BVA9502360 DOCKET NO. 93-04 355 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD William W. Berg, Counsel INTRODUCTION The veteran had active military service from September 1966 to July 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky, that denied the veteran's application to reopen his claim of entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that he has an acquired psychiatric disorder, including post-traumatic stress disorder, as a result of his active military service. In his Substantive Appeal and in statements associated with the record, the veteran claims that, while incarcerated in service, he was in a "kill or be killed" situation and that he has been diagnosed as having post-traumatic stress disorder. The veteran contends that he saw violence and suicides during his inservice incarceration and maintains that because he has symptoms of post-traumatic stress disorder, he must have had a stressor. He asserts that he had symptoms of post-traumatic stress disorder as early as 1970 and 1971, that he had such symptoms through the time of the initial diagnosis of a psychiatric disorder in 1976, and that he continues to have symptoms currently. The veteran claims the onset of symptoms of an acquired psychiatric disorder, including post-traumatic stress disorder, between the summer of 1968 and the summer of 1969 while in service. He recites the symptoms of his claimed post-traumatic stress disorder and relates them to the criteria for that disorder contained in the third revised edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that new and material evidence has not been received to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. FINDINGS OF FACT 1. Entitlement to service connection for an acquired psychiatric disorder was denied by the Board on the merits in October 1979. 2. In a decision dated in January 1981, the Board found that new and material evidence had not bee received to reopen the claim. 3. The evidence added to the record since the October 1979 Board decision is not wholly cumulative, but when viewed in conjunction with the evidence previously of record, the new evidence is not sufficient to raise a reasonable possibility of an outcome different from that reached by the Board in 1979. CONCLUSION OF LAW Evidence received since the October 1979 Board decision denying service connection for an acquired psychiatric disorder is not new and material, and the claim for this benefit is not reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim for service connection for an acquired psychiatric disorder was denied by the Board in a decision dated in October 1979. The Board found at that time that the veteran had not exhibited symptoms of an acquired psychiatric disorder during his active service and that a psychosis was not present to a compensable degree within a year following his separation from service. The Board further found that any current acquired psychiatric disorder did not have its onset during the veteran's active service, nor was any such disability aggravated during his active service. In a decision dated in January 1981, the Board found that evidence submitted in conjunction with an application to reopen the claim for service connection for an acquired psychiatric disorder was essentially cumulative in nature and that the factual basis with respect to the issue of service connection for an acquired psychiatric disorder remained essentially unchanged. The Board essentially concluded that new and material evidence had not been received to reopen the previously denied claim. Those decisions are final based on the evidence then of record. 38 U.S.C.A. §§ 7103, 7104 (West 1991); 38 C.F.R. § 20.1100 (1993). However, the claim will be reopened if new and material evidence has been submitted since the last final decision on the merits. 38 U.S.C.A. § 5108; 38 C.F.R. §§ 3.156(a), 20.1105 (1993); Manio v. Derwinski, 1 Vet.App. 140, 145 (1991); see Glynn v. Brown, 6 Vet.App. 523, 528-29 (1994). After a careful review of the record, the Board finds that the evidence received since the 1979 Board decision is new, in part, because it was not previously physically of record and is not wholly cumulative. The Board further finds, however, that the newly submitted evidence is not material, because although the new evidence is relevant and probative, it does not raise a reasonable possibility of an outcome different from that reached by the Board in 1979, when considered in conjunction with the evidence then of record. Evidence that was of record at the time of the 1979 Board decision included the veteran's service medical records, which show no complaints or findings of psychiatric disability when the veteran was examined for service entrance in August 1966. In March 1969, the veteran was seen at a service dispensary for complaints of chest pain of about a week's duration accompanied by increasingly rapid respiration and anxiety. The veteran reported that he did not have any nervous problems, although there was some question of whether he had sleeping or eating problems. A physical examination of the chest and heart was unremarkable, and the impression was anxiety. The service medical records, including a June 1969 separation examination report, are otherwise negative for complaints or findings of any psychiatric disorder. Other evidence of record at the time of the 1979 Board decision included the veteran's initial claim for VA benefits received in June 1977; an August 1978 report of VA examination; documents pertaining to proceedings before a service discharge review board in 1978; a January 1979 statement by a retired colonel who had been a service judge advocate; the transcript of a June 1979 hearing before the Board in Washington, D.C. Also of record were the transcript of the veteran's special