Citation Nr: 0007539 Decision Date: 03/21/00 Archive Date: 03/28/00 DOCKET NO. 97-18 826 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania THE ISSUES 1. Whether the claim of service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), is well-grounded. 2. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD John M. Clarkson, III, Counsel INTRODUCTION The veteran had active service from March 1959 to January 1963 and from July 1963 to April 1964. Military personnel records associated with the claims folder in or about January 1998 show that the veteran had 13 days of active duty for training (ACDUTRA) in June 1964. This appeal arises from a March 1997 rating decision which denied service connection for an acquired psychiatric disorder, to include PTSD. The veteran was accorded a hearing before a hearing officer at the RO in August 1997, and a transcript of the hearing is included in the claims folder. FINDING OF FACT The claim of service connection for an acquired psychiatric disorder, to include PTSD, is plausible. CONCLUSION OF LAW The claim of service connection for an acquired psychiatric disorder, to include PTSD, is well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION Factual Background The veteran's Form DD-214s ("Armed Forces of the United States Report of Transfer or Discharge") show that he served in the U.S. Navy, with an occupational specialty of damage control. His service medical records do not contain a complaint, diagnosis, or treatment for an acquired psychiatric disorder, to include PTSD. In a December 1996 statement, the veteran asserted a claim of service connection for PTSD, and indicated that he was receiving medical treatment at the VA Medical Center in Butler, Pennsylvania (Butler VAMC). In a report of a June 1995 mental health clinic consultation at Butler VAMC, a VA social worker indicated that the veteran was being referred for psychiatric evaluation, medication management, and diagnostic clarification. The social worker's diagnostic impressions included Axis I: general anxiety and dysthymia. It was also noted that the veteran had been in receipt of disability benefits from the Social Security Administration (SSA) since the early 1980s for what he described as a variety of reasons, including a lung disorder reportedly associated with chemical exposure while he was employed as a welder. Records of treatment of the veteran at Butler VAMC, dating from August 1995 to November 1996, include an October 1995 medical report in which it was noted that the veteran had traumatic memories of working aboard an aircraft carrier. In a January 1997 statement, the veteran described stressful events which occurred during his military service. He indicated that, in the summer of 1960, while serving aboard the USS Intrepid, an aircraft carrier, an enlisted man was killed on the deck of the carrier. He recalled that, between August 1960 and February 1961, three pilots were killed. Two were killed when their aircraft impacted the flight deck. The veteran explained that he worked in the carpenter shop just below the rear of the flight deck. One of the pilots was killed 10 feet above the veteran's work location, and body parts were scattered over the rear section of the flight deck. An enlisted man committed suicide by jumping into the sea from near the ship's bow. The veteran indicated that he was assigned to damage control duties, and he assisted in operations surrounding the death of a man in the boiler room. He described dangerous conditions involving his attempts to assist in making repairs after an explosion near the ship's anchors. The veteran stated that he experienced fear and stress during the Cuban missile crisis in October 1962, when the ship's captain announced his belief that the United States would probably go to war with the Soviet Union. The veteran was accorded a VA examination at the VA Medical Center at University Drive, Pittsburgh, Pennsylvania (University Drive VAMC) by a psychologist in January 1997. The psychologist concluded that the veteran did not present sufficient data to warrant a diagnosis of PTSD. The psychologist indicated that this assessment was based on a review of the available medical records and clinical findings. Diagnoses included Axis I: generalized anxiety disorder and dysthymic disorder, which were chronic and moderate in intensity and not related to service, and Axis II: mixed personality disorder, with passive dependent, histrionic, and narcissistic traits. The psychologist added that, while the veteran had some psychiatric problems which appeared to be related to his character development and his early history, with possible involvement of biogenetic factors, there was no evidence of a psychiatric disability related to service. The veteran was referred for an additional evaluation in January 1997 by the Chief of Psychology Services at Butler VAMC. The psychologist indicated that the veteran had been seen on five occasions between December 1996 and January 1997. The veteran reported stressful events including: watching planes miss aircraft carrier deck restraining cables while attempting to land, and going overboard, making repairs in heavy seas, working in the carpenter shop below the flight deck when planes were landing on the deck above, learning that several men were killed aboard another aircraft carrier when a restraining cable snapped, working in damage control activities after fatal accidents, and scraping rust for 2 weeks as punishment because of problems with a supervisor. Clinical testing revealed moderate problems with anxiety, depression, and self-esteem, which the examiner believed were likely to be chronic in