BVA9502313 DOCKET NO. 90-30 799 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: AMVETS WITNESSES AT HEARINGS ON APPEAL Appellant and appellant's son ATTORNEY FOR THE BOARD Nadine W. Benjamin, Counsel INTRODUCTION The veteran served on active duty from December 1967 to January 1969. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 1988 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. In May 1985, the Board denied service connection for a psychiatric disorder, including post-traumatic stress disorder (PTSD). The veteran has since that time continued to submit evidence to reopen his claim. In October 1988, the RO found that no new and material evidence had been received to reopen the veteran's claim. In July 1991, the Board remanded the claim to the RO, and on remand, the RO was requested to schedule the veteran for a VA psychiatric examination. The case was returned to the Board in August 1992. In January 1993, the Board again remanded the case to the RO for additional development. In June 1994, the RO determined that new and material evidence had been received, and the veteran's claim was reopened. After a de novo review, the RO denied service connection for PTSD. In March 1991, in connection with the instant appeal, the veteran testified before two members of the Board who are no longer employed at the Board. However, in light of the decision that follows, it is determined that no further hearing opportunity need be accorded the veteran. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection is warranted for PTSD, which he argues was incurred in service. He states that he has been treated for PTSD for many years and that he experienced several stressful situations during service which caused his current symptoms, which include nightmares, nervousness, social isolation and suicidal 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 file. 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 evidence is at least in equipoise and thus, with resolution of reasonable doubt in the veteran's favor supports a finding that service connection is warranted for PTSD. FINDINGS OF FACT 1. All relevant evidence necessary for the equitable dissolution of the veteran's claim has been obtained by the RO. 2. The veteran has PTSD related to service. CONCLUSION OF LAW PTSD was incurred as a result of active service. 38 U.S.C.A. § § 1110, 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board initially finds that the veteran has submitted a well grounded claim, meaning that the claim is not implausible. 38 U.S.C.A. § 5107(a) (West 1991). The Board further finds that the evidence of record is adequate to make a fair determination in this case and that there is no further duty to assist him as mandated by 38 U.S.C.A. § 5107(a). Service connection may be granted for a disease or injury incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110. A review of the record shows that the veteran served in the United States Army as a heavy vehicle driver, and that he was awarded the National Defense Service Medal, the Vietnam Service Medal and the Republic of Vietnam Campaign Medal. He served in Vietnam from June 1968 to July 1969. The veteran did not receive any awards or decorations specifically related to combat. Service medical records do not show complaints or findings of psychiatric disability. VA and private medical records show that the veteran was treated in the early 1980's, for complaints of nervousness, depression and sleep problems. Medication was prescribed. When he was examined by VA in June 1980, hyperventilation syndrome of unknown etiology, was diagnosed. In an April 1984 letter to VA, the veteran's wife reported stressful situations which her husband had encountered during service in Vietnam. She stated that he had seen Vietnamese prisoners who had been wounded and maimed. She also reported that the veteran had been shot at making deliveries, and that on one occasion he had witnessed the collapse of a bridge onto people below. It was also stated that on one night, an ammunition dump was blown up, and a Lieutenant and his driver were burned in a Jeep. She stated that the veteran also had to identify a friend of his and saw bodies in bags at the morgue. She said that the veteran reported being fired at when he went to pick up a Lieutenant from the Officers Club. When the veteran was examined by VA in May 1984, he complained of depression, sadness and sleep problems. It was reported that he was taking Limbitrol and Sinequan. He recalled experiences in Vietnam which included an incident when an army dump blew up and two men in a Jeep nearby were incinerated. He reported having to visit a morgue to identify a body. He also reported having to drive his company commander through potentially dangerous country at night. Dysthymic disorder was diagnosed, and the examiner noted that the veteran's service in Vietnam did not appear to have been as stressful as that reported by many veterans, and that he showed only some of the features of PTSD. In a September 1985 letter, Rashmi Kumar, M.D. reported that she had been treating the veteran since June 1985 with psychotherapy and medications, and that the veteran had denied any psychiatric symptoms prior to his return from Vietnam. It was opined that the veteran's current symptoms suggested that he suffered from panic attacks, depression, nervousness, temper outbursts and agoraphobia, all secondary to PTSD secondary to his Vietnam experiences. In a February 1986 letter, Dr. Kumar reported that, in her opinion, the veteran's psychiatric history clearly reflected that his psychiatric symptoms began in Vietnam and worsened