BVA9504176 DOCKET NO. 92-23 882 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for post traumatic stress disorder (PTSD). 2. Entitlement to an increased disability evaluation for acne vulgaris, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J.W. Engle, Counsel INTRODUCTION The appellant served on active duty from August 1967 to July 1971. This matter came before the Board of Veterans' Appeals (the Board) on appeal from a decision dated in February 1992 by the St. Louis, Missouri, Department of Veterans Affairs Regional Office (VARO). This case was remanded by the Board in October 1993 for additional development. The requested development has been completed and the case has been returned to the Board for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that he has PTSD as a result of his experiences in Vietnam. He further argues that his service- connected acne vulgaris is of such severity as to warrant an increased disability evaluation. 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 preponderance of the evidence is against the appellant's claim to service connection for PTSD and for an increased disability evaluation for acne vulgaris. FINDINGS OF FACT 1. The appellant served on active duty from August 1967 to July 1971. He served for one year in Vietnam and his commendations include the Vietnam Service Medal, the National Defense Service Medal and the Republic of Vietnam Campaign Medal with no combat related medals or decorations. His major occupational specialty (MOS) during his tour of duty in Vietnam was carpenter. 2. The evidence of record does not establish that the appellant engaged in combat with the enemy while serving in Vietnam. 3. Service medical records do not reflect a history or diagnosis of any psychiatric disorder. 4. VA outpatient treatment reports dated from 1984 to 1992 consisting of counseling reports noted assessments of PTSD and a VA examination report dated in January 1992 noted a diagnosis of PTSD, "non-combat related." 5. In January 1994 the U.S. Army and Joint Services Environmental Support Group was unable to verify the appellant's reported stressor incidents due to the lack of detailed information supplied by the appellant. A request to the appellant for additional information was made but no additional specific information was provided. 6. The appellant's service records do not corroborate his reported stressor incidents. 7. A VA psychiatric examination report dated in March 1994 noted a diagnosis of anxiety disorder with atypical features; however, there was no medical evidence to relate this diagnosis to the appellant's period of service. The diagnosis further noted that the appellant did not report the necessary number of symptoms in adequate severity to determine that he has PTSD. 8. The record does not reflect a confirmed diagnosis of PTSD. 9. The appellant's service-connected acne vulgaris is manifested by nodulocystic tender lesions with scarring over the face, back, neck and buttocks and is productive of two active lesions on the back and two lesions in the "drying up" phase on the buttocks. 10. The appellant's acne vulgaris is not productive of severe scars of the head, face or neck or symptoms analogous to eczema with exudation or constant itching, extensive lesions or marked disfigurement. CONCLUSIONS OF LAW 1. An acquired psychiatric disorder, PTSD, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.304(f) (1993). 2. The schedular criteria for a disability evaluation in excess of 10 percent for acne vulgaris are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, Diagnostic Codes 7806, 7800 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for PTSD The appellant is seeking service connection for PTSD, which he attributes to his military service experiences in Vietnam. 38 U.S.C.A. § 1110 (West 1991). With regard to PTSD, VA regulations recognize that symptoms attributable to PTSD often do not appear in service. 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 medical evidence, between current symptomatology and the claimed inservice stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. 38 C.F.R. § 3.304(f) (1993). However, where VA determines that the veteran did not engage in combat with the enemy, or that the veteran did engage in combat with the enemy but the claimed stressor is not related to such combat the veteran's lay testimony, by itself, will not be enough to establish the occurrence of the alleged stressor. Instead, the record must contain service records which corroborate the veteran's testimony as to the occurrence of the claimed stressor. Zarycki v. Brown, 6 Vet.App. 91 (1993). Review of the record reveals that the appellant's claim to service connection for PTSD was found to be well grounded based upon his service in Vietnam and post service assessment and diagnosis of PTSD. 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v. Derwinski, 1 Vet.App. 78 (1990). As indicated above, the appellant must provide evidence establishing that he experienced inservice stressors recognized by a medical professional as incident to a diagnosis of PTSD, and he must show current symptomatology which links those stressors to a current diagnosis of PTSD. In June 1984 the appellant was seen at the VA Mental Health Clinic for complaints of depression. The appellant reported that he was in Vietnam as a noncombatant in a combat zone and indicated that his symptoms included intrusive thoughts, crying spells, psychic numbing, social withdrawal, decreased appetite, survivor guilt, exaggerated startle response and decreased energy. It was further noted that the appellant had been experiencing marital difficulties over the past 15 months. The impression was PTSD, delayed, chronic, with depression. Subsequent VA outpatient treatment reports dated from 1984 to 1992 noted that the appellant received counseling for his PTSD symptoms. In various statements by the appellant submitted in support of his claim he reported that on several occasions he was required to drive a semi-trailer truck with building supplies into hostile situations, where he witnessed men who had been severely injured and where he was confronted by several hostile Vietnamese civilians who stole his supplies. He further related that his unit's encampment at Danang experienced hostile shell fire which threatened several fuel tanks nearby, and that