text: to

text: substantiate

text: the

text: Veteran

text: s

text: claim

text: Therefore

text: no

text: further

text: assistance

text: to

text: the

text: Veteran

text: with

text: the

text: development

text: of

text: evidence

text: is

text: required

text: Service

text: Connection

text: In

text: seeking

text: VA

text: disability

text: compensation

text: a

text: veteran

text: generally

text: seeks

text: to

text: establish

text: that

text: a

text: current

text: disability

text: results

text: from

text: disease

text: or

text: injury

text: incurred

text: in

text: or

text: aggravated

text: by

text: service

text: U

text: S

text: C

text: A

text: Service

text: connection

text: basically

text: means

text: that

text: the

text: facts

text: shown

text: by

text: evidence

text: establish

text: that

text: a

text: particular

text: injury

text: or

text: disease

text: resulting

text: in

text: disability

text: was

text: incurred

text: coincident

text: with

text: active

text: service

text: in

text: the

text: Armed

text: Forces

text: or

text: if

text: preexisting

text: such

text: service

text: was

text: aggravated

text: therein

text: Establishing

text: direct

text: service

text: connection

text: generally

text: requires

text: medical

text: or

text: in

text: certain

text: circumstances

text: lay

text: evidence

text: of

text: a

text: current

text: disability

text: an

text: in

text: service

text: incurrence

text: or

text: aggravation

text: of

text: a

text: disease

text: or

text: injury

text: and

text: a

text: nexus

text: between

text: the

text: claimed

text: in

text: service

text: disease

text: or

text: injury

text: and

text: the

text: present

text: disability

text: See

text: Davidson

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: Hickson

text: v

text: West

text: Vet

text: App

text: Caluza

text: v

text: Brown

text: Vet

text: App

text: aff

text: d

text: per

text: curiam

text: F

text: d

text: Fed

text: Cir

text: table

text: Service

text: connection

text: may

text: also

text: be

text: established

text: for

text: disability

text: that

text: is

text: proximately

text: due

text: to

text: or

text: the

text: result

text: of

text: a

text: service

text: connected

text: disability

text: C

text: F

text: R

text: a

text: Further

text: a

text: disability

text: which

text: is

text: aggravated

text: by

text: a

text: service

text: connected

text: disability

text: may

text: be

text: service

text: connected

text: to

text: the

text: degree

text: that

text: the

text: aggravation

text: is

text: shown

text: C

text: F

text: R

text: Allen

text: v

text: Brown

text: Vet

text: App

text: Service

text: connection

text: for

text: PTSD

text: requires

text: medical

text: evidence

text: diagnosing

text: the

text: condition

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: a

text: link

text: established

text: by

text: medical

text: evidence

text: between

text: current

text: symptoms

text: and

text: an

text: in

text: service

text: stressor

text: and

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: occurred

text: unless

text: the

text: stressor

text: is

text: related

text: to

text: a

text: Veteran

text: s

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: C

text: F

text: R

text: f

text: The

text: Veteran

text: contends

text: that

text: his

text: psychiatric

text: disorder

text: was

text: caused

text: by

text: service

text: or

text: by

text: his

text: service

text: connected

text: residuals

text: of

text: frostbite

text: Specifically

text: in

text: his

text: September

text: claim

text: the

text: Veteran

text: asserts

text: that

text: he

text: never

text: experienced

text: mental

text: issues

text: before

text: service

text: but

text: became

text: easily

text: irritated

text: and

text: alarmed

text: during

text: service

text: and

text: it

text: has

text: never

text: diminished

text: In

text: his

text: October

text: stressor

text: statement

text: the

text: Veteran

text: listed

text: four

text: stressors

text: First

text: he

text: stated

text: that

text: I

text: witness

text: ed

text: Pvt

text: name

text: omitted

text: trying

text: to

text: kill

text: an

text: instructor

text: by

text: drawing

text: his

text: weapon

text: on

