BVA9502747 DOCKET NO. 92-10 821 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to an increased rating for neurodermatitis, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARINGS ON APPEAL Appellant, wife, and daughter ATTORNEY FOR THE BOARD William H. Hickman, Associate Counsel INTRODUCTION The veteran had active military service from October 1950 through October 1953. The case comes before the Board of Veterans' Appeals (Board) on appeal from a July 1989 and subsequent rating decisions of the Department of Veterans Affairs (VA) Columbia, South Carolina, Regional Office (RO) which in effect have denied the veteran's claim for an increased rating above 10 percent for his service- connected neurodermatitis and which have denied service connection for PTSD. The case was previously at the Board in July 1992 at which time it was returned to the RO in order to afford the veteran a personal hearing with regard to his claim for service connection for PTSD. This hearing was held in February 1994 at which time the veteran withdrew one of the claims and clarified that the issues on appeal are those listed on the cover page. CONTENTIONS OF APPELLANT ON APPEAL With regard to the claim for service connection for PTSD, it is contended, in essence, that while the veteran was stationed in Germany he was exposed to stressful events, consisting of an incident in which he had to kill a dog that had been directed to attack him and another incident in which he witnessed when a child was killed by a Russian tank. It is further contended that a VA doctor has diagnosed the veteran as having PTSD as a result of exposure to these "stressors" and, therefore, service connection for PTSD is warranted. With respect to the claim for an increased evaluation for neurodermatitis, it is alleged, essentially, that this skin pathology causes the veteran to have a chronic body rash which, in turn, causes chronic itching which, in turn, interferes with the veteran's daily living pattern and, therefore, a higher evaluation is warranted. 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 evidentiary record is against the veteran's claims for service connection for PTSD and for an increased rating for neurodermatitis. 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 official records from a service department do not demonstrate that the veteran was involved in combat while serving on active duty. 3. The evidentiary record does not independently corroborate the occurrence of the stressful events claimed by the veteran. 4. The evidentiary record does not demonstrate that the veteran meets the criteria for an award of service connection for PTSD. 5. The evidentiary record does not demonstrate that the veteran has constant exudation or itching, extensive lesions, or marked disfigurement of the skin. 6. The veteran's neurodermatitis does not present an exceptional or unusual disability picture rendering impractical the application of the regular schedular standards. CONCLUSIONS OF LAW 1. PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303(b)(d), 3.304(f) (1993). 2. The criteria for an evaluation greater than 10 percent for neurodermatitis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.7, 4.10, 4.20, Part 4, Diagnostic Code 7806 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran's claims are well grounded; that is, they are claims which are plausible and capable of substantiation. All relevant facts have been properly developed and no further assistance to the veteran, to include additional VA examinations, is required to comply with the duty to assist him mandated by 38 U.S.C.A. § 5107(a). I. The Claim For Service Connection For PTSD Under the applicable law and regulations, service connection may be established for a chronic disability resulting from personal injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303(b) (1993). The applicable regulations also provide that service connection may be granted for any disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1993). With respect to a claim for service connection for PTSD, there are VA regulations which specify that certain criteria must be met in order to establish the existence of that disorder. 38 C.F.R. § 3.304(f) states that: Service connection for post-traumatic stress disorder 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. Additionally, if the claimed stressor is related to the claimant having been a prisoner-of-war, prisoner-of- war experience which satisfies the requirements of § 3.1(y) of this part 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). So as prescribed by VA regulations, a prerequisite for a diagnosis of PTSD is that the person claiming the disorder has been exposed to a stressor. That currently is defined as: The person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; (2) the person's response involved intense fear, helplessness, or horror. The American Psychiatric Association's, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., 427, 428 (1994) (hereinafter DSM IV). A service department DD Form 214 indicates that for 2 years, 3 months and 15 days of the veteran's three-year enlistment he was stationed overseas. Other data on the form indicates he was assigned to an artillery battalion in Germany. This form does not reflect that the veteran was the recipient of any awards for valor or combat or of the Purple Heart, or that the veteran otherwise participated