Citation Nr: 0004343 Decision Date: 02/18/00 Archive Date: 09/08/00 DOCKET NO. 92-21 561 DATE FEB 18, 2000 On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to an increased (compensable) evaluation for right ear hearing loss. 3. Entitlement to a total rating based on individual unemployability due to service-connected disabilities. REPRESENTATION Veteran represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD M.S. Lane, Associate Counsel INTRODUCTION The veteran served on active duty from August 1950 to January 1954 and from January 1962 to June 1963. Service in Korea is indicated by the record. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 1990 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which denied the veteran's claims of entitlement to service connection for PTSD, entitlement to a compensable evaluation for hearing loss of the right ear and entitlement to a total rating based on individual unemployability due to service- connected disabilities. By that decision, the RO also denied the veteran's claim of entitlement to an increased evaluation for tinnitus. 1 In an August 1994 decision, the Board determined that the veteran's claim of entitlement to service connection for a psychiatric disorder, to include PTSD, had been previously denied by the RO in a September 1988 rating decision. The Board further determined that although the veteran had initiated an appeal regarding that decision, and a statement of the case had been issued by the RO, the veteran subsequently failed to submit a timely substantive appeal (VA Form 9). See 38 C.F.R. 20.200, 20.201, 20.202, 20.302 (1999). The Board therefore concluded that the veteran had failed to perfect his appeal and that the RO's September 1988 rating decision had become final. See 8 U.S.C.A. 7105 (West 1991); 38 C.F.R. 20.1103 (1999). The Board further concluded that the issue on ---------------------------------------------------------------- 1 During his October 1998 personal hearing, the veteran withdrew his appeal as to the claim of entitlement to an increased evaluation for tinnitus. See 38 C.F.R. 20.204 (1999). Therefore, the Board will not address this issue further. 2 - appeal was thus more appropriately characterized as whether new and material evidence had been submitted to reopen a claim of entitlement to service connection for PTSD. After reviewing the veteran's claim on that basis, the Board proceeded to find that new and material evidence had been submitted, and the veteran's claim of entitlement to service connection for PTSD was reopened. See 38 U.S.C.A. 5108 (West 1991); 38 C.F.R. 3.156(a) (1999). Having reopened the veteran's claim of entitlement to service connection for PTSD, the Board then remanded this case to the RO for further evidentiary development. The requested development was completed, and in March 1999, the RO issued a Supplemental Statement of the Case in which it continued to deny the veteran's claims of entitlement service connection for PTSD and entitlement to total rating based on individual unemployability due to service- connected disabilities. The RO also continued to deny the veteran's claim of entitlement to a compensable evaluation for right ear hearing loss. Thereafter, the claims folder was returned to the Board. In October 1994, the RO issued a letter to the veteran requesting that he indicate whether he desired to appear at a personal hearing, either before a member of the Board or a hearing officer. Thereafter, in January 1995, the veteran submitted a statement in which he expressed his desire to appear at a personal hearing before a "member of Board or [h]earing officer" at the RO. The record reflects that in October 1998, the veteran presented testimony at a personal hearing before a hearing officer at the San Diego RO. During this hearing, the veteran withdrew his request for an additional hearing before traveling a member of the Board. Additional issues not currently on appeal In a signed statement submitted in August 1990, the veteran raised a claim of entitlement to service connection for left ear hearing loss. The Board notes that this claim was previously denied by the RO in a February 1989 rating decision. As the issue of whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for left ear hearing loss has not been addressed, 3 - this matter is accordingly referred to the RO for appropriate action. See Godfrey v. Brown, 7 Vet. App. 398 (1995) [the Board is without jurisdiction to consider issues not yet adjudicated by the RO]. In a June 1997 rating decision, the RO denied entitlement to service connection for an episodic imbalance (claimed as vertigo) and a dental disability. To the Board's knowledge, the veteran has not expressed disagreement with that decision. Thus, these issues are not presently on appeal. 38 C.F.R. 20.200, 20.201, 20.202, 20.302 (1999). During his October 1998 personal hearing, the veteran presented testimony regarding his history of bilateral ear infections and his difficulties with keeping his balance, which he believed to be related to his right ear hearing loss. To the extent that the veteran is attempting to reopen his claim of entitlement to service connection for vertigo and/or claim entitlement to service connection for recurrent ear infections, these issues are referred to the RO for appropriate action. FINDINGS OF FACT 1. The veteran has no awards or decorations denoting engagement in combat with the enemy or direct combat participation and no other supportive evidence reflects that the veteran engaged in combat with the enemy. 2. The weight of the medical evidence does not support a finding that the veteran has PTSD. 3. The veteran currently has an average pure tone threshold of 41 decibels in the right ear, with speech recognition ability of 92 percent. 4. The veteran currently has Level I hearing in his right ear. 4 - 5. The veteran's service-connected disabilities do not prevent him from securing and following substantially gainful employment. CONCLUSIONS OF LAW 1. PTSD was not incurred in or aggravated by active service. 38 U.S.C.A. 1110 (West 1991); 38 C.F.R. 3.303, 3.304 (1999). 2. The criteria for a compensable schedular evaluation for hearing loss in the right ear are not met. 38 U.S.C.A. 1155 (West 1991); 38 C.F.R. 4.85-4.87, Diagnostic Code 6100 (1998); 38 C.F.R. 4.85-4.87, Diagnostic Code 6100 (1999). 