Citation Nr: 0001442 Decision Date: 01/18/00 Archive Date: 01/27/00 DOCKET NO. 96-36 997A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUES 1. Whether new and material evidence had been submitted to reopen a claim of service connection for a bilateral foot disability. 2. Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Shawkey, Counsel INTRODUCTION This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 1996 rating decision of the Department of Veterans Affairs (VA) regional office (RO) in Buffalo, New York, that denied the veteran's application to reopen a claim of service connection for a bilateral foot disability and denied his claim of service connection for PTSD. FINDINGS OF FACT 1. In a September 1973 rating decision the RO denied a claim of service connection for a bilateral foot condition; this decision is final. 2. Evidence added to the record since the September 1973 RO decision is not cumulative or redundant, is relevant and probative, and, when viewed in conjunction with the evidence previously of record is so significant that it must be considered in order to fairly decide the merits of the case. 3. Recurrent keratomas between the toes of the veteran's feet are attributable to service. 4. The veteran has in-service stressors associated with combat during service which support a diagnosis of PTSD; PTSD is attributable to service. CONCLUSIONS OF LAW 1. Evidence received since the September 1973 RO decision denying a claim of service connection for a bilateral foot disability is new and material; and the veteran's claim is reopened. 38 U.S.C.A. §§ 5108, 7105 (West 1991); 38 C.F.R. § 3.156 (1999). 2. Recurrent keratomas between the toes of the veteran's feet were incurred in active military service. 38 U.S.C.A. §§ 1110, 1111 (West 1991); 38 C.F.R. § 3.303 (1999). 3. The veteran has PTSD as a result of active military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.304(f) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran's service records show that he served with the "C" Co, 11th Engineer Battalion, 3d Marine Division, from December 1967 to January 1969, and his military occupational specialty was that of a combat engineer. He was not awarded any decorations evincing combat. At his enlistment examination in March 1967, the veteran had a normal clinical examination of his feet as well as a normal psychiatric examination. He denied having any foot trouble on a March 1967 Report of Medical History. In May 1967 the veteran was seen at a medical facility complaining of a heloma molle bilaterally in the 4rth interspace. He was also seen for complaints of pain in both arches which had been present for approximately six months. He was diagnosed as having pronation. The veteran was seen at a medical facility in May 1967 complaining of recurrent soreness between his toes. He reported that he had been treated for soreness between his great toe and second toe by a civilian doctor "3 wks", and that the pain persisted between the toes of his right foot. Findings in May 1967 revealed hyperhydroses interspaces toes in both feet. The examiner noted that the veteran " 'now states' pain between the 4th & 5th digit right foot [for] three wks." He prescribed Burrow's cream and Burrow's soaks. A June 1967 service medical record contains the veteran's report that his boots were too large and that he had a soft corn between the 4th and 5th digit of both feet. It was noted that he was in his 5th week of training. An impression was given of "soft corn - boots to(sic) large". In September 1967 the veteran was seen on several occasions for bilateral foot pain. The veteran was found to have a wart between the 4th and 5th digits of both feet in October 1967. A December 1967 Report of Medical History states that the veteran had a faulty gait due to foot trouble. His foot trouble was described as a "heloma mole". In May 1968 the veteran was seen at a medical facility where he was treated for large calluses on both feet. Service medical records dated in August 1968 reflect the veteran's complaints of pain between the 4rth and 5th toes bilaterally. Findings revealed maceration and cracking between these toes on both feet. An August 1968 service medical record from the dermatology clinic reflects a diagnosis of pitted keratotopahysesis. The veteran was found to have recurrent soft corns between his toes as noted on October and November 1968 service medical records. Service medical records in December 1968 and April 1969 show continuing complaints of pain in the veteran's feet due to corns. An April 1969 service medical record notes that there was no local pathology to explain the type of symptoms. In May 1969 the veteran underwent callous reduction bilaterally in the balls of his feet and the lateral side of his heel. In July 1969 the veteran was seen by a medical officer who noted that the veteran was from a broken family and the product of foster homes and families. He also noted that the veteran had been frustrated early in life by attempts at close interpersonal relationships. He said that the veteran had diffuse anger and hostility directed mainly toward white people, the source of which was his own family and foster homes. He said that the veteran showed no evidence of any psychosis, neurosis, character or