in combat. Inasmuch as the evidentiary record discloses the veteran was a noncombatant during service, the provisions of 38 C.F.R. § 3.304(f), with respect to the requirement that there be credible supporting evidence that the claimed inservice stressor(s) actually occurred, will be for application in the instant case. The service medical records indicate that the veteran was hospitalized for 22 days in October and November 1951. This was for an outbreak of acute eczematous dermatitis of the antecubital, popliteal, cervical, and pelvic regions. These records reflect that during the veteran's hospitalization he had a neuropsychiatric consultation. Those records indicate that the veteran stated that he developed neurodermatitis about one week after learning that his girl friend had been impregnated by another soldier. It was reported the veteran showed insight into this situation and expressed his intention to master the problem. The rest of the service medical records, to include the report of a separation examination dated in October 1953, are negative for any other complaints, findings, or diagnoses of psychiatric pathology. The post service medical records are absent for any psychiatric complaints or treatment up until 1981. Beginning at this time and continuing into 1982, VA records from a VA Medical Center in Kansas City, Missouri, reflect that the veteran had numerous psychiatric and psychological consultations for depression. These records further reflect that the depression was seen as resulting from the restricted life style and chronic pain imposed on the veteran due to his having sustained severe injuries to his cervical and lumbar spines (due to an accident occurring at his civilian workplace). These medical records also reflect that the veteran experienced some hallucinations during this time, the particulars of which were not specified, due to the use of medication, but that the hallucinations ceased when the use of a particular medication was stopped. No reference is made in these records to the veteran's time in service, nor is the depression linked by any medical practitioner to the veteran's inservice experiences. The veteran underwent a VA special psychiatric examination in April 1982. By history, the veteran related he was treated for neurodermatitis in service. He also reported having seen a psychiatrist while in service because his girl friend had left him to marry another man. It was reported that he had been in a severe accident at work in 1980 when he crushed some disks in his neck and back. At the time of the VA psychiatric evaluation the veteran complained of having chronic pain. It was indicated that veteran's current lifestyle was restricted, including being unable to work and not having an active sex life, due to his spinal injuries. Symptomatology was reported as consisting of a short temper, poor memory, and depression. This latter symptom was related to the veteran experiencing chronic pain. It was indicated the veteran was having trouble coping with his inability to work and that prior to sustaining the spinal injuries he had always led an active and useful life. Diagnosis was of chronic depression. There was no reference in this record to any psychiatric symptomatology that was occurring as a result of the veteran's inservice experiences. VA outpatient clinical notes dated between April 1988 and April 1989 indicate that the veteran participated in a discussion group of some kind at a VA mental health clinic. The records reflect that the subject of the group's discussion was primarily of the ways and techniques for coping with pain and/or any resulting depression. There is no reference in these outpatient clinic notes with regard to the veteran having psychiatric symptomatology as a result of his experiences in service. On a VA Form 21-4138, dated in October 1989, which served as a notice of disagreement to a RO rating decision which denied the veteran increased ratings for various service-connected disabilities, the veteran indicated that the rating board failed to consider his "nervous condition", which he maintained was related to his skin disorder. On a VA Form 1-9, received in June 1990, the veteran indicated essentially, that he wished to file a claim for service connection for PTSD. In August 1990 the veteran submitted a written statement in support of his claim for PTSD. He stated that during service while stationed in Germany he observed many Russian tanks lined up close to the border (apparently between East and West Germany) with all their guns simultaneously pointed at his position. He indicated that after witnessing this event he broke out in a massive body rash. Additionally, he further reported that on one occasion he was assigned to crowd control duty in West Berlin and that in the course of this duty he was forced to bayonet a German citizen's dog which resulted in the animal's death. He reported he had recurring memories about the look on the dog owner's face. He also indicated that in the course of crowd control duty he had to force a woman and her 8-10 year old daughter onto a bridge whereupon the daughter was runover and killed by a Russian tank. He reported, essentially, the gruesome details of the girl's death consisting in part of exploding body parts and the severance of the girl's head from her body. He went on to state that although he had initially been able to block out this event