Citation Nr: 0004745 Decision Date: 02/24/00 Archive Date: 02/28/00 DOCKET NO. 97-10 915 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to service connection for acute and subacute peripheral neuropathy, as a result of claimed exposure to herbicide agents, including Agent Orange (peripheral neuropathy). 2. Entitlement to service connection for chloracne, as a result of claimed exposure to herbicide agents, including Agent Orange (chloracne). 3. Whether new and material evidence has been submitted to reopen a claim of service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: North Carolina Division of Veterans Affairs WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD K. Ehrman, Counsel INTRODUCTION The veteran had active military service from January 1970 to January 1972, which included a tour of duty in the Republic of Vietnam from January 22, 1971 to September 2, 1971. He also had subsequent inactive duty in the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from RO rating decisions dated in January 1997 and September 1998. The January 1997 rating decision denied service connection for acute and subacute peripheral neuropathy and chloracne, claimed as due to exposure to herbicide agents, to include Agent Orange. The September 1998 rating decision found that new and material evidence had not been received to reopen a claim of service connection for PTSD. FINDINGS OF FACT 1. The veteran had active military service in the Republic of Vietnam during the Vietnam War era. 2. Neither acute and subacute peripheral neuropathy, nor chloracne, are currently demonstrated by competent evidence. 3. The veteran has not submitted competent evidence sufficient to justify a belief by a fair and impartial individual that he has presented a plausible claim of service connection for either acute and subacute peripheral neuropathy or chloracne, as a result of claimed exposure to herbicide agents, to include Agent Orange. 4. Service connection for PTSD was denied by a July 1994 Board decision. The veteran appealed the July 1994 Board decision to the United States Court of Appeals for Veterans Claims (Court), and the Court summarily affirmed the denial of service connection for PTSD. 5. Evidence received since the July 1994 Board denial includes additional service medical records, including a September 1971 psychiatry treatment record identifying the veteran's military unit duty as "mechanic (fly boy) door gunner" while stationed in Vietnam; This evidence, not previously of record when the Board decided the case in 1994, is so significant by itself or in connection with evidence previously assembled that it must be considered in order to fairly decide the merits of the veteran's claim. CONCLUSIONS OF LAW 1. The claims of service connection for acute and subacute peripheral neuropathy and chloracne due to claimed exposure to herbicide agents, including Agent Orange, are not well grounded. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1116, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309 (1999). 2. New and material evidence sufficient to reopen the previously denied claim of service connection for PTSD has been submitted. 38 U.S.C.A. §§ 1110, 5108, 7104 (West 1991); 38 C.F.R. §§ 3.156, 20.1100 (1999). 3. The claim of service connection for PTSD is well grounded. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.306 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for Claimed Agent Orange Exposure Service connection may be granted for disability resulting from disease or injury incurred in, or aggravated by, active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999). The initial question that must be answered is whether the veteran's claims of service connection for acute and subacute peripheral neuropathy and chloracne are well grounded. In this regard, the veteran -- not the VA -- has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claims are well grounded. That is, the claims must be plausible and capable of substantiation. See 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). In order for a claim of service connection to be well grounded, there must be competent evidence (lay or medical, as appropriate) of: (1) a current disability; (2) an in- service injury or disease; and (3) a nexus between the current disability and the in-service injury or disease. Epps v. Gober, 126 F.3d 1464, 1468 (1997); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Where, as in the present case on appeal, the determinative issue involves medical diagnosis and etiology, competent medical evidence is required to the effect that each claim is plausible. Id. The veteran again asserts that he is entitled to service connection for acute and subacute peripheral neuropathy, as well as chloracne, due to claimed exposure to herbicide agents, specifically including Agent Orange, while in Vietnam in 1971 during his active military service. VA laws and regulations provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, and later is found to have any of the diseases listed at 38 C.F.R. § 3.309(e), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C.A. § 1116(a)(3) (West 1999); 38 C.F.R. § 3.307(a)(6)(iii) (1999). The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. 