BVA9503701 DOCKET NO. 93-08 801 ) 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 ATTORNEY FOR THE BOARD Constance C. Hickey, Associate Counsel INTRODUCTION The veteran had active service from June 1941 to June 1961. This appeal to the Board of Veterans' Appeals (Board) arises from the June 1992 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida which denied service connection for post-traumatic stress disorder (PTSD). The Board notes that in his substantive appeal the veteran has raised claims for a total rating on the basis of PTSD and a total rating on the basis of individual unemployability. He has established service connection for several disorders, rated at a 30 percent level, in combination. The issue of entitlement to a total disability rating has not been developed for appellate review and is not "inextricably intertwined" with the issue properly before the Board. Accordingly, it will not be addressed herein, but, in light of the action taken below, is referred to the RO for consideration and action as appropriate. In May 1975, the Board denied service connection for a nervous condition. In light of the veteran's current contentions the Board will treat his claim for service connection for PTSD as a new claim. The Board also notes, after a review of the record, that in July 1972, when the veteran filed his initial claim for service- connected compensation benefits, he included "ringing in ears." His retirement examination indicates a long history of tinnitus and hearing loss. Although a diagnosis of "alleged tinnitus" was recorded on the VA examination conducted in October 1972, no action on the veteran's claim for service connection for tinnitus has ever been taken by the RO. The Board finds that this claim remains in a pending status and directs the RO to review the record and take proper adjudicative action. CONTENTIONS OF APPELLANT ON APPEAL It is contended by and on behalf of the veteran that he is entitled to service connection for post-traumatic stress disorder. The veteran asserts that he was subject to stressors during combat in World War II and was treated for nervousness, insomnia, and palpitations during active service. He states that he is currently under treatment for PTSD which results from stressful events he experienced during service. 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 our review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence is in equipoise on the issue and, granting the veteran the benefit of any doubt, service connection is established for post traumatic stress disorder. FINDINGS OF FACT 1. The veteran was subject to stressors while engaged in combat in World War II. His service was recognized by numerous decorations including the Purple Heart. During combat he was required to assist in the identification and burial of his dead companions. 2. The credible evidence suggests that a diagnosis of PTSD is reasonably substantiated, and that such disorder is of service origin. CONCLUSION OF LAW Post-traumatic stress disorder was incurred as a result of military service. 38 U.S.C.A. §§ 1110, 1131, 5107(b), 1154 (West 1991); 38 C.F.R. §3.304 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION At the outset, the Board finds that the veteran has met his burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim is well-grounded; that is, the claim is plausible. Additionally, there is no indication that there are unobtained records which are available and which would aid a decision in this case. Accordingly, we conclude that the record is complete and that there is no further duty to assist the veteran in developing the claim, as mandated by 38 U.S.C.A. § 5107(a). Factual Background Service medical records indicate no nervous or psychiatric abnormalities at the time of the veteran's enlistment in June 1941. At the time of his retirement examination in April 1961 the veteran reported a history of nervous trouble, depression and palpitations, or pounding of the heart. On clinical evaluation no neurological or psychiatric abnormalities were noted. Later the same month, the veteran was treated for nervousness and insomnia. A prescription for Meprobamate was issued and apparently refilled the following month. During an October 1972 VA compensation examination for claimed disabilities, which the veteran described in part as "anything that may appear in my medical records," he complained of nervousness and insomnia, and was noted to state that he took daily doses of Valium. He was reported to be "quite nervous." No specific psychiatric diagnosis was rendered. Of record are outpatient treatment records for June 1971 through April 1973 from the Orlando Naval Hospital which indicate that Valium was prescribed for the veteran's complaints of nervousness. During a January 1973 neuro-psychiatric consultation the examiner noted much anxiety and the somatic equivalents of depression. No psychotic signs or suicidal thinking were found. The examiner's impression was passive dependent personality, conversion symptoms, and depressive reaction. During a July 1973 VA hospitalization for observation and evaluation of his physical disabilities, VA neurologists noted that the veteran apparently had tension headaches of nervous etiology; there was no specific workup for psychiatric illness. Also of record are VA outpatient records for August 1975 through July 1976 indicating that the veteran was treated with Valium for various complaints noted as nervousness, anxiety, tension and chest pains that he reportedly experienced on deep inspiration. On March 1976 mental health consultation the examiner noted complaints of typical anxiety symptoms, including tension headaches, fear, nervousness, sweating episodes, and roving somatic complaints. The impression noted by the examiner was anxiety neurosis with some hysterical features. VA records for June 1977 through November 1982 indicate repeated Valium prescriptions, generally issued in relation to complaints of various pains in the right shoulder, feet, back or chest. In November 1979 a VA examiner noted that the veteran was very anxious. An October 1978 statement from the veteran's wife asserts her opinion that the veteran was a very nervous person, who had nightmares following the war, which she apparently attributed to his military experience. She stated that the veteran needed tranquilizers and that he had taken nonprescription medication during service, but was afraid to ask military doctors for help because he feared being given a medical discharge. During a January 1989 VA compensation examination for an unrelated claim the veteran gave a history of a nervous condition and complained of irritability, insomnia, and fear of being around people. In August 1989 the veteran filed documents related to his application for vocational rehabilitation in which he noted that he was extremely nervous in addition to having numerous physical disorders. The veteran reportedly told a VA counseling psychologist that after having to quit a job in 1968, because of his foot pain, his nervousness was such that he was very irritable and short tempered. In August 1989 he asserted that he was willing to do any work within his physical limitations. The VA counselor rated the veteran as capable