BVA9501894 DOCKET NO. 92-56 384 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Barry F. Bohan, Counsel INTRODUCTION The appellant served on active duty in the United States Army from March 1968 to March 1970. Service in Vietnam is indicated by the evidence of record. The appeal arose from a December 1989 decision of the Department of Veterans Affairs Regional Office in Detroit, Michigan (VARO) which denied the appellant's claim for service connection for an acquired psychiatric disorder. In October 1993, the Board of Veterans' Appeals (the Board) remanded this case so that the appellant could be examined by a Board of two psychiatrists. This was accomplished in March 1994. In June 1994, VARO issued a Supplemental Statement of the Case which continued to deny the appellant's claim for an acquired psychiatric disorder, including post-traumatic stress disorder (PTSD). The appellant's claims folder was returned to the Board, where it was received in December 1994. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in substance, that his present psychiatric symptomatology is the result of his experiences in Vietnam. In particular, in a November 1989 statement in support of his claim, during his personal hearing and at other times, he reported that he caused the death of a female Vietnamese child. 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 folder. 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 service connection is not in order for an acquired psychiatric disorder. FINDINGS OF FACT 1. The appellant served on active duty in the United States Army from March 1968 to March 1970, including service in Vietnam. 2. An acquired psychiatric disorder was first diagnosed in 1988. 3. Although symptoms of the appellant's diagnosed depression include thoughts of his past unpleasant experiences, including his service in Vietnam, the medical evidence does not point to his military experiences as a cause of his current psychiatric symptomatology. CONCLUSION OF LAW An acquired psychiatric disorder was not incurred in or was aggravated by military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant is seeking service connection for an acquired psychiatric disorder, which he has suggested is PTSD. Initially, the Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v. Derwinski, 1 Vet.App. 78 (1990). Furthermore, we believe that this case has been adequately developed for appellate purposes by VARO and that we may therefore proceed to a disposition on the merits without the necessity of a another remand. In the interest of clarity, the Board will first review the appellant's pertinent medical history. The issue presented on this appeal will then be discussed. Medical history Service medical records do not reveal any complaints of psychiatric problems. There is no medical evidence of record for many years after service. The appellant was hospitalized at the Ardmore Center due to psychiatric problems, described as depression, behavioral problems, suicidal ideation, and cocaine usage, in September 1988. He reported feeling depressed for approximately two years. He stated that he had flashbacks from his days in Vietnam. He was free basing $150 worth of cocaine daily and admitted past use of alcohol and marijuana. Diagnoses included major depression with suicidal ideation, PTSD, and polysubstance dependency. Another hospitalization at the same facility in April and May 1989 resulted in the same diagnoses. The appellant was hospitalized at Woodside Medical in December 1988 because he had been feeling severely depressed and angry, with insomnia and thoughts of suicide. Diagnoses were major depression with psychotic features and cocaine abuse. The appellant was hospitalized at a VA facility in May and June 1989 because of "bad dreams" and reported symptoms of PTSD. He admitted using cocaine. His PTSD symptoms were evaluated during the hospitalization, but no diagnosis of PTSD was made. Discharge diagnoses were schizo-affective disorder and cocaine abuse. A July 1989 report of Robinwood clinic in Detroit, Michigan included diagnoses of PTSD, adjustment reaction with depressed mood, and polysubstance addiction. The appellant was hospitalized at a VA facility from October to December 1989 due to sleep problems and nightmares. Diagnoses were PTSD and cocaine abuse. A VA psychological evaluation of the appellant was completed in March 1990. He listed as his symptoms trouble sleeping, nightmares, difficulty holding jobs, suicidal thoughts, and recurrent periods of depression. After psychological testing, the examiner stated that the appellant showed high levels of anxiety, recurrent periods of depression, problems with substance abuse and passive/aggressive ways of handling situations. Diagnoses were dysthymic disorder; substance abuse in partial remission; and PTSD, delayed. The appellant testified at a personal hearing at VARO in September 1990. He related stressful experiences in Vietnam, including killing a Vietnamese girl while driving a truck. He stated that he used alcohol and drugs to self-medicate himself. He reported not drinking or using drugs until many years after service. A VA psychiatric evaluation of the appellant was completed in November 1990. He reported being in combat in Vietnam. He also stated that he ran over a school girl while driving a truck, killing her. Diagnoses were dysthymic disorder and substance abuse in partial remission. The examiner stated that although "his symptoms are mixed up with experience of Vietnam