3. The criteria for a total disability rating based on individual unemployability due to a service-connected disability have not been met. 38 U.S.C.A. 1155 (West 1991); 38 C.F.R. 3.340, 3.341, 4.15, 4.16, 4.18, 4.19 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran is seeking service connection for PTSD; a compensable disability rating for service-connected right ear hearing loss; and a total rating based on individual unemployability due to service- connected disabilities. In the interest of clarity, the Board will separately discuss the three issues on appeal. 5 - Entitlement to service connection for PTSD. Preliminary Matter Applicable Law and Regulations Service connection - in general In general, under pertinent law and VA regulations, service connection may be granted if the evidence establishes that the veteran's claimed psychiatric disability 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 (1999). Notwithstanding the lack of a diagnosis of a psychiatric disorder during service or within one year thereafter, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. 1113(b) (West 1991); 38 C.F.R. 3.303(d) (1999); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). Congenital or developmental defects such as personality disorders are not diseases or injuries within the meaning of the applicable legislation. 38 C.F.R. 3.303(c), 4.9 (1999). Service connection - PTSD For service connection to be awarded for PTSD, three elements must be present: (1) a medical diagnosis of PTSD; (2) medical evidence of a causal nexus between current symptomatology and the claimed in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. 38 C.F.R. 3.304(f); Moreau v. Brown, 9 Vet. App. 389 (1996). In Zarycki v. Brown, the Court set forth the analytical framework and line of reasoning for determining whether a veteran was exposed to a recognizable stressor during service, which, as discussed above, is an essential element in solidifying a 6 - claim for service connection for PTSD. 6 Vet. App. 91 (1993). In Zarycki, it was noted that, under 38 U.S.C.A. 1154(b), 38 C.F.R. 3.304(d) and (f), and the applicable provisions contained in VA Manual 21-1, the evidence necessary to establish the incurrence of a recognizable stressor during service to support a claim of service connection for PTSD will vary depending on whether the veteran "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60 (1993). The determination as to whether the veteran "engaged in combat with the enemy" is made, in part, by considering military citations that expressly denote as much. Doran v. Brown, 6 Vet. App. 283, 289 (1994). However, the Court has recently held that the Board may not rely strictly on combat citations or the veteran's MOS to determine if he engaged in combat; rather, other supportive evidence of combat experience may also be accepted. See Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996); West v. Brown, 7 Vet. App. 70, 76 (1994). If combat is affirmatively indicated, then the veteran's lay testimony regarding claimed combat-related stressors must be accepted as conclusive as to their actual occurrence and no further development or corroborative evidence will be required, provided that the veteran's testimony is found to be "satisfactory' " i.e., credible, and "consistent with the circumstances, conditions, or hardships of such service." Zarycki, 6 Vet. App. at 98. If there is no combat experience, or if there is a determination that the veteran engaged in combat but the claimed stressor is not related to such combat, there must be independent evidence to corroborate the veteran's statement as to the occurrence of the claimed stressor. See Doran, 6 Vet. App. at 288-89. The veteran's testimony, by itself, cannot, as a matter of law, establish the occurrence of a non- combat stressor. See Dizoglio, 9 Vet. App. at 166. Further, an opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of a stressor. See Moreau v. Brown, 9 Vet. App. at 395-96 (1996); Cohen v. Brown, 10 Vet. App. 128 (1997). 7 - Factual Background Upon enlistment in August 1950, an examiner noted that psychiatric and personality examination of the veteran revealed no significant abnormalities. Subsequent service medical records from the veteran's first period of service are negative for any complaints or treatment related to psychiatric problems. In a report of medical examination completed at separation, an examiner noted "normal" for the veteran's psychiatric condition. The veteran's Form DD 214, Report of Separation from the Armed Forces of the United States, from his first period of service indicates that his occupational specialty was Aircraft Engine Mechanic and that he was assigned to the 30th Bombardment Squadron, 19th Bombardment Group. The veteran's awards and commendations include the National Defense Service Medal, the Korean Service Medal, and the United Nations Service Medal. Upon reenlistment in January 1962, the veteran reported no history of depression or excessive worry and no history of any nervous trouble of any sort. In a report of medical examination dated in January 1962, an examiner again found the veteran's psychiatric condition to be normal. Service medical records from the veteran's second period of service! reveal that in May 1963, the veteran was hospitalized for psychiatric evaluation. The veteran reported that during his prior period of service, he had received 5 disciplinary actions during a three-month period near the end of his tour of duty. In explaining the difficulties he experienced at the time, the veteran stated that "the Korean war was over and all the rules had changed. Things got more strict in petty ways." The veteran reported that following his discharge in January 1954, he attended trade school for nine months and then went to a junior college for two and a half years. The veteran indicated that he then quit college to get married and worked as a salesman until he volunteered for the Army in January 1962. The veteran stated 8 - that during this period, he and his wife had frequent arguments and separations, and finally became separated for good in 1961. The examiner noted that the veteran related a long history of an inability to relate himself effectively to the Army situation, which revolved around certain attitudes regarding authority figures. The examiner