Back to BVA DecisionsDENIEDService Branch NAVY Special Benefit NO SPECIAL BENEFIT Docket No. 201217-127828
TRAUMATIC BRAIN INJURY
M. C. GRAHAM · 2026 · Case ID: A26032421
Summary
The veteran, who served in the U.S. Navy from June 1989 to March 1993, appeals the denial of service connection for a traumatic brain injury (TBI). The veteran claimed a TBI occurred in 1990 after being struck by a truck while walking to his car, reporting post-traumatic amnesia and subsequent headaches and personality changes. The Board reviewed evidence from the appeal period, November 2019 to October 2020, and prior service treatment records. A February 2020 VA examination found no TBI or residuals, attributing the veteran's reported symptoms to a personality disorder. While a subsequent October 2020 VA examination noted the accident and reported post-traumatic amnesia, it ultimately concluded no TBI or residuals were present, finding symptoms more likely due to a personality disorder. Service treatment records from the time of the accident in February 1990 did not document any head trauma or loss of consciousness, only a right knee injury. Later service records and a March 1993 separation examination also did not document a TBI. The Board found the veteran's statements regarding the accident, its timing, and his recollections inconsistent and not credible, particularly noting discrepancies between his reported knee treatment (cast) and service records (ace wrap, splint). A private psychologist's May 2024 opinion opined a TBI occurred, but the Board found it lacked probative value due to its remote nature, failure to address conflicting evidence, and lack of objective testing. The Board accorded greater weight to the contemporaneous VA examinations and service treatment records. The Board concluded the evidence persuasively weighed against a TBI diagnosis, denying service connection.
Rationale
Veteran's statements regarding accident timing, circumstances, and recollections were inconsistent and not credible.; Service treatment records did not document head trauma or loss of consciousness related to the in-service accident.; Private opinion lacked probative value due to remote nature and failure to address conflicting evidence.
Full Decision Text
Citation Nr: A26032421 Decision Date: 04/08/26 Archive Date: 04/08/26 DOCKET NO. 201217-127828 DATE: April 8, 2026 ORDER Entitlement to service connection for a traumatic brain injury is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran had a traumatic brain injury, to include residuals thereof, at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for a traumatic brain injury are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from June 1989 to March 1993. The Board of Veterans' Appeals (Board) thanks the Veteran for his service to our country. In May 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested review of a March 2020 rating decision based on new and relevant evidence. In October 2020, the agency of original jurisdiction (AOJ) issued the rating decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision. In the December 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 9, 2024. Therefore, the Board may only consider the evidence of record at the time of the October 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim of entitlement to service connection for a traumatic brain injury, to include residuals thereof, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. As a final preliminary matter, the Board acknowledges that on June 3, 2020 VA received from the Veteran's representation information which contained hyperlinks to content that was not otherwise part of the record on appeal; however, that content was not accessed nor considered as part of the record before the Board. See Bowey v. West, 11 Vet. App. 106, 108-09 (1998) (holding that the mere reference to non-VA documents is insufficient to incorporate them into the record). 1. Entitlement to service connection for a traumatic brain injury, to include residuals thereof The Veteran contends service connection for a traumatic brain injury is warranted. In his November 2019 application benefits, the Veteran claimed service connection for traumatic brain injury as he was "[h]it by a truck" in "1992". In a November 2019 statement, the Veteran reported "[w]as hit by a truck when I was walking to my car." During the April 2024 Board hearing, the Veteran testified "I don't remember getting hit by the vehicle, I just remember waking up with a cast on my leg" that "I don't remember even going to the hospital or anything" and "I just know... waking up." Generally, service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131, 38 C.F.R. § 3.303(a). To establish service connection on a direct incurrence basis, the Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during I just remember waking up with a cast on my leg" that "I don't remember even going to the hospital or anything" and "I just know... waking up." Generally, service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131, 38 C.F.R. § 3.303(a). To establish service connection on a direct incurrence basis, the Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The requirement for a current disability is satisfied if the disability is present at any point proximate to the claim, during the claim, or to the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Additionally, there must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998). Under the AMA, the Board is bound by favorable findings of the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104. The October 2020 AOJ decision on appeal provided a favorable finding. Specifically that the evidence showed that a qualifying event, injury, or disease had its onset during the Veteran's service, as he received medical treatment in February 1990 after being hit by a truck as a pedestrian, though no treatment for a head injury was recorded. The appeal period for consideration is from November 1, 2019, the date of receipt of the claim, through October 19, 2020, the date the AOJ decision on appeal was issued. Under any theory of entitlement, the threshold question for the Board is whether the Veteran has had a traumatic brain injury, or residuals thereof, at any time during or approximate to the pendency the claim. In this regard, the Board concludes that the Veteran did not have a traumatic brain injury, or residuals thereof, at any time during or approximate to the pendency of the claim. In this regard, a February 2020 VA examiner found the Veteran did not now have and had not ever had a traumatic brain injury or any residuals of a traumatic brain injury. However, in a June 2020 statement, the Veteran's representative argued the February 2020 VA examiner was a "graduate of Chinese Medical School in 1985 in Physical Therapy and Rehabilitation. Really. Can we not do better than this for our veterans?" In her June 2020 statement, the Veteran's representative also argued a "[g]oogle research indicates a horrible review" and there was an "[a]rrogant comment written on this examination documents this man has some bias against instructions given to him by VA or against VA applicants for SC benefits when he writes, 'Since active duty related TBI can not be diagnosed, the following 10 facet assessments have become baseless and irrelevant' ... and this man over estimates his worth in his knowledge of service connection criteria and upon whim imposes some preconceived criteria". In the June 2020 statement, the Veteran's representative also requested "a TBI 10 Facet Review by a competent specialist such as a psychologist, psychiatrist or neuropsychologist." In May 2020 argument provided with the VA Form 20-0995, Decision Review Request: Supplemental Claim, the Veteran's representative again argued the February 2020 VA examination was inadequate and "requested residual TBI 10 facet analysis be completed with standardized testing." Without addressing all the Veteran's representative's argument regarding February 2020 VA examiner, the Board finds that because the February 2020 VA examiner did not conduct an assessment with the facets of traumatic brain injury-related cognitive impairment and subjective symptoms of a traumatic brain injury, and this VA examination report is inadequate as to the lack of a diagnosis of a traumatic brain injury or any residuals thereof, and need not be discussed further. Thereafter, an October 2020 VA examiner documented the Veteran described in 1990, he was a pedestrian struck by a motor vehicle, specifically al Claim, the Veteran's representative again argued the February 2020 VA examination was inadequate and "requested residual TBI 10 facet analysis be completed with standardized testing." Without addressing all the Veteran's representative's argument regarding February 2020 VA examiner, the Board finds that because the February 2020 VA examiner did not conduct an assessment with the facets of