Citation Nr: 0006162 Decision Date: 03/08/00 Archive Date: 03/17/00 DOCKET NO. 94-13 578 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to an increased rating for a thoracolumbar spine disorder, currently evaluated as 20 percent disabling. 2. Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Wm. Kenan Torrans, Associate Counsel INTRODUCTION The veteran served on active duty from May 1984 to October 1989. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois, which denied the veteran's claims for an evaluation in excess of 10 percent for his low back disorder and for service connection for PTSD. In March 1998, the Board remanded the case back to the RO for additional development. The requested development having been completed to the extent possible, the case has been returned to the Board for resolution. As a preliminary matter, the Board notes that the veteran had initially requested that he be afforded a personal hearing before a member of the Travel Board. However, all attempts to contact the veteran to schedule a time and place for his hearing or to otherwise clarify his request were unsuccessful. By a letter dated in December 1997, the veteran's service representative indicated that attempts to reach the veteran via telephone to clarify his request for a hearing were not successful; therefore, it was requested that the case be forwarded for appellate review. Accordingly, the Board will proceed with its review of the case at this time. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable resolution of the issues on appeal have been obtained by the RO. 2. The veteran's spine is not shown to be ankylosed, and his back disorder is productive of not more than slight-to- moderate limitation of motion, with objective evidence of pain on motion. 3. The veteran is not shown to have served on overseas duty or to have engaged in combat with any enemy during his period of active military service. 4. The veteran's currently diagnosed PTSD is not attributable to military service or to any verified or verifiable in-service stressor. CONCLUSIONS OF LAW 1. The criteria for entitlement to an evaluation in excess of 20 percent for the veteran's low back disorder have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1-4.14, 4.40, 4.45, 4.71a, Diagnostic Codes 5291, 5292, and 5295 (1999). 2. PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. §§ 3.301, 3.303, 3.304 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Increased Rating The preliminary question before the Board is whether the veteran has submitted a well-grounded claim within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), and if so, whether the VA has properly assisted him in the development of his claim. A mere allegation that a service-connected disability has become more severe is sufficient to establish a well-grounded claim for an increased rating. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App. 628, 632 (1992). Accordingly, the Board finds that the veteran has submitted a well-grounded claim. Once a claimant has submitted a well-grounded claim, the VA has a duty to assist him in developing facts which are pertinent to that claim. See 38 U.S.C.A. § 5107(a). The Board finds that all relevant facts have been properly developed, and that all evidence necessary for an equitable resolution of the issue on appeal has been obtained. The evidence includes the veteran's service medical records, records of treatment following service, reports of VA rating examinations, and statements made on the veteran's behalf in support of his claim. The Board is not aware of any additional evidence which is available in connection with the present appeal. Therefore, no further assistance to the veteran regarding the development of evidence is required. See 38 U.S.C.A. § 5107(a); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997). Disability evaluations are determined by evaluating the extent to which the veteran's service-connected disability affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.10 (1999). In addition, where entitlement to an increased rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In addition, disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examinations upon which ratings are based adequately portray the anatomical damage and the functional loss with respect to all these elements. The functional loss may be due to the absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. See 38 C.F.R. §§ 4.40, 4.45 (1999). Under DeLuca v. Brown, 8 Vet. App. 202, 206-7 (1995), the Board may consider granting a higher evaluation in cases in which functional loss due to pain is demonstrated. Historically, service connection for lumbosacral strain was granted by an August 1991 rating decision, and a 10 percent evaluation was initially assigned, effective from June 11, 1991. During the course of the veteran's appeal, his assigned disability rating was increased to 20 