Citation Nr: 0005487 Decision Date: 02/29/00 Archive Date: 03/07/00 DOCKET NO. 90-25 460A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. M. Rogers, Associate Counsel INTRODUCTION The veteran had active duty in the Army from August 1965 to August 1971. This matter comes to the Board of Veterans' Appeals (Board) from a January 1990 rating decision of the Department of Veterans Affairs (VA) Los Angeles, California Regional Office (RO), in which the RO denied entitlement to service connection for PTSD. The veteran perfected an appeal of the January 1990 decision. In July 1991, September 1994, and August 1995 the Board of Veterans' Appeals (Board) remanded the claim to the RO for further development. The matter was then returned to the Board for appellate review. FINDINGS OF FACT 1. All relevant evidence necessary for an informed decision on the veteran's claim has been obtained. 2. The veteran carries a diagnosis of PTSD. 3. The claim of entitlement to service connection for PTSD is supported by corroborative evidence showing that the claimed stressor(s) actually occurred. CONCLUSION OF LAW PTSD was incurred in active military service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.304(f) (1999). REASONS AND BASES FOR FINDINGS AND CONLCUSION I. Factual Background The veteran's service medical records are negative for complaints, findings, diagnosis or treatment for PTSD. The veteran's two Form DD 214 reflect that his period of active duty included more than two years of sea and/or foreign service. The veteran's awards and commendations include the Silver Service Star to Vietnam Service Medal, Vietnam Campaign Medal and the Joint Service Commendation medal. There are no combat awards or decorations reported. The veteran's occupational specialty, as reported on his DD 214, was equipment store specialist. The veteran served in Vietnam from August 1968 to February 1970. The veteran initially claimed entitlement to VA disability compensation in June 1989, at which time he indicated that he had PTSD as the result of service. The veteran's VA Medical Center (MC) outpatient treatment records dated July 1987 to June 1989 show ongoing treatment for problems with work and family, anger outbursts, difficulty falling asleep, sensitivity to noises, depression, irritability, and episodes of crying. A June 1989 treatment report shows a diagnosis of PTSD. The veteran was hospitalized at a VAMC from June 1989 to August 1989. The veteran reported experiencing occasional flashbacks and depression with anxiety. On admission, the veteran denied having nightmares or feelings of guilt, although he had an exaggerated startle reflex and insomnia. He reported that at times he is angry and he has felt scared ever since he returned from Vietnam. The medical report also noted that the veteran had no combat injuries but had been in areas under enemy fire. The veteran was diagnosed with chronic PTSD with depression. After the veteran's discharge in August 1989, he continued to receive treatment at a VAMC for his PTSD symptoms. In August 1989 the veteran's wife stated that after the veteran returned from Vietnam she recognized a dramatic change in his behavior. She explained that the veteran subjected her and the children to constant physical and emotional abuse. In August 1989 the veteran's son also stated that his father physically abused his mother, himself, and his other siblings. He further stated that his father expressed a lot of anger and hostility towards everyone in the immediate family. In November 1991, the veteran completed the MMPI-2 (Minnesota Multiphasic Personality Inventory-2). A staff psychologist found that the results of the MMPI-2 were not valid due to an exaggerated or distressed response by the veteran. The staff psychologist noted that the veteran is known to have problems reading and his history indicates that he completed only the sixth grade. In addition the veteran has had numerous recent stressors including marital separation, unemployment, the attempted suicide of a daughter, and an unstable living condition. The staff psychologist did, however, note that the veteran appeared to be suffering significantly from symptoms of PTSD. The veteran had vivid memories of Vietnam, a sense of reliving Vietnam, avoidance of thoughts and feeling about Vietnam, a loss of interest in his usual activities, a feeling of detachment from others, a sense of a foreshortened future, sleep problems, anger outbursts, hypervigilance, and poor concentration. In November 1991, the veteran also completed the Mississippi Scale for PTSD. The veteran obtained an overall score of 125, which was well-above the empirically established cut-off for PTSD (107). The results suggested that the veteran would meet the diagnostic criteria for PTSD. During the examination, the veteran admitted suffering from a number of PTSD symptoms including flashbacks, nightmares, heightened startled response, anger control problems, depression, guilt, sleep disturbances, trouble keeping a job, alcohol abuse, and alienation from family and friends. In December 1991 the veteran described events that he believed to be his underlying PTSD stressors. He stated that while in Vietnam he was a truck driver and he transported weapons, small arms, and bullets. According to him, while transporting weapons in 1968 during the Tet Offensive, he was exposed to enemy fire. He suffered no injuries