traumatic brain injury-related cognitive impairment and subjective symptoms of a traumatic brain injury, and this VA examination report is inadequate as to the lack of a diagnosis of a traumatic brain injury or any residuals thereof, and need not be discussed further. Thereafter, an October 2020 VA examiner documented the Veteran described in 1990, he was a pedestrian struck by a motor vehicle, specifically that he was in a parking lot when a car struck a parked truck striking him in the right knee, that he reported he had post traumatic amnesia, and the first thing he remembered was waking up in the emergency department where he was treated and released. The October 2020 VA examiner also documented the Veteran reported that since that time, he had experienced headaches and personality changes. However, the October 2020 VA examiner determined that Veteran did not now have and had not ever had a had a traumatic brain injury or any residuals of a traumatic brain injury. The October 2020 VA examiner also addressed the 10 facets of traumatic brain injury-related cognitive impairment and subjective symptoms, and found as to memory, attention, concentration and executive functions, the Veteran reported a complaint of mild memory loss, that his judgement was normal, that his social interaction was frequently inappropriate, that he was always oriented to person, time, place, and situation, that his motor activity normal, that his visual spatial orientation was normal, that he reported a subjective symptom of occasional headaches, and that he had one or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both but do not preclude them, specifically that he had personality disorder and has been written up at work for an argument with his supervisor, and that his wife had contacted the police secondary to the Veteran hitting his stepdaughter, and that he was discharged from the Navy on account of this diagnosis, as to communication, he was able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language, and that his consciousness was normal. The October 2020 VA examiner also found the Veteran did not have any subjective symptoms or any mental, physical or neurological conditions or residuals attributable to a traumatic brain injury (such as migraine headaches or Meniere's disease). The October 2020 VA examiner also noted neuropsychological testing had been performed in February 2020 and resulted in a diagnosis of an unspecified personality disorder. The October 2020 VA examiner also explained a traumatic brain injury diagnosis was not warranted and the symptoms listed in Section II (the 10 facets of traumatic brain injury-related cognitive impairment and subjective symptoms) were more likely than not due to a personality disorder. The October 2020 found given the Veteran's initial normal neurologic presentation it was less likely than not the claimed condition incurred in or caused by the claimed in-service injury. Moreover, consistent with the October 2020 VA examiner's findings and opinion, as provided discussed above as a favorable finding, review of the Veteran's service treatment records demonstrate he received medical treatment in February 1990 after being hit by a truck as a pedestrian, but no treatment for a head injury was recorded. For example, a February 5, 1990 service treatment record documented the Veteran arrived by ambulance with right leg pain after he was hit by a truck. Another February 5, 1990 service treatment record documented the Veteran had right knee effusion secondary to trauma today. Another February 5, 1990 service treatment record documented the Veteran was hit by a parked truck and complained of pain to his right knee, and also notably, that he had had no loss of consciousness, no neck or back problems, and no head trauma. Another February 5, 1990 service treatment record documented the Veteran had status post trauma to his right knee today, that he was struck by parked car, as the parked car was hit by passing vehicle, and now the Veteran complained of swelling and pain his right knee, was unable to fully weight bear, and provided an assessment/plan of possible right lateral collateral ligament sprain, documented that ace wrap would be used, Motrin for pain, light duty for one week, and he was to follow-up as need or persistent symptoms. Another February 5, 1990 service treatment record described that apparently there was avoidance of tractor when it hit a parked truck which hit the patient on the right leg at the lower knee, that he fell down and could not put weight on the right leg and provided an assessment/diagnosis of right knee effusion status post trauma and noted by parked car, as the parked car was hit by passing vehicle, and now the Veteran complained of swelling and pain his right knee, was unable to fully weight bear, and provided an assessment/plan of possible right lateral collateral ligament sprain, documented that ace wrap would be used, Motrin for pain, light duty for one week, and he was to follow-up as need or persistent symptoms. Another February 5, 1990 service treatment record described that apparently there was avoidance of tractor when it hit a parked truck which hit the patient on the right leg at the lower knee, that he fell down and could not put weight on the right leg and provided an assessment/diagnosis of right knee effusion status post trauma and noted treatment with a splint. Thus, these February 5, 1990 service treatment records documented that the Veteran was involved in accident, which injured his right knee, but do not reflect he sustained a head injury, but rather documented he had no loss of consciousness, and no head trauma. Moreover, thereafter, the Veteran's service treatments, dated the year following the February 5, 1990 accident, again do not reflect treatment for a head injury, or related chronic complaints, to include psychiatric issues, memory issues or headaches. For example, a February 6, 1990 service treatment record documented the Veteran had a follow-up visit for right lateral collateral ligament sprain yesterday and that he was able to weight bear slightly more. A February 12, 1990 service treatment record documented the Veteran had a follow-up visit for right knee pain, that he reported his pain only slightly improved and he also complained of an episode of giving way and also noted he had not been resting the knee. A February 13, 1990 service treatment record documented the Veteran's right knee pain had improved somewhat, but he unable to fully weight bear and provided an impression right knee sprain improving. A February 16, 1990 service treatment record documented the Veteran's right knee pain was improving slowly, that he was walking more easily and provided an impression of resolving right knee sprain. A February 17, 1990 service treatment record documented the Veteran had hit by a truck on February 5, 1990, was seen then, and he was now having sharp pain, a pinching feeling on the bottom of right knee, and he had posterior knee pain which began this morning while working, and the pain was described as sharp in nature. Another February 17, 1990 service treatment record documented the Veteran stated that his knee had been hurting for about 10 minutes. Also, a February 1991 service treatment record documented the Veteran reported a history of excessive sleepiness, but also notably, that he had no history of seizure or central nervous system trauma, and his pupils were equal, round, and reactive to light, that as to his neurological system, cranial nerves 2 to 12 were intact by all specific tests, that strength was five out of five throughout, and coordination and gait were normal. Thus, these and other service treatment records, dated the year following the February 5, 1990 accident, do not reflect treatment for a head injury, or related chronic complaints, to include psychiatric issues, memory issues or headaches, but do document other complaints. Thereafter, a December 1991 service treatment record documented the Veteran admitted to a more irritable mood recently and feelings of sadness, that he explained that his step-father passed away in March 1991, and although he and spoke angrily of his abusive treatment, he also explained that this was the first Christmas without him and he could not help but miss him. A January 1992 service treatment record documented the Veteran complained of head and back pain, that headaches occurred two days ago and he had had back pain for 24 hours, that he came in two days ago for headaches but now his back starting hurting. The January 1992 service treatment record also documented the Veteran's pupils were equal, round, and reactive to light and accomodation. A February 1993 service treatment record documented the Veteran reported an eight month history of progressive depression and provided an impression of structured depression. Another February 1993 service treatment record documented the Veteran had an eight month