BVA9503123 DOCKET NO. 94-02 096 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, including post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from November 1965 to August 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of August 1993 from the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. Review of the claims file shows that service connection for post- traumatic stress disorder (PTSD) was denied by a rating decision in September 1988. As there is no evidence in the claims file that the veteran was advised of that adverse determination, finality does not attach to that decision. In March 1993, the veteran reopened his claim for service connection for PTSD by submitting new and material evidence. The RO considered that claim on a de novo basis. His claim was denied, giving rise to this appeal. The Board has also considered this appeal on a de novo basis. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO committed error in failing to grant service connection for an acquired psychiatric disorder, claimed as PTSD, because it did not take into account or properly weigh the medical and other evidence of record. It is contended that the veteran's currently manifested PTSD is a consequence of his combat experiences in the Republic of Vietnam; that he was selected to serve as a helicopter door gunner during his initial period of Vietnam service due to his prior training with the M-60 weapon and his light weight; that he flew 40 to 50 missions as a door gunner; and that he experienced several combat stressors, including seeing a man run over by a tank, seeing five men trampled by retreating troops, seeing a Vietnamese youth detonate an explosive device, killing himself and 8 to 9 American soldiers, seeing a close friend killed when a helicopter exploded, and seeing the driver of a truck in which he was riding be shot through the head. It is contended that the veteran's receipt of the Air Medal following his first tour of duty in the Republic of Vietnam is evidence that he flew in combat during this period of service. It is contended that the veteran's psychiatric disorder was diagnosed as PTSD in 1981, and that letters from VA physicians reflect a diagnosis of PTSD and cite combat stressors in support of that diagnosis. 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 in this matter, and for the following reasons and bases, it is the decision of the Board that the medical and other evidence of record supports a grant of service connection for PTSD. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the instant appeal has been obtained by the RO. 2. The record, taken in its entirety, adequately establishes that the veteran engaged in combat with the enemy; stressors consistent with the circumstances, conditions, or hardships of service are demonstrated. 3. The evidence as a whole establishes a link between the veteran's current PTSD and stressors experienced during his periods of Vietnam service. CONCLUSION OF LAW PTSD was incurred in wartime service. 38 U.S.C.A. §§ 1110, 1154 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is plausible and thus, "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), which mandates a duty to assist the veteran in developing all pertinent evidence. The RO has obtained the veteran's service medical records, service administrative records, and all clinical records from VA medical facilities from the time of service separation until the present. The veteran has also been afforded a personal hearing on appeal before a traveling member of this Board. On appellate review, we see no areas in which further development might be productive. In order to establish service connection for a claimed disability, the facts, as shown by evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. 38 U.S.C.A. § 1110, 1131 (West 1991). In determining whether an injury or disease was incurred or aggravated in service, the evidence in support of the claim is evaluated based on the places, types and circumstances of service, as shown by service records, the official history of each organization in which the veteran served, the veteran's medical records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. §§ 3.303(a), 3.304 (1994). Even where there is a lack of official records to corroborate that injury or disease was incurred or aggravated during service (including a period of combat), VA is required to accept as sufficient proof of service connection satisfactory lay or other evidence that an injury or disease was incurred or aggravated during such period of service, if the evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. §§ 3.303(a), 3.304 (1994). Service connection for PTSD 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 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. § 3.304(f) (1994). The veteran's DD Forms 214 from his several periods of active duty show that his military occupational specialty was Food Service Specialist and/or Cook (94B). His DA Form 20 and 2015 file