to the body but he reported that he was exposed to dead bodies, shooting, and he ran people over with his truck. He further stated that he saw dead mothers and babies on the streets. As a result he now has nightmares and sleep disturbances that are overwhelming and depressive. In December 1991, the veteran met with a VA social worker and upon observation she noted that the veteran was very tense, holding on to the chair, and his voice was direct but shaky. According to her, the veteran had tears in his eyes, he was withdrawn and remorseful in thought, and he experienced a lot of survivor's guilt. A February 1992 VA medical evaluation shows an Axis I diagnosis of PTSD, Generalized Anxiety Disorder, and Depression in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Revised (DSM-III-R). During a December 1992 VA psychiatric examination the veteran again reported that while in Vietnam he was a supply specialist. According to him, his combat exposure was intermittent except during the Tet Offensive, when his base was under constant attack. He stated that rocket attacks occurred nightly and he saw a lot of body bags and burned bodies. He further stated that he saw a helicopter explode when preparing to land and everyone inside was burned and killed. During the examination, the VA psychiatrist noted that the veteran was tearful when discussing his Vietnam experiences. The VA psychiatrist described the veteran as fully oriented, coherent, relevant, moderately anxious and depressed. The veteran had adequate insight and judgment, he denied suicidal or homicidal ideation, and he denied hallucinations or delusional ideas. His concentration and memory, however, were impaired. The veteran was diagnosed with chronic PTSD and recurrent major depressive disorder. In December 1992 the VA social worker noted that the veteran was suffering from flashbacks, anxiety attacks, heightened startled response, sleep disturbance and auditory and olfactory hallucinations of Vietnam experiences. The veteran also cried as he was recalling his Vietnam experiences. The VA social worker noted that the veteran was cooperative during the interview, he had good eye contact, and his affect was appropriate. She found that the veteran was totally disabled as a result of his PTSD symptomatology. In December 1992, the veteran completed another MMPI-2 (Minnesota Multiphasic Personality Inventory-2). A staff psychologist concluded that the results of the MMPI-2 were not valid due to an exaggerated or distressed response by the veteran. In May 1993, the RO sent a letter to the U.S. Army and Joint Services Environmental Support Group (ESG) requesting verification of the traumatic incidents the veteran reported he encountered during his service in Vietnam. In March 1995 ESG's response was that due to insufficient information it was not able to document that the 649th Supply and Service Company was stationed in Vietnam during 1968 to 1970. This was the company the veteran was assigned to while stationed in Vietnam. In August 1995, the veteran was hospitalized for PTSD and depression. The veteran expressed a sense of guilt about his experiences in Vietnam and the pain and suffering he had brought upon his family. The report noted that the veteran was in this condition due to his experiences in Vietnam, job difficulties, and his wife's depression. In June 1997 a VA psychiatrist found that upon mental examination, the veteran was well-groomed with an increased startle response, he had no autonomic hyperactivity, there was no evidence of psychomotor agitation, he had a rapid rate of speech, and he was fully oriented. The veteran's mood was depressed and his affect was tearful. The VA psychiatrist found that the multiple vegetative signs of depression were present, including loss of interest in sex and other pleasurable activities, early morning wakening, and poor concentration. The veteran's behavior was appropriate during the interview and his impulse control was good. The veteran did not appear to experience hallucinations, illusions, delusions, and ideas of reference or influence. His short- term memory was intact, but he admitted recent problems with long-term memory. The veteran denied having any suicidal or homicidal plans and his judgment and insight were intact. His diagnosis was PTSD and recurrent major depressive episodes with psychotic features. In July 1997 a VA social worker stated that she had been treating the veteran for combat related PTSD since 1990. According to the VA social worker, the veteran suffers from all the characteristics of a person exposed to extreme traumatic stressors. She further stated that the veteran has remained dysfunctional at a chronic level, he has not been able to maintain employment, and he has experienced multiple failures at rehabilitation efforts. The veteran continues to have severe panic attacks, he is easily triggered with extreme anger, intense irritability, mood swings, and avoidant patterns. In July 1997 another VA psychiatrist stated that he had been treating the veteran for combat related PTSD since 1992 and that the veteran has a current diagnosis of PTSD, panic disorder, major depression, and avoidant personality disorder. During a July 1997 personal hearing, the veteran stated that while in Vietnam he served as a truck driver and almost every night his base was subject to rocket attacks. He further stated that while in Vietnam