history of progressive depression and he wanted discharge from the Navy. A March 1993 service treatment record, from psychiatry, provided diagnoses of malingering and personality disorder, not otherwise specified, with passive aggressive and borderline traits, and documented the Veteran would receive a routine administrative separation for unsuitability based on a personality disorder. Thus, the Veteran's service treatment records, following the February 5, 1990 accident, reflect he subsequently reported psychiatric symptomology in December 1991, in the context of, at least partially, missing a deceased family member documented the Veteran reported an eight month history of progressive depression and provided an impression of structured depression. Another February 1993 service treatment record documented the Veteran had an eight month history of progressive depression and he wanted discharge from the Navy. A March 1993 service treatment record, from psychiatry, provided diagnoses of malingering and personality disorder, not otherwise specified, with passive aggressive and borderline traits, and documented the Veteran would receive a routine administrative separation for unsuitability based on a personality disorder. Thus, the Veteran's service treatment records, following the February 5, 1990 accident, reflect he subsequently reported psychiatric symptomology in December 1991, in the context of, at least partially, missing a deceased family member at Christmastime, approximately 22 months later. The Veteran's service treatment records, following the February 5, 1990 accident, also reflect he subsequently he reported headaches, with a two day history, in January 1992, approximately 23 months later. Furthermore, the Veteran's March 1993 in-service examination, conducted in conjunction with his separation from active duty, do not document a traumatic brain injury but rather documented the Veteran's neurologic system, as relevant to a traumatic brain injury, was clinically normal upon examination. In a corresponding March 1993 Report of Medical History, the Veteran checked "no" to existence of periods of unconsciousness, but did check "yes" to the existence of hearing loss, frequent trouble sleeping, and depression or excessive worry. The March 1993 Report of Medical History also documented the Veteran described he had been slowly losing his hearing, that he wore glasses that corrected his eyes to 20/20, and that he had frequent trouble sleeping because of stress and because of worries, and that his stress and worries and a lack of sleep put him into a depression. The March 1993 Report of Medical History also documented findings from a medical provider as to the Veteran's hearing, that he wore glasses, myopic, corrected to 20/20, and that he had been diagnosed with malingering and personality disorder, not otherwise specified, with passive aggressive and borderline traits. The Board finds that if the Veteran had experienced a traumatic brain injury, or related symptoms during his active duty service, it would have been documented during such service, and also that it would have been reasonable for him to have reported, including at the time of the accident in February 5, 1990, during his subsequent service, or during the March 1993 Report of Medical History, given other medical problems were identified by the Veteran during such service, and also because the Veteran had an opportunity to identify periods of loss of consciousness specifically at the time February 5, 1990 accident and in the March 1993 Report of Medical History. Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the condition or symptoms did not exist). Moreover, consistent with the October 2020 VA examination report, despite VA treatment during the appeal period, the Veteran's VA treatment records do not reflect a diagnosis of a traumatic brain injury or residuals thereof. For example, November 2019 VA treatment record, dated the same month the Veteran filed this claim, documented the Veteran complained of a headache today and noted a history of a motor vehicle accident/pedestrian injury during active duty, and that consequently a MRI was ordered, and also that as to cognition, the Veteran reported a memory issue, but there no testing, and a consult was placed with neuropsychology for cognition testing. A January 2020 MRI provided an impression of "no acute intracranial abnormality" as well as findings of bilateral mastoiditis and minimal sinus disease. Thereafter, a February 2020 VA treatment record documented the Veteran underwent a neuropsychological evaluation, conducted by a clinical neuropsychologist, and during his evaluation, he complained of a history of headaches but was unwilling to provide current details stating "he doesn't recognize if he's having a headache anymore or not." The February 2020 VA treatment record also documented there was no known history of certain disabilities, including migraine, or other traumatic brain injury. The February 2020 VA treatment record concluded the results of the neuropsychological evaluation were consistent with an unspecified personality disorder and intact cognition. Specifically, the February 2020 neuropsychological evaluation stated there were no areas of cognitive deficit with cognitive functioning ranging from average to superior including superior memory performance, and the Veteran had some difficulty staying engaged with testing resulting in some variability in performance, but effort was deemed to be adequate and the resulting overall performance was believed to adequately reflect his cognitive functioning. The February details stating "he doesn't recognize if he's having a headache anymore or not." The February 2020 VA treatment record also documented there was no known history of certain disabilities, including migraine, or other traumatic brain injury. The February 2020 VA treatment record concluded the results of the neuropsychological evaluation were consistent with an unspecified personality disorder and intact cognition. Specifically, the February 2020 neuropsychological evaluation stated there were no areas of cognitive deficit with cognitive functioning ranging from average to superior including superior memory performance, and the Veteran had some difficulty staying engaged with testing resulting in some variability in performance, but effort was deemed to be adequate and the resulting overall performance was believed to adequately reflect his cognitive functioning. The February 2020 neuropsychological evaluation stated that a motor vehicle collision in 1990 resulted in a fractured leg but no known head trauma, and no medical records were available from the time of the accident, and the MRI in January 2020 indicated only an unspecified degree of microvascular ischemia, likely related to his history of smoking and hyperlipidemia. The February 2020 neuropsychological evaluation stated it was doubtful that the Veteran sustained a traumatic brain injury at the time of the accident, or that if he did, it was likely relatively mild. The February 2020 neuropsychological evaluation explained there did not appear to be cognitive or behavioral residuals from the event and noted the Veteran completed a bachelor's degree in four years in 2017. The February 2020 neuropsychological evaluation explained there appeared to be a long history of characterological problems resulting in difficulty conforming to societal norms. The February 2020 neuropsychological evaluation explained the Veteran was dismissed from the military early due to these behaviors, that he had had difficulty maintaining employment, and had had two known investigations for domestic assault on his step-children and that he externalized these situations onto others and had difficulty accepting personal responsibility for his behaviors. The February 2020 neuropsychological evaluation stated there appeared to be traits of narcissism along with lack of empathy, but ongoing mental health care should help to elucidate the overall characterological pattern, and with a more physically and socially active lifestyle, improved pro-health behaviors, and improvement in his psychiatric functioning he should experience improved social and occupational functioning. The February 2020 neuropsychological evaluation provided a diagnostic impression of unspecified personality disorder. Also, a March 2020 VA treatment record documented the Veteran denied any acute posttraumatic stress disorder (PTSD) symptoms but claimed that he has sustained a truck injury in 1990 in the Navy in which he was struck by a semitruck, specifically in 1990 he was struck by a truck and only remembers thinking "[o]h, shit" before being hit and vague recollections of people at the scene trying to provide him with aid, and that he occasional flashbacks from that but no acute or severe PTSD symptoms were reported. The March 2020 VA treatment record also stated "[r]ecords also indicated that