38 C.F.R. § 3.307(a)(6)(iii) (1999). "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. Id. If a veteran was exposed to an herbicide agent during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, the following diseases shall be service-connected if the requirements of 38 U.S.C.A. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied: chloracne or other acneform disease consistent with chloracne, and acute and subacute peripheral neuropathy (the term acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset). 38 C.F.R. § 3.309(e), and Note 2, which follows (1999). Under 38 C.F.R. § 3.309(e), chloracne (or other acneform disease consistent with chloracne) and acute and subacute peripheral neuropathy, shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii) (1999). The Secretary of VA has determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Diseases Not Associated With Exposure to Certain Herbicide Agents, 61 Fed. Reg. 41442, 41448 (1996). Nevertheless, the United States Court of Appeals for the Federal Circuit has held that the Veteran's Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, Pub. L. No. 98-542, § 5, 98 Stat. 2725, 2727-29 (1984), does not preclude a claimant from establishing service connection with proof of direct causation, a task "which includes the difficult burden of tracing causation to a condition or event during service." Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In the veteran's case instantly on appeal, he claims that current problems with his lower extremities and his skin are due to possible exposure to herbicides when he was in the Republic of Vietnam in 1971. -The veteran's service medical and administrative records include no indication of any exposure to herbicide agents, including Agent Orange, during his military service. His military service discharge document indicates his participation in a tour of duty in the Republic of Vietnam, from January 22, 1971 to September 2, 1971. While treatment for various disorders is shown, treatment for lower extremity or skin disorders is not shown. On service entry physical examination in January 1970, the veteran was found to have a scar on the left leg. During his tour of duty in Vietnam, in May 1971, the veteran was seen for pneumonitis. Upon his return from Vietnam, in September 1971, he was placed in a drug rehabilitation program. On examination in December 1971, at separation from service, the veteran denied any skin diseases, leg cramps, boils, lameness, foot trouble, neuritis, or paralysis. No disorders or abnormalities were noted on separation examination. The veteran's service medical records include a February 1975 report of medical history and report of medical examination taken upon his entry into inactive duty with the Army National Guard. At that time, the veteran, once again, denied any skin or lower extremity disorder. Indeed, his health was described by the medical examiner to be excellent. Notation was made of a history of treatment for pneumonia in Vietnam in 1971. Having discussed the applicable laws and regulations, and having reviewed the veteran's service medical records, the Board will first address the question of whether the veteran experienced an exposure to herbicide agents in service. In this regard, the Board finds it is clear that the veteran served in Vietnam. The Board notes, however, that there is no competent evidence of record that the veteran was diagnosed with acute and subacute peripheral neuropathy as defined within Note 2 of 38 C.F.R. § 3.309(e). Nor was the veteran diagnosed with chloracne or any other presumptive disorder. In this regard, it is noted that the veteran does not currently have a diagnosis of any disorder presumptively recognized by VA as etiologically related to exposure to herbicide agents used in Vietnam. As the veteran does not have a diagnosis for one of the disorders specifically enumerated in 38 C.F.R. § 3.309(e), the presumption of exposure to Agent Orange or other herbicide agents is unavailable to him. See McCartt v. West, 12 Vet. App. 164 (1999). The Board notes that VA Adjudication Procedure Manual, M21-1, Part VI, para. 7.20b previously contained a more liberal interpretation of the presumption of exposure, stating that "unless there is affirmative evidence to the contrary, a veteran who served on active duty in the Republic of Vietnam during the Vietnam era is presumed to have been exposed to an herbicide agent." However, pursuant to McCartt, that M-21-1 provision has been revised in order to conform with the McCartt decision, and the more liberal presumption is no longer available to establish exposure. The Board notes, however, that the veteran has contended within his original claim that he was exposed to Agent Orange in service. Furthermore, solely for purposes of determining the well-groundedness of his claim, these contentions will be considered credible by the Board. See King, supra. However, even conceding for this limited purpose that the veteran experienced exposure to herbicide agents in service, the Board notes that there is no credible evidence of record indicating that the veteran was diagnosed with acute and subacute peripheral