show that he served in the Republic of Vietnam with the 116th Aviation Company from April 20, 1966, to April 10, 1967, and with the HHC, 3rd Brigade, 1st Cavalry Division (Air Mobile) from January 20, 1971, to June 19, 1971. His DD Forms 214 further reflect that the veteran was awarded the Air Medal and the Bronze Star Medal. The veteran has asserted that he was selected to serve as a helicopter door gunner during his initial period of Vietnam service due to his prior training with the M-60 weapon and his light weight, and that he flew 40 to 50 missions as a helicopter door gunner. He has recounted several combat stressors, including seeing a man run over by a tank, seeing five men trampled by retreating troops, seeing a Vietnamese youth detonate an explosive device killing himself and 8 to 9 American soldiers, seeing a close friend killed when a helicopter exploded, and seeing the driver of a truck in which he was riding be shot through the head. The veteran's service entrance examination, conducted in October 1965, disclosed no pertinent abnormalities. Service medical records dated in September 1971 show that the veteran was seen for complaints of nausea, vomiting, and abdominal cramps. It was indicated that he was a "nervous individual." In February 1973, the veteran was seen for complaints of daily emesis of stomach contents when "upset or nervous." A report of internal medicine consultation in August 1974 noted that the veteran's epigastric symptoms were aggravated by people shouting at him and that this was a relatively frequent occurrence in the Army. He was started on Thorazine, 25 milligrams twice daily. However, the veteran remained "nervous" and it was noted that his epigastric pain was definitely related to his anxiety periods. Thorazine dosage was increased to 50 milligrams at bedtime. Service medical records dated in June 1976 show that the veteran was seen for complaints of vomiting after eating of one month's duration. He stated that he wanted to sleep all the time. He was described as "very nervous" and "agitated." The veteran was hospitalized in June and July 1976 with complaints of nausea, vomiting and diarrhea. The diagnosis was alcoholic pancreatitis. He was subsequently referred to the psychiatric clinic for treatment of depression and excessive consumption of alcohol. The record shows that the veteran was being treated with Valium. He was hospitalized for 10 days in August 1976 for depression. The diagnosis at hospital discharge was depression. An entry dated in November 1976 noted the veteran's history of depression and alcohol abuse. His service separation examination is not available. A report of VA examination in January 1978 noted the veteran's history of treatment for a neuropsychiatric disorder in service. A VA hospital summary dated in August 1981 shows that the veteran was admitted with symptoms which included nervousness, insomnia, visual hallucinations, loneliness, and depression. He was treated with Sinequan and Mellaril. The diagnoses at hospital discharge included depressive neurosis and a history of excessive drinking. A VA hospital summary shows that the veteran was hospitalized from October to December 1981 following a drug overdose. His complaints included combat dreams, depression with suicidal ideation, fearfulness, increased startle reflex, crying, loss of appetite, and loss of interest in sex or his usual pursuits. The diagnoses included major depressive disorder, multiple drug abuse, and PTSD. VA outpatient clinic records dated from October 1981 to April 1982 show that the veteran was seen on a regular basis for depressive neurosis and habitual excessive drinking. The symptoms included anxiety, outbursts, "blowing up," and fighting. His medications included Mellaril and Doxepin. A report of VA psychiatric evaluation in July 1982 cited the veteran's complaints, including insomnia, loneliness, depression, bad dreams involving killing people, suicidal ideation, feelings of worthlessness and hopelessness, and easy anger. A review of prior VA outpatient clinic records reflected findings of poor impulse control in March 1982 and persistent increased anxiety in April 1982. The diagnoses included dysthymic disorder, and continuous alcohol abuse, in remission. A report of VA examination conducted in May 1983 noted the veteran's history of a nervous disorder versus depression, and indicated that he had been medivaced from Vietnam in 1971 due to ulcers and nervousness. In May 1988, the veteran claimed entitlement to service connection for depression and alienation which he attributed to his Vietnam service. A report of VA psychiatric evaluation in June 1988 cited the veteran's complaints of depression and offered a diagnosis of dysthymic disorder. In a claim for VA nonservice-connected pension benefits, submitted in May 1989, the veteran reported that he experienced "anxiety, depression, etc." A report of VA psychiatric evaluation conducted in July 1989 noted that the veteran used Thorazine, 200 