Citation Nr: 0001818 Decision Date: 01/21/00 Archive Date: 01/28/00 DOCKET NO. 90-44 184 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to service connection for attention deficit hyperactive disorder. 2. Whether new and material evidence has been received to warrant reopening a claim of entitlement to service connection for a psychiatric disorder. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD J.M. Daley, Associate Counsel INTRODUCTION The veteran served on active duty from June 1943 to April 1946, and again from March 1951 to September 1953. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision of June 1990 from the New Orleans, Louisiana, Department of Veterans' Affairs (VA) Regional Office (RO). In June 1992, the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") vacated a March 1991 Board decision that denied reopening the veteran's claim of service connection for a psychiatric disorder and remanded the case to the Board for evaluation of counter-designated materials and, if necessary, re-adjudication of the veteran's claim. In February 1993, the Board issued a new decision in the appeal, and in June 1993 denied the veteran's motion for reconsideration of that decision. On appeal of the February 1993 Board decision, the Secretary of VA filed a Motion to Remand and to Stay Further Proceedings so that the Board could obtain the veteran's brother's service medical records and determine their relevance to the veteran's case as previously ordered by the Court. The Court granted the motion and remanded the case to the Board, pursuant to 38 U.S.C.A. § 7252(a) (West 1991), for compliance with the instructions in the Secretary's motion. Pursuant thereto, the Board remanded the case to the RO in March 1994, June 1996 and May 1997, in part to obtain the service medical records of the veteran's brother. All requested actions have now been accomplished to the extent possible. See Stegall v. West, 11 Vet. App. 268 (1998). The Court has held that a new diagnosis of a new disorder, which is not inextricably intertwined with a previously denied claim, and which was not considered at the time of the prior decision, constitutes a new claim and requires an initial adjudication of such claim. Ephraim v. Brown, 82 F.3d 399, 402 (Fed.Cir. 1996), cf. Ashford v. Brown, 10 Vet. App. 120. In that regard, the Board notes that the RO first considered and denied service connection for the specific diagnosis of attention deficit hyperactive disorder (ADHD) in a rating decision dated in August 1998. In so doing, the RO properly treated that claim as a new claim, rather than addressing such as part and parcel with the question of whether new and material evidence has been presented to reopen the claim for service connection for an acquired psychiatric disorder. Ephraim v. Brown, 82 F.3d 399, 401 (Fed. Cir. 1996) (a newly diagnosed disorder, whether or not medically related to a previously diagnosed disorder, cannot be the same claim when it has not been previously considered). In the recent supplemental statement of the case, however, the RO discusses ADHD in tandem with the question of whether new and material evidence has been received to warrant reopening of the previously denied claim of service connection for a psychiatric disorder. In any case, the veteran has perfected an appeal with respect to the ADHD question and has been advised of the laws and regulations pertinent to service connection. Thus, the Board will discuss the question as one of entitlement to service connection for ADHD, separate from the materiality question also addressed herein. The veteran is not prejudiced by such discussion in that in treating the claim as a new claim instead of a reopened claim, the veteran is afforded greater consideration. See Bernard v. Brown, 4 Vet. App. 384, 390-92 (1993). FINDINGS OF FACT 1. The record does not contain a competent diagnosis of existing ADHD opined to be related to the veteran's period of service so as to render such claim plausible and/or capable of substantiation. 2. In a final decision dated in June 1980, the Board determined that no new and material evidence sufficient to reopen a claim of entitlement to service connection for a psychiatric disorder had been received. 3. Evidence received subsequent to the Board's June 1980 decision is new and so significant that it must be considered in order to fairly decide the merits of the claim. 4. The veteran has failed to present competent evidence that any diagnosed psychiatric disability had its onset in or is otherwise related to his military service so as to render his claim plausible and/or capable of substantiation. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for ADHD is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The June 1980 Board decision that denied reopening the claim of entitlement to service connection for a psychiatric disorder was final. 38 U.S.C. § 4004(b) (1976) [38 U.S.C.A. § 7104(b) (West 1991)]. 3. New and material evidence having been received subsequent to the June 1980 final Board decision, the claim of entitlement to service connection for a psychiatric disorder is reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). 4. The claim of entitlement to service connection for a psychiatric disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Legal Criteria Service Connection In order to establish service connection for a claimed disability the facts must demonstrate that a disease or injury resulting in current disability was incurred in the active military service or, if pre-existing active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of examination, acceptance, and enrollment. 38 U.S.C.A. § 1132 (West 1991), 38 C.F.R. § 3.304(b) (1999). There are medical principles so universally recognized as to constitute clear and unmistakable proof, and when in accordance with these principles existence of a disability prior to service is established, no additional or confirmatory evidence is necessary. Consequently, with notation or discovery during service of such residual conditions with no evidence of the pertinent antecedent active disease or injury during service the conclusion must be that they preexisted service. Similarly, manifestation of lesions or symptoms of chronic disease from date of enlistment, or so close thereto that the disease could not have originated in so short a period will establish pre-service existence. 38 C.F.R. § 3.303(c). A veteran who served during a period of war, or a veteran who had peacetime service after December 31, 1946, is presumed to have been in sound condition except for defects noted when examined and accepted for service. Clear and unmistakable evidence that the disability manifested in service existed before service will rebut the presumption. 