he has been diagnosed with traumatic brain injury, but he denied any acute headache or dizziness during the session." The March 2020 VA treatment record documented DSM-5 diagnoses of anxiety disorder, specified, unspecified bipolar related disorder, probable, other specified trauma and stress related disorder, probable, traumatic brain injury by history, and rule out unspecified neurocognitive disorder due to traumatic brain injury. Thus, the March 2020 VA treatment record endorsed a diagnosis of traumatic brain injury by history, but this only relied on the Veteran's own reported history, which as discussed below, is not credible. Moreover, the March 2020 VA treatment record documented the Veteran denied any acute headache or dizziness during the session and ruled out unspecified neurocognitive disorder due to traumatic brain injury. Thus, the March 2020 VA treatment record did not endorse a diagnosis of a traumatic brain injury or endorse any current related symptomology. An April 2020 VA treatment record documented the Veteran reported increased anxiety following a self-reported traumatic brain injury while active duty. A May 2020 VA treatment record documented the Veteran claimed that sometimes he felt that he has memory issues but claimed that it was not causing any significant impairment in his day-to-day functioning, he claimed that he enjoyed outdoor activities such as swimming fishing and spending time with his family, and that he continued to be preoccupied with what happened in 1991, referring to accident leading to head injury according to him, which probably caused traumatic brain injury according to him, and provided the same diagnoses, discussed above. Thus, consistent with the October 2020 VA examination report, the Veteran's VA treatment records do not provide a diagnosis of a traumatic brain injury or residuals thereof. Rather as discussed above, the February 2020 neuropsychological evaluation explained it was doubtful that the Veteran sustained a traumatic brain injury at he felt that he has memory issues but claimed that it was not causing any significant impairment in his day-to-day functioning, he claimed that he enjoyed outdoor activities such as swimming fishing and spending time with his family, and that he continued to be preoccupied with what happened in 1991, referring to accident leading to head injury according to him, which probably caused traumatic brain injury according to him, and provided the same diagnoses, discussed above. Thus, consistent with the October 2020 VA examination report, the Veteran's VA treatment records do not provide a diagnosis of a traumatic brain injury or residuals thereof. Rather as discussed above, the February 2020 neuropsychological evaluation explained it was doubtful that the Veteran sustained a traumatic brain injury at the time of the in-service accident, or that if he did, it was likely relatively mild, and there appeared to be a long history of characterological problems resulting in difficulty conforming to societal norms and provided a diagnostic impression of unspecified personality disorder. Further, prior to November 2019, the medical and lay evidence, does not contain a diagnosis of a traumatic brain injury, or chronic complaints thereof, including memory issues or headaches, but instead reflect the opposite. For example, a May 1993 VA general examination report documented, as to the Veteran's nervous system, he had no gross neurological deficits. A May 1993 VA mental disorders examination report documented the Veteran had no Axis I diagnosis at this time, that he had history of alcohol abuse and adjustment disorder with depressed mood while he was in the Navy and endorsed an Axis II diagnosis of mixed personality disorder. Also, an August 1999 VA treatment record documented the Veteran reported right wrist soreness after a work related injury earlier that same month. December 2008 VA treatment records documented the Veteran complained of sinus pressure, drainage and as well as a cough with sputum production and associated with a low grade fever, which started before Christmas and was continuous with time and over the counter medication. December 2008 VA treatment records also documented the Veteran reported a sore throat and as well as having problems with his temporomandibular joint, as he reported it popped off and on. December 2008 VA treatment records documented, as to the Veteran's central nervous system, he was awake and alert and cooperative, cranial nerve was intact, motor and sensory systems were intact, and gait intact, and depression and PTSD screenings were negative. A February 2009 VA treatment record documented the Veteran reported he had a knot under his skin for years, but since Saturday all of a sudden, he noticed redness and a raised area, and the area had gotten larger. A March 2009 VA treatment record documented the Veteran presented for his vesting physical examination, that he had "no complaints today" and also documented his neurological system, was "within normal limits". An April 2009 VA treatment record documented the Veteran presented with an infected area on the right arm, that he had been present for about a week and he did not know how it got started, that he had a similar infection in the same are that resolved with antibiotic therapy, and that he also had a problem with nasal allergies that was manifested by nasal congestion rhinorrhea and posterior nasal discharge. October 2009 VA treatment records documented the Veteran reports a lesion on his right upper arm, which occasionally became infected and a history of a lipoma on his forehead, and also that a depression screening was negative. Thereafter, an August 2012 VA treatment record documented the Veteran was requesting a PTSD evaluation and anger management problems, he also requested an eye examination, and otherwise offered no medical problems. Other August 2012 VA treatment records of the same date documented the Veteran reported right knee pain, that a depression screening was negative and the Veteran denied neurological problems. Another August 2012 VA treatment record, a mental health record, documented the Veteran reported was here because "everybody in my family thinks I have short fuse" and he reported it started after he left the service, that he was in active combat in the Gulf, that he had been angry since then, and reported he was discharged seeing a psychiatrist, who thought he had "mental issues and split personality" "because I was angry over the things they did", and documented the Veteran's memory was "intact" and endorsed a diagnosis of mood disorder, not otherwise specified, and ruled out PTSD. Another August 2012 VA treatment record of the same date noted Veteran had some symptoms of PTSD, but he had been very vague, and it was hard to get answers out of him, that he had legal issues for "smacking my 15 yr old daughter". Also, in an August 2012 statement, the Veteran reported he was experiencing symptoms of PTSD and expressed a desire to return to counseling. In a September 2012 traumatic reported he was discharged seeing a psychiatrist, who thought he had "mental issues and split personality" "because I was angry over the things they did", and documented the Veteran's memory was "intact" and endorsed a diagnosis of mood disorder, not otherwise specified, and ruled out PTSD. Another August 2012 VA treatment record of the same date noted Veteran had some symptoms of PTSD, but he had been very vague, and it was hard to get answers out of him, that he had legal issues for "smacking my 15 yr old daughter". Also, in an August 2012 statement, the Veteran reported he was experiencing symptoms of PTSD and expressed a desire to return to counseling. In a September 2012 traumatic brain injury screening, the Veteran did not endorse that he had experienced certain events, including vehicular accident/crash (any vehicle, including aircraft), and likewise, he did not endorse any symptoms immediately afterward including, losing consciousness/knocked out, nor did not endorse any problem began or got worse afterward, including memory problems or lapses and headaches. An October 2012 VA treatment record, a psychological evaluation, documented the Veteran reported several past stressors, including during service, being hit by a truck that was travelling 35 mph, and endorsed a diagnosis of anxiety disorder, not otherwise specified. An October 2012 PTSD VA examination report documented the Veteran's symptoms did not meet the diagnostic criteria for PTSD under DSM-IV criteria, the Veteran did not have a mental disorder that conformed with DSM-IV criteria, that he had no mental disorder diagnosis and he had no diagnosis of traumatic brain injury. A November 2012 VA treatment record documented the Veteran reported blurred vision, especially at nighttime, and provided an impression of bilateral refractive error. A December 2012 VA treatment record documented the Veteran reported