BVA9504941 DOCKET NO. 93-12 385 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Robert E. O'Brien, Counsel INTRODUCTION The veteran had active service from December 1967 to July 1969. He served in Vietnam from January 1968 to January 1969. His principal duty assignment in Vietnam was as an assistant machine gunner and an assistant gunner with Battery G, 55th Artillery (USARPAC). The first matter to be addressed is that of the procedural status of this case. A review of the evidence of record discloses that service connection for post-traumatic stress disorder was denied by the RO in October 1984. The denial was based on a hospital summary which did not show any symptoms of post-traumatic stress disorder. A computer generated document dated October 18, 1984, indicates that the veteran may have been notified of the determination. In any event, new and material evidence with regard to this issue has been added to the record since this denial and the veteran's claim is being adjudicated on a de novo basis. REMAND A review of the evidence of record discloses varying psychiatric diagnoses, with post-traumatic stress disorder being the predominant diagnosis in recent years. However, critical elements of this diagnosis, most fundamentally those concerning the existence of a stressor or stressors, appear to be based wholly upon statements of history provided to the various examiners by the veteran. The question of whether he was exposed to a stressor in service is a factual determination and VA adjudicators are not bound to accept such statements simply because treating medical providers have done so. Wood v. Derwinski, 1 Vet.App. 190 (1991) affirmed on reconsideration, 1 Vet.App. 406 (1991); Wilson v. Derwinski, 2 Vet.App. 614 (1992). The RO has obtained pertinent pages from the veteran's military personnel file but had made no other attempt to corroborate the stressors reported by the veteran. The RO, in the Statement of the Case dated in November 1991, dismissed the stressors reported by the veteran as being inconsistent, without identifying any specific inconsistency. While the veteran's accounts of alleged stressors are vague, he may have provided sufficient details to permit meaningful research. In the case of Zarycki v. Brown, 6 Vet.App. 91 (1993), the Court set forth the framework for establishing the presence of a recognizable stressor, which is the essential prerequisite to support the diagnosis of post-traumatic stress disorder. The Court analysis divides into two major components: The first component involves the evidence required to demonstrate the existence of an alleged stressful event; the second involves a determination as to whether the stressful event is of the quality required to support the diagnosis of post-traumatic stress disorder. With regard to the first component of the Court analysis, under 38 U.S.C.A. § 1154(b) (West 1991), 38 C.F.R. § 3.304 (1992), and the applicable VA's Manual 21-1 provisions, the evidence necessary to establish the occurrence of a recognizable stressor during service to support a claim of entitlement to service connection for post-traumatic stress disorder will vary depending on whether or not the veteran "engaged in combat with the enemy." See Hayes v. Brown, 5 Vet.App. 604 (1993). Whether or not a veteran "engaged in combat with the enemy" must be determined through recognized military citations or other service department evidence. In other words, the claimant's assertions that he "engaged in combat with the enemy" are not sufficient, by themselves, to establish this fact. The record must first contain recognized military citations or other supportive evidence to establish that he "engaged in combat with the enemy." If the determination with respect to this step is affirmative, then (and only then), a second step requires that the veteran's lay testimony regarding claimed stressors must be accepted as conclusive as to their actual occurrence and no further development or corroborative evidence will be required, provided that the veteran's testimony is found to be "satisfactory," e.g., credible, and "consistent with the circumstances, conditions, or hardships of such service." Zarycki at 98. In West v. Brown, 7 Vet.App. 70 (1994), the Court elaborated on the analysis in Zarycki. In Zarycki, the Court held that in addition to demonstrating the existence of a stressor, the facts must also establish that the alleged stressful event or events was or were sufficient to give rise to post-traumatic stress disorder. Id. at 98-99. In West the Court held that the sufficiency of a stressor is a medical determination, and therefore adjudicators may not render a determination on this point in the absence of independent medical evidence. Upon reviewing Zarycki and West, it appears that in approaching a claim for service connection for post-traumatic stress disorder, the question of the existence of an event claimed as a recognizable stressor must be resolved by adjudicatory personnel. If the adjudicators conclude that the record establishes the existence of such a stressor or stressors, then and only then, the case should be referred for a medical examination to determine the sufficiency of a stressor and to determine whether the remaining elements required to support the diagnosis of post- traumatic stress disorder have been met. In such a referral, the adjudicators should specify to the examiner(s) precisely what stressors have been accepted as established by the record, and the medical examiners must be instructed that only those events may be considered in determining whether stressors to which the appellant was exposed during service were of sufficient severity as to have resulted in current psychiatric symptoms. In other words, if the adjudicators determine that the existence of an alleged stressor or stressors in service is not established by the record, a medical examination to determine whether post- traumatic stress disorder, due to service, is present would be pointless. Likewise, if the examiners render a diagnosis of post-traumatic stress disorder that is not clearly based upon stressors in service whose existence the adjudicators have accepted, the examination would be inadequate for rating purposes. In light of the foregoing, it is the VA's duty to assist the veteran in the development of facts pertinent to his claim as mandated by 38 U.S.C.A. § 5107(a) (West 1991) and the case is REMANDED to the RO for the following actions: 1. The RO should request from the veteran a comprehensive statement containing as much detail as possible regarding the stressor or stressors to which he alleges he was exposed to in service. The veteran should be asked to provide specific details of the claimed stressful event or events during service, such as dates, places, detailed descriptions of events, and identifying information concerning any other individuals involved in the events, including their names, ranks, units of assignment or any other identifying detail. The veteran is advised that this information is vitally necessary to obtain supportive evidence on the stressful event or events and that he must be as specific as possible because without such details an adequate search for verifying information cannot be conducted. 2. With the additional information obtained, the RO should review the file and prepare a summary of all the claimed stressors. This summary and all associated documents, should be sent to the United States Army and Joint Services Environmental Support Group, 7798 Cissna Road, Springfield, Virginia 22159. They should be requested to provide any information which might corroborate the veteran's alleged stressor or stressors. This should include the obtaining of information pertaining to the activities of Battery G, 55th Artillery (USARPAC) between January 1968 and December 1968. 3. Following the above, the RO must make a specific determination, based upon the complete record, with respect to whether the appellant was exposed to a stressor or stressors in service, and if so, what was the nature of the specific stressor or stressors. In rendering this determination, the attention of the RO is directed to the cases of Zarycki and West. In any event, the RO must specifically render a finding as to whether the appellant "engaged in combat with the enemy." If the RO determines that the record establishes the existence of a stressor or stressors, the RO must specify what stressor or stressors in service it has determined are established by the record. In reaching this determination, the RO should address any credibility questions raised by the record. 4. If, and only if, the RO determines that the record establishes the existence of a stressor or stressors, then the RO should arrange for the veteran to be accorded a psychiatric examination to determine the diagnosis of all psychiatric disorders that are present. The RO must specify for the examiner the stressor or stressors that it has determined are established by the record. The examination report should reflect a review of pertinent material in the claims folder. The examiners should integrate the previous psychiatric findings and diagnoses with current findings to obtain a true picture of the nature of the veteran's psychiatric status. If the diagnosis of post-traumatic stress disorder is deemed appropriate, the examiner should comment upon the link between the current symptomatology and one or all of the inservice stressors found to be established by the RO. The claims folder must be made available to the examiner prior to the examination. 5. The RO should then review the record and ensure that all of the above actions have been completed. When the RO is satisfied that the record is complete and the psychiatric examination is adequate for rating purposes, the claim should be readjudicated. If the benefit sought on appeal is not granted to the veteran's satisfaction, a supplemental statement of the case should be prepared and the veteran and his representative should be given the applicable time period in which to respond. Thereafter, the claim should be returned to the Board for further review, if otherwise in order. No action is required of the veteran until he receives further notice. The Board does not intimate any factual or legal conclusions as to any final outcome warranted in the appeal. GARY L. GICK 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. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).