nature. There were significant degrees of conversion or psychophysiological symptoms and a preoccupation with somatic events. The veteran was thought to most likely be obsessional, with much repression and denial. The psychologist concluded that diagnostic testing did not suggest the presence of PTSD. The examiner's impressions included generalized anxiety disorder. The evidence also includes an April 1997 letter from the VA social worker who conducted a June 1995 VA evaluation of the veteran. The social worker noted that the veteran had been treated at the Butler VAMC mental hygiene clinic since June 1995, and his symptoms were consistent with generalized anxiety and post-traumatic stress resulting from exposure to traumatic events while serving aboard an aircraft carrier during the Cuban missile crisis. These traumatic events were noted to include seeing people maimed and killed, and planes and helicopters exploding and sinking. At a hearing before an RO hearing officer in August 1997, the veteran testified that he had recurring dreams of being pinned or crushed in a ship, and being unable to escape. He recalled that the ship on which he served had been caught in a hurricane for three days, and he described his damage control activities during the storm. The veteran indicated that he had been receiving SSA disability benefits since 1979 or 1980 for disabilities resulting from exposure to toxic fumes when he was employed as a welder after service. Following the hearing, records of medical treatment of the veteran at the Irene Stacy Community Mental Health Center (Irene MHC) were associated with the claims folder. The records from Irene MHC include an April 1992 report by Walter W. Hiller, Jr., M.D. Dr. Hiller referred to an evaluation of the veteran in October 1986, during which the veteran reported a 10-year history of "nervousness". Dr. Hiller recalled that his impressions at that time included, generalized anxiety disorder, dysthymic disorder, and mixed personality disorder. The records from Irene MHC do not contain any medical opinion relating an acquired psychiatric disorder to service or an episode in service. A June 1997 letter from the medical director of the mental hygiene clinic at Butler VAMC was associated with the record. The physician noted that the veteran had PTSD and a mood disorder. The physician indicated that, from the history provided by the veteran, his post-traumatic symptoms were consistent with his exposure to events aboard the USS Intrepid during the Cuban missile crisis; when he reported seeing people maimed and killed and planes going into the sea. In an August 1997 VA evaluation of the veteran by a VA social worker at the VA Medical Center on Highland Drive in Pittsburgh, Pennsylvania (Highland Drive VAMC), the veteran's preservice, military, and social history were reported. The social worker noted that, following diagnostic testing, an exact diagnostic determination was difficult to make. While clinical indications pointed to a diagnosis of PTSD, the examiner concluded that the veteran's purpose in undergoing the evaluation was to validate a diagnosis of PTSD, and he presented as someone very interested in being diagnosed with PTSD. Military personnel records added to the claims folder in January 1998 show that the veteran was assigned to duty aboard the USS Intrepid in June 1960. In a June 1998 letter from a VA social worker at Butler VAMC, it was reported that the veteran's symptoms continued to reflect generalized anxiety and PTSD resulting from his duty aboard an aircraft carrier and related experiences. Thereafter, copies of the ship's deck logs of the USS Intrepid were added to the claims folder. The veteran submitted the deck logs with hand-written annotations asserting that he was present, took part in, or had personal knowledge of, various events chronicled therein including, the loss of a pilot in August 1960, the loss of a seaman overboard (who is identified in the deck logs as "R.A. Pickett", and with whom the veteran indicated he was personally acquainted) in August 1960, and aircraft accidents on the flight deck in September 1960. In a June 1999 letter, Robert L. Eisler, M.D. reported interviewing the veteran in his office in June 1999. Dr. Eisler noted that the veteran recalled having been in numerous life-threatening situations, including a severe hurricane, and working in connection with aircraft accidents and fire and steam explosions. Dr. Eisler concluded that the veteran had developed PTSD and a major depressive disorder as a result of his experiences during service. Dr. Eisler opined that the veteran has anxiety and panicky feelings which are not associated with PTSD. On VA examination of the veteran by a VA psychologist at Butler VAMC in June 1999, the psychologist reported having reviewed the claims folder, with special attention to the ship's deck logs, and reports of prior psychiatric evaluations of the veteran. Following an extensive discussion of the veteran's history, the psychologist's diagnostic impressions included Axis I: generalized anxiety disorder, and Axis II: personality disorder, not otherwise specified. The psychologist opined that the veteran's symptom picture was not consistent with a diagnosis of PTSD, but was more consistent with generalized anxiety disorder. On VA examination of the veteran in August 1999 at University Drive VAMC, the examiner reported having reviewed the claims folder in detail prior to the examination. The examination report contains an extensive discussion of prior psychiatric evaluations of the veteran, including the January 1997 VA examination at University Drive VAMC, the June 1999 VA examination