Citation Nr: 0002938 Decision Date: 02/04/00 Archive Date: 02/10/00 DOCKET NO. 94-18 677 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to an increased evaluation for atherosclerotic heart disease, status post angioplasty and history of hypertension, currently evaluated as 30 percent disabling. 2. Entitlement to service connection for a psychiatric disorder, to include schizophrenia and post-traumatic stress disorder. REPRESENTATION Appellant represented by: Al Chadick, attorney WITNESSES AT HEARING ON APPEAL Appellant and Dr. Rodrigo M. Galvez ATTORNEY FOR THE BOARD A. P. Simpson, Associate Counsel INTRODUCTION The appellant served on active duty from July 1960 to October 1976. This case comes before the Board of Veterans' Appeals (the Board) on appeal from a September 1993 rating decision of the Jacksonville, Mississippi, Department of Veterans Affairs (VA) Regional Office (RO). In the September 1993 decision on appeal, the RO denied service connection for post-traumatic stress disorder. At the March 1994 RO hearing, the appellant's attorney stated that they wanted to include a claim for service connection for schizophrenia and gave testimony on such claim. In a September 1994 hearing officer's decision, the hearing officer referred the claim for service connection for schizophrenia to the rating board for consideration. In a September 1994 rating decision, the RO denied service connection for schizophrenia. At the September 1996 hearing before this Board Member, the appellant stated that he wished to amend the issue of service connection for post-traumatic stress disorder to service connection for a psychiatric disorder, to include schizophrenia and post-traumatic stress disorder. The Board finds that the September 1993 rating decision was broad enough as to the claim for service connection for post- traumatic stress disorder to allow the issue of service connection for a psychiatric disorder to include schizophrenia to be in appellate status and currently before the Board. Thus the issue before the Board is service connection for a psychiatric disorder, to include schizophrenia and post-traumatic stress disorder Additionally, in the September 1993 decision on appeal, the RO continued the 10 percent disability evaluation for essential hypertension. In a March 1997 rating decision, the RO reclassified the appellant's disability as atherosclerotic heart disease, status post angioplasty with history of hypertension and granted a 30 percent disability evaluation. The Board remanded these claims in March 1996, November 1996, September 1997, and June 1999. The requested development has been accomplished, to the extent possible, and the case has been returned to the Board for further appellate review. Review of the record reveals that the RO expressly considered referral of the case to the Chief Benefits Director or the Director, Compensation and Pension Service for the assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1) (1999). This regulation provides that to accord justice in an exceptional case where the schedular standards are found to be inadequate, the field station is authorized to refer the case to the Chief Benefits Director or the Director, Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. The governing criteria for such an award is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. The United States Court of Appeals for Veterans Claims (formerly the United States Court of Veterans Appeals) (hereinafter "the Court")) has held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance; however, the Board is not precluded from raising this question, and in fact is obligated to liberally read all documents and oral testimony of record and identify all potential theories of entitlement to a benefit under the law and regulations. Floyd v. Brown, 9 Vet. App. 88 (1996). The Court has further held that the Board must address referral under 38 C.F.R. § 3.321(b)(1) only where circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The Board has reviewed the record with these mandates in mind and finds no basis for further action on this question. VAOPGCPREC. 6-96 (1996). FINDINGS OF FACT 1. Atherosclerotic heart disease, status post angioplasty and history of hypertension is currently manifested by workload of METs of between 5 and 7. 2. The appellant does not have a current diagnosis of post- traumatic stress disorder. 3. A psychiatric disorder, to include schizophrenia, did not manifest during service or within one year following service. 4. A psychiatric disorder, to include schizophrenia, is not due to service. CONCLUSIONS OF LAW 1. Atherosclerotic heart disease, status post angioplasty and history of hypertension is 60 percent disabling. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7005 (1999). 2. The claim for service connection for post-traumatic stress disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991) 3. A psychiatric disorder, to include schizophrenia was not incurred or aggravated in active service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Increased evaluation The Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claim for an increased evaluation for atherosclerotic heart disease, status post angioplasty and history of hypertension is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). That is, his assertion that his service-connected disability has worsened raises a plausible claim. See Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). The appellant has been recently examined and his medical records have been obtained. See Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). All relevant facts on this issue have been properly developed and the duty to assist has been met. 38 U.S.C.A. § 5107(a). Service connection for hypertension was granted by means of a May 1977 rating decision and assigned a 10 percent evaluation. In March 1997 rating decision, the RO granted a 30 percent evaluation and reclassified the service-connected disability as atherosclerotic heart disease, status post angioplasty with history of hypertension. The Board notes that it is presumed that the appellant is seeking the maximum benefit allowed by law and regulation, and "it follows that such a claim remains in controversy where less than the maximum available benefit is awarded." AB v. Brown, 6 Vet. App. 35, 38 (1993). The appellant underwent a VA examination in July 1993. He reported that he was not on a low-salt diet. Cardiac examination revealed a regular rate without murmurs, rubs or gallops. Point of maximum impulse was not displaced. Precordium was not hyperactive, and there was no peripheral edema. Blood pressure was 150/84, 150/82 sitting, 150/88 reclining, and 130/88 standing. The VA examiner noted that the appellant brought three blood pressure readings from the local fire department, which were 129/88, 139/82, 143/87. The VA examiner stated that chest x-ray and EKG were within normal limits. The diagnosis was hypertension. The appellant had an RO hearing in March 1994. The appellant stated that he could tell when his blood pressure would rise, which was usually due to stress. He stated that when he did not take his medication, he would get light headed. The appellant stated that his systolic readings usually ranged from 130-140 and that his diastolic readings were usually 100. In September 1994, the appellant was admitted to a private hospital in its emergency room with complaints of chest pain. It was noted that examination was unremarkable. The final relevant diagnoses were chest pain, uncertain etiology, and hypertension. In August 1995, the appellant was seen at a private facility with complaints of edema for approximately two days. He denied chest pain, dyspnea, or paroxysmal. Examination of the heart revealed normal rhythm and rate. The heart sounded normal, and there was no systolic or diastolic murmurs. The differential diagnosis was congestive heart failure. The appellant had a hearing before this Board Member in September 1996. The appellant stated that he had never had a heart attack, but that he had had chest pains. He stated that his last blood pressure reading was approximately 166/82. He stated that he believed that an increased evaluation should be granted because it had been hard for him to control his blood pressure. Private medical records reveal that in September 1996, the appellant underwent cardiac catheterization in September 1996 and then an angioplasty. The appellant had been reporting chest discomfort. A chest x-ray taken in October 1996 showed normal cardiomediastinal silhouette. The aorta was noted to be mildly elongated. The conclusion was no acute cardiopulmonary process. In a November 1996 letter, Dr. Jefferson A. Fletcher stated that the appellant had been checked into the emergency room with chest pain. Dr. Fletcher noted that the appellant had been previously seen in the emergency room with chest pain and that the chest pain was atypical for ischemic heart disease. Dr. Fletcher stated that the appellant underwent a treadmill exercise test by the Bruce protocol to around 5 METs. He stated that the test was negative for exercise induced myocardial ischemia to a submaximal heart rate. In a November 1996 letter, Dr. Jimmy W. Lott stated that he had seen the appellant and that his blood