Citation Nr: 0001078 Decision Date: 01/13/00 Archive Date: 01/27/00 DOCKET NO. 97-26 425 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, Puerto Rico THE ISSUE Entitlement to service connection for post traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Puerto Rico Public Advocate for Veterans Affairs WITNESSES AT HEARING ON APPEAL Appellant and Dr. J. Juarbe ATTORNEY FOR THE BOARD L. M. Barnard, Counsel INTRODUCTION The veteran served on active duty from March 1951 to December 1952. This appeal arose from a March 1997 rating decision of the San Juan, Puerto Rico, Department of Veterans Affairs (VA), Regional Office (RO), which denied entitlement to service connection for PTSD. In December 1997, the veteran and his physician testified at a personal hearing at the RO. FINDING OF FACT The veteran's diagnosed PTSD is not shown to have its origin in his military service. CONCLUSION OF LAW PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991); 38 C.F.R. § 3.304(f) (1999). REASONS AND BASES FOR FINDING AND CONCLUSION The veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim that is plausible. It is also found that all relevant facts have been properly developed. The record is devoid of any indication that there are other records available which should be obtained. Therefore, no further development is required in order to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Under the applicable criteria, service connection may be granted for a disability the result of disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). According to the applicable regulation, service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in- service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. If the evidence establishes that the veteran was a prisoner-of-war under the provisions of 38 C.F.R. § 3.1(y) and the claimed stressor is related to that prisoner-of-war experience, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (1999). The veteran's DD-214 indicated that he had been awarded the Combat Infantryman's Badge, the Korean Service Medal and the United Nations Service Medal. This document also indicated that he had received a flesh wound to the neck on September 21, 1952. Subsequent records also noted that he had received the Purple Heart. A private physician, J. Juarbe, submitted a statement in February 1996. According to the veteran, whenever he hears explosions he would throw himself to the floor. He also thinks that chipping hammers are machine guns and he hides when he sees or hears helicopters. He tended to seclude himself at home and reported that he "goes back" to Korea whenever he sees any Chinese. The veteran had also stated that he had recurrent nightmares of Korea and feelings of guilt about his inability to help wounded friends. The veteran was examined by VA in September 1996. He admitted that he had not had any psychiatric treatment since his discharge from service in December 1952. His chief complaint was of nightmares ever since he was wounded in Korea. He would think about his comrades in service who had been wounded; he felt guilty about not having been able to help them. He reported that he could tolerate loud noises and that the sound of a chipping hammer would transport him back to Korea. Because of his irritability, he was socially isolated. The objective examination found that he was alert and oriented in three spheres, with an anxious and depressed mood. His affect was constricted. Attention, concentration and memory were described as good. His speech was clear and coherent and he denied hallucinations. A diagnosis was deferred pending a review of the claims file. In February 1997, following review of the folder, the veteran was diagnosed with an anxiety disorder, not otherwise specified and rule out alcohol abuse. The veteran and Dr. Juarbe testified at a personal hearing in December 1997. Dr. Juarbe testified that he had examined the veteran twice, in September 1996 and December 1997. It was his opinion that the veteran met the criteria for a diagnosis of PTSD. He admitted that he had not treated the veteran prior to 1996, and it was conceded that the veteran had not sought any treatment for any psychiatric complaints between 1952 and 1996. The physician commented that the veteran had told him that he been assigned to stack dead bodies on Kelly Hill in order to collect their dog tags. These soldiers had reportedly been dead for at least three days. It was while carrying out this assignment that he was wounded. The veteran also testified about collecting the dog tags and recounted how he was wounded by sniper fire. He indicated that he suffered from insomnia, a bad temper, irritability, intolerance to strong noises, nightmares, and recollections of service experiences. He also noted that he did not socialize. The veteran was re-examined by VA on June 4, 1999. Again, it was noted that he had never had any psychiatric treatment. He claimed to have had nightmares involving helicopters and wounded people. He indicated that he had constant memories of his service. The objective examination found that he was alert, oriented in three spheres, pleasant and cooperative. His mood was slightly depressed and anxious and his affect was constricted. His attention, concentration and memory were good. His speech was clear and coherent and his judgment and insight were fair. The diagnoses were anxiety disorder, not otherwise specified; and alcohol abuse. The examiners stated that "[b]ased on the veteran's history, records, evaluation and psychological evaluation, the Board considers that the veteran does not fulfills (sic) the diagnostic criteria for post traumatic stress disorder." On June 28, 1999, he was evaluated by a VA psychologist. During this interview, the veteran described himself as very strict, irritable, explosive, tense and depressed. While he was tense during the interview, he was cooperative. He was oriented in three spheres and was anxious and depressed. His testing results showed a great deal of emotional turmoil, manifested by anxiety, tension and agitation. He displayed a high level of anxiety. After a careful review of the evidence of record, it is determined that that evidence does not support a finding of entitlement to service connection for PTSD. The veteran has established that he suffered an inservice stressor sufficient to result in PTSD. He was clearly engaged in combat with the enemy, as is evidenced by his Combat Infantryman's Badge and his Purple Heart award. However, this evidence does not establish an unequivocal diagnosis of PTSD. While the veteran has submitted an opinion from a private physician (who also testified at a personal hearing in the veteran's behalf) that his symptoms met the criteria for a diagnosis of PTSD, it is noted that this physician never saw the veteran prior to 1996. His opinion was not based upon a review of the claims folder, nor on the results of psychological testing. The two VA examinations, however, did include a review of the entire folder, as well as a psychological evaluation with proper testing. Therefore, it is found that greater weight will be afforded to the objective and extensive testing performed by VA. These two examinations failed to diagnosis PTSD; rather, both diagnosed an anxiety disorder. In fact, the examination conducted in June 1999 specifically found that the veteran's symptoms did not fulfill the diagnostic criteria for PTSD. Therefore, it is concluded that the preponderance of the evidence is against the veteran's claim for service connection for PTSD. ORDER Service connection for PTSD is denied. M. S. SIEGEL Acting Member, Board of Veterans' Appeals