personality disorders and was found to be the product of society - prejudice, chronic. The veteran underwent a psychiatric evaluation in September 1969. His recent history included recurrent outbursts of violence and belligerence. He reported that his stepmother accused him of trying to seduce her and that he was up for administrative separation. On examination he had no psychosis, thought disorder or disabling neurosis. He was diagnosed as having sociopathic personality, chronic, severe, which existed prior to enlistment. In October 1969 the veteran was placed on sick call due to complaints of corns on both feet. The veteran was found to have a normal psychiatric evaluation as well as a normal evaluation of his feet at his separation examination in November 1969. In April 1971 the veteran spent nine days as an inpatient at a VA orthopedic facility due to a pressure sore, secondary to condyle proximal phalanx of 5th toe. The hospital summary notes that surgery was being deferred because of skin breakdown between the 4th and 5th toes, and would be rescheduled at a time when there would be no fungus infection. In May 1971 the veteran was admitted to a VA medical facility for six days and given a diagnosis of bilateral clavus deformity between the 4th and 5th toes. Excision of the proximal condyle, lateral 4th toes, bilaterally, was performed. A related hospital record indicates that the veteran had had the deformity for five years. In July 1973 the veteran filed a claim of service connection for a bilateral foot disability. The RO denied this claim in September 1973. In May 1980 the veteran was evaluated by a rehabilitation counselor for vocational rehabilitation purposes. He was given a provisional diagnosis of alcoholism and depression. A May 1987 VA outpatient record notes that the veteran had erosion between the right 4th and 5th toes and metatarsal head pain on minimal palpation. He was diagnosed as having callosities - tinea pedis - rule out osteomyelitis. A July 1987 VA consultation record from the orthopedic clinic contains an assessment of multiple corns. It also contains a history of pain in both toes since 1968. A July 1987 record from the VA podiatry clinic notes that the veteran had multi hyperkeratic lesion on his feet including in the web on the 4th and 5th toes bilaterally - soft corns. In November 1987 the veteran was admitted to a VA medical facility for two days where he underwent debridement of a hypertrophy scar on the right foot in the 4th to 5th intermetatarsal area. Private podiatry records in 1987 and 1988 show treatment for the veteran's foot problems, including a finding in February 1988 of intractable keratomas in the interdigital spaces of the right and left 4th interspace. In November 1988 the veteran was seen at a VA orthopedic clinic with a history of many years of bilateral foot pain between the 4th and 5th metatarsal heads. The treatment record notes that the veteran underwent right foot excision of an interdigit neuroma between the 4th and 5th interspace with temporary relief. It also contains am impression of interdigital nerve compression between the 4th and 4th metatarsal heads bilaterally. Private podiatry records from 1989 to 1995 show continuing treatment for the veteran's foot problems, including a finding in May 1990 of massive heloma molles between the 4th and 5th toes bilaterally in conjunction with dorsal helomas to the 5th toes bilaterally. A July 1993 podiatry note shows that the veteran returned at monthly intervals for the reduction of keratomas. A March 1995 VA neuropsychiatric record states that the veteran had been referred to the Vet Center to rule out depression. He was given an impression of major depression. A bilateral foot X-ray taken by VA in August 1995 revealed no major abnormalities of the left foot except for a 2-3 millimeter bony density projected within the 5th middle interphalangeal joint. The right foot demonstrated some degenerative changes of the first metatarsal phalangeal joint and the interphalangeal joints. On file is an August 1995 VA general examination report containing an impression of "[s]tatus post multiple surgeries to the feet, which [the veteran] dates to his military service and with continuing pain to be evaluated by Orthopedics." At a VA examination in September 1995, the veteran complained of bilateral foot pain since 1969 which he attributed to prolonged drills and walking on rough terrain in the jungle during the Vietnam war. He was diagnosed as having bilateral foot pain secondary to degenerative changes of the metatarsal and interphalangeal joints, no evidence of fracture or ligament instability, and hyperkeratosis of both feet. A VA examination report dated in September 1995 contains a diagnosis of adjustment disorder with mixed emotional features of anxiety and depression. This report also states that the veteran denied any symptoms suggestive of PTSD. In December 1995 the veteran filed an application to reopen a claim of service connection for a bilateral foot disability and filed a claim of service connection for PTSD. On file are counseling notes from a VA mental health center showing that the veteran and his partner attended counseling sessions for two months beginning in February 1996. In a March 1996 statement, the