text: an

text: instructor

text: Second

text: he

text: asserted

text: that

text: I

text: witness

text: ed

text: in

text: Ft

text: Rucker

text: a

text: group

text: of

text: Privates

text: force

text: bathing

text: another

text: Private

text: with

text: a

text: steel

text: brush

text: Third

text: he

text: wrote

text: that

text: I

text: witness

text: ed

text: a

text: group

text: of

text: Privates

text: giving

text: a

text: Private

text: a

text: G

text: I

text: Party

text: Blanket

text: Party

text: If

text: I

text: had

text: turned

text: them

text: in

text: then

text: I

text: could

text: have

text: been

text: next

text: Fourth

text: he

text: averred

text: that

text: At

text: Ft

text: Jackson

text: South

text: Carolina

text: during

text: Basic

text: one

text: of

text: the

text: trainees

text: dropped

text: a

text: live

text: grenade

text: in

text: the

text: bunker

text: This

text: drill

text: sergeant

text: Instructor

text: jumped

text: on

text: it

text: and

text: was

text: killed

text: The

text: Veteran

text: concluded

text: that

text: those

text: stressors

text: made

text: it

text: hard

text: for

text: me

text: to

text: concentrate

text: on

text: my

text: studies

text: as

text: a

text: Tower

text: Operator

text: And

text: that

text: s

text: why

text: I

text: failed

text: the

text: course

text: In

text: February

text: the

text: Veteran

text: added

text: that

text: I

text: did

text: receive

text: stress

text: counseling

text: in

text: service

text: at

text: Ft

text: Rucker

text: as

text: I

text: was

text: failing

text: my

text: course

text: In

text: his

text: October

text: substantive

text: appeal

text: the

text: Veteran

text: added

text: that

text: my

text: frostbite

text: residuals

text: cause

text: me

text: much

text: anxiety

text: and

text: frustration

text: After

text: reviewing

text: the

text: record

text: the

text: Board

text: finds

text: that

text: the

text: most

text: probative

text: evidence

text: is

text: against

text: a

text: finding

text: of

text: in

text: service

text: incurrence

text: or

text: aggravation

text: of

text: an

text: acquired

text: psychiatric

text: disorder

text: including

text: PTSD

text: there

text: is

text: no

text: credible

text: supporting

text: evidence

text: that

text: any

text: claimed

text: in

text: service

text: stressor

text: occurred

text: and

text: the

text: most

text: probative

text: evidence

text: demonstrates

text: that

text: the

text: Veteran

text: s

text: service

text: connected

text: residuals

text: of

text: frostbite

text: did

text: not

text: cause

text: or

text: aggravate

text: an

text: acquired

text: psychiatric

text: disorder

text: including

text: PTSD

text: As

text: a

text: finder

text: of

text: fact

text: when

text: considering

text: whether

text: lay

text: evidence

text: is

text: credible

text: the

text: Board

text: may

text: properly

text: consider

text: the

text: internal

text: inconsistency

text: of

text: the

text: statements

text: facial

text: plausibility

text: and

text: consistency

text: with

text: other

text: evidence

text: submitted

text: on

text: behalf

text: of

text: the

text: Veteran

text: See

text: Dalton

text: v

text: Nicholson

text: Vet

text: App

text: Caluza

text: v

text: Brown

text: Vet

text: App

text: aff

text: d

text: per

text: curiam

text: F

text: d

text: Fed

text: Cir

text: Here

text: the

text: multiple

text: contradictions

text: in

text: the

text: Veteran

text: s

text: evidence

text: lead

text: the

text: Board

text: to

text: conclude

text: that

text: the

text: alleged

text: incidents

text: and

text: stressors

text: did

text: not

text: occur

text: First

text: the

text: Veteran

text: expressly

text: denied

text: experiencing

text: psychiatric

text: symptoms

text: in

text: service

text: in

text: his

text: April

text: and

text: May

text: Reports

text: of

text: Medical

text: History

text: wherein

text: he

text: checked

text: boxes

text: indicating

text: that

text: he

text: did

text: not

text: have

text: and

text: had

text: never

text: had

text: depression

text: or

text: excessive

text: worry

text: loss

text: of

text: memory

text: or

text: amnesia

text: or

text: nervous

text: trouble

text: of

text: any