percent, effective from January 1, 1993, by an October 1999 rating decision. The veteran now contends, in substance, that the severity of his service-connected low back disorder warrants assignment of an evaluation in excess of 20 percent. He maintains that his symptoms include chronic and constant pain, and symptoms consistent with sciatic neuropathy. He asserts that he is unable to obtain or retain gainful employment due to his service-connected disability. The report of a VA rating examination dated in March 1992 shows that the veteran had no postural abnormalities. There were no fixed deformities, and the muscles of his back appeared normal with no spasm. He had forward flexion of 90 degrees, backward extension of 35 degrees, lateral flexion of 25 degrees, bilaterally, and rotation of 30 degrees to the right and to the left. There was no objective evidence of pain on motion, and no evidence of neurological involvement. The examiner concluded with a diagnosis of a history of low back pain. The X-ray results at that time showed normal lumbar lordosis, and vertebral alignment was otherwise normal. Disc interspaces were preserved and no arthritic changes were present. The X-ray examiner concluded with his diagnosis of a normal lumbar spine. VA treatment records dating from September 1989 through April 1993 show that the veteran was seen for complaints of low back pain during this period. At the time, he was taking Motrin for the pain, but no functional impairments were indicated. Contemporaneous clinical treatment records dating from April 1984 through June 1995 show that in May 1990, the veteran sustained what was characterized as a low to mid-back strain in a work-related accident. X-rays taken at that time showed a normal lumbar and thoracic spine. In addition, MRI and X-rays taken in April 1992 showed that the veteran had no abnormalities in his lumbar or thoracic spine. In July 1994, the veteran sustained an injury to his upper back in the cervical spine or neck area. At the time of the injury, his thoracic spine was not shown to have any defects. The veteran underwent a VA rating examination in July 1993. He gave a history of having sustained a low back injury following a vehicle accident in service, and that he continued to experience intermittent numbness radiating from his lower back into his lower extremities. Such numbness would recur on heavy lifting. The veteran reported experiencing difficulty in sitting for extended periods, and that he experienced continuous pain, particularly on lifting anything. In addition, the veteran indicated that while walking did not present any real difficulty, he was unable to run. On examination, there was no evidence of any neurological deficit, and the veteran was found to have full muscle strength. The veteran was found to have loss of forward flexion to an unspecified degree, and experienced pain on both flexion and extension. Left and right lateral flexion were both limited, and a total arc in each plane of less than 45 degrees was observed. X-ray results showed the veteran to have what were characterized as "probable old compression versus burst fractures" at T-9, T-10, and T-11. A diffuse mild to moderate osteoarthritic change was noted between those levels. X-ray results showed the lumbar spine to be within normal limits. The examiner concluded with a diagnosis of diffuse mild to moderate osteoarthritc post- traumatic changes at the lower thoracic spine. Pursuant to the Board's March 1998 Remand Order, the veteran underwent an additional VA rating examination in November 1998. The report of that examination shows that the veteran reported having been involved in a vehicle accident and three helicopter crashes. The veteran reported experiencing constant pain which was worse in the thoracic area. The veteran indicated that he took Motrin, Tylenol, and other prescription pain medication provided by family members when he experienced flare-ups of pain. The veteran further indicated that his pain was concentrated in the thoracic area, and that his flare-ups were precipitated by standing, sitting, walking, lifting, or any other activity. According to the veteran, there were no alleviating factors. The veteran stated that he was unemployed due to his service- connected back disability. He indicated that he performed all of his housework, and attended to his basic needs including cooking and cleaning. On examination, the veteran had 70 degrees of forward flexion with pain. Rotation to the left was 25 degrees, and to the right was 20 degrees with pain. In addition, the veteran had lateral flexion to the left of 25 degrees, and to the right to 20 degrees accompanied by complaints of pain. The veteran complained of pain and tenderness in his back, but no muscle spasms were noted. No postural or fixed deformities were noted, and musculature of the back was within normal limits. The veteran did not show any deep tendon reflexes, and