Citation Nr: 0007636 Decision Date: 03/21/00 Archive Date: 03/28/00 DOCKET NO. 95-41 120 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Hal Smith, Counsel INTRODUCTION The veteran served on active duty from September 1965 to July 1969. This matter comes to the Board of Veterans' Appeals (Board) from rating determinations of the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. In June 1994, the veteran filed a claim for VA benefits, claiming service connection for PTSD. By rating decision in May 1995, the RO denied service connection for PTSD since neither the medical evidence in the file nor the veteran's statements indicated verifiable stressors due to combat. In August 1998, the Board remanded the claim for additional development to include an attempt to verify the appellant's stressors. The RO again denied service connection for PTSD in November 1999 as the stressors related by the veteran were not verified. The appeal continues. FINDINGS OF FACT 1. The veteran did not engage in combat while in service. 2. There is no credible supporting evidence of an inservice stressor necessary to support a diagnosis of PTSD. 3. The veteran does not have PTSD as a consequence of his military service. CONCLUSION OF LAW PTSD was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1101, 1110, 1154 (West 1991); 38 C.F.R. §§ 3.303, 3.04(f) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION A PTSD claim is well grounded if there is medical evidence of a current disability, lay evidence (presumed to be credible for these purposes) of an in-service stressor, which in a PTSD case is the equivalent of in-service incurrence or aggravation; and medical evidence of a nexus between service and the current PTSD. Gaines v. West, 11 Vet. App. 353, 357 (1998). Where there is a clear diagnosis of PTSD, an appellant's assertions of participation in combat are generally accepted as true for purposes of determining whether the claim is well grounded. Falk v. West, 12 Vet. App. 402, 404 (1999); but see Samuels v. West, 11 Vet. App. 11 Vet. App. 433 (1998) (VA is not required to accept the truthfulness of inherently incredible assertions). The Board has found the veteran's claim to be well grounded. VA and private medical records contain diagnoses of PTSD. The only reported stressors supporting those diagnoses were combat stressors reported by the veteran. However, even where the claim is found to be well grounded, service connection for PTSD requires more. There must be medical evidence establishing a 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 Medal, the Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of a claimed inservice stressor. Gaines v. West, at 357; 38 C.F.R. § 3.304(f). In this regard, in August 1998, the Board remanded this case. At that time, the Board stated that the RO should request from the appellant a comprehensive statement containing as much detail as possible regarding the stressors to which he alleged he was exposed in service. The appellant was to provide specific details of the claimed stressful events during service, such as dates, locations, detailed descriptions of events, units involved, and number and names of causalities. The RO advised the appellant that his information was vitally necessary to obtain supportive evidence of the stressful events and that he should be as specific as possible because without such details, an adequate search for verifying information could not be conducted. The veteran responded by reporting that he could supply only one date, that being his date of arrival in Vietnam. He related that on that occasion the base was under rocket attack. He reported no additional stressors. The Board's remand instructed the RO to submit a request to the USASCRUR for further documentation or confirmation regarding the veteran's claimed stressors. The USASCRUR responded to this request in October 1999. USASCUR reported that it while it could document rocket attacks on other occasions, it could not document a rocket attack on the day of the veteran's arrival at his base in Vietnam. The Board notes that the records do not document that the veteran participated in combat. Therefore, in light of the above, the Board is satisfied that all available relevant evidence is of record and that the statutory duty to assist the appellant in the development of evidence pertinent to this claim has been met. In general, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. With regard to service connection for PTSD, there must be: (1) medical evidence establishing a diagnosis of the disorder in accordance with 38 C.F.R. § 4.125 (American Psychiatric Association: DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS, 4th Ed., (DSM-IV)); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) a link, established by medical evidence, between current symptomatology and the claimed in- service stressor. 38 C.F.R. § 3.304(f); See also Cohen v. Brown, 10 Vet. App. 128, 138 (1997) (citing Moreau v. Brown, 9 Vet. App. 389, 394-95 (1996)). If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat, or that the veteran received an award of the Purple Heart, Combat Infantryman Badge, or other similar combat citation, will be accepted as conclusive evidence of the claimed in-service stressor, absent evidence to the contrary. See Cohen, supra, (quoting 38 C.F.R. § 3.304 (f)); see also VA ADJUDICATION PROCEDURE MANUAL M-21-1, Part III, 5.14 (April 30, 1999) (hereinafter M21-1). An earlier version of § 3.304(f), which is applicable in this case required a "clear diagnosis" of PTSD. 38 C.F.R. § 3.304(f) (1998). This change has no effect on the adjudication of the veteran's claim, since he has a diagnosis of PTSD that meets the requirements of both the old and new versions of the regulation. Evidence to support a PTSD claim must be evaluated in light of the places, types and circumstances of service as evidenced by service records, the official history of each organization in which the veteran served, the military records, and all pertinent medical and lay evidence. The requirements vary depending upon whether or not the veteran engaged in combat with the enemy. 