from his mind, that he had been having flashbacks of the incident ever since undergoing spinal surgery (in 1980). He indicated that the flashbacks were responsible for his frequent inability to sleep. Additionally, in August 1990 the veteran's spouse submitted a written statement in support of the veteran's claim. She indicated she met her husband overseas in 1951. She reported that late in the year 1951 his cheerful mood changed radically and the veteran underwent hospitalization. She further indicated that the veteran would not talk to her about the cause of the hospitalization. Without indicating when, the wife reported that following the birth of her first child the veteran could not sleep for any length of time. She further indicated that the veteran had been under VA medical treatment since 1959. The reason for this treatment was not specified. Received into evidence in April 1991 were VA outpatient clinical records dated between January 1990 and April 1991. These records initially indicated the veteran was participating in some type of group therapy at a VA mental health clinic due to his feelings and concerns about his wife having cancer, and also due to his concerns about his own physical ailments. However, starting with the VA clinical records dated in June 1990, the entries reflect to the veteran having flashbacks concerning a Russian tank running over a little girl while he was in service. The clinical notes indicate that this happened in World War II. The notes also indicate dreams and flashbacks about World War II in general. A VA clinical record dated in October 1990 indicates these flashbacks are related to PTSD. VA clinical notes, dated between January and March 1991, reflect diagnoses of PTSD. Copies of VA outpatient treatment reports dated between May and August 1991 also reflect diagnoses of PTSD being made in June and July. The veteran underwent a special VA psychiatric examination in November 1991. This reported that the veteran had not worked since 1980 due to having sustained a severe spinal injury at that time. The veteran claimed to have experienced nightmares, intrusive thoughts, and flashbacks of the stressful events in 1952 while he was in service. He claimed he was still reexperiencing these same symptoms. The veteran stated he remained depressed because he could clear his mind of the stressful incidents. On mental status examination it was reported that the veteran's mood denoted evidence of significant depression, and that the veteran cried frequently when discussing his inservice experiences in Germany. Diagnosis was of a dysthymic disorder, chronic and severe, and of PTSD if all the history reported by the veteran was to be accepted as fact. The examiner indicated that none of the records that he found indicated the presence of PTSD, but that the veteran was being referred for a special PTSD evaluation which would be added as an addendum to the report. An addendum to the report was done in December 1991. This reported that the examiner had received the results of psychological testing which were consistent with a diagnosis of PTSD and, therefore, the veteran met the criteria for a diagnosis of PTSD. However, no rationale or information was given as to the veracity of the alleged stressors. In a letter dated in August 1992 addressed to his service representative, the veteran again recounted the previously heretofore recited traumatic incidents that he experienced while on active duty in Germany. With reference to the death of the little girl, he stated that the force of the Russian tank running over her body caused the child's head to fly through the air and hit the feet and legs of the (unnamed) second soldier on his left. He states he was sprayed with the girl's blood and brains. He further indicated that he went to some sort of religious service conducted by a priest which caused his memory of this "terror" to go away. He also wrote that all his memories of the incidents he experienced while on active duty came back to him during and following surgery on his back in 1980. He stated that since 1980 he has had continuous flashbacks of these incidents. The veteran attached to this letter a copy of an article entitled Cold War On The Iron Curtain Armored Cav Rides the Razor's Edge. The magazine article goes on to describe stressful incidents of soldiers stationed in Germany during the time the veteran was stationed in that country. The article refers to an alert being conducted in May 1951 where an American unit moved to the border between East and West Germany to confront Russian tanks lined up on the border. It does not specifically mention the veteran's unit as a participant in this alert, or refer to any of the other stressful events in which he claims to have participated while performing crowd control duty. Received into evidence in October 1993 were five letters written by soldiers who served in military service in Germany at approximately the same time that the veteran served there. These letters were written to the veteran in response to his inquiry of whether any of the soldiers recalled his being assigned to West Berlin for crowd control duty in June of 1951. None of the letters mention or confirmed the specific incidents involving the dog and the Russian tanks reported by the veteran. Pastor Donald Abbott of St. Joseph's Catholic Church in Anderson, South Carolina, submitted a letter in 1993 recounting