had pain in the lower back with leg raises. He stated that his inability to exercise caused him to have depression. The examiner concluded with a diagnosis of chronic back pain, and limited range of motion of the spine and a normal thoracic spine per X-ray. The X-ray report showed that the veteran had minimal hypertrophic spurring involving the anterior margins of a few of the middle and lower thoracic vertebral bodies. Normal height, alignment, and kyphotic curvature of the vertebral bodies were maintained. Intervertebral disc spaces were of average width, and there was no evidence of fracture, dislocation, or other significant abnormality. The Board observes that the evidence does not show the veteran's spine to be ankylosed, and his service-connected low back disorder is properly evaluated under those diagnostic codes addressing limitation of motion of the thoracic and lumbar spine. Under 38 C.F.R. § 4.71a, Diagnostic Code 5291 (1999), a 10 percent evaluation is warranted for moderate or severe limitation of the dorsal (thoracic) spine. Under Diagnostic Code 5292, a showing of slight limitation of motion of the lumbar spine warrants assignment of a 10 percent evaluation. A 20 percent evaluation is contemplated for moderate limitation of motion, and a showing of severe limitation of motion warrants assignment of a 40 percent evaluation, the highest rating available under Diagnostic Code 5292. Id. Under 38 C.F.R. § 4.71a, Diagnostic Code 5293 (1999), mild symptoms of intervertebral disc syndrome warrant assignment of a 10 percent disability evaluation. Where there are moderate, recurring attacks of intervertebral disc syndrome, a 20 percent evaluation is contemplated. A 40 percent evaluation is warranted where there are severe recurring attacks with intermittent relief. For assignment of a 60 percent evaluation, pronounced symptomatology must be shown, including persistent symptoms compatible with sciatic neuropathy with characteristic pain and demonstrable muscle spasm, absent ankle jerk, or other neurological findings appropriate to the site of the diseased disc, with little intermittent relief. Under Diagnostic Code 5293, a 60 percent evaluation is the highest rating available. Id. Under 38 C.F.R. § 4.71a, Diagnostic Code 5295, a 10 percent evaluation is contemplated for lumbosacral strain with characteristic pain on motion. For assignment of a 20 percent evaluation, there must be a showing of muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in the standing position. Under Diagnostic Code 5295, a 40 percent evaluation is the highest rating available. Assignment of a 40 percent evaluation is contemplated for severe lumbosacral strain with listing of the whole spine to the opposite side, positive Goldthwaite's sign, marked limitation of forward bending in the standing position, loss of lateral motion with osteoarthritic changes, or narrowing or irregularity of joint space, or some of the above with abnormal mobility on forced motion. Id. Applying the objective medical evidence to the applicable diagnostic criteria, the Board concludes that the currently assigned 20 percent evaluation is appropriate, and that the preponderance of the evidence is against assignment of an evaluation in excess of 20 percent under any diagnostic code. The veteran appears to contend that his service-connected low back disorder is completely debilitating. However, the objective medical evidence fails to disclose an overall disability picture to the degree of severity he has indicated. An early VA rating examination conducted in March 1992 failed to show that the veteran had any limitation of motion, neuropathy, objective evidence of painful motion, or any other functional impairment. The veteran sustained intercurrent back injuries in May 1990 and in July 1994, but these injuries, while causing short-term difficulties, were not shown to have resulted in any permanent aggravation of the veteran's service-connected back disorder. MRI and X-ray results of April 1992 showed a completely normal thoracic and lumbar spine. In any event, in subsequent VA rating examinations of March 1993 and July 1998, the veteran complained of experiencing symptomatology consistent with sciatic neuropathy. However, neither examination disclosed any such symptoms, and the veteran was found to have a normal lumbar spine. The Board also notes that in March 1993, the veteran was found to have degenerative changes or other irregularities in his lower thoracic spine, but such abnormalities were not found in the subsequent July 1998 rating examination. The veteran was shown to have a limited range of motion in his lumbar spine in both the 1993 and 1998 rating examinations, but his range of motion was not measured in degrees at the time of the March 1993 examination. In July 1998, the veteran was shown to have approximately a 25-degree loss of motion on forward flexion, and a 10 to 15 degree loss of