court-martial in December 1968, with documents relating to pretrial and post trial proceedings, and documents relating to a clemency recommendation during service following his conviction by special court-martial and ensuing confinement. The record of trial by special court- martial included a verbatim transcript, which contained the veteran's sworn testimony in extenuation and mitigation of his offenses. The evidence previously of record showed that the veteran pled guilty to larceny and housebreaking at a trial by special court- martial in December 1968 and that he was convicted in accordance with his pleas and sentenced to a bad conduct discharge and confinement of hard labor for three months. The bad conduct discharge was subsequently upgraded by a service discharge review board. However, the transcript of the court-martial contains no indication whatsoever of the presence or manifestations of a psychiatric disorder. It is notable that the veteran testified under oath during the sentencing phase of his trial in extenuation and mitigation of his offenses. Had a psychiatric disorder, or symptoms of a psychiatric disorder, been present, it is reasonable to assume that this would have been presented either as a defense to the charges or as part of the defense's case in extenuation and mitigation, yet the record is silent on this point. Although the veteran claims that he had an inordinate fear of incarceration, the record of trial contains no indication of any fear of incarceration. Rather, the veteran was principally concerned with remaining in the service despite his conviction. Indeed, he testified that he had applied for a tour in Vietnam and that he had received orders to Vietnam. He testified that he still had a desire to serve in Vietnam, if given the opportunity to do so. (The evidence of record does not show that he ever actually served in Vietnam during his period of active duty.) Moreover, the veteran was advised by the court that he could be confined at hard labor for six months for his offenses, but he persisted in his guilty pleas. When, later in the trial, he was afforded an opportunity to say anything he desired to the court, in addition to his previous testimony, he did not mention any emotional or psychiatric problems, substance or alcohol abuse as a means of dealing with his emotional problems, or a fear of incarceration. Following service, the veteran initiated attempts to upgrade his bad conduct discharge. He also filed a claim for nonservice- connected pension benefits in June 1977, when he described the nature of his disability as "emotionally upset 1963 thru present." The record in 1979 showed that the veteran was first seen for complaints referable to a psychiatric disorder in October 1974 by a private physician, who diagnosed anxiety neurosis and personality inadequacy. Although the private physician did not attribute the veteran's anxiety neurosis to service, he acknowledged that he did not have expertise in psychiatric disorders. The veteran was also seen privately in June and July 1976 for complaints of anxiety, depression and an inability to hold gainful employment or sustain personal relationships. His problem was felt to be chronic, to have persisted for about 15 years, and to be affecting all spheres of his daily life. It was further reported that the veteran had used drugs and alcohol to cope with previous life stresses. The initial clinical impression was simple schizophrenia, but psychological testing was thought necessary to establish a diagnosis. It is significant that the veteran's psychiatric problems were not attributed to service and that no history pertinent to service was elicited at that time. When seen in early July 1976, it was reported that he had had no previous psychiatric experience. The final diagnosis when treatment was ended in December 1976 was simple schizophrenia. Thereafter, the veteran was examined on several occasions to determine his eligibility for Social Security disability benefits. In a letter dated in August 1976, Dr. Morris stated that the veteran claimed that he had gotten "into a bad position" with two of his employers in 1970 and in 1972 and that he ended up quitting both jobs. The veteran reported that he never liked the discipline of the service and took to alcohol and marijuana, which in turn led him to a bad discharge and 90 days in the stockade. Dr. Morris said that the veteran gave an excellent historical account and that he showed considerable insight. The veteran was felt not to show schizophrenic characteristics at that time, although he was also felt to exhibit massive ambivalence and personal disorganization. Dr. Morris said that he could not say whether this was the result of a latent schizophrenia. His psychiatric impression was phobic neurosis, focalized at present in a fear of failure, chronic. The examiner did not associate the diagnosis with the veteran's active service. In a disability determination evaluation report dated in April 1977, Dr. Urton reported that the veteran had had a number of jobs since service, the longest lasting about 10 or 11 months. Following a psychiatric workup, Dr. Urton diagnosed chronic paranoid schizophrenia, but he did not attribute it to service. He remarked that the veteran appeared to be deteriorating and that he had no particular insight regarding his illness. In its proceedings, a service discharge review board found that the veteran attributed his larceny in service to having been persuaded by another individual involved and that the veteran admitted his use of drugs after his entry into service and during the period of his offenses. The veteran indicated that his association with the other individual involved in the larceny was precipitated by that individual's possession of drugs at the time and their mutual use of the