BVA9502673 DOCKET NO. 93-11 753 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder. 2. Entitlement to service connection for hiatal hernia. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Robert E. O'Brien, Counsel INTRODUCTION The veteran had active service from October 1965 to February 1969. He served in Vietnam from August 1967 to August 1968. His principal duty assignment in Vietnam was as an intelligence operations specialist with the 20th Tactical Air Support Squadron at Da Nang Air Base, Vietnam. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania, which denied service connection for both a hiatal hernia and post-traumatic stress disorder as not being shown by the evidence of record. REMAND A review of the evidence of record discloses that when the veteran was accorded a psychiatric examination by VA in June 1992, he was given Axis I diagnoses of major depression and "post-traumatic stress disorder, mild symptoms." He was also given an Axis II diagnosis of mixed personality disorder with schizotypal and paranoid features. The examiner commented that the veteran "appears to be a psychological (sic) vulnerable person and this may have made him more prone to PTSD symptoms despite the relatively mild level of the stressors he received while in Vietnam." Despite the diagnosis of post-traumatic stress disorder, service connection was denied, primarily on the basis of a lack of a showing of a recognizable stressor. However, specific details regarding any claimed stressful event or events while serving in Vietnam are not of record and the Board believes that additional development in this area is warranted. Available records show that from August 1967 to August 1968, the veteran was assigned as an intelligence operations specialist with the 20th Tactical Air Support Squadron at Da Nang Air Base in Vietnam. No information regarding the activities of that unit from August 1967 to August 1968 is of record. The Board believes that the record, as it now stands, is inconclusive as to the veteran's claim. Under 38 C.F.R. § 3.304(f) (1993), 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 or stressors actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor or stressors. 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 Medal, the 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. In addition, VA's Manual 21-1 contains specific procedures for VA to follow in evaluating claims for service connection for post-traumatic stress disorder. Manual 21-1, Part VI, para. 7.46(e), (f) (Dec. 21, 1992). In Zarycki v. Brown, 6 Vet.App. 91 (1993), the United States Court of Veterans Appeals (Court) set forth procedures for VA to follow in adjudicating claims for service connection for post- traumatic stress disorder. The Court concluded that the statutory and regulatory criteria provided a framework in which the evidence necessary to establish the occurrence of a recognizable stressor during service to support a claim of entitlement to service connection for post-traumatic stress disorder will vary depending on whether or not the veteran was "engaged in combat with the enemy." Where it is determined, through recognized military citations, or other supportive evidence, that the veteran was engaged in combat with the enemy and the claimed stressors are related to such combat, the veteran's lay testimony regarding claimed stressors must be accepted as conclusive as to their actual occurrence and no further development for corroborative evidence will be required, provided that the veteran's testimony is found to be credible and "consistent with the circumstances, conditions, or hardships of such service." (Emphasis added.) 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. § 3.304(d), (f) (1994); Manual 21-1, Part VI, para. 7.46(e), (f). If VA determines that the veteran did not engage in combat with the enemy, or that the veteran did engage in combat with the enemy but 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, unless it is substantiated by service records. Id. The Court further held that even if it is found that there was a stressful event in service, it must still be determined whether that stressful event was of sufficient gravity to support a diagnosis of post-traumatic stress disorder. The Court emphasized, however, that near service in a combat zone, in and of itself, was insufficient to support a diagnosis of post- traumatic stress disorder. In West v. Brown, 7 Vet.App. 70 (1994), the Court commented that a "significant feature of PTSD requires that the sufficiency of the stressor be clinically established." It must be determined whether the claimed events are sufficient stressors to support a diagnosis of PTSD. The current posture of the record does not establish that the appellant "engaged in combat with the enemy." The appellant is not shown to have received one of the citations specified in 38 C.F.R. § 3.304(f). Nevertheless, even if the record contained evidence that the appellant "engaged in combat with the enemy," his accounts would still have to be reviewed to determine if they were credible and consistent with the circumstances, conditions, and hardships of his service. In light of the above discussion, the Board finds that the appellant should be provided the opportunity to submit additional evidence in light of Zarycki, West, 38 C.F.R. § 3.304(f) and the considerations discussed above. With