pressure was 150/104. Dr. Lott noted that the appellant's chest pain had become stable. The appellant underwent a VA examination in January 1997. The appellant reported that he had undergone an angioplasty three months prior. He stated that he followed a low-salt diet. The appellant denied a history of headaches or peripheral edema. The appellant's blood pressure was 200/110, 196/110 sitting, 190/108 reclining, and 190/110 standing. Cardiac examination revealed a regular rate and rhythm without murmurs, rubs, or gallops. Point of maximum impulse was not displaced. Precordium was not hyperactive. There was a trace of pretibial edema on the right, but it was negative on the left. EKG revealed right atrial enlargement, otherwise it was within normal limits. Chest x-ray revealed the cardiac silhouette to be normal. The VA examiner noted that the appellant's blood pressure was taken later on in the day and that the readings obtained were 200/170 sitting, 172/112 reclining, and 200/128 standing. The diagnoses were hypertension, poor control, and coronary artery disease, status post angioplasty. In January 1997, the appellant was seen at a private facility with complaints of left-sided chest pain. Examination of the heart revealed regular rhythm without a murmur. Dr. Frank Koe stated that the appellant was placed on a cardiac monitor. An EKG was performed, and it was normal. Cardiac enzymes were normal. A chest x-ray taken at that time revealed no evidence of infiltrate or effusion. The cardiomediastinal shadow was unremarkable. It was noted that there was no active disease. The diagnosis was atypical chest pain. In a January 1997 letter, Dr. George E. Patton stated that he had been treating the appellant for hypertension and noted that the appellant had been treated for atherosclerotic heart disease by a cardiologist. Dr. Patton stated that the appellant's blood pressure had become more labile and more difficult to control, but noted that recently, the appellant had gotten his blood pressure under control with a number of medications. In a July 1997 letter, Dr. Lott stated that the appellant had been experiencing right upper extremity aching sensation, which radiated down to the right forearm. The appellant reported that this had occurred over the last several days. Dr. Lott stated that upon physical examination, the appellant's range of motion was not limited and his neurologic examination was grossly normal. A cardiogram showed sinus mechanism with non-specific ST-T abnormality. Dr. Lott determined that the pain was musculoskeletal in nature, noting that the appellant's discomfort was not characteristic of anginal syndrome. In August 1997, the appellant was seen at a private facility with complaints of chest pain. The appellant reported that the chest pain was similar to angina pain. Examination of the appellant's heart revealed regular rhythm without murmur, rub, or gallop. An EKG was normal. Chest x-rays showed that the cardiac silhouette was normal. The clinical impression was chest pain, resolved. Dr. William P. Burke noted that this may have been the appellant's angina pain. Chest x-rays taken in January 1999 and February 1999 revealed no acute cardiopulmonary disease. The appellant underwent a VA examination in July 1999. The VA examiner noted that the claims file was reviewed. The appellant reported that he started having chest pains in 1994 or 1995. He stated that the chest pain occurred once every week or two and that he would sit and relax for a while, which would bring him relief. He stated that the used nitroglycerine two to three times per year for chest pain. The appellant reported that he exercised by swimming two to three times per day for 20 minutes. He stated that he also did other water exercises. The VA examiner noted that there was no history of dizziness, syncope, dyspnea, nor fatigue. The appellant reported some swelling in the legs but that it would usually resolve itself. The VA examiner stated that the appellant's blood pressure was 200/94, 170/94, sitting, and 180/94 reclining. He noted that a later blood pressure reading was 140/80 standing. Cardiac examination revealed a regular rate without murmurs, rubs, or gallops. Point of maximum impulse was not displaced. Precordium was not hyperactive. There was no peripheral edema. Chest x-ray showed a normal heart size. The diagnoses were hypertension, atherosclerotic cardiovascular disease, status post angioplasty with angina (5 to 7 METs). Service-connected disabilities are rated in accordance with a schedule of ratings that are based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4 (1999). In the rating decision on appeal, the RO reviewed the appellant's claim for an increased evaluation for atherosclerotic heart disease, status post angioplasty and history of hypertension under the old rating criteria for cardiovascular disorders. The criteria for cardiovascular disorders were amended in January 1998. When a regulation changes after a claim has been filed but before the appeal process has been completed (which would apply here), the version most favorable to the claimant will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Under the old criteria for coronary artery bypass, a 100 percent evaluation was assigned for one year following bypass surgery and thereafter, residuals were rated under arteriosclerotic heart disease (Diagnostic Code 7005) with a minimum evaluation of 30 percent. 38 C.F.R. Part 4, Diagnostic Code 7017 (1997). Under Diagnostic Code 7005, a 100 percent evaluation is warranted during and for six months following acute illness from coronary occlusion or thrombosis, with circulatory shock, etc. 38 C.F.R. Part 4, Diagnostic Code 7005 (1997). Additionally a 100 percent evaluation is warranted when after six months following acute illness, the veteran has chronic residual findings of congestive heart failure or angina on moderate exertion or more than sedentary employment is precluded. Id. A 60 percent evaluation is warranted following typical history of acute coronary occlusion or thrombosis as above, or with history of substantiated repeated anginal attacks, more than light manual labor is not feasible. Id. A 30 percent evaluation is warranted when following typical coronary occlusion or thrombosis, or with history of substantiated anginal attack and ordinary manual labor feasible. Id. Under the old criteria, hypertensive vascular disease (essential arterial hypertension) manifested by diastolic pressure which is predominantly 100 or more warrants a 10 percent evaluation. 38 C.F.R. Part 4, Diagnostic Code 7101 (1997). When the diastolic pressure is predominantly 110 or more with definite symptoms, a 20 percent evaluation is warranted. Id. For diastolic pressure predominantly 120 or more and moderately severe symptoms, a 40 percent evaluation is warranted. Id. If pressure is predominantly 130 or more and there are severe symptoms, a 60 percent evaluation is warranted. Id. For the 40 percent and 60 percent evaluations, there should be careful attention to diagnosis and repeated blood pressure readings. Id. at Note 1. Under the new criteria, a 100 percent evaluation may be assigned for arteriosclerotic heart disease (coronary artery disease) with documented coronary artery disease resulting in chronic congestive heart failure, or; workload of 3 metabolic equivalents (METs) or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. Part 4, Diagnostic Code 7005 (1999). A 60 percent evaluation may be assigned with more than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. Id. A 30 percent evaluation is warranted when workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or shows evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram or x-ray. Id. Under the new criteria, when hypertensive vascular disease is manifested by diastolic pressure predominantly 100 or more, or systolic pressure of 160 or more, or minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control, a 10 percent evaluation is assigned. 38 C.F.R. Part 4, Diagnostic Code 7101 (1999). If diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more, a 20 percent evaluation is assigned. Id. For diastolic pressure predominantly 120 or more, a 40 percent evaluation is assigned. Id. For diastolic pressure predominantly 130 or more, a 60 percent evaluation is assigned. Id. After having reviewed the evidence of record, the Board concludes that the evidence supports a 60 percent evaluation for the service-connected atherosclerotic heart disease, status post angioplasty and history of hypertension. The appellant underwent a cardiac catheterization in September 1996 and then an angioplasty. He has been seen numerous times following the surgery for chest pain. In November 1996, the appellant's workload was 5 METs. At the time of the July 1999 VA examination, the appellant reported that he had chest pain on a weekly basis. He underwent a VA examination in July 1999. The VA examiner determined that the appellant's workload fell between 5 and 7 METs. The Board finds that the application of 38 C.F.R. § 4.7 (1999) is raised by the evidence in this case. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more closely approximates the criteria required for that evaluation. See id. Additionally, the Board finds that the appellant's current disability picture is more accurately evaluated under the Diagnostic Codes (the old and the new) for heart disease versus hypertension. In reviewing the old criteria, the appellant has reported chest pain repeatedly since undergoing the angioplasty. He reported at the time of the July 1999 examination report that he had weekly chest pain. The Board finds that such manifestations fall between the symptoms contemplated for a 30 percent and a 60 percent evaluation and thus would warrant a 60 percent evaluation under the old criteria. See 38 C.F.R. § 4.7, Part 4, Diagnostic Code 7005 (1997). In reviewing the new criteria, the appellant's workload has been reported as between 5 and 7 METs. A workload of METs of between 4 and 5 warrants a 60 percent evaluation. See 38 C.F.R. Part 4, Diagnostic Code 7005 (1999). A workload of METs of between 5 and 7 warrants a 30 percent evaluation. Id. The appellant's workload of between 5 and 7 METs would fall in between the 30 percent and 60 percent evaluations, and thus the Board finds that a 60 percent evaluation is warranted. See 38 C.F.R. § 4.7; Part 4, Diagnostic Code 7005 (1999). The Board notes that it has determined that neither the old criteria or the new criteria are more beneficial to the appellant. See Karnas, supra. Although the Board has noted above that the appellant's service-connected atherosclerotic heart disease, status post angioplasty and history of hypertension was more appropriately evaluated under the Diagnostic Codes that address heart disease, even considering the old and new criteria for Diagnostic Code 7101, the Board's granting of a 60 percent disability evaluation would place the appellant at the maximum evaluation under Diagnostic Code 7101. Therefore, the Board need not apply the old and new criteria for Diagnostic Code 7101 to his service-connected disability. An evaluation in excess of 60 percent is not warranted. In reviewing the old criteria, the evidence has not established that the appellant the appellant has undergone bypass surgery nor coronary occlusion or thrombosis with circulatory shock. See 38 C.F.R. Part 4, Diagnostic Codes 7005, 7017 (1997). Additionally, the evidence has not established that the appellant had acute illness more than six months ago and now has chronic residuals of congestive heart failure or angina on moderate exertion or that more than sedentary employment is precluded. See 38 C.F.R. Part 4, Diagnostic Code 7005 (1997). The appellant underwent catheterization and an angioplasty in September 1996. Such does not constitute coronary occlusion or thrombosis. Therefore, the appellant's service-connected atherosclerotic heart disease, status post angioplasty and history of hypertension would not warrant any more than a 60 percent evaluation under the old criteria. As to the new criteria, the medical evidence has not shown, nor has the appellant claimed, that he has chronic congestive heart failure. See 38 C.F.R. Part 4, Diagnostic Code 7005 (1999). His METs have been reported as between 5 and 7, which would warrant no more than a 60 percent evaluation under the new criteria. See id. Additionally, the evidence has not established that the appellant has left ventricular dysfunction. See id. Therefore, an evaluation in excess of 60 percent for atherosclerotic heart disease, status post angioplasty and history of hypertension is not warranted. See id. The appellant is competent to report his symptoms. To the extent that he stated that his atherosclerotic heart disease, status post angioplasty and history of hypertension was worse than the evaluation assigned, he was correct, and the RO granted a 30 percent disability evaluation in March 1997, and the Board has now granted a 60 percent evaluation. However, to the extent that the appellant has implied that he warrants a higher evaluation, the Board finds that the medical findings do not support an evaluation in excess of 60 percent. The Board attaches greater probative weight to the clinical findings of skilled, unbiased professionals than to the appellant's statements, even if sworn, in support of a claim for monetary benefits. To this extent, the preponderance of the evidence is against his claim, and there is no doubt to be resolved. II. Service connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). Service connection for schizophrenia (a psychosis) may be granted if manifest to a compensable degree within one year of separation from service. Service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). In making a claim for service connection, the appellant has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well-grounded claim for service connection generally requires medical evidence of a current disability; evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, a nexus, or link, between the inservice disease or injury and the current disability as provided by competent medical evidence. Cohen v. Brown, 10 Vet. App. 128, 137 (1997); Caluza v. Brown, 7 Vet. App. 498 (1995) aff'd per curiam, 78 F.3d 604 (Fed.Cir. 1996) (table); see also 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303 (1996); Layno v. Brown, 6 Vet. App. 465 (1994); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Alternatively, the nexus between service and the current disability can be satisfied by evidence of continuity of symptomatology and medical or, in certain circumstances, lay evidence of a nexus between the present disability and the symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495 (1997). Establishing direct service connection for a disability that was not clearly present in service requires the existence of a current disability and a relationship or connection between that disability and a disease contracted or an injury sustained during service. Cuevas v. Principi, 3 Vet. App. 542 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). With a "chronic disease," such as schizophrenia (a psychoses), service connection is warranted when the disease is manifested to a compensable degree within one year following service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309(a) (1999). Moreover, establishing a well-grounded claim for service connection for a particular disability requires more than an allegation that the particular disability had its onset in service. It requires evidence relevant to the requirements for service connection cited above and of sufficient weight to make the claim plausible and capable of substantiation. Tirpak v. Derwinski, 2 Vet. App. 609 (1992); see also Murphy, 1 Vet. App. at 81. The kind of evidence needed to make a claim well grounded depends upon the types of issues presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). For some factual issues, competent lay evidence may be sufficient. However, where the claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Grottveit, 5 Vet. App. at 93. Service medical records reveal that reports of medical examinations conducted in July 1960 (two separate examinations), August 1961, August 1962, August 1963, September 1964, September 1965, August 1966, October 1967, December 1968, November 1969, February 1970, August 1971, October 1972, December 1973, February 1975, November 1975, and October 1976 showed normal psychiatric evaluations. In reports of medical history completed by the appellant in July 1960, October 1972, December 1973, and October 1976, he stated "no" to ever having or having now depression or excessive worry or nervous trouble of any sort. The appellant underwent a VA examination in January 1977. The VA examiner noted that the appellant was cooperative, oriented, coherent, and relevant in his responses. The appellant was hospitalized at a VA medical facility in August 1980 with a diagnosis of paranoid schizophrenia. In the hospitalization summary report, the VA examiner stated that for the previous two weeks, the appellant had had a normal history; however, he stated that for the last two weeks, the appellant had reported different behavior. The appellant reported paranoid feelings that there was some sort of plan, that someone was looking out for him, and that everybody was talking about him. The appellant was hospitalized in May 1985 at St. Dominic- Jackson Memorial Hospital with a diagnosis of paranoid schizophrenia. Dr. J. E. Ruff stated that at the time of admission, the appellant "almost certainly seemed to have thought disorder consistent with schizophrenia." The appellant reported that he had been in the military from 1960 to 1976 and was a helicopter pilot and served in Vietnam. He stated that he was not promoted and chose not to stay in the service as a noncommissioned officer. He stated that this had been a continuing stress to him, although he reported that this had been a good experience for him and that he later made lieutenant colonel in the reserves. At the time of discharge, Dr. Ruff noted that there was no evidence of a thought disorder and no evidence of significant depression. A February 1993 outpatient treatment report reveals that the appellant was seen with a complaint of post-traumatic stress disorder. The appellant reported that his physician, Dr. Rodrigo M. Galvez, had diagnosed him with post-traumatic stress disorder. The VA examiner entered medical findings, and the diagnostic