his tent was struck by a mortar round and that one of the soldiers in the tent was injured at that time. In January 1992 a VA psychiatric examination was conducted and diagnoses of PTSD, mild, non-combat related, polysubstance abuse, chronic, moderate in severity and mixed personality disorder were noted. In the Board's evaluation of the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the appellant's military records and all pertinent medical and lay evidence pursuant to 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. §§ 3.303(a), 3.304 (1993); and Hayes v. Brown, 5 Vet.App. 60, 66 (1993), it was concluded that the January 1992 VA examination which diagnosed "non-combat" related PTSD was inadequate since it was unclear from the examination report how the VA examiner reached this conclusion, or any of his stated psychiatric conclusions. The examiner's objective findings were essentially normal, and his diagnosis appeared to be based solely upon the appellant's stated history and complaints. He did not include a discussion of the non- combat related experiences which resulted in the diagnosis of mild PTSD. Accordingly, this case was remanded by the Board in October 1993 in an effort to assist the appellant in the development of facts pertinent to his claim and clarify the diagnosis noted on VA examination in relation to the appellant's reported military experiences. In January 1994, in response to a request from VARO, the U.S. Army and Joint Services Environmental Support Group (ESG) indicated that they were unable to verify any of the appellant's reported stressor incidents and requested that the appellant provide the dates of incident to within seven days, type and location of the incident, number and full names of casualties and other units involved. VARO forwarded this request to the appellant in February 1994 to which the appellant responded in March 1994. He indicated that: [T]o provide the information you requested would probably be impossible for just about anyone. I feel the additional information I am sending will provide you with the evidence you need to help substantiate my claim for post-traumatic stress disorder. Additional information submitted by the appellant included photographs of the appellant apparently reflecting the condition of his service-connected acne vulgaris. Other pictures portrayed an unidentified soldier wearing a bandage and reflected the damaged roof of a building which the appellant indicated was due to mortar fire. In addition, the appellant submitted a photocopy of the unit history for the 820th Civil Engineering Squadron for 1969. This unit history provided no information regarding stressor incidents reported by the appellant. There was no additional information submitted with regard to the specifics of the alleged stressor incidents as requested by ESG. In March 1994 VA psychiatric and PTSD examinations were conducted. The appellant reiterated his experiences during his tour of duty in Vietnam including witnessing numerous casualties and undergoing nightly mortar attacks and bombing raids. He reported that he had a long term intermittent problem with the trauma of his experience in Vietnam. He stated that he experienced flashbacks on occasion and had problems with nightmares with a combat theme on a regular basis. However, the examiner indicated that the appellant was unable to provide a specific example of any event that was the most traumatic one for which he suffered in terms of flashbacks or nightmares. He also reported complaints of anger control and anxiety which he attributed to his military service in Vietnam. He denied reexperiencing combat trauma during waking hours and did not report significant problems with exaggerated startle response or avoidant behavior around situations that would remind him of his combat experience. He indicated that he had been divorced and since remarried and that conflicts were present with two children from the first marriage, but he did not attribute this to his military service. On examination the appellant was cooperative and compliant with the interview process. He was alert and oriented throughout the interview. His affect was broad and appropriate and occasionally tearful when discussing the traumatic nature of experiences in Vietnam. Mood was reported to be irritable and anxious. On mental status examination his judgment was intact and insight into the nature of his situation in relation to the causes of his mildly impaired cognitive testing did not reveal impairment in the area of immediate recall, concentration or ability to abstract. It was further noted that the appellant reported a long term intermittent history of substance abuse, primarily cannabis and a past history of alcohol use. He stated that he was compliant with Amipramine for anxiety and indicated that it continued to benefit him in the reduction of the level of anger and insomnia. The psychiatric examination diagnosis was as follows: Axis I: 1. Anxiety disorder with atypical features. Veteran presents with a history of having some problems with anxiety and dysphoria on a chronic, intermittent basis. He does not report having the necessary number of symptoms in adequate severity to determine that he has post traumatic stress disorder. Veteran's history of substance abuse and ethanol use in the long term makes it difficult to differentiate this anxiety separate from any substance abuses. 2. Past history of ethanol substance abuse, in full remission and partial remission, respectively, by veteran's report. Axis II: 1. Possible mixed personality disorder. Veteran gives a history of difficulty with relationships and reports having problems with compliance with requirements in areas such as substance abuse and relationships that he indicated a problems in this area. This would not be related to his service or combat experience. The diagnosis noted on the PTSD examination was as follows: Axis I: 1. Veteran has an anxiety disorder, by history, and clinical presentation, however, (sic) I do not find adequate symptoms or history of criteria in numbers, frequency or severity that would indicate a diagnosis of post traumatic stress disorder for this veteran, as it would relate to his combat experience in Vietnam as described to me. I am not contending this veteran does not have some form of anxiety disorder but has the typical nature and has responded somewhat to medication management, however, (sic) the presence of PTSD separate from this and/or his ongoing substance use and abuse would be difficult to differentiate. 