Citation Nr: 0004612 Decision Date: 02/23/00 Archive Date: 02/28/00 DOCKET NO. 96 - 35 289 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from February 1964 to December 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of January 1996 from the Department of Veterans Affairs (VA) Regional Office (RO) in Wichita, Kansas. This case was previously before the Board in May 1997, and was Remanded to the Board for further development of the medical and other evidence of record. The requested actions have been satisfactorily completed, and the case is now before the Board for further appellate consideration. FINDINGS OF FACT 1. The veteran's claim for PTSD is plausible because it contains a VA diagnosis of PTSD and relates the condition to the veteran's unverified history of a stressor during his military service. 2. The veteran did not engage in combat against the enemy during his military service. 3. The record contains no diagnosis of PTSD based upon credible supporting evidence that a claimed in-service stressor actually occurred. CONCLUSIONS OF LAW 1. The veteran's claim for PTSD is well grounded because it is plausible, contains a VA diagnosis of PTSD, and relates the condition to the veteran's unverified history of a stressor during his military service. 38 C.F.R. § 3.304(f) (1999); Cohen v. Brown, 10 Vet. App. 128 (1997). 2. The criteria for a grant of service connection for PTSD are not met. 38 U.S.C.A. § 1110, 1131, 1154(b), 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.304(d), 3.304(f) (1999). 3. PTSD was not incurred in or aggravated by active service. 38 U.S.C.A. § 1110, 1131, 1154(b), 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.304(d), 3.304(f) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds that the appellant's claim for service connection for PTSD is plausible and is thus "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). A claim for PTSD that contains a VA or private provider diagnosis of PTSD and relates the condition to the veteran's unverified history of a stressor during his military service is generally well-grounded. Cohen v. Brown, 10 Vet. App. 128 (1997). We further find that the facts relevant to the issue on appeal have been properly developed and that the statutory obligation of VA to assist the veteran in the development of his claim has been satisfied. 38 U.S.C.A. § 5107(a)(West 1991). In that connection, we note that the RO has obtained available evidence from all sources identified by the veteran, that he has been afforded a personal hearing before a Hearing Officer at the RO in September 1996, and that he underwent VA psychiatric examinations in connection with his claim in September 1995 and in August 1998, and comprehensive VA psychological testing and psychiatric examinations in November 1998. On appellate review, the Board sees no areas in which further development might be productive. The veteran contends that he served as a crash crewman on an air/sea rescue unit during active service; that he had to pick up body parts on runways; and that he developed PTSD as a consequence of his exposure to horrifying and traumatic experiences I. The Evidence The veteran's DD Form 214N shows that he served on active duty in the United States Navy from February 1964 to December 1967; that he did not complete any service technical or specialty training schools; that he was not wounded in service; and that he did not receive any awards or decorations for valor. His military occupational specialty was Aviation Bosun's Mate (H). The equivalent civilian occupation for the veteran's duties in service was Lineman (air transport). The veteran's service medical records are silent for complaint, treatment, findings or diagnosis of an acquired psychiatric disability during his period of active service, on service separation examination, or within the initial postservice year. In September 1979, approximately 12 years following final service separation, the veteran sustained severe facial and brain trauma in a motorcycle accident. A report of private psychological testing and evaluation of the veteran in June 1980 yielded a diagnosis of psychophysiological depressive reaction secondary to remaining mild residuals from a head injury in a man with something of a repressive-hysterical personality makeup. At a personal hearing held in April 1982, the veteran made no mention of PTSD stressors or symptomatology. A February 1987 evaluation of the veteran by a private physician for purposes of a disability determination resulted in a diagnosis of paranoid personality disorder. A December 1985 VA hospital summary diagnosed an adjustment reaction to stress (job/family). A report of psychological testing at The Memminger Center in May 1987 diagnosed organic brain damage consistent with the type of coup-contracoup brain trauma often associated with motor vehicle accidents. VA outpatient clinic records dated in October 1988 show Axis I diagnoses of organic personality syndrome, and insomnia related to organic factors; an Axis II diagnosis of paranoid traits; and Axis III diagnoses of anosmia, left optic nerve nonfunctional, right tinnitus, chronic headache, seizure disorder. The veteran was further noted to claim PTSD stemming from duties as a fireman in the Navy, but he declined to give details. At a personal hearing held at