BVA9500687 DOCKET NO. 91-38 896 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD A. K. Mulroy, Associate Counsel INTRODUCTION The veteran had active duty from February 1976 to January 1978. This matter came before the Board of Veterans' Appeals (hereinafter the Board) on appeal from a December 1990 rating decision from the Columbia, South Carolina, Regional Office (hereinafter RO), in which the RO denied service connection for post-traumatic stress disorder. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his post-traumatic stress disorder is due to his experiences during basic training. Essentially, he maintains that he was underwent needless punishment in "motivation training" because he was told he had a poor attitude, and that this included receiving lashes to his injured hand, face and body, and being required to perform brutal exercises including one-arm and two-arm push-ups on his knuckles. He alleges that his supervisors shot at him during training with live ammunition and that he was told that if he did not stay down, he would be killed. Additionally, he maintains that he was denied treatment for his injured right wrist condition, and that this also contributed to his post-traumatic stress disorder. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material of record in the veteran's claims file, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against a claim for service connection for post-traumatic stress disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained. 2. A stressor required to support a finding of post-traumatic stress disorder was not demonstrated during service. The veteran is not shown to have been involved in combat. 3. The veteran does not have post-traumatic stress disorder due to an inservice event. CONCLUSION OF LAW Post-traumatic stress disorder was not incurred in service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107. That is, the Board finds that the veteran has presented a claim that is plausible. The Board is satisfied that all reasonable efforts have been made in helping the veteran prove his claim. There is no indication of outstanding evidence, and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. Service connection may be established for disability resulting from injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. §1131. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for post-traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice 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 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) (1993). In determining whether service connection is warranted for a disability, the Department of Veterans Affairs (hereinafter the VA) is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet.App. 49 (1990). In West v. Brown, No. 92-890 (U.S. Vet.App. Aug. 8, 1994), the United States Court of Veterans Appeals (hereinafter the 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 by 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, No. 92-976 (U.S.Vet.App. December 20, 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). As previously noted, the veteran served from February 1976 to January 1978. In service medical records, it was indicated that the veteran injured his wrist prior to service. He was first seen in service with complaints regarding his wrist in August 1976. He was eventually released from service because of his wrist disorder. There are no indications in the service records of treatment for mental health problems. Service documents indicated that the veteran was designated as a Rifleman, but it is noted that he served in the Marines during peacetime, and there is no indication otherwise that he was engaged in combat. In VA and private inpatient and outpatient medical records dated from July 1982 to September 1991, it was noted that the veteran was hospitalized numerous times for treatment of chronic alcoholism. There is no indication that the veteran was treated for any psychiatric disorder, to include post-traumatic stress disorder (hereinafter PTSD) since service. In a record dated in 1982, it was noted that the veteran underwent psychiatric testing in conjunction with his treatment for alcoholism. The profile based on this testing was noted to be indicative of an individual who was experiencing a significant amount of emotional distress; who is typically oversensitive, suspicious, angry, agitated and evasive; and who is apt to be irritable, demanding, argumentative, and resentful of others. A history of disruptive interpersonal relationships was noted as being likely, as well as that such patients are typically immature, narcissistic, ego-centric, and self-indulgent. The profile was also noted as being indicative of a tendency toward addiction proneness to drugs and alcohol. In a VA examination dated in March 1992, the examiner noted that the veteran reported that during basic training he had undergone "motivational" training for punishment "because he was not been fearful of his Sergeant." He stated that this included being forced to stand from sun up to sun down in a ditch, and being expected to do push-ups on his knuckles, which exacerbated his right wrist condition, and his complaints of pain were ignored. He stated that he was also slapped in the face and in other parts of his body, and beaten and kicked, and that he underwent this for two weeks, and feared he may be beaten to death, particularly in light of rumors that other trainees had died there. He reported that after separation, he began drinking to cope with the depression, pain, and frustration of his experiences in service. He reported that since he stopped drinking approximately two years ago, he has had nightmares of increasing intensity approximately one every two months, and that he has flashbacks, no friends, difficulty with family, feelings of hopelessness, worthlessness, anergia, anhedonia, social withdrawal, and difficulty with early morning awakenings. The examiner concluded that the veteran's symptoms were ongoing and met the criteria for PTSD, and that during basic training his experience was outside the usual range of human experience, and that he felt he might die during the experience. The examiner concluded that while the primary source of occupational and social disability has been chronic alcoholism, the veteran stated that he was using alcohol to medicate his PTSD symptoms, and the examiner concluded that he was moderately impaired due to his symptoms. In a VA examination dated in April 1994, the veteran underwent psychological testing. It was noted that patients with a similar profile tended to have poor tolerance for stress, limited judgment and insight, difficulty thinking clearly, and that organic impairment was often present. Problems with attention, concentration and memory were noted as common, and that the patients tended to be withdrawn, deficient in social skills, and resentful of demands made on them, and were often described as moody, irritable, insecure, with low self-esteem. It was noted that while this profile was most often associated with a diagnosis