38 U.S.C.A. §§ 1111, 1137; 38 C.F.R. § 3.304(b). The burden of proof is on the government to rebut the presumption of sound condition upon induction by showing that the disorder existed prior to service, and if the government meets this requirement, by showing that the condition was not aggravated in service. Kinnaman v. Principi, 4 Vet. App. 20, 27 (1993). A pre-existing injury or disease will be considered to have been aggravated by active service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153 (West 1991); 38 C.F.R. § 3.306(a) (1999). It is the Secretary's burden to rebut the presumption of in-service aggravation. See Laposky v. Brown, 4 Vet. App. 331, 334 (1993); Akins v. Derwinski, 1 Vet. App. 228, 232 (1991). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(b) (1999); Falzone v. Brown, 8 Vet. App. 398, 402 (1995). Temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition, as contrasted with symptoms, has worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991); Green v. Derwinski, 1 Vet. App. 320, 323 (1991); Jensen v. Brown, 4 Vet. App. 304, 306-307 (1993). Where a veteran served for at least 90 days during a period of war or after December31, 1946, and certain chronic diseases, such as psychoses, become manifest to a degree of 10 percent within one year from the date of termination of such service, such diseases shall be presumed to have been incurred in service, even though there is no evidence of such diseases during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Where there is a chronic disease shown as such in service or within the presumptive period under 38 C.F.R. § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). This rule does not mean that any manifestation in service will permit service connection. To show chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established, there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required where the condition noted during service or in the presumptive period is not shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The chronicity provision of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded if (1) the condition is observed during service, (2) continuity of symptomatology is demonstrated thereafter and (3) competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 489 (1997); see also Grottveit v. Brown, 5 Vet. App. 91, 93 (1993) (where the issue involves questions of medical diagnosis or an opinion as to medical causation, competent medical evidence is required). Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Finality When a claim is denied by the Board, the Board's decision is final and the claim, generally, may not thereafter be reopened and granted and a claim based upon the same factual basis may not be considered. 38 U.S.C.A. § 7104 (b) (West 1991 & Supp. 1999); 38 C.F.R. § 20.1100 (1999). If new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C.A. § 5108 (West 1991). Materiality A final decision cannot be reopened unless new and material evidence is presented. Pursuant to 38 U.S.C.A. § 5108, the Secretary must reopen a finally disallowed claim when "new and material" evidence is presented or secured with respect to that claim. Hickson v. West, 12 Vet. App. 247 (1999). Only evidence presented since the last final denial on any basis (either upon the merits of the case, or upon a previous adjudication that no new and material evidence had been presented), will be evaluated in the context of the entire record. Evans v. Brown, 9 Vet. App. 273 (1996). In determining whether to reopen previously and finally denied claims, a three-step analysis was recently announced by the Court. Elkins v. West, 12 Vet. App. 209 (1999). Under the Elkins test, the Board must first determine whether the veteran has presented new and material evidence under 38 C.F.R. § 3.156(a) (1998) in order to have a finally denied claim reopened under 38 U.S.C.A. § 5108. Second, if new and material evidence has been presented, immediately upon reopening the claim, the Board must determine whether, based upon all the evidence of record in support of the claim, the claim as reopened (as distinguished from the original claim) is well grounded pursuant to 38 U.S.C.A. § 5107(a) (West 1991). Third, if the claim is well grounded, the Board may then proceed to evaluate the merits of the claim but only after ensuring the VA's duty to assist under 38 U.S.C.A. § 5107(b) (West 1991) has been fulfilled. Winters v. West, 12 Vet. App. 203 (1999). New and material evidence is defined as evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration; which is neither cumulative nor redundant; and which, by itself or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a). In Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998), the Federal Circuit noted that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it would not be enough to convince the Board to grant a claim. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In Kutscherousky v. West, 12 Vet. App. 369 (1999) the Court held that the prior holdings in Justus and Evans that the evidence is presumed to be credible was not altered by the Federal Circuit decision in Hodge. Well groundedness "[A] person who submits a claim for benefits under a law administered by the Secretary shall have 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); Carbino v. Gober, 10 Vet. App. 507 (1997); Anderson v. Brown, 9 Vet. App. 542, 545 (1996). A well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of [section 5107(a)]." Murphy v. Derwinski, 1 Vet. App. 79, 81 (1990). In Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992), the Court held that a claim must be accompanied by supportive evidence and that such evidence "must 'justify a belief by a fair and impartial individual' that the claim is plausible." For a claim to be well grounded, there generally must be (1) a medical diagnosis of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. See Anderson, supra; Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (table). In any case, a claim for service-connection for a disability must be accompanied by evidence that establishes that the claimant currently has the claimed disability. Absent proof of a present disability there can be no valid claim. See, e.g., Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). Medical evidence is required to prove the existence of a current disability and to fulfill the nexus requirement. Lay or medical evidence, as appropriate, may be used to substantiate service incurrence. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). For the purposes of determining whether this claim is well grounded, the Board must presume the truthfulness of the evidence, "except when the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion." King v. Brown, 5 Vet. App. 19, 21 (1993). If a claim is not well grounded, the application for service connection must fail, and there is no further duty to assist the veteran in the development of his claim. 38 U.S.C.A. § 5107, Murphy v. Derwinski, 1 Vet. App. 78 (1990). Factual Background The veteran served on active duty from June 1943 to April 1946, and again from March 1951 to September 1953. The service medical records for his initial period of service do not reflect any psychiatric problems. The report of medical examination prior to discharge from his first period of service, dated in March 1946, is negative for any psychiatric diagnosis. A clinical record dated in January 1947, at which point the veteran was employed with the United States Army as a civilian, reflects incurrence of a gunshot wound to the chest. Examination at admission revealed him to be " a bit euphoric." The veteran admitted to having been drinking alcohol and indicated he had been playing with his gun when it went off and injured him. A neuropsychiatric consultation report dated several days later reflects that, following review of the veteran's chart and an examination, the impression was that he was neither psychotic nor neurotic and that no definite psychiatric disorder was found. The veteran was noted to have no significant psychiatric abnormalities when examined in conduction with recall to active duty, dated in February 1951. A service personnel record dated in May 1952 indicates that the veteran requested relief from assignment to German language training due to severe living conditions resulting in monetary hardship and forcing him to leave his wife and children in a distant city with the paternal grandparents. The personnel report indicates that that arrangement "developed into such a turbulent situation as to cause subject officer unrelenting anxiety during the period he was assigned to this training." A report of service medical examination at release from active duty, dated in August 1953, indicates that the veteran's psychiatric status was normal. An Air Force Reserve Annual examination report, dated in October 1957, notes that the veteran's psychiatric status was normal. On the accompanying report of medical history the veteran denied having or having had trouble sleeping, nightmares, depression, memory loss, or any nervous trouble. The veteran was hospitalized at a VA facility in May 1958 for a duodenal ulcer. In January 1959, he was hospitalized at a VA facility with a diagnosis of depressive reaction. It was noted that he had a history of having become depressed during the past year, especially the four or five months prior to hospitalization. He gave a history of a two-week hospitalization at Confederate Memorial Hospital one year earlier. The hospital report indicates that the veteran was seen by a psychologist who found him to be of superior intelligence, with markedly impaired intellectual efficiency. The veteran was noted to have obsessive-compulsive tendencies, which seemed to be weakening, possibly revealing a latent schizophrenic process. The diagnosis was chronic anxiety reaction, moderate, with excessive (sic) - compulsive tendencies. In January 1959, the veteran submitted a claim for VA disability benefits based on "NSC" nervousness that reportedly began in 1958. In a decision dated in March 1959, the RO denied pension benefits, noting that he had a nonservice-connected anxiety reaction. . The veteran was re-admitted for VA hospitalization from May to June and from August to October 1959. On both occasions he was noted to have problems with alcohol abuse and to have a history of prior psychiatric treatment. There were diagnoses of anxiety reaction with obsessive compulsive tendencies, depressive features and alcoholism. A VA interim summary, dated and received in February 1962, includes note of psychiatric admission in July 1960 based on recurrent depression and excessive drinking. The diagnosis in February 1962 was anxiety reaction, chronic, moderate, with depressive features. A March 1962 VA report of hospitalization (received in 1962) notes symptoms demonstrated by the veteran during employment: He was "slow to catch on," unable to remember what was demonstrated to him, and acted as if he were "desperately afraid of everyone." The summary notes the financial hardships of the veteran's family, and that the veteran had been unable to keep a job for more than four years due to fear of people, irritability, lack of self-confidence, and pre-occupation. A sporadic alcohol problem was noted. A July 1962 final hospital summary reflects hospitalization from July 1960 to July 1962 and shows a diagnosis of schizophrenic reaction of the paranoid type, chronic. He was then transferred to another VA facility. A VA admission summary dated and received in August 1962 notes the veteran's prior hospitalizations and shows a diagnosis of anxiety reaction with depressive and obsessive compulsive features. In a statement dated in 1963 and received in April of that year, E.R., Jr., M.D., reported having first seen the veteran in 1958, for abdominal complaints, with referral to the VA. The veteran reportedly had complained of "sluggishness" in July 1958 and was given Dexedrine. He had been seen again in late July 1958 at which time it was the doctor's impression that he needed a psychiatric evaluation and he was referred to Confederate Memorial Hospital where he was accepted for treatment. In April 1960 the veteran again was having emotional difficulties. Dr. E.R. opined that, in retrospect, the veteran was probably having psychiatric difficulties the first time he was seen in 1958. In April 1963, the RO received a statement from the veteran's mother indicating that when the veteran returned from service he had changed from a dependable young man to a restless alcoholic. Also received in April 1963 were statements from the veteran's pastor and brother T.D., Jr., relevant to the veteran's changed mental status after returning from service. The veteran's brother indicated that during the winter of 1951/1952 the veteran had visited his home several times, that he had not seen the veteran for several years previously, and that he was amazed at the change in the veteran's