after discharge. It was reported that after the veteran's return from Vietnam, he experienced temper outbursts, irritability, insomnia, nightmares about his war experiences, flashbacks, seclusive and paranoid behavior, nervous diarrhea and neurodermatitis. Periods of hyperventilation were reported, and it was noted that he was often suicidal and constantly depressed. It was pointed out that after service, the veteran was treated by a family physician with medication until the physician died in 1981 or 1982. The veteran was reported to then have begun treatment at a VA facility. In November 1986, VA received two lay statements concerning the veteran's claim. His mother reported that prior to service the veteran had no nervous problems, but that after his return from Vietnam, he had changed. An acquaintance of the veteran also wrote that the veteran was not nervous prior to going to Vietnam, but that after service, the veteran's personality had changed and that he was not the same person he had been before service. Dr. Kumar reported in an April 1987 letter that she was continuing to treat the veteran with psychotherapy and medications. She noted that his symptoms of PTSD continued to exist, and included intense depression, flashbacks, nervousness, seclusive behavior, lack of confidence and explosiveness. In September 1987, the veteran was examined at the Prestera Center for Mental Health Services, Inc., and he reported taking medication since 1972. He complained of depression and nightmares about Vietnam. He stated that while stationed in Vietnam, he ran convoys and mail to a small town 8 miles away from the military base. He also reported having had guard duty regularly. He stated that while he was on guard duty, an ammunition dump was blown up and he saw several dead bodies, as well as a driver that had been burned. He also stated that he had been under fire many times transporting officers to town. He also reported going to a morgue to identify a body and seeing bodies hanging in green bags. It was reported that he was sobbing while discussing this. He said that he resided with his wife and children, and that he spent his time helping around the house, taking walks and watching television. He also said that he had a few friends who visited, but that he rarely left his home. On examination, it was noted that the veteran appeared anxious and shook visibly. His affect was flat, but he became quite tearful in talking about his Vietnam experiences. Speech was relevant and coherent, and he was oriented to time, place and person. There was no evidence of hallucinations, delusions, paranoia or phobias. It was reported that he was extremely preoccupied with his Vietnam experiences and thought often of death. Interpersonal relationships appeared disturbed by his psychiatric condition. His insight and judgment appeared intact. PTSD was diagnosed, and the examiner noted that the veteran's PTSD was a result of the veteran's experiences in Vietnam. VA outpatient treatment records show that the veteran was treated in early 1988 for nervous problems. An undated VA psychological evaluation found the most probable diagnosis to be schizoid or schizotypal personality disorder. At his March 1989 personal hearing, the veteran reported that he had flashbacks about Vietnam, and that he was first treated for his nervous symptoms in 1972. He also reported having auditory and visual hallucinations. The veteran testified that hewas fired on in convoy situations, and that two men were killed as a result of an attack. He noted that he was taking medication. He stated that the main thing that bothered him regarding his wartime experience was seeing Vietnamese without legs. A complete transcript is of record. VA outpatient treatment records dated in March and April 1989 show continuing treatment for nervous problems and diagnoses of PTSD. There are also records of continuing treatment in the early 1990's with diagnoses of PTSD, by history, and rule out PTSD. The veteran and his son testified at a hearing before the Board in Washington, D.C., in March 1991. The veteran testified that he had been ambushed while on convoy, and that on one occasion a person's arm had been blown off, and that on another occasion a person was killed and several were wounded. He reported that he returned fire during these attacks. He testified that he had close friends who were killed in Vietnam and that he saw the body of one friend. He reported that he had guard duty and that he was fired on and that he returned fire, and that he saw many dead bodies, as well as many wounded and maimed. He testified that he saw Vietnamese that were wounded and who had arms and legs missing. The veteran stated that he saw bodies in the morgue in body bags. He testified as to the route he took when he drove supplies and mail in Vietnam. He stated that he currently had nightmares, flashbacks, auditory and visual hallucinations, an exaggerated startle response, memory problems, temper problems and depression. He reported attempting suicide in the past. His son stated that the veteran would wake up in the middle of the night and holler about taking cover, and about getting ammunition. He stated that the veteran had attacked him and his mother. In September 1991, the veteran was again examined at the Prestera Center for Mental Health Services. He complained of nightmares and flashbacks. He reported spending most of his time alone, frequently looking out of a window at home. On examination, it was noted that he became extremely nervous when talking about combat related activities. He reported extreme depression and crying. It was reported