veteran's mother said that the veteran did not have any problems with his feet prior to his military service. In an April 1996 rating decision, the RO denied the veteran's application to reopen a claim of service connection for a bilateral foot disability and denied his claim of service connection for PTSD. In December 1996 the veteran's readjustment counseling therapist from the Vet Center said that he had been seeing the veteran since February 1995 and that in addition to other issues, the veteran was being treated for "subdiagnostic" PTSD. At a RO hearing in December 1996, the veteran testified that he had no foot problems prior to service. He said that in service he was issued boots that were too big for him (a size 11 compared to his size 8 1/2), and that he had been too afraid to say anything. He said that as a result his feet kept sliding back and forth in the boots causing calluses and corns. He said that while on leave during active duty he sought treatment with a private podiatrist who had provided some relief for him. The veteran said that he continued to have problems with his feet after service. In regard to his PTSD claim, he said that he was bothered by having shot a Vietnamese boy while on patrol and that he remembered being afraid in Vietnam all of the time. He said that there had been a lot of artillery attacks with six confirmed dead. He said that he had been bothered by these experiences ever since service. He also said that his duties as a combat engineer included mine sweeps. He recalled a racial incident where some servicemen burned a cross in front of his tent. He denied ever having been treated for psychological problems prior to service. Private podiatry records in 1996 and 1997 show continuous treatment for the veteran's foot problems, including monthly debridement of scattered keratomas including on the right and left 4th and 5th toes dorsal laterally proximal interphalangeal joints. In February 1997 the veteran's readjustment counselor from the Vet Center completed a medical questionnaire diagnosing the veteran as having "subclinical" PTSD. In March 1997 the veteran underwent a psychiatric evaluation for purposes of Social Security benefits. The examiner stated that the veteran's psychiatric history began in 1967 or 1968 when serving a 14 month tour in Vietnam involving active combat. He said that following the veteran's wartime experience, he experienced symptoms of PTSD although he did not seek any help for it. He diagnosed the veteran as having adjustment order and history of PTSD. In this regard, the examiner said that "[the veteran] has, by his own account, some lingering signs of posttraumatic stress secondary to his Vietnam experience. This is not part of the disability claim." Psychological testing conducted by a private psychologist in May 1997 revealed evidence that the veteran was suffering from moderate or greater levels of a PTSD as well as a mood disorder, not otherwise specified, with dysthymic, atypically depressed, anxious, and episodically irritable features. In August 1997 the RO received a copy of the 11th Engineer Battalion Marine Division command chronology from the Department of the Navy for the period of August to November 1968. This chronology shows that in September 1968 the 11th Battalion performed mine sweeps and came under incoming fire on two occasions at Dong Ha Combat Base. Similar notations are noted for the month of October including the following statement: On 22 October this Battalion (11th) received three KIA's (killed in action's) and four WIA's (wounded in action's) from enemy 130 mm rounds. During the last week in October the Battalion spent an inordinate amount of time on blue alert (enemy incoming in progress or expected). The Battalion messhall took a direct hit in the galley... The chronology report also shows that the veteran's battalion continued to perform mine sweeps in the month of November with the battalion sweep team coming under sniper and automatic weapons fire on one occasion. There were two hostile WIA's reported that month. In July 1997 Felipe Diaz, M.D., stated in a letter that the veteran was under his care for a low back disability and that he was also suffering from depression and PTSD which had worsened due to the veteran's chronic pain. A VA Social Survey was conducted in September 1997 at which time the veteran reported stressors of having killed a Vietnamese boy, being responsible for blowing up land mines and booby traps, seeing a log of buddies killed or injured, seeing choppers discharge "GI's" who were mowed down by the enemy, handling body bags and dead without body bags, being exposed to enemy fire, including artillery, yelling and screaming, being in the jungle for 38 days and being on patrols despite telling his superiors of his foot problems. Bilateral foot X-rays taken at a VA medical facility in October 1997 revealed some deformity of the distal end of the proximal phalanges of the 4rth and 5th toes on the right and in the proximal interphalangeal joint of the left 5th toe. Both deformities were thought to have possibly been the result of surgery. At a VA foot examination in October 1997, the veteran could not recall specific events involving his feet in service other than to say that his feet were "somehow 'corroded' while in the service." He reported needing ongoing podiatry care for calluses of his feet and also reported surgery in the 1980s which involved "moving the nerves in his feet". The examiner noted that the veteran's claims file was quite disorganized and very difficult to assess. He also noted that the veteran's 4th and 5th toes of both feet appeared to have been sutured together. He provided an overall impression of right and left foot with hypertrophic scarring, calluses, and degenerative joint disease of both feet pending X-rays. He gave an addendum opinion in where he reported the October 1997 X-ray findings. In October 1997 the veteran underwent a VA psychiatric evaluation where he reported being exposed to multiple traumatic experiences in service including killing a 9 year old boy and being in multiple death defining situations. He was given an impression of depressive disorder not otherwise specified. The examiner commented that although the veteran presented with some PTSD symptoms related to some traumatic experiences in Vietnam during the war, he did not meet DSM-IV criteria for PTSD. A private psychiatric examination was also performed in October 1997 for purposes of Social Security benefits. The examiner reported that the veteran was a Vietnam veteran and had been experiencing symptoms of PTSD throughout his adult life related to traumatic events that he was exposed to while in combat during his 14 months in Vietnam. He said that after service the veteran began abusing drugs very heavily in a maladaptive attempt to distance himself from some of the anxiety, rageful outbursts, depression, and intrusive memories that he had experienced. He said that despite the veteran's continuous symptoms of PTSD over the years, he did not become involved in any mental health treatment until two years earlier. The examiner diagnosed the veteran as having PTSD. In a February 1998 decision from the Social Security Administration, the veteran was found to be disabled and entitled to disability income due to PTSD and a back disability. II. Legal Analysis Bilateral Foot Disability The RO denied the veteran's claim of service connection for a bilateral foot condition in September 1973. The veteran did not appeal this decision and it is final. 38 C.F.R. § 20.1103 (1999). Accordingly, new and material evidence must be submitted since the September 1973 RO decision in order to reopen the claim of service connection for a bilateral foot disability. See 38 U.S.C.A. § 5108; Manio v. Derwinski, 1 Vet. App. 140 (1990); Evans v. Brown, 9 Vet. App. 273 (1996). The standard for determining whether new and material has been submitted has changed. Under the "old" standard, in order to reopen a claim, the new evidence, when viewed in the context of all the evidence, both new and old, must create a reasonable possibility that the outcome of the case on the merits would be changed. Colvin v. Derwinski, 1 Vet. App. 171 (1991) Subsequent to the Colvin decision, in 1998, the Federal Circuit expressly rejected the "old" standard and instead held that new and material evidence means evidence not previously submitted to agency decision makers, which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with the evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a); Hodge v. West, 155 F.3d 1356 (Federal Circuit 1998). When the RO denied the veteran's application to reopen a claim of service connection for a foot disability in April 1996, it relied on the "old" standard for determining whether new and material evidence has been submitted as set forth in the Colvin decision. However, by applying the "new" standard set out in the Hodge decision, it is clear that the evidence submitted after the RO's September 1973 decision bears directly and substantially on a claim of service connection for a bilateral foot disability and is thus new and material. Such evidence includes numerous private and VA medical records which reflect the veteran's continuous foot symptomatology affecting the same area of the veteran's feet as in service. This evidence is indeed significant to the veteran's claim of service connection for a bilateral foot disability. Hodge, supra. Having determined that new and material evidence has been added to the record since the September 1973 RO decision, the veteran's claim of service connection for a bilateral foot disability is reopened. Hodge, supra. Now that the veteran's claim has been reopened, it must be immediately determined whether, based upon all the evidence of record in support of the claim, presuming its credibility, the reopened claim is well grounded pursuant to 5107(a). Elkins v. West, 12 Vet. App. 209 (1999); Winters v West, 12 Vet. App. 203 (1999). Three types of evidence must be presented in order for a claim for service connection to be well grounded: (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Where the determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required. Epps v. Gober, 126 F.3d at 1464, 1468 (Fed Cir 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995). The veteran's service medical records show that he was treated on numerous occasions in service for foot problems. The majority of these problems pertained to complaints of pain between the toes of his 4th and 5th digits and findings of growths in these areas identified as calluses, lesions, corns and warts. Postservice evidence includes continuing complaints and treatment related to the veteran's toes and feet as early as 1971. In view of the veteran's statements and testimony as to experiencing continuous foot problems since service, along with medical evidence reflecting continuous foot problems since service, the veteran's claim of service connection for a bilateral foot disorder is plausible and is thus well grounded. 