neuropathy, or chloracne, as one of the conditions specified within 38 C.F.R. § 3.309(e), within the required presumptive time period. In this regard, the Board notes that private and VA medical records, dated from March 1983 to 1997, show treatment for skin and lower extremity disorders, without any medical diagnosis of chloracne, or a skin disorder consistent with chloracne, or acute and subacute peripheral neuropathy. Given the above, and without any medical opinion evidence linking any current skin or neurologic disorders to the veteran's military service, this claims of service connection are not well grounded. Caluza, supra. In finding so, the Board has given due consideration to the veteran's repeated history of left foot "jungle rot" reported on various examinations since July 1991. The medical evidence of record, however, shows treatment for multiple rectal skin tags, status post surgical removal in March 1991, a stitch abscess in March 1992, and anal abscesses in December 1993 and December 1994. These records include no medical nexus evidence. The post-service medical evidence also shows a left below the knee amputation. However, the medical records clearly show that this was secondary to work-related trauma in 1990, and the veteran testified as such at his October 1998 personal hearing. No medical nexus evidence is of record. While he testified that he had had left leg numbness prior to his amputation, the record contains no evidence of treatment for any peripheral neuropathy. Without any such diagnosis, and with no nexus evidence, the claim is not well grounded on the basis of the veteran's statements that there may, somehow, be a connection between the two events. As noted above, the initial burden of submitting a well- grounded claim rests with the veteran. Murphy, 1 Vet. App. at 81. The veteran cannot meet his initial burden of submitting a well-grounded claim by relying on his own assertions and opinions regarding medical issues. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). As a layperson, without the appropriate medical training and expertise, he is not competent to render an opinion on a medical matter, such as a diagnosis or etiology. See also Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). While the veteran asserts that his skin and lower extremity disorders are due to claimed exposure to herbicide agents while in Vietnam, without current medical diagnoses of skin disease consistent with chloracne, or a diagnosis of (acute and subacute) peripheral neuropathy, as well as any competent nexus evidence, i.e., medical evidence of a nexus between current skin and lower extremity disorders and the veteran's prior service, his assertions alone are not sufficient to establish his claim as well grounded. Id.; Savage v. Gober, 10 Vet. App. 488, at 498 (1997). Additionally, the presumption of service incurrence or aggravation in 38 C.F.R. § 3.307 (1999) is not helpful to the veteran because evidence has not been received showing that any tumor affecting the skin was evident within a year of the veteran's separation from active military service. 38 C.F.R. §§ 3.307, 3.309. As such, the claims of service connection for chloracne or acute and subacute peripheral neuropathy are not well grounded, specifically for lack of current diagnoses and for lack of any medical nexus evidence linking any current disorder to his military service. Finally, the Board notes that the veteran has not informed VA of the existence of any available evidence that would render his current claim well grounded. He has not contended that any further relevant records exist. The Board therefore finds that no further action is warranted relative to the development of the appellant's claim, based upon the information currently of record. Hence, the Board concludes that there are no additional pertinent records of treatment which are not in the claims folder and would be available. See Counts v. Brown, 6 Vet. App. 473, 477 (1994). Therefore, under the circumstances of this case, the appellant's application is not incomplete, and VA has not been put on notice that other relevant evidence exists, or could be obtained, which, if true, would make the claim "plausible." Robinette v. Brown, 8 Vet. App. 69, 80 (1995); see also Epps v. Brown, supra. Moreover, VA is not required to notify the veteran of particular evidence needed to make his application complete if the Department has not reasonably had notice of the existence of such evidence. McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997). Consequently, a remand for additional evidentiary development is not warranted under the facts of this case. II. New and Material Evidence - PTSD Service connection for PTSD was denied by a Board decision dated in July 1994. The veteran appealed this denial to the Court, and in July 1995, the Court summarily affirmed that decision. The decision of the Board became final. As a result, the Board may now consider the veteran's claim of service connection for PTSD on the merits, only if "new and material evidence" has been presented or secured since the July 1994 Board decision. 