his right butt cheek was bothering him, and sometimes his leg felt like it was "going to throw out" that this had been going on for about one week, that he had no injury as far as he knew but he did repetitive lifting and turning at work. A June 2013 VA treatment record documented the Veteran presented with complaints of left ear pain for two days and indicated his left ear was impacted with cerumen. A December 2013 VA treatment record the Veteran presented for an annual examination, that his blood pressure was controlled, that cardio-pulmonary-renal was stable, his lipids were not controlled, and he had gained weight, but offered no new or medical problems or concerns and noted active problems, including anxiety disorder, not otherwise specified, and mood disorder, in conditions classified elsewhere. Another December 2013 VA treatment record documented the PTSD and depression screenings were negative. A January 2015 VA treatment record the Veteran presented for an annual examination, that his blood pressure was controlled, that cardio-pulmonary-renal was stable, his lipids could be better controlled with diet modification and weight loss, and he had gained weight, and that he was doing well overall and offered no new or medical problems or concerns other than tinnitus, and noted active problems, including anxiety disorder, not otherwise specified, and mood disorder, in conditions classified elsewhere. Another January 2015 VA treatment record documented a depression screening was negative. A June 2015 VA treatment record documented the Veteran reported he woke up four days ago with right ear pain, with progressively lessened hearing, and he had pain, fullness and edema to the ear. A later June 2015 VA treatment record documented the Veteran called stating his left ear and his jaw felt okay but his right ear was still a little painful, still stopped up, and he had decreased hearing. A subsequent to June 2015 documented the Veteran called stating his right ear "feels better...but I'm still having decreased hearing and it feels stopped up still". A February 2016 VA treatment record documented the Veteran presented for an annual examination, that his blood pressure was controlled, that cardio-pulmonary-renal was stable, and his lipids were at goal. Another February 2016 VA treatment record of the same date also documented the Veteran complained chronic right knee and right hand pain since active service and that he stated was hit by tractor trailer, and also documented that a depression screening was positive. Another February 2016 VA treatment record discussed the Veteran's psychiatric history and noted he has been involved in an incident in which he struck his teenage step-son, that he reported he had considerable financial stress and little in the way of support outside of his immediate family system, and that he gave indication of little insight into his condition and of his having an explosive anger issue. A June 2016 VA treatment record documented the Veteran called and reported he had sudden left ear hearing loss and decreased hearing in right ear, as well as ear pressure, soreness in left ear, the Veteran complained chronic right knee and right hand pain since active service and that he stated was hit by tractor trailer, and also documented that a depression screening was positive. Another February 2016 VA treatment record discussed the Veteran's psychiatric history and noted he has been involved in an incident in which he struck his teenage step-son, that he reported he had considerable financial stress and little in the way of support outside of his immediate family system, and that he gave indication of little insight into his condition and of his having an explosive anger issue. A June 2016 VA treatment record documented the Veteran called and reported he had sudden left ear hearing loss and decreased hearing in right ear, as well as ear pressure, soreness in left ear, an unknown temperature, no drainage, some sneezing, and nasal congestion, for about seven days. A March 2017 VA treatment record documented the Veteran complained of discomfort to his feet, that his right foot was "flat footed" and causing back discomfort and he would like to be considered for inserts. A March 2017 VA treatment record documented a depression screening was negative. A later March 2017 VA treatment record documented the Veteran was seen for a routine follow-up and he had no complaints, that he declined inserts and that he also denied dizziness, slurring of speech, weakness, and sensory loss. An October 2017 VA treatment record documented the Veteran reported he had a rash on his fingers with blisters noted. The Board finds that if the Veteran had experienced symptoms related to a traumatic brain injury, or residual thereof, prior to November 2019, it would have been reasonable for him to have reported it, given that he sought treatment for various other medical conditions. Buczynski, 24 Vet. App. at 224. Moreover, the Veteran has provided inconsistent statements as to the year of the in-service accident, the circumstances of the in-service accident, and his recollections or lack of recollection, of the in-service accident. For example, an October 2012 PTSD VA examination report documented the Veteran reported certain stressors, including that he "[w]hile walking off the USS Roosevelt, a tractor truck hit him" that he "suffered a fractured right knee" and he "was released from the hospital that day." Also a February 2016 VA treatment record documented the Veteran complained chronic right knee and right hand pain since active service and that he stated was hit by tractor trailer. However, these records do not document the Veteran reported a head injury or a loss of consciousness as related to the in-service accident but rather reported a right knee problem and/or right hand pain. Also, during a February 2020 VA examination the Veteran reported "he was hit by a truck in Norfolk, VA in 1990" and he could not remember what happened to him but he has "flash-backs" of the accident, which relate to bystanders asking him if he was okay. In a June 2020 statement, the Veteran responded to the February 2020 VA examiner's documentation of his statements and that "I only know it was in 1990 when I got hit by a truck because it is written in my medical record" that he did not remember anything from that day, that he did not know where he was going, whether he had just left the boat, but he was told he going on liberty and he did have flashback, which started several days later, and specifically that he had flashbacks of "two blurry black faces looking at me, they are female faces I can tell by their voices" and said "Oh my god you just got hit by that truck don't move, don't move you got hit by that truck oh my god you got hit don't move" and they do not say anything else. He also reported a flashback of white man looking down at him, asking me if he was in pain and where did he hurt, that he started touching him and asking if it hurt, "but when he grabs my knee I scream out in pain" and "[t]hings go black and all I hear is someone screaming 'Oh my god he is going into shock'." He also stated he was "told by the medic in the boats medical weeks later when I was having the cast removed from my leg that my leg and knee had been fractured" and also he "was also told at some point (I do not remember when) by a VA doctor that my knee had been fractured and the reason for some of the pain I have now could be caused by arthritis developing" and that "I do not remember getting the cast put on my leg but it was there." He also stated "I suffered from head aces, blurred vision, and dizziness" and "went to medical on the boat twice about head aces and all the is someone screaming 'Oh my god he is going into shock'." He also stated he was "told by the medic in the boats medical weeks later when I was having the cast removed from my leg that my leg and knee had been fractured" and also he "was also told at some point (I do not remember when) by a VA doctor that my knee had been fractured and the reason for some of the pain I have now could be caused by arthritis developing" and that "I do not remember getting the cast put on my leg but it was there." He also stated "I suffered from head aces, blurred vision, and dizziness" and "went to medical on the boat twice about head aces and all the corps-men gave me was aspirin". As discussed above, the October 2020 VA examiner documented the Veteran described in 1990, he was a pedestrian struck by a motor vehicle, that he was in a parking lot when a car struck a parked truck, striking the Veteran in the right knee, that he reported he had post traumatic amnesia and the first thing he remembered was waking up in the emergency department and he was treated and released. In a November 2020 statement, the Veteran disputed the October 2020 VA examiner's documentation of his statements, specifically that he stated he said "I either