condition. The veteran was described as agitated, nervous, and depressive, and left in a rage when advised to see a doctor. Reportedly, the veteran then disappeared for a while. The veteran himself submitted a statement in which he related the circumstances of his self-inflicted gunshot wound in 1947, referencing moments that were "hazy and obscure" in his memory. He argued that there was "plenty of indication of neuropsychiatric disturbance and instability in connection with this incident. It seems that there must at least have been present the element of proneness." He reported that prior to such incident he had experienced several spells of very severe depression and profound despondency. The veteran stated that he reported to sick call at the Army Air Base complaining of gastric and digestive disorders and that a physician reported recognizing such as symptoms of a nervous disorder. In April 1963, the RO received another copy of the January 1947 medical records pertaining to treatment of the veteran's gunshot wound. A VA interim hospital summary dated and received in April 1963, reflects the veteran's admission in July 1962 and shows a diagnosis of anxiety reaction. A statement from the veteran's brother R.D., dated and received in April 1963, recounts that he and the veteran were very close in age and had had a close relationship as children. R.D. indicated that when the veteran returned from Germany in 1947 he there was a radical change in his personality due to service. These included that he developed nervousness, anxiety, depression and a drinking habit. In another statement, K. H. reported having attended a language course with the veteran in 1951 and 1952 and noticing that the veteran had "fears or fancies" that caused him to withdraw from his surroundings and stare into space. Reportedly, other classmates suspected that that the veteran might have family problems or be lonely and tried to cheer him up without success. Eventually the veteran's behavior alternated between normalcy, silence, and deep derepression. A May 1963 sheriff's report indicates that the veteran was arrested in June 1951 and charged with being absent without leave. In a letter dated and received in May 1963, M.A., a psychiatric social worker at the Confederate Memorial Medial Center, indicated that the veteran had been hospitalized from August to September 1958 with a diagnosis of paranoid schizophrenia. In June 1963, the RO received a statement from M.A., a fellow serviceman, who indicated that he had noted periods of agitation, nervousness and moodiness in the veteran during service. In a statement from the veteran received in June 1963, he related suffering from a "mental blackout" in June 1951, at which time he was absent without leave from the military. A July 1963 VA hospital summary reflects that the veteran sought hospitalization for alcohol problems. The final diagnoses were acute brain syndrome associated with alcohol intoxication and schizophrenic reaction. In an August 1963 rating decision, the RO denied service connection for a psychiatric disorder. In December 1963, the RO received a letter a retired colonel who stated that in 1951 the veteran had been assigned to him as Group Adjutant. The colonel reported that he had found the veteran to be an officer of many moods and that on numerous occasions the veteran manifested extreme depression. In December 1963, the RO continued to deny the veteran's claim and the Board did likewise in December 1964. In November 1965, the RO received a letter from the a retired Air Force colonel who reported that in early 1952 he had been ordered to investigate the facts surrounding the veteran's failure to attend language classes and found such to be due to some "deep down" cause within himself, noting that the veteran reflected a state of "insecurity, instability, and nervousness." It was stated that a psychiatrist had been used to evaluate the veteran's emotional situation. A VA summary, received in January 1966, reflects hospitalization of the veteran from September to November1965 and shows a diagnosis of passive aggressive personalty disorder. In May 1966, the Board found that new and material evidence had not been received to reopen the veteran's claim. In a January 1967 VA medical report, C.A., M.D., a psychiatrist, noted that according to the veteran, his nervous trouble began in June 1958 and he was discharged from service in 1953. The veteran reported that his younger brother had retired from the Air Force with "pretty much the same thing." The veteran complained of anxiety. Dr. C.A. noted that the veteran had a passive dependent personality and indicated that the veteran probably had carried a diagnosis of schizophrenia in the past. A March 1967 VA hospital report indicates that the veteran had diagnoses of acute brain syndrome due to intoxication and passive aggressive personality disorder. In May 1967, the veteran submitted a lengthy statement with 47 attachments in which he reiterated many of his prior statements and arguments. He included a copy of a Board decision pertaining to his brother R.D.'s claim for an increased rating for his service-connected psychiatric disorder, for the purpose of establishing that, inasmuch as the veteran's psychiatric symptoms were the same as his brother's, the Board's decision established precedents that should be applied to the veteran's case. R.D. was service- connected for a depressive reaction, by reason of which he had been discharged from military service. The veteran specifically cited a "congenital, inborn and possibly heredity-oriented propensity and proneness towards nervous disorder which in both of our cases was activated by certain conditions of military service." Attachments also include lay statements attesting to the veteran's mental status prior and subsequent to service; letters from his mother raising concerns over his mental health during service, as well as suggesting that his prior gunshot wound had not been accidental; correspondence that he had written during service to his parents; and part of a "dream diary" kept by him in 1954 and 1955, with a note by the veteran stating that some of the dreams had occurred within one year after service and that there were definite pathological elements in the dreams. The veteran submitted a copy of his diary in late 1967 that covers the period of September 1946 to November 1946. In a late October entry he stated that he had been "terribly blue" the prior week and had been sick from alcohol. In a decision dated in June 1968, the Board found that the prior Board decision was final. In