Citation Nr: 0314800 Decision Date: 07/03/03 Archive Date: 07/10/03 DOCKET NO. 99-00 106 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Sioux Falls, South Dakota THE ISSUES 1. Entitlement to service connection for headaches due to an undiagnosed illness. 2. Entitlement to service connection for memory and concentration problems due to an undiagnosed illness. 3. Entitlement to service connection for depression/irritability due to an undiagnosed illness. 4. Entitlement to service connection for fatigue due to an undiagnosed illness. 5. Entitlement to service connection for a skin condition due to an undiagnosed illness. 6. Entitlement to service connection for joint and muscle pain due to an undiagnosed illness. 7. Entitlement to service connection for shortness of breath due to an undiagnosed illness. 8. Entitlement to service connection for sore throats/sinus infections/greater susceptibility to colds and flus and sensitivity to aerosols and cigarettes due to an undiagnosed illness. 9. Entitlement to service connection for ear infections due to an undiagnosed illness. 10. Entitlement to service connection for digestive problems/diarrhea/weight gain or loss due to an undiagnosed illness. 11. Entitlement to service connection for nose bleeds due to an undiagnosed illness. 12. Entitlement to service connection for hypothyroidism. 13. 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 Panayotis Lambrakopoulos, Counsel INTRODUCTION The veteran served on active duty from September 1987 to September 1991. The matter comes before the Board of Veterans' Appeals (Board) from a November 1997 RO rating decision that denied service connection for various conditions claimed as due to undiagnosed illness from service in Southwest Asia during the Persian Gulf War (headaches; memory and concentration problems; fatigue; depression and irritability; a skin condition; joint and muscle pain; shortness of breath; sore throats, sinus infections, a greater susceptibility to colds and flus, and sensitivity to aerosols and cigarette smoke; ear infections; digestive problems, diarrhea, and weight gain or loss; and nose bleeds), and also denied service connection for hypothyroidism and PTSD. The veteran testified at a Board hearing held at the RO (Travel Board hearing) in June 2001. In September 2001, the Board remanded the matter for further action. The claim for service connection for PTSD is the subject of the remand portion of this decision. FINDINGS OF FACT 1. The veteran served on active duty in Southwest Asia during the Persian Gulf War. 2. Current headaches are associated with a diagnosed condition which began after active service and was not caused by any incident of active service. 3. Memory and concentration problems, depression/irritability, and fatigue are asssociated with a diagnosed mental disorder that began after active service and was not caused by any incident of active service. There is no diagnosis of chronic fatigue syndrome. 4. Preservice acne did not permanently worsen during active duty. No other chronic skin condition is currently shown. 5. Joint and muscle pains are associated with diagnosed conditions which began after active service and were not caused by any incident of active service. There is no diagnosis of fibromyalgia. 6. There is no current disability involving claimed shortness of breath. 7. Sore throats and sinus infections are attributed to known clinical diagnoses which began after active service and were not caused by any incident of active service; greater susceptibility to colds and flus and sensitivity to aerosols and cigarettes are not shown. 8. Ear infections are attributed to known clinical diagnosis which began after active service and was not caused by any incident of active service. 9 Digestive problems, diarrhea, and weight gain or loss complains after service are associated with known clinical diagnoses which began after active service and were not caused by any incident of active service. There is no diagnosis of irritable bowel syndrome. 10. There is no current disability involving nose bleeds. 11. Hypothyroidism began more than a year after active duty and was not caused by any incident of service. CONCLUSIONS OF LAW The following claimed conditions were not incurred in or aggravated by active service: headaches, memory and concentration problems, depression/irritability, fatigue, a skin disorder, joint and muscle pain, shortness of breath, sore throats/sinus infections/greater susceptibility to colds and flus and sensitivity to aerosols and cigarettes, ear infections, digestive problems/diarrhea/weight gain or loss, nose bleeds, and hypothyroidism. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317 (2002). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual background The veteran served on active duty in the Army from September 1987 to September 1991, including service on Southwest Asia from May to late July 1991 during the Persian Gulf War. On his service enlistment examination in February 1987, the only pertinent abnormality noted was acne, for which the veteran was taking medication. Service medical records from the veteran's active duty do not otherwise mention the conditions now claimed for service connection. On the service separation examination in August 1991, all pertinent objective findings were normal (except for some facial acne); and on the associated medical history form from August 1991, the veteran denied any pertinent history except for acne. [The Board notes that some of the writing on the back of the August 1991 medical history form was evidently added in February 1995 during annual medical screening as part of the veteran's reserve/National Guard service.] After separation from active duty in September 1991, the veteran was in the Army Reserve and National Guard. Post-active duty VA medical records show that in October 1992 the veteran requested a physical examination. It was noted he was a Persian Gulf War veteran. He reported that he had no symptoms except for feeling more tired and drinking more water. Current examination was essentially normal except for some facial pimples, an external hemorrhoidal tag, and pruritis ani. The next VA medical record is from January 1994, at which time the veteran was seen for a complaint of sore throat of unknown etiology. Impressions in March 1994 included a question of Gulf syndrome, mononucleosis, chronic sinusitis, and cephalgia of unknown etiology. He was seen for headaches in connection with a viral syndrome in April 1994; he also had thyroid fullness. A viral etiology and myositis were considered for photophobia, migratory muscle aching, and decreased appetite. By August 1994, there had been marked improvement of the thyroid with medication. It was noted that he had had thyroiditis "viral" in November 1994; his headaches were less frequent, albeit still daily. He was treated with medication and the headaches were much improved. As noted above, a February 1995 entry was written on the back of the August 1991 active duty medical history form, and it appears that this was done during February 1995 annual medical screening as part of the veteran's reserve/National Guard service. This entry bears a date in early February 1995, and then the veteran's initials. The February 1995 entry lists a history of changes in health, swollen or painful joints, frequent or severe headaches, dizziness, throat trouble, thyroid trouble, shortness of breath, a growth under the left arm, frequent trouble sleeping, and loss of memory. The veteran also stated on the form that these symptoms had been treated at the VA hospital at Fort Meade, South Dakota. On another annual medical certificate for the reserve/National Guard, dated at about the same time in early February 1995, the veteran mentioned that he was being treated at the Fort Meade VA for variable symptoms including headache, joint pain, and a deficient thyroid, which he described as Desert Storm related illness. He continued to be treated for hypothyroiditis in 1995, as well as for recurrent pharyngitis, joint pains, and otitis media. He reported being always tired. On June 1995 pulmonary function testing, the results were within normal limits, although he had an audible wheeze with forced expiration. In connection with October 1995 VA treatment, he stated that he thought his headaches were due to school and stress. In December 1995, he reported that he had been healthy until service in Southwest Asia, after which he had complaints of fatigue, headaches, chronic sore throat, joint pain, shortness of breath, memory loss, rash, hair loss, and depression. On neurological evaluation in January 1996 for headaches, joint pain, memory difficulty, and numbness, the examiner assessed mainly muscle contraction headaches, which were not a serious problem. He also assessed memory problems, which were stress-related. Other assessments were a history of intermittent difficulty with elbow and knee joint pains and a history of hand numbness with negative examination at present, but consistent with possible ulnar neuropathy. In February 1996, he underwent a VA neuropsychological evaluation with regard to memory loss, headaches, and depression. He had deficits in right-sided sensory perception, verbal attention, instant verbal memory, planning, foresight, and problem solving, suggesting multifocal dysfunction. Possible causes included several mild traumatic head injuries and exposure to smoke from oil fires in the Persian Gulf. Diagnoses included cognitive disorder not otherwise specified and adjustment disorder with mixed anxiety and depressed mood. On VA psychiatric examination in March 1996, the psychiatrist noted the veteran's report of his service experiences. Diagnoses were PTSD, cognitive disorder not otherwise specified, and dysthymia. Serous otitis was noted in March 1996. In March 1996, the veteran filed claims for service connection, attributing various conditions to his service in Southwest Asia during the Persian Gulf