drugs. The record of the special court-martial, however, does not reflect this. The discharge review board noted that a service correctional officer had recommended that the veteran be granted clemency because of his attitude and conduct while confined. The discharge review board found that the record of the veteran's post conviction confinement indicated that there was a high likelihood that he would have been a successful participant in a rehabilitation program. However, the Board observes that if, as the veteran maintains, he was afflicted with psychiatric disability that began in service, it is reasonably inferable that his participation in a rehabilitation program for return to useful service would have met with limited success. Nowhere do the documents relating to the inservice clemency recommendation mention any symptoms of emotional stress or psychiatric disability. In a letter dated in January 1979, a retired service staff judge advocate reported that he had interviewed the veteran at the time of his confinement in 1969 and that it was his "best recollection" that the veteran was inordinately afraid of confinement and that, after his release, that fear was still present, possibly even magnified. The opinion of the former staff judge advocate, however, is entitled to little weight in determining whether the veteran developed a chronic psychiatric disorder as a result of confinement. A judge advocate is not a psychiatrist, and his lay opinion is not competent evidence of psychiatric disability. Espiritu v. Derwinski, 2 Vet.App. 492, 494-95 (1992). Moreover, a considerable fear of incarceration was not an irrational response by the veteran to his predicament, and it does not follow that his fear, however magnified, constituted the presenting symptom of psychiatric illness. In statements and testimony of record at the time of the Board's 1979 decision, the veteran persisted in his contention that he had a phobia about confinement. He indicated that this was a manifestation of the use of drugs to which he was exposed during service. The veteran claimed that his confinement compounded his phobia, eventually maturing into a paranoia for which he was never treated because he was separated from service with a bad conduct discharge as a part of the sentence of his court-martial. In a statement dated in April 1979, his field representative maintained that confinement caused or aggravated the veteran's psychiatric disorder. It was claimed that the veteran first became involved in alcohol and drug abuse while he was overseas and that the stress of his confinement was the cause and basis of his current psychiatric disability. It was asserted that he spent more than two years overseas and that the record demonstrated that since his confinement overseas, he had been "unable to relate to people because of everyday emotional stress" and that he was unable to sustain any type of gainful employment. It was maintained that his mental condition, formerly diagnosed as inadequate personality, was now correctly diagnosed as simple schizophrenia and that his simple schizophrenia was aggravated by overseas confinement. In June 1979, the veteran gave sworn testimony at a hearing before the Board in Washington, D.C., in which he recounted his service experience, including his encounter with drugs and alcohol in the months leading up to his involvement in a barracks larceny. He said that he and another serviceman got "high" during this time and that there was "a lapse, or I went blank or something when I agreed to commit this offense." The veteran further testified that he took one of the stolen items to a pawn shop and pawned it because he just wanted to get rid of it. He said that the pawn shop had the "theft sheet" noting the item and that it was reported, leading to his arrest. The veteran also reported, as he had during his court-martial, that he had received a number of nonjudicial punishments for failure to repair, which he said was being late for work, because of trouble oversleeping. He also reiterated what he described as his intense fear of confinement amounting to a phobia. However, he further testified that his confinement was normal and that he carried out the duties of confinement without incident. He stated that he was confined from late December 1968 until late March 1969. The veteran reported that a couple of weeks following his release, he was lying on his bunk and heard a clinking noise of someone walking down the hall with keys dangling and opening a door. He claimed that he instantly froze up and became paranoid. He said that, whenever he heard dangling keys or a door slamming, he would jump and become nervous, paranoid and fearful and that he would perspire and have trouble breathing. He also testified regarding his problems holding a job following his separation from service. He said that his last full-time employment was in about 1972 and that he had not worked steadily since then. The veteran stated that he was not taking medication for any psychiatric disorder and that he was not under treatment by a psychiatrist. He reported that he was not on any prescription drugs at the time of his separation from service. When the veteran was examined by VA in August 1978, however, it was remarked that he did not present any psychiatric distress and that with regard to his alleged nervous problems, a review of his history seemed to demonstrate that he had been unable to adjust to rules and environment since he was in his teens. Although the report of VA examination reflects a claim by the veteran that he was under treatment for his nervous problem by a private psychiatrist in 1966 and 1967, there is no evidence of record to support this. On mental status examination, his behavior, insight and judgment were found to be within normal limits. The