motion on rotation. There was also objective evidence of pain on motion. The Board considers the veteran's loss of motion in his lumbar spine to be from slight to moderate, and taking the effects of pain on motion into consideration, finds that a 20 percent evaluation under Diagnostic Code 5292 to be appropriate. In addition, the Board finds that the veteran is not shown to have intervertebral disc syndrome. After reviewing the evidence, and in particular, taking the effects of functional limitation due to pain into consideration, the Board concludes that the veteran's symptomatology is most consistent with muscle spasm on extreme forward bending, with loss of lateral spine motion, unilateral, in the standing position. Under the applicable criteria of Diagnostic Code 5295, a 20 percent evaluation is contemplated for such symptomatology. In this regard, the Board recognizes that the veteran has expressly been found not to experience any muscle spasm, and that his functional impairment primarily involves some limited motion in the lumbar spine due to pain. Even so, given that he has been found to experience limitation of motion due to pain, the Board finds that his symptomatology most nearly approximates the criteria for assignment of a 20 percent evaluation under Diagnostic Code 5295. See generally 38 C.F.R. §§ 4.40, 4.45; DeLuca, supra. The Board further acknowledges the veteran's contentions regarding the alleged debilitating nature of his back disability. However, as noted, the objective medical evidence fails to disclose an overall disability picture to that degree of severity. In the absence of objective medical evidence showing that the veteran is unable to function or that he experiences what could be reasonably characterized as severe functional impairment due to his back disability, his claim for entitlement to an evaluation in excess of 20 percent for a back disorder must be denied. The potential application of Title 38 of the Code of Federal Regulations (1999) has also been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1999). The Board has carefully considered the evidence presented, and the veteran's contentions, but finds that there is no showing that the disability under consideration, a back disorder, has necessitated frequent (or any) periods of hospitalization, or has markedly interfered with employment, or otherwise renders impracticable the application of the regular schedular standards. The Board recognizes that the veteran is presently unemployed, and has been so unemployed for an extended period. However, his unemployment has not been shown to have been the result of his service-connected low back disorder. In this regard, the Board observes that while the veteran has maintained that he is more or less completely debilitated as a result of his low back disorder, he is shown, through his own statements to that effect, to be able to perform his normal household duties including cooking, cleaning, and other activities of daily living. Moreover, the Board observes that the applicable diagnostic criteria encompass a full range of ratings on a schedular basis, which contemplate varying degrees of severity of back disorders. The severity of the veteran's back disorder is not found to warrant assignment of a disability evaluation in excess of 20 percent on a schedular basis, and is likewise not found to warrant assignment of a disability rating on an extraschedular basis. The Board finds, therefore, that the evidence fails to show that the veteran is incapable of obtaining or retaining gainful employment as a result of his back disorder. Therefore, in the absence of factors suggestive of an unusual disability picture, further development in keeping with the procedural actions outlined in 38 C.F.R. § 3.321(b)(1) (1999) is not warranted here. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). As the preponderance of the evidence is against the veteran's claim, the benefit of the doubt doctrine is not applicable, and the claim for entitlement to an evaluation in excess of 20 percent for the veteran's back disorder is denied. See 38 U.S.C.A. § 5107(b) (West 1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Should the veteran's disability picture change, he may apply at any time for an increase in his assigned disability rating. See 38 C.F.R. § 4.1. At present, however, the Board finds no basis upon which to grant a disability rating in excess of 20 percent for the veteran's low back disorder. II. Service Connection As a preliminary matter, the Board finds that the veteran's claim for service connection for PTSD is plausible and capable of substantiation. It is therefore well grounded within the meaning of 38 U.S.C.A. § 5107(a). As a result, the VA has a duty to assist the veteran in developing facts which are pertinent to the claim. See 38 U.S.C.A. § 5107(a). As will be discussed, the Board finds that all relevant facts have been properly developed and that no further action by the VA is warranted. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Service connection for PTSD requires a showing of three elements. First, there must be medical evidence establishing a diagnosis of PTSD. Second, there must be credible supporting evidence that the claimed in-service stressor actually occurred. Third, there must be a link, established by the medical evidence, between current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f) (1999); Cohen v. Brown, 10 Vet. App. 128, 137 (1997). In adjudicating a claim for service connection for PTSD, the Board is required to evaluate the supporting evidence in light of the places, types, and circumstances of service, as evidenced by the veteran's military records, and all pertinent medical and lay evidence. See 38 U.S.C.A. § 1154(a) (West 1991); 38 C.F.R. § 3.304(f); Hayes v. Brown, 5 Vet. App. 60, 66 (1993). The evidence necessary to establish the occurrence of a stressor during service to support a claim of entitlement to service connection for PTSD will vary depending on whether or not the veteran was "engaged in combat with the enemy." Id. If the VA determines that the veteran engaged in combat with the enemy and that his alleged stressor is combat related, then the veteran's lay testimony or statements are accepted as conclusive evidence of the occurrence of the claimed stressor, and no further development or corroborative evidence is required. This is provided that such testimony is found to be "satisfactory," i.e., credible and "consistent with the circumstances, conditions, or hardships of service." See 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. § 3.304(f); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). In a recent opinion, the General Counsel stated that the term "combat" is defined to mean a "fight, encounter, or contest between individuals or groups" and "actual fighting engagement of military forces." VAOPGPREC 12-99 (October 1999) citing Webster's Third New Int'l Dictionary at 452 (1981). That opinion further states that the phrase "engaged in combat with the enemy" requires that the veteran "have personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality." VAOPGPREC 12-99. If, however, the VA determines either that the veteran did not engage in combat with the enemy or that the veteran did engage in combat, but that the alleged stressor is not combat related, the veteran's lay testimony by itself is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain service records or other evidence to corroborate the veteran's testimony or statements. See Moreau v Brown, 9 Vet. App. 389 (1996). In the present case, the veteran maintains that he was subjected to abuse by his drill instructors during basic training, and that he was the target of various forms of abuse by his superiors after sustaining a back injury in 1985. In addition, he told a VA examiner, in July 1993, that he had served in Grenada, Panama, and Beirut, and that he had been involved in three helicopter crashes. At that time, the veteran reported that he had witnessed many people killed and wounded. He presently contends that the trauma induced by experiencing these events resulted in his PTSD. In addition, the veteran has submitted statements indicating that he was involuntarily admitted for psychiatric treatment, and subject to further abuse shortly before his discharge from the Marine Corps in October 1989. A review of the veteran's service personnel and service medical records fails to show that he served on any overseas or sea duty. The veteran's Form DD-214 indicates that he spent 0 years, 0 months, and 0 days on foreign or sea duty. His service personnel and service medical records show that he served in various capacities in San Diego, California, Camp Lejeune, North Carolina, Norfolk Virginia, and at Dam Neck Annex in Virginia Beach, Virginia. None of his records indicate or otherwise suggest any duty in Beirut, Lebanon, the island of Grenada, or Panama. Moreover, the service medical and service personnel records fail to make any mention of any alleged helicopter crashes. The incident concerning the 1985 motor vehicle accident is well documented and is not in dispute. Even so, the record does not disclose any instances of abuse either at the hands of the veteran's drill instructor or by any of his superiors. The veteran's service medical records also do not reflect any in-service psychiatric treatment, and the report of his service separation examination does not indicate or suggest the presence of any psychiatric disorder. The record does show that in September 1989, while awaiting discharge from the Marine Corps, the veteran was admitted to a VA psychiatric ward for treatment. At the time, he complained of feeling suicidal over the breakup of his marriage. His marriage was noted to have been failing over the past two months, and episodes of domestic violence