War. On VA examination in April 1996, there were no skin rashes or lesions; he only had a few scattered freckles. He had mild bilateral cervical adenopathy. He also had early male pattern baldness, a clean scalp without lesions, and nontender sinuses. His thyroid was not enlarged, and there was no tenderness or nodule. His ear canals appeared slightly irritated and slightly scaly. He complained of a dry cough and an occasional wheeze, but his exercise tolerance was good, and his lungs were completely clear. No digestive system problems were noted. Examination of his musculoskeletal system revealed no functional limitations or specific tenderness; he had full range of motion of all joints without deformity, and all muscle groups were strong and equal. Diagnoses were hypothyroid, cephalgia, depression, fatigue, short term memory loss, and arthralgias/myalgias. On VA examination in April 1996 for hypothyroidism, no abnormalities were noted; there was no enlargement, tenderness, or nodule of the thyroid. He reported fatigue and depressed mood, but no nervous, cardiovascular, or gastrointestinal symptoms. He was taking synthroid daily. The diagnosis was hypothyroid that was probably overcorrected. The veteran's wife and his mother submitted statements in April 1996, indicating that the veteran had started experiencing fatigue, frustration and depression, joint and muscle pain, headaches, abnormal weight gain and loss, nightmares, nosebleeds, chronic sinus and ear infections, sore throats, swollen tonsils, breathing problems, migraines, a thyroid disease, emotional ailments. In May 1996, he was seen for fatigue, poor sleep, and decrease in memory and concentration with diagnoses of dysthymia, major depression, highly questionable PTSD, and Gulf War syndrome. On periodic reserve duty examination in June 1996, he reported swollen or painful joints, headaches, dizziness or fainting spells, ear, nose, or throat trouble, skin disease, thyroid trouble, adverse reaction to serum, drug, or medicine, sleep problems, depression or excessive worry, loss of memory or amnesia, and nervous trouble. He noted no sequelae of headaches, hypothyroid, or depression. In July 1996, he was seen for follow-up of Persian Gulf War syndrome with headaches, fatigue, myalgia, and depression. The major problem in August 1996 was aching in the elbows and knees; the assessment was possible early degenerative joint disease aggravated by push-ups. He was seen in November 1996 for follow-up of Persian Gulf War syndrome with insomnia, energy, and mood problems. Medication was continued. In December 1996, he was seen for fatigue, apathy, joint pain, and a presumptive diagnosis of Persian Gulf War syndrome. A memorandum from December 1996 in connection with reserve service reflects complaints of stiffness in the elbows and other joints, along with elbow pain and swelling; he was exempted from performing push-ups. On VA examination in December 1996, diagnoses included tension or contraction type headaches, memory loss, elbow pain secondary to mild tendonitis, mild arthralgias of the knees which did not functionally restrict him outside of running over three miles. He also was diagnosed with fatigue, but he did not meet the criteria for chronic fatigue syndrome; the examiner felt that fatigue was due to depression or dysthymia. The examiner also felt that fatigue was not due to hypothyroidism, and he questioned the diagnosis of hypothyroidism. He was also examined by the VA for psychiatric problems in December 1996. He reported symptoms of PTSD since service in the Persian Gulf War. He also had symptoms of major depression, and the symptoms of depression. Diagnoses included major depression, in partial remission, and PTSD. He also was noted as having hypothyroidism, joint pain, especially in the knees and elbows, and headaches. The examiner commented that major depression was due to both Persian Gulf War experience and the loss of a cousin. In February 1997, he still needed medication for chronic fatigue, with continued insomnia and stress at home. By April 1997, he stated that his throat and ears were a big problem. He had mild cervical adenopathy. Assessments included hypothyroid and arthralgias. He continued to have partner relational problems and an assessment of Gulf War syndrome in May 1997. In September 1997, he was treated for allergic rhinitis, stress, and hypothyroid. He continued to have a sore throat in October 1997, with an assessment of unknown etiology; a throat culture the next month was negative. The veteran reported right and left elbow problems in February 1998; he was given tennis elbow straps. He also reported feeling pretty fair, although his throat still hurt off and on. He was treated for recurrent tonsillitis and pharyngitis in March 1998. In April 1998, he had a tonsillectomy for chronic infected tonsils. In September 1998, it was noted that he had the symptoms of PTSD per a questionnaire. He continued feeling "blue" in October 1998, with poor