BVA9500754 DOCKET NO. 93-10 287 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Reno, Nevada THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Military Order of the Purple Heart ATTORNEY FOR THE BOARD M. Auer, Counsel REMAND The veteran served on active duty from September 1966 to September 1968. This appeal arises from a September 1992 rating decision of the Department of Veterans Affairs (VA), Reno, Nevada, Regional Office (RO). In that decision, service connection for PTSD was denied. During this appeal, the veteran has described several incidents that he claims are the stressors precipitating PTSD. In a statement dated in September 1992, the veteran reported that, while stationed with the 20th Engineering Brigade at the 547th Map Depot, he worked in supplies until he hurt his back and was assigned to the suicide tower. He reported that after being in Vietnam for several weeks, the 547th Map Depot was hit with motors, rockets, and machine gun fire during the Tet Offensive. In a statement dated in May 1992, he reported that he saw many GI's die during this time, but is unable to remember their names because he was new to the company. In his September 1992 statement, the veteran related that, following the Tet Offensive, he worked to clean up Highway One by picking up the dead bodies of "N.V.A. and Cong." In February 1993, he reported that the skin on these bodies was burned and separated from the bodies as he loaded them onto a truck. The veteran also reported witnessing another soldier smash in the head and face of a young child and that brain matter splattered onto his person. A review of the record indicates that pertinent development remains to be accomplished. In particular, the RO requested verification of stressful incidents related by the veteran from the United States Army and Joint Services Environmental Support Group (ESG). In March 1993, the ESG responded to the RO's request for verification by stating that they were unable to document the veteran's unit of assignment, or his duties and responsibilities during his tour in Vietnam. It was stated that any future research request should include the veteran's DA Form 20. It was also requested that the veteran provide the date of the specific combat incident(s) to within seven days, type and location, numbers and full names of casualties, and other units involved. It was noted that the more detailed the information provided, the better chance that the research would be successful. Additional recommendations were provided on how the veteran and his representative could find morning reports. It was noted that the ESG PTSD unit could only verify specific combat incidents as recalled by the veteran. In order to conduct a meaningful research, the veteran must provide the "who, what, where and when" of each stressor. 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. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f) (1993); see Hayes v. Brown, 5 Vet.App. 60, 66 (1993). Additionally, 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 the medical evidence, between current symptomatology and the claimed inservice stressor. See Zarycki v. Brown, 6 Vet.App. 91, 97 (1993). In West v. Brown, 7 Vet.App. 70 (1994), the Court elaborated on the analysis in Zarycki. In Zacycki, the Court held that in addition to demonstrating the existence of a stressor, the facts must also establish that the alleged stressful event was sufficient to give rise to PTSD. Id. at 98-99. In West, the Court held that the sufficiency of the stressor is a medical determination, and therefore adjudicators may not render a determination on this point in the absence of independent medical evidence. Id. at 79. The Court also held in West that a psychiatric examination for the purpose of establishing the existence of PTSD was inadequate for rating purposes because the examiners relied, in part, on events whose existence the Board had rejected. Id. at 78. Upon reviewing Zarycki and West, it appears that in approaching a claim for service connection for PTSD, the question of the existence of an event claimed as a recognizable stressor must be resolved by adjudicatory personnel. If the adjudicators conclude that the record establishes the existence of such a stressor or stressors, then and only then, the case should be referred for a medical examination to determine the sufficiency of the stressor and whether the remaining elements required to support the diagnosis of PTSD have been met. In such a referral, the adjudicators should specify to the examiner(s) precisely what stressors have been accepted as established by the record, and the medical examiners must be instructed that only those events may be considered in determining whether stressors to which the veteran was exposed during service were of sufficient severity as to have resulted in current psychiatric symptoms. In other words, if the adjudicators determine that the existence of an alleged stressor or stressors in service is not established by the record, a medical examination to determine whether PTSD due to service is present is pointless. Likewise, it the examiners render a diagnosis of PTSD that is not clearly based upon stressors in service whose existence the adjudicators have accepted, the examination would be inadequate for rating purposes. In light of the foregoing, the Board finds that the actions ordered below are warranted even though the development will further delay the entry of a final decision in this appeal. Accordingly, the claim is REMANDED for the following actions: 1. The RO should send a copy of the March 1993 letter from the ESG to the veteran. 2. The RO should request from the veteran a comprehensive statement containing as much detail as possible regarding the stressors to which he alleges he was exposed in service. The veteran should be asked to provide specific details of the claimed stressful events during service, such as dates, places, detailed descriptions of events and identifying information concerning any other individuals involved in the events, including their names, ranks, units of assignment or any other identifying detail. The veteran is advised that this information is vitally necessary to obtain supportive evidence of the stressful events and that he must be as specific as possible because without such details an adequate search for verifying information can not be conducted. 3. With the additional information obtained, the RO should review the file and prepare a summary of all the claimed stressors. This summary, together with a copy of the DD 214 and the DA Form 20, or equivalent, and all associated documents, should be sent to the United States Army and Joint Services Environmental Support Group, 7798 Cissna Road, Springfield, Virginia 22150. They should be requested to provide any information that might corroborate the veteran's alleged stressors. 4. If, and only if, the RO determines that the record establishes the existence of a stressor or stressors, then the RO should arrange for the veteran to be accorded an examination by a board of two VA psychiatrists, if available, who have not previously examined him to determine the diagnosis of all psychiatric disorders that are present. The RO must specify for the examiners the stressor or stressors that it has determined are established by the record and the examiners must be instructed that only those events may be considered for the purpose of determining whether exposure to a stressor in service has resulted in current psychiatric symptoms and, whether the diagnostic criteria to support the diagnosis of PTSD have been satisfied. The examination report should reflect review of pertinent material in the claims folder. The examiners should integrate the previous psychiatric findings and diagnoses with current findings to obtain a true picture of the nature of the veteran's psychiatric status. It the diagnosis of PTSD is deemed appropriate, the examiners should comment upon the link between the current symptomatology and one or more of the inservice stressors found to be established by the RO. The report of examination should include the complete rationale for all opinions expressed. All necessary special studies or tests, to include psychological testing and evaluation, such as the Mississippi Scale for Combat-Related post- traumatic stress disorders, should be accomplished. The claims folder, or copies of all pertinent records, must be made available to the examiner for review prior to, and during, the examination. 5. The RO should then review the record and ensure that all the above actions have been completed. When the RO is satisfied that the record is complete and the psychiatric examination is adequate for rating purposes, the claims should be re adjudicated. If his claim remains denied, the veteran and his representative should be provided with a supplemental statement of the case that includes any additional pertinent law and regulations and a full discussion of the evidence in his case. The appropriate response time should be allowed. The case should be returned to the Board, if in order, after compliance with all regulatory appellate procedures. No action is required of the veteran until he is so informed. The Board intimates no opinion as to the ultimate decision warranted in this case, pending completion of the requested development. ALBERT D. TUTERA 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. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).