BVA9503997 DOCKET NO. 92-22 226 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and [redacted], [redacted], and [redacted] ATTORNEY FOR THE BOARD Richard F. Williams, Counsel INTRODUCTION The veteran served on active duty from August 1968 to April 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 1990 decision by the Department of Veterans Affairs (VA), Nashville, Tennessee Regional Office (RO), which denied service connection for PTSD. The case was remanded by the Board to the RO in July 1993, and it was returned to the Board in December 1994. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his PTSD began as the result of stressful experiences he had while on active duty in Vietnam. He claims that his duties and experiences during that time, including being a helicopter door gunner, were essentially combat conditions. He points out that there is medical evidence on file that shows that he has been treated for PTSD, and he maintains that there is no other explanation for the disability at issue, as the only stressful events to which he has been exposed during his life occurred while serving in Vietnam. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence, and for the following reasons and bases, it is the decision of the Board that the evidence supports the claim for service connection for PTSD. FINDINGS OF FACT 1. The veteran engaged in combat with the enemy during service, and there is other credible supporting evidence establishing an in-service stressor which would lead to PTSD. 2. There is a clear post-service diagnosis of PTSD, medically linked to an in-service stressor. CONCLUSION OF LAW PTSD was incurred as a result of active service. 38 U.S.C.A. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.304 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Background The veteran served on active duty from August 1968 to April 1970. His service medical records are negative for any finding indicative of a psychiatric disorder, including PTSD. His service personnel records show that he served in Vietnam for approximately one year, including during the Tet Offensive. He was a helicopter mechanic assigned to an aviation unit during his tour of duty in Vietnam. He did not receive the Combat Infantryman Badge. His decorations included the Vietnam Cross of Gallantry with Palm. Several statements from a former employer, friends, and neighbors of the veteran were received by the RO in January 1990. The declarants essentially supported the veteran's claim that his PTSD began as the result of his experiences in Vietnam. A program clerk with a VA medical center (VAMC) PTSD program reported in a January 1990 statement that the veteran was placed on a waiting list for an appointment in the PTSD program. The veteran underwent a VA psychiatric examination in March 1990. He described his two most vivid recollections of Vietnam. In one incident, he said that he had been blown out of a guard tower by a nearby explosion and in a second incident, his microphone was shot away while he was flying in a helicopter. He gave no history of prior psychiatric hospitalization or treatment. When asked to describe his difficulties, he stated that he became nervous in crowded places, but acknowledged that he quite often visited friends and went to church weekly. He said that he frequently tossed and turned at night and often thought of Vietnam and the two episodes noted above. Although he rarely watched television, he apparently did not avoid all opportunities to view or see a war or scene of Vietnam. Mental status examination showed that he was oriented to time, place, and person. He showed no evidence of delusions or hallucinations or any other thought disorder. His mood and affect were considered to be appropriate, as was his behavior. Initially, he appeared somewhat mentally retarded, but ultimately appeared to be within the normal range of intelligence, with an appropriate fund of information. A diagnosis was deferred. The examiner added that, in view of the statements from friends and neighbors attesting to the veteran's alleged impairment resulting from his service experience, consideration should be given to a period of observation and evaluation with psychological testing in an appropriate VA hospital where a more accurate diagnosis could be determined. A private psychological evaluation, performed in March 1990 by G. Douglas Huet-Cox, Ph.D., showed that the veteran functioned intellectually in the low average range of intelligence, read at the seventh grade level, appeared to have a learning disability in the area of arithmetic, and was in poor physical health, particularly due to chronic back pain, which appeared to be a factor in the deterioration of his social and occupational adjustments. The psychologist said that the veteran was experiencing odd episodes which might be physical in origin, but were more likely evidence of a dissociative state related to anxiety and war-related stress. The examiner opined that, within the confines of any physical disabilities, the veteran's current psychological distress, which was thought to be more intense than seen in one interview, would severely hamper his efforts to sustain a routine, effective work schedule. The pertinent