impression was post-traumatic stress disorder. In May 1993, the appellant underwent the Minnesota Multiphasic Personality Inventory to be evaluated for post- traumatic stress disorder. The VA licensed clinical social worker stated that the appellant was fully alert, fully oriented, and cooperative throughout the interview process. His mood and affect appeared normal; however, he noted that the appellant would laugh inappropriately on occasion. The appellant reported traumatic events, one of which included his witnessing the shooting of a helicopter with two officers as passengers. He reported that his chief warrant officer was fatally injured in the flight and that the he had observed severe open head wounds in an attempt to remove the officer from the helicopter. The VA social worker stated that during this interview and subsequent disclosures of this traumatic event, the appellant became significantly aroused and demonstrated frequent movement in his legs. At that time, the appellant reported reexperiencing this traumatic event in the form of intrusive thoughts about twice a day, but that the intrusive thoughts increased with warm temperatures. The appellant reported that prior to his psychotic episode in August 1980, he experienced nightmares and intrusive thoughts. He further reported that when he has these thoughts, he would isolate himself. He denied insomnia and reported sleeping well secondary to psychotropic medications. The VA social worker stated that the appellant was cooperative during the testing and appeared to read and work rapidly. The validity scales indicated that the profile was valid, but the VA social worker noted that the appellant's profile was not typical of the profiles seen in Vietnam veterans who have post-traumatic stress disorder. He noted that individuals who have profiles similar to the appellant's were those manifesting multiple neurotic symptoms, which included depression, nervousness, anxiety, weakness, fatigue, lack of initiative, and a pervasive lack of self-esteem and self-confidence. VA outpatient treatment reports dated from March 1993 to September 1993 show that the appellant was attending the Trauma Recovery Program. The VA social workers reported the appellant's complaints as to intrusive thoughts and nightmares. The appellant occasionally discussed a traumatic event. In an April 1993 treatment report, the VA social worker noted that the appellant's private psychiatrist, Dr. Galvez, had been contacted and that he had diagnosed the appellant with paranoid schizophrenia with anxiety related to war stress. The appellant underwent a VA psychiatric evaluation in August 1993. The appellant reported that he was first treated for emotional problems in 1979, when he noted he had a psychotic episode and was under a lot of stress. The appellant stated that he had been treated at the VA at that time. The VA examiner noted that the appellant had been hospitalized August 1980 at a VA medical facility. The appellant reported his current status as "fair" and that he had "good days and bad days." The appellant reported that the last auditory hallucinations he had had were in 1981. He denied any history of homicidal thoughts, or suicidal thoughts. The appellant reported nightmares about Southeast Asia every two to three weeks. The VA examiner stated that the appellant was appropriately dressed, adequately groomed, and exhibited no unusual motor activity. There were no flight of ideas, looseness of associations, and speech was slightly slow. Mood was euthymic, and affect was blunted. He denied hallucinations, delusions, homicidal, and suicidal thoughts. He was oriented to person, place, situation, and time. Remote, recent and immediate recall were good. He appeared to be of average intelligence. Judgment was good, and abstracting ability was good. Insight was fair. The VA examiner stated that the appellant gave a 14-year history of symptoms suggestive of chronic paranoid schizophrenia and noted that although the appellant reported attending Trauma Recovery Program and reported occasionally experiencing a Vietnam-related nightmare, "he d[id] not satisfy the criteria needed for a diagnosis of post-traumatic stress disorder." Private medical records from Dr. Galvez are dated from January 1991 to March 1994. The records indicate the he saw the appellant usually once a month during that time. There were times when he saw the appellant more frequently. In the records, Dr. Galvez discussed whether the appellant was psychotic, which he stated throughout the records that the appellant was not currently psychotic. He believed that the 1980 and 1985 previous episodes were indicative of psychotic breaks and that the appellant may have had a psychotic break again in January 1991. Upon his initial meeting with the appellant, Dr. Galvez gave a diagnosis of paranoid schizophrenia in moderate remission. At that time, he noted that the appellant disclosed no overt psychotic symptoms. The appellant had an RO hearing in March 1994. He and his physician, Dr. Galvez testified at the hearing. Dr. Galvez stated that he was a board certified psychiatrist. He stated that he first saw the appellant in January 1991, when the appellant was referred to him. He stated that the appellant gave him a history of having his first psychotic break in 1979, when he was returning from a trip in Atlanta. Dr. Galvez noted that the appellant was admitted to the VA medical facility at that time and that he eventually went to St. Dominic Hospital in 1985. Dr. Galvez stated the following: Well[,] the history given to me was that he was in the military and was a helicopter pilot. And I don't remember, he told me he had three tours in Vietnam. And we talked very extensively about these. And he returned to the states and was still in the military. But he was pas[sed] for a promotion twice. And that was practically the third time being asked to leave the military-he got [sic] to leave the military. And that is when he got the first psychotic break, in '79. Dr. Galvez stated that the appellant's diagnosis was paranoid schizophrenia. He noted that the appellant got much worse in March 1992 when he was working and received some unsatisfactory evaluations. He stated that the appellant was under tremendous frustration and rejection, which was "pretty much the same as was felt in the military. . ." When asked if his initial diagnosis (in January 1991) was schizophrenia, Dr. Galvez stated yes. When asked if that was still the diagnosis, he responded as follows: It's still my diagnosis. And I don't know whether I should say here or not, when he went to, for the evaluation for post[-]traumatic stress [disorder], it didn't make s[e]nse to me that it will be a relative for post[-]traumatic stress [disorder] because the main issue here is paranoid schizophrenia. Now the paranoid schizophrenia[,] it is true that he has a residual problem from this [stress] that he was exposed in Vietnam. It is [the] truth. But the truth that he had the first break at the age of 39, the first schizophrenic break which was very unusual for a man. But there was a definite psychosocial illustration, that rejection from the military. That is no question in my mind that [it] was what triggered the schizophrenic break on this man. And he has some problems, and we talked many times about his experiences in Vietnam, but the main issue now is the paranoid schizophrenia. When asked to clarify the cause of the appellant's schizophrenia, Dr. Galvez stated the following: There's no question in my mind. He was in Vietnam, exposed to combat, but he was accepted by the troops. He was a good officer. He could perform his duties fairly well. But he was putting himself into the military. His life was the military. The military reject[ed] him[,] and that triggered the first schizophrenic break. The appellant testified that he was a helicopter pilot and served two tours in Vietnam. The appellant reported there were two episodes in service that still bothered him. He stated that he found one of his fellow pilots who had been shot in the head through his helmet. He stated that when he went to take off the helmet, part of the skull came off with it. He reported difficulties with that incident. Another incident the appellant reported was his having to move dead people, and the odor was something he would never forget. The appellant stated that he had been passed up for lieutenant colonel twice, and decided to leave the military. He stated that he did not fight it because he respected the service so much. He noted that he lost touch in reality while he was in Atlanta and that he was hospitalized, which he stated was in 1979. In a June 1994 statement, the appellant stated that the first treatment he received for a psychiatric condition was at the VA Medical Center in Jackson, Mississippi, in the summer of 1980. The appellant had a hearing before this Board Member in September 1996. When asked why the appellant felt that service connection for a psychiatric disorder should be granted, the appellant read testimony provided by Dr. Galvez at the March 1994 RO hearing. There's no question in my mind. He was in Vietnam, exposed to combat, but he was accepted by the troops. He was a good officer. He could perform his duties fairly well. But he was putting