were involved. The veteran requested treatment for his outbursts of temper. The treatment record shows that the veteran was still on active duty status at the time, and that he was released into military custody in less than 24 hours. The record shows that he was discharged without medication to Scott Air Force Base escorted by corpsmen. The treating physician concluded with a diagnosis of adjustment disorder with a disturbance of conduct. As noted above, the service medical records do not include any indication of in-service psychiatric treatment. Post-service medical treatment records show the first treatment for a psychiatric disorder in August 1992, approximately three years after the veteran was discharged from service. At that time, the veteran was found to be suffering from depression following the breakup of a relationship with his girlfriend. The treatment note indicated that the veteran was experiencing difficulty in dealing with his emotional problems, and noted that he had served in the Marine Corps for seven years. However, there was no suggestion in the treatment record of service incurrence of any psychiatric disorder, and no indication of any PTSD. Additional VA clinical treatment records dated in September 1992 show that the veteran was seen on an outpatient basis for emotional outbursts and for symptoms of depression. A letter dated in April 1993 was received from Mary Ann Allen, Case Manager for the Community Resource Center. She stated that the veteran was seen on an outpatient basis for depression and suicidal ideation. The veteran had reported symptoms including being very angry and having a bad temper. Ms. Allen stated that the veteran was seen in January 1993, and the intake person found him to have been suffering from flashbacks, outbursts of temper, moodiness, and distrust. The veteran reported that he had been hospitalized for PTSD. However, Ms. Allen stated that the veteran failed to report for follow-up appointments. The veteran underwent a VA rating examination in July 1993. The report of that examination shows that the veteran reported that over the past several years, he had experienced problems with temper outbursts, fighting, depression, and flashbacks. He reported to the examiner that he had been involved in two helicopter crashes, and had been stationed in Grenada, Panama, and Beirut. He also stated that he had been involved in a "combat" motor vehicle accident in 1985, sustaining a back injury. According to the veteran, he began experiencing problems with temper outbursts in 1988. In addition, he reported that he had been arrested for desertion from the military in August 1989, that he had been taken to the Jefferson Barracks VA Medical Center (VAMC) for a week of psychiatric treatment, and that he was subsequently transferred to Wright Patterson Air Force Base Hospital for another week before being discharged in October 1989. The veteran reported experiencing several symptoms the examiner found to be indicative of PTSD. Such symptoms included flashbacks of military experience, startle response to loud noises, and hypervigilance. He denied having nightmares, and indicated that he had no friends, avoided crowds, and had little social life. The examiner noted that the veteran reported having been followed by several psychiatrists and that he had been treated with Prozac and Thorazine. The veteran further indicated that he did not work due to his psychiatric and back problems, and that his wife worked to support his family. He indicated that he had a problem with alcohol between ages 26 and 27, but that he had not experienced symptoms associated with withdrawal. The veteran did not report that he had experienced any abuse at the hands of his drill instructors or other Marine Corps superiors during his tour of duty. On examination, the veteran was found to be well groomed and dressed. He was alert and oriented, but had a dysphoric mood and blunted affect. The veteran maintained good eye contact and had normal psychomotor activity. His speech was slow and somewhat monotone but otherwise goal directed. The veteran denied experiencing psychotic symptoms, but admitted to "multiple depressive symptoms." He reported no current suicidal or homicidal ideation, and his insight and judgment were characterized as fair. The examiner concluded with diagnoses of Axis I PTSD, intermittent explosive disorder, and probable dysthymia. A letter dated in June 1995 was received from Carol R. Volkers, M.A., Counselor at the Schuyler Counseling and Health Services Center. Ms. Volkers stated that the veteran referred himself for outpatient counseling beginning in November 1993. According to Ms. Volkers, the veteran's stated goal was to win back his estranged wife by seeking treatment for domestic violence through working on stress management and anger control. He was not allowed contact with his wife due to a court restraining order. Ms. Volkers indicated