diagnostic impressions were anxiety disorder and rule out PTSD. The veteran underwent a private medical examination in May 1990, performed by Sarada N. Misra, M.D. History obtained at that time included nervousness, particularly when driving through traffic. Following a general medical examination, the diagnoses included rule out absence-type seizures, and a previous diagnosis of PTSD was noted. In a statement dated in June 1990, the veteran's former employer recalled that, initially, the veteran was healthy and energetic and seemed to be able to carry out almost any task with ease, but later became very slow, deliberate and cautious. The individual said that the veteran's nervous condition was deteriorating. The individual also noted that the veteran had had nightmares from his experiences in Vietnam, and it was believed that this was affecting him and aggravating his nervous condition. Several color photographs, apparently of the veteran and his home, were received by the RO in June 1990. The veteran underwent a VA general medical examination in July 1990. Mr. and Mrs. [redacted], friends of the veteran, requested an interview, and they informed the examiner in detail regarding the veteran's poor living conditions and what they believed was a progressive deterioration in his mental status. The veteran was described as childlike, living in a one-room shack in mountain foothills, and eating out of cans or at other neighbors' homes. The veteran was hospitalized in a VAMC from late August to early September 1990 for psychiatric evaluation and treatment. He was brought to the hospital by friends who reported periods of strange posturing as if firing a gun or being afraid. These episodes were accompanied by diaphoresis and tachycardia. He was said to be amnestic during these periods, which were often preceded by watching war movies or hearing loud noises. Additional history included intrusive thoughts of his experiences in Vietnam, frequent nightmares which caused him to have difficulty sleeping, avoidance of certain people, increased fatigue, and anxiety. He was seen by the psychology service and intelligence testing showed limitations intellectually which probably were sociocultural in origin. The psychologist indicated that the veteran might have chronic delayed PTSD. Referral to a Vietnam Vet Outreach Program for further evaluation and treatment was recommended. The primary discharge diagnosis was PTSD. The discharge diagnoses also included major depression without psychotic features. Clinical records from the Overlook Center, dated from November 1990 to July 1991, show that the veteran was seen on numerous occasions during that time by a licensed clinical social worker for individual psychotherapy sessions. Clinical findings included recurrent nightmares, flashbacks, and intrusive thoughts of Vietnam; anxiety; and isolation. The diagnoses were PTSD and depression. A VA Vocational Rehabilitation and Counseling Officer reported in a May 1991 statement that the veteran's application to participate in the vocational training program was denied because it was determined that, based upon his disabilities, it was not reasonably feasible for him to benefit from the program enough to become employed. A social worker with the Overlook Center reported in an October 1991 summary that she had no doubt as to the reliability of any information the veteran related, as his memories of Vietnam were vivid, but noted that he was unable to recall dates, places, or names of people during that time. An official with the United States Army and Joint Services Environmental Support Group (ESG) reported in a February 1992 statement that a review of the 4th Aviation Battalion (Avn Bn) Operational Reports-Lessons Learned (OR-LL's) for the periods ending July 1969 and January 1970 confirmed that the unit's area of operations included the providences of Pleiku, Kontum, Darlac and Penh Ding. It was further reported that the OR-LL indicated that the unit was involved in combat activity. ESG was unable to document the helicopter or friendly fire incidents (described by the veteran) or that he was a door gunner. However, ESG verified that he was a helicopter mechanic assigned to an aviation unit during his Vietnam tour. The Avn Bn Operational Reports and the OR-LL's accompanied the ESG's statement and are on file. Additional statements, submitted on behalf of the veteran and received by the RO in June 1992 by neighbors and a Bi-Vocational Pastor, are essentially duplicates of statements previously received. The declarants attested to the honesty of the veteran and again noted his recurrent difficulties with symptoms that were attributed to his Vietnam war experiences. Polly Crisp, Ph.D., a clinical psychologist with the Overlook Center, reported in a July 1992 statement that she has been seeing the veteran for individual therapy since May 1992 after individual therapy, and ongoing medication was requested due to his becoming more withdrawn and less able to associate with people. It was noted that he had spoken repeatedly of his situation in Vietnam, continued to struggle with tremendous feelings of guilt over shooting children, and continued to have memories of being shot down while in his