July and October 1968, the RO received several service department officer efficiency reports covering the period from May 1952 through September 1954. The ratings in these reports show a general trend of decreasing quality of the veteran's performance. In a July 1969 decision, the Board again denied the veteran's claim. Additional service personnel records were received in August 1969. They show that the veteran was excused from duty. In an October 1971 letter to the veteran, received by the RO in June 1972, M.L., M.D., stated that after reviewing the veteran's August 29, 1970 letter and his previous letter and Dr. M.L.'s response to it, he had to again point out that it was impossible for him to remember consultation with the veteran in January 1947 and that it was "Obviously...impossible" to make any further statement to substantiate or refute "that the psychiatric factor was absolutely ruled out in 1947." (emphasis in the original). In a forwarding letter, the veteran noted that Dr. M.L. was the medical officer who had conducted the psychiatric evaluation in January 1947 when the veteran was hospitalized for a self-inflected gunshot wound, and argued that the letter was new and material evidence to reopen his claim. In May 1973, the Board again denied the veteran's claim. In July 1979, the veteran submitted an unsigned statement, purportedly written by his mother, in which she reported that the veteran changed after service, becoming an alcoholic and acting restless and immature. In July 1979 the veteran submitted additional service department evidence, including a January 1964 letter advising him that his recent physical examination showed that he did not meet the requirements for retention, along with other service department documents showing that his disqualification from Air Force service was based on a history of neuropsychiatric disease. In a statement dated and received in December 1979, the veteran's brother R.D. authorized access to his claims file in connection with the veteran's case. In a final decision dated in June 1980, the Board considered the above and denied the veteran's claim based on the lack of new and material evidence sufficient to reopen the claim. Evidence Received Subsequent to 1980 The claims file contains a copy of a letter dated in September 1988 and addressed to a member of Congress. The veteran discussed a "Carbon Copies Doctrine" or "Carbon Copies Syndrome," stating that that label arose years earlier when a VA psychiatrist stated that he and his brother were "carbon copies of each other" in medical cases and histories. The veteran named the physician, W.B., M.D., and later provided information as to his potential whereabouts. In a May 1989 statement, the veteran petitioned the Board to reconsider its 1980 decision on the basis that the VA had ignored the "Carbon Copies" theory and that the Board's handling of that matter in the 1980 decision had been error. The Board responded to his letter but did not grant reconsideration. In May 1990, the RO received a letter from the veteran's brother R.D., who stated that he and the veteran had "almost identical backgrounds from both heredity and environment." He reported that they were victims of a broken home and separated parents and being placed in a boys' home for a year. He further noted that they were sworn into service at the same time but received different assignments. He reported that during service in Germany the veteran became depressed and shot himself in a suicide attempt. R.D. also reported that after service the veteran became nervous and depressed, drinking heavily. R.D. opined that the veteran's psychoneurosis was caused by his military service in World War II and aggravated by service during the Korean War period. Also in May 1990, the RO received a statement from the veteran's spouse, who reported that she knew the veteran in 1946 and had noted a change in his mental and emotional nature. She indicated that the veteran and his brother were the "equivalent of twins" as far as neuropsychiatry was concerned. The veteran submitted an article attempting to establish the whereabouts of a Dr. Bruschi, purported to have provided an opinion as to his being a "carbon copy" of his brother. In November 1994, the veteran was afforded a VA examination, at which time he stated that his psychiatric problems went back a long time and that he had been in and out of hospitals since 1958. He reported having had a variety of diagnoses - schizophrenia, anxiety reaction, and depression. The veteran stated that had been labeled suicidal in the past and that in 1947, during one of those periods, he sustained a self inflicted gunshot wound to the chest and that there was still controversy over service connection. The veteran also stated that he had tried to cover up the injury by stating that it was accidental. Following a mental status examination, the diagnoses were generalized anxiety disorder with depressive features and passive-dependent personality disorder. In January 1995, VA requested a medical opinion relevant to the veteran's "carbon copy" theory. N. Gilbert, M.D., conducted a Medline search, without response, and also stated that the National Library of Medicine had no information on that subject. Dr. Gilbert also indicated that the DSM (Diagnostic and Statistical Manual of Mental Disorders) did not reflect a "carbon copies syndrome" or carbon copies doctrine" as a psychiatric diagnosis, and concluded that there was no indication that such was appropriate to the veteran as such a condition did not exist as a recognized diagnosis. In June 1995, the RO received records dated in from 1970 to 1972 showing VA treatment of the veteran for psychiatric symptoms. In October 1995, the RO received some service personnel and medical records pertinent to the veteran's brother R.D. Those records reflect that R.D. was medically retired from the military due to a chronic depressive reaction. He was noted to have a severe predisposition for same, and the disorder was noted to be manifested by insomnia, a heavy alcohol intake, anorexia, anxiety, impotence and lack of interpersonal relationships outside of his family. In June 1996, the Board remanded the veteran's claim to the RO for further development. Thereafter, the RO attempted to obtain additional service medical records pertaining to the veteran and in August 1996 service medical records were received. They are duplicates of ones previously on file except for a report of medical history executed by the veteran in February 1951, when he was examined for his second period of service. He