concluded that there was no evidence of psychosis, neurosis, or organicity, and that there were no signs or symptoms of depression. The examiner further concluded that certain characterological deficiencies were present, which seriously impaired the veteran's usefulness to service. The veteran was diagnosed with passive aggressive reaction, chronic, severe, manifested by marked stubbornness and passive obstructionism, immature and impulsive judgment, and poorly controlled hostility and anxiety. In a report of medical history completed in May 1963, the veteran again reported no history of depression or excessive worry. In a report of examination conducted for discharge, an examiner noted "normal" for the veteran's psychiatric condition. The veteran was separated from his second period of service as a private E-3. The character of this second discharge was under honorable conditions. In June 1963, the veteran filed a claim of entitlement to service connection for a "nervous condition". This claim was denied by the RO in a November 1963 rating decision on the basis that the veteran's psychiatric disability, diagnosed as a chronic passive- aggressive reaction, was a constitutional or developmental abnormality, and not a disability for which service connection could be granted under the law. See 38 C.F.R. 3.303(c), 4.9. The record reflects that in 1985, the veteran went to work as a civilian employee in the Real Estate Department of the U.S. Army Corps of Engineers. The veteran was reportedly placed in a supervisory position, for which he apparently felt he was not qualified for and should never have been put into. A disagreement subsequently developed between the veteran and his employers involving travel vouchers and advances, which led to the Army referring the matter to the Criminal Investigation Division for investigation. The veteran then accepted a job with the Department of - 9 - the Navy which was to start in September 1985. However, the veteran contended that the Army then took harassing actions against him for leaving his position there so soon, which led to the Navy canceling his assignment before it was to start. The veteran was then informed that the moving expenses that had been F,aid to him by the Army to relocate to New York had been in@error and had to be repaid. The veteran claimed that this led to further harassment and a reduction in his pay. Repayment of these expenses reportedly resulted in financial hardship for the veteran and led to his seeking psychiatric care in February 1986. A VA psychiatric evaluation dated in February 1986 is associated with the claims folder. It reveals that the veteran reported feelings of constant stress, anxiety, and depression, involving financial hardship and job-related stress. A diagnosis of "adjustment reaction" was noted by the examiner. Subsequent VA outpatient treatment records dated throughout 1986 and 1987 show continued psychiatric treatment for anxiety and stress related to pressure from his working conditions. In August 1987, another VA examiner noted a diagnosis of adjustment disorder with anxiety and depressed mood. None of these reports mentions the veteran's military service as being implicated in his psychiatric problems. In July 1987, the veteran was evaluated by Dr. R.F., a private psychiatrist. On examination, Dr. R.F. noted that the veteran's primary concerns related to his depressed mood and stresses that he experienced as a civilian employee for the Army Corps of Engineers. The veteran stated that he experienced many conflicts while working for the military and that this resulted in the resurfacing of painful memories of combat duties in Korea. Dr. R.F. diagnosed the veteran with atypical depression and generalized anxiety disorder. In January 1988, the veteran filed a claim of entitlement to service connection for PTSD. In a September 1988 rating decision, the RO denied this claim on the grounds that there was no competent medical evidence indicating that the veteran had ever been diagnosed with PTSD. 10 - Thereafter, the veteran submitted treatment records from Dr. J.P., a private psychiatrist. A report of psychiatric examination dated in April 1989 notes that the veteran's mental state was that of an anxious person who complained of a depressed and worried mood, with some improvement noted in the veteran's mood since he had retired on medical disability in March 1988. During the examination, the veteran reported that he had experienced nightmares of friends who had died in Vietnam. He stated that he could see their faces and would sometimes get tearful over this. Dr. J.P. diagnosed the veteran with an anxiety state, with some depressive features relating to various stresses. Dr. J.P. concluded that the veteran was likely to have a recurrence of symptoms whenever he was subjected to stress, especially the type of stress that involved his employment with the Army. In January 1990, Dr. J.P. further evaluated the veteran. Dr. J.P. noted that the veteran had continued to experience nightmares of Korea, and that he would often wake up sweating and be unable to return to sleep at night. The veteran also reported that he had been more depressed around Christmas because he had been reminded of a close friend who had been killed on Christmas in 1952. Dr. J.P. concluded that the veteran suffered from anxiety and depression related to various stressors which date as far as treatment was concerned back to 1963, and as far as some symptoms were concerned back to the Korean War. Dr. J.P. further concluded that he had "some symptoms suggestive of post traumatic stress disorder." In January 1990, a VA psychiatric examination was conducted. The veteran reported that he had worked for the Post Office from 1975 to 1988, when he was retired on medical disability "due to PTSD". The veteran indicated that he experienced forgetfulness and anxiety, and that he had recently experienced feelings of depression and hopelessness during Christmas. He linked his symptoms and difficulties to the time that he spent as a ground crew member in Korea attached to the 20th Air Force, 19th Bomber Wing. The veteran stated that he shared a room with a tail gunner who was killed during a mission, and that it was around that time that he received news from home that his grandmother had died. Upon examination, the VA examiner could find