himself into the military. His life was the military. The military reject[ed] him[,] and that triggered the first schizophrenic break. The appellant stated that he did not seek psychiatric treatment in service. When asked when the first time he sought psychiatric treatment after service, the appellant responded that he had a mental break in 1979. The appellant stated that what precipitated it was that he was in job training in Atlanta, Georgia, when he became paranoid about people talking about him and fearing for his family's welfare. When asked if he had felt that way before, he stated, But it had happened to me more than once, and it happened to me while I was in the service." He described feeling that when he walked into a room that everyone stood up, and he felt a sense of power. He stated that he suspected that such thoughts were not rational, but that he would not have gone to see a psychiatrist because that would have put a mark on his record and kept him from advancing in his military career. When asked to describe a traumatic event in service, the appellant stated that he had served two tours in Vietnam and "a tour in Korea, which was just as intense." The appellant stated that a helicopter he was in had been shot so badly that he could not land. He stated that he had people shot down and had people killed. When asked if he had experienced one of those episodes during combat, the appellant stated, "Not during the, during the combat missions[.] I was so well trained that I didn't think at all[. E]verything I ever did on a combat mission was pure Adrenalin reaction training, never thought, never planned, never, I just did it." The appellant submitted bills from private hospitals and the City Clerk's Office in Vicksburg, Mississippi. Private medical records dated from September 1996 to January 1997 from the Jackson Heart Clinic relate to the appellant's service-connected atherosclerotic heart disease, status post angioplasty and history of hypertension. The appellant underwent a VA psychiatric evaluation in January 1997. The appellant reported his medical history as of 1979. The appellant reported that he had good days and bad days. He stated that he woke up a lot because of irrational dreams about all kinds of things and emotions. He reported that he had an auditory hallucination about a couple of months ago. He denied a history of command hallucinations. He denied recent interpersonal conflicts or paranoid delusions. He denied history of homicidal or suicidal thoughts. The VA examiner stated that the appellant was appropriately dressed, adequately groomed, and did not exhibit any unusual motor activity. Speech was unremarkable without no flight of ideas or looseness of associations. Mood was pleasant and euthymic. Affect was blunted. He was oriented to person, place, situation, and time. Remote, recent and immediate recall were good. Estimated to be of average intelligence. Judgment to avoid common danger and abstracting ability were both noted to be adequate. Insight was fair. The VA examiner stated that the appellant gave an 18-year history of symptoms consistent with paranoid schizophrenia. He noted that the claims folder was not available and that the appellant denied any treatment for emotional problems or any significant emotional problems prior to 1979. In a January 1997 addendum to the psychiatric evaluation conducted that month, the VA examiner (same examiner who conducted the evaluation) stated the following: C-file was examined and a note written by Dr. Harold Ford, dated January 14, 1971, referred to the patient's initial psychiatric treatment being at VA Hospitalization, Downey, Illinois, for six to eight months in 1962. Therefore, it is clear that the patient's schizophrenia did manifest itself during the military (Dr. Ford gave the patient [a] diagnosis of schizophrenia, schizo- affective type). Although it can be said that schizophrenia appeared while in the military, there is no clear[,] unequivocal relationship of the patient's schizophrenia to his military service other than the fact that it did occur while in the military. In a second addendum, dated February 1997, the VA examiner stated the following: Please note that the undersigned did indeed see a note by Dr. Ford in the record dated January 14, 1971. I attempted to locate the note today; however, the structure of the chart is such that it would take an inordinate amount of time to relocate this information, which, by the way, was originally tabbed when left on my desk. With regard to the patient's note stating that he received first psychiatric treatment in 1980, all that can be said is that his statement conflicts with the information provided by Dr. Ford in his note of January 14, 1971. In an August 1997 letter from Dr. Galvez , he stated that he had been treating the appellant for several years and that the diagnosis was chronic paranoid schizophrenia. He stated that it was his opinion that the appellant's illness "was [the] direct consequences of the stress, emotional stress, that he was under in Vietnam." He stated that the appellant had unsuccessfully tried to get benefits from VA and that VA had "made [an] erroneous diagnosis; called him post- traumatic stress disorder when actually he is a paranoid schizophrenic." The Board remanded this case in September 1997 for a VA psychiatric evaluation wherein the VA examiner would review the claims folder prior to the evaluation. The examiner was asked to answer the following questions: "(1) Did the appellant's schizophrenia manifest itself during active service? (2) Did schizophrenia manifest itself within one year after his discharge from service? (3) Is the appellant's schizophrenia related to his period of active service?" The appellant underwent a VA psychiatric evaluation in October 1997. The appellant reported his psychiatric history to the VA examiner, and the VA examiner noted in the report that he had reviewed the claims file. The VA examiner stated that the appellant was appropriately dressed and adequately groomed and exhibited no unusual motor activity. Speech was fluent without flight of ideas or looseness of associations. Mood was euthymic, and affect was appropriate. The appellant denied hallucinations, delusions, homicidal, and suicidal ideations. His remote, recent, and immediate recall were good. He was estimated to be of average intelligence. Judgment to avoid common danger and abstracting ability was adequate. Insight was fair. The diagnosis was schizophrenia, paranoid type. The VA examiner answered the Board questions as follows: As the onset of symptoms was 1979, and the patient's last active duty was 1976, he did not manifest symptoms during active service, nor did he manifest these symptoms within one year after discharge. No unequivocal relationship between the patient's schizophrenia and his active service could be determined. Private medical records from the Vicksburg Medical Center dated from May 1985 to August 1997 are not relevant to the appellant's claim for service connection for a psychiatric disorder, to include paranoid schizophrenia and post- traumatic stress disorder. In September 1998, the Board solicited an opinion from an independent medical expert. In the letter to the independent medical expert, the Board noted Dr. Galvez's testimony at the March 1994 RO hearing and his statements in the August 1997 letter that discussed the etiology of the appellant's diagnosis of paranoid schizophrenia. The questions proposed to the independent medical expert were as follows: "(1) Is there any support in the record for Dr. Galvez's findings at the March 1994 RO hearing and/or the findings made in August 1997 regarding the etiology of the diagnosis of schizophrenia? (2) Is there any evidence that schizophrenia was manifested during service or within one year of service or otherwise due to service?" A response from Dr. Douglas S. Lehrer, Diplomate of the American Board of Psychiatry and Neurology with added qualifications for forensic psychiatry was received by the Board in October 1998. Dr. Lehrer noted that although the diagnosis given to the appellant was schizophrenia, paranoid type, that there was evidence to suggest that the appellant may have bipolar disorder. Dr. Lehrer noted that psychiatric literature does document that a latency period of several years between the earliest signs of illness and the time of the first diagnosis is common. As for the first question, as to whether Dr. Galvez's findings at the March 1994 RO hearing and/or findings made in the August 1997 letter as to the etiology of the appellant's diagnosis of schizophrenia were supported by the record, Dr. Lehrer's response was that Dr. Galvez's hypotheses were not adequately supported by the facts in the case or by general scientific bases. Specifically, he stated the following: It is my opinion that Dr. Galvez'[s] comments are scientifically unfounded. If we assume that the onset of the appellant's illness was in 1979-1980, then Dr. Galvez is asking us to believe that persistent negative feelings about the appellant's separation from active duty three years earlier had precipitated his first psychotic episode. Fi[r]st of all, there is inadequate documentation in the record about the nature and severity of that unhappiness just prior