Citation Nr: 0000656 Decision Date: 01/10/00 Archive Date: 01/19/00 DOCKET NO. 97-18 600 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boise, Idaho THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD D. M. Fogarty, Associate Counsel INTRODUCTION The veteran served on active duty from October 1966 to August 1969, and from October 1979 to March 1994. This matter is before the Board of Veterans' Appeals (Board) on appeal of a June 1996 rating decision from the Department of Veterans Affairs (VA) Boise, Idaho Regional Office (RO), which denied entitlement to service connection for PTSD. The Board notes that at his August 1997 hearing before a member of the Board, the veteran submitted additional evidence consisting of a report from a VA contract social worker, D. Golas. The veteran and his representative did not waive RO consideration of the newly submitted evidence. However, a review of the record reflects that the RO considered this evidence in its November 1998 rating decision and issued a supplemental statement of the case. Therefore, the Board had determined that a remand pursuant to 38 C.F.R. § 20.1304(c) (1999) is not warranted. FINDING OF FACT Competent medical evidence of a nexus between PTSD and an incident of service has not been presented. CONCLUSION OF LAW The claim of entitlement to service connection for PTSD is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION Service personnel records reflect that the veteran served in the Republic of Vietnam during the Vietnam era. The veteran received citations and awards including the Vietnam Service Medal, the Republic of Vietnam Gallantry Cross with palm, and the Vietnam Campaign Medal. Service medical records reflect that the veteran was treated for homesickness and excessive worrying in January 1967. Upon separation examination dated in July 1969, no defects or diagnoses were noted. A February 1995 clinical record reflects notations of a questionable bipolar disorder. Service medical records also reflect treatment for alcohol abuse. A June 1990 discharge summary reflects a diagnosis of continuous alcohol dependence. A discharge summary dated in November 1990 reflects a diagnosis of continuous alcohol dependence and rule out bipolar disorder, manic type. Impressions of alcohol abuse were noted in March 1990 and May 1990 clinical records. A December 1990 discharge summary reflects relevant diagnoses of alcohol dependence in remission, alcohol hallucinations by history, and passive aggressive personality traits. In a November 1995 letter, the RO requested a detailed description of the in-service stressors claimed to result in PTSD. The veteran did not respond to the RO's letter. The RO sent a second letter to the veteran in April 1996 requesting the same information; however, the veteran failed to respond. A December 1996 VA clinical record reflects a relevant diagnosis of major depression versus substance abuse induced depression. Additional VA clinical records dated in 1996 reflect continued treatment for depression. VA clinical records dated in 1997 reflect relevant diagnoses of substance abuse in remission and organic affective disorder versus major depression versus bipolar disorder. An August 1997 evaluation report from a licensed clinical social worker reflects a history of the veteran's military service in Vietnam as well as a post-military history. The veteran reported being under rocket and mortar attacks several times a month during active service in Vietnam, participating in three enemy ambushes, exchanging fire, and witnessing supply trucks blow up around him. The veteran also reported being assigned to rebuild a salvage company after a massacre and encountering human blood and tissue in vehicles. It was also noted that the veteran was frequently involved in recovering the dead and wounded from combat. The veteran reported sleep disturbances, auditory hallucinations, and a recurring nightmare. The veteran also reported that he did not have any friends or belong to any churches, clubs or organizations. It was noted that the veteran avoided stimuli of Vietnam. Diagnoses of mild PTSD, recurrent major depressive disorder, and alcohol dependence in early full remission were noted. It was noted that the veteran had problems related to social environment and he isolated himself. At his August 1997 hearing before a member of the Board, the veteran stated that during his Vietnam service, he served with the 526 CC&S Company. The veteran also testified that a personal friend was killed on a mail run out of his unit in April or May 1968. (Transcript, page 6). The veteran also stated that he was rocketed or mortared about twice a month. (Transcript, page 7). In an August 1997 letter to the RO, the veteran noted some stressful events that occurred during his active service in Vietnam. The veteran reported being ambushed and subjected to mortar attacks, loading three hospital ships, and finding body parts in recovered vehicles. Upon VA mental examination dated in July 1998, the veteran reported hallucinatory experiences and admitted to having what he called transitory out of body experiences. The examiner noted that the veteran appeared to be obsessed with thoughts that everyone was out to get him. The veteran also reported intrusive recollections, usually involving refugee children. The veteran stated that the only person he trusted was his wife. Recent and remote memory was noted as intact, and the examiner noted the veteran had intellectual insight and judgment for simple social situations. The examiner noted that October 1997 psychological testing indicated the presence of some underlying psychotic process with paranoid ideation and some depressive features, supporting a diagnosis of schizoaffective disorder. The examiner noted relevant diagnoses of mixed schizoaffective disorder, chronic PTSD and polysubstance abuse in remission. The examiner opined that the veteran's schizoaffective disorder and PTSD could not be disentangled from one another. The examiner further opined that the schizoaffective disorder caused most of the veteran's dysfunction. A June 1998 VA social and industrial survey reflects that the veteran served with the 86th Battalion in "Charang" Valley for three months before he was transferred to the 526 CC&S Company at Phu Bai. The veteran reported having to clean up vehicles after an attack which killed 41 men. The veteran reported encountering the remains of fatally wounded soldiers. The veteran also stated that his base received incoming rounds nightly and he witnessed others die during combat recovery. The veteran also reported seeing piles of bodies that he believed were killed by Koreans. The veteran reported having no friends and very little contact with others. It was noted that the veteran worked at night irrigating a golf course. Difficulties sleeping were not noted. The veteran described himself as "mentally explosive." In a November 1998 rating decision, the RO granted entitlement to service connection for a mixed schizoaffective disorder, evaluated as 70 percent disabling, effective from October 1997. In a May 1999 rating decision, the RO granted entitlement to individual unemployability. Pertinent Law and Regulations Basic entitlement to disability compensation may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection connotes many factors but basically means that the facts, 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 C.F.R. § 3.303(a) (1999). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic disabilities, such as hypertension, will be presumed to be related to service if manifested to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309 (1999). The threshold question that must be resolved with regard to each claim is whether the veteran has presented evidence of a well-grounded claim. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78 (1990). A well-grounded claim is a plausible claim that is meritorious on its own or capable of substantiation. See Murphy, 1 Vet. App. at 81. An allegation of a disorder that is service-connected is not sufficient; the veteran must submit evidence in support of a claim that would "justify a belief by a fair and impartial individual that the claim is plausible." 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In order for a claim to be well grounded, there must be competent evidence of current disability; lay or medical evidence of incurrence or aggravation of a disease or injury in service; and competent medical evidence of a nexus between the in-service injury or disease and the current disability. Caluza v. Brown, 7 Vet. App. 498 (1995). Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Lay assertions of medical causation cannot constitute evidence sufficient to render a claim well grounded under 38 U.S.C.A. § 5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Analysis Following a careful review of the evidence of record, the Board concludes that service connection for PTSD is not warranted. The record is silent for competent medical evidence of a nexus between PTSD and an incident of service. Although the record reflects a diagnosis of PTSD, that disorder has not been related to any incident of the veteran's active service. Even on the assumption that the social worker is competent to provide a psychiatric diagnosis, her report of August 1997 failed to link PTSD with any degree of specificity to the veteran's military service. Likewise, the July 1998 psychiatric examiner did not associate PTSD to military service. It is true that each of these reports did describe events over many years of the veteran's lifetime which were of a stressful nature. The key consideration, however, is that no particular circumstance or series of circumstances of military service were declared causative of PTSD. The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") has made it clear that a lay party is not competent to provide probative evidence as to matters requiring expertise regarding specialized medical knowledge, skill, training, or education. Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1994). The Court has also held that the adequacy of a stressor is a medical conclusion for which the Board may not substitute its own judgment. See Cohen v. Brown, 10 Vet. App. 128, 147 (1997). Consequently, the veteran's lay assertion that PTSD was caused by active service is neither competent nor probative of the issue in question. While the veteran is competent to testify regarding the events that are alleged to have occurred during his active service, he is not competent to diagnose the etiology of his own condition. See Cromley v. Brown, 7 Vet. App. 376, 379 (1995); Boeck v. Brown, 6 Vet. App. 14, 16 (1993); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Fluker v. Brown, 5 Vet. App. 296, 299 (1993); Moray v. Brown, 5 Vet. App. 211, 214 (1993); Cox v. Brown, 5 Vet. App. 93-95 (1993); and Clarkson v. Brown, 4 Vet. App. 565, 657 (1993). In the absence of competent medical evidence of a nexus between PTSD and an incident of service, the claim is not well grounded and must be denied. ORDER The claim of entitlement to service connection for PTSD is denied. John E. Ormond, Jr. Member, Board of Veterans' Appeals