sleep, hypersomnia, fatigue, and ongoing stress. Problems with his wife were noted, and he was assessed as having major depression. In November 1998, stresses included continued conflict with a stepson. On dysthymia follow-up in February 1999, he was doing well on medication with mild decrease in sex drive; temper control issues remained somewhat of a problem. In May 1999, he reported left arm tingling and losing feeling in the 4th and 5th fingers recently; assessments included anemia of unknown etiology, hypothyroid, and dysthymia. In September 1999, he complained of right knee pain; but the pain appeared to be temporarily related to a right heel injury from that summer. In January 2000, he presented with occasional pain on the bottom of his left heel ever since injuring it while jumping over a creek about one and half years earlier. X-rays were negative for any recent or remote bone injury; there may have been the beginning of a plantar calcaneal spur on the left, but it was very small. He had an assessment of plantar fasciitis and heel spur syndrome on the left. On complaint of heartburn, knee pain, and more depression lately in March 2000, assessments were hypothyroid, dysthymia, and gastroesophageal reflux disease. On regular check-up in September 2000, he reported feeling down, depressed, or hopeless in the past month. He stated that he had problems with finances and a lot of stress from family matters. He stated that his headaches were not as frequent as they had been, but he had more fatigue again lately. His elbows still hurt quite often, and he had occasional knee discomfort. Examination revealed no problems with the throat, nares, or ears. His thyroid had no nodules or enlargement. Lungs were clear. Bowel sounds were active, and there was no organomegaly, masses, or tenderness. The assessments included "Persian Gulf symptoms" and dysthymia. He was seen in January 2001 with a history of depression and relationship stress. He had anger management problems. The diagnoses were dysthymic disorder and partner relational problem. The examiner recommended counseling because of marital conflict. He reported continuing bilateral elbow pain in March 2001. He also was concerned about recent weight gain despite no decrease in physical activity. He expressed worry that his thyroid might be out of balance further. He reported being on the same dose of thyroid for quite some time. He also reported stress from his marriage and noted taking medication for dysthymia. Assessments were hypothyroid, dysthymia, and erectile dysfunction. In April 2001, he also was concerned with low testosterone levels, and it was noted that he developed vertigo and syncopal episodes on testosterone injections. He also had been having sinus and allergy problems. He had had some facial discomfort, a nasal discharge, and slightly raw throat for several weeks. He was sleeping fairly well, and he was taking thyroid and dysthymia medication faithfully. The tympanic membranes were slightly dull with some fluid bubbles but no redness. He was slightly tender over the frontal sinus. Nares were very swollen. He had no cervical adenopathy. Lungs were clear. Assessments were hypogonadism, dysthymia, hypothyroid, and allergic rhinitis with sinusitis. The veteran testified at a Travel Board hearing in June 2001 that he first received treatment for the claimed conditions more than a year after service, at the Fort Meade VAMC. He related that he was mainly being treated now for depression, a thyroid condition, and fatigue. He testified that his PTSD stressor was a July 11, 1991, vehicle explosion in Southwest Asia that injured two friends (including his roommate, Robert Spearrow) who had switched duties with him. Medical records show that after reportedly falling from a chair, the veteran underwent an open reduction and internal fixation of the left distal fibula with ligament repair in October 2001. On examination in connection with reserve service in April 2002, the only identified abnormality was decreased visual acuity; all other systems were normal. It was noted that his hypothyroidism was stable on medication for 5 years. However, on accompanying medical history report, the veteran noted sinusitis, hay fever, thyroid trouble, painful shoulder, elbow, or wrist, numbness or tingling, swollen or painful joints, broken bones (broken leg from October 2001), frequent indigestion or heartburn, skin diseases, recent unexplained weight change, headaches, heart trouble or murmur, sleep problems, and depression or excessive worry. He denied various respiratory symptoms, ear, nose, or throat problems, stomach problems, adverse reaction to serum, food, insect stings, or medicine, prolonged bleeding, and memory loss. He said that he was currently in good health. He clarified that he had been taking medication for thyroid problems for 5 years and that his elbows were arthritic and painful when doing push-ups. In May 2002, the veteran sought VA treatment for a growth on the inside of his