that he had difficulty with sleep, memory and concentration and that there was no evidence of delusions or hallucinations. PTSD was diagnosed, and it was noted that he continued with rather extreme symptoms including possible suicidal ideation, bouts of depression, crying spells, hypervigilance, frequent flashbacks, nightmares and difficulty sleeping. The veteran underwent a series of psychological tests in January 1992 at the Prestera Center in conjunction with a psychiatric evaluation. The examiners diagnosed PTSD. It was concluded that after examining the veteran's past files from VA and from the Prestera Center, and after the current psychological examination, the veteran was experiencing symptoms indicative of PTSD. He was also examined by VA in April 1992, and he reported having been under enemy fire in Vietnam, and that a convoy truck blew up on one occasion when it hit a land mine. He stated that he had nightmares of mutilated Vietnamese soldiers and that he had to go to the morgue to identify the dead body of a friend. He reported that he last worked in 1979 or 1980. He complained of sleep problems, nervousness and explosiveness. He also noted having flashbacks. On examination, he was fully oriented in all spheres with a depressed mood and affect. PTSD was diagnosed. In a March 1993 statement, the veteran pointed out the stressors which he experienced in Vietnam. He also provided a hand-drawn map of the places where the stressful events occurred and provided approximate dates. He noted a prisoner-of-war (POW) camp where wounded and maimed Vietnamese were seen, the morgue where he identified the body of his friend, the road along which the convoy rode and the bridge that was blown up. The Director of the Environmental Support Group stated in a December 1993 letter to VA that although the January 1969 attack at the ammunition dump that the veteran reported could not be documented, it was known that storage areas in the area of Qui Nhon were attacked during the veteran's Vietnam tour. The records did not document the wounding or killing of the Veteran's friend whose last name was Williams. In April 1993, the veteran was again examined by VA. He reported that his primary duties in Vietnam were driving a truck that carried supplies and mail. He reported that he drove from Qui Nhon to Pleiku almost daily, passing a POW of war camp that housed North Vietnamese prisoners, and that he would often see the prisoners with no arms or legs and open wounds. He stated that he heard mortars every day. He stated that he had been married for 28 years and had two children. It was stated that he had some marital problems, and that he had not worked since 1981. The veteran reported being irritable, having difficulty sleeping and withdrawing from his family. He noted visual hallucinations, and that he was not close with anyone, including his wife. He reported stressful events in Vietnam of a truck blowing up, trapping his friend. A past suicidal episode was reported, and it was stated it occurred after he heard news about Grenada on television. On examination, he was oriented to time, place and person. Visual hallucinations were reported. It was noted that the veteran presented with symptoms suggestive of PTSD, and PTSD was the diagnosis. The award of service connection for PTSD requires that a current diagnosis be established which conforms to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. 1987) (DSM- III-R of the American Psychiatric Association. 38 C.F.R. 4.126 (1993). An essential element for a diagnosis is that there have been a verifiable stressor for PTSD. DSM-III-R defines a stressor as a life-threatening circumstance or other event that is outside the range of usual human experience and that would be markedly distressing to almost anyone. The Board finds that the medical evidence of record supports a finding that the veteran has PTSD attributable to his Vietnam service. The record shows that PTSD has been diagnosed by VA and by private physicians, and the Board notes that the veteran's treating physician has attributed the veteran's PTSD to his service in Vietnam, as did a private physician at the Prestera Center for Mental Health Services. The determination as to the occurrence or nonoccurrence of events which might be accepted medically as stressors for PTSD involves a finding of fact, not medical judgments. The Board finds that the efforts put forth by the veteran since his initial claim to corroborate his allegations concerning stressors, including statements and hearing testimony have been impressive. The information provided throughout his claim has been consistent. He has given specific testimony concerning the almost daily route he traveled during which he witnessed the wounded and maimed bodies at a prisoner of war camp, and provided a detailed map showing the location of the claimed incidents. Information concerning full names and complete dates was not as specific as one would like; however, they are not contradicted by the evidence of record. Further, a lay statement provided by the veteran's wife in 1984, documents the stressful situations claimed by her husband to have confronted him while serving in Vietnam, providing further consistency to his claim. When looking at the evidence in its totality, the Board finds that the veteran has PTSD, and that his account of his service and the stressors is credible. The evidence for and against the veteran's claim is at least in equipoise and, as such, the claim is resolved in the veteran's favor. ORDER Service connection for PTSD is granted. ROBERT E. SULLIVAN 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.