the RO in September 1990, the veteran's private attorney introduced into evidence a chronology of the veteran's medical history from his 1979 head injury to the present date, but made no mention of PTSD, and the veteran's testimony was devoid of any reference to PTSD stressors or symptoms. A report of VA psychiatric examination in May 1991 diagnosed organic personality syndrome; alcohol dependency, by history; seizure disorder, by history; and residuals of head injury and bifrontal craniotomy. That report noted the veteran's statement that he did not feel that he developed any PTSD symptoms from his experiences as a crash crewman while in service. A rating decision of September 1991 granted a permanent and total disability rating for pension purposes, effective April 1, 1991, based upon the veteran's nonservice-connected residuals of a head injury. The veteran was also awarded Social Security Administration disability benefits, effective September 1, 1991. At that time, there was no claim for or medical diagnosis of PTSD. VA outpatient treatment records dated in December 1994 show that the veteran sought treatment for marijuana abuse, but was unwilling to enter a program until after his Court date on charges of selling marijuana. In May 1995, he was accepted as an outpatient in the Alcohol and Drug Treatment Unit (ADTU), VAMC, Topeka, for marijuana abuse. A VA hospital summary, dated in May 1995, shows that the veteran was admitted at the request of the Court following conviction of sale of marijuana. He reported that he had used 3 to 5 joints of marijuana every night since 1967; that he had been drinking since age 15 and had experienced withdrawal symptoms including tremors, sweating, nervousness, nausea, vomiting and diarrhea; that he had been using cocaine since the 1960's; that he had experimented with LSD, but was not addicted; that he had been taking two tablets of Percocet daily for the last nine years; and that he had been taking Xanax, .25 mgs. three times daily for six years. The veteran further claimed that he was an Air/Sea Crash Rescue Worker, and that he had PTSD due to traumatic rescue missions while in service, stating that he occasionally has nightmares or flashbacks. He denied an exaggerated startle response, denied hypervigilance; denied having guilt or survivor guilt; denied emotional numbing or problems with intimacy; denied problems with anger control; denied sleeping with weapons; reported that his sleep was not disturbed, and stated that he did not wish to be treated in the PTSD unit. The Axis I diagnoses at hospital discharge included cannabis abuse; nicotine dependence; alcohol dependence; distant history of heroin dependence; distant history of cocaine and LSD abuse. The veteran's initial application for service connection for PTSD (VA Form 21-526) was received at the RO in May 1995. In that document, he asserted that he was treated for PTSD at the VAMC, Topeka, Kansas. He subsequently failed to respond to stressor development letters in June 1995 and in November 1995. A report of VA psychiatric examination, conducted in 1995, cited the veteran's statement that he had PTSD due to his experiences in service. He claimed that he was stationed in Florida, Georgia, Newfoundland, and Iceland; that his work consisted of cleaning up after accidents on the airport runway and picking up body parts after crashes. He alleged stressful incidents which included seeing individuals cut in half in aircraft wheel wells, mid-air collisions, helicopter crashes, ejection-seat firings inside hangars, and individuals sucked into jet engine intakes. He reported that he has traumatic dreams which wake him up and stress him out; alleged that he has an increased startle response when he hears sirens; claimed that he is hypervigilant and has a fear of fire; but denied avoidant behavior in connection with his "combat experiences", denied feelings of guilt, and denied difficulties with anger. No psychological testing was performed. The Axis I diagnoses included organic personality syndrome, alcohol dependence by history, history of cannabis abuse, and possible PTSD; the Axis II diagnosis was organic personality disorder; Axis IV psychosocial stressors were identified as financial difficulties, limited social support, and serious medical illness. The examiner stated that with the veteran's organicity, it was difficult to assess objectively the contributions from his head injury versus other diagnoses such as PTSD, but noted that he was clearly impaired by his organic brain dysfunction. When asked by the RO to clarify the diagnosis of "possible PTSD", and to identify stressors, the examiner responded that "to ask the [veteran] to give specifics as far as names, dates, locations, of his trauma is ludicrous given his organic brain syndrome and difficulty with memory." She went on to state that the veteran had "experienced events in the war zone which are quite disturbing and distressing to him, he re-experiences the trauma through dreams and occasional flashbacks, he has difficulty staying asleep secondary to nightmares, he has difficulty concentrating, he describes hypervigilance and a startle response to sirens." She refused to identify stressors, asserting that retelling the stories was traumatizing to the veteran. The examiner again stated that with the