left thigh that he had just noticed the day before. It was also noted on mental health screening that in the past month he had not felt depressed or down. He reported exercising regularly (running 4 times per week for 10 to 12 miles per week). On VA annual physical examination in May 2002, he appeared very well; affect was very happy and outgoing. Tympanic membranes were intact, without redness or cerumen in the canals. His throat was clear. There was no sinus tenderness on palpation. His lungs were completely clear. No abnormal skin lesions were noted; he had one small skin tag in the upper interior left thigh, but he was reassured about this. Bowel sounds were active, and abdominal examination revealed no hepatosplenomegaly or tenderness. A left ankle fracture from October 2001 was noted, but it was healing well. In fact, he was starting to run again. Urinalysis and blood counts were normal, with no sign of infection. There was no sign of anemia. The examining doctor discussed further treatment for depression, but both the doctor and the veteran decided that he certainly did not need further treatment at the time. Assessments were hypothyroidism; dysthymia, in remission; hyperlipidemia; testicular hypofunction; allergic rhinitis, stable at present; status post fracture of the left ankle. On VA treatment in August 2002 for high cholesterol, the veteran complained of a sore throat that had been going on for several weeks. He reported being extremely physically active. On examination, he appeared very healthy. His tympanic membranes were intact without redness. His nares were patent without discharge. His throat was very slightly erythematous. No exudate was noted. Only minimal cervical adenopathy was noted at all. There was no sinus tenderness on palpation. His lungs were completely clear. The assessments were hyperlipidemia, improved, and pharyngitis, probably viral. II. Analysis Through discussions in correspondence, RO decisions, the statement of the case, the supplemental statements of the case, and the Board's remand, the VA has informed the veteran of the evidence necessary to substantiate his claims and of his and the VA's mutual responsibilities for providing evidence (except with regard to the claim for service connection for PTSD). Identified medical records have been obtained, and necessary VA examinations have been provided. The VA has satisfied the notice and duty to assist provisions of the law as to these claims. 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. § 3.159; Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection will be rebuttable presumed for certain chronic diseases, such as endocrine disorders and arthritis, which are manifest to a compensable degree within the year following active service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may only be established if there is a current disability. Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Subject to various conditions, service connection may be granted for a disability due to undiagnosed illness of a veteran who served in the Southwest Asia theater of operations during the Persian Gulf War. Among the requirements are that there are objective indications of a chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as fatigue, signs and symptoms involving the skin, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs and symptoms involving the respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. The illness must become manifest during either active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more, under the appropriate diagnostic code of 38 C.F.R. Part 4, not later than December 31, 2006. By history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. There must be objective signs that are perceptible to an examining physician and other non- medical indicators that are capable of independent verification. There must be a minimum of a 6 month period of chronicity. There must be no affirmative evidence that relates the undiagnosed illness to a cause other than being in the Southwest Asia theater of operations during the Persian Gulf War. 38 U.S.C.A. 1117; 38 C.F.R. 3.317. If signs or symptoms have been medically attributed to a diagnosed (rather than an undiagnosed) illness, the Persian Gulf War presumption of service connection does not apply. VAOPGCPRC 8-98. The Persian Gulf War illness provisions were amended effective March 1, 2002. In pertinent part, the new law provides that, in addition to certain chronic disabilities from undiagnosed illness, service connection may also be given for medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs and symptoms, as well as for any diagnosed illness that the VA Secretary determines by regulation warrants a presumption of service connection. 38 U.S.C.A. 1117; 38 C.F.R. 3.317. 