a story told to him by the veteran. He noted that the "terror" the veteran experienced from his stressful incidents in service went away when he was prayed over by a Catholic priest, but returned to the veteran following the severe accident he had in 1980 which damaged his spine. In February 1994 the veteran and his spouse appeared and testified at a personal hearing held at the RO. The veteran's spouse testified that she met her husband in Germany in June or July 1951 and that when he came back from an operation he would sweat profusely and have terrible headaches. Received into evidence in May 1994 was a report from The United States Army and Joint Services Environmental Support Group (ESG) dated in April 1994. A letter attached to the report indicated that the ESG was not able to research anecdotal incidents and that unless an official (military) report had been filed concerning the incident of the German girl's death, that they would be unable to confirm this event. It was indicated that if an investigation into this incident took place, that the ESG would need the full names and military unit designations of the personnel involved in order to verify the incident. The ESG attached to this letter a copy of the Command Report of the 29th Field Artillery Battalion, 4th Infantry Division, from 1 January, 1951, to 31 December, 1951. This report does not include reference to any of the incidents which the veteran claims as being traumatic. It is clear that the veteran has been diagnosed to have PTSD. The question is whether the evidence establishes the occurrence of a recognizable stressor and a link between the current symptoms and the claimed stressors. 38 C.F.R. 3.304(f)(1993) requires, in the absence of service department evidence that the veteran engaged in combat, that there be credible supporting evidence that the claimed inservice stressor(s) actually occurred. The United States Court of Veterans Appeals (hereinafter Court) has stated in the case of Swann v. Brown, 5 Vet. App. 229 (1993), that the Board is not obligated to accept a veteran's uncorroborated account of his combat experiences, or the opinions of physicians whose diagnoses of PTSD are based on uncorroborated history as related by an appellant. In the case of Zarycki v. Brown, 6 Vet.App. 91 (1993), the Court stated that when it is determined that the veteran did not engage in combat with the enemy, the veteran's lay testimony, by itself, is not enough to establish the occurrence of the alleged stressor. In Zarycki, the Court went on to state that the record must contain service records which corroborate the veteran's testimony as to the occurrence of the alleged events. In the instant case, the evidentiary record establishes that the veteran did not engage in combat with the enemy. The only source as to the occurrence of the events claimed as "stressors" is the veteran himself. There are no service records, or lay statements, or statements from soldiers in the veteran's unit, or statements from soldiers in other units, or statements from anyone, that can corroborate the veteran's history. The records of treatment during service clearly show that the reasons why the veteran sought treatment in service were not related to combat activities, but rather to personal problems. It was not until more than 25 years after service that the veteran began reporting the alleged stressors. However, no independent corroboration has been provided. In fact, none of the statements from former soldiers that served with the veteran contain information related to the claimed stressors. It is interesting to note that as late as 1992, the veteran told a VA psychiatrist that he had seen a psychiatrist in service after his girl friend left him to marry another man. This statement is consistent with the records of treatment during service. Inasmuch as there is no evidence to establish the occurrence of the claimed stressors, the medical diagnoses of PTSD must be rejected as they have been based on uncorroborated information. It is important to note that when the veteran was examined by the VA in 1993, the examiner noted that the diagnosis of PTSD was warranted only if all the history of the veteran was to be accepted. In sum, the Board finds that the evidence has failed to establish the actual existence of the claimed stressors. Accordingly, service connection for PTSD is not warranted. In reaching the decision herein, the Board has considered the provisions of 38 U.S.C.A. § 5107(b) with respect to affording the veteran the benefit of any doubt. However, the evidentiary record is not in equipoise in its positive and negative evidence as to warrant resolution on the basis of reasonable doubt. II. The Claim For An Increased Evaluation For Service-Connected Neurodermatitis The service medical records reflect that in October and November 1951 the veteran was treated for acute neurodermatitis. In March 1959 the veteran filed a claim for service connection with the VA for "skin disease." A VA examination accomplished in May 1959 diagnosed the veteran as having neurodermatitis, chronic, disseminated, in partial remission. An RO rating decision dated in June 1959 granted the veteran service connection for neurodermatitis and assigned a 10 percent evaluation. The veteran has maintained that evaluation through the present. In conjunction with the current claim for an increased rating, the veteran underwent a