helicopter. It was further reported that he was unable to watch any violence on television or go hunting, despite having greatly enjoyed hunting prior to his Vietnam experience. It was thought that he was coping much better overall since treatment was initiated, but still had left tremendous scars and an inability to lead a productive and normal life. Dr. Crisp added that the veteran was an extremely conscientious and honest man, kept appointments regularly, and made good use of therapy. The veteran testified at a hearing conducted at the RO in August 1992 that he was a helicopter mechanic assigned to an aviation battalion while in Vietnam, but was utilized as a helicopter door gunner on numerous occasions. He said that he was shot down twice and was involved in multiple incidents that resulted in fatalities, including women and children. He described recurrent intrusive thoughts and nightmares of his Vietnam experiences, nervousness, avoidance of crowds, social withdrawal, and decreased ability to concentrate. He said that his primary problem was nervousness, and he noted that he has been in therapy and on medication for the past three years for this problem. He also described an increased startle response. [redacted], [redacted], and [redacted] testified that the veteran has had recurrent episodes of shaking and having a blank stare. They also indicated that he had an increased startle response. A licensed clinical social worker (Max Williamson) and a physician (Devi Deean, M.D.) with the Overlook Center reported in a September 1993 statement that the veteran continued to receive treatment at that clinic for PTSD related to his experiences in Vietnam. It was noted that he was medicated with Mellaril, 50 milligrams at bedtime. It was further reported that his behavior and symptoms were typical of PTSD and were clearly related to his military service. Additional statements submitted by [redacted], [redacted] and [redacted] were submitted on behalf of the veteran and received by RO in 1993. The declarants essentially reiterated their earlier statements. Pursuant to a request from the RO (and the Board's June 1992 remand), the director of the ESG reported in a May 1994 statement that ESG was unable to document that the veteran was a door gunner. ESG reiterated that it could only verify that he was a helicopter mechanic assigned to an aviation unit during his Vietnam tour. It was noted that only specific combat incidents as recalled by the veteran could be verified and, in order to conduct meaningful research, he must provide more specific information of each stressor. II. Analysis The Board initially finds that the veteran has presented a well- grounded claim within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is not inherently implausible. The relevant evidence has been obtained by the RO, and there is no further duty to assist him in developing facts pertinent to his claim. Id. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection for PTSD requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. If the claimed stressor is related to the combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed in-service stressor. 38 C.F.R. § 3.304(f). A review of VA and private clinical evidence on file shows that PTSD has been diagnosed on several occasions following service. Dr. Deean reported in a 1993 statement that the veteran was being treated for the disability in question, and it was opined that his behavior and symptoms were typical of PTSD and were clearly related to his military service. The primary impediment to granting service connection is proof of a valid in-service stressor for the condition of PTSD. 38 C.F.R. § 3.304(f). Although the veteran served in Vietnam, mere service in a combat zone does not necessarily constitute a stressor for PTSD. Wood v. Derwinski, 1 Vet.App. 406 (1991). Moreover, when a veteran did not actively engage in combat with the enemy, there must be service records or other credible supporting evidence to corroborate allegations of an in-service stressor. Zarycki v. Brown, 6 Vet.App. 91 (1993), Doran v. Brown, 6 Vet.App. 283 (1994). The evidence shows that the veteran was a helicopter mechanic in Vietnam. Although he received no decorations indicative of combat participation, there is credible evidence --the Operational Report and Lessons Learned, which accompanied the ESG's February 1992 statement--which shows that his unit did engage in combat and sustained casualties. While his purported involvement in helicopter crashes and other combat-related experiences are not corroborated by his service personnel records, the fact remains that there is strong evidence from the ESG in support of the claim. This evidence verifies the allegations that a stressor was sustained. Consistent with this finding are the statements from friends, neighbors, and treating clinicians, who have all attested to his veracity. Hence, the Board finds credible supporting evidence of an in- service stressor, a clear diagnosis of PTSD, and medical evidence linking an in-service stressor with the diagnosis. Thus, service connection for PTSD is warranted. ORDER Service connection for PTSD is granted. M. CHEEK 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.