1. Headaches Medical records from the veteran's 1987-1991 active duty are negative for headaches. He was first seen for this condition more than a year after active service. Post-service medical records refer to diagnosed cephalgia, muscle contraction headaches, and headaches related to viral syndromes and colds. As a diagnosed condition is involved (and not one of the special listed condition of the Persian Gulf War law), the law on presumptive service connection for Persian Gulf War illness does not not apply. The evidence demonstrates that diagnosed headaches began long after active service and were not caused by any incident of service. As the contition was not incurred in or aggravated by service, service connection is not warranted. 2. Memory and concentration problems, depression, irritability, fatigue. With regard to memory loss and concentration problems, depression, irritability, and fatigue, such are not shown during the veteran's active duty. Such complaints first appeared more than a year after active service, and they have been medically attributed to a diagnosed mental disorder. Chronic fatigue syndrome has not been diagnosed. As a diagnosed mental condition is the source of these complaints, the law on presumptive service connection for Persian Gulf War illness does not not apply. The evidence demonstrates that diagnosed mental disorder began long after active service and were not caused by any incident of service. As the condition was not incurred in or aggravated by service, service connection is not warranted. 3. Skin condition Acne was noted when the veteran entered and left active duty, as well as subsequent to service. There is no indication that acne was permanently worsened in service, and thus aggravation of preservice acne is not shown. No other chronic skin condition is currently demonstrated, and without competent medical evidence of the current existence of a claimed disability, there may be no service connection. Degmetich, supra. A claimed skin condition was not incurred in or aggravated by service, and thus service connection is not warranted. 4. Joint and muscle pain With regard to claimed joint and muscle pain, such is not shown during the veteran's active duty. Joint and muscle complaints first appeared more than a year after active duty, and they have essentially been attributed to diagnosed conditions (such as transient post-service injuries). There is no diagnosis of fibromyalgia. The evidence does not show other joint and muscle pain to a compensable degree since service, and thus there is no basis for service connection under the Persian Gulf War provisions. A claimed condition manifested by joint and muscle pain was not incurred in or aggravated by service, and thus service connection is not warranted. 5. Shortness of breath With regard to shortness of breath, no such problem was shown in service, and there were no related complaints until years after service. The veteran's pulmonary function tests have been normal, and he has good exercise tolerance. There is mention of some wheezing at times, but there is no finding of any respiratory impairment. The evidence does not show shortness of breath from undiagnosed illness to a compensable degree since service, and thus there is no basis for service connection under the Persian Gulf War provisions. No diagnosed respiratory disorder is shown. A claimed condition manifested by shortness of breath was not incurred in or aggravated by service, and thus service connection is not warranted. 6. Sore throats, sinus infections, greater susceptibility to colds and flus, and sensitivity to aerosols and cigarettes With regard to sore throats, sinus infections, greater susceptibility to colds and flus, and greater sensitivity to aerosols and cigarettes, there is no evidence of such a problem during active duty, and related complaints first appear years after service. He has also been treated on occasion since service for pharyngitis, colds, and allergic rhinitis with sinusitis. He also underwent a tonsillectomy for chronic infected tonsils in 1998. Post-service sore throats and infections have been attributed to pharyngitis, sinusitis, allergic rhinitis, and tonsillitis, which are diagnosed illnesses. Since these symptoms are not attributable to an undiagnosed illness, service connection for these symptoms is not warranted based on the Persian Gulf War presumptions. The diagnosed conditions are not medically linked to service, and thus direct service connection also is not in order. Moreover, there is no showing of sensitivity to aerosols and cigarettes, beyond what normal people might experience, and thus no related disability which might be service connected is shown. 7. Ear infections With regard to ear infections, such are not shown in active service or for more than a year later. Since service the veteran has been diagnosed on occasions with serous otitis and with otitis media. Since the ear infections are attributable to a diagnosed condition, service connection is not warranted based on the Persian Gulf War presumption. The diagnosed condition is not medically linked to service, and thus direct service connection also is not in order. 