2. Substance abuse, by history, chronic, intermittent, cannabis, past history of ethanol abuse in full remission, by history. Axis II. 1. Possible personality disorder, mixed type. After careful scrutiny of the appellant's official service records relating to his tour of Vietnam duty from 1969 to 1970, the Board finds no corroboration that he engaged in combat activity with the enemy. Neither a combat citation nor his major occupational speciality (carpenter) indicates that he was exposed to more than the ordinary stressful environment inherent in a combat zone. Furthermore, the Board finds that the record does not provide any objective support for his various reported stressor incidents including driving a semi-trailer truck with building supplies into hostile situations, exposure to soldiers who had been severely injured and an incident where he was confronted by several hostile Vietnamese civilians who stole his supplies. Nor is there is any objective reports that his unit's encampment at Danang experienced hostile shell fire or that a soldier in the unit was injured when a mortar round struck his tent. In fact, ESG was unable to process VARO's request due to the vague nature of the stressor incidents reported by the appellant. In this regard, the Board notes: A veteran seeking service connection for PTSD may not rely on mere service in a combat zone, solely in and of itself, to support a diagnosis of PTSD. Rather, in order to support a diagnosis of PTSD, a stressor must consist of an event during such service 'that is outside of the range of usual human experience and that would be markedly distressing to almost anyone,' such as experiencing an immediate threat to one's life or witnessing another person being seriously injured of killed. Zarycki v. Brown, 6 Vet.App. 91 (1993) citing Wood v. Derwinski, 1 Vet.App. 190, 193 (1991), reconsideration den., 1 Vet.App. 406 (1991). As noted above, where as here VA (the Board) determines that the veteran did not engage in combat with the enemy, his lay testimony, by itself, will not be enough to establish the occurrence of the alleged stressor(s). Instead, the record must contain service records which corroborate the veteran's testimony as to the occurrence of the claimed stressor. Zarycki v. Brown, 6 Vet.App. 91 (1993). The record simply does not contain service or other objective records which corroborate the appellant's reported stressor incidents. With the above in mind, the Board acknowledges the assessment of PTSD noted on VA Mental Health Clinic counseling reports and the diagnosis of PTSD on VA examination in January 1992. However, in view of the lack of an objectively verified stressor, these findings are considered to be based upon the appellant's reported history alone and are insufficient to establish the presence of PTSD related to the appellant's period of active duty. The Board is not required to accept the appellant's uncorroborated account of his military experiences as a basis for substantiating a claim, notwithstanding health professionals who accept as truthful the appellant's reported service medical history for purposes of treatment and diagnosis. See Wood v. Derwinski, 1 Vet.App. 406 (1991). In addition, on the most recent VA examination in March 1994, a VA psychiatrist noted after review of the appellant's claims folder and thorough psychiatric examination that the appellant does not meet the diagnostic criteria for PTSD. While an anxiety disorder was diagnosed, there were no objective findings to relate that diagnosis to the appellant's period of active duty. Accordingly, in view of the above, entitlement to service connection for PTSD is not warranted. In reaching this conclusion, the undersigned has placed particular emphasis upon the lack of evidence to establish that the appellant engaged in combat with the enemy, the lack of objective corroboration of the appellant's reported stressor events, and the lack of a confirmed diagnosis of PTSD. II. Increased Disability Evaluation The appellant's service-connected acne vulgaris is currently evaluated pursuant to Diagnostic Code 7806 as analogous to eczema, which provides, in pertinent part, that eczema with exudation or constant itching, extensive lesions or marked disfigurement warrants a 30 percent disability evaluation. Diagnostic Code 7800 provides that disfiguring scars of the head, face or neck which are severe in nature, especially if producing a marked or unsightly deformity of the eyelids, lips or auricles warrant a 30 percent disability evaluation and complete or exceptionally repugnant deformity of one side of the face or marked or repugnant bilateral disfigurement of the face warrants a 50 percent disability evaluation. After review of the evidence of record, the undersigned concludes that the appellant's acne vulgaris appropriately evaluated at the 10 percent disability level pursuant to Diagnostic Code 7806. In reaching the above conclusion, the undersigned placed particular emphasis upon the VA dermatological examination in June 1994 which only noted the presence of two active tender nodulocystic lesions on the appellant's back with two lesions in the "drying up" phase on his buttocks. While scars covering the buttocks as well as much of the face were noted, the scars over the appellant's face, after review of the numerous color photographs submitted in support of the claim, are considered to be moderately disfiguring in nature and consistent with no more than the previously assigned 10 percent disability evaluation. The facial scars resulting from the appellant's acne are not found to be severely disfiguring. The extent of the condition noted over the appellant's back and buttocks, as part of the service-connected acne vulgaris, is not shown to be productive of symptoms analogous to "active" eczema which exudation or constant itching, extensive lesions or marked disfigurement. Accordingly, entitlement to an increased disability evaluation for acne vulgaris is not warranted. ORDER Service connection for PTSD is denied. A disability evaluation in excess of 10 percent for acne vulgaris is denied. C.P. RUSSELL 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.