no evidence of a thought disorder and no - 11 - evidence of anxiety or memory impairment. Based on his examination, the VA examiner concluded that no psychiatric diagnosis was warranted. In March 1990, the veteran was evaluated by Dr. K.G., a private psychiatrist. The veteran reported that whenever he was under stress, he would become depressed, anxious, and unable to cope with his job. He also reported that he would become agitated by memories of the Korean War. Dr. K.G. concluded that the veteran had symptoms suggestive of PTSD and that these symptoms would become more severe whenever the veteran was placed in a stressful situation. In a signed statement submitted in July 1991, the veteran reported that his troubles with the Army relating to relocation expenses began in Christmas 1985, which was the anniversary of when he lost a close friend in Korea in December 1952 and his grandmother in December 1953. He asserted that his problems with the Army at that time created so much stress that he contemplated suicide and experienced a nervous breakdown. In another signed statement submitted in May 1992, the veteran asserted that he was unemployable as a result of his PTSD. In May 1993 and June 1993, the veteran was examined by Dr. C.W., a private psychiatrist. The veteran reported that ever since he had a nervous breakdown in 1985, he has been unable to handle even the slightest stress. He further reported that he was handling his PTSD from Korea until he had to deal with the Army again. Dr. C.W. noted a history of stress problems since the early 1950's, which reportedly became exacerbated after one of his friends was killed. Dr. C.W. also stated that the veteran had been diagnosed with "combat fatigue" in 1963 and was found to be unsuitable for service. Dr. C.W. diagnosed the veteran with PTSD, which he determined made it unlikely that the veteran would be able to return to work in the foreseeable future. In April 1997, the veteran was examined by two VA psychiatrists. The veteran reported that his stressors involved getting to know the flight crews of various aircraft involved in the bombing of North Korea who were killed in action. He indicated that he had seen a lot of body bags and blood, and that the sadness over 12 - losing his friends was very destructive to him. The VA psychiatrists noted that the veteran indicated that he was not exposed to incoming fire and was not involved directly in combat. The VA psychiatrists reviewed the veteran's medical history and found the record to be very conflicting. The VA psychiatrists noted that most health care practitioners merely found that the veteran had a suggestion of PTSD or elements of PTSD. The VA psychiatrists also determined that the veteran did have a clear diagnosis of a character disorder in the past. The VA psychiatrists concluded that the veteran exhibited elements of PTSD, but that they were unable to provide a diagnosis of PTSD based on the description of stressors provided by the veteran. They found that in their opinion, the stressors reported by the veteran were not the type to generate classic PTSD symptomatology. They diagnosed the veteran with alcohol dependency, in remission for twenty years, and mixed personality disorder. In October 1998, the veteran presented testimony at a personal hearing at the RO. He testified that his stressors occurred when he served as a mechanic in Korea and that these stressors consisted of seeing friends take off and not return. He further testified that he had been particularly disturbed by the fact that his friends were only permitted to fire on other craft after they had been fired upon, which he felt exposed them to a lot of unnecessary risk. He stated that he had also seen many soldiers return as wounded and on several occasions had to clean blood out of aircraft. In December 1998, the USACRUR provided extracts from the U.S. Air Force Listing of Casualties. These extracts documented the deaths of several individuals who had been listed by the veterans as friends he had lost during the Korean War. The casualty list included Sgts. R.N., D.O., and D.R., who were noted to have died on December 31, 1953. The list also included Airmen First Class H.I., J.P., F.S., and J.0., who were noted to have died on January 30, 1954. 2 In March 1999, the RO informed the two VA psychiatrists who had examined the veteran in April 1997 that the USACRUR had verified the deaths of several people --------------------------------------------------------- 2 The veteran left military service on January 15, 1954. - 13 the veteran had listed as friends during the Korean War. The RO noted that while it was unlikely that the veteran was present when these soldiers died, it was likely that he knew these individuals and was aware of their deaths at the time. The RO requested that the VA psychiatrists determine whether these stressors were sufficient to give rise to a diagnosis of PTSD, and whether verification of these stressors cause them to change their diagnosis of the veteran. In a March 1999 addendum to their report, the two VA psychiatrists determined that they had no reason to change the conclusions expressed in their April 1997 report. Analysis Initial matter- well groundedness of the claim/duty to assist/standard of proof The threshold question in any veteran's claim for service connection is whether that claim is well grounded pursuant to 38 U.S.C.A. 5107(a). A well-grounded claim is one that is plausible, meritorious on its own or capable of substantiation. See Murphy v. Derwinski, 1 Vet. App. 78 (1990). In order for a claim to be well grounded, there must be competent evidence of (1) a current disability (a medical diagnosis); (2) incurrence or aggravation of a disease or injury in service (lay or medical evidence); (3) a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). As an initial matter, the Board concludes that the veteran's claim of entitlement to service connection for PTSD is well grounded. 38 U.S.C.A. 5107(a). This is based on Dr. C.W.'s diagnosis of PTSD and the veteran's statements as to his alleged stressor. The Board wishes to make it clear that the veteran's statements are presumed to be true only for the limited purpose of establishing whether the claim is well grounded. See King v. Brown, 5 Vet. App. 19, 21 (1993). A well-grounded claim having been submitted, VA has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. 