to that first psychotic episode (in 1979-1980) to support such a hypothesis. Second, while the psychiatric literature points out that many psychotic episodes develop during times of high stress, that association is not reliably seen in all cases. The DSM-IV is quite deliberately non-etiologic in its definitions of schizophrenia and bipolar disorder, that is, our understanding of the causes of both of those disorders is too weak to easily conclude that a given stressful situation (especially three years later) is the proximate cause of the mental disorder. In fact, other factors in this case are frankly far more compelling, such as a family history (father's mental illness which was probably either schizophrenia or a major mood disorder) and a very stressful job demanding constant travel and long hours at the time of the psychotic episode. As to the second question of whether there was any evidence that schizophrenia was manifested in service or within one year following service, Dr. Lehrer stated that the only evidence that would suggest a mental disorder may have been present during or shortly after the appellant's term of active duty was his testimony at the September 1996 hearing (before this Board Member). He noted that the appellant stated that the feelings he had at the time of his psychotic episode in 1979-1980 he had while he was in service, which were grandiose distortions and irrational thoughts. Dr. Lehrer stated that the only reference in the entire record which was suggestive of mental illness during or within one year following separation from active duty; otherwise, the record was devoid of medical or administrative evidence of mental illness during that time interval. It was Dr. Lehrer's opinion that there was inadequate evidence to conclude that the appellant's mental disorder was due to his military service. A. Post-traumatic stress disorder Service connection for post-traumatic stress disorder requires: (1) medical evidence diagnosing the condition in accordance with DSM-IV; (2) credible supporting evidence that the claimed inservice stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed inservice stressor. 38 C.F.R. § 3.304(f) (1999); see Cohen v. Brown, 10 Vet. App. 128, 138 (1997). If the diagnosis of post-traumatic stress disorder does not conform to DSM-IV or is not supported by the findings in the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis. 38 C.F.R. §§ 3.304(f); 4.125(a) (1999). After having reviewed the evidence of record, the Board finds that the appellant's claim for service connection for post- traumatic stress disorder is not well grounded. As stated above, in order for a claim for post-traumatic stress disorder to be well grounded, there must be a current medical diagnosis of post-traumatic stress disorder in accordance with DSM-IV. In a February 1993 VA outpatient treatment report, the VA examiner noted that the appellant's physician, Dr. Galvez, had diagnosed the appellant with post-traumatic stress disorder. No medical findings were reported, and a diagnostic impression of post-traumatic stress disorder was entered. The Board does not find that such was a current medical diagnosis of post-traumatic stress disorder. The appellant reported no stressors, and the VA examiner did not report any clinical findings. The Board finds that it appears to be a conclusory "impression." A diagnosis of post-traumatic stress disorder which is not based upon post- traumatic stress disorder symptomatology and the sufficiency of a claimed inservice stressor will not be accepted as medical evidence diagnosing the condition in accordance with DSM-IV. 38 C.F.R. §§ 3.304(f); 4.125(a); see also Cohen, 10 Vet. App. at 138. The Board concludes that the word "diagnostic impression" is not the same as a "diagnosis," and in this case, it appears that the impression is based on history provided by the appellant. Regardless, this examiner did not attribute the diagnostic impression to inservice events. Additionally, Dr. Galvez has established that the appellant does not have post-traumatic stress disorder. In essence, the diagnostic impression made by the VA examiner is the recording of an inaccurate history filtered through a lay person. In an April 1993 VA outpatient treatment report, the VA social worker noted that Dr. Galvez had diagnosed the appellant with paranoid schizophrenia and with anxiety related to war stress. A diagnosis of anxiety related to war stress is not a diagnosis of post-traumatic stress disorder. The Board notes that the examiner did not enter a diagnosis of an anxiety disorder or establish chronicity of the anxiety. In May 1993, the appellant underwent the Minnesota Multiphasic Personality Inventory. The VA social worker stated that the validity scales indicated that the profile the appellant presented was valid; however, the appellant's profile was not typical of profiles seen in Vietnam veterans who have post-traumatic stress disorder. VA outpatient treatment reports dated from March 1993 to September 1993 do not show a diagnosis of post-traumatic stress disorder. Thus, such evidence does not show a current diagnosis of post-traumatic stress disorder. The appellant underwent a VA examination in August 1993. The VA examiner noted the appellant's medical history as to his psychiatric disorder. It was the VA examiner's determination that the appellant gave a 14-year history of symptoms suggestive of chronic paranoid schizophrenia and noted that although the appellant reported attending the Trauma Recovery Program and reported occasionally experiencing a Vietnam- related nightmare, "he d[id] not satisfy the criteria needed for a diagnosis of post-traumatic stress disorder." This is negative evidence that the appellant has a current diagnosis of post-traumatic stress disorder in accordance with DSM-IV. Finally, Dr. Galvez has not entered a diagnosis of post- traumatic stress disorder in accordance with DSM-IV. In fact, he has implied that the appellant does not have post- traumatic stress disorder. At the March 1994 hearing, he stated that the appellant going for an evaluation at VA for post-traumatic stress disorder did not make sense to him since "the main issue here is paranoid schizophrenia." It is his contention that the appellant's paranoid schizophrenia is a result of stress the appellant felt in service. In an August 1997 letter, Dr. Galvez noted that the VA had made an "erroneous diagnosis" of post-traumatic stress disorder, when the appellant actually was a paranoid schizophrenic. Such is negative evidence that the appellant has a current diagnosis of post-traumatic stress disorder in accordance with DSM-IV. Thus, the appellant has not brought forth evidence of a current diagnosis of post-traumatic stress disorder which is based upon post-traumatic stress disorder symptomatology and a claimed inservice stressor. The Board finds that the above evidence is evidence to the contrary-that the appellant does not have post-traumatic stress disorder. The Court has stated that, "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability," and held that "[i]n the absence of proof of a present disability[,] there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau, 2 Vet. App. at 143-44. Without a current diagnosis of post- traumatic stress disorder, there is no current disability, and the appellant's claim for post- traumatic stress disorder is not well grounded. Id.; see also Caluza, 7 Vet. App. at 505. The Board notes that under 38 C.F.R. § 4.125(a), if a diagnosis of a mental disorder is entered, but does not conform to the DSM-IV criteria or is not supported by the findings in the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis. In the February 1993 VA outpatient treatment report, the VA examiner entered a diagnosis of post-traumatic stress disorder that was not in accordance with DSM-IV. Therefore, the rating agency should have returned the report to the examiner to substantiate the diagnosis. However, here, the RO had the appellant undergo additional examinations, with no medical professional entering a diagnosis of post-traumatic stress disorder. The Board finds that because the appellant underwent additional examinations where a diagnosis post-traumatic stress disorder was not entered and in fact refuted, the February 1993 diagnostic impression did not need to be returned to be substantiated. The Board further notes that the appellant received awards and decorations during service which are indicative of his having engaged in combat. Thus, entitlement to application of 38 U.S.C.A. § 1154(b) is warranted. However, the Board does not challenge the allegations of combat stressors. It is basing its denial of service connection for post-traumatic stress disorder on the lack of submitting a well-grounded claim; specifically, the lack of a current diagnosis of post- traumatic stress disorder in accordance with DSM-IV. Section 1154(b) cannot assist any combat veteran when the claim is denied based on the lack of a current disability. See Beausoleil v. Brown, 8 Vet. App. 459, 464 (citing Caluza, 7 Vet. App. at 507) (Section 1154(b) does not assist the veteran as to questions of either current disability or nexus to service, both of which generally require competent medical evidence). Although the VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim when it is determined to be not well grounded, it may be obligated under 38 U.S.C.A. § 5103(a) (West 1991) to advise a claimant of evidence needed to complete his/her application. This obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette, supra. Here, VA fulfilled its obligation under section 5103(a) by issuing a statement of the case in February 1994 and a supplemental statement of the case in September 1994. Additionally, following the March 1994 RO hearing, the RO wrote the appellant a letter, asking him to submit them any treatment records from his date of discharge until 1980 as to his psychiatric condition. The RO noted that if he could not get the records that he could sign the authorization form and that VA would go get the records. In this respect, the Board is satisfied that the obligation imposed by section 5103(a) has been satisfied at both the RO level and the appellate level. See Franzen v. Brown, 9 Vet. App. 235 (1996) (VA's obligation under sec. 5103(a) to assist claimant in filing his claim pertains to relevant evidence which may exist or could be obtained). Although the RO did not specifically state that it denied the appellant's service connection claim for post-traumatic stress disorder on the basis that it was not well grounded, the Board concludes that this was harmless. See Edenfield v. Brown, 8 Vet. App. 384, 390 (1995) (en banc) (disallowance of a claim as not well grounded amounts to a disallowance of the claim on the merits based on insufficiency of evidence). The Board acknowledges that it has decided the present appeal as to this issue on a different legal basis than the RO did. When the Board, in a decision, addresses a question that has not been addressed by the RO, it must be considered whether the claimant has been given adequate notice and opportunity to respond and, if not, whether the claimant will be prejudiced thereby. See Bernard v. Brown, 4 Vet. App. 384 (1993). However, the Board concludes that the appellant has not been prejudiced by this decision. It has considered the same law and regulations and merely concludes that the appellant did not meet the initial threshold evidentiary requirements of well-grounded claims under the standards set forth in Caluza, supra. The result is the same. B. Schizophrenia The appellant has not claimed that schizophrenia arose under combat situation. In a September 1996 hearing before this Board Member, the appellant testified as to "episodes," which he later determined were indicative of manifestations of schizophrenia. When asked if any of these "episodes" were experienced during combat, the appellant stated no. Thus, entitlement to application of 38 U.S.C.A. § 1154(b) is not warranted. The Board notes that it views the issue of well-groundedness in a vacuum. Dr. Galvez has related the appellant's diagnosis of paranoid schizophrenia to his service. Specifically, he has stated that the appellant was passed up for promotion twice and was asked to leave the military and that it caused the appellant feelings of rejection from the military. Dr. Galvez opined that such rejection triggered the schizophrenic break that the appellant had in 1979. When determining whether a claim is well grounded, the evidence submitted in support of the claim must be accepted as true; however, once well-groundedness is established, the weight and credibility of the evidence must be assessed. Robinette v. Brown, 8 Vet. App. 69, 75-76 (1995). The Board finds that Dr. Galvez's opinion on its face is sufficient to establish a well-grounded claim for service connection for paranoid schizophrenia. 38 U.S.C.A. § 5107(a). However, there is another standard that must be addressed; the benefit of the doubt. When all the evidence is assembled, the Secretary, is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In reaching the merits determination, truthfulness and credibility are no longer assumed. The appellant's diagnosis of paranoid schizophrenia is not in dispute. He has been given such diagnoses by numerous physicians, both VA and private. The appellant has repeatedly stated that he had a psychotic break in 1979, at which time he was hospitalized at a VA facility. The hospitalization to which the appellant refers was in August 1980. The appellant submitted a statement in June 1994 that the first treatment he had for a psychiatric condition was at the VA Medical Center in Jackson, Mississippi, during the summer of 1980. Regardless of whether his first psychotic break was in 1979 or 1980, it is undisputed that the appellant's first diagnosis (not manifestations) of paranoid schizophrenia was not made during service or within one year following service. The appellant has not asserted such, Dr. Galvez has not asserted such, and his representative has not asserted such. The issue before the Board is whether the appellant's current diagnosis of paranoid schizophrenia is related to service. The Board notes that additional private medical records, dated January 1999 to February 1999, were received by the appellant's attorney. There are records that address symptoms related to the appellant's schizophrenia and diagnoses of schizophrenia. However, the medical records generally do not address the etiology of such symptoms or the etiology of the diagnoses of schizophrenia. As stated above, the issue before the Board is whether the appellant's current diagnosis of paranoid schizophrenia is related to service. The medical records that do address the etiology state that chronic schizophrenia was shown as of 1979, which does not provide a nexus to the appellant's service. Therefore, the Board has not layed out the findings in the medical records because they are neither positive nor negative evidence as to the appellant's claim for service connection for schizophrenia and would not assist the appellant in his claim for service connection for schizophrenia. After having reviewed the evidence of record, service connection for paranoid schizophrenia is not warranted. The Board finds the preponderance of the evidence is against the appellant's claim that paranoid schizophrenia is related to his military service. The evidence in favor of a finding that the appellant's diagnosis of paranoid schizophrenia is related to service is Dr. Galvez's opinions. At the June 1994 RO hearing, Dr. Galvez stated that the appellant's rejection from the military "was what triggered the schizophrenic break" in the appellant. He made that statement unequivocally. In the August 1997 letter, he stated that the appellant's illness "was [the] direct consequences of the stress, emotional stress, he was under in Vietnam." Therefore, Dr. Galvez has made a determination that the appellant's paranoid schizophrenia is due to service. However, the Board finds that the preponderance of the evidence is against a finding that the appellant's diagnosis of paranoid schizophrenia is related to service. First, the appellant underwent a VA examination in October 1997. In the VA examination report, the VA examiner noted that he had reviewed the appellant's claims file. The VA examiner determined that the appellant did not manifest symptoms of schizophrenia during service nor within one year following service. He further stated that, "No unequivocal relationship between the patient's schizophrenia and his active service could be determined." Such evidence is against a finding that the appellant's diagnosis of paranoid schizophrenia is related to service. Second, Dr. Lehrer's opinion is against a finding that the appellant's diagnosis of paranoid schizophrenia is related to service. Dr. Lehrer reviewed the appellant's claims folder. He was asked whether Dr. Galvez's findings that the appellant's paranoid schizophrenia is related to service were supported by the evidence of record. Dr. Lehrer stated that he found Dr. Galvez's comments were "scientifically unfounded." He noted that Dr. Galvez was proposing that persistent negative feelings that the appellant had about his separation from service precipitated his first psychotic episode. It was his determination that there was inadequate documentation in the record about the nature and severity of the appellant's unhappiness just prior to that first psychotic episode in 1979-1980 to support Dr. Galvez's hypothesis. Additionally, Dr. Lehrer stated that the cause of schizophrenia, in general, was "too weak to easily conclude that a given stressful situation (especially three years later) is the proximate cause of the mental disorder." He felt that the factors which were more compelling in the appellant's case were his family history and a stressful job at the time of the psychotic episode. Dr. Lehrer was also asked if there was any evidence that schizophrenia was manifested in service, within one year following service, or was otherwise due to service. Dr. Lehrer stated that the only evidence he could find of manifestations of schizophrenia in service was based upon testimony that the appellant provided at the September 1996 Board hearing. At that hearing, the appellant discussed feeling that when he walked in a room that everyone stood up and he felt a sense of power. The appellant described feelings of grandiose distortions and irrational thoughts. The appellant stated that such feelings