Got hit by a Semi Truck (Tractor Truck) or got hit my a vehicle it hit" and "I do not know what happened because I do not remember it" and "I remember people telling me I got hit by a truck and the police report saying I got hit by a semi truck". In his November 2020 statement, the Veteran also stated he was asked if he was taken to a hospital and he responded "I would hope so if I was just hit by a truck", that as to the hospital he was taken that he stated "I would assume the Naval Hospital sense I was in the Navy" and that he stated "I don't remember any of it but I have flashes and the first one is of a couple of blurry black faces looking at me saying 'oh god don't move you just got hit by that truck oh my god.'" In his November 2020 statement, the Veteran also argues he reported headaches. Also, a March 2020 VA treatment record documented the Veteran claimed that he has sustained a truck injury in 1990 in the Navy in which he was struck by a semitruck, specifically in 1990 he was struck by a truck and only remembers thinking "'[o]h, [expletive]' before being hit and he vague recollections of people at the scene trying to provide him with aid, and that he occasional flashback from that but no acute or severe PTSD symptoms were reported. However, in April 2024 testimony, the Veteran stated "I don't remember getting hit by the vehicle, I just remember waking up with a cast on my leg" and that was all he remembered, he did not even remember going to the hospital or anything. Thus, the Veteran has inconsistently reported that he did not remember anything before being hit but conversely, that he also remembered thinking "'[o]h, [expletive]' before being hit as well has having vague recollections of people at the scene trying to provide him with aid" and also that "I remember people telling me I got hit by a truck and the police report saying I got hit by a semi truck". Moreover, the Veteran has provided inconsistent statements as to his reported flashbacks. For example, in April 2024 testimony the Veteran did not report he experienced any flashbacks. Also, the February 2020 VA examiner documented the Veteran reported flashbacks of the accident related to bystanders asking him if he was okay. However, in his June 2020 statement, he additionally reported a flashback of white man looking down at him, asking me if he was in pain and where did he hurt, that he started touching him and asking if it hurt, "but when he grabs my knee I scream out in pain" and "[t]hings go black and all I hear is someone screaming 'Oh my god he is going into shock'." Also, as discussed above, the record reflects the Veeran was involved in-service accident on February 5, 1990. However, a May 2020 VA treatment record documented the Veteran continued to be preoccupied with what happened in 1991 referring to accident leading to head injury according to him. Also, in his November 2019 application benefits, the Veteran claimed a traumatic brain injury as he was "[h]it by a truck" in "1992". Thus, the Veteran reported his traumatic brain injury was related to an accident that occurred, not when it was documented to have occurred on February 5, and all I hear is someone screaming 'Oh my god he is going into shock'." Also, as discussed above, the record reflects the Veeran was involved in-service accident on February 5, 1990. However, a May 2020 VA treatment record documented the Veteran continued to be preoccupied with what happened in 1991 referring to accident leading to head injury according to him. Also, in his November 2019 application benefits, the Veteran claimed a traumatic brain injury as he was "[h]it by a truck" in "1992". Thus, the Veteran reported his traumatic brain injury was related to an accident that occurred, not when it was documented to have occurred on February 5, 1990, but also in 1991 and 1992. Further, the Veteran's assertions as to his in-service accident are inconsistent with the objective evidence of record. For example, as discussed above, the during the April 2024 Board hearing, the Veteran testified "I just remember waking up with a cast on my leg". In a June 2020 statement, the Veteran reported he was "told by the medic in the boats medical weeks later when I was having the cast removed from my leg that my leg and knee had been fractured". However, as discussed above, the Veteran's February 5, 1990 service treatment records documented his right knee injury was not treated with a cast but rather with an ace wrap, a splint, Motrin for pain, light duty for one week, and he was to follow-up as need or persistent symptoms. Moreover, contrary to the Veteran's assertions that he sustained a right knee fracture, his February 5, 1990 service treatment records documented other diagnoses, to include a possible right lateral collateral ligament sprain and right knee effusion status post trauma. Also, contrary to the Veteran's November 2020 statement that he reported headaches, as discussed above, his service treatment records reflect he reported headaches, with a two day history, in January 1992, approximately 23 months after his February 5, 1990 accident. Thus, although the Veteran asserts he experienced an in-service traumatic brain injury, along with residuals thereof, the other evidence of record, including objective evidence to the contrary, specifically service treatment records and post service medical and lay evidence, and the Veteran's own inconsistent statements, is not consistent with his assertions, made in the context of a claim for compensation; therefore, such assertions are not credible. See Curry v. Brown, 7 Vet 59 (1994); Cartwright v. Derwinski, 2 Vet. App. 24, 25-26 (1991). Also, in a May 2024 private opinion, Douglas Brady, a psychologist, opined the Veteran "did suffer a TBI in his accident while on active duty with the United States Navy" and found had "brief loss of consciousness and post trauma amnesia" and the "exact time for these signs of a TBI were not documented in his USN Medical Records but he has ongoing memory deficits that do not allow for specificity for these behaviors at this time." The May 2024 private opinion stated the Veteran "becomes angry when asked to specifically describe the accident and where he was hospitalized and the consequences" and [s]adly, he has been inaccurately diagnosed with a Personality Disorder (general term and not specified) as his reason for Separation from the USN" and two VA examinations, including the October 2020 VA examination reports continued the diagnosis of a personality disorder. The April 2024 private opinion argued the October 2020 VA examiner described symptoms of TBI Residual behaviors and noted a MoCA score of 16/30 which was reflective of moderate cognitive impairment and the VA neuropsychological examination with the VA is "not sufficiently described for the tests utilized, instead, it appears to be a description of each of the MoCA subtests in extended terms" and "[o]nly the final MoCA score is correctly utilized in this screening instrument." The April 2024 private opinion also stated that reference to severe impairment was sometimes used to help with cognitive diagnosis and in this case the reason for the impaired score, of moderate cognitive impairment, was at odds with a college educated individual and the "timing of these exams and the VA decision for denial of a TBI and residuals in rather odd as it is within a very short, reported time range in 2020." However, April 2024 private opinion did not address relevant, objective evidence that conflicted with the proffered opinion, including the Veteran's service treatment record such as February 5, 1990 service treatment record, which documented the Veteran was hit by a parked truck, and also notably, that he had no loss of consciousness, no neck or opinion also stated that reference to severe impairment was sometimes used to help with cognitive diagnosis and in this case the reason for the impaired score, of moderate cognitive impairment, was at odds with a college educated individual and the "timing of these exams and the VA decision for denial of a TBI and residuals in rather odd as it is within a very short, reported time range in 2020." However, April 2024 private opinion did not address relevant, objective evidence that conflicted with the proffered opinion, including the Veteran's service treatment record such as February 5, 1990 service treatment record, which documented the Veteran was hit by a parked truck, and also notably, that he had no loss of consciousness, no neck or back problems, and no head trauma. Rather, the April 2024 VA examiner merely stated the Veteran "had brief Loss of consciousness and post trauma amnesia" then stated "exact time for these signs of a TBI were not documented in his USN Medical Records." However, the Board reiterates that review of the Veteran's service treatment reflects no loss of consciousness or post trauma amnesia related to his February 5, 1990 accident but do