that the veteran was seen for four counseling sessions over a two-week period. During that time, Ms. Volkers stated that the veteran "revealed little insight into his problems, blaming his problems on his wife's behavior." She indicated that psychiatric test results showed his depression range to be severe. After two weeks, the veteran requested a verification letter to present to the court, and afterwards failed to attend further treatment sessions. Due to his failure to continue treatment, the veteran was removed from the waiting list to see a psychiatrist. Given that the veteran was diagnosed with PTSD in July 1993, the Board remanded the case back to the RO for additional development in March 1998. Specifically, the RO was directed to contact the veteran, and to obtain a statement as to the specifics of any stressors relating to PTSD he was alleging. Upon receipt of this statement, the RO was to refer the pertinent information to the United States Armed Services Center for Research of Unit Records (USASCRUR) to obtain verification of the claimed stressors. In the event that the veteran's stressors could be verified, he was to be scheduled to undergo a VA psychiatric rating examination to determine the nature and extent of any PTSD, limited to those verified stressors. Pursuant to the Board's directive, by letter of March 1998, the RO again requested that the veteran provide a detailed account of his alleged stressors. The letter was organized in a questionnaire format, which would enable the veteran to submit detailed responses to questions necessary to elicit information required to verify his claimed stressors. Similar letters had been sent to the veteran shortly after he had filed his claim for service connection for PTSD. However, while the veteran was able to report to the scheduled VA rating examination to evaluate his low back disorder in November 1998, and made inquiries as to the status of his claim in June 1999, he failed to respond to the RO's letter requesting information regarding his purported stressors. Given that the veteran failed to provide any information regarding his purported stressors which was capable of being verified, his information was not referred to USASCRUR for verification, and he was not scheduled to undergo any additional VA psychiatric rating examinations. The RO nonetheless was able to obtain copies of the veteran's service personnel records from the National Personnel Records Service Center (NPRC) in St. Louis, Missouri. As noted above, the records show that the veteran served in various capacities at the San Diego Recruit Training Depot, California, Camp Lejeune Marine Corps Base in North Carolina, at the Norfolk Naval Station in Norfolk, Virginia, and at the Dam Neck Annex to the Oceana Master Naval Jet Base in Virginia Beach, Virginia. None of the service personnel records indicated any overseas or foreign service, or indicated that the veteran had served on sea duty while in the Marine Corps. The Board emphasizes that the veteran's diagnosis of PTSD was based solely on his self-reported history of in-service stressors while stationed in the Marine Corps. He reported serving in Beirut, Panama, and Grenada, but as noted, such claimed foreign service is directly contraindicated by his service personnel and service medical records. The record shows that the veteran entered active duty in May 1984, and was discharged in October 1989. The Board takes judicial notice of the fact that the United States invasion of the island nation of Grenada took place in October and November 1983. The United States deployment to Beirut, Lebanon, took place from August 1982 through February 1984, and the Marine barracks in Beirut was destroyed in October 1983. Further, the Board observes that Operation Just Cause, the United States invasion of Panama, took place from December 1989 through January 1990. It appears then, that the operations involving Beirut and Grenada took place before the veteran entered the Marine Corps in May 1984. The military operations in Panama took place one month after the veteran's discharge from service in October 1989. Under the circumstances, the Board finds the credibility of the veteran to be highly suspect. Likewise, the Board finds that the veteran's assertions that he either witnessed or was involved in two or three helicopter crashes during his active service are without any factual support in the record. The veteran was offered multiple opportunities to provide relevant information that could lead to confirmation of his purported stressors, but he failed to do so. The Board finds that the July 1993 diagnosis of PTSD is based upon invalid stressor accounts, namely duty in Panama, Grenada, and Beirut, in addition to witnessing carnage from multiple helicopter crashes. Here the evidence fails to show that the veteran or any close friend or relative encountered any sort of a life-threatening situation. Such