veteran's organicity, it was difficult to assess objectively the contributions from his head injury versus other diagnoses such as PTSD. She stated that he was clearly impaired by his organic brain dysfunction and that such impairment was exacerbated by elements of the PTSD, some of which were common to both disorders and others of which were difficult to demonstrate or clarify because of the organicity. She repeated the Axis I diagnoses of organic brain syndrome, alcohol dependence by history, history of cannabis abuse, and removed the "possible" from her diagnosis of PTSD; continued the Axis II diagnosis of organic personality disorder; and the Axis IV psychosocial stressors were again identified as financial difficulties, limited social support, and serious medical illness. A rating decision of January 1996 denied service connection for PTSD, giving rise to this appeal. In his Notice of Disagreement, the veteran cited stressful events in service to which he attributed the development of PTSD. A personal hearing was held in September 1996 before a Hearing Officer at the RO. Prior to the hearing, the veteran insisted that he had revoked his appointment of Veterans of Foreign Wars as his accredited representative, and appointed Disabled American Veterans. Since that was not confirmed in the record, the veteran insisted on representing himself. At his hearing, the veteran testified that he was an Aviation Bosun's Mate Third Class Petty Officer, and that his job consisted of being on a crash crew, going to downed aircraft, and pulling out dead bodies and others. He stated that he thinks he has PTSD after an interview with an individual at [VAMC] Topeka; that his service medical records were burned up in a fire in St. Louis; that after leaving boot camp, he served at the super secret CIA headquarters at NAS [Naval Air Station] Glynco, Georgia; that he then served at Keflavik, Iceland, in 1964 and 1965, where he was went to the site of a helicopter crash and saw severed heads in flight helmets; that while stationed at NAS Jacksonville in 1966, a serviceman was sucked into the intake of a F8U Crusader; that while stationed at NAS Pensacola or Jacksonville, someone ejected inside a hanger; that while at MCAS Yuma, Arizona, in 1967, he witnessed a mid-air collision over the field; that an aircraft landing gear collapsed in Newfoundland, crushing a serviceman; that he participated in raising the aircraft from the victim's body; that one guy flew into a barrier chain in Newfoundland; that a serviceman was run over by a ground compressor unit; and that when he attempted to give him mouth-to-mouth resuscitation, the victim's innards came up into his mouth. The veteran further testified that he was stationed for six months in Newfoundland and for a year and a half in Iceland; and that he was assigned to VW-13 while in Newfoundland, and to VA-44 while at NAS Jacksonville. A transcript of the testimony is of record. The veteran's service personnel records show that he attended boot camp at the U.S. Naval Recruit Training Depot, San Diego, from February to May 1964; that he was transferred for temporary duty at NAS Glynco, Georgia, from May to September 1964; that he was assigned to a training school at NAS Pensacola, but was dropped for lack of aptitude and interest and served as a messman for 30 days; that in December 1964, he was sent to the Naval Receiving Station, Norfolk, Virginia; that he was assigned to Airborne Early Warning Squadron Thirteen (AEW-13) in Argencia, Newfoundland, from January 1965 to June 1965; that in June 1965, he was transferred to NAS Keflavik, Iceland, where he served for one year; and that in July 1966, he was transferred to Attack Squadron Forty-four (VA-44) at NAS Cecil Field, Florida, where he served until service discharge in December 1967. In November 1996, the veteran submitted a written statement in which he asserted, in pertinent part, that the transcript of his testimony disclosed that there was very little evidence to support his claim; that while in Iceland, he was part of a crew that worked for Icelandic fireman; that he recently moved to a village to get away from airports and sirens; and that he wanted an increase in his disability payments. The case was Remanded to the RO in May 1997 in order to obtain verification of the veteran's alleged stressors from the United States Armed Services Center for Research of Unit Records (USASCRUR), and to obtain a special VA psychiatric evaluation of the veteran by a panel of two board-certified psychiatrists under the newly-revised criteria for evaluating mental disorders, effective November 7, 1996. In June 1997, the veteran submitted duplicate copies of his private and VA medical records dated from October 1979 to April 1995, together with a copy of his September 1996 hearing transcript and additional material not relevant to his PTSD claim. In response to a request for the name and address of any physician who had treated him for PTSD, he cited only an individual named Padilla at the VAMC, Topeka. Treatment records from that facility were already of record. A June 1998 letter from USASCRUR stated that available military records did not confirm the veteran's stressor stories. It was noted that available histories of the NAS, Cecil Field, and Attack Squadron Forty-four showed that in March 1966, one of the squadron's A4E aircraft experienced inflight engine failure and was lost northeast of Gainesville, Florida; that the pilot ejected and was recovered uninjured; that also in March 1966, another squadron A4E experienced an inflight engine failure while in the bombing pattern at Yuma, Arizona, and was lost; that the pilot ejected and was recovered uninjured; and that no squadron history for 1967 was available. Histories of the NAS Keflavik for 1965 and 1966 were not found, and the Naval Safety Center in Norfolk was unable to verify the helicopter accident at Keflavik or the other aircraft accidents alleged by the veteran, including the mid-air collision at Yuma in 1967. The Naval Safety Center indicated that it would need the specific dates and aircraft identification numbers to conduct any further investigation of the claimed incidents. A report of VA psychiatric examination, conducted in August 1998, offered an Axis I diagnosis of PTSD, chronic, delayed onset; organic personality disorder; history of depression; and polysubstance abuse, currently in remission; and an Axis IV diagnosis of severe stress of being bothered by the PTSD symptoms, his inability to work in gainful employment, [and] his financial situation. The diagnosis of PTSD was based upon subjective complaints and an unverified history of inservice stressors offered by the veteran. No psychological testing was conducted, and the examiner stated that, "I really do not need any diagnostic tests at this point because he has had all the tests . . . ." A report of VA psychological testing, conducted in November 1998, provided a detailed interpretation of a full battery of psychological test results, and yielded an Axis I diagnosis of dementia secondary to head injury; while Axis IV psychosocial stressors were modest income and cognitive dysfunction secondary to a head injury. There were no findings indicative of PTSD. A report of VA psychiatric examination of the veteran by a Board of two psychiatrists, conducted in November 1998, showed that the examiners reviewed the veteran's medical records, his claims folders, and documents produced by the veteran, including his DD Form 214, a summary of diagnoses associated with brain trauma, and photographs of his art work. In addition, the report cited the veteran's family, medical, educational, occupational, military, and social history. The veteran's subjective complaints of PTSD symptomatology were noted, as well as his statements regarding inservice traumatic stressors while serving as a crash rescue fireman. The veteran denied any direct involvement with removing bodies from airplanes or of being involved in any unique or overwhelming psychological experience during his time in the Navy. Rather, he described simply being in an area where an accident happened or observing some aspect of a fire and rescue or participating from his truck in some type of rescue event. Findings on mental status examination were reported in detail, and reference was made to the limitation of memory, judgment, and intellect secondary to brain trauma demonstrated on the contemporaneous report of psychological testing. The diagnoses were status post traumatic brain injury with mild organic deficits; history of clonic seizures; and history of cannabis abuse, alcohol abuse, and polysubstance abuse. The examiners stated that they did not find evidence of a psychological stressor that would qualify the veteran for a diagnosis of PTSD; that the symptoms and findings on psychiatric examination were for the most part those of a post head trauma patient; and that his generalized functioning and psychological adjustment did not support a diagnosis of PTSD. In January 1999, the veteran filed VA Form 21-22, appointing Disabled American Veterans Wars as his accredited service organization representative. In a February 1999 letter, the veteran objected to the recent VA psychiatric examinations, asserting, in pertinent part, that the three examiners were "good friends"; that he was good friends with one of them; and that they could not see through the organic brain syndrome to the PTSD. A printout from the VA outpatient clinic, Wichita, Kansas, reported no additional treatment records of the veteran at that facility after 1995. II. Analysis In April 1997, the United States Court of Appeals for Veteran's Claims (Court) issued its opinion in Cohen v. Brown, 10 Vet. App. 128 (1997). That decision substantially modified prior decisions dealing with service connection for PTSD, and relies strongly on the November 7, 1996 amendments to VA regulations. See 38 C.F.R. §§ 4.125-4.132 (1996) (as amended at 61 Fed. Reg. 52695-52702 (1996)). The revised regulations specifically adopt the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (DSM-IV) of the American Psychiatric Association, for the purpose of determining service connection for PTSD. A well-grounded claim for service connection for PTSD has been submitted when there is "[1] medical evidence of a current [PTSD] disability; [2] lay evidence (presumed to be credible for these purposes) of an in-service stressor, which in a PTSD case is the equivalent of in-service incurrence or aggravation; and [3] medical evidence of a nexus between service and the current PTSD disability." Cohen, 10 Vet. App. at 137 (1997). After Cohen, a claim which contains a VA or private provider diagnosis of PTSD and relates the condition to the veteran's unverified history of a stressor during his military service will almost always be well- grounded. See also Gaines v. West, No. 97-39, slip op. at 5 (U. S. Vet. App., Aug. 6, 1998) (comparing a well-grounded PTSD claim to a claim for which service connection for PTSD may be awarded). Service connection for PTSD is governed by 38 C.F.R. § 3.304(f), and the following must be present for a grant: 1. Medical evidence establishing a clear diagnosis of the condition; 2. credible supporting evidence that a claimed in-service stressor actually occurred; and 3. a link, established by medical evidence, between the veteran's current symptomatology and the claimed in-service stressor. A clear diagnosis of PTSD must be established by medical evidence. A clear diagnosis is an unequivocal diagnosis. "[A] clear (that is, unequivocal) diagnosis by a mental health care professional must be presumed (unless evidence shows to the contrary) to have been made in accordance with the applicable DSM criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor. . . . Mental health professionals are experts and are presumed to know the DSM requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis." Cohen, 10 Vet. App. at 140. If a "clear" diagnosis of PTSD is made by a "mental health care professional," neither the RO (nor the Board) can find that it is not supported by the findings on the examination report or that such does not conform to the DSM-IV. If VA disagrees with the diagnosis, the only appropriate course is to return to the report to the examiner for clarification or further examination. Id. To that point, previous Court decisions holding that "stressors must be of sufficient gravity to evoke the symptoms [of PTSD] in almost anyone" (See, e.g., Zarycki v. Brown, 6 Vet. App. 91, 99 (1993); Swann v. Brown, 5 Vet. App. 229, 232-233 (1993)) are specifically found no longer applicable. Cohen, 10 Vet. App. at 142. Since there is no longer an "average person" standard for determining whether a stressor is of sufficient gravity to cause a veteran's PTSD symptoms, VA "may reject favorable medical evidence [i.e., a "clear diagnosis"] as to stressor sufficiency only on the basis of independent medical evidence." Id. In this case, the Board has not rejected VA psychiatric diagnoses of PTSD offered in September and December 1995 and in August 1998 (favorable medical evidence), but has obtained independent medical evidence, consisting of further VA psychiatric examinations and psychological testing, to which the Board has assigned the greater weight. The Court has held that the Board has the duty to assess the credibility and weight to be given the evidence, but must provide adequate reasons and bases. Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The record shows that the pertinent diagnosis offered on VA psychiatric examination in September 1995 was "possible PTSD", which does not constitute a "clear" diagnosis because it is not unequivocal. Further, when challenged, the reporting physician refused to identify stressors and stated that with the veteran's organicity, it was difficult to assess objectively the contributions from his head injury versus other diagnoses such as PTSD; and that impairment from his organic brain dysfunction was exacerbated by elements of the PTSD, some of which were common to both disorders and others of which were difficult to demonstrate or clarify because of the organicity. Although she removed the "possible" prefix from her September 1995 diagnosis of PTSD, the Board finds that diagnosis not to be unequivocal, and further notes that the Axis IV psychosocial stressors were identified as financial difficulties, limited social support, and serious medical illness, not inservice stressors or PTSD symptomatology. The VA psychiatric examiner in August 1998 likewise relied upon the veteran's subjective symptom reports and unsubstantiated allegations regarding inservice stressors in reaching his diagnosis of PTSD. The examiner further declined to undertake or order any additional diagnostic testing, asserting that, "I really do not need any diagnostic tests at this point because he has had all the tests . . . .", while failing to note that none of those tests were diagnostic of PTSD. Nevertheless, the Board does not find that VA diagnoses of PTSD in May and December 1995 and in August 1998 are not supported by the findings on the examination report or that such do not conform to the DSM-IV. Rather, the Board has disagreed with the diagnosis returned case to the report to the RO for further examination and opinion. Further, while the veteran has been afforded psychiatic evaluations under the criteria in effect both prior to and on and after November 7, 1996, the Cohen decision specifically requires application of the DSM IV criteria found under 38 C.F.R. Part 4, § 4.125-4.130, in effect on and after November 7, 1996, and the Board has applied that criteria in assessing the veteran's claim. The Board further notes, in passing, that the revised criteria are more favorable to the veteran than those in effect prior to November 7, 1996, because they ease the burden of proof required of the claimant and remove such elements as awards, decorations, and