of working around others and working with others. VA determined that the veteran was eligible for vocational rehabilitation and assistance in finding employment. VA records for May through October 1990 indicate that the veteran was under treatment for generalized anxiety disorder, with complaints of insomnia, irritability and difficulty in adjustment to civilian life. In May 1990 it was noted that he sought therapy for his problems adjusting to civilian life. At that time he also reported nightmares related to his World War II experiences. In September 1991 the veteran sought referral for PTSD from a VA outpatient facility. On mental status examination he was found to be alert, coherent, oriented and somewhat nervous. The examiner's assessment included PTSD. On November 1991 mental health consultation, the veteran gave a history of PTSD. The examiner noted that he had not been diagnosed with PTSD, but had a history of treatment for nervousness, which the veteran described as PTSD after hearing a discussion of the topic on television. On examination the veteran was alert, oriented and coherent. It was noted that mood and affect were appropriate and there was no psychosis or delusion. The examiner's impression was of history of chronic anxiety disorder. In January 1992 the veteran submitted a statement in support of his claim in which he asserted that he had been taking tranquilizers on a daily basis since 1961. The statement also described his experience in the Battle of the Bulge where he reportedly was required to pick up and identify the bodies of his dead comrades. The veteran asserted that this experience remained with him to the current time despite attempts to drown the memory with whiskey. He related that after retirement he could not adjust to civilian life and did not want to be around people unless he drank first. On February 1992 VA compensation examination the veteran reportedly stated that he felt extremely nervous, lacked confidence in himself, and had a poor self image. He also reported difficulty falling asleep because of foot pain. He reportedly described trembling spells and nightmares about his military experience. It was noted that his experiences during the Battle of the Bulge were very traumatic because many of his comrades were killed. On personality study the examiner noted that the veteran was uneasy in a crowd, and believed that people watched him and did not like him. He reported that he had difficulty adjusting to civilian life and felt worthless and needless. He admitted considering suicide after leaving the army, which he described as his home. The veteran acknowledged being overly critical and worrying about his grandchildren. He had a bad temper at times, reduced memory and occasionally cried. Auditory hallucinations reportedly were denied. The examiner found no psychiatric difficulties or diagnostic illness, except that the veteran's limited education made it difficult for him to relate in other than a subordinate way. After a reported hour long discussion of the veteran's traumatic experience of the carnage in the Battle of the Bulge, the examiner indicated that the veteran did not rate being tagged with a psychiatric diagnosis. However, dysthymia was indicated as a "working diagnosis." With respect to the suggested diagnosis of PTSD, the examiner indicated that he did not find confirmation of the requisite diagnostic criteria. Outpatient records for September 1992 indicate that the veteran was treated at the mental health clinic for complaints of nightmares related to his combat experiences, including picking up the bodies of dead friends. The examiner indicated otherwise normal findings. The diagnostic impression was noted as PTSD. Also of record is a September 1992 statement by the veteran's wife in which she reiterated her assertion that the veteran had taken medication for nervousness since he was in the service. She reported that he had taken only non-prescription medicine until the final period of his active duty, because he was ashamed of his nervousness, and felt that as a non-commissioned officer he should not admit this to military doctors. She stated that after returning from World War II the veteran had nightmares in which he would scream that his buddies were in danger of enemy fire. The veteran's wife also reported that he drank heavily during service. In October 1992 the veteran noted that the VA physician who was treating him for PTSD would be scheduling him for psychotherapy for this disorder. Entitlement to service connection for PTSD Service connection connotes many factors, but basically it means that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131. Such a determination requires a finding of a current disability which is related to an injury or disease incurred in service. Watson v. Brown, 4 Vet.App. 309, 310 (1993); Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). Each disabling condition as shown by a veteran's service records, or for which he seeks service connection, must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154. Additionally, the regulations provide that service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for PTSD, therefore, requires evidence of a current diagnosis of PTSD resulting from traumatic or stressful experiences during service. 38 C.F.R. § 3.304(f). At the outset, a PTSD diagnosis requires the existence of a recognizable stressor that would evoke significant symptoms of distress in almost anyone. In the instant case the veteran has reported, and the documents of record confirm, that he experienced numerous stressful events during combat in World War II to include the award of the Purple Heart. A longitudinal review of the claims folder reflects evidence of psychiatric symptoms dating back to military service, although an acquired psychiatric diagnosis was not made until many years thereafter. The record is replete with references to nervousness, nightmares of combat experiences, irritability, difficulty adjusting and the need for tranquilizing medication. The statements of the veteran's wife have been carefully considered and are found to be credible and highly probative of the veteran's ongoing symptoms. While it is true that the VA examiner in February 1992 did not find confirmation of the diagnostic criteria of PTSD, it is also true that he remarked on the veteran's having been "overwhelmed emotionally" by the carnage he witnessed at a young age while participating in the Battle of the Bulge. More recently the veteran is shown to be under the care of a VA mental health clinic for PTSD and he has reported that psychotherapy has been recommended. After careful weighing of all the evidence, both negative and positive, the Board finds that the evidence in this case is in equipoise on the question of whether the veteran has PTSD as a result of stressful experiences during his military service. In accord with the provisions of 38 U.S.C.A. § 5107(b), the Board gives the benefit of any doubt to the veteran and finds that he has PTSD of service origin. Therefore a grant of service connection for this disability is warranted. ORDER Service connection for post-traumatic stress disorder is granted. N. R. ROBIN 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.