he saw a helicopter crash and dead bodies. After his discharge, he began having nightmares and he was unable to get along with his family. In March 1998 the United States Army Services Center for Research of Unit Records (USASCRUR) submitted copies of March 1969 unit records submitted by the Military Assistance Command, Vietnam (MACV) and the U.S. Army Support Command, Saigon (USASUPCMD-SGN). USASCRUR also submitted extracts from the Air Base Defense in the Republic of Vietnam 1961-73. The letter from USASCRUR indicated that military documents reflect that the veteran's listed unit received mortar, rocket and stand- off attacks during the 1968 TET offensive. Additionally, the documents reveal that the Saigon Port encountered enemy attacks during the reporting period. In July 1999, a VA psychiatrist and social worker submitted a letter stating that the veteran had been treated for PTSD, major depression, and a panic disorder since 1990 and that the PTSD and panic episodes have exacerbated the veteran's medical state. II. Laws and Regulations Under the law, service connection can be granted for any disability resulting from disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. § 1110. As to a PTSD claim, the United States Court of Appeals for Veterans Claims (Court) has held that such a claim is well- grounded where there is medical evidence of a current diagnosis of PTSD, lay evidence of an in-service stressor, and medical-nexus evidence linking PTSD to the veteran's service. See Gaines v. West, 11 Vet. App. 353 (1998); Cohen v. Brown, 10 Vet. App. 128, 136-137 (1997). After it has been determined that a PTSD claim is well- grounded, the merits of the claim must be adjudicated. Eligibility for a PTSD service connection award requires a medical diagnosis of PTSD, credible supporting evidence that the claimed in-service stressor actually occurred, and medical evidence of a causal nexus between the current symptomatology and the specific claimed in-service stressor. See 38 C.F.R. § 3.304(f); Gaines, 11 Vet. App. at 357; Cohen, 10 Vet. App. at 138. The evidence necessary to establish the occurrence of a recognizable stressor during service to support a claim of entitlement to service connection for PTSD will vary depending on whether or not the veteran was engaged in combat with the enemy. If the claimed stressor is related to combat, and the evidence shows that the veteran served in combat, his lay testimony may be sufficient to establish that the claimed incidents occurred. If the veteran did not serve in combat, or the claimed stressors are not related to combat, corroborating evidence is required to show that the claimed events actually occurred. Moreau v. Brown, 9 Vet. App. 389 (1996). III. Analysis Numerous VAMC outpatient treatment records and VA psychiatric reports show that the veteran meets the DSM-III-R criteria for PTSD. The first element of Gaines is satisfied because there is a current medical diagnosis of PTSD. The veteran has provided lay evidence of an in-service stressor by recounting numerous traumatic incidents he experienced while serving in Vietnam as a supply specialist and these statements are presumed to be credible because there is no indicia of incredibility. Arms v. West, 12 Vet. App. 188 (1999). The Board finds therefore, that the second Gaines element, lay evidence of an in-service stressor, has been satisfied. The Board further finds that the numerous statements of VA psychiatrists and social workers linking PTSD to the veteran's experiences in Vietnam are sufficient evidence of a nexus between PTSD and the veteran's service. For these reasons the Board has determined that the claim of entitlement to service connection for PTSD is well-grounded. As to service connection for PTSD, the first and third elements of eligibility are met because there is a medical diagnosis of PTSD and there is medical evidence of a causal nexus between the current symptomatology and the specific claimed in-service stressor, based on evaluations made by VA psychiatrists and social workers linking PTSD to the veteran' service. Cohen, 10 Vet. App. at 138 (1997). The veteran claims that during the 1968 Tet Offensive his base was exposed to constant enemy fire and rocket attacks . He also claims that he saw dead bodies, burned bodies in a helicopter crash, and he ran over civilians with his truck. Some of the stressors have not been corroborated, but, in the Board's judgment, there is sufficient corroboration of others to create a reasonable doubt as to their occurrence. USASCRUR, having reviewed unit records from MACV and USASUPCMD-SGN as well as airbase defense records, concluded that the veteran's listed unit received mortar, rocket and stand- off attacks during the TET offensive, as he alleged. Additionally, USASCRUR concluded that the Saigon Port where he was stationed encountered enemy attacks during the reporting period, also as he alleged. These records thus provide verification that some of the traumatic events alleged by the veteran actually occurred. Although they do not specifically document the veteran's involvement, they create a reasonable doubt as to that involvement. With application of the benefit of the doubt rule, service connection for PTSD is granted. ORDER The claim of entitlement to service connection for PTSD is granted. ________________________________ NANCY I. PHILLIPS Member, Board of Veterans' Appeals