38 C.F.R. § 3.303(b); McManaway v. West, No. 97-280 (U.S. Vet. App. Sept. 29, 1999). See also Savage v. Gober, 10 Vet. App. 488 (1997). Moreover, VA has fulfilled its statutory duty to assist the veteran with the facts relevant to this claim by properly developing the evidence. Caluza; Elkins; Winters. In view of the plausibility of the veteran's claim of service connection for a bilateral foot disability and the fulfillment of VA's duty to assist the veteran in developing this claim, consideration will now be given to the underlying merits of service connection. Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in line of duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. 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). In addition, service connection may be granted under the provisions of 38 C.F.R. § 3.303(b), when the evidence, regardless of its date, shows that a veteran had a chronic condition in service or during the applicable presumptive period. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established, there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. In this regard, the Court of Appeals for Veterans Claims (formerly known as the Court of Veterans Appeals) (Court) has repeatedly cautioned that the regulatory requirement is for a showing of continuity of symptomatology, not treatment. Savage v. Gober, 10 Vet. App. 488, 496-497 (1997); Wilson v. Derwinski, 2 Vet. App. 16, 19 (1992). The evidence in this case supports a showing of continuity of foot symptomatology since service. § 3.303(b). That is, the evidence shows frequent in-service treatment for the veteran's feet diagnosed as molles, soft corns, calluses and warts located between the 4th and 5th toes bilaterally, as well as continuous complaints in the same area within two years after service. There is no evidence at the time of the veteran's entry into service which supports a finding that the condition existed prior to entry, nor is there clear and unmistakable evidence of preexistence. See 38 U.S.C.A. § 1111 (West 1991); Crowe v. Brown, 7 Vet. App. 238 (1994). The veteran was found to have a normal evaluation of his feet at his enlistment examination in March 1967, and reported having no history of foot problems on a March 1967 Report of Medical History. Accordingly, he is presumed to have been sound at entry into service. Id. Although a May 1967 service medical record indicates that the veteran had had arch pain that predated service by six months, there is no similar notation as to preexisting problems with corns, calluses, molles, or warts between the veteran's toes. While another May 1967 service medical record notes that the veteran had been treated by a civilian doctor for soreness between the great toe and secondary toe "3 weeks", this notation in no way indicates that such treatment predated service. In fact, the veteran testified in December 1996 that he did not have these problems prior to service and that the treatment that he received by a civilian doctor occurred while he was on active duty, but in a leave status. Moreover, a notation on a May 1967 service medical record that the veteran " 'now states' pain between the 4th & 5th digit right foot [for] three wks" indicates the onset of such pain in service. In view of the evidence showing numerous complaints and treatment in service for recurrent growths between the veteran's toes in service, primarily between the 4th and 5th toes, as well as similar complaints and treatment for this problem within two years of service and continuing, the veteran's claim of service connection for residuals of recurrent keratoma between the toes, bilaterally, is granted. 38 C.F.R. § 3.303(b). PTSD The veteran's claim of service connection for PTSD is well grounded within the meaning of 38 U.S.C.A. § 5107, in that it is plausible. This is based on diagnoses of PTSD in the file, presumed-to-be credible history of stressors as related by the veteran, and a medical opinion that the PTSD is related to traumatic experiences in service. See King v. Brown, 5 Vet. App. 19 (1993); Cohen v. Brown, 10 Vet. App. 128, 137 (1997). In addition, VA has fulfilled its duty to assist the veteran in developing evidence pertinent to his claim. § 5107(a). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with VA's schedule for rating disabilities, § 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. 38 C.F.R. § 3.304(f) (1999). 