reflect many other subsequent complaints. Also, as discussed above, the April 2024 private opinion opined that the Veteran has been inaccurately diagnosed with a personality disorder as his reason for separation from service, and also argued that, at that time, consideration was not given to a traumatic brain injury with cognitive and behavioral patterns of behavior, that the in-service psychiatric examination made no specific cluster of any personality disorder and it was "inconceivable" that the Veteran would have had a personality disorder sufficient for him being discharged or separated from service prior to his accident given his excellent service and awards and medals as personality disorders did not suddenly develop, and they are long standing clusters of behavior, thinking and social interaction. However, the Board notes that common sense dictates the in-service psychiatric examination did not consider a traumatic brain injury because there is no objective evidence the Veteran sustained a traumatic brain injury service, including during the February 5, 1990 accident. Further, as to the argument that it was "inconceivable" that the Veteran would have had a personality disorder sufficient for him being discharged or separated from service prior to his accident given his excellent service and awards and medals as personality disorders did not suddenly develop, and they are long standing clusters of behavior, thinking and social interaction, the Board notes, that in fact, the Veteran did report psychiatric symptomology, a few months after induction into service and prior to the February 5, 1990 accident. For example, an August 1989 service treatment record documented the Veteran reported a chief complaint of "psych disorder", provided an assessment/diagnosis of depression, and noted the Veteran was referred to psychiatry. A subsequent August 1989 service treatment record, from psychiatry, provided an impression of situation stress reaction with brief dissociative episode, that the Veteran was return to duty and have further evaluation tomorrow. A subsequent August 1989 service treatment record, from psychiatry, provided an assessment of no psychiatric diagnosis, that the Veteran had odd behavior but history and testing insignificant and he was to return to duty. Thus, the April 2024 private opinion again did not address relevant, objective evidence that conflicted with the proffered opinion. The April 2024 private opinion, as best the Board is able to discern, also appears to dispute the findings of the February 2020 VA neuropsychological testing, citing to a "20/19/2020" date and generally quarreling with how this examination was conducted, including "[n]o list of neuropsychological tests is reported save for the MoCA results" and there was "a lengthy description of ..[the Veteran's] behaviors and education" and "[n]o description is provided for Shipbound duties in the USN." However, there is no probative evidence to support the April 2024 private opinion's assertions as to any material irregularity with the February 2020 VA neuropsychological testing nor is the Board able to discern any material irregularities with the February 2020 VA neuropsychological testing. Moreover, the February 2020 VA neuropsychological testing was not obtained in conjunction with this claim but rather was obtained in response to the Veteran's own reports of cognitive impairment raised in a November 2019 VA treatment record. Indeed, the April 2024 private opinion stated "[t]he timing of these exams and the VA decision for denial of a TBI and residuals in rather odd as it is within a very short, reported time range in 2020." However, to the extent there is any inference of impropriety of VA's part as to any timing, the procedural history is that in November 2019, able to discern any material irregularities with the February 2020 VA neuropsychological testing. Moreover, the February 2020 VA neuropsychological testing was not obtained in conjunction with this claim but rather was obtained in response to the Veteran's own reports of cognitive impairment raised in a November 2019 VA treatment record. Indeed, the April 2024 private opinion stated "[t]he timing of these exams and the VA decision for denial of a TBI and residuals in rather odd as it is within a very short, reported time range in 2020." However, to the extent there is any inference of impropriety of VA's part as to any timing, the procedural history is that in November 2019, the Veteran filed his claim for a traumatic brain injury. That same month, a November 2019 VA treatment record documented the Veteran complained of a headache today and noted a history of a motor vehicle accident/pedestrian injury during active duty, and that consequently, a MRI was ordered, and also that as to cognition, the Veteran reported a memory issue, but there was no testing, and a consult was placed with neuropsychology for cognition testing. Thus, the February 2020 VA neuropsychological consult was obtained in response to the Veteran's November 2019 complaints. The February 2020 VA examination report was obtained in conjunction with this claim, and was argued to be inadequate by the Veteran's representative, and in response, in October 2020, the AOJ obtained another VA examination report, then the AOJ subsequently adjudicated the claim. The April 2024 private examiner also stated the impaired score of moderate cognitive impairment was at odds with a college educated individual. However, in this regard, the April 2024 private examiner again did not address relevant evidence which conflicted with the proffered opinion. Specifically, the February 2020 neuropsychological evaluation explained it was doubtful that the Veteran sustained a traumatic brain injury at the time of the accident, or that if he did it was likely relatively mild, and explained there did not appear to be cognitive or behavioral residuals from the event and noted he completed a bachelor's degree in four years in 2017. Rather, the Board reiterates the February 2020 neuropsychological evaluation stated there appeared to be a long history of characterological problems resulting in difficulty conforming to societal norms, and cited to the Veteran's early dismissal from the military due to these behaviors, his difficulty maintaining employment, and his two known investigations for domestic assault on his step-children. As to the October 2020 VA examination report, the April 2024 private opinion argued facets such as judgement were described as normal which conflicted with the reason the Veteran was separated from service, that interactions were described as frequently inappropriate but this "was not described in depth" and orientation and motor activity was described as normal "which is factually incorrect for the consequences of his injury." However, the Board observes that common sense dictates Veteran's level of judgement, due to a personality disorder at the time of separation from service in 1993, and many years later in 2020, may not be the same. Also, disputing the level of documentation for a VA examiner's specific finding, specifically that interactions were described as frequently inappropriate but this "was not described in depth" is not indicative of an inadequate examination. Also, while orientation and motor activity was described as normal "which is factually incorrect for the consequences of his injury" the Board again reiterates that an in-service head injury or a traumatic brain injury is not conceded nor established by the evidence of record. Indeed, the April 2024 private opinion does also not address the Veteran's inconsistent statements as to the year of the in-service accident, the circumstances of the in-service accident, and his recollections or lack of recollection, of the in-service accident, nor inconsistencies with the post service medical and lay evidence. In his April 2024 private opinion, Douglas Brady, a psychologist, also argued the October 2020 VA examiner endorsed a diagnosis of a personality disorder but was "not qualified to make this diagnosis given that his medical specialty is Physiatrist or Doctor of Physical Medicine." However, under AMA procedure, as applicable here, as this challenge was raised in the April 2024 private opinion, after the AOJ decision on appeal, it cannot constitute or identify a pre-decisional error on the part of the AOJ, and the Board cannot remand for development on this basis. Also, as discussed above, in a June 2020 statement, the Veteran's representative requested "a TBI 10 Facet Review by a competent specialist such as a psychologist, psychiatrist or neuropsychologist." Here, the October 8, 2020 Appointment Confirmation provided to the Veteran included provider training and credential qualified to make this diagnosis given that his medical specialty is Physiatrist or Doctor of Physical Medicine." However, under AMA procedure, as applicable here, as this challenge was raised in the