were similar to the ones he had at the time of his psychotic episode in 1979- 1980. Dr. Lehrer concluded that other than this testimony, there was no evidence in the record which was suggestive of a mental illness either during service or within one year following service. He further stated that there was inadequate evidence in the record to conclude that the appellant's mental disorder was due to his military service. The Board will address the appellant's testimony at the September 1996 hearing, as Dr. Lehrer has noted that the only evidence of record which would show manifestations of schizophrenia in service was based upon the appellant's testimony. This Board member must point out that he had an opportunity to listen to the appellant and observe his mannerisms and demeanor during the September 1996 hearing. This Board Member found that the appellant was not a credible witness. He had previously testified at an RO hearing, and submitted statements, in which he did not report having such feelings in service. Additionally, the statements made at the hearing were made 20 years following his separation from service and made in connection with a claim for monetary benefits. Regardless of the length of time between his testimony and service and his failure to mention such feelings prior to the Board hearing, this Board Member found his testimony that he had grandiose and irrational feelings in service not credible and accords it no probative value. Therefore, Dr. Lehrer's speculation that the only evidence in the record which would place manifestations of schizophrenia in service or within one year following service has been discounted. More importantly, Dr. Lehrer discounts his own statement. The Board must note that Dr. Lehrer stated, "In my opinion, with a reasonable degree of medical certainty, that the aforementioned statements [made by the appellant at the September 1996 hearing], made 20 years after separation from active duty, do not provide an adequate basis to conclude that evidence of [] mental illness existed during or within one year of active duty." This substantiates the Board's finding that the appellant's statements alone do not provide a basis that schizophrenia had manifested in service or within one year following service. Dr. Galvez's opinion that the appellant's diagnosis of schizophrenia is related to service has been outweighed by the October 1997 VA psychiatric evaluation report and the independent medical expert opinion. Dr. Galvez has not stated that he has reviewed the appellant's claims file. His opinion seems to be based upon recitation of the facts provided to him by the appellant. Notwithstanding such, the Board accords more probative value to the VA examiner's opinion and Dr. Lehrer's opinions. The VA examiner, after having reviewed the appellant's claims file, made a determination that "[n]o unequivocal relationship between the patient's schizophrenia and his active service could be determined." He noted that the appellant had an onset of symptoms in 1979 and that the appellant was discharged in 1976. Therefore, he stated that the appellant did not manifest symptoms during service nor within one year following service. Dr. Galvez's hypothesis is undermined by Dr. Lehrer's determination that such hypothesis is not supported by the record. Dr. Lehrer had an opportunity to review the appellant's claims file. He determined that there was inadequate evidence to conclude that the appellant's mental disorder was due to service. Although Dr. Lehrer noted that the only evidence in the record which would show manifestations of a mental disorder in service or within one year following service was the appellant's testimony at the September 1996 Board hearing, the Board has found the appellant's testimony to be not credible. Additionally, reading Dr. Lehrer's opinion as a whole, he formed a negative conclusion. Thus, there is no other evidence of record to establish manifestations of schizophrenia in service or within one year following service. The Board must discuss the January 1997 psychiatric evaluation report and the January 1997 and February 1997 addendums submitted by the VA examiner who conducted the January 1997 evaluation. Although this same discussion was provided in the September 1997 remand, the Board finds that another discussion of this is necessary. As to the VA examiner's statement that a January 1971 medical record showing a diagnosis of schizophrenia, schizo-affective type, this Board Member would like to point out that he is completely unaware of such a document ever existing in the appellant's claims file. Prior to the September 1996 hearing, this Board Member reviewed the appellant's claims file thoroughly and the January 14, 1971, note from Dr. Ford was not of record. Reviewing the record in its entirety, the Board is of the opinion that this record was not in reference to this particular appellant because it is completely inconsistent with the record. First, the appellant's private physician, Dr. Galvez, in a January 1991 private medical record, stated that the appellant's psychiatric history went back to "1979." Dr. Galvez reiterated this point at the March 1994 RO hearing when he gave sworn testimony that the appellant had "the first psychotic episode [] in 1979." Second, the appellant signed a statement in June 1994, stating that the first treatment he received for a psychiatric condition was during the summer of 1980. Third, the appellant gave sworn testimony at the September 1996 Board hearing that he had not sought psychiatric treatment in service, and that the first time he sought psychiatric treatment was in 1979. Fourth, the appellant gave sworn testimony at the March 1994 RO hearing that he had two tours in Vietnam stating, "the first one was very early in 1962-63." This is corroborated in the appellant's service personnel records. Those records show that the appellant was in Hawaii from October 1961 to September 1962, at which time, he was sent to Vietnam. There is nothing in the appellant's service medical records that show that he was hospitalized in Downey, Illinois, for schizophrenia. Thus, the Board believes that the January 14, 1971, note from Dr. Ford was not related to this appellant and therefore accords the January 1997 psychiatric evaluation and the two, subsequent addendums submitted by the VA examiner no probative value. First, the VA examiner's determination that the appellant's schizophrenia was manifested in service is based on a record that is not in the claims file. Second, the inconsistent statements provided by the examiner in his addendums and his failure to review the record in its entirety to see if such record was in the claims files cannot lead the Board to accord any probative value to his statements. Stated differently, a medical opinion based on false or incorrect information is factually useless. The Board has discussed why it finds that the preponderance of the evidence is against the appellant's claim for service connection for schizophrenia. The Court has recognized that the Board is not compelled to accept medical opinions; rather, if the Board reaches a contrary conclusion, it must state its reasons and bases and be able to point to a medical opinion other than the Board's own, unsubstantiated opinion. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board has based its decision on the VA examiner's October 1997 medical opinion, and Dr. Lehrer's medical opinion, both of whom determined that the appellant's schizophrenia was not related to service. See id. The Board notes that the Court has not adopted a treating physician rule which gives the opinions of treating physicians greater weight in evaluating veterans' claims and which would give Dr. Galvez's opinion more probative weight than that of the VA examiner and Dr. Lehrer. Harder v. Brown, 5 Vet. App. 183, 189 (1993); Guerrieri v. Brown, 4 Vet. App. 467, 471 (1993). Although there are numerous other medical records in the claims file, the Board has only addressed the evidence which provides a positive or negative nexus between the appellant's diagnosis of schizophrenia and service. The other medical evidence may show diagnoses of schizophrenia, but the examiners, whether VA or private, did not address the etiology of the appellant's diagnosis of schizophrenia, which would not be relevant as to whether the appellant's psychiatric disorder, to include schizophrenia, was related to his service. Finally, the appellant has alleged that his schizophrenia is related to service. The appellant is not competent to provide a nexus between the diagnosis of schizophrenia to service, as that requires a medical opinion. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). The preponderance of evidence is against the appellant's claim for service connection for a psychiatric disorder, to include schizophrenia, and there is no doubt to be resolved. 38 U.S.C.A. § 5107(b). ORDER A 60 percent evaluation for atherosclerotic heart disease, status post angioplasty and history of hypertension is granted, subject to the controlling regulations applicable to the payment of monetary benefits. The claim for a psychiatric disorder, to include schizophrenia and post- traumatic stress disorder is denied. H. N. SCHWARTZ Member, Board of Veterans' Appeals