combat military occupational specialties as dispositive elements. To establish service connection, the medical evidence establishing a diagnosis of PTSD, or a nexus between an in- service stressor and currently-diagnosed PTSD, must be from a "mental health professional." Cohen, 10 Vet. App. at 140. The nature of "credible supporting evidence" of the occurrence of an in-service stressor depends on whether the claimed stressor is combat-related or noncombat-related. The requirement of 3.304(f) for "'credible supporting evidence' means that 'the appellant's testimony, by itself, cannot, as a matter of law, establish the occurrence of a noncombat stressor." See Moreau v. Brown, 9 Vet. App. 389, 395 (1996). However, "credible supporting evidence" need not be service department evidence (See Doran v. Brown, 6 Vet. App. 283, 288-291 (1994); Moreau, 9 Vet. App. at 395, citing to Doran, supra, and post-Doran changes in Manual M21- 1, Part VI, 7.46c (Oct. 11, 1995)). Where the veteran claims that he "engaged in combat," and that his PTSD derives from a combat-related stressor, 38 U.S.C.A. § 1154(b) may require that the veteran's statements be accepted as sufficient proof of the existence of the stressor. This is the case even if the only evidence showing that the veteran "engaged in combat" is not service department evidence, but "other supportive evidence." See West v. Brown, 7 Vet. App. 70, 76 (1994). The Court has observed that this "serves to provide an almost unlimited field of potential evidence to be used to 'support' a determination of combat status." See Gaines, No. 97-39, slip op. at 7. In connection with the above analysis, where a veteran claims that a combat-related stressor occurred, VA must make a determination as to whether or not the veteran "engaged in combat with the enemy." See Gaines, No. 97-39, slip op. at 6-7; Zarycki, 6 Vet. App. at 98. In this case, the evidence shows that the veteran has neither contended nor established that he engaged in combat against the enemy, and he has disclaimed any such combat service. The Board finds, as a matter of fact, that the evidence establishes that the veteran did not engage in combat against the enemy during his period of active service. Accordingly, the veteran is not entitled to the lightened evidentiary burden afforded combat veterans under the provisions of 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d) (1999). Further, the requirement of § 3.304(f) for "'credible supporting evidence' means that 'the appellant's testimony, by itself, cannot, as a matter of law, establish the occurrence of a noncombat stressor." See Moreau v. Brown, 9 Vet. App. 389, 395 (1996). Thus, although the evidence shows that the veteran has a clear diagnosis of PTSD made by a mental health care professional in August 1998, the fact that the veteran did not engage in combat against the enemy renders the veteran's statements insufficient as proof of the existence of the stressors. The service department records and USASCRUR research do not verify the claimed stressors, and the subsequent report of VA psychiatric examination conducted in November 1998 note that the veteran denied any direct involvement with removing bodies from airplanes or of being involved in any unique or overwhelming psychological experience during his time in the Navy. Rather, he described simply being in an area where an accident happened or observing some aspect of a fire and rescue or participating from his truck in some type of rescue event. Accordingly, diagnoses of PTSD are not based upon "credible supporting evidence" where they rely upon unsubstantiated, and subsequently self-contradicted, allegations such as removing body parts from runways, pulling out dead bodies from downed aircraft, seeing severed heads in flight helmets, witnessing an individual sucked into the intake of a F8U Crusader, washing off blood after an individual fired an ejection seat inside a hanger, witnessing a mid-air collision, raising an aircraft after a landing gear collapsed and crushed a serviceman, or assertions that the claimant attempted to give mouth-to-mouth resuscitation to an injured serviceman, resulting in the victim's innards coming into his mouth. To the same point, the Naval Safety Center in Norfolk was unable to verify the helicopter accident at Keflavik, or any of the other aircraft accidents alleged by the veteran. Finally, the veteran has not submitted competent medical evidence establishing a nexus between an in-service stressor and the currently-diagnosed PTSD because the only such "clear" diagnosis of PTSD relied entirely upon a stressor history related by the veteran, which is without substantiation in the evidentiary record and which, as a matter of law, cannot by itself constitute "credible supporting evidence" to establish the occurrence of a noncombat stressor. While such evidence is sufficient for purposes of establishing a well-grounded claim, it is insufficient to provide the veteran's case on the merits. Based upon the foregoing, the Board finds that the veteran has failed to establish that he meets the evidentiary and schedular criteria for a grant of service connection for PTSD. Accordingly, the claim for that benefit is denied. ORDER The claim for service-connection for PTSD is denied. F. JUDGE FLOWERS Member, Board of Veterans' Appeals