text: sort

text: See

text: Curry

text: v

text: Brown

text: Vet

text: App

text: contemporaneous

text: evidence

text: has

text: greater

text: probative

text: value

text: than

text: subsequently

text: reported

text: history

text: Second

text: in

text: April

text: and

text: May

text: Reports

text: of

text: Medical

text: Examination

text: clinicians

text: found

text: that

text: the

text: Veteran

text: was

text: psychiatrically

text: normal

text: See

text: Buczynski

text: v

text: Shinseki

text: Vet

text: App

text: noting

text: that

text: where

text: there

text: is

text: a

text: lack

text: of

text: notation

text: of

text: medical

text: condition

text: or

text: symptoms

text: where

text: such

text: notation

text: would

text: normally

text: be

text: expected

text: the

text: Board

text: may

text: consider

text: this

text: as

text: evidence

text: that

text: the

text: condition

text: or

text: symptoms

text: did

text: not

text: exist

text: Third

text: the

text: Veteran

text: s

text: counseling

text: records

text: were

text: for

text: academics

text: not

text: stress

text: as

text: the

text: Veteran

text: inaccurately

text: asserted

text: in

text: a

text: February

text: letter

text: to

text: VA

text: For

text: example

text: in

text: a

text: June

text: service

text: personnel

text: record

text: a

text: counselor

text: opined

text: that

text: I

text: have

text: personally

text: interviewed

text: this

text: SM

text: and

text: found

text: him

text: to

text: have

text: a

text: good

text: attitude

text: towards

text: the

text: Army

text: However

text: he

text: has

text: a

text: serious

text: academic

text: problem

text: His

text: ability

text: to

text: read

text: and

text: comprehend

text: the

text: material

text: in

text: his

text: AIT

text: course

text: is

text: extremely

text: poor

text: and

text: his

text: exam

text: grades

text: indicated

text: that

text: he

text: will

text: develop

text: into

text: a

text: marginal

text: soldier

text: at

text: best

text: Recommendation

text: I

text: don

text: t

text: feel

text: that

text: this

text: SM

text: can

text: obtain

text: an

text: MOS

text: and

text: recommend

text: he

text: be

text: discharged

text: Similarly

text: the

text: Veteran

text: s

text: own

text: contemporaneous

text: assessment

text: reflected

text: academic

text: rather

text: than

text: psychiatric

text: concerns

text: as

text: described

text: by

text: an

text: in

text: service

text: supervisor

text: in

text: his

text: service

text: personnel

text: records

text: He

text: says

text: that

text: he

text: doesn

text: t

text: know

text: what

text: the

text: problem

text: is

text: but

text: guesses

text: that

text: the

text: test

text: is

text: too

text: hard

text: I

text: agree

text: with

text: him

text: it

text: is

text: too

text: hard

text: for

text: him

text: and

text: he

text: should

text: not

text: be

text: in

text: a

text: service

text: organization

text: where

text: his

text: and

text: other

text: persons

text: lives

text: may

text: depend

text: upon

text: his

text: ability

text: to

text: respond

text: logically

text: and

text: rapidly

text: to

text: requirements

text: He

text: tried

text: the

text: Active

text: Army

text: and

text: could

text: not

text: pass

text: the

text: tests

text: Fourth

text: the

text: Veteran

text: s

text: stressor

text: statements

text: to

text: VA

text: clinicians

text: and

text: examiners

text: are

text: often

text: unrelated

text: to

text: or

text: in

text: direct

text: contradiction

text: with

text: his

text: stressor

text: statements

text: in

text: support

text: of

text: his

text: claim

text: For

text: example

text: the

text: Veteran

text: told

text: a

text: treating

text: VA

text: psychiatrist

text: in

text: September

text: that

text: he

text: had

text: not

text: seen

text: the

text: recruit

text: shoot

text: a

text: drill

text: sergeant

text: but

text: rather

text: had

text: heard

text: about

text: it

text: This

text: conflicts

text: with

text: the

text: Veteran

text: s

text: October

text: stressor

text: statement

text: wherein

text: he

text: stated

text: that

text: I

text: witness

text: ed

text: Pvt

text: name

text: omitted

text: trying