war, I do not diag[nose] PTSD." As noted in the Introduction, the Board remanded this case in October 1993 in order to ascertain the etiology of the appellant's psychiatric problems and to resolve the conflicting diagnoses of depression and PTSD. Black v. Brown, 5 Vet.App. 177, 180 (1993). In its March 1994 report, the board of two VA psychiatrists reviewed the appellant's military history and concluded that the appellant experienced stressors beyond the range of usual human experience in Vietnam. The appellant's pertinent medical history was also reviewed. The appellant was interviewed and reported isolation from others, problems with sleep, problems with outbursts of anger, problems concentrating and exaggerated startle responses. He admitted to polysubstance abuse. Diagnoses were depression and substance-dependent personality traits. In its discussion of the appellant's case, the board of psychiatrists stated that, although the appellant did display some signs of PTSD, it was the conclusion of the board that substance abuse was the primary condition and that "the depressions that come from this condition naturally would take their imagery from themes of death in Vietnam and elsewhere." The board further concluded "the symptoms that appear allied to the criteria for PTSD, such as sleeping problems, irritability and problems concentrating, as well as detachment and estrangement from others and general pessimism, plus the bad dreams, appear more directly attributable to the various forms of withdrawal [from alcohol and drug abuse]." PTSD was not diagnosed. Analysis Under pertinent law and VA regulations, service connection may be granted if the greater weight of the evidence establishes that an acquired psychiatric disorder was incurred in service, or was manifested to a compensable degree within one year after service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.303(a), 3.307, 3.309 (1993). Notwithstanding the lack of a diagnosis of such disease during service or within one year thereafter, however, service connection may be granted if all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1993). Evidence which must be considered includes service records, the appellant's medical records, and all pertinent lay and medical evidence. 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. §§ 3.303(a), 3.304 (1993); Hayes v. Brown, 5 Vet.App. 60, 66 (1993). The Department of Veterans Affairs has promulgated regulations which specifically deal with service connection for PTSD. In order for service connection for PTSD to be granted, there must be "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." 38 C.F.R. § 3.304(f) (1993). The appellant served as an artillery man in Vietnam from September 1968 to August 1968. His decorations include the Vietnam Service Medal, the Vietnam Campaign Medal and the Vietnamese Cross of Gallantry. The Board finds from this evidence that the appellant's service demonstrates that in service stressors may in fact have occurred. There is also no question that the appellant currently exhibits psychiatric symptomatology, although there is some dispute concerning the diagnosis. Based on the evidence, in particular the report of the November 1990 VA psychiatric examination and the March 1994 report of the board of psychiatrists, the Board has concluded that the most likely diagnosis is major depression, not PTSD. There is no "clear diagnosis" of PTSD. The question which must now be answered is whether there is a connection between the appellant's experiences in Vietnam and his diagnosed depression. The appellant has contended that his psychiatric problems are due to his military service, specifically his experiences in Vietnam, and that his alcohol and drug abuse is a form of self-medication. He has presented no medical evidence in support of that position. The Board cannot entertain lay speculation on medical matters. Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). The medical evidence of record, in particular the March 1994 report of the board of psychiatrists which was obtained in an effort to answer previously unresolved diagnostic questions, indicates that the appellant's primary problem is polysubstance abuse and that his depression is a product of his substance abuse. Further, although the board of psychiatrists found that Vietnam was a factor in the appellant's psychiatric picture, his nightmares and thoughts about Vietnam were a result of his substance abuse and depression, not a cause. The Board places great weight on the report of the board of psychiatrists, due to the thorough longitudinal review of the appellant's medical history, the discussion of his symptoms and the expertise of the VA psychiatrists. Willis v. Derwinski, 1 Vet.App. 66, 70 (1991); Sklar v. Brown, 5 Vet.App. 140, 146 (1993). In conclusion, the Board finds that the preponderance of the evidence is against the appellant's claim. Gilbert v. Derwinski, 1 Vet.App. 49, 57 (1990). The appellant's psychiatric problems began a number of years after service and, according to the recent medical evidence, are unrelated to his military service. Rather, according to the medical evidence, the appellant's psychiatric symptomatology is an offshoot of his substance abuse, which also began many years after service. Service connection for an acquired psychiatric disorder is therefore denied. ORDER Service connection for an acquired psychiatric disorder is denied. C.P. RUSSELL 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.