VA examination in October 1990. By history, the veteran indicated that he experienced a recurring rash 1 to 2 times per year which, he indicated, was brought on by stress. It was reported that the rash was pruritic in nature and endured for approximately 7 to 10 days twice a year. On physical examination it was indicated that no rash was currently present. By history, the veteran described the rash as being red, splotchy, with macular lesions, and that the distribution was over his entire body. Diagnosis was of a history of neurodermatitis not present at the time of the examination. The veteran, his wife, and his daughter testified at a personal hearing held in December 1990. At this time the veteran stated that he had 3 or 4 episodes of a total body rash on a monthly basis. He indicated that this caused his skin to appear like raw meat. He further testified that his wife had knitted him a pair of gloves to protect him from the effects of scratching while he slept. He reported that his lower extremities were the most affected. The veteran's wife testified to the effect that when the veteran is symptomatic, he has trouble sleeping, cannot wear a shirt, and takes frequent baths. The veteran's daughter testified to the effect that the veteran, when symptomatic, has a flushed appearance and sweats profusely. She stated that at these times she has to come to her father's house and provide a calming influence as he is easily upset. Subsequently, in October 1991, the veteran submitted into evidence three color photographs of his skin. These appear to show a small fine rash on his chest, abdomen, and lower extremities. In August 1993 the veteran submitted a list of 12 prescriptions which he stated he used to control his skin disorder. Disability evaluations are based upon a comparison of clinical findings with the applicable schedular criteria. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, (1993). Neurodermatitis is rated analogous to symptomatology associated with eczema. 38 C.F.R. § 4.20, Part 4, Diagnostic Code 7806 (1993). The applicable diagnostic code provides that a 30 percent evaluation is warranted when the clinical evidence establishes there is evidence of exudation or constant itching, extensive lesions, or marked disfigurement. A 10 percent evaluation is warranted when there is exfoliation, exudation or itching, if it involves an exposed surface or an extensive area. The evidentiary record indicates that the veteran's estimates as to the frequency of his symptomatology vary widely. At the time of a VA examination conducted in October 1990, the veteran indicated that he experienced outbreaks of his skin disorder twice a year for a period of 8 to 10 days. Subsequently, at a personal hearing held two months later, his testimony was to the effect that he had an outbreak of the rash on a monthly basis, sometimes several times within the same month. At the personal hearing the veteran's testimony was supported by his spouse and daughter. Nevertheless, the discrepancy between the two reported histories does bring into question the credibility to be afforded the veteran's statements. The pertinent VA examination was negative for any active skin rash or neurodermatitis. Subsequently, the photographs the veteran submitted showed, apparently, a fine rash over different parts of his body that did not appear to contain extensive lesions or markedly disfigure the veteran. Although the veteran and his relatives have testified to the contrary, the Board is of the view that the evidentiary record with more weight is the clinical evidence of the VA examination that occurred in October 1990 which indicated that no symptomatology for any skin pathology was present, and the color photographs submitted by the veteran showing no open lesions or marked disfigurement of the skin. This evidence, to which the Board gives more weight, does not demonstrate the requirements for the higher evaluation. That is, it does not demonstrate that extensive lesions, marked disfigurement, or exudation is present. Accordingly, an increased evaluation for neurodermatitis is denied. The Board has also considered whether the veteran qualifies for an evaluation greater than 10 percent under the provisions of 38 C.F.R. § 3.321(b)(1). This code section provides, in part, that when the evidentiary record demonstrates that a service- connected disorder is causing exceptional or unusual circumstances, such as requiring periods of frequent hospitalization or markedly interfering with the veteran's employment, so as to make application of the schedular criteria impractical, the Board is empowered to award compensation on an extraschedular basis. In the instant case, the evidentiary record does not portray that the neurodermatitis has required frequent hospitalizations, nor that it has caused marked interference with employment. Accordingly, an extraschedular evaluation is not warranted. In reaching this decision the Board has considered its obligation of affording the veteran the benefit of any doubt as mandated by 38 U.S.C.A. § 5107(b). However, the evidentiary record does not demonstrate an approximate balance of positive and negative evidence so as to warrant resolution of the issue in favor of the appellant. ORDER Service connection for PTSD is denied. An increased evaluation for neurodermatitis is denied. JOAQUIN AGUAYO-PERELES 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.