5107. In August 1994, this case was remanded for additional evidentiary development, which was completed by the RO. There is now ample medical and other evidence of record, - 14 - the veteran has been provided with a recent VA psychiatric examination, and there is no indication that there are additional records that have not been obtained and which would be pertinent to the present claim. Thus, the Board finds that no further development is required in order to comply with VA's duty to assist as mandated by 38 U.S.C.A. 5107(a). It is noted that the veteran's service personnel records are not on file and were apparently destroyed in a fire at the National Personnel Records Center (NPRC) in St. Louis, Missouri, in 1973. The Board recognizes that there is a heightened obligation to explain findings and conclusions and to consider carefully the benefit of the doubt rule in cases, such as this, in which records are presumed to have been or were destroyed while the file was in the possession of the government. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991); Pruitt v. Derwinski, 2 Vet. pp. 83, 85 (1992). The analysis of the veteran's claim was undertaken with these duties and obligations in mind . 3 As was discussed above, the veteran's claimed in-service stressors have been verified by the U.S. Armed Services Center for Research of Unit Records (USACRUR). Thus, the Board believes that the absence of the veteran's service personnel records is unlikely to affect the outcome of his claim. Once a well-grounded claim has been established, the Board has the duty to assess the credibility and weight to be given to the evidence. See Madden,v. Gober, 125 F.3d 1477 (Fed.Cir. 1997) and cases cited therein. When there is an approximate balance of evidence regarding the merits of an issue, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. 5107(b); 38 C.F.R. 3.102 (1999). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on ---------------------------------------------------------------- 3 These cases do not lower the legal standard for proving a claim for service connection but rather increase the Board's obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the appellant. See Russo v. Brown, 9 Vet. App. 46, 51 (1996) [citing Ussery v. Brown, 8 Vet. App. 64 (1995)]. - 15 - its merits, the preponderance of the evidence must be against the claim. Alemany V. Brown, 9 Vet. App. 518, 519 (1996). Discussion At the outset, the Board notes that the record does not reflect that the veteran received any combat citation in service and there is no official record or other corroborative evidence showing that he was ever exposed to combat in service. Furthermore, the veteran in this case has never alleged that he was directly exposed to combat in service. Rather, he has asserted that his in-service stressor was his knowledge that several of his close friends were killed in action during air missions over Korea. Thus, because there is no evidence indicating that the veteran was exposed to combat in Korea, and because the veteran is not alleging that such was the case, the Board finds that the provisions of 38 U.S.C.A. 1154 and 38 C.F.R. 3.304(d) regarding combat veterans are not for application in this case. As noted above, for service connection to be awarded for PTSD, three elements must be present: (1) a current medical diagnosis of PTSD; (2) medical evidence of a causal nexus between current symptomatology and the claimed in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. 38 C.F.R. 3.304(t); Moreau v. Brown, 9 Vet. App. 389 (1996). As to item (2), as discussed above, if, as here, there is no combat experience, there must be independent evidence to corroborate the veteran's statement as to the occurrence of the claimed stressor. See Doran, 6 Vet. App. at 288-89. Further, an opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of a stressor. See Moreau, 9 Vet. App. at 395-96. Regarding the first element, the Board finds that the veteran in this case does not have a current diagnosis of PTSD. Although the Board is cognizant, that the veteran was diagnosed with PTSD by Dr. C.W. in May 1993 and June 1993, for the reasons expressed below, the Board places much more probative weight on the findings of 16 - the April 1997 VA psychiatrists, who thoroughly reviewed the veteran's claims folder and specifically ruled out a diagnosis of PTSD related to the veteran's stressors. In particular, the Board notes that the April 1997 VA psychiatrists determined that although some of his clinical symptoms were consistent with PTSD, the veteran's reported in-service stressors were not sufficient to support a diagnosis of PTSD. The April 1997 psychiatrists apparently found that the veteran suffered from a personality disorder, which accounted for his long history of anxiety and other symptoms. The Board further finds that the conclusions of the April 1997 VA psychiatrists are supported by the earlier findings of the January 1990 VA psychiatrist, who also considered the veteran's medical history and reported stressor, but determined that no psychiatric diagnosis was warranted. Regarding Dr. C.W.'s diagnosis of PTSD, the Board notes that it places very little probative value on this diagnosis, as it was apparently based not only on the veteran's report of having lost friends in service, but also on the veteran's report of having been diagnosed with "combat fatigue" in 1963, during service. However, the veteran's service medical records are negative for any evidence that the veteran was ever in combat or was diagnosed with "combat fatigue" in service. Rather, his service medical records show that he was diagnosed in May 1963, during his second period of service, with chronic and severe passive aggressive reaction, which was found to related a long history of an inability to relate himself effectively to the Army situation and certain attitudes the veteran held regarding authority figures. There is no indication that this in-service diagnosis was attributed by the military examiner to combat exposure or "combat fatigue." Furthermore, the veteran himself has since acknowledged that he was never directly exposed to combat in Korea, but rather that his PTSD is related to the loss of several close friends who died on air missions over Korea. Therefore, the Board finds that Dr. C.W.'s diagnosis of PTSD, which appears to have been specifically based on an assumption that the veteran was diagnosed with "combat fatigue" in service, is of no probative value. See Swann v. Brown, 5 Vet. App. 229, 233 (1993) a diagnosis "can be no better than the facts alleged by the appellant."] 