BVA9507402 DOCKET NO. 92-23 500 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Togus, Maine THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Maine Division of Veterans Services WITNESSES AT HEARING ON APPEAL Appellant; J. O. ATTORNEY FOR THE BOARD Julia M. Kurtz, Associate Counsel INTRODUCTION The veteran served on active duty from June 1963 to January 1965 and from April 1965 to March 1968. This appeal arises from a June 1992 rating decision of the Togus, Maine, Regional Office (RO) which denied service connection for post-traumatic stress disorder. The veteran testified before a hearing officer at the RO in February 1993. This case was previously before the Board in April 1994 when it was remanded for further development. The case is now ready for further appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran asserts on appeal that the RO erred in denying service connection for post-traumatic stress disorder. He asserts that, while in the Republic of Vietnam, he served on guard duty the first night without ammunition, was mortared the second night, was exposed to gun fire, and, while unloading from a ship, saw several dead Marines in the water. He also asserts that he was a combat medic at Ft. Bragg for eighteen months and that he has been diagnosed with post-traumatic stress disorder. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file(s). Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claim for entitlement to service connection for post- traumatic stress disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran did not engage in combat with the enemy and his accounts of alleged stressful events in service are not corroborated by the record. 3. The clinical criteria to support a diagnosis of post- traumatic stress disorder have not been met. CONCLUSION OF LAW Post-traumatic stress disorder was not incurred in or aggravated by the veteran's active duty service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, it is necessary to determine if the veteran has submitted a well-grounded claim within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), and if so, whether the Department of Veterans Affairs (VA) has properly assisted him in the development of his claim. A "well-grounded" claim is one which is not implausible. A review of the record indicates that the veteran's claim is plausible and that all relevant facts have been properly developed. The veteran advances that he suffers from post-traumatic stress disorder as a result of experiences during Vietnam. Under the applicable criteria, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.304 (1994). Service connection for post-traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or other similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. 38 C.F.R. § 3.304(f) (1994). In West v. Brown, 7 Vet.App. 70 (1994), the United States Court of Veterans Appeals (Court) recently set forth a framework for analysis of claims for service connection for post-traumatic stress disorder. This involves an initial determination of whether the veteran was engaged in combat and whether any of the alleged stressors occurred during combat. If the veteran was engaged in combat and the claimed stressors are related to combat, the veteran's lay testimony regarding claimed stressors must be accepted as conclusive as to their actual occurrence. Where the veteran did not engage in combat with the enemy or the claimed stressor is not related to such combat, the veteran's lay testimony by itself, will not be enough to establish the occurrence of the alleged stressor. It must then be determined whether the testimony as to the claimed stressor is corroborated sufficiently be service records to establish the occurrence of the claimed stressful events. Finally, it must be determined whether the claimed events are sufficient stressors to support a diagnosis of post-traumatic stress disorder. Service connection for post-traumatic stress disorder is not warranted unless it is related to the veteran's military service by a showing that the veteran experienced an inservice recognizable stressor "that is outside the range of usual human experience and that would be markedly distressing to almost anyone, such as experiencing an immediate threat to one's life or witnessing another person being seriously injured or killed." Zarycki v. Brown, 6 Vet.App. 91 (1993). This is a factual determination and the Board is not bound to accept the uncorroborated account of the veteran on this point. Swann v. Brown, 5 Vet.App. 229 (1993); Wilson v. Derwinski, 2 Vet.App. 614 (1992); Wood v. Derwinski, 1 Vet.App. 190 (1991); reconsidered, 1 Vet.App. 406 (1991). Some of the basic facts are not in dispute. The veteran had active service during the Vietnam Era. Service personnel records reflect that the veteran served in Vietnam from June 1967 to January 3, 1968. Information on his DD 214 associated with his second period of service shows that his military occupational specialty was combat medic. Administrative service records show that, while in Vietnam, his principal duties were pack crate specialist and equipment storage specialist. While stationed in Fort Bragg, his principal duty was supply handler. The veteran received the National Defense Service Medal, Vietnam Service Medal, and Vietnam Campaign Medal with Device 60. Service medical records reveal the veteran was hospitalized in July 1964. He presented with complaints of nervousness all his life. He stated that when he is nervous, he becomes nauseas and has acute anxiety symptoms. The examiner indicated that he worried about everything and had moderately severe anxiety problems continually. The diagnosis, based on an upper gastrointestinal