of the veteran at Butler VAMC, and Dr. Eisler's June 1999 letter. The veteran's significant and traumatic experiences in service, his history and the results of diagnostic testing were reported in detail. The examiner opined that, consistent with VA examinations of the veteran in January 1997 and June 1999, the clinical findings did not support a diagnosis of PTSD. The examiner added that the veteran did not evidence the full range of PTSD symptoms, and his responses on psychological testing suggested significant over-reporting. The examiner concluded that, while a previous diagnosis of generalized anxiety disorder had been made, it was unclear whether that diagnosis was accurate. The veteran's present symptomatology and symptom picture appeared to be more likely a result of his personality disorder than by any subsequent psychiatric disorder. Analysis Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 1991). In order for a claim for service connection to be well-grounded, there must be competent medical evidence of a current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). In this case, the VA psychiatric social worker letters of April 1997 and June 1998, the June 1997 letter from the director of the mental hygiene clinic at Butler VAMC, and Dr. Eisler's letter of June 1999 contain diagnoses of PTSD. This satisfies the first requirement of well-groundedness set forth in Caluza. The veteran's Form DD-214s do not reflect combat service or a military occupational specialty relating to combat. There is no evidence that he engaged in actual combat with the enemy. His military occupational specialty was in damage control. Following review of the ship's deck logs and the veteran's annotations thereto, the Board is satisfied that the significant events reported by the veteran as occurring during his service aboard the USS Intrepid took place. Thus, the second element of Caluza is met. The letters from VA social workers, the VA physician's letter of June 1997 and Dr. Eisler's June 1999 report relate a current diagnosis of an acquired psychiatric disorder, to include PTSD, to the veteran's service or alleged "stressful" events in service. Therefore, the third element of Caluza is present. Accordingly, the Board finds that the claim of service connection for an acquired psychiatric disorder, to include PTSD, is well-grounded, and to this extent, the claim should be granted. ORDER The claim of service connection for an acquired psychiatric disorder, to include PTSD, is well-grounded, and to this extent, the appeal is granted. REMAND As noted in the medical evidence and as indicated at the RO hearing in August 1997, the veteran is currently in receipt of disability benefits from the SSA. Although the evidence indicates that he is receiving disability benefits for reasons unrelated to an acquired psychiatric disorder, the Board is constrained by decisions of the United States Court of Appeals for Veterans Claims (Court) to obtain medical records upon which the SSA decision assigning disability benefits to the veteran was based. Masors v. Derwinski, 2 Vet. App. 181 (1992); Murincsak v. Derwinski, 2 Vet. App. 363 (1992). More importantly, as indicated above, there is medical evidence in this case which is favorable to the veteran's claim and other medical evidence which is unfavorable. Given the conflicting medical evidence and the necessity to remand the claim to obtain records from the SSA specified above, the Board concludes that, in the event additional medical evidence is available from the SSA demonstrating either the existence of PTSD or the existence of another acquired psychiatric disorder which is said by a health care professional to be related to service, a further medical opinion should also be obtained. Accordingly, the claim of service connection for an acquired psychiatric disorder, to include PTSD, is REMANDED to the RO for the following: 1. The RO should contact the Social Security Administration and obtain a copy of any decision awarding the veteran disability benefits and the medical records upon which such decision was based. 2. If the medical evidence underlying the award of disability benefits to the veteran by the Social Security Administration contains any diagnosis or clinical impression of PTSD or contains a diagnosis or clinical impression of any other acquired psychiatric disorder said to be related to service, the entire claims folder and the evidence obtained from the Social Security Administration should be referred to the VA examiners who conducted the examinations of the veteran in June 1999 at Butler VAMC and in August 1999 at University Drive VAMC for a complete review and a response to the following questions: (a) Does the veteran have PTSD, and if so, is it related to service or the verified events the veteran regards as stressful in service? (b) Is any acquired psychiatric disorder, other than PTSD related to service or the verified events the veteran regards as stressful in service? 3. If the medical evidence obtained from the Social Security Administration does not contain a diagnosis or clinical impression of PTSD or of another acquired psychiatric disorder said by a health care professional to be related to service, the RO may review and adjudicate the claim of service connection for an acquired psychiatric disorder to include PTSD without any further development of the evidence. If the claim remains denied, the veteran and his representative should be furnished an appropriate supplemental statement of the case and given an opportunity to respond. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. BRUCE E. HYMAN Member, Board of Veterans' Appeals