17 - In support of his claim, the veteran has also submitted the treatment records of Drs. J.P. and K.G., his private physicians. However, in determining whether the veteran has a diagnosis of PTSD, the Board finds these records to be of very little probative value, as there is no indication that these psychiatrists ever diagnosed the veteran with PTSD. While both Drs. J.P. and K.G. found that the veteran experienced symptoms "consistent with" or "suggestive of' PTSD, neither physician ever offered a diagnosis of PTSD in their reports. Thus, to the extent that the veteran has submitted these records to show that he has been diagnosed with PTSD, the Board finds that these physician's opinions are in fact more consistent with the findings of the April 1997 VA psychiatrists, who specifically considered the veteran's reports of losing close friends in Korea, and concluded that a diagnosis of PTSD was not appropriate. In summary, the Board finds that the preponderance of the competent and probative evidence of record is against finding that the veteran has PTSD. There is no current of PTSD in this case. The Board also finds that there is no medical evidence of a sufficient in-service verified stressor. Although the veteran's reported of several friends being killed in Korea appears to have been verified by the USACRUR, the April 1997 VA psychiatrists specifically determined that the veteran's mere knowledge of his friends' deaths was an insufficient stressor on which to support a diagnosis of PTSD. See also Cohen, 10 Vet. App. at 143 [the sufficiency of a stressor, as opposed to the occurrence of a stressor, is a medical determination]. The Board also notes in passing that, with respect to several of the veteran's comrades, their deaths took place after he left service and any stressor associated therewith could not have occurred while he was in service. In summary, for the reasons and bases expressed above, the Board concludes that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for PTSD. The benefit sought on appeal is accordingly denied. - 18 - Entitlement to a compensable evaluation for right ear hearing loss. Applicable Law and Regulations Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Ratings Schedule). 38 C.F.R. Part 4 (1998). Separate diagnostic codes identify the various disabilities. The VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 5 89 (1991). The requirements set forth in these regulations for evaluation of the complete medical history of the veteran's condition operate to protect veterans against adverse decisions based on a single, incomplete or inaccurate report, and to enable the VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath, 1 Vet. App. at 593-94. Where entitlement to compensation has already been established and[ an increase in the disability rating is at issue, the present level of disability is of primary concern. See 38 C.F.R. 4.1, 4.2 (1998); see also Francisco v. Brown, 7 Vet. App. 55 (1994). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. 4.7 (1999). All benefit of the doubt will be resolved in the veteran's favor. 38 C.F.R. 4.3 (1999). Effective June 10, 1999, during the pendency of this appeal, the VA's Ratings Schedule, 38 C.F.R. Part 4, was amended with regard to evaluating hearing impairment and other diseases of the ear. 64 Fed. Reg. 25208, 25209 (1999) (codified at 38 C.F.R. 4.85-4.87). The Court has held that where a law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version more favorable to the veteran will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 19 - (1991). Although the RO did not consider the change in regulation, the Board concludes that this is not prejudicial as the change in regulation was not a substantive change regarding the portion of the regulations pertinent to this veteran's claim. Consequently, the change has no effect on the outcome of this claim. See Edenfield v. Brown, 8 Vet. App. 384 (1995). The Board finds, therefore, that it may proceed with a decision in this case without prejudice to the veteran. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Prior to June 10, 1999, the severity of hearing loss was determined by comparison of audiometric test results with specific criteria set forth at 38 C.F.R. 4.85, Part 4, DC 6 through 6110 (1998). Effective June 10, 1999, the severity of hearing loss continues to be determined by comparison of audiometric test results with specific criteria set forth at 38 C.F.R. 4.85, Part 4, DC 6100 through 6110. See also 64 Fed. Reg. 25208 and 25209, published at 38 C.F.R. 4.85-4.87 (effective June 10, 1999). Under both the new and old regulations, evaluations of bilateral defective hearing range from non compensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1,000, 2,000, 3,000 and 4,000 Hertz (cycles per second). The Schedule allowed for such audiometric test results to be translated into a numeric designation ranging from Level I, for essentially normal acuity, to Level XI, for profound deafness, in order to evaluate the degree of disability from bilateral service- connected defective hearing. The evaluations derived from the schedule are intended to make proper allowance for improvement by hearing aids. See 38 C.F.R. 4.85-4.87 (1998); See also 64 Fed. Reg. 25208 and 25209, published at 38 C.F.R. 4.85 (effective June 10, 1999). In situations where service connection has been granted for hearing loss in only one ear, compensation is payable for the combination of the service-connected and the non service-connected disabilities as if both disabilities were service connected only if there is total deafness in both ears. 38 U.S.C.A. 1160; 38 C.F.R. 3.383(a) (1999). Otherwise, the non service-connected ear is deemed normal for rating purposes. VAOPGCPREC 32-97 (August 29, 1997). Accordingly, for rating 20 - purposes, the veteran's non service-connected left ear will be considered to be at Level I. 38 C.F.R. 4.85(f). Factual Background In December 1989, the veteran filed a claim of entitlement