premises are not supported by the evidence of record and, therefore, such diagnosis cannot be valid, given the faulty premises upon which it is based. The Board also notes that the veteran has maintained that he suffers from PTSD as a result of constant harassment and abuse at the hands of his drill instructors in basic training and by his superiors while on active duty. However, he has presented no medical evidence to this effect, and the examiner who offered the diagnosis of PTSD in July 1993 did not relate that diagnosis to any purported abuse by superiors while in service. In addition, the veteran has offered no evidence to suggest that such abuse did, in fact, occur. With respect to the veteran's failure to provide the requested stressor information, the Board notes that the VA's duty to assist a claimant is not a one-way street. The veteran also has the obligation to assist in the adjudication of his claim. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The veteran must be prepared to meet his obligations by cooperating with the VA's efforts in securing medical and other evidence by submitting to the Secretary all evidence and information he may otherwise possess supporting his claim. Such cooperation necessarily includes providing information necessary for verification of claimed stressors when such information is requested. Otherwise, the veteran should be prepared to offer some sort of explanation as to why such cooperation was not possible. See generally Olson v. Principi, 3 Vet. App. 480 (1992); see also 38 C.F.R. § 3.321 (1999). In this case, the veteran has been in contact with the RO following its request for stressor- related information, and had even reported for a VA physical examination. However, he failed to provide the requested information or to offer any explanation as to why such information was not forthcoming. The Board acknowledges that the veteran was seen at a VA hospital for what was diagnosed as an adjustment disorder with disturbance of conduct in September 1989, approximately one month prior to his discharge from service in October 1989. However, contrary to his assertions of being seen on an involuntary inpatient basis for one week at the VAMC, the treatment record shows that the veteran sought treatment on his own initiative for domestic and emotional problems, and that he was discharged into military custody within 24 hours of his admission. His service medical records, however, do not show any treatment for a psychiatric disorder. As set forth in the Diagnostic and Statistical Manual, Fourth Edition, (DSM-IV), "adjustment disorders" do not meet the criteria for an Axis I diagnosis, and are not considered to be chronic psychiatric disorders. Rather, they may either be developmental in nature, or acute. In any event, the adjustment disorder with which the veteran was diagnosed in service is not considered to be a disability under 38 C.F.R. § 3.303 for which service connection may be granted. Here, the veteran was not diagnosed with depression until August or September 1992, some three years after separation from active duty. The Board observes that this diagnosis was not rendered within any presumptive period for establishing a basis for service connection. In addition, there is no medical opinion of record establishing a nexus or link between the diagnosed depression and the veteran's active service. Accordingly, the Board finds that the evidence does not support a grant of service connection for depression. In conclusion, as the veteran has failed to produce any credible supporting evidence or information that his claimed stressors actually occurred, the Board finds that the preponderance of the evidence is against his claim of entitlement to service connection for PTSD. While the veteran may well believe that he has PTSD which is related to service, as a layperson lacking in medical training or expertise, he is not qualified to address questions requiring an expert medical opinion, including medical diagnoses or opinions as to medical etiology. See Moray v. Brown, 5 Vet. App. 211 (1993); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Hence, the veteran's claim for entitlement to service connection for PTSD must be denied. Because the Board's decision to deny service connection for PTSD is based upon the absence of credible supporting evidence confirming the existence of his claimed stressors, even without regard to its sufficiency, it would not be changed by application of the criteria adopted under DSM-IV. Accordingly, the Board finds that the veteran is not prejudiced by its rendering of a decision on this issue, and there is no requirement to remand this case to the RO for additional consideration. ORDER Entitlement to assignment of an evaluation in excess of 20 percent for a thoracolumbar spine disorder is denied. Entitlement to service connection for PTSD is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals