BVA9501290 DOCKET NO. 93-07 849 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to service connection for post traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: AMVETS WITNESSES AT HEARINGS ON APPEAL The appellant and his wife ATTORNEY FOR THE BOARD Jeffrey A. Pisaro, Counsel INTRODUCTION The veteran had active service from April to October 1957, and from June 1963 to October 1972. This appeal arises from a March 1991 rating decision of the Atlanta, Georgia, Regional Office (RO). The veteran appeared and testified in March 1994 at a personal hearing which was conducted at the Board of Veterans' Appeals (Board) before I.S. Sherman, who is a member of the Board. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO erred by failing to grant service connection for PTSD which resulted from his wartime experiences in Vietnam. The veteran maintains that he was exposed to multiple stressors in Vietnam to include mortar and rocket attacks, being in a motel which suffered a direct hit killing a service comrade, performing perimeter guard duty, being ambushed in truck convoys with three trucks being destroyed, and performing body bag detail. Due to his experiences in Vietnam, the veteran states that he began to drink excessively and exhibited changed behavior as compared to his pre-Vietnam personality. It is further requested that the claim be remanded to facilitate additional development of the evidence. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claim. FINDINGS OF FACT 1. All available relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran was not engaged in combat during his service in Vietnam. 3. Objective demonstration of an inservice stressor has not been shown. 4. The veteran does not currently suffer from PTSD as a result of his wartime experiences in Vietnam. CONCLUSION OF LAW PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 1154, 5107 (West 1991); 38 C.F.R. § 3.304 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran has presented a claim which is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed and that no further assistance is required to comply with the duty to assist under 38 U.S.C.A. § 5107(a). The remand request for additional evidentiary development involves putative stressors; however, as documented hereinafter, the veteran's alleged stressor events are wholly anecdotal and unresearchable. Service connection will be granted for a disability resulting from disease or injury which was incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. 38 C.F.R. § 3.304(f) provides: 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. The veteran's DD-Form 20, enlisted qualification record, shows that he was in Vietnam from August 1966 to August 1967, and from May 1970 to April 1971. His military occupational specialty (MOS) during his first tour of duty in Vietnam was a heavy vehicle driver and dispatcher assigned to HHD USA Headquarters Area Command, and his MOS during his second tour in Vietnam was a heavy truck driver assigned to the 321st Transportation Company. The veteran was awarded the National Defense Service Medal, the Vietnam Service Medal with two bronze stars, the Republic of Vietnam Campaign Medal with device and the Good Conduct Medal.. An August 1964 service medical notation indicates that the veteran had felt a sharp pain in his back when he was lifting a heavy object. The diagnosis was sprains or strains of the sacroiliac area. A July 1966 notation from a dispensary in Okinawa indicates that he veteran had been picked up in the local bar district by ambulance and brought to the dispensary. He was highly intoxicated and quite violent. A December 1969 psychiatry notation indicates that the veteran had been drinking heavily the night before and had become unruly. He had threatened his wife and to kill himself with a knife. A history of family problems and similar episodes were noted. It was reported that the veteran had been drinking since age 14, and that for the last four to five years he had been drinking to excess rather regularly. He had been getting drunk almost every night for the last few months, and it was noted that the veteran was unable to control his alcohol intake. When things went wrong for the veteran, either big or little, he would become relatively depressed and started drinking. The veteran had not been promoted since 1965 which had been very frustrating to him. His frustration had increased when he failed an E-5 board in an area outside his MOS. The veteran appeared to be rather limited socially along with being rather immature in his solutions to problems. The examiner opined that the veteran might be an alcoholic. Medical history provided in May 1972 included depression or excessive worry, and nervous trouble of any sort. The veteran was clinically evaluated as normal psychiatrically. Medical history reported in August 1972 included frequent trouble sleeping and nervous trouble of any sort. The veteran was clinically evaluated as normal psychiatrically. On VA examination in December 1972, psychiatric and personality examination were normal. An August 1973 involuntary hospitalization application indicates that the veteran had been admitted to the local VAH in the past on an outpatient basis for acute depression. He was admitted due to acute depression, alcoholism, suicidal ideation, and considerable family trouble. It was reported that the veteran had spent six months in an alcoholic clinic at Fort Riley, Kansas and had used that to get out of the service. An August to September 1973 VA hospital summary includes a diagnosis of alcohol addiction. A February 1974 VA nursing goal oriented interview indicates that the veteran had injured his back in 1964 and had been drinking more heavily since 1964. An August 1974 VA psychological evaluation shows that the veteran had been referred due to his "attitude problem." Reportedly, the veteran was immediately very defensive if people hassled him or asked unreasonable requests. The provisional diagnoses were depressive neurosis and anxiety reaction, alcoholic addiction, and psychophysiologic musculoskeletal reaction manifested by weakness in both legs. Psychological testing conducted during an April to May 1975 VA hospitalization revealed psychophysiological reaction, passive aggressive personality, and latent schizophrenia. A October 1980 VA psychiatric examination report shows that the veteran dated the onset of his difficulties from 1965 when he was lifting a heavy piece of artillery and hurt his back. Apparently he began drinking rather heavily so that prior to his discharge he 1972 he had been found to be an alcoholic. Presently, the veteran indicated that he had been dry for four years. Back pain was severe and interfered significantly with his ability to hold a job and his social life. The diagnosis was psychogenic pain disorder. The veteran was not psychotic and was competent to handle funds. On VA psychological testing in October 1980, results indicated a psychophysiological neurotic reaction. There was no indication of psychopathic deviancy or character disorder. The veteran tended to overstate his physical complaints and suffered from autonomic nervous system over-reactivity. The veteran had no problems in interpersonal relationships. A February 1981 statement from K. W. Covey, M.D., indicates that he had examined the veteran in that same month. The veteran reported having first injured his back in 1964, and that his back pain got so bad that he began drinking and finally was discharged in 1972 due to alcoholism. The veteran has been hospitalized at a VA medical facility on numerous occasions between 1990 and 1993. In October 1990, the veteran was admitted following an episode of violent behavior which he stated was precipitated by Vietnam flashbacks. The diagnosis was PTSD. A November to December 1990 VA hospital report indicates that the veteran was admitted for a PTSD exacerbation. He stated that "I had a flashback and hurt my friend." The veteran stated that he felt that he was back in Vietnam stuffing bodies into bags. He indicated that the flashbacks were coming on and that he "had to get out of there." On examination, the veteran admitted to flashbacks and nightmares but denied having suicidal and homicidal ideations. The diagnoses included PTSD. A January 1991 VA psychiatric examination report indicates that most of the veteran's problems in service centered around chronic and acute alcoholism. He was in Vietnam in 1965 and was stationed at Saigon. The veteran was unable to remember his outfit, but he was a truck driver and apparently was not involved in combat. He was in Vietnam again in 1970, and was stationed at Long Binh as a truck driver. The veteran was not involved in search and destroy missions or sweeps, but stated that his outfit did get shelled at times. He reported having some friends killed, but did not know their names. The veteran hurt his back in 1964, had chronic low back pain thereafter, and had been a heavy drinker since 1964. He denied any alcohol use since 1975. The veteran's first hospitalization for nerves was in 1990. He was given the diagnosis of PTSD because of his claims of severe nightmares and flashbacks, and attacking people thinking they were Viet Cong. Reported symptoms included auditory and visual hallucinations of Viet Cong, shooting guns at the enemy and nightmares when he hollered "incoming, incoming" and not remembering anything. Nightmares occurred daily. The veteran reported that he stayed by himself all of the time. An interview with the veteran's wife documented his history of severe nightmares, flashbacks, an inability to get along with people, and severe depression. On mental status examination, the veteran talked and related adequately, but he was somewhat hostile. He was well oriented, but rather vague as to past events. Affect was rather hostile. Mood did not denote evidence of any significant anxiety or depression. The veteran claimed extreme paranoia about the Viet Cong being around his house during flashbacks. He admitted to auditory and visual hallucinations associated with the flashbacks. Judgment and insight were defective. The possibility of malingering or manipulation could not be excluded. Axis I diagnosis indicated there was not enough evidence in the record to document extreme stressors in Viet Nam in that he was a truck driver and apparently was never in actual close contact with the enemy. He described significant flashbacks and nightmares supported by the wife's history. If it were accepted that there were stressors, then the diagnosis would be PTSD. Diagnoses also included organic amnesic syndrome, extensive neuropsychological testing had indicated some organic problems, and explosive personality. A February to March 1991 VA hospital report shows that the veteran complained of increased flashbacks, nightmares, anxiety, and depression. He admitted to flashbacks with auditory and visual components. Diagnoses included PTSD. In March 1991, the veteran submitted an executed form which was entitled attachment to PTSD claim. On the form, the veteran listed his duties as truck driver, prepared bodies for transport, and carried supplies to combat area. In answer to the question, "The military experiences I found most terrifying, life- threatening, or stressful include the following:" the veteran checked armed combat or enemy action, bombed or shelled or tripped booby-trap, shipwrecked or in airplane or vehicle accident, and other action that threatened my life. He reported that nightmares and flashbacks had occurred daily over the past 22 years. A May 1991 VA hospital report shows that the veteran felt he was a nuisance to his family and was afraid that he might hurt them when he was having flashbacks. He reported having daily Vietnam flashbacks, combat nightmares, blackouts, combat related auditory and visual hallucinations and homicidal ideations. Diagnoses included PTSD. A July 1991 request to the U.S. Army and Joint Service Environmental Support Group (Task Force) stated that the veteran claimed to have prepared bodies for transport, carried supplies to combat areas, and having been involved in armed combat. An August 1991 VA hospital summary indicates that another Vietnam veteran had been living with the veteran, that the friend had turned on him, and that the veteran had responded with rage which had increased his flashbacks. Diagnoses included adjustment disorder with mixed disturbance of mood and conduct, and PTSD. A September 1991 Task Force response enclosed a 1970 Annual History Report for the 321st Transportation Company. The history stated that the unit transported supplies and provided convoy support for combat operations conducted in Cambodia. It indicated that the unit suffered some casualties; however, the history did not indicate that unit personnel conducted combat operations or that they prepared or transported bodies. Also, unit records submitted by the U.S. Army Headquarters Area Command did not indicate that unit personnel conducted combat operations or transported bodies. In order to provide information concerning combat incidents, the veteran had to provide more specific information to include the date of an incident to within seven days, the type and location of the incident, numbers and full names of casualties, and units involved. The PTSD unit can verify only specific combat incidents as recalled by the veteran. In order to conduct a meaningful research, the veteran must provide the who, what, where and when of each stressor. An October to November 1991 VA hospital report shows that the veteran reported continuing dreams and flashbacks. He reported staying by himself and going out to the woods. Diagnoses included PTSD. An April to May 1993 VA hospital report shows that the veteran complained of feeling depressed, sleep disturbance, and irritability. He reported feeling angry most of the time and being unable to relate to people. A long history of PTSD symptoms to include flashbacks and nightmares with recurrent exacerbations were noted. Diagnoses included PTSD with depression. At the March 1994 personal hearing at the Board the veteran testified that he was living in a hotel in Saigon which was blown up and that many people were killed, but he could not remember the name of the hotel or the names of any casualties (T-3-4); that he performed perimeter guard duty (T-4); that a holding point was mortared with casualties, but he could not remember the date or the outfit he was attached to (T-6); that he was a truck driver in convoys which were ambushed and that his truck was blown up (T-6); that he worked on a body bag detail, but he could not remember any dates (T-7); that mortar attacks occurred once or twice a week (T-7); that he was ambushed while on truck convoy and that he saw enemy troops (T-8); that he started drinking heavily when he was in Vietnam as he was scared (T-9); the veteran's wife testified that the veteran began drinking heavily upon returning from Vietnam and suffered from symptoms to include nightmares and night sweats (T-10-11); the veteran testified that his roommate who was right next to him at the hotel was blown to bits, but he could not remember the comrade's name (T-13); and he testified that flashbacks included trucks being blown-up, dead bodies, body bags, and firing at the enemy (T-15). Adjudication of a claim for service connection for PTSD requires evaluation of the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the official history of each organization in which the veteran served, the veteran's military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(b). In Smith v. Derwinski, 2 Vet.App. 137, 140 (1992), in reviewing the legislative history of 38 U.S.C.A. § 1154, the Court stated that "...the matter of service connection is a factual determination which must be made by the Secretary based upon the evidence in each individual case..." VA Adjudication Procedure Manual, M21-1, Part VI, provides: If the evidence shows the veteran engaged in combat with the enemy and the claimed stressor is related to combat, no further development for evidence of a stressor is necessary...If the claimed stressor is not combat related, a history of a stressor as related by the veteran is, in itself, insufficient. Service records must support the assertion that the veteran was subjected to a stressor of sufficient gravity to evoke symptoms in almost anyone. The existence of a recognizable stressor or accumulation of stressors must be supported. It is important the stressor be described as to its nature, severity and date of occurrence. All relevant statutes and regulations, to include 38 U.S.C.A. § 1154, 38 C.F.R. § 3.304, and Manual M21-1, mandate that an initial determination must be made as to whether a veteran was engaged in combat. See also Hayes v. Brown, 5 Vet.App. 60 (1993). If it is determined that a veteran was engaged in combat, lay testimony from the veteran regarding putative stressors must be accepted as conclusive, provided that the testimony is satisfactorily credible; however, if VA determines that a veteran did not engage in combat, lay testimony by the veteran by itself is not sufficient to establish that a putative stressor occurred. West v. Brown, No. 92-890 (U.S. Vet. App. August 8, 1994). If the veteran was not engaged in combat, the service records must corroborate lay testimony as to the facts and circumstances of an alleged stressor. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d); Manual M21-1, Part VI. While he was in Vietnam, the veteran was a heavy vehicle driver, dispatcher, and heavy truck driver. Clearly, his duties were not combat related. In other words, the veteran's work details would not in the general course entail exposure to combat. Service personnel records demonstrate that the veteran did not receive any awards or commendations related to combat service. Accordingly, the Board finds that the veteran was not engaged in combat while he was in Vietnam. It must now be determined whether service records corroborate the veteran's lay testimony regarding specific non-combat putative stressors. The September 1991 Task Force statement includes a unit history for the 321st Transportation Company for calendar year 1970, which covers a substantial portion of the veteran's tenure with that unit. The unit history shows that unit personnel did not conduct combat operations or prepare or transport bodies. In order to provide information regarding specific incidents, it was indicated the veteran had to provide the who, what, where and when to enable a meaningful search to be made. At no time, despite repeated requests, has the veteran been able to provide specific information upon which a meaningful stressor search could be based. He has testified that a hotel was blown-up and that his roommate was killed, but he could not remember the date of the incident, the name of the hotel, or even the name of the comrade. He testified that he performed perimeter guard duty, yet his MOS does not corroborate that fact. Mortar and rocket attacks were testified to, but necessary particulars were not forthcoming to corroborate any specific mortar or rocket attack. He has testified that truck convoys were attacked and that his truck was destroyed; however, supporting evidence to underpin this contention has not been provided. Interestingly, the veteran has stated that he performed body bag detail, yet the Task Force was able to document that personnel in the veteran's unit did not perform that detail. In short, the veteran's putative stressors are completely anecdotal in nature and unresearchable. The PTSD form which was submitted in March 1991 indicates that the veteran's stressful episodes included armed combat with the enemy, tripped booby trap, shipwrecked or in airplane or vehicle accident. The documented record reveals no plausible basis upon which to verify such incidents, further eroding the veteran's credibility. The Board finds that the service record does not corroborate the veteran's non-combat related stressors. The veteran's PTSD claim is also deficient in that a verifiable diagnosis of PTSD is not contained in the medical record. The Court has determined that medical evidence is inadequate where medical opinions consist of general conclusions based on history provided by the appellant and on unsupported clinical evidence. See Black v. Brown, 5 Vet.App. 177 (1993). Diagnoses of PTSD have been made on VA hospitalizations in October 1990, November to December 1990, February to March 1991, May 1991, August 1991, October to November 1991, and April to May 1993. Specific stressor events upon which the diagnoses were based are almost entirely absent from the hospital records. In October 1990, the veteran was hospitalized following an episode of violent behavior precipitated by non-specific Vietnam flashbacks; in February and March 1991, increased non-specific flashbacks and nightmares were reported; in May 1991, non-specific combat nightmares were reported; increased non-specific flashbacks were reported in August 1991; continuing non-specific dreams and flashbacks were reported in October and November 1991; and a generic long history of symptomatology was reported from April to May 1993. Significantly, the one specific stressor event contained in the hospital records, stuffing friends into body bags, as reported in November to December 1990, has been excluded from possible stressor events in the veteran's case by the Task Force. Hospital diagnoses of PTSD lack validity as they are based solely on history provided by the veteran, and on unsupportable clinical evidence. The veteran and his wife testified that the veteran started drinking heavily following his first tour of duty in Vietnam. Presumably, this testimony was provided to document the stress involved in the veteran's Vietnam service, and to demonstrate the early onset of PTSD symptomatology; however, the record does not substantiate the 1990's version as to the date of onset of heavy drinking. The veteran injured his back in August 1964. In July 1966, one month before his initial Vietnam tour began, the veteran was picked up in Okinawa in a highly intoxicated and violent state. Between tours of duty in Vietnam, a December 1969 notation indicates that the veteran had been drinking since age 14, and that he had been drinking to excess rather regularly for four to five years. That chronology places the onset of heavy drinking following the 1964 back injury, and provides no nexus to Vietnam service for his drinking. Factors such as a failure to obtain a promotion and immaturity were cited in December 1969, anxiety from service in Vietnam was not mentioned. A February 1974 VA nursing notation, made less than two years after separation, indicates that the veteran had been drinking more heavily since 1964. A February 1981 statement from Dr. Covey, made more than eight years after separation, indicates that the veteran had started drinking due to back pain following an injury. The extant record severely undercuts the 1994 testimony provided by the veteran and his wife which would associate his heavy drinking with his Vietnam service. In Wood v. Derwinski, 1 Vet.App. 190 (1991), the Court stated that the Board was not bound to accept uncorroborated accounts of stressors, or medical opinions which were based on such accounts. That principle was especially true when there was a considerable passage of time between putative stressors and the onset of the alleged PTSD. Classic PTSD symptoms were not reported in the veteran's case until the early 1990's, more than 18 years after the purported stressors in Vietnam. Testimony by the veteran and his wife which indicate that PTSD symptoms were present from the late 1960's and early 1970's, lacks credibility in view of medical notations from 1969 to 1981 which do not contain symptomatology indicative of PTSD. The January 1991 VA psychiatric examination report initially notes that most of the veteran's inservice problems involved alcoholism. It was stated that the veteran was unable to remember specific details regarding stressor events. Once again, generic stressor events were recounted, such as shooting guns at the enemy. Names, dates, places, or any other specifics were not forthcoming. Interestingly, the veteran did remember that he hurt his back in 1964 and that he had been a heavy drinker thereafter. The examiner opined that there was insufficient evidence in the record to document extreme stressors and a diagnosis of PTSD was not rendered. The Board finds that the record does not include a valid diagnosis of PTSD which is based on verifiable evidence of a stressor event. In summary, the veteran was not engaged in combat in Vietnam, his MOS did not entail more than an ordinary stressful environment, there was a considerable passage of time between the veteran's putative stressors and the onset of alleged PTSD in 1990, the veteran's putative stressors are wholly anecdotal and unresearchable, and a verifiable diagnosis of PTSD has not been made. Moreover, the credibility of the veteran's testimony has been severely undermined by the evidence of record. In view of these factors, the Board concludes that the preponderance of the evidence is against the veteran's claim for entitlement to service connection for PTSD. ORDER Entitlement to service connection for PTSD is denied. I. S. SHERMAN 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.