to a compensable evaluation for his service-connected right ear hearing loss. He contended that his right ear hearing loss had continued to worsen in severity. In support of his claim, the veteran submitted treatment records from Dr. J.G., a private neurologist, dated between July 1989 and October 1989. In a July 1989 letter, Dr. J.G. noted that the veteran had reported a history of bilateral deafness, which he attributed to exposure to noise trauma during service. In November 1989, the veteran was examined by Dr. M.K., a private ear, nose, and throat (ENT) specialist. Dr. M.K. noted a history of loud noise exposure in Korea and a history of fungal infections in both ears in 1988. On the audiogram conducted by Dr. M.K., pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 RIGHT 15 15 75 80 Dr. M.K. noted an average hearing loss of 36.6 decibels in the right ear. In January 1990, the veteran underwent a VA audiological evaluation. Pure tone thresholds, in decibels, were as follows: HERTZ 100 2000 3000 4000 RIGHT 20 20 75 80 -21- The VA audiologist noted a pure tone average of 20-22 in the right ear and a speech recognition ability of 84 percent in the right ear. The VA audiologist diagnosed the veteran with bilateral high- frequency sensorineural hearing loss, severe on the right. In August 1994, the Board remanded the veteran's case for additional evidentiary development. The Board instructed the RO to provide the veteran with VA otolaryngology and audiological examinations to determine the nature and extent of any current hearing loss disability. In March 1997, the veteran was provided with a VA audiological evaluation. The VA audiologist found that the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 RIGHT 5 15 65 80 Average pure tone threshold was noted to be 41 in the right ear with a speech recognition ability of 92 percent in the right ear. In March 1997, the veteran was also provided with a VA ENT examination. The VA specialist diagnosed the veteran with symmetric sensorineural hearing loss; bilateral tinnitus; complaints of episodic imbalance with a reported caloric weakness on the right side in past testing; and a history of noise exposure. In a June 1997 rating decision, the RO denied entitlement to service connection for episodic imbalance (claimed as vertigo) on the basis that there was no competent medical evidence linking the claimed disability to service. During his October 1998 personal hearing, the veteran testified that his right ear hearing loss had continued to worsen in severity. He also presented testimony regarding his history of bilateral ear infections and his difficulties with keeping his balance, which he believed to be related to his right ear hearing loss. - 22 - Analysis The assignment of disability ratings for hearing impairment is derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The most recent VA audiological evaluation available (March t 997) reveals an average pure tone threshold of 41 decibels in the right ear, and a speech discrimination ability of 92 percent in the right ear. Applying these values to the rating schedule under both the new or old regulation results in a numeric designation of Level I hearing in the right ear. As noted above. as the veteran's left ear hearing loss disability is not service-connected, it must be considered to be at Level I for rating purposes. See 38 C.F.R. 4.85(f). Under Diagnostic Code 6100, a non compensable evaluation is assigned where hearing is at Level I in both ears. Therefore, the objective clinical evidence of record does not support a compensable schedular evaluation for hearing loss in the right ear. 38 C.F.R. 4.85-4.87, Diagnostic Code 6100 (1998); 38 C.F.R. 4.85- 4.87, Diagnostic Code 6100 (1999). The Board has also reviewed the results of the audiological evaluations conducted in November 1989 and January 1990. Applying the results of the veteran's November 1989 evaluation to the rating schedule results in a numeric designation of Level II hearing in the right ear and Level I hearing in the left ear, which also results in a non compensable evaluation under Diagnostic Code 6100. Additionally, applying the results of the veteran's January 1990 evaluation results in a numeric designation of Level I hearing in the right ear and Level I hearing in. the left ear, which again results in a non compensable evaluation under Diagnostic Code 6100. The veteran appears to be contending that his ear infections and balance difficulties are somehow related to his service-connected right ear hearing loss. As noted above, the veteran's claim of entitlement to service connection for vertigo was 23 - denied in an unappealed June 1997 RO rating decision. See the Board's discussion of this matter in the Introduction. To the extent that the veteran is claiming that vertigo and recurrent ear infections are part and parcel of his service- connected right ear hearing loss and therefore should be taken into consideration in the assignment of a disability rating for hearing loss, there is no competent medical evidence that vertigo and ear infections are part of his service-connected right ear hearing loss disability. There is no indication that the veteran possesses the specialized knowledge, skill, experience, training or education to provide competent testimony on medical matters. See Espiritu v. Derwinski, 2 Vet. App. 492, 495-496 (1992). In any event, the Board must rate the veteran's hearing loss according to the schedular criteria and cannot consider extraneous factors in assigning a disability rating. In its review of claims for increased schedular ratings, the Board is bound to apply the applicable rating criteria, and only the applicable rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); Pernorio v. Derwinski, 2 Vet. App. 625, 628 (1992). In summary, the Board has reviewed all the evidence of record, and the objective clinical evidence does not support a compensable schedular evaluation for hearing loss in the right ear. As discussed above, the level of hearing that has been demonstrated on objective evaluation is not consistent with a compensable schedular evaluation under the regulation. See Lendenmann, 3 Vet. App. 349. Accordingly, the Board finds that the preponderance of the evidence is against the claim for a compensable schedular evaluation for hearing loss in the right ear. The benefit sought on appeal is denied. Entitlement to at total rating based on individual unemployability due to service-connected disabilities. Relevant Law and Regulations It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities - 24 - shall be rated totally disabled. 