milligrams daily. The diagnosis was dysthymia. VA hospital summaries dated in March and in May and June 1989 show diagnoses which include an organic mood disorder, substance abuse, and a mixed personality disorder. VA outpatient clinic records dated in June 1989 note some resurfacing of Vietnam issues aroused by the television series, "China Beach." VA outpatient clinic records dated in June 1990 show that the veteran continued to be medicated with Thorazine, Librium and Compazine. Numerous VA hospital summaries between August 1990 and December 1993 reflect treatment of the veteran for multiple physical disorders. A summary dated in October 1992 showed a diagnosis of major depression, recurrent, with psychotic features. In March 1993, the veteran reopened his claim for service connection for PTSD by submitting additional evidence. A letter from a VA physician, dated in April 1993, stated that the appellant was a Vietnam veteran with chronic and delayed PTSD secondary to combat experiences, and that he had been enrolled in the PTSD program since October 1992. A PTSD questionnaire completed by the veteran in May 1993 cited stressors which included flying 50 missions as a helicopter door gunner; seeing a man run over by a tank; seeing five men trampled by retreating troops; seeing a Vietnamese youth detonate an explosive device, killing himself and 8 to 9 American soldiers; seeing a close friend killed when a helicopter exploded; and seeing the driver of a truck in which he was riding be shot through the head. Mental status evaluation disclosed insomnia, nightmares of people being burned or blown up, anger, and preoccupation with Vietnam. The diagnoses included PTSD and major depression, in remission. A report of VA neuropsychiatric evaluation conducted in May 1993 cited specific stressor stories related by the veteran, as well as complaints which included nightmares of people being burned or blown up, depression, anger, and recurrent thoughts and memories of events in Vietnam. Mental status evaluation disclosed a preoccupation with events in Vietnam. The diagnoses included PTSD, chronic and severe; major depression, in remission; and alcohol and heroin abuse, in remission. The precipitating stressors were described as severe. A letter from a VA psychiatrist, dated in June 1993, stated that the veteran was currently enrolled in the PTSD clinic. Vietnam service with the 116th Assault Helicopter Company and Headquarters Company, 1st Air Cavalry Division, was noted. The veteran was said to experience recurrent intrusive thoughts and to reexperience being in firefights and seeing individuals being hit and blown apart. It was indicated that the veteran flew as a door gunner in both combat and transport missions, and was haunted by nightmares of the war. A personal hearing on appeal was held at the RO in January 1994 before a traveling member of the Board. The veteran testified in detail concerning his Vietnam combat experiences. He stated that, although his military occupational specialty was cook, he was selected to fly as a door gunner due to his training with the M-60 and his light weight. He called attention to his receipt of the Air Medal while serving in Vietnam, noting that he would not have received that award had he not flown in combat. A transcript of his testimony is of record. The Board has reviewed the evidence in this case in its entirety. While specific combat stressors alleged by the veteran have not been verified, we note that he served in Vietnam with a helicopter squadron and with the 1st Cavalry (Air Mobile). We have reviewed his testimony at his personal hearing, and find it to be credible. We further find that his service administrative records and his DD Forms 214 indicate that he did, in fact, fly in combat during his first period of Vietnam service, as evidenced by his receipt of the Air Medal and Bronze Star. We further note that the VA is required to accept as sufficient proof of service connection satisfactory lay or other evidence that an injury or disease was incurred or aggravated during such period of service, if the evidence is consistent with the circumstances, conditions, or hardships of such service. We further note that PTSD was first diagnosed during a period of VA hospitalization in 1981 based upon symptoms which included combat dreams, fearfulness, increased startle reflex, crying, loss of appetite, loss of sex drive and loss of interest in his usual pursuits. We further note that the more recent diagnoses of PTSD offered by VA physicians, including a staff psychiatrist, cite both current symptoms diagnostic of PTSD, as well as combat stressors which are consistent with the known circumstances, conditions, or hardships of Vietnam service. Based upon the foregoing, the Board finds that entitlement to service connection for PTSD is warranted. (C0NTINUED ON NEXT PAGE) ORDER Service connection for PTSD is granted. ____________________________ J. U. JOHNSON 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.