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, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f); see also Gaines v. West, 11 Vet. App. 353, 357-58 (1998). The veteran's alleged stressors of being subjected to enemy fire, of being responsible for blowing up land mines and of being in constant fear are most certainly related to a combat environment. The above stressors are consistent with the command chronology records of the 11th Engineer Battalion Marine Division. These records, which cover the period from August 1968 to November 1968, show that the veteran's battalion routinely performed mine sweeps and received incoming hostile fire on numerous occasions. More specifically, they show that in August 1968 the battalion was subjected to hostile enemy fire on two occasions and sustained four nonhostile casualties. In the last week of October 1968, the battalion spent an "inordinate amount of time on blue alert" meaning "enemy incoming in progress or expected" and sustained three hostile killed in action and eight hostile wounded in action. Since there is no evidence that the veteran was personally precluded from experiencing these verified traumatic events as chronologized, it is assumed that he was in fact exposed to them. Suozzi v. Brown, 10 Vet. App. 307, 310 (1997). In addressing the requirement that there be a diagnosis of PTSD, the evidence is inconsistent. For example, initial psychiatric treatment records in 1995 reflect diagnoses of major depression and adjustment disorder with mixed emotional features of anxiety and depression. They do not mention PTSD. Similarly, the veteran was diagnosed at a VA psychiatric examination in October 1997 as having depressive disorder not otherwise specified. This diagnosis was made in conjunction with the veteran's report of having killed a 9 year old boy in service and of having been in multiple death defining situations. In this regard, the examiner stated that although the veteran presented with some PTSD symptoms related to some traumatic experiences in Vietnam during the war, he did not meet DSM-IV criteria for PTSD. There is also a March 1997 psychiatric examination report that was completed by a private examiner for Social Security disability benefit purposes. In this report, the examiner diagnosed the veteran as having adjustment disorder and history of PTSD. He went on to state that the veteran's psychiatric history began in 1967 or 1968 when he was serving 14 months in Vietnam and was involved in "active combat". He also said that the veteran had, by his own account, some lingering signs of PTSD secondary to his Vietnam experience, but that that "[was] not part of the disability claim". In contrast to the above-noted evidence, the veteran's readjustment counselor from the Vet Center opined in December 1996 that the veteran had "subdiagnostic" PTSD. In a subsequent statement in February 1997, he diagnosed the veteran as having "subclinical" PTSD. Later, in October 1997, the veteran underwent a psychiatric examination for Social Security Administration disability purposes and was again diagnosed as having PTSD. This examiner stated that the veteran had been experiencing symptoms of PTSD throughout his adult life related to traumatic events that he was exposed to while in combat during his 14 months in Vietnam. In addition, in February 1998, the Social Security Administration determined that the veteran was disabled due to PTSD and a back disability. While determinations by the Social Security Administration are not controlling in regard to VA's determinations, like other pertinent evidence, such determinations must be considered. Murincsak v. Derwinski, 2 Vet. App. 363 (1992); Collier v. Derwinski, 1 Vet. App. 413 (1991). While the medical evidence as summarized above is not consistent as to a diagnosis of PTSD, it does stand in relative equipoise. As such, the veteran should be given the benefit of the doubt in this matter resulting in a finding of a diagnosis of PTSD. 38 U.S.C.A. § 5107(b). In light of a diagnosis of PTSD and verified in-service stressors, it must next be determined whether there exists a link, established by medical evidence, between current symptomatology and the verified in-service stressors. 38 C.F.R. § 3.304(f). In Cohen v. Brown, 10 Vet. App. 128 (1997), the Court held that the sufficiency of a stressor in warranting a diagnosis of PTSD is a clinical determination for the examining mental health professional. The examining health professional in this case who specifically provides links the veteran's PTSD and service is the private examiner in October 1997 who evaluated him for Social Security disability purposes. Although this examiner did not make reference to the veteran's specific stressors other than to classify them as "traumatic events that [the veteran] was exposed to while in combat during his 14 months in Vietnam (1967-1968)", this statement when considered in conjunction with the verified stressors that relate to combat (routine mine sweeps, exposure on numerous occasions to incoming enemy fire, confirmed hostile casualties, and being in constant fear), is sufficient evidence to satisfy this nexus element. § 3.304(f). In light of a diagnosis of PTSD, conclusive evidence of stressors related to combat, and medical evidence linking the veteran's PTSD symptoms to the traumatic incidents in Vietnam, the claim of service connection for PTSD is granted. 38 C.F.R. § 3.304(f). ORDER Service connection for recurrent keratoma between the veteran's toes, bilaterally, is granted. Service connection for PTSD is granted. C.W. Symanski Member, Board of Veterans' Appeals