Citation Nr: 0004677 Decision Date: 02/23/00 Archive Date: 02/28/00 DOCKET NO. 98-12 116 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Oklahoma Department of Veterans Affairs ATTORNEY FOR THE BOARD Stephen L. Higgs, Associate Counsel INTRODUCTION The veteran served on active duty from July 1980 to April 1983. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision dated in September 1997 by the Department of Veterans Affairs (VA) Regional Office (RO) Muskogee, Oklahoma. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The claim for service connection for PTSD is not plausible. CONCLUSION OF LAW The claim for service connection for PTSD is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background The veteran's DD Form 214 reflects that he had active service from July 1980 to April 1983. He received the Overseas Service Ribbon, the Army Services Ribbon, the Air Assault Badge, and a Multinational Force Observers decoration. A letter dated in December 1980, addressed from the United Nations Command Support Group, Joint Security Area, (UNCSG- JSA) to the veteran's parents, indicates that the veteran was hand-picked to serve in the UNCSG-JSA and met extremely high standards in being selected. The unit was described one of the most unique units in the United States Army. The letter states the veteran would be a security guard in the unit. A unit history provided with the letter describes sporadic violence -- for example, in July 1977 a CH 47 was shot down after it strayed into North Korean airspace, and three of four crewmembers were killed in the crash; and in December 1979 one American soldier was killed and two seriously injured in an explosion on the North Korean side of the Demilitarized zone. The veteran's service records reflect that he served from November 1980 to November 1981 in Korea, and that he served with a multinational force from April 1982 to February 1983, apparently in the Sinai area of Egypt. He served as a security guard, and his occupational specialty was that of an infantryman. Service medical records, to include the veteran's April 1983 separation examination, are negative for psychiatric complaints, treatment or diagnosis. An April 1983 report of mental status evaluation noted the veteran to be normal and mentally responsible. May 1997 records of treatment include a diagnosis of mood disorder secondary to substance abuse, and PTSD by history. During an August 1997 VA examination, the veteran gave a history of having served in Korea and for two years in Egypt with the United Nations peace keeping forces. He stated that in Korea in the winter of 1980, a Sergeant was on patrol with him, when the Sergeant was shot in the head during a racial incident. He further gave a history of having been exposed to bombs going off causing traumatic amputation of limbs of people during his duty in the Sinai Desert patrols in 1982 and 1983. He said "we would put tourniquets on and ship them off." He also stated that while on the peacekeeping force, his unit blew up a lot of cities and woods and killed everyone there. He stated he had killed hundreds of people. The veteran also reported at the examination that he was in drug rehabilitation his entire time during service. The examiner reviewed the service medical records and noted there was one entry in June of 1982 pertaining to possible drug abuse. After review of the veteran's history and subjective complaints and conducting a mental status examination, the examiner's diagnoses were psychotic disorder, not otherwise specified; polysubstance dependence in partial remission; substance induced mood disorder; and anti-social personality disorder. The examiner commented that the veteran met the criteria for psychotic disorder not otherwise specified but did not meet the full criteria for PTSD. VA records of treatment in August 1997 include a history of an inservice incident in which a friend was killed in a friendly fire incident in the early 1980s. After review of past medical history and examination of the veteran, the diagnosis was PTSD and major depression with psychotic features. Records of VA hospitalization from August 1997 to September 1997 reflect a diagnosis of PTSD. During treatment the veteran reported that during his United Nations peacekeeping duties people started dying around him and he just didn't care. He noted almost getting killed several times. He reported the death of a Sergeant who died in his lap. Past surgical history included a craniotomy, approximately 1992, for a gunshot wound to the left frontal region. The principal diagnosis in the discharge summary was PTSD. VA records of hospitalization from October 1997 to December 1997 reflect a diagnosis of PTSD. The records include a history of a gun shot wound to the head with resultant surgery. The records are silent for military history. The Axis I diagnoses were PTSD, chronic; intermittent explosive disorder; history of mixed substance abuse, in remission; and depression, secondary to history of multiple traumatic brain injures. A June 1998 letter from the Director, Center for Research of Unit Records, Department of the Army, states that the Center was not able to obtain a history for the United Nations Command Support Group, Joint Security Area, during the veteran's Korean tour. The letter additionally states that available United States Army casualty data didn't list any United Sates casualties in Korea during 1980 and 1981. Analysis The threshold question that must be resolved with regard to a claim is whether the veteran has presented evidence of a well-grounded claim. See 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1991). A well-grounded claim is a plausible claim that is meritorious on its own or capable of substantiation. See Murphy, 1 Vet. App. at 81. An allegation of a disorder that is service connected is not sufficient; the veteran must submit medical evidence in support of a claim that would "justify a belief by a fair and impartial individual that the claim is plausible." See 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The quality and quantity of evidence required to meet this statutory burden of necessity will depend upon the issue presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). If the veteran has not presented a well-grounded claim, his appeal on the pertinent issues must fail and there is no duty to assist him further in the development of the claim. 38 U.S.C.A. § 5107(a). See Epps v. Gober, 126 F.3d 1464 (1997). In order for a claim to be well-grounded, there must be competent 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); 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Lay assertions of medical causation cannot constitute evidence to render a claim well- grounded under 38 U.S.C.A. § 5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well-grounded. Id. Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1131 (West 1991). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A disorder may be service connected if the evidence of record, regardless of its date, shows that the veteran had a chronic disorder in service or during an applicable presumptive period, and that the veteran still has such a disorder. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Such evidence must be medical unless it relates to a disorder that may be competently demonstrated by lay observation. Savage. If the disorder is not chronic, it may still be service connected if the disorder is observed in service or an applicable presumptive period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present disorder to that symptomatology. Id. Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. If the evidence establishes that the veteran was a prisoner-of-war under the provisions of 38 C.F.R. § 3.1(y) and the claimed stressor is related to that prisoner-of-war experience, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (1999). See also, Cohen v. Brown, 10 Vet. App. 128 (1997); Moreau v. Brown, 9 Vet. App. 389, 394-95 (1996). The evidence necessary to establish the occurrence of a recognizable stressor during service will vary depending on whether the veteran "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet. App. 60 (1993). If the claimed stressor is not combat related, the veteran's lay testimony regarding his inservice stressor is insufficient, standing alone, to establish service connection and must be corroborated by credible evidence. Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996); Doran v. Brown, 6 Vet. App. 283, 289 (1994). 38 U.S.C.A. § 1154(b) provides that in the case of any veteran who engaged in combat with the enemy in active service during a period of war, campaign, or expedition, the Secretary shall accept as sufficient proof of service- connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incidence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service. Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. Collette v. Brown, 83 F.3d 389 (Fed. Cir. 1996). The ordinary meaning of the phrase "engaged in combat with the enemy," as used in 38 U.S.C.A. § 1154(b), requires that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. VAOPGCPREC 12-99. The Board acknowledges the veteran's contention that he was subject to witnessing the violent deaths of fellow servicemen under combat conditions during his period of active service. The Board further acknowledges the history as given by the veteran of blowing up cities and woods and killing all people in the area while serving in the Sinai Desert. Neither United States nor the United Nations was at war during the years 1980 to 1983, so that the types of combat he describes being subject to are not consistent with the conditions of his service. The Department of the Army has indicated that there were no United States casualties in Korea in 1980 and 1981. There is no corroboration of the types of combat conditions to which the veteran claims he was exposed during service. Some of his claims, such as taking part in blowing up cities and woods and killing hundreds of people while serving on a peacekeeping force, are patently incredible and unbelievable, to the great detriment of his credibility. In light of the foregoing, Board finds that the veteran did not serve in combat and could not have incurred a combat-related stressor. The Board further notes that the veteran has described as a stressor an incident in which he witnessed a Sergeant with whom he served being killed in friendly fire. He described this Sergeant as having died in his lap. He referred to this as being a racially motivated incident. There is no independent corroboration of this non-combat incident in the record, and therefore we cannot accept the veteran's unsubstantiated testimony of this incident as sufficient to establish a stressor. The Board acknowledges the contentions of the veteran that he has PTSD as a result of exposure to inservice combat stressors and the incident in which he witnessed a friend being killed by friendly fire. A written medical opinion to this effect would be required to satisfy the medical nexus requirement for a well grounded claim. The veteran, as a lay person, is not competent to provide medical opinions, so that his assertions as to medical diagnosis or causation cannot constitute evidence of a well-grounded claim. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The Board notes that many years after the veteran's period of active service he received a gunshot wound to the head, and that VA records of hospitalization for PTSD from October 1997 to December 1997 include this incident in the veteran's history but are silent for military history. The Board notes that, even viewing the evidence in the light most favorable to the veteran, and in the absence of an explicit medical nexus opinion, any possible inference which could be drawn of a link between diagnosed PTSD and the veteran's period of active service is greatly attenuated by the veteran's post- service history of a gunshot wound to the head, which would appear to be a possible nonservice-related stressor. The veteran is receiving Social Security Disability Insurance, and he has asserted that these benefits are being provided on the basis of his PTSD. Social Security disability benefits are provided without regard to etiology, but rather only in light of the current level of disability. Thus, the fact that he is currently awarded Social Security benefits is not probative of a link between the veteran's PTSD and his period of active service, nor is it probative of the veteran's claimed inservice stressors. The Board notes that neither the veteran nor his representative has claimed that the Social Security Administration records would provide evidence of a link between the veteran's period of active service and his current PTSD; nor have they averred that the Social Security records would in any way be probative of an inservice stressor. Accordingly, the Board finds that a remand for the purpose of obtaining the Social Security administration records is not warranted under the particular facts of this case. In sum, there are clear diagnoses of PTSD of record. However, there is no medical "nexus" evidence of record linking the veteran's PTSD to a verified inservice stressor, or, for that matter, to any claimed inservice stressor. Accordingly, the claim for service connection for PTSD must be denied as not well grounded. Epps; Caluza. For essentially the same reasons, the Board finds that the requirements for service connection for PTSD as set forth in 38 C.F.R. § 3.304(f) are not met. ORDER Entitlement to service connection for PTSD is denied. RENÉE M. PELLETIER Member, Board of Veterans' Appeals