BVA9507294 DOCKET NO. 92-13 516 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL Appellant; [redacted] ATTORNEY FOR THE BOARD Julia M. Kurtz, Associate Counsel INTRODUCTION The veteran served on active duty from January 1944 to May 1946. This appeal arise from a July 1991 rating decision of the St. Petersburg, Florida, Regional Office which determined that the veteran had not submitted new and material evidence sufficient to reopen his claim for entitlement to service connection for post- traumatic stress disorder. The veteran testified before a hearing officer at the RO in January 1992. In February 1992, the hearing officer determined that the veteran had submitted new and material evidence and reopened his claim for entitlement to service connection for post-traumatic stress disorder. Although there are indications in subsequently developed portions of the procedural history that the veteran's claim was not reopened, it is readily apparent that new and material evidence has been submitted in this case, which is now being reviewed on a de novo basis. A hearing before a member of the Board sitting in Washington, D.C. was conducted in February 1993. In May 1993, the Board remanded the case for further development. In June 1993, the case was transferred to the Louisville, Kentucky, Regional Office (RO). 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 he has been diagnosed with post-traumatic stress disorder by his private physicians and a VA examiner. He contends that he was exposed to a traumatic event in World War II when he witnessed the explosion of a naval ship which killed many people. He asserts that, as a medic, he helped treat the injured and tend to the dead. 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 record supports the allowance of service connection for post-traumatic stress disorder. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's appeal. 2. Post-traumatic stress disorder has been shown to have originated during the veteran's period of active military service. CONCLUSION OF LAW Post-traumatic stress disorder was incurred during service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 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 record shows that the veteran testified before a member of the Board who is now retired and is no longer with the Board. However, in view of the disposition of the veteran's appeal, it is not necessary to afford the veteran another hearing with another Board Member, as proceeding with the decision which has been reached on the merits at this time represents a complete grant of benefits. The veteran advances that he suffers from post-traumatic stress disorder as a result of experiences during World War II. 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). The veteran's service medical records make no reference to either a psychiatric disorder or any symptoms indicative of the onset of such a disability. The veteran's separation record shows that he served as a pharmacist's mate and received the European Theater Ribbon, Pacific Theater Ribbon, American Theater Ribbon, and Victory Medal. Statements dated in April 1985, July 1991, and December 1991 were received from Robert C. Smith, M.D. Initially, he indicated that he treated the veteran from 1950 to 1985 for anxiety, that the veteran had taken Symmetrel, Trilafon, Tranxene, and Elavil for several years, and that the diagnosis was acute phobic anxiety with periodic evidence of depression. He later indicated that the veteran's condition was recognized as a response to his battle condition as a medical corpsman, that the course of his neurosis was considered fixed due to the time interval between the traumatic event in November 1944 and his beginning therapy in the fall of 1948, and that the veteran's course was one of a typical fixed post-traumatic stress disorder with lessening of intensity of symptoms followed by exacerbations of varying degrees of intensity. Statements were received in October 1988, July 1991 and December 1991, from David Roebker, Ph.D., a psychologist who evaluated the veteran. He stated that the veteran had lost 60 pounds, was still preoccupied with tragedies witnessed while in the Navy during World War II and expressed guilt over the incident. The veteran had reported that he stayed away from any form of violence, had sleep difficulties, increasing thoughts regarding his war experiences and was feeling detached from other individuals socially. He noted that the veteran exhibited startle responses to loud noises, had memory and concentration problems and frequent headaches. He opined that the veteran was having problems largely associated with post-traumatic stress disorder connected with his military experiences and definitely required psychiatric treatment. In July 1991, he added that he based his diagnosis of post-traumatic stress disorder upon the veteran's lack of emotional problems prior to service, traumatic events experienced during service, and continuing preoccupation with the incident, startle response, restricted range of affect, irritability, anger, and difficulty sleeping. In November 1991, he further clarified the veteran's disorder as delayed post- traumatic stress disorder. The veteran was afforded a VA psychiatric examination in February 1989. The veteran gave a history of the explosion of the U.S.S. Mount Hood in service, complained of depression, anxiousness, and indicated that he avoided violence. He had been married for 38 years and had two grown children. He has been retired since 1985. The examiner indicated that the veteran had experienced a traumatic event in service which kept recurring periodically and was sparked by related events such as association with others from the service. The diagnosis was anxiety reaction with history of depression and post-traumatic stress disorder. A letter was received from Donald A. Saelinger, M.D. in September 1989, who listed the veteran's medical problems which included chronic anxiety and depression, listed his medications, and indicated that the veteran had been on large amounts of various psychotropic drugs for many years, from which he was trying to taper off. In December 1989, Dr. Saelinger added that the veteran's psychiatric problems began when he returned from military duty and that his emotional difficulties have been largely attributed to the trauma which he sustained during World War II. In August 1991, Dr. Saelinger stated that he has seen the veteran probably 100 times over the last 15 years and the veteran was preoccupied about people dying around him during World War II. He strongly suggested that the veteran had very classic post-traumatic