8. Digestive problems, diarrhea, weight gain or loss With regard to digestive problems, diarrhea, and weight gain or loss, the service medical records do not show any such problems. Related complaints first appear years after service, and either have been medically attributed to diagnosed conditions, and where not so attributed, the symptoms do not represent illness to a compensable degree. There is no diagnosis of the Persian Gulf War illness of irritable bowel syndrome. Consequently, service connection for this claimed disability is not warranted on either a direct basis or under the Persian Gulf War provisions. 9. Nose bleeds With regard to nose bleeds, the service medical records do not show any such problem, nor are there medical records of the problem after service. In the absence of the current existence of the claimed disability, service connection is not warranted. 10. Hypothyroidism With regard to hypothyroidism, such is not shown during the veteran's 1987-1991 active duty or for a few years later. This is a diagnosed condition and the Persian Gulf War provisions do not apply. The medical evidence does not link this post-service condition to service, and thus direct service connection also is not warranted. 11. Benefit of the doubt The preponderance of the evidence is against the above claims for service connection. Thus, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for headaches is denied. Service connection for memory and concentration problems is denied. Service connection for depression/irritability is denied. Service connection for fatigue is denied. Service connection for a skin condition is denied. Service connection for joint and muscle pain is denied. Service connection for shortness of breath is denied. Service connection for sore throats/sinus infections/greater susceptibility to colds and flus and sensitivity to aerosols and cigarettes is denied. Service connection for ear infections is denied. Service connection for digestive problems/diarrhea/weight gain or loss is denied. Service connection for nose bleeds is denied. Service connection for hypothyroidism is denied. REMAND The remaining issue on appeal is service connection for PTSD. The RO denied service connection for PTSD on the basis that, while PTSD had been diagnosed on VA examination, a service stressor had not been verified. At his Board hearing, the veteran testified that the traumatic incident that precipitated PTSD was a July 11, 1991 vehicle explosion (while he was stationed in Southwest Asia) that injured two of his friends, including Robert Spearrow, who had switched duties with him. In August 2002, the RO requested stressor verification by the U.S. Armed Services Center for Research of Unit Records (USASCRUR). In August 2002, USASCRUR responded that the information provided about the alleged in-service stressor was insufficient to conduct meaningful research. In December 2002, the RO sent the veteran a follow-up letter regarding his PTSD claim, informing him that more specific information from him was needed to assist in verifying the occurrence of an alleged in-service stressor. In its prior request to the USASCRUR, the RO provided only identifying information for the veteran himself and his service personnel records. There was no mention of the July 11, 1991, accident or the name of one of the injured soldiers, who purportedly was a roommate of the veteran in service. As part of the duty to assist the veteran, the RO should attempt to verify this alleged service stressor through USASCRUR. In its letter to the USASCRUR, the RO should provide specific information regarding the named soldier who was injured (Robert Spearrow), the date of the incident (July 11, 1991), and the veteran's unit. Therefore, this issue is remanded to the RO for the following development: 1. The RO should forward an account of the veteran's alleged service stressors (along with copies of his service personnel records and any other relevant evidence) to the USASCRUR, and request that organization investigate and attempt to verify the alleged stressors. The RO should specify in its request that the USASCRUR attempt to verify whether a soldier named Robert Spearrow and attached to the veteran's unit was injured in an explosion on July 11, 1991. If the USASCRUR is unable to investigate the matter due to insufficient information, such should be documented for the claims folder. 2. After the above development has been accomplished, the RO should review the claim for service connection for PTSD. If the claim is denied, the RO should issue to the veteran and his representative a supplemental statement of the case and afford them an opportunity to respond, before the case is returned to the Board. On remand the veteran may submit additional evidence and argument on the matter the Board remands to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). ______________________________________________ L.W. TOBIN Veterans Law Judge, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.