psychiatric diagnosis was that no psychosis was present and the he most probably manifested an inadequate personality. Evidence received since the October 1979 Board decision includes a February 1968 letter of commendation mentioning the veteran; an April 1980 report of psychiatric evaluation by John J. Schwab, M.D., professor and chairman in the Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Louisville, with Dr. Schwab's June 1980 addendum; private treatment reports; and a number of lay witness statements, including those of a service comrade who was a senior noncommissioned officer in service; and numerous statements by the veteran himself; a statement dated in April 1988 from Dr. Urton; a fee-basis psychology report dated in November 1989; reports of VA outpatient treatment from March 1989 to June 1992; a September 1992 report of VA examination; a letter dated in May 1971 from the former staff judge advocate and a duplicate of his letter dated in January 1979; a letter dated in May 1971 from a Louisville attorney; a letter dated in October 1981 from a service comrade who was senior noncommissioned officer in service; a duplicate of findings and conclusions from proceedings before a service discharge review board; a duplicate of a Statement of Accredited Representative in Appealed Case (VA Form 1-646) dated in April 1979; a copy of the veteran's resume and numerous statements from the veteran, including a statement dated in March 1992 in which he enclosed the diagnostic criteria for post-traumatic stress disorder and generalized anxiety disorder contained in the third revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). Other evidence received since the 1979 Board decision included a statement from the chief of police of Louisville, Kentucky, dated in May 1971, to the effect that the veteran did not have a record with the police in Louisville. Other lay witness statements, including a statement from his mother and statements from several employers, tended to indicate post service adjustment problems. His mother, in particular, asserted that, after returning from service overseas in July 1969, the veteran was listless, nervous, and very withdrawn, while before service he had always seemed to be interested and sociable. Letters from a service comrade who supervised him following his release from confinement in 1969 were favorable regarding his work habits and trustworthiness and contended that "his conviction for theft was exceptional, the product of a misguided grudge against the person whose property he took, which was exaggerated by some of the poor acquaintanceships [the veteran] had made in the squadron." "New" evidence is evidence that is not merely cumulative of evidence previously of record. Colvin v. Derwinski, 1 Vet.App. 171, 174 (1991). "Material" evidence is evidence that is relevant to, and probative of the issue at hand and which is of sufficient weight or significance that there is a reasonable possibility that the new evidence, when viewed in the context of all of the evidence of record, both new and old, would result in a different outcome. Cox v. Brown, 5 Vet.App. 95, 98 (1993). In determining whether to reopen a previously denied claim, the new evidence is presumed to be credible. Justus v. Principi, 3 Vet.App. 510, 513 (1992). However, a medical opinion based on an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet.App. 458, 460-61 (1993). The evidence added to the record since the 1979 Board decision is partially cumulative because it repeats contentions or evidence that was considered by the Board in 1979. Although some of the evidence is new, the Board finds that none of the newly submitted evidence convincingly attributes any of the veteran's current psychiatric problems to service that ended in 1969. The 1980 reports of Dr. Schwab and the April 1988 letter of Dr. Urton are the only new medical evidence concerning the veteran's contention that he has chronic psychiatric disability as a result of service. In his April 1980 report, Dr. Schwab stated that he had reviewed documents from a private mental health center, as well as the reports of Drs. Morris and Urton, and that he had also met with the veteran for about an hour and a half. During that interview, the veteran reportedly claimed that he was pressured by peers into beginning drug use in service. The veteran asserted that he was under the influence of marijuana when he assisted another serviceman in a theft for no reason and for no personal profit. The veteran claimed that he began to suffer from panic attacks and claustrophobia during his confinement at hard labor. In the two years following his separation from service, the veteran said that he had severe nervousness, "spells of feeling freezing cold even though it was in July," and an inability to function. Dr. Schwab's diagnostic impression was chronic anxiety with phobia and panic attacks; low tolerance of stress with psychosomatic reactions; difficulties with interpersonal relationships; and social and vocational dysfunctions since his discharge from service. Dr. Schwab attributed the veteran's problems to service. In an addendum dated the following June, Dr. Schwab said that the diagnosis under new diagnostic criteria would be chronic severe generalized anxiety disorder with intermittent panic attacks, some phobic characteristics, and psychosomatic reactions. Dr. Schwab said that no diagnosis of a personality disorder had been made. In his April 1988 letter, Dr. Urton reviewed his association with the veteran and offered the opinion that neither a diagnosis of anxiety neurosis with inadequate personality nor a diagnosis of schizophrenic reaction, paranoid type, reflected the veteran's clinical picture. Dr. Urton therefore recommended a diagnosis of chronic post-traumatic stress disorder. Although