text: to

text: kill

text: an

text: instructor

text: by

text: drawing

text: his

text: weapon

text: on

text: an

text: instructor

text: Additionally

text: the

text: Veteran

text: told

text: his

text: treating

text: VA

text: psychiatrist

text: in

text: November

text: that

text: he

text: remembered

text: one

text: surgeon

text: scraping

text: another

text: with

text: a

text: metal

text: brush

text: in

text: service

text: causing

text: bleeding

text: in

text: his

text: body

text: This

text: appears

text: to

text: be

text: a

text: variant

text: of

text: his

text: October

text: assertion

text: that

text: I

text: witness

text: ed

text: in

text: Ft

text: Rucker

text: a

text: group

text: of

text: Privates

text: force

text: bathing

text: another

text: Private

text: with

text: a

text: steel

text: brush

text: Furthermore

text: the

text: Veteran

text: told

text: a

text: VA

text: psychologist

text: in

text: August

text: that

text: he

text: had

text: been

text: revolted

text: and

text: horrified

text: in

text: service

text: by

text: one

text: of

text: his

text: superiors

text: who

text: kept

text: on

text: his

text: desk

text: a

text: large

text: jar

text: of

text: pickled

text: ears

text: from

text: dead

text: NVA

text: and

text: Vietcong

text: soldiers

text: the

text: Veteran

text: never

text: listed

text: this

text: stressor

text: in

text: his

text: claim

text: Based

text: on

text: the

text: foregoing

text: the

text: Board

text: concludes

text: that

text: the

text: Veteran

text: s

text: reports

text: of

text: in

text: service

text: incidents

text: and

text: stressors

text: lack

text: credibility

text: In

text: March

text: VA

text: obtained

text: a

text: medical

text: opinion

text: as

text: to

text: the

text: Veteran

text: s

text: claimed

text: PTSD

text: and

text: psychiatric

text: disorders

text: The

text: clinician

text: opined

text: that

text: It

text: is

text: LESS

text: LIKELY

text: THAN

text: NOT

text: that

text: the

text: Veteran

text: s

text: claimed

text: mental

text: health

text: condition

text: to

text: include

text: PTSD

text: incurred

text: was

text: caused

text: by

text: or

text: proximately

text: due

text: to

text: his

text: months

text: in

text: military

text: service

text: In

text: support

text: of

text: her

text: opinion

text: the

text: clinician

text: relied

text: on

text: the

text: absence

text: of

text: verification

text: of

text: the

text: Veteran

text: s

text: stressors

text: the

text: in

text: service

text: counseling

text: report

text: showing

text: discharge

text: due

text: to

text: an

text: academic

text: deficiency

text: and

text: the

text: absence

text: of

text: medically

text: based

text: scientific

text: evidence

text: found

text: in

text: his

text: service

text: record

text: to

text: indicate

text: that

text: his

text: short

text: time

text: in

text: military

text: service

text: was

text: the

text: underlying

text: cause

text: of

text: his

text: current

text: diagnoses

text: of

text: PTSD

text: and

text: Depression

text: The

text: clinician

text: also

text: opined

text: that

text: it

text: is

text: less

text: likely

text: than

text: not

text: that

text: the

text: Veteran

text: s

text: mental

text: health

text: condition

text: is

text: caused

text: by

text: proximately

text: due

text: to

text: or

text: related

text: to

text: his

text: service

text: connected

text: bilateral

text: lower

text: extremity

text: disabilities

text: to

text: include

text: peripheral

text: neuropathy

text: and

text: vascular

text: disease

text: because

text: t

text: here

text: is

text: no

text: current

text: literature

text: or

text: scientifically

text: based

text: medical

text: evidence

text: to

text: support

text: such

text: a

text: nexus

text: The

text: Board

text: finds

text: that

text: the

text: clinician

text: s

text: opinion

text: is

text: competent

text: because

text: she

text: is

text: qualified

text: through

text: education

text: training

text: or

text: experience

text: to

text: offer

text: medical

text: diagnoses

text: statements

text: or

text: opinions

text: C

text: F

text: R

text: a

text: Also

text: the

text: clinician

text: s

text: etiological

text: opinions