regard to the claim for service connection for hiatal hernia, since the case must be developed on the issue of service connection for post-traumatic stress disorder, the opportunity will also be used for the development on the remaining appellate issue. The veteran has never been accorded an examination by VA with regard to this claim and his representative asks that this be done. The service medical records disclose the veteran was seen for complaints of gastric pain. Notation was made on one occasion in September 1967 that he had had pyloric stenosis as a child which had been surgically corrected. In view of the foregoing, the case is REMANDED for the following actions: 1. The RO should contact the veteran and request that he provide the names and addresses of any health care providers, other than VA, who have treated him for a psychiatric disability and/or a hernia and specify the approximate dates of treatment, if possible. Then, after any necessary authorization is obtained from the veteran, the RO should obtain copies of all treatment records for the veteran from the health care providers identified. 2. The RO should request from the veteran a statement containing as much detail as possible regarding the alleged stressful event or events to which he was exposed in service. The veteran should be asked to provide specific details of the claimed stressful event(s) during service, such as dates, places, detailed descriptions of the events, his service in Vietnam, duty assignments and the names, ranks, unit of assignment and any other identifying information concerning any other individuals, such as a pilot he has mentioned, involved in the event(s). The veteran should be told that the information is necessary to obtain supportive evidence of the stressful events and that failure to respond may result in adverse action. 3. With the additional information obtained, the RO should review the file and prepare a summary of all the claimed stressors. If sufficient detail is provided, this summary, and all associated documents, should be sent to the United States Army and Joint Services Environmental Support Group, 7798 Cissna Road, Springfield, Virginia 22150. They should be requested to provide any information which might corroborate the veteran's alleged stressors. This should include the obtaining of information pertaining to the activities of the 20th Tactical Air Support Squadron at Da Nang Air Base, from August 1967 to August 1968. Any information obtained is to be associated with the claims folder. 4. Following the above, if, and only if, the RO determines that the record establishes the existence of a stressor or stressors, then the RO should arrange for the veteran to be accorded a VA psychiatric examination to determine the diagnoses of all psychiatric disorders that are present, specifically to include PTSD. The RO must specify for the examiner the stressor or stressors that it has determined or established by the record for the purpose of determining whether the appellant was exposed to a stressor in service. It is essential that the claims folder be made available for review in connection with the examination. All necessary special studies or tests, to include psychological testing and evaluation, such as the Minnesota Multiphasic Personality Inventory, and the Mississippi Scale for Combat-Related Post- Traumatic Stress Disorders, should be accomplished. If the examiner is unable to reach a diagnosis of PTSD, the report should explain why the diagnostic criteria are not satisfied, addressing as appropriate (1) whether each alleged stressor found to be established by the record by the RO is sufficient to produce post-traumatic stress disorder;(2) whether the remaining diagnostic criteria to support the diagnosis of post-traumatic stress disorder have been satisfied; and (3) whether there is a link between the current symptomatology and one or more of the inservice stressors found by the RO to be established by the record. 5. The RO should then review the record and ensure that all the above actions are completed. If a diagnosis of post- traumatic stress disorder is of record, the RO must also make a determination as to whether the existence of an adequate stressor or stressors has been established consistent with Zarycki. 6. The veteran should also be accorded an examination by a gastroenterologist for the purpose of determining whether or not he has a hiatal hernia or other disability of the gastrointestinal system. If a hiatal hernia is present, the examiner should provide an opinion as to the degree of probability, if any, that the disorder is related to the veteran's complaints of gastric pain during service. The claims folder must be provided to the examiner for review in connection with the examination. If the benefits sought on appeal are not granted on readjudiation, a supplemental statement of the case should be prepared and the veteran and his representative should be afforded the applicable time to respond. Thereafter, the claim should be returned to the Board for further review, if otherwise in order. No action is required of the veteran until he receives further notice. The Board does not intimate any factual or legal conclusions as to any final outcome warranted in the appeal. CHARLES E. HOGEBOOM 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. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).