38 C.F.R. 4.16. A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." 38 C.F.R. 3.340(a)(1), 4.15 (1999). "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. 4.16(a). A total disability rating for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service- connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more. If there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and the combined rating must be 70 percent or more. 38 C.F.R. 4.16(a). A claim for a total disability rating based upon individual unemployability "presupposes that the rating for the [service- connected] condition is less than 100%, and only asks for TDIU because of 'subjective' factors that the 'objective' rating does not consider." Vettese v. Brown, 7 Vet. App. 31, 34-35 (1994). In evaluating a veteran's employability, consideration may be given to his level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or impairment caused by non service-connected disabilities. 38 C.F.R. 3.341, 4.16, 4.19 (1999). Pursuant to 38 C.F.R. 4.16(b), when a claimant is unable to secure and follow a substantially gainful occupation by reason of service- connected disabilities, but fails to meet the percentage requirements for eligibility for a total rating set forth in 38 C.F.R. 4.16(a), such case shall be submitted for extraschedular consideration in accordance with 38 C.F.R. 3.321. 25 - Analysis The veteran is seeking entitlement to a total rating based on individual unemployability due to service-connected disabilities. In essence, the veteran contends that he is unable to secure or maintain substantially gainful employment due to PTSD and vertigo, two conditions for which he is not service-connected. The record reflects that the veteran is currently assigned a 10 percent disability rating for tinnitus and a non compensable disability rating for right ear hearing loss. These are his only service-connected disabilities. Thus, he has a combined disability rating of 10 percent, which does not meet the requirements for the assignment of a total disability rating based upon individual unemployability. See 38 C.F.R. 4.25, 4.16(a). As a result, the veteran is not eligible for a total rating due to unemployability under 38 C.F.R. 4.16(a). However, the Board must still consider whether the veteran is unable to secure or follow substantially gainful employment so as to warrant assignment of an extraschedular evaluation under 38 C.F.R. 3.321. See 38 C.F.R. 4.16(b). The veteran has reported that he left high school in the 9th grade and later obtained a GED. Following his discharge from service in 1954, he attended electrical trade school for nine months and then went to a junior college for a year and a half. Although it is unclear from the record what type of work the veteran did immediately following his final discharge in 1963, he has indicated that he worked for the U.S. Postal Service from 1973 to 1985. He then went to work for the U.S. Army Corps of Engineers from 1985 through 1988, when he was reportedly forced to leave work due to emotional difficulties. The veteran was then awarded entitlement to disability benefits under the Federal Employees' Compensation Act for emotional problems caused by his employment with the U.S. Army. Thereafter, the record reflects that the veteran accompanied his wife to England, where he enrolled in college courses to acquire a Masters in Business Administration. During his VA psychiatric examination in April 1997, the veteran reported that he has remained unemployed since he left his job with the Army in 1988. - 26 - After reviewing the record, the Board finds that the veteran's service-connected disabilities are not of such severity as to render him unable to secure or follow substantially gainful employment. Although the veteran has contended that he is unable to work due to his disabilities, the Board notes that the veteran's contentions in this regard have referred solely to impairment caused by his non service- connected disabilities, rather than his service-connected right ear hearing loss and tinnitus. However, the Court has held that when determining entitlement to a total rating based on individual unemployability due to service-connected disabilities, impairment caused by non service-connected disabilities cannot be considered. See Pratt v. Derwinski, 3 Vet. App. 269, 272 (1992). In this case, the veteran has never asserted that his service- connected tinnitus or right ear hearing loss are so severe as to render him unemployable and there is no evidence to indicate that such is the case. Although the evidence reveals that the veteran has not worked since 1988, and that he retired at that time due to disability, the evidence likewise shows that this retirement was due solely to impairment caused by "emotional problems" at that job. There is no evidence indicating that his service-connected tinnitus and right ear hearing loss played any role in his retirement. To the contrary, the record shows that prior to the onset of his emotional difficulties in 1985, the veteran was able to maintain full-time employment with the Postal Service for twelve years while experiencing both right ear hearing loss and tinnitus. In summary, the Board finds that there is no evidence indicating that the veteran's service-connected tinnitus and right ear hearing loss have ever interfered with the his ability to secure or follow substantially gainful employment. Therefore, the Board concludes that the preponderance of the evidence is finding that the assignment of an extraschedular evaluation is warranted under 38 C.F.R. 3.321. See 38 C.F.R. 4.16(b). The veteran's claim of entitlement to a total rating based on individual unemployability due to service-connected disabilities is accordingly denied. - 27 ORDER Entitlement to service connection for PTSD is denied. Entitlement to a compensable evaluation for right ear hearing loss is denied. Entitlement to a total rating based on individual unemployability due to service- connected disabilities is denied. Barry F. Bohan Member, Board of Veterans' Appeals 28 -