BVA9409701 DOCKET NO. 93-24 227 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for a fungal infection as residual of a circumcision. 3. Entitlement to service connection for a metallic foreign body located in the left side of the chest. REPRESENTATION Appellant represented by: Patricia Roth, Attorney WITNESSES AT HEARING ON APPEAL The veteran and his wife ATTORNEY FOR THE BOARD E. A. Artman, Associate Counsel INTRODUCTION The veteran served on active duty from September 1960 to November 1969 in the United States Marine Corps. This matter comes before the Board of Veterans' Appeals (Board) of the Department of Veterans Affairs (VA) on appeal from an April 1992 rating decision of the Louisville, Kentucky, Regional Office (RO). Among other actions, this decision denied claims of service connection for PTSD, a fungal infection as residual of a circumcision, and a metallic foreign body located in the left side of the chest. In support of his appeal, the veteran, along with his wife, presented testimony at a hearing conducted by a Board member in Washington, D.C., in March 1994. The appellant previously had designated the Vietnam Veterans of America as his service organization representative but, in December 1993, executed a power of attorney in favor of Patricia Roth of the Public Interest Law Clinic of the Washington College of Law of the American University. REMAND The veteran has appealed a claim of service connection for PTSD. In order to establish service connection for this disorder, legislation requires that the disorder be demonstrated by "medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptoma-tology and the claimed inservice stressor." 38 C.F.R. § 3.304(f) (1993). With regard to the inservice stressor(s), the United States Court of Veterans Appeals (Court) has determined that the veteran is under an obligation to assist VA in the ascertainment of concrete data, such as the time, place and names of witnesses, of the claimed stressor event(s). Wood v. Derwinski, 1 Vet.App. 190 (1991). As stated by the Court, "[t]he duty to assist is not always a one- way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood at 193. In the present appeal, the veteran has submitted written and oral argument to the effect that, during his service in Vietnam, he witnessed Vietcong prisoners being transported to Saigon and suspected that they were thrown off the plane in mid-flight because of the early return of the aircraft; that he witnessed a plane crash into a mountainside which contained members of his company (including a Captain T. [redacted] and Mr. [redacted]); and that a good friend was killed in a mortar attack and the veteran assisted in the recovery of his remains. The veteran testified at his March 1994 hearing that he was unable to give dates of these occurrences, except to say what season they occurred in, and could remember no names other than those of Captain [redacted] and Mr. [redacted]. Medical evidence received thus far does not assist in the clarification of the claimed stressor events. Four psychological assessments offer no additional detail regarding these events and fail to provided a diagnosis of PTSD. See report of VA psycho- logical evaluation performed by Thomas L. Shurling, Ph.D. (veteran examined on January 23, 1992); report of VA examination for PTSD performed by Tom M. Hall, M.D. (veteran examined on February 25, 1992); report of psychiatric examination performed by Robert J. Dane, M.D. (veteran examined on October 7, 1991); letter of Charles Lindquist, M.A., summarizing treatment of veteran at the Vet Center of Lexington, Kentucky (February 25, 1994). Correspondence of John H. Wolaver, M.D., the veteran's treating psychiatrist in recent years, has also been received into record. In this correspondence, Dr. Wolaver does provide a diagnosis of PTSD which in part he attributes to the veteran's war experience, but fails to document the stressor events upon which he bases his conclusions. Having been provided with a questionnaire designed for this purpose, Dr. Wolaver responded by stating that he did not have time to review his voluminous notes on the veteran. Questionnaire regarding PTSD diagnosis completed by John H. Wolaver, M.D. (February 23, 1994) In light of this evidence, it appears that the veteran does have a well-grounded claim. See 38 U.S.C.A. § 5107(a) (West 1991). He did serve in Vietnam and has presented medical evidence of a PTSD diagnosis. See Grottveit v. Brown, 5 Vet.App. 91 (1993). However, the evidence does not meet the requirements of 38 C.F.R. § 3.304(f). The veteran has also appealed a claim of service connection for a fungal infection he claims was incurred as a result of an inservice circumcision. Evidence has been submitted to the effect that the veteran has a chronic skin condition. See letter of Robert C. Griffith, M.D. (May 23, 1991); office visit notes of Melissa Knuckles, M.D. (June 27, 1991); letter of Melissa Knuckles, M.D. (June 22, 1992); VA general medical examination (veteran examined on February 13, 1992). In her letter of June 22, 1992, Dr. Knuckles stated that, in her opinion, it was possible that the condition had been contracted while the veteran was overseas in the service. However, none of the medical evidence links the veteran's condition to his inservice circumcision, performed in July 1966, in the sense that the infection was not found to be located in the genital area. Rather a rash was found to be present on his right foot at the February 1992 VA examination, and on his upper inner thighs by Dr. Griffith in May 1991. Given the discrepancy of these findings with the veteran's claims, we find it appropriate to seek further resolution of the evidence as it relates to the veteran's skin condition. Accordingly, this case is REMANDED for the following actions: 1. The RO should request a copy of all treatment records pertaining to the veteran's psychiatric problems or skin condition from February 1992 to date. Any records received should be associated with the veteran's claims file. 2. The veteran should be afforded a VA psychiatric examination to determine whether, in the examiner's opinion, he has PTSD. The claims file should be provided to the examiner for review prior to the examination. The examination and any diagnosis made should conform to the guidelines set forth in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. 1987). If PTSD is diagnosed, the specific stressor events that resulted in the disorder should be clearly identified and linked to his present symptomatology. In addition, the examiner's findings should include a rating on the Global Assessment of Functioning Scale (GAF Scale). (The examiner should feel free to request any additional studies or consultations for this purpose.) All findings, opinions and bases therefor should be set forth in detail. 3. The RO should arrange for a genitourinary examination of the veteran to be performed. The examiner should specify what, if any, residuals of the veteran's circumcision are present. The examiner should expressly state whether or not a skin disorder is present and, if so, if it is thought to be causally linked to the circumcision. Any additional studies or consultations should be performed as deemed necessary. All findings, opinions and bases therefor should be set forth in detail. 4. Based upon all the evidence obtained pursuant to the development sought above, the RO should take adjudicatory action. If benefits sought by the veteran are not granted, a supplemental statement of the case should be issued. After the veteran and his representative have been given an opportunity to respond to the supplemental statement of the case, the claims file should be returned to this Board for further appellate review. No action is required by the veteran until he receives further notice. The purpose of this REMAND is to procure clarifying data and to comply with governing adjudicative procedures. The Board intimates no opinion, either legal or factual, as to the disposition of this appeal. (Action with regard to the claim of service connection for a metallic foreign body located in the left side of the chest is deferred, pending completion of the development outlined above.) STEPHEN L. WILKINS U. H. ANG, M.D. DANIEL J. STEIN Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).