text: are

text: credible

text: based

text: on

text: their

text: internal

text: consistency

text: and

text: her

text: duty

text: to

text: provide

text: truthful

text: opinions

text: The

text: Board

text: further

text: finds

text: that

text: the

text: March

text: clinician

text: s

text: opinion

text: is

text: most

text: probative

text: because

text: she

text: considered

text: the

text: Veteran

text: s

text: medical

text: records

text: and

text: discussed

text: his

text: medical

text: history

text: provided

text: unequivocal

text: and

text: conclusive

text: opinions

text: and

text: offered

text: clear

text: reasoning

text: for

text: her

text: conclusions

text: See

text: Nieves

text: Rodriguez

text: v

text: Peake

text: Vet

text: App

text: see

text: also

text: Stefl

text: v

text: Nicholson

text: Vet

text: App

text: Where

text: as

text: here

text: conflicting

text: competent

text: opinions

text: are

text: of

text: record

text: the

text: Board

text: can

text: ascribe

text: greater

text: probative

text: weight

text: to

text: one

text: opinion

text: over

text: another

text: provided

text: that

text: a

text: rational

text: basis

text: is

text: given

text: Winsett

text: v

text: West

text: Vet

text: App

text: aff

text: d

text: F

text: d

text: Fed

text: Cir

text: The

text: Board

text: is

text: cognizant

text: of

text: the

text: February

text: VA

text: psychologist

text: s

text: letter

text: the

text: additional

text: VA

text: treatment

text: records

text: and

text: the

text: December

text: VA

text: examination

text: report

text: linking

text: the

text: Veteran

text: s

text: PTSD

text: to

text: his

text: service

text: However

text: the

text: Board

text: accords

text: those

text: opinions

text: less

text: probative

text: weight

text: because

text: they

text: are

text: based

text: on

text: acceptance

text: of

text: the

text: Veteran

text: s

text: reported

text: stressors

text: which

text: as

text: the

text: Board

text: demonstrated

text: above

text: lack

text: credibility

text: Id

text: Likewise

text: the

text: Board

text: finds

text: that

text: the

text: March

text: VA

text: medical

text: opinion

text: warrants

text: greater

text: probative

text: weight

text: than

text: the

text: Veteran

text: s

text: own

text: contentions

text: based

text: on

text: the

text: examiner

text: s

text: greater

text: knowledge

text: and

text: expertise

text: as

text: well

text: as

text: her

text: greater

text: factual

text: accuracy

text: in

text: accordance

text: with

text: the

text: claims

text: file

text: See

text: Kahana

text: v

text: Shinseki

text: Vet

text: App

text: The

text: Board

text: further

text: finds

text: that

text: service

text: connection

text: for

text: PTSD

text: is

text: not

text: warranted

text: under

text: C

text: F

text: R

text: f

text: because

text: the

text: Veteran

text: was

text: not

text: diagnosed

text: with

text: PTSD

text: during

text: service

text: did

text: not

text: engage

text: in

text: combat

text: with

text: the

text: enemy

text: did

text: not

text: experience

text: a

text: stressor

text: related

text: to

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: was

text: not

text: a

text: prisoner

text: of

text: war

text: and

text: did

text: not

text: sustain

text: an

text: in

text: service

text: personal

text: assault

text: The

text: most

text: probative

text: evidence

text: of

text: record

text: shows

text: that

text: the

text: Veteran

text: s

text: psychiatric

text: disorders

text: including

text: PTSD

text: are

text: unrelated

text: to

text: service

text: or

text: to

text: his

text: service

text: connected

text: residuals

text: of

text: frostbite

text: Accordingly

text: reasonable

text: doubt

text: does

text: not

text: apply

text: and

text: the

text: Veteran

text: s

text: appeal

text: of

text: the

text: issue

text: of

text: entitlement

text: to

text: service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: including

text: PTSD

text: is

text: denied

text: ORDER

text: Service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disorder

text: including

text: PTSD

text: is

text: denied

text: MICHAEL

text: E

text: KILCOYNE

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs