BVA9502472 DOCKET NO. 91-42 657 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for arthritis of multiple joints. 2. Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD P. M. Lynch, Associate Counsel INTRODUCTION The veteran's active military service extended from June 1964 to June 1967 and from December 1979 to May 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 1989 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia which denied service connection for generalized arthritis and an August 1990 rating decision which denied, in part, entitlement to service connection for generalized arthritis and for PTSD. The case was previously before the Board in May 1992 when it was remanded to give the veteran an opportunity to describe his alleged stressors for verification and to afford him a VA psychiatric examination, to include psychological testing. It is noted that the file contains a detailed psychological assessment dated in July 1990. The VA examiners in January and February 1994 determined that the case did not require additional psychological testing. In light of these medical opinions, the Board deems the necessary development to have been completed. The Board now proceeds with its review of the appeal. The Board also notes that a rating decision in May 1994 denied service connection for a skin condition diagnosed as tinea versicolor as a result of exposure to herbicides during service. There is no Notice of Disagreement of record with respect to this claim. Therefore, the issue is not currently before the Board. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO committed error in denying service connection for arthritis of multiple joints and for PTSD. He maintains that he has arthritis of multiple joints as the result of a service connected gunshot wound to his left foot. In particular, he avers that as a result of the gunshot wound to his left foot, he has developed arthritis in his left foot and leg which has spread into his hips, back and shoulders. He avers that his physicians have confirmed this diagnosis. He further argues that he has PTSD as the result of his service in Vietnam. Specifically, he maintains that he went on search and destroy missions lasting up to four weeks with little rest between missions; that his unit came under sniper attack and that he shot a sniper; that he had his rifle shot out of his hands causing him to almost lose a finger; that he was accidentally shot in the left foot by a fellow soldier; that he witnessed rotting and decomposing bodies; and that he had to bury bodies and gather up the wounded and body parts to be put onto a Medivac helicopter. As a result of these experiences, the veteran contends that he has recurring nightmares, insomnia, irritability, and frequent intrusive thoughts. 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 files. 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 veteran has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim for service connection for arthritis of multiple joints is well-grounded. It is also the decision of the Board that the preponderance of the evidence is against entitlement to service connection for PTSD. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's well-grounded PTSD claim. 2. Arthritis of multiple joints was not manifested during service or within the first post service year. 3. There is no medical opinion linking arthritis of multiple joints to the veteran's active military service. 4. Arthritis of any joint other than the left foot is not shown to be of service origin or otherwise related to active service. 5. The veteran does not have PTSD as a result of his active military service. CONCLUSIONS OF LAW 1. The veteran has not presented a well-grounded claim for service connection for arthritis of multiple joints. 38 U.S.C.A. § 101(16), 1101, 1110, 1112, 1131, 1137, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). 2. PTSD was not incurred in or aggravated by active military service. 38 U.S.C.A. §1110, 5107 (West 1991); 38 C.F.R. 3.304(f) (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Arthritis of Multiple Joints Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131, 1137 (West 1991). Service connection may also be granted for a disability which is proximately due to and the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1993). The veteran asserts that during service he suffered from a gunshot wound to his left foot. He contends that this service-connected injury caused residuals which include arthritis of multiple joints. A review of the service medical records indicate that in September 1966, the veteran sustained an accidentally self- inflicted gunshot wound to his left foot. However, the service medical records made during the period of service from June 1964 to June 1967 do not show any complaints, findings or diagnoses involving arthritis of the joints. Significantly, on his separation examination in June 1967, there were no complaints or findings relating to arthritis. The veteran rejoined active service in December 1979. Similarly, on entrance examination in October 1979, there were no complaints or findings of arthritis. At the medical board examination in January 1980, he was diagnosed as having arthritis of his left foot, secondary to the bullet wound, and thereafter discharged from service. Arthritis may be presumed to have been incurred during active military service if it is manifest to a degree of 10 percent within the first year following active service. 38 U.S.C.A. §§ 1101, 1112, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). The veteran underwent a VA examination in September 1980. The examiner reported that all joints, except for the left foot, moved through their full range of motion. On VA examination in September 1983, the veteran complained of a problem only with his left foot. There were no finding of arthritis of multiple joints. It was not until January 1989 that the veteran filed a claim for arthritis of multiple joints. He contended that the arthritis in his left foot had spread throughout his entire body and maintained that this diagnosis was confirmed by his physicians. A review of the post service medical records reveals that in December 1988 the veteran complained of arthritis of multiple joints, including his hips, back and shoulders. The examiner diagnosed osteoarthritis. The veteran also complained of arthritic pain in April 1989 and in July 1990. Significantly, there is no medical documentation or opinion of record relating the veteran's generalized osteoarthritis to the service connected gunshot wound or arthritis of his left foot. Pursuant to 38 U.S.C.A. § 5107(a) (West 1991), "a person who submits a claim for benefits under a law administered by the Secretary [of Veterans Affairs] shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded". A well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation." Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). Although the claim need not be conclusive, it must be accompanied by supporting evidence sufficient to justify a belief by a fair and impartial individual that the claim is plausible. See Tirpak v. Derwinski, 2 Vet.App. 609, 610 (1992). Franko v. Brown, 4 Vet.App. 502, 505 (1993). For the purposes of determining whether a claim is well-grounded, evidentiary assertions by the veteran must be accepted as true unless the assertions are inherently incredible. See King v. Brown, 5 Vet.App. 19 (1993). In this case, there is nothing in the service medical records which would indicate a plausible claim. There is no evidence that shows that arthritis of joints other than the left foot had its onset during service, was aggravated during service, or was manifested during the first post service year. Further, there is no credible evidence of continuity of symptomatology with respect to arthritis of multiple joints following service. The earliest medical reports dealing with arthritis of multiple joints are dated in December 1988. Regulations require continuity of symptomatology to link the post-service symptoms to injury during service. 38 C.F.R. 3.303(b) (1993). Significantly, contrary to the veteran's assertions there is no medical evidence of record establishing an etiological relationship between the service connected disability and the current disorder. See Montgomery v. Brown, 3 Vet.App. 343 (1993). The veteran has indicated that the residual arthritis in his left foot has spread throughout his entire body. The question of whether certain symptoms are residuals of a certain injury is a matter requiring medical expertise which the veteran does not have. The Board finds that his statements are not competent for the purpose of establishing the etiology of his current disorder. See Espiritu v. Derwinski, 2 Vet.App. 492 (1992). This claim is supported only by the veteran's unsworn statement without any credible evidentiary support. The Board has thoroughly reviewed the claims files. However, it finds no evidence of a plausible claim. Since the veteran has not met his burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded, it must be dismissed and the VA has no further duty to assist. 38 U.S.C.A. § 5107(a) (West 1991). II. PTSD The veteran's claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, he has presented a claim which is plausible. All relevant facts have been properly developed and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). To establish service connection for PTSD, the records must show that the criteria for that diagnosis are met. 38 C.F.R. § 4.125 (1993). Service connection for PTSD requires medical evidence establishing a clear 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, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. 38 C.F.R. § 3.304(f) (1993). In this case, there are diagnoses of PTSD by a physician and two psychologists at the VA outpatient clinic in Salem, Virginia. However, these diagnoses were subsequently refuted by a board of two VA psychiatrists who conducted the veteran's most recent psychiatric evaluation. Further, even if there was a confirmed diagnosis, there is no evidence of a qualifying stressor during service. Initially, we note that the service records are essentially against the claim. The veteran was deployed to Vietnam in late August 1966. He was assigned to Company B, 1st Battalion, 5th Cavalry, and served as a rifleman. He claimed that his squad went on search and destroy missions during which time he came under sniper attack. He further claimed that the unit would be out for three to four weeks at a time with only a few days back at base before going out on another mission. To the contrary, the service medical records indicate that the veteran suffered from a self-inflicted gunshot wound in mid-September 1966, only three weeks after he arrived in Vietnam. Following this incident, he was evacuated to Japan where he was hospitalized for several months. He returned to duty in mid-January 1967 as a security guard on the docks and was subsequently discharged from duty in June 1967. These documented events cast substantial doubt of the extensive combat service reported by the veteran. Of note, the service department has documented the combat service of the veteran's infantry unit before and after his brief service with it. A review of the record reveals that six days after his self-inflicted gunshot wound, his unit became involved in the Thayer I Movement, which was the forerunner of Irving AO. Therefore, the unit to which the veteran was assigned did in fact engage in an assault, but this assault took place after his hospitalization. He was not part of the unit during these activities. He was not awarded the Purple Heart, Combat Infantryman Badge, or any similar combat citation. Consequently, although he was a rifleman, there is strong evidence indicating that he was not actually involved in combat as he described. The service medical records for the veteran's first period of service are devoid of any complaints, symptoms or medical findings suggestive of a psychiatric disorder. His second period of service commenced in December 1979. On examination, he denied a history of frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. Similarly, at the medical board examination in January 1980, psychiatric findings were normal and he denied any psychiatric symptoms. 38 U.S.C.A. § 1110 (West 1991). Subsequent to service, the veteran was afforded a VA examination in September 1980. He made no reference to symptoms indicative of a psychiatric disorder. The psychiatric and personality description included that he was "apparently a good, hard working man who is planning to set himself up in a business because the work he did before required considerable standing". The first indication of any type of psychiatric treatment was approximately eight years later in December 1988. On examination, the veteran complained of depression, nervousness, and crying spells which were worse for the past month. Significantly, he stated that he could not relate these feelings to anything in particular. He denied any suicidal thoughts. He gave a history of hospitalization for a "nervous breakdown" two years earlier. Reportedly, this entailed a flashback of Vietnam while drinking and hunting with his brother. At present, he stated that he had occasional nightmares about Vietnam, but none recently. The examiner reported that his speech was logical and coherent. His mood was depressed with corresponding affect. He had no hallucinations or delusions. The examiner diagnosed major depression, recurrent with melancholia. He was subsequently seen at the Mental Hygiene Clinic in January 1989 and medication was prescribed. Thereafter, the veteran sought treatment in February 1990 requesting that his medication be refilled. He complained of "bad nerves", depression and poor sleep. He denied suicidal or homicidal ideation. The examiner diagnosed mild depression. The veteran attended regular therapy sessions at the VA outpatient clinic in Salem, Virginia from February 1990 to November 1990. A review of the record reveals that he also participated in group therapy in Cedar Bluff during this same time period. Throughout his treatment, he complained of numerous psychiatric symptoms, including depressive periods, nervousness, intrusive thoughts, difficulty concentrating, difficulty communicating, anxiety, irritability, apathy, insomnia, guilt feelings, and nightmares. In August 1990, he stated that he had dreams about Vietnam when he first returned from service, but such dreams were rare for years thereafter. He reported that the dreams increased after his "nervous breakdown". The earliest diagnosis of PTSD is found in a letter from a VA psychologist dated in May 1990. He reported that he had treated the veteran for several months and diagnosed him as having PTSD, severe, chronic. He also stated that due to the severity of the condition, the veteran quit his job which required that his spouse remain in the home to monitor him and provide for his needs. In June 1990, a social worker at a veteran's center provided a statement to the effect that the veteran had been participating in group therapy at the Vietnam Rap Support Group at Claypool Hill since February 1990. He stated that he seemed withdrawn and alienated, appeared to have a well developed sense of helplessness about his condition, and suffered from deep seated depression. He also stated that the veteran was unable to talk much or share his feelings with his combat peers about Vietnam combative experiences. The social worker suggested that there was a possibility that the events that he experienced may be too painful to discuss. He did not discuss the possibility that the veteran did not have any combat experience to talk about. Nor did he provide a diagnosis for the veteran, although he commented that he was currently in a support group designed to provide a forum for veterans with PTSD. The veteran provided a statement dated in June 1990 in which he described various stressors he experienced while in Vietnam. He stated that on one occasion his unit was pinned down by snipers. He reported that he shot a sniper whose body then became caught on a limb as he fell. He maintained that he continues to dream about this incident. He stated that he also dreamed of being in a field hospital looking for his body among the faces of the dead but was unable to find it. He further recounted an occasion when his unit was ambushed while on patrol. He stated that his rifle was shot out of his hands and his left index finger was cut down to the bone. A service medical record dated in September 1966 indicated that the veteran's left finger was lacerated by glass. Again, the records conflict with his assertions and cast further doubt on his credibility. The veteran underwent a psychological assessment in July 1990. His primary complaint was "My nerves, I get real depressed. I get upset, angry and shaky really easy". He described his recollection of going on search as destroy missions lasting up to four weeks in duration. As indicated above, he was hospitalized only three weeks after he arrived in Vietnam, and his unit's assault activities occurred after his hospitalization. He also stated that he was injured twice, once when his rifle was shot out of his hands, and a second time when he was accidentally shot by a fellow soldier trying to unjam his gun. He reported that half of his foot was blown away. Significantly, the service medical records indicate that the veteran sustained a self- inflicted gunshot wound to the foot, and that the laceration on his finger was caused by glass. He further stated that when he returned to duty in Saigon, he served as a security guard on the docks. He reported that he was subject to frequent incoming fire. He also and recounted several traumatic incidents, including seeing dead, wounded and burning bodies. He maintained that he buried bodies and gathered up the wounded and body parts to be put on the Medivac helicopter. None of the alleged stressors have been documented. The examiner stated that the veteran reported many symptoms of PTSD. He reported nervousness, feeling shaky inside and out, getting upset easily, restlessness, constant worrying, recurring nightmares, and insomnia. She also indicated that he reported symptoms of depression, including lack of interest, sadness, guilt over coming home when others did not, difficulty in making decisions, thoughts of death, waking up frightened and checking his house, feelings of detachment, and difficulty feeling and expressing affection. He reported that he was uncomfortable being around other people. He denied flashbacks of Vietnam but reported frequent intrusive thoughts. He stated that he was uncomfortable around deer hunters, camouflage, "the National Guard on the move", or blasting. Although he denied being bothered about movies about Vietnam, the examiner indicated that he was agitated and upset when he discussed the movie "Platoon". The examiner also stated that the veteran reported symptoms of obsessive-compulsive disorder, although his obsessive thoughts did not appear to be related to Vietnam as a rule. Psychological testing was also conducted. The examiner stated that the results suggested that the veteran had experienced serious psychological and emotional problems. No specific testing for PTSD was reported. He was diagnosed as having PTSD, obsessive-compulsive disorder, and episodic alcohol abuse. However, it is important to note that this diagnosis was based solely on subjective information provided by the veteran. His statements with respect to his experiences in Vietnam are uncorroborated by the evidence of record. In particular, the extensive exposure and gory stories described by the veteran are not consistent with his documented three weeks of service with an infantry unit. In addition, he told of being shot by a fellow soldier as a stressor. If this was in fact a traumatic stressor he would most likely have mentioned it before this time. This new story appears to be part of a pattern of continued fabrication and is not credible. Also of record is a letter dated in March 1991 from the veteran's outpatient psychiatrist at the VA Medical Center in Salem, Virginia. The psychiatrist stated that it was her opinion that the veteran's diagnosis of PTSD, severe, chronic, was quite accurate. She further stated that the veteran had no other known trauma in his life that would account for these PTSD symptoms, and that his symptoms reflect very directly his traumatic war experiences. This diagnosis, similarly, was based on the veteran's subjective complaints and recollections as described above. Pursuant to the Board's remand, the veteran submitted a description of his stressors during service. He reiterated his previous recollections and indicated that he was unable to remember specific names, dates and places. The veteran was subsequently examined by two VA psychiatrists, one in January 1994 and the other in February 1994. In January 1994, the veteran repeated the same history as given in past examinations. The examiner noted that he was unable to give any specific dates or involved personnel regarding the sniping incident which he stated was his most frequently recalled incident. He also noted that the veteran admitted that he had lied about the self-inflicted gunshot wound in order to protect a fellow soldier who accidentally shot him in the foot. However, he was unable to recall the name of the soldier, and in fact stated that he had no friends in service and could not explain why he engaged in such an altruistic act. He stated that he could not recall the last time he had a bad dream. During the interview, the examiner discussed Desert Storm with the veteran. He reported that the veteran stated that he had no interest in Desert Storm and did not admit to exacerbation in symptomatology while it was in progress. The examiner also noted that at the time the veteran had his "nervous breakdown", he was undergoing what he described as a very difficult divorce. On mental status examination, the examiner indicated that the veteran was alert, oriented, cooperative and pleasant. There was no acute distress. He was slightly anxious, though his mood was essentially euthymic. His affect was full and engaging. Psychomotor activity was calm and relaxed. He was neatly groomed and dressed; his speech displayed normal prosody; and his thought processes were goal directed and coherent. The examiner noted that he did not appear to become anxious when discussing incidents in Vietnam or any of his symptoms. It was also noted that he was quite vague about details. There was no evidence of delusions, hallucinations, elusions. Nor was there current homicidal or suicidal ideation. The examiner diagnosed the veteran as having major depression, recurrent, manifested by repeated episodes, each of more than two weeks in duration, of the development of depressed or irritable mood, insomnia, some psychomotor agitation, feelings of worthlessness, recurrent suicidal ideation without a plan not due to an organic factor, presently in remission. Significantly, the examiner concluded that there was not sufficient evidence of PTSD. He stated that although the veteran described symptoms that could be consistent with PTSD, particularly insomnia, disturbed sleep and easy irritability, these symptoms were also consistent with a diagnosis of major depression. It was noted that his first psychiatric symptoms occurred during a time of heavy alcohol use when undergoing significant psychosocial stressors, namely, divorce. The examiner also stated that the veteran had not undergone any clear traumatic events. Although he did sustain a self-inflicted gunshot wound, it did not occur in combat. Rather, it occurred at a time when his unit was likely preparing for combat. The examiner further stated that if the veteran had undergone such trauma as the gunshot wound and shooting of the sniper, he would be better able to recall the dates and individuals involved. Furthermore, the veteran did not convincingly display persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness. For example, he found that the Gulf War news reports were "boring". The examiner also noted that he was able to attain relationships with others. On examination in February 1994, the veteran complained of similar symptoms. As to avoiding particular activities, he could think of none other than that he disliked group therapy. He denied experiencing startle reactions and being particularly wary or paranoid. Similarly, he was unable to recall the specific details regarding his Vietnam experiences. With respect to the sniper incident, he stated "I don't think I shot the guy". The examiner concluded that there was insufficient evidence to establish a credible stressor in Vietnam to cause PTSD. Rather, the examiner stated that he may have sufficient symptoms of an affective condition to merit a diagnosis of major depression. In its analysis of all the evidence of record, the Board must assess the credibility of the veteran's statements, both oral and written, pursuant to his appeal. See O'Hare v. Derwinski. 1 Vet.App. 365 (1991) and Ferguson v. Derwinski, 1 Vet.App. 428 (1991). However, the Board is not required to accept every assertion made by the veteran pursuant to his appeal which is not substantiated by the evidence of record. See Smith v. Derwinski, 2 Vet.App 137 (1992) and Wood v. Derwinski, 1 Vet.App. 190 (1991). To support a diagnosis of PTSD, there must be credible supporting evidence that the claimed inservice stressor actually occurred. In this case, the information on the stressful events was provided by the veteran. An assessment of his credibility is necessary to determine if the diagnosis is adequately supported. As mentioned above, there are inconsistencies in his statements which amount to questionable credibility on his part. Of note, he has consistently been unable to recall details with respect to names, dates and locations in Vietnam; he has made false allegations with respect to the cause of his injuries; and his assertions with respect to the duration of his combat service are clearly bogus as they are contradicted by the service records. In fact, his statements are not supported by any records. Furthermore, the diagnoses of PTSD of record are based on his statements which were not credible. Notably, both psychiatrists at the time of the January and February 1994 examinations did not diagnose PTSD. These two examinations are the most extensive evaluations of record and are highly probative. Therefore, there is no adequately supported diagnosis of PTSD of record. In the absence of proof of a present disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet.App. 223 (1992). In conclusion, the lack of a present definitive diagnosis of PTSD, the lack of corroboration of a traumatic stressful event, and the veteran's inconsistent statements which impugn his credibility result in the clear preponderance of the evidence being against entitlement to service connection for PTSD. ORDER 1. The claim for entitlement to service connection for arthritis of multiple joints is dismissed. 2. The claim for entitlement to service connection for PTSD is denied. JAN DONSBACH 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.