series, was duodenum ulcer. The remainder of the service medical records reveal no complaints or findings of a psychiatric disorder. A report of VA hospitalization dated August to September 1970 shows treatment for psychoneurosis, anxiety state, moderately severe. The veteran gave a history of headaches, frequent nausea, and inability to keep a job. The veteran was provided vocational counseling and advised to seek treatment at his local mental health clinic. A VA psychiatric examination was conducted in February 1975. The veteran stated that he was trained as a corpsman, medic. He was then stationed at Fort Bragg, North Carolina for 18 months where he served as a truck driver and mail clerk. He spent 5 months in Vietnam at Dong Ba Thin as a mail carrier and medic; he was not wounded but reported that he was under fire a good deal of the time. He was next sent to Na Trang where he was in the mail department and the company medic. While there, he was under considerable fire from rockets and harassment but was not injured. He spent a total of 10 1/2 months in Vietnam. He was currently self-employed servicing oil burners and was married. He stated that he had battle nightmares when he was first discharged. He complained of irritability and being easily startled but that as time went on, the symptoms were less and he did not feel they were too incapacitating. The diagnosis was anxiety neurosis, mild, manifested by battle nightmares, irritability, startle reaction and tension, improving. An outpatient treatment note dated in May 1978 notes a diagnosis of anxiety. Medical records from Thornton W. Merriam, dating from January 1974 reveal treatment for a stomach disorder. In October 1982, it was suspected the veteran's symptoms were related to anxiety and depression. In October 1984, the veteran was treated for depression and tension headaches. It was noted the veteran's own business had gone bankrupt a few months earlier and that the veteran's wife had suffered two miscarriages. At a VA psychiatric examination in May 1992, the veteran stated that he arrived at Vietnam by ship and when they docked, he saw dead bodies in the water. He said that he was not in heavy combat but felt survivor guilt. He stated that mortars often went overhead; two military policemen were killed. A friend was hit by a sniper but survived. He stated that people were wounded from the mortars and that as a combat medic, he gave them aid. He also served as a mail carrier in Vietnam. He indicated that he did not wish to discuss his experiences in Vietnam with others. He described flashbacks which became worse after the Gulf War. The examiner noted the post-traumatic stress disorder symptoms of experiences of unusual activities in Vietnam, flashbacks, avoidance behavior, irritability, difficulty concentrating, exaggerated startle response and disturbance which had lasted several years and were more marked recently. He also noted that a diagnosis of generalized anxiety disorder was present and had overlapping post-traumatic stress disorder features. However, he noted that the veteran was employed, had a fairly good work history and of social interactions. The diagnosis was generalized anxiety disorder with depression. A medical statement from Richard J. Sagall, M.D., dated in February 1993, indicates that he was currently treating the veteran for anxiety, depression, and stress. The veteran and his wife testified before a hearing officer at the RO in February 1993. He testified that: he went over to Vietnam as a combat medic, also did guard duty and flew transporting items; he provided first aid to veterans, but nothing major; he was not in a firefight and did not treat any combat veterans while in a firefight; on his second day there while on perimeter guard duty two military policemen were killed; he went over on a troop ship which let marines off at Ben Thu, and, as they were going down the ladder, they were fired upon, and dead bodies were in the water, and the ship thereafter turned and left because they were going to Cam Ran Bay; he has had flashbacks of getting off the ship with no ammunition to protect them and of the first night on guard duty without ammunition; he would lay there at night and hear mortars going overhead; the biggest thing that affects him is that he survived and others did not; he has had twelve to fifteen jobs since service; he has thought about suicide but never dwelled upon it; he works for the state; and the Gulf War reminded him of Vietnam. His wife testified that: he wakes up often at night, sometimes with tremors; he only talked to her about Vietnam the week before the hearing; after he returned from Vietnam, he would wake up with bad dreams related to Vietnam. The veteran identified the physicians who have treated him for nervous symptoms and stated that he had also had counseling with his pastor. A statement was received from the veteran's pastor, Richard A. Rockwell, in March 1993, which indicated that he was counseling the veteran. A medical record from Kathleen M. Fortier, L.C.P.C., L.S.A.C., noted the veteran's complaints of avoidance of war shows on television, nightmares, feelings of numbness, reexperiences, anxiousness, survivor's guilt, flashbacks, detachment from others, irritability of future, occasional outbursts of anger, hypervigilance, difficulty concentrating, and exaggerated startle response. She noted that the veteran met the criteria for post- traumatic stress disorder as outlined in the DSM III-R. Reports of psychiatric evaluations dated in November 1993 and May 1994 were received from James C. Healey, M.D. In November 1993, he indicated that the veteran gave a history of being in the infantry and having seen some action; the diagnoses were post-traumatic stress disorder, generalized anxiety disorder, major affective disorder, and dissociative disorder. He noted the veteran was suffering from post-traumatic stress disorder stemming from his Vietnam experience and long-standing lack of treatment. In May 1994, he indicated that the veteran had had eighteen psychotherapy sessions since September 1993. He continued to conclude that the veteran was suffering from severe dissociative problems which stemmed directly from his post- traumatic stress disorder. He also noted that the veteran's experience in Vietnam was extremely dislocating and damaging to him. In June 1994, the veteran was afforded a VA psychiatric examination by a board of two psychiatrists. The veteran stated that he had been working as a boiler maintenance man at the air base for the past eleven years. The examiners indicated that they went over his activities in Vietnam but no new material was gathered. The veteran stressed feelings of guilt, low self- esteem, diminished libido, and rare feelings of euthymia. He stated that he feels stressed all the time, has suffered from anxiety, flashbacks which he described as a dissociative phenomenon, and poor concentration. The examiners indicated that the criteria for post-traumatic stress disorder were present. They also noted that the evidence did not show sufficient evidence of stressful incidences to support a service-connected post-traumatic stress disorder diagnosis. The diagnosis was post-traumatic stress disorder with severe depression. In December 1994, the veteran submitted a statement in support of claim, clarifying that he never told Dr. Healey he was in the infantry as he was not, in fact, in the infantry. The Board finds that the evidence does not show on its face that the veteran engaged in combat with the enemy. The administrative records provided by the service department do not show that the veteran was entitled to receive the Purple Heart Medal, the Combat Infantryman Badge, the Combat Action Ribbon, or other awards or decorations denoting participation in combat with the enemy. Although his military occupational specialty was combat medic; his principal duties in Vietnam were pack crate specialist and equipment storage specialist and, in Fort Bragg, supply handler, and these duties would also not denote combat exposure or otherwise serve as a prima facie indication that he was subjected to profoundly disturbing experiences associated with those duties. The veteran's claimed stressors consist of exposure to mortar rounds and gunfire , being on guard duty without ammunition, seeing dead bodies in the water in Vietnam, and of combat medic duty for eighteen months at Fort Bragg. Upon review of the record, the Board finds that the service medical and personnel records do not demonstrate that the veteran experienced an inservice stressor which would satisfy the threshold criteria for a diagnosis of post-traumatic stress disorder. The veteran's records do not reflect any exposure to combat circumstances, or that he was otherwise sufficiently traumatized from a psychic standpoint. Although the veteran claims that two miliary policemen and a friend died from mortar rounds and of seeing dead bodies floating in the water, he has not offered any corroborating evidence to substantiate his claim nor do the service records relate any such incidents. Furthermore, the veteran related to a psychiatrist that, while stationed at Fort Bragg, his principal duties were that of a truck driver and mail clerk. Such duties stateside do not reflect exposure to combat circumstances or that the veteran was otherwise sufficently traumatized from a psychic standpoint. The Board has considered the veteran's testimony on appeal; however, the veteran is not found to be a credible historian, given the vague accounts he has reported concerning the alleged stressors. It is not apparent that several of the reported experiences would, even if true, constitute a valid stressor as they would not be sufficiently outside the range of human experience such as to be markedly distressing to almost anyone. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, (3d ed. rev. 1987) (DSM-III-R), 146-48. The Board notes that diagnoses of post-traumatic stress disorder were rendered by the veteran's psychiatrist, Dr. Healey, and by Kathleen Fortier, L.C.P.C., L.S.A.C. However, their opinions are based on the veteran's own reported history and which did not include any information, otherwise corroborated by the record, which would approximate a stressor experience. The board of two VA examiners are noted to have diagnosed post-traumatic stress disorder in June 1994. However, they also noted that the veteran's records did not show sufficient evidence of stressful incidences during service to support a diagnosis of post- traumatic stress disorder. The information presented by the veteran is, for the most part, typical of the spectrum of events which are experienced by an individual who was in active military service stationed in a combat theater of operations; the veteran's alleged stressors have not been even remotely corroborated and accordingly, the veteran's history does not reflect an authentically developed background history and experience that would satisfy the criteria requisite to support a diagnosis of post-traumatic stress disorder. As the examiners' diagnoses were based on uncorroborated stressor information, and as the veteran did not have combat, the diagnoses do not serve to put the evidence in equipoise. West v. Brown, 7 Vet.App. 70 (1994). ORDER Service connection for post-traumatic stress disorder is denied. JEFFREY MARTIN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.