of schizophrenia, it was not inconsistent with PTSD and schizoid personality disorder. The examiner concluded that a diagnosis of PTSD could not be ruled out on the basis of the tests, but that the veteran was unable to provide adequate information during the interview to assist in diagnosis. The assessment was major depression, low average intellectual functioning, and alcohol dependence, in remission by self-report. In the same examination dated in April 1994, a psychiatrist, after an examination and a complete review of the file and the psychological tests, stated that "when specifically questioned, the veteran does describe stressors that appear to be outside the realm of normal human experience, if taken at face value, the veteran's descriptions of physical beatings and having live rounds of ammunition fired over his head, would definitely be considered a traumatic stressor." The psychiatrist also concluded that the veteran's primary source of social and occupational impairment between 1978 and 1990 was his chronic alcoholism. He stated that there were personality issues indicated in the file which had not been previously described or taken into account. These included his psychological profile indicating an immature, narcissistic and self-indulgent individual; and a history of impulsivity and of multiple brushes with the law, including arrests for drunk and disorderly conduct, attempting to break into a car, and writing bad checks. A history of chronic difficulty with interpersonal relationships was also noted. The psychiatrist concluded that it was hard to rationalize all of these aberrant behaviors and chronic maladjustment as being related to an Axis I psychiatric illness as they had been persistent over time, and that they indicated that the veteran had a personality disorder. In summary, the psychiatrist stated that the veteran's primary factor affecting social and industrial functioning appeared to be his chronic alcoholism. He stated that he did meet the minimum diagnostic criteria for PTSD although he rarely reported these symptoms unless specifically asked and did not report these symptoms between 1980 and 1990, and that such symptoms include nightmares, intrusive thoughts, and a feeling of anxiousness when reminded of his military duties. Other symptoms endorsed during evaluation for PTSD appeared to more appropriately be assigned to a depressive disorder that appeared to have been present and persistent since approximately 1992. On Axis I, the diagnoses were inclusive of alcohol dependence, and history consistent with PTSD (not combat related). The Axis II diagnosis was personality disorder not otherwise specified (borderline, anti-social and narcissistic traits). Axis IV chronic and acute stressors were noted as moderate. Additionally, the veteran submitted a statement from his mother dated in March 1992, in which she stated that she did not know what he was going through in basic training at the time, but that when they visited, he told them that he did not want them to visit anymore. He told them that he did not want to talk about it, to not ask questions, and that he would be alright. It wasn't until he left basic training that he told her about the physical hittings and brutal exercises, and that he was denied the right to treatment for his sore arm. She stated that after he was discharged because of his right wrist disorder, and after the Marine Corps refused treatment, the veteran "turned to alcohol and the streets." As noted previously, the Board must first determine whether the veteran was engaged in combat and whether the claimed stressors are related to combat. The Board concludes that the evidence does not reasonably support a finding that the veteran engaged in combat. He had active duty during peacetime, and does not allege combat duty. The Board must also determine whether the claimed events are sufficient stressors to support a diagnosis of post-traumatic stress disorder. The Board notes that although the veteran undoubtedly endured hardships during basic training, this would not, of itself, constitute a valid stressor experience, absent psychic trauma of such severity as to be "outside the range of usual human experience and that would be markedly distressing to almost anyone...." It is noted that difficult experiences would be fairly typical to those individuals in basic training in the Marine Corps. Additionally, the veteran did not complain of beatings, brutal exercises, and refusal of medical treatment, until the early 1990's, in conjunction with his claim for compensation and pension for PTSD. There were no reports of such treatment in the numerous VA and private outpatient and hospitalizations for alcoholism during the 1980's. The veteran did not report being fired upon by his supervisors until late in 1993. Furthermore, as noted by the Court in West, the veteran's uncorroborated testimony by itself, will not be enough to establish the existence of the alleged non-combat stressor. Instead, the record must contain service records which corroborate the veteran's testimony as to the occurrence of the claimed stressor. The Board finds that there is no evidence in the service records, or other probative records, to support the occurrence of the experiences that are alleged by the veteran to be outside the range of usual human experience. The veteran is not found to be a particularly credible historian, and his evolving accounts regarding his experiences during basic training have minimal probative value. While examiners offering diagnoses of post-traumatic stress disorder have found stressor experiences to be sufficient, and discussed various details pertaining to such experiences, it is evident from a review of the record that their findings were premised upon the experiences either being corroborated or accepted at face value, which is not an established circumstance in this case. It should also be pointed out that the diagnoses of post-traumatic stress disorder which have been rendered were somewhat equivocal. On the most recent, and most thorough, examination, the psychiatrist indicated that the veteran's social and industrial impairment were significantly attributable to his alcoholism, and that although the minimal diagnostic criteria for PTSD were met, some symptomatology was perhaps more appropriately attributed to his personality disorder and depression. Although the psychiatrist stated that the veteran's described experiences during basic training were significant stressors, in light of the Board's findings noted above regarding the lack of corroboration of the claimed stressors, the Board concludes that service connection for post-traumatic stress disorder is not warranted. The evidence is not in equipoise on this point and the appeal must be denied. It is unnecessary to engage in extensive discussion about whether alcoholism is associated with PTSD in view of the above decision to deny service connection for PTSD. ORDER Service connection for post-traumatic stress disorder is denied. JEFF 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.