Dr. Urton reviewed the veteran's assertions regarding his confinement and drug abuse in service, it is notable that Dr. Urton first saw the veteran only a few years prior to the date of his letter and thus many years following the veteran's separation from service. The record shows that the history that Dr. Urton relied on derived solely from the story told by the veteran, and it is significant that, even with this history, Dr. Urton does not specifically attribute his diagnosis to service. Although this may be implicit in his letter, there is no explicit statement of any etiological relationship. It is also notable that Dr. Schwab's evaluation and Dr. Urton's assessment, as well as the history elicited on VA examination in September 1992 and reflected in the VA outpatient treatment reports for the period from 1989 to 1992, make no mention of the "kill or be killed" situation that the veteran claims he was in during his confinement, nor does this evidence confirm that the veteran saw violence and suicides during his confinement, as he claimed in a statement dated in July 1992. Just as significantly, clemency documents dated near the end of his confinement in 1969 do not refer to any of his contentions regarding the violence and suicides he claims he witnessed while incarcerated and the "kill or be killed" situation he claims he found himself in while incarcerated. The findings of a service discharge review board in 1978 are similarly negative for any reference to the allegedly adverse conditions of the veteran's confinement. A May 1971 letter, which was not received until March 1992, from the former staff judge advocate who wrote the clemency interview contains his opinion that the veteran exhibited "marked immaturity" from before his entry into service through the time of his court- martial; an inordinate fear of confinement is not mentioned. The record simply does not support the October 1981 statement of the senior noncommissioned officer who supervised the veteran following his release from confinement. This statement notes for the first time that a change came over the veteran following his release and that it was noticed that he was extremely nervous, sensitive and attentive. He reported that the veteran excelled in his work but that he still showed evidence of nervousness and paranoia and always suspected that someone was spying on him or rejecting him. It is significant that none of these symptoms was mentioned by the same service supervisor in the letter he wrote in February 1970 supporting the veteran's request to have his discharge upgraded. That letter records that the veteran actually lived for several months with him and his family, yet none of the symptoms that he mentions in 1981 were noticed in 1970. The Board accords the 1970 correspondence greater weight because it was written less than a year following the veteran's release from confinement at a time when the veteran's conduct and demeanor following confinement would have been fresh in the writer's mind. The veteran himself seems to have had trouble getting his story straight concerning the motivation for his criminal conduct in service. A clemency evaluation document indicates that the veteran gave the impression that another serviceman "used" the veteran to "square" a grudge with a third service member, who was portrayed as being held in low esteem by many members of the command. When asked whether he considered another person's antisocial attitude a reason for stealing from him, the veteran said that he did not. The veteran stated that he was certain that the theft was aberrational and the result of an immature mind open to suggestion. However, the veteran made no mention of any grudge against the victim of the larceny in proceedings before a service discharge review board a number of years later; rather, he said that his involvement in the larceny was precipitated by another service member's possession of drugs and their mutual use of those drugs. When the veteran was examined by VA in September 1992, he claimed that the traumatic event in service was not combat, but arose from his being incarcerated in service. He stated that his trauma was from "just being locked up." He gave no history of flashbacks or of intense psychological distress when he was exposed to events that might symbolize this trauma. After an extensive review in light of the applicable diagnostic criteria for post-traumatic stress disorder, the examiner stated that it was "quite evident" that the veteran did not meet the full diagnostic criteria for post-traumatic stress disorder. The veteran gave a history of having been chronically depressed and anxious since 1964, when his father died. He indicated that he had been depressed and anxious since that time. The examiner remarked that he did an extensive review of the veteran's outpatient mental hygiene clinic records and noted that the veteran first sought outpatient psychiatric treatment in 1989 and that, after three years of compliant outpatient treatment, a diagnosis of post-traumatic stress disorder had not been made. The diagnoses on Axis I were dysthymia; anxiety disorder, not otherwise specified; cannabis abuse, in remission; amphetamine abuse, in remission; and alcohol abuse, in remission. The diagnosis on Axis II was mixed personality disorder. The examiner again commented that the veteran did not meet the full diagnostic criteria for post-traumatic stress disorder. In light of the history elicited, the examiner concluded that his psychiatric symptoms predated his military service. The veteran underwent a fee-basis psychological evaluation in November 1989 that included a battery of psychological tests. The examiners noted the veteran's history of a "struggle to survive" while incarcerated and also noted that there were times when the