38 U.S.C.A. § 5108 (West 1991); Manio v. Derwinski, 1 Vet. App. 144, 145-146 (1991). The Court recently held that the determination of new and material evidence requires a three-step process. See Elkins v. West, 12 Vet. App. 209 (1999) (en banc), interpreting and applying a decision of the United States Court of Appeals for the Federal Circuit in Hodge v. West, 155 F.3d. 1356 (Fed. Cir. 1998). See also Winters v. West, 12 Vet. App. 203, (1999) (en banc). The procedure which we must now follow is - first, it must be determined whether the appellant has presented new and material evidence under 38 C.F.R. § 3.156(a); second, after the claim has been reopened, it must be determined whether, based upon all the evidence of record, the claim, as reopened, is well grounded; third, if the claim is well grounded, the merits of the claim must be addressed, but only after ensuring that the duty to assist has been fulfilled. Winters, 12 Vet. App. 203. A. New and material evidence "New and material evidence" means evidence not previously submitted to agency decision makers, which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with the evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a) (1998); Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998) (overruling Colvin v. Derwinski, 1 Vet. App. 171 (1991) to the extent that Colvin defined, in a petition to reopen, "material" evidence to be evidence that would raise a reasonable possibility of a change in the outcome of the case on the merits). Also, for the purpose of determining whether a case should be reopened, the credibility of the evidence added to the record is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence available at the time of the July 1994 Board denial included the veteran's service medical records, his service discharge record and some personnel records, as well as VA and private treatment records dated from February 1983. Service medical and administrative records then available showed that the veteran had a military occupational specialty (MOS) of wheel vehicle mechanic and vehicle mechanic, and that these MOS designations remained throughout his entire Vietnam tour of duty, from January 1971 to September 1971. The veteran was assigned to the 62nd Aviation Company during his service in Vietnam. His service personnel records indicated no combat decorations. Service medical records were silent for any psychiatric complaints, treatment, or diagnosis, other than his participation in a drug rehabilitation program in November 1971 after his return from Vietnam. The post-service medical evidence of record at the time of the Board's July 1994 decision revealed a history of a provisional diagnosis of questionable PTSD from December 1982, as well as a current diagnosis of PTSD, but without verification of any of the reported PTSD stressors. The veteran's statement of the facts and circumstances of his claimed PTSD stressors was documented in an April 1989 VA examination report. The reported PTSD stressors included witnessing the violent death of a friend and fellow serviceman, at close proximity, when the man was shot in the head by enemy gun fire. The veteran also claimed combat exposure while serving as a perimeter guard and as a helicopter door gunner. However, his service personnel records showed only that he was a vehicle mechanic. The veteran claimed that his military duties while stationed in Vietnam included that of a door gunner on a helicopter, and that during his time, he was exposed to almost daily combat action. His statement was not supported by any evidence, including the service medical and personnel records then on file. [It should be noted that his service medical and service personnel records then appeared complete, as they do presently.] In October 1990, the U.S. Army and Joint Services Environmental Support Group (ESG) reported to the RO that the veteran's asserted PTSD stressors, including his claimed combat as a helicopter door gunner and as a perimeter guard, could not be verified or documented. A thorough search appeared to have been made, and many documents were received. In short, previously received medical evidence referred to a current diagnosis of PTSD, without relation to any verified stressor in service. Additionally, the veteran was not shown to have had any combat while stationed in Vietnam. Accordingly, the statements of combat and PTSD stressors were thought to be contradicted, and unsubstantiated by sufficient credible evidence. Zarycki v. Brown, 6 Vet. App. 91 (1993). The claim was accordingly denied. The evidence received since the July 1994 Board denial includes a September 15, 1971 in-service psychiatry treatment record (SG Form 84), from the Madigan General Hospital in Tacoma, Washington, identifying the veteran's military unit duty as "mechanic (fly boy) door gunner." This record is accompanied by three other records, dated September 12 -- 15, 1971, or undated, but regarding the same incident of treatment. While the record shows psychiatry treatment for the improper use of opiates (Heroin) and an upper respiratory infection, the notation of the duty of "mechanic (fly boy) door gunner" presents new information, not previously of record when the Board decided the case in 1994. The veteran additionally submitted a hand-written