April 2024 private opinion, after the AOJ decision on appeal, it cannot constitute or identify a pre-decisional error on the part of the AOJ, and the Board cannot remand for development on this basis. Also, as discussed above, in a June 2020 statement, the Veteran's representative requested "a TBI 10 Facet Review by a competent specialist such as a psychologist, psychiatrist or neuropsychologist." Here, the October 8, 2020 Appointment Confirmation provided to the Veteran included provider training and credentialling information which showed the October 2020 VA examiner was as a licensed Medical Doctor, with a specialty as a physiatrist, with a Board Certification from the American Board of Physical Medicine and Rehabilitation, with 22 years of medical experience and with specialized compensation and examination experience and training. The Board therefore concludes the October 2020 VA examiner was qualified to provide the report requested. Accordingly, the Board finds review of the October 2020 VA examiner's credentials and experience shows he was qualified to provide this report. The Board therefore concludes that the fact that the October 2020 VA examiner is a Medical Doctor and not a "psychologist, psychiatrist or neuropsychologist" as argued by the Veteran's representative, in June 2020, prior to the obtainment of the October 2020 VA examination, does not, alone, make him unqualified to provide the report requested. Accordingly, the Board finds remand for another examination by a "psychologist, psychiatrist or neuropsychologist" based on a duty to assist error is not warranted. Essentially as discussed above, the April 2024 VA opinion disputes the Veteran's in-service diagnosis of a personality disorder, not otherwise specified, with passive aggressive and borderline traits, disputes the findings and diagnostic impression of unspecified personality disorder provided in a February 2020 VA neuropsychological evaluation, conducted by a clinical neuropsychologist, and disputes the findings of the October 2020 VA examination report, which also did not endorse a diagnosis of a traumatic brain injury or residuals thereof but instead found the Veteran's symptoms were more likely than not due to a personality disorder. However, the Board finds that the clinical examinations contemporaneous to these periods and were based upon actual examinations, and the resulting diagnoses, to be more probative than the April 2024 private opinion of a remote nature, reinterpreting such records many years later. Indeed, the Board observes the April 2024 private opinion merely noted he had "reviewed the records for" the Veteran. However, there is no documentation as to an interview of the Veteran, an examination of the Veteran, and no testing was undertaken. In this regard, the Board finds the lack of testing to be especially relevant, because as discussed above, in a June 2020 statement, the Veteran's representative requested "a TBI 10 Facet Review by a competent specialist". However, here the April 2024 private opinion did provide any actual testing. Moreover, as discussed above, the April 2024 private opinion disputed other testing results including that provided in February 2020 VA neuropsychological evaluation and October 2020 VA examination report; however, again, the April 2024 private opinion did not provide any independent testing. Thus, for these reasons and noted deficiencies, the Board finds the April 2024 private opinion has little to no probative value, and thus, cannot establish the existence of a current traumatic brain injury or residuals thereof. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Thus, in weighing the evidence, the Board accords significant probative weight to the October 2020 VA examination report, which outweighs the April 2024 private opinion. The October 2020 VA examines provided findings and opinions based on an accurate medical history and provided explanations that contained clear conclusions and supporting data, with consideration of the Veteran's subjective complaints. Thus, the October 2020 VA examination report is entitled to substantial probative weight. Nieves-Rodriguez, 22 Vet. App. at 304. Thus, the evidence of record does not show a diagnosis of a traumatic brain injury, or any credible evidence that potentially existing symptoms, resulted in functional impairment of earning capacity with respect to the claimed disability. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Indeed, the Board has found the Veteran's statements as to the existence of VA examines provided findings and opinions based on an accurate medical history and provided explanations that contained clear conclusions and supporting data, with consideration of the Veteran's subjective complaints. Thus, the October 2020 VA examination report is entitled to substantial probative weight. Nieves-Rodriguez, 22 Vet. App. at 304. Thus, the evidence of record does not show a diagnosis of a traumatic brain injury, or any credible evidence that potentially existing symptoms, resulted in functional impairment of earning capacity with respect to the claimed disability. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Indeed, the Board has found the Veteran's statements as to the existence of an in-service traumatic brain injury and any residuals thereof to be not credible, nor are any such traumatic brain injury residual symptoms credibly identified chronically the evidence of record. Given the credible and competent medical evidence does not reflect a diagnosis or recurrent or persistent symptoms of a traumatic brain injury, the Board finds that the evidence is persuasively against finding a diagnosis or recurrent or persistent symptoms of a disability with respect a traumatic brain injury. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). However, none of the circumstances outlined in Jandreau are applicable here. The Veteran has not been shown to be competent to provide a diagnosis of a traumatic brain injury, which is medically complex, as it requires specialized medical education, and the Board has found the Veteran's statements as to the existence of an in-service traumatic brain injury and any residuals thereof, to be not credible. Consequently, the Board gives more probative weight to the competent medical evidence, including October 2020 VA examination report discussed above. Finally, the Board recognizes the Veteran is considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). Specifically, in January 2023 VA issued Memorandum, which indicated the Veteran was a covered veteran under 38 U.S.C. § 1117, and which is a legal finding and for Board consideration. In cases involving Persian Gulf veterans, when the medical evidence of record (e.g., VA examination reports) does not provide a diagnosis or medical explanation for symptoms, VA is required to address whether such signs or symptoms allow for presumptive service connection under 38 C.F.R. § 3.317, to include as a medically unexplained chronic multisymptom illness (MUCMI). See Lucas v. Wilkie, 2020 U.S. App. Vet. 548 (Vet. App. Mar. 31, 2020). In Lucas, the United States Court of Appeals for Veterans Claims found the VA examiner's failure to explain the etiology of Veteran's unspecified joint pain renders the examination inadequate as to whether the veteran suffers from an unexplained chronic multi-symptom illness, citing to Stewart v. Wilkie, 30 Vet. App. 383, 389 (2020) (holding that under 38 C.F.R. § 3.317, an illness is an unexplained chronic multisymptom illness where either etiology or pathophysiology of the illness is inconclusive). Lucas, 2020 U.S. App. Vet. at 548. However, the Board finds the holding in Lucas is inapplicable to this claim as the most probative competent and credible evidence of record has not demonstrated the existence of a traumatic brain injury, or residuals thereof, proximate to or during the appeal period at issue. Further, as discussed above, the record does not demonstrate that the Veteran experienced an in-service traumatic brain injury and the Board has found the Veteran's statements as to the existence of an in-service traumatic brain injury and any residuals thereof to be not credible. As such, the Board finds Veteran was not suffering from symptoms related to the alleged claim, and thus, does not have a qualifying chronic disability under 38 C.F.R. § 3.317. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a traumatic brain injury is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, of an in-service traumatic brain injury and any residuals thereof to be not credible. As such, the Board finds Veteran was not suffering from symptoms related to the alleged claim, and thus, does not have a qualifying chronic disability under 38 C.F.R. § 3.317. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a traumatic brain injury is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Espinoza, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.