38 U.S.C.A. § 1154(b); 38 C.F.R. §§ 3.303, 3.304(f); West v. Brown, 7 Vet. App. 70, 75 (1994); Hayes v. Brown, 5 Vet. App. 60, 66 (1993). 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. It is not sufficient to simply rely on service in a combat zone. Zarycki v. Brown, 6 Vet. App. 91, 99 (1993). Nor is the veteran's lay testimony alone sufficient to establish the occurrence of the alleged stressor. In such cases, the record must contain service records or other corroborative evidence that substantiates or verifies the veteran's testimony or statements as to the occurrence of the claimed stressor. See West, 7 Vet. App. at 76; Zarycki, 6 Vet. App. at 98. In Doran v. Brown, 6 Vet. App. 283, 290-91 (1994), the United States Court of Veterans Appeals (Court) held that "the absence of corroboration in the service records, when there is nothing in the available records that is inconsistent with other evidence, does not relieve the BVA of its obligations to assess the credibility and probative value of the other evidence." West, Zarycki, and Doran cited a provision of the M21-1 which has now been revised as to "Evidence of Stressors in Service" to read, in part,... "[C]orroborating evidence of a stressor is not restricted to service records, but may be obtained from other sources." Since an October 1995 revision of the M21-1, the Court has held that the requirements in 38 C.F.R. § 3.304(f) for "credible supporting evidence" means that the "appellant's testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor." See Moreau, 9 Vet. App. at 395; Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). The Board notes that VA has adopted the fourth edition of the American Psychiatric DSM-IV, in amending 38 C.F.R. §§ 4.125 and 4.126. See 61 Fed.Reg. 52695-52702 (1996). The standard as to whether a stressor is sufficient to trigger PTSD is a subjective standard, requiring exposure to a traumatic event and a response involving intense fear, helplessness, or horror. See Cohen, 10 Vet. App. at 153 (Nebeker, C.J., concurring). VA's General Counsel has recently defined the phrase "engaged in combat with the enemy" as used in 38 U.S.C.A. § 1154, as requiring that the veteran have personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. VAOPGCPREC 12-99 (1999). The record before the Board demonstrates that the appellant has clearly been diagnosed as having PTSD. While there is evidence of treatment for psychiatric complaints and a diagnosis of depression as early as the late 1980s, a diagnosis of PTSD was not clearly evidence until the VA compensation and pension examination report conducted on August 5, 1994. At that time, the veteran reported that when he was in military service, he saw a man walking down the highway carrying another man's hand. He also described a time when he was under enemy attack and stuck in a foxhole. He was disturbed because he had heard that they had "wrote us off." When asked about whether his experience in Vietnam affected him currently, he said that at times, his experiences were "pretty vivid" and he felt a sense of sympathy and camaraderie with other veterans. He said that he did not dream and reported no flashbacks. Following psychological testing to include the Minnesota Multiphasic Personality Inventory, the examiner concluded that the veteran met the criteria for sub-threshold PTSD. Upon VA PTSD examination on August 9, 1994, the veteran again related the stressors noted above. Following evaluation, the diagnoses were PTSD and dysthymic disorder secondary to loss of vision. Private records from 1995 reflect that the veteran was seen for PTSD symptomatology. In an October 1997 statement, the veteran's daughter noted that she had been witness to sudden changes of behavior in her father. For example, she said that he often expressed his anger verbally or physically. She and her siblings, as well as her mother, were always afraid that they were going to "trigger" something in their father which would suddenly cause him to lose his temper. At a videoconference hearing before the undersigned in June 1998, the veteran testified in support of his claim. He said that he encountered rocket or mortar fire on numerous occasions to include one occasion when a soldier in the latrine was obliterated by a rocket. Hearing [Hrg.] Transcript [Tr.] at 8. He also recalled that when driving from one part of the base to another, he picked up a marine who was carrying another soldier's forearm and his hands. Tr. at 9. He did not know the names of these soldiers. Tr. at 11. In an October 1999 report, the USASCRUR reviewed the veteran's personnel records. They were unable to verify that the veteran was exposed to combat. The records did show that his base at Phu Bai, was hit by rocket and mortar fire in May 1968, resulting in the death of two military personnel. However this event took place a few days before the veteran's arrival. During his time at Phu Bai, the records reflect one rocket attack in August 1968, with no casualties noted. Analysis In this case, the medical evidence shows that VA and other examiners have given the appellant a diagnosis of PTSD for his current symptomatology. The record supports a conclusion that the veteran currently has PTSD, and the Board does not dispute that fact. Pursuant to 38 C.F.R. § 3.304(f), the first element is therefore met, which is a diagnosis of PTSD made in accordance with 38 C.F.R. § 4.125. The Board's review of the evidence of record to include the veteran's DD 214 and personnel records does not document the receipt of any medals, badges, or citations which would denote participation in combat. The veteran's service personnel records show that his specialty during service was as an electric power production specialist. A specialty that would not be expected to involve combat. The veteran's service personnel records do not show that he was stationed in Vietnam, although subsequently dated Air Force records show that he was on TDY (temporary duty) at Phu Bai, Vietnam from June 5 to October 1, 1968. This record shows that the veteran did not have a combat specialty, and the unit reports show his unit was involved in little, if any combat, while he was on temporary duty in Vietnam. The veteran has reported involvement in various amounts of combat. However, the Board finds his variable statements to be less probative than the service records, which directly contradict some of his assertions, and the records which show his noncombat specialty, and the lack of combat decorations, and concludes that he did not engage in combat while in Vietnam. Since the record does not show that the veteran participated in combat, in order to establish entitlement to service connection for PTSD, there must be credible supporting evidence of his claimed stressors. The Board notes, that "[j]ust because a physician or other health professional accepted the appellant's description of [his]...experiences as credible and diagnosed the appellant as suffering from PTSD does not mean the [Board is] required to grant service connection for PTSD." Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). The Board is not required to accept the appellant's uncorroborated account of his experiences. Swann v. Brown, 5 Vet. App. 229, 233 (1993); Wood v. Derwinski, 1 Vet. App. 190, 192 (1991). Furthermore, as noted above, there is no documentation of records confirming that the appellant engaged in combat with the enemy or in combat situations. Therefore, in light of the above, the appellant received no combat citations or other awards which could be "accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressors." 38 C.F.R. § 3.304(f). Nor is there any evidnece of any wounds associated with combat. The second element of 38 C.F.R. § 3.304(f) regards whether there is a recognizable stressor. If the veteran was not a combat veteran, such as in this case, his claimed stressors are insufficient standing alone and must be corroborated by credible evidnece, not to include after the fact medical- nexus evidence. See Doran and Moreau, supra. In the instant case, the appellant has maintained that during service, he was under enemy attack on numerous occasions and that he one picked up a soldier who was carrying another soldier's forearm and hand. As noted earlier, however, the USASCRUR was unable to verify that the alleged inservice stressors occurred, and there is no other credible supporting evidence for any of the veteran's claimed stressors. In light of the above, the Board finds that there is no credible supporting evidence that the appellant's claimed inservice stressors actually occurred. The Board notes that the appellant's own statements cannot, as a matter of law, establish the occurrence of non-combat stressors. Dizoglio, supra. Moreover, lay statements submitted in support of the appellant's claim are probative but not conclusive of any specific stressors alleged by the appellant in service. As detailed above, the record of evidence does not verify that the appellant engaged in combat, and there is no credible evidence that his claimed non-combat stressors actually occurred, as required by 38 C.F.R. § 3.304(f) and M-21-1, Part III, 5.14. Accordingly, the preponderance of the evidence is against entitlement to service connection for PTSD. The Board observes that in this case, there are several diagnoses of PTSD. However, the Board notes that credible supporting evidence of the actual occurrence of the inservice stressors cannot consist solely of after-the-fact medical nexus evidence. Moreau, supra. Additionally, where the evidence does not support any verifiable inservice non-combat related stressor, the veteran cannot be service-connected for PTSD. The criteria for service connection for PTSD, therefore, have not been met in this case. The Board is not required to accept the appellant's uncorroborated account of his claimed stressors as a basis for substantiating his claim notwithstanding health professionals who accept as truthful the appellant's reported service medical history for purposes of treatment and diagnosis. See Cohen, at 142 (an opinion by a mental health professional based on a post-service examination of the veteran cannot be sued to establish the occurrence of a stressor). See also Swann v. Brown, 5 Vet. App. 229, 233 (1993); Wood v. Derwinski, 1 Vet. App. 406 (1991). As demonstrated by the evidence discussed above, the appellant's account of incidents occurring during his period of time in the military have not been verified and no credible evidence has otherwise been presented to support the occurrence of the inservice stressors. An alleged link set forth by various examiners between the claimed stressors and service is not in and of itself sufficient to grant service connection for PTSD. While in this case, medical evidence establishing a clear diagnosis of PTSD is present, credible supporting evidence that the claimed inservice stressors occurred is not. As such, the appellant's claim for service connection for PTSD therefore fails on the bases that all three elements required for such a showing under 38 C.F.R. § 3.304(f) have not been met, and that the preponderance of the evidence is against the claim of service connection for PTSD. In reaching this decision, the Board has considered the doctrine of reasonable doubt. However, as the preponderance of the evidence is against the appellant's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49, 54-55 (1990). ORDER Service connection for PTSD is denied. Mark D. Hindin Member, Board of Veterans' Appeals