statement, dated December 1998, from his brother, who is identified as having served in Vietnam from 1967 to 1968 and from 1970 to 1971. The veteran's brother indicates that the veteran was a helicopter door gunner in 1971, and that on one occasion the helicopter he was a passenger in was shot down by enemy fire. Several crewmembers were reportedly killed in the crash, and the veteran appeared, to his brother, to be very upset by the incident, and was never the same thereafter. The veteran's brother indicates that the veteran received subsequent psychiatric treatment in Da Nang, Vietnam. The above evidence not only supports the veteran's previously unsupported assertions of his in-service military duties, but also tends -- for the first time -- to lend independent documentary support to the facts and circumstances of his asserted combat-related PTSD stressors while stationed in Vietnam. Accordingly, the claim for service connection for PTSD is reopened: this sort of evidence is so significant by itself or in connection with evidence previously assembled that it must be considered in order to fairly decide the merits of the veteran's claim for service connection for PTSD. The newly received 1998 lay statement and service medical records of September 12 -15, 1971 corroborate the veteran's prior statements that his military duties included those of helicopter gunner, and give new credence to his statements and explanations of what happened to him while in service. Consequently, even though the new evidence may represent no more than a reiteration of the veteran's own story, because this evidence for the first time includes documentation supportive of his claims and statements, including his statements of combat, and PTSD stressors, this evidence tends to provide more information than that which was of record prior to the July 1994 Board decision. With evidence and documentation supportive of the veteran's assertions, the Board now finds that it is sufficiently significant that it must be considered in order to fairly decide the underlying claim. § 3.156. Consequently, the claim for service connection for PTSD is reopened. This reopening resolves the first question in the test presented by Elkins and Winters, namely whether new and material evidence has been presented under 38 C.F.R. § 3.156. The next question for the Board to resolve, after the claim has been reopened, is whether based upon all the evidence of record the claim is well-grounded. B. Well Grounded Claims Turning now to the question of the well-groundedness of the veteran's claim, the Board finds that the veteran's claim seeking service connection for PTSD is well-grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is not inherently implausible. See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well-grounded claim requires more than an allegation; the claimant must submit supporting evidence. Furthermore, the evidence must justify a belief by a fair and impartial individual that the claim is plausible. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). Also, in order for a claim to be well-grounded, there must be competent evidence of a current disability (medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). See Elkins v. West, 12 Vet. App. 209, 213 (1999) (en banc), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Also, evidentiary assertions by the veteran must be accepted as true for the purposes of determining whether a claim is well-grounded, except where the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. King v. Brown, 5 Vet. App. 19, 21 (1993). Applying these standards to the current claim seeking service connection, the Board notes that the veteran has contended that he was exposed to multiple stressor incidents during his service. Solely for the purpose of determining the well- groundedness of his claim, these contentions will be deemed credible. See King, 5 Vet. App. 19. Furthermore, the veteran has also submitted a lay statement from his brother into the record which tends to corroborate at least one of the veteran's claimed stressors. There is also a new service medical record within the claims file that has a history tending to indicate that the veteran did serve as a doorgunner. There has also been continued medical evidence of a diagnosis of PTSD and this diagnosis is apparently attributed to some of the alleged stressor incidents. In summation, for the first time in this case, documentary evidence of record exists which tends to support the veteran's version of at least one of his alleged PTSD stressors: the veteran may have had duties other than vehicle mechanic, including helicopter door gunner, and these duties may have involved combat situations, as he has long asserted. The salient point is that his statements of PTSD stressors are no longer "patently incredible" and without any independent evidentiary support, as found by the Board in July 1994. Given this new information, the Board finds the claim of service connection for PTSD is now at least plausible. See Caluza v. Brown, 7 Vet. App. 498 (1995). ORDER The claims of service connection for chloracne and for acute and subacute peripheral neuropathy are not well grounded. New and material evidence sufficient to reopen a claim of service connection for PTSD having been submitted, the claim is reopened; to this extent the appeal is granted. The claim of service connection for PTSD is well grounded, and to this extent, the appeal is also granted. REMAND While diagnoses of PTSD and major depression, with psychotic features, are shown, questions remain as to whether PTSD is the result of the veteran's active military service, whether the veteran had combat, whether he experienced a valid PTSD stressor while on active duty so as to support a diagnosis of PTSD, and whether there is competent medical evidence linking the symptoms he is experiencing as a result of his PTSD to any of the alleged stressors which are verified. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by a veteran's active service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). It is also noted that a presumption of service connection arises for certain chronic conditions, to include a psychosis (to include major depression), manifested to a compensable degree within a prescribed period post-service (one year for a psychosis); such presumption is rebuttable by provide evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). A review of the record reveals that additional development is warranted. It is noted that the October 1991 VA PTSD examination report indicates that the veteran is in receipt of disability compensation from the Social Security Administration (SSA). As his claim of service connection for PTSD is now well grounded, the medical records underlying the SSA determination should be requested and associated with the record. Furthermore, should any such records suggest a nexus between the veteran's current PTSD and his military service, a medical opinion in this regard should be obtained by the RO. As noted above, VA treatment records include specific references to a diagnosis of PTSD. However, service connection for PTSD requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressors actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor(s). See 38 C.F.R. § 3.304(f); See also, Cohen v. Brown, 10 Vet. App. 128, 137-138 (1997); West v. Brown, 7 Vet. App. 70 (1994). The evidence necessary to establish the occurrence of a recognizable in-service stressor to support a diagnosis of PTSD will vary depending upon whether the veteran engaged in "combat with the enemy," as established by recognized military combat citations or other official records. See, e.g., Hayes v. Brown, 5 Vet. App. 60, 66 (1993); Doran v. Brown, 6 Vet. App. 283, 289 (1994). If the VA determines that the veteran engaged in combat with the enemy and his alleged stressor is combat-related, then his lay testimony or statement is accepted as conclusive evidence of the stressor's occurrence and no further development or corroborative evidence is required-provided that such testimony is found to be "satisfactory," i.e., credible, and "consistent with the circumstances, conditions, or hardships of service." See 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. 3.304(f) (1998); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). If, however, the VA determines either that the veteran did not engage in combat with the enemy, or that he did engage in combat, but that the alleged stressor is not combat related, then his lay testimony, in and of itself, is not sufficient to establish the occurrence of the alleged stressor. Instead, the record must contain service records that corroborate his testimony or statements. See Zarycki, 6 Vet. App. at 98. The evidence currently of record does not clearly establish that the veteran engaged in combat with the enemy. Service medical and personnel records show no combat. While he had a tour of duty in Vietnam in 1971, his military occupational specialty is officially identified to have been limited to vehicle mechanic. Accordingly, while no combat is shown, the new and material evidence of record, including a September 15, 1971 psychology service treatment record, indicates that the veteran may have been assigned additional military occupational specialties, possibly those involving combat, as asserted by the veteran and his brother. While the veteran has also described several other PTSD stressors, no definitive statement has been received since VA examination in October 1991. Additional facts need to be verified, including the circumstances of his brother's service: the December 1998 statement of his brother, identifies him as a Sergent serving with the 1st Air Casualty Air Mobile Unit, 23rd Infantry Division, out of Cho Lia, Vietnam, from 1970 to 1971. The Board would emphasize, however, that the mere presence in a combat zone or the reporting of indirect experiences of an individual are not sufficient to show that the veteran engaged in combat with the enemy. Collette v. Brown, 82 F.3d. 389, 392 (Fed. Cir. 1996); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Rather, it is the veteran's duty to provide as detailed information as possible to permit verification or corroboration of his alleged stressful experiences, which is not an impossible or onerous burden. Wood, 1 Vet. App. at 193. Accordingly, the RO should request and obtain a complete and comprehensive statement from the veteran identifying each and every PTSD stressor, in as much detail as possible. The Board acknowledges that some of the stressors reported by the veteran appear to be the type of general feelings and experiences that are not objectively verifiable. However, the December 1998 statement of the veteran's brother makes reference to an incident in which the helicopter in which the veteran was a passenger was shot down during a combat mission. The Board believes that the veteran should be given another opportunity to submit more specific information concerning his alleged participation in combat and his- stressful in-service experiences in service that may be verifiable, such as being a helicopter door gunner and being shot down and witnessing the deaths of former comrades. This may consist of, but is not limited to, verification of the names of any members of his unit who were involved in those experiences, or the names of soldiers or civilians who were killed or wounded, or any other pertinent information, such as the dates of the incidents in question, the places where they occurred, etc. The veteran should be advised that the submission of this sort of detailed information is essential to substantiate his allegations. The veteran also should also be advised that it may be prudent for him to submit lay statements of follow servicemen regarding the claimed PTSD stressors in order to help corroborate his alleged in-service PTSD stressors. Whether the requested information as described above is provided or not, the RO should contact any potential source of verification that has access to this type of information, to include the National Personnel Records Center, and/or the U.S. Armed Services Center for Research of Unit Records (USASCRUR). If, after obtaining a response from the NPRC, USASCRUR, or any other department or agency that is contacted by the RO, either the veteran's participation in combat (to which a claimed stressful event is related), or noncombat- related stressor is corroborated, a VA psychiatrist should be given the opportunity to examine the veteran and determine whether any diagnosis of PTSD is the result of any verified in-service stressor. See Russo v. Brown, 9 Vet. App. 46 (1996). In view of the above, this case is hereby REMANDED for the following: 1. The RO should contact the veteran and request that he submit the names, addresses and approximate dates of treatment of all medical care providers (both VA and non-VA) who treated him for PTSD from January 1972 to the present. After securing any necessary release(s), the RO should obtain copies of any records not already in the claims folder. However, VA mental health and/or PTSD clinic records from the VA Medical Center in Fayetteville, North Carolina (as well as any other VA medical center identified) should be obtained, regardless of whether the veteran responds to the RO's inquiry. If any requested records are unavailable or any search otherwise yields negative results, that fact should clearly be documented in the claims file. 2. The RO should obtain and associate with the record copies of the decision on the veteran's claim for SSA disability benefits and all psychiatric records upon which that determination may have been based. 3. The RO should also request the veteran's complete service personnel records, to include his Official Military Performance File (OMPF), from the National Personnel Records Center (NPRC). If for any reason, the OMPF is not available, the NPRC should specifically so indicate. These records should be reviewed to ascertain where the veteran was assigned, and what type of work he performed while in Vietnam. They should specifically be reviewed to ascertain whether the veteran was ever assigned duties as a helicopter doorgunner and whether he was ever on a helicopter which was shot down or crashed as a result of enemy fire. 4. The RO should also contact directly the veteran's brother, and ask that he provide sufficient information to verify his service, to include his dates of service, dates of service in Vietnam, and units of service in Vietnam. The RO should then attempt to verify, through official channels, the veteran's brother's periods of military service. The RO should also request the brother's complete service personnel records, to include his OMPF, from the NPRC. These records should be reviewed to ascertain when and where he was assigned in Vietnam and whether he served at the same time and in the same area as the veteran. 