stress disorder. In January 1992, he reiterated his earlier comments regarding the veteran's post- traumatic stress disorder. At hearings on appeal conducted in April 1990, January 1992, and February 1993, the veteran testified that: he served as a medic during World War II; for a period of time he was stationed at an island named Manus in the Pacific; one morning in November 1944, he was walking on the landing pier when there was a loud explosion and he felt the effects of a blast; the U.S.S. Mount Hood along with 2 destroyer escorts had blown up; all aboard were killed, many individuals nearby were injured from the concussion of the blast; the veteran helped tend to the wounded, administered plasma and morphine; he became nauseous but continued helping all day; he felt nauseous for several days afterward; he also helped move the dead; a mass burial was conducted the next day; he was later stationed in New Guinea and Australia where he tended to the injured; he took tranquilizers after service to deal with his problems; in 1946, he had to walk out of a movie; he has had nightmares of explosions, woken with night sweats, is startled by loud noise, cannot keep from biting his fingernails, although he has a good relationship with his wife and two grown children; he saw a physician periodically since 1948, and has been diagnosed with post-traumatic stress disorder; when he went to Hawaii he was unable to go see the Memorial, he later saw the Punchbowl Cemetery Memorial and cried. His friend, [redacted], testified that he was also present at the explosion, was a Navy Pilot, that the explosion was due to a Japanese bomb, and that a retired Navy commander told him that the ship was carrying the atomic bomb, the firing pin had not been perfected, and the bomb exploded when the ship was hit. He also stated that he was given electric shock treatments by the Navy and the VA which partially destroyed his memory. Mr. [redacted] also submitted a statement reiterating his testimony. Based on an August 1993 VA psychiatric examination, the examiner indicated that the veteran gave a history of two overwhelming events during World War II, followed by a prolonged history of hyper-alertness, ready startle response and nightmares. He noted that the veteran did not give a history of alcoholism, family disruption and drug usage, but systematically avoided crowds, excitement, and war movies. The examiner had reviewed the earlier diagnoses from the claims folder. His diagnosis was post-traumatic stress disorder with symptoms noted above, moderate impairment. In February 1994, information was received from the U.S. Army and Joint Services Environmental Support Group which confirmed that on November 10, 1944, tons of ammunition exploded aboard the U.S.S. Mount Hood. The ship and all personnel on board were blown to bits. Pieces of metal and projectiles were hurled in all directions. The concussion and flying missiles caused casualties and damage to ships and small craft within a 2000 yard radius. Approximately 295 individuals were reported missing and 1 dead from onboard Mount Hood; as a result of the blast, 44 individuals were dead, 32 missing, and 371 injured, from other ships in the area. Pursuant to the Board's remand, the veteran was afforded a VA psychiatric examination in April 1994. The examiner indicated that the veteran was highly sophisticated about the symptoms and presentation of post-traumatic stress disorder, spoke about it in an almost clinical manner, and that the veteran firmly believed he suffers from the disorder The examiner confirmed that the veteran suffers from an anxiety based disorder, with depression. However, he viewed the probability of post-traumatic stress disorder as the cause of his tension and anxiety as very remote. He noted that, given the absence of projected data to support the diagnosis, and given the remoteness and the delayed onset of seeking care of any psychiatric condition, it was his opinion that post-traumatic tress disorder was not a primary consideration in the veteran's current psychological condition. The Board has carefully weighed the probative evidence including the veteran's voluminous testimony and argument on appeal. Based upon the medical evidence, the Board is persuaded that a diagnosis of post-traumatic stress disorder relating to the veteran's war experiences has been properly established. Although the latest VA examiner concluded that the veteran did not have post-traumatic stress disorder, the veteran's private physicians and a previous VA examiner concluded that the veteran does suffer from post-traumatic stress disorder and have also provided reasoning to support their conclusions. The evidence is at least in equipoise. The evidence needed to support a claim of entitlement to service connection for post-traumatic stress disorder must show that the veteran engaged in combat, or his testimony must be corroborated sufficiently by service records to establish the occurence of the claimed stressful events. West v. Brown, 7 Vet.App. 70 (1994). In the instant case, the evidence documents that the veteran served in the Pacific Theater during World War II. Efforts to obtain personnel records which would establish the veteran's presence on Manus Island in November 1944 were initiated pursuant to the Boards recent remand request, although such records are still not associated with the file. The veterans statements and personnel testimony are, however, found to be credible, as is the statement from a service associate describing having served with the veteran on Manus Island at the time of the explosion of the U.S.S. Mount Hood. Additionally, information which is of record documenting aspects of the veterans service during World War II is not inconsistent with the veteran's presence on Manus Island in November 1944. Furthermore, the records from the Environment Support Group document the tremendous explosion of the U.S.S. Mount Hood and that many individuals were injured or killed. The Board notes that the veteran served as a medic and has testified that he was present at the explosion and provided medical care to the injured. Health care professionals who have provided a diagnosis of post-traumatic stress disorder are also noted to have assessed the alleged traumatic events and have found them sufficient for purposes of meeting the threshold requirement of a stressor. West v. Brown, 7 Vet.App. 70 (1994). Accordingly, the Board concludes that service connection for post-traumatic stress disorder is granted. ORDER Service connection for post-traumatic stress disorder is granted. 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.