BVA9507760 DOCKET NO. 93-13 457 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUE Service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Barry F. Bohan, Counsel INTRODUCTION The appellant served on active duty in the United States Army from July 1943 to November 1945. He served as a combat engineer in Europe and was awarded the Purple Heart Medal. In a March 1946 rating decision, service connection was granted for a shrapnel scar of the right leg. In July 1949, service connection was granted for residuals of a shell fragment wound of the chest. In March 1982, service connection was granted for generalized anxiety disorder, superimposed dysthymic disorder and somatization with psychological factors affecting physical illness. A 30 percent disability rating was assigned. In an August 1991 decision, the Board of Veterans' Appeals (the Board) granted the appellant an increased disability rating, to 50 percent disabling, for his service-connected anxiety disorder. In December 1991, the appellant, through his representative, Disabled American Veterans, filed a claim for service connection for post-traumatic stress disorder (PTSD). This appeal arose from a July 1992 decision of the Department of Veterans Affairs Regional Office in Phoenix, Arizona (VARO) which denied the appellant's claim. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in substance, that he has PTSD, which was caused by his experiences in combat during World War II. 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 appellant's claims folders. 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 preponderance of the evidence is against the appellant's claim and that service connection should be denied for PTSD. FINDINGS OF FACT 1. The appellant served on active duty in the United States Army from July 1943 to November 1945. 2. The appellant has been diagnosed as having anxiety disorder. Service connection has been granted for such disability. 3. The appellant has never been diagnosed as having PTSD. CONCLUSION OF LAW PTSD was not incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1154 (West 1991); 38 C.F.R. §§ 3.303, 3.304(f) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant is seeking service connection for PTSD. In the interest of clarity, the appellant's medical history will be reviewed. The issue presented on appeal will then be discussed. Medical history As reported in the Introduction, the appellant served as a combat engineer in the European Theatre during World War II. In February 1945, he sustained shell fragment wounds of the right calf and right chest. He was hospitalized in July 1945 due to nervousness, headaches and stomach discomfort. His military physician noted "he has many bizarre complaints." In January 1982, the appellant, then age 57, underwent a VA psychiatric examination. He complained of nervousness, depression, difficulty breathing, sweating, fear of crowds and numerous somatic complaints. The diagnosis was generalized anxiety disorder, superimposed dysthymic disorder and somatization with psychological factors affecting physical illness (hypertension, intractable pain). As noted in the Introduction, service connection was granted for that disability in March 1982. The appellant was hospitalized at VA facilities on at least five different occasions from 1990 to 1992. During those hospitalizations, he complained of anxiety, depression and multiple physical complaints, as well as poor energy level and difficulty concentrating. CT scans in February 1991 and August 1992 were normal. Psychological testing in August 1992 resulted in a conclusion that the appellant had a largely somatically organized anxiety state, which may have had its inception in his experiences during World War II. Diagnoses during the hospitalizations were generalized anxiety disorder; dysthymic disorder. There was no mention of PTSD during any of the hospitalizations. The appellant's VA outpatient treatment records have also been reviewed. PTSD has never been diagnosed. Analysis Under pertinent law and VA regulations, service connection may be granted if the greater weight of the evidence establishes that PTSD was incurred in service. 38 U.S.C.A. §§ 1110, 1154 (West 1991); 38 C.F.R. §§ 3.303(a) (1994). Notwithstanding a lack of a diagnosis of PTSD during service, service connection may be still granted if all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1994). Evidence which must be considered includes service records, the appellant's medical records, and all pertinent lay and medical evidence. 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. §§ 3.303(a), 3.304 (1993); Hayes v. Brown, 5 Vet.App. 60, 66 (1994). The Department of Veterans Affairs has promulgated a regulation which specifically deals with service connection for PTSD. In order for service connection for PTSD to be granted, there must be "medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in service stressor." 38 C.F.R. § 3.304(f) (1994). In the appellant's case, it is clear that in service stressors indeed existed. He was wounded in combat. There is, however, no clear diagnosis of PTSD. Indeed, there is no medical evidence which suggests that the appellant has PTSD. In the absence of medical evidence which establishes such disability, service connection for PTSD is denied. 38 C.F.R. § 3.304(f) (1994); Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). In arriving at its conclusion, the Board is in no way belittling the appellant's combat experiences. The medical evidence establishes that he does indeed have a service-connected psychiatric disorder, generalized anxiety disorder with depressive features, which is related to his experiences in World War II. The preponderance of the evidence, however, does not lead to the conclusion that service connection is also in order for PTSD. Gilbert v. Derwinski, 1 Vet.App. 49, 57 (1990). ORDER Service connection for post-traumatic stress disorder is denied. C.P. RUSSELL Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.