attitude of "kill or be killed" was very pronounced, but the examiners specifically found that symptoms associated with post-traumatic stress disorder, while evident, were not of sufficient severity or frequency to warrant the diagnosis of post-traumatic stress disorder. The psychological evaluation also indicated that the veteran had a tendency to exaggerate symptoms. The examiners stated that it appeared that the veteran had depression with associated symptoms of anxiety, coupled with features of a borderline and paranoid personality disorder. The diagnoses on Axis I were dysthymia, primary, late onset; anxiety disorder, not otherwise specified (with partial symptoms of post- traumatic stress disorder); alcohol abuse, in remission; psychoactive substance abuse, in remission; and somatoform disorder, not otherwise specified. The diagnosis on Axis II was borderline and paranoid features. The findings of the psychological evaluation are thus essentially consistent with the findings on subsequent VA examination. Despite the reference to partial symptoms of post-traumatic stress disorder, it is apparent from the psychological evaluation and the subsequent VA examination that a diagnosis of post-traumatic stress disorder has not been confirmed medically. Moreover, the Board is of the opinion that stressful incidents of a nature to support a diagnosis of post-traumatic stress disorder have not been substantiated, despite the veteran's recitation of events surrounding his incarceration. His numerous recent statements, while interesting, simply recite assertions that coincide with the criteria for post-traumatic stress disorder with which the veteran is familiar, in light of the fact that he submitted into the record the diagnostic criteria for post- traumatic stress disorder and generalized anxiety disorder from DSM-III-R. However, the evidence more contemporaneous with service, including the clemency evaluation, the service medical records, and the proceedings before a service discharge review board are, in the Board's opinion, entitled to considerably greater weight than the veteran's various assertions, which were made while a claim for compensation benefits was pending and which are not shown to be corroborated by the record. Although the veteran is competent to testify about the symptoms he experienced in service, he is not competent to offer a medical opinion attributing a chronic psychiatric disorder to service. See Grottveit v. Brown, 5 Vet.App. 91, 92-93 (1993); Espiritu v. Derwinski, 2 Vet.App. at 494-95 (1992). The assertions of a medical causation by lay witnesses, including the veteran or his representative, do not constitute new and material evidence to reopen a previously denied claim. Moray v. Brown, 5 Vet.App. 211, 214 (1993). The new evidence, considered in the context of the evidence previously of record, does not demonstrate that the veteran has a psychiatric disorder that was acquired as a result of service. Rather, the earliest indication of chronic psychiatric disability is shown a number of years following service and is not shown to be related to service. The Board notes that there is no convincing evidence that the veteran had alcohol or drug abuse in service as a result of chronic psychiatric disability, and primary drug or alcohol abuse does not constitute a disability for which VA compensation benefits are payable. 38 U.S.C.A. § 105(a) (West 1991); 38 C.F.R. § 3.301 (1993). Similarly, a personality disorder, as such, is not a disability under the law governing the payment of compensation benefits. 38 C.F.R. § 3.303(c) (1993). Although the record suggests that the veteran's symptoms of depression and anxiety might have preexisted service, there is simply no evidence to show that his symptoms increased in severity during service. Although a transient attack of anxiety was noted in March 1969, a chronic psychiatric disorder as a result of service is not demonstrated, especially in light of a separation examination a few months later that was completely negative for complaints or findings of any psychiatric abnormality. The veteran himself has offered no medical evidence to show that he had a preexisting psychiatric disorder that increased in severity during service. Rather, he maintains that he has a chronic psychiatric disorder that began in service. The Board takes special note of the evidence of Dr. Urton and Dr. Schwab. However, the opinions of Drs. Urton and Schwab regarding the etiology of the veteran's psychiatric disability are based completely on a history furnished by the veteran and can be no better than the facts alleged by him. Elkins v. Brown, 5 Vet.App. 474, 478 (1993); Reonal v. Brown, 5 Vet.App. at 460-61; Swann v. Brown, 5 Vet.App. 229, 233 (1993). A rejection of the factual premise necessarily involves a rejection of the etiological opinion based on that premise. As indicated above, there are many sound reasons to reject the history furnished to Drs. Urton and Schwab by the veteran. The Board also notes that neither Dr. Urton nor Dr. Schwab appears to have actually reviewed the relatively extensive claims file. Accordingly, the Board finds that the additional evidence lacks sufficient weight, when viewed in conjunction with the evidence previously of record, to raise a reasonable possibility of an outcome different from that reached by the Board in 1981. Cox v. Brown, 5 Vet.App. at 98. It follows that the application to reopen the claim of entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder, must be denied. ORDER New and material evidence not having been submitted, the application to reopen a claim of entitlement to service connection for an acquired psychiatric disorder, to include post- traumatic stress disorder, is denied. ROBERT E. SULLIVAN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.