5. The RO should contact the veteran and provide him with another opportunity to provide a comprehensive statement containing as much detail and information as possible concerning the specifics (i.e., who, what, where, when, specific dates, and units involved) of the combat actions and stressful events that he alleges to have experienced during active military service - including the incidents of his alleged duty as a helicopter door gunner when it was shot down, as reported by his brother in a December 1998 statement. The veteran should be informed that it is essential that any additional statement include a full, clear, and understandable description of the stressful events in question, and that it contain identifying information concerning any other individuals who purportedly were involved. The veteran should specify the date of any such stressor incidents; he must describe whether any individuals he identifies were wounded or killed; whether he witnessed their injuries or death, or learned of their tragedies through other means; and whether any of them have other information that could corroborate this allegation of stressful experiences in service, including their full names, ranks, and unit designations to the company level. He also should provide any information he had concerning other units that were involved, or any other identifying detail such as the best estimate of the date and location of the incidents, etc. The veteran should also submit to the RO any statements from former service comrades, preferably, or other individuals who can corroborate his claimed combat/stressful experiences in service. 6. Regardless of whether the veteran responds to RO's inquiry, above, the RO must then review the entire file, including the veteran's previous statements of stressors and any additional information submitted by the veteran or otherwise obtained pursuant to this remand, and prepare a summary of all the claimed stressors. This summary and all associated documents should be sent to the USASCRUR, 7798 Cissna Road, Springfield, VA 22150. A copy of all information obtained pertaining to the service of the veteran's brother and the brother's statements regarding the veteran's stressors should be included in this request. The USASCRUR should be requested to provide any information which might corroborate the veteran's alleged stressors, to include the helicopter crash reported by the veteran's brother. 7. Following the above, the RO must make a specific determination, based upon the complete record, as to whether the veteran was engaged in combat and whether he did experience any of his claimed stressor(s) (whether in combat or otherwise) and determine whether the evidence is sufficient to establish the occurrence of the stressor(s). If so, these findings should be specified for the record. 8. If, and only if, the RO determines that the record establishes the existence of a stressor or stressors, the RO should specify those stressors for the record. If there is no such verification, the RO need not undertake another examination of the veteran. If however, there is such verification, the RO should then schedule the veteran for a VA psychiatric examination in order to determine, after a review of all pertinent evidence and evaluation of the veteran, whether he currently meets the diagnostic criteria for PTSD. In determining whether the veteran has PTSD due to an inservice stressor, the examiner is hereby notified that only the verified history detailed in the reports provided by USASCRUR and/or by the RO may be relied upon. If a diagnosis of PTSD is deemed appropriate, the examiner should explain how the diagnostic criteria of the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders are met, to include identification of the specific stressor(s) underlying any PTSD diagnosis, and comment upon the link between the current symptomatology and one or more of the in-service stressors found to be established by the RO. The claims folder, to include a copy of this remand, along with any additional evidence obtained pursuant to this remand, should be provided to the examiner for review. The examination report should reflect review of pertinent material in the claims folder and include the complete rationale for all opinions expressed. All necessary special studies or tests, to include psychological testing and evaluation, such as the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorders, should be accomplished. The examiner's typewritten report must include all examination results, along with the complete rationale underlying all opinions expressed, citing, if necessary, to specific evidence in the record. The report should be associated with the other evidence on file in the veteran's claims folder. 9. The RO should review the examination report to determine if it is in compliance with this REMAND. If deficient in any manner, it should be returned, along with the claims file, for immediate corrective action. 10. After the development requested above has been completed, the RO should again review the record. If the determination remains unfavorable to the veteran, the RO should furnish him and his representative with a supplemental statement of the case, in accordance with 38 U.S.C.A. § 7105 (West 1991). Thereafter, the veteran and his representative should be given the opportunity to respond. The case should then be returned to the Board for further appellate consideration, if otherwise in order, following appropriate appellate procedure. By this REMAND the Board intimates no opinion, either legal or factual, as to the ultimate determination warranted in this case. The purpose of this REMAND is to further develop the record. No action is required by the veteran until he receives further notice. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. BRIAN LEMOINE Acting Member, Board of Veterans' Appeals