denied having or having had trouble sleeping, nightmares, depression, memory loss, and any nervous trouble. In July 1997, the veteran submitted a copy of a June 1933 letter written to him by his brother F, in essence inquiring about the veteran's school grades, indicating that his mother had said the veteran was kind of hard to handle, and telling him to be a good boy. In February 1998, the veteran submitted medical journal abstracts and references regarding attention deficit and hyperactivity disorders in children. In an accompanying letter the veteran stated that his service medical records and the other evidence on file should clearly indicate ADHD and that untreated ADHD, as in his case, resulted in devastating consequences in and by military service. He further stated that ADHD could not have been cured but could have been managed and that that disorder intensified the connection of his medical history with that of his brother. The veteran asked that the VA provide an examination for ADHD since he could not afford to obtain one privately. In March 1998, the RO received records pertinent to the veteran from Doctors' Hospital. They reflect treatment and examination in August and September 1991 pertinent to longstanding alcohol abuse. In March 1998, the veteran was afforded a VA examination by R. R., D.O., Ph.D., the Chief of the Psychiatry Service at VA medical center. The examiner reviewed the veteran's claims file, including the medical records, as well as records pertinent to the veteran's deceased brother R. The examiner noted that throughout R.'s record there was evidence of a depressive disorder, a significant history of alcohol abuse and diagnoses of a personality disorder. The veteran provided a psychiatric history significant for depression and anxiety symptoms beginning in childhood, "from his earliest memories." The examiner noted that the veteran had undergone many hospitalizations for depressive disorder and that significant in his history was the self-inflected gunshot wound in 1947 and an overdose in the 1970s. The examiner further noted a significant history of alcohol abuse. A mental status examination was performed, and the examiner questioned the veteran about the "Carbon Copy Syndrome." The veteran responded that he had coined the term years earlier after a doctor told him his symptoms were very similar to his brother's. The veteran admitted that such was not a syndrome described in a medical text, but rather a term used for descriptive purposes. The examiner clarified that the veteran in no way believed that he was a duplicate of his brother, only that he had similar genetic influences and similar symptoms. The examiner diagnosed a major depressive disorder; anxiety disorder; a history of alcohol dependence; and a personality disorder. The March 1998 VA examiner concluded that there was no evidence of any relationship between the veteran's psychiatric disorder and his brother's psychiatric disorder, and specifically stated that such was not representative of any "Carbon Copy" syndrome or doctrine, which "could not be found in the medical literature. According to the examiner, "The fact that the brother ... was noted to have a psychiatric disorder during his period of service has no significance as to whether the veterans [sic] psychiatric disorders are of service origin because the patient states that his problems began during childhood. The history given by the veteran during this interview is one of an essentially lifelong psychiatric disorder present from the time of his earliest memories." In a statement received in September 1998, the veteran argued that the statements submitted by his family members should be considered those of "disinterested" parties in that they could not have known what was going to happen decades later. The veteran argued that what was needed in his case was "examination and testing by a disinterested, detached, independent, and properly certified specialist." He stated that it was obvious that unmanaged ADHD did not mix well with the military and that disastrous aggravation would be expected. The veteran challenged the "competency" of service entrance examinations. In September 1999, the RO received multiple volumes of VA treatment records pertaining to the veteran's brother R.D., along with R.D.'s VA claims file. A review of the claims file and records reveals that such were provided to the RO and to the March 1998 examiner as indicated in the examination report, but that they were returned and then re- associated with the veteran's files at the Board in September 1999. The claims file shows that R.D. died as a result of carcinomatosis, carcinoma of the larynx and that organic brain syndrome associated with alcoholism with psychosis was a contributory cause of death. During his lifetime R.D. had a 100 percent service-connected rating for psychiatric illness, initially characterized as depressive reaction, and evolving into organic brain syndrome with alcoholism with psychosis, per medical opinions contained in his claims file. Medical records reflect treatment and evaluation for psychiatric illness, and for heart and other medical problems including the fatal cancer. In connection with one episode of treatment for depression in February 1975, R.D. stated that his brother had "similar trouble." Medical reports pertinent to R.D. do not contain any notation by medical personnel relevant to "carbon copy" syndrome or doctrine, or any medical evidence/opinion relevant to the veteran's claim. Analysis ADHD The Board has carefully reviewed the entire evidentiary record; however, it is absent any diagnosis or opinion by a competent medical professional that the veteran has or has ever had ADHD. A current diagnosis of the claimed disorder is essential to well-grounding the claim of entitlement to service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The veteran himself argues that he has ADHD and has submitted medical treatise information in support of such, arguing that the characteristics both he and his brother exhibited, as described by his family and friends, are symptoms of ADHD. Notably, the treatise information he submitted speaks only generally about manifestations and treatment of attention/hyperactivity disorders. It can not serve to establish a competent diagnosis of ADHD in the veteran. Additionally, the Court has held that for the purposes of establishing a well-grounded claim, generic medical journal or treatise evidence that does not specifically opine as to the relationship between a given veteran's condition and active service cannot establish the remaining element of medical nexus evidence, and in fact, constitutes only an unsubstantiated medical opinion rather than a conclusion based on the medical evidence of record. In short, although medical treatise evidence may be sufficient to well ground a claim if it discusses the plausibility of a link, speculative generic statements are insufficient. Wallin v. West, 11 Vet. App. 509 (1998); Sacks v. West, 11 Vet. App. 314 (1998). The veteran also points to the letter written by his brother in 1933 to establish the presence of symptomatology attributable to ADHD. However, the record does not reflect that the veteran or his brother possesses a recognized degree of medical knowledge to render their opinions on medical diagnoses competent. Thus, lacking a diagnosis of ADHD by a competent medical professional, the veteran's own belief that he has or has had such a disorder does not establish a plausible claim. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The Board notes the veteran's request that he be tested for ADHD or provided with an examination by "a disinterested, neutral, and objective specialist, or else stipulate the condition." (emphasis in original). The Board can not concede the existence of a diagnosis where there is no competent medical evidence of such. In fact, although the veteran was afforded a VA psychiatric examination as recently as March 1998, the examiner did not diagnose ADHD. Absent a diagnosis of the claimed condition the Board finds the claim of service connection for ADHD not well grounded. Thus, there is no duty to assist the veteran by affording additional testing or obtaining an opinion as to whether he has ADHD. See 38 U.S.C.A. § 5107, Murphy v. Derwinski, 1 Vet. App. 78 (1990). See also Brewer v. West, 11 Vet. App. 228, 235 (1998). In fact, in Morton v. West, 12 Vet. App. 477 (1999), the Court held that in the absence of a well grounded claim VA could not undertake to assist a veteran in developing the facts pertinent to the claim. Absent a competent diagnosis of ADHD, the claim is denied as not well grounded. See Caluza, supra. Psychiatric Disorder (other than ADHD) First, the Board notes that since the time of its 1980 decision, which is the last final decision of record, the evidence received includes the report of a VA examination conducted in March 1998. That examination report, which includes commentary and an opinion, goes against the claim with respect to the veteran's argument of a "Carbon Copy" syndrome. However, it notes a history given by the veteran of lifelong psychiatric problems (unrelated to his brother's illness), thus suggesting that the veteran's psychiatric disorder preexisted service. Also received since 1980 were additional medical records and lay statements pertinent to the veteran's military behavior, post-service symptoms, medical history and exhibited behavioral changes. This evidence contributes to a more complete picture of the circumstances surrounding the origin of the veteran's psychiatric disability and the veteran's claim is successfully reopened. See Hodge, supra. The Board must next determine whether the veteran's claim is well grounded. See Elkins, supra. The Board notes that the claims file contains multiple psychiatric diagnoses, including of a personality disorder, which is not a disability warranting service connection under VA applicable law, 38 C.F.R. § 3.303(c) (1999)), and anxiety or depressive disorders. Several records also note a diagnosis of schizophrenia. Thus, there is no question of whether the veteran has a diagnosed psychiatric illness in this case. At issue, rather, is whether any of the veteran's diagnosed, acquired psychiatric disorders are related to service. Service medical records from both periods of service, including at service entrance and discharge, are negative for any psychiatric disability. Psychiatric evaluation conducted in 1947, when the veteran shot himself, specifically did not identify any psychiatric disorder. Nor is there competent evidence that any psychosis was compensably manifested or even diagnosed within a year after the veteran's discharge from wither period of service. See 38 C.F.R. §§ 3.303, 3.307, 3.309. Rather, the first psychiatric diagnoses of record appear several years after the veteran's second period of active service. Neither the physician reports dated from that time, nor any of the competent medical evidence to date relates an anxiety disorder, depressive disorder, schizophrenia, or other diagnosed acquired psychiatric disorder to either of the veteran's periods of military service either by incurrence or aggravation. The hospital reports from 1959, although suggesting a latent schizophrenic process in the veteran, do not indicate that such disorder was present during service or manifested within one year thereafter, or that the eventual development/manifestation of psychiatric disability was otherwise related to the veteran's periods of service. The claims file includes medical records outlining a long history of treatment and evaluation for psychiatric problems, beginning in or around 1958. There is no earlier competent medical evidence of any psychiatric process in the veteran. The Board acknowledges that the veteran, as well as other lay individuals including family members and former military supervisors, have indicated that the veteran underwent personality and/or behavioral changes during and/or as a result of service. The veteran has likewise argued that his psychiatric problems are service related. However, the record does not reflect that the veteran or any of his family members, former fellow servicemen, supervisors or other affiants in this case possess a recognized degree of medical knowledge that would render them competent to offer a medical diagnosis or opinion as to the etiology of the veteran's existing psychiatric disability. Although competent to provide testimony as to observable symptoms or circumstances, lay individuals are not competent to provide the requisite diagnosis of a chronic psychiatric disorder in service, or of a nexus between continuity of symptomatology and any currently diagnosed psychiatric disability. See Niemiec v. West, No. 96-920 (U.S. Vet. App. Dec. 1, 1999) (per curiam) (the Court found the veteran's claim not well grounded where there was no medical evidence of a chronic psychiatric disorder manifested in service, and where there was no medical evidence linking a diagnosed post-service psychiatric disorder to service); see also Clyburn v. West, 12 Vet. App. 296 (1999). Therefore, the lay statements of record, including the numerous letters and statements provided by the veteran, are not sufficient to establish a plausible claim of entitlement to service connection for a psychiatric disability. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The Board notes the veteran's statements and arguments as to the similarities between his symptoms and those of his now- deceased brother, R.D, who was discharged from service due to, and service-connected for, a psychiatric illness deemed to be totally disabling. The Board also notes the veteran's contentions as to various similarities between himself and his brother R.D. However, to well ground the veteran's claim, the record must demonstrate, by competent evidence, a plausible relationship between his current psychiatric disability and service. The Board has reviewed the extensive records pertinent to R.D., the veteran's brother. Those records do not include any opinion by medical personnel as to the existence, nature, onset, or etiology of any diagnosed psychiatric illness in the veteran, but rather reflect treatment and evaluation of psychiatric and other illnesses in R.D. Despite the fact that the veteran and his brother shared a similar upbringing and may have similar genetic traits and predispositions, they are not one and the same individual. The establishment of entitlement to VA benefits by R.D. does not hold any precedential value in establishing the veteran's entitlement to benefits. The record contains competent medical opinion dismissing the veteran's "carbon copy" syndrome or doctrine as a nonexistent psychiatric diagnosis, and the March 1998 VA examiner specifically opined that there was no relationship between R.D.'s psychiatric disorder and the veteran's. That examiner specifically noted that the fact R.D.'s psychiatric disorder began in service was of "no significance" with respect to the onset of the veteran's psychiatric disorder. A review of the veteran's medical records (and his brother's) reveals no medical evidence that the veteran's current acquired psychiatric disability had its onset during the his active military service, that a psychosis was compensably manifested within the initial year after either period of active duty, or that any currently identified psychiatric illness is otherwise related to service, thus failing to meet the nexus requirement of well groundedness. See Caluza, supra. Here the Board notes the veteran's argument to the effect that his claim should be considered and granted based on aggravation. In that respect the Board notes not only that the reports of examinations at entrance, discharge and throughout active service are negative for any noted psychiatric disorder, but also that the veteran specifically denied any depression, worry or nervousness in connection with such examinations, including at discharge from his final period of active service. To the extent any examiners have referenced the lifelong nature of the veteran's illness, this appears to have been based solely on the veteran's self- reported history of symptoms beginning in childhood as there is no competent evidence contemporaneous with the veteran's childhood that shows a psychiatric disorder. (In fact the veteran previously reported the onset of his psychiatric disorder as 1958.) In any event, the 1998 VA examination report merely relates the history given by the veteran, with no enhancement by the examiner. See LeShore v. Brown, 8 Vet. App. 406, 410 (1995) (evidence that is simply information recorded by a medical examiner, unenhanced by any additional medical comment by that examiner, does not constitute competent medical evidence). However, even if such history were sufficient to overcome the presumption of soundness afforded the veteran, see 38 C.F.R. § 3.304(b); Vanerson v. West, 12 Vet. App. 254 (1999), the record lacks a diagnosis of any psychiatric disability until years after service, and is absent competent evidence or opinion that there was an increase during active service in any underlying psychiatric disease entity. See 38 C.F.R. § 3.306(a). In short, the existing record establishes only that the veteran developed a psychiatric disorder first identified and diagnosed many years after active service, without any competent professional relating a current psychiatric disorder to the veteran's service by way of incurrence or aggravation. Thus, the nexus requirement of Caluza, supra, has not been met and the veteran's claim must be denied as not well grounded. 38 U.S.C.A. § 5107(a). The Board recognizes that the Court has held that there is some duty to assist the veteran in the completion of his application for benefits under 38 U.S.C.A. § 5103 (West 1991 & Supp. 1999) even where his claims appear to be not well- grounded where a veteran has identified the existence of evidence that could plausibly well-ground the claim. See generally, Beausoleil v. Brown, 8 Vet. App. 459 (1996); and Robinette v. Brown, 8 Vet. App. 69 (1995), as modified in this context by Epps v. Brown, 9 Vet. App. 341, 344 (1996). In the instant case, however, the veteran has not identified any medical evidence that has not been requested, submitted or obtained, which will support a well-grounded claim. Thus, the VA has satisfied its duty to inform the veteran under 38 U.S.C.A. § 5103(a). See Slater v. Brown, 9 Vet. App. 240, 244 (1996). Finally, the Board notes that in its May 1997 remand, a VA examination by a board-certified psychiatrist was requested if the November 1994 examiner could not be located. Although the subsequently obtained examination was not conducted by either the November 1994 examiner or a board certified medical doctor (M. D.), the examiner was the chief of the psychiatry service at a VA medical center; thus he is accepted as qualified to perform a psychiatric examination, state a diagnosis and provide an opinion. In any event, noncompliance with remand instructions does not warrant another remand in the instant case, see Stegall v. West, 11 Vet. App. 268 (1998), as the claim is not well grounded. See Morton v. West, 12 Vet. App. 477 (1999), wherein the Could held that in the absence of a well grounded claim VA could not undertake to assist a veteran in developing the facts pertinent to the claim. ORDER The claim of entitlement to service connection ADHD is denied as not well grounded. New and material evidence having been received, the claim of entitlement to service connection for a psychiatric disorder is reopened. The claim of entitlement to service connection for a psychiatric disorder is denied as not well grounded. JANE E. SHARP Member, Board of Veterans' Appeals