Citation Nr: 9923032 Decision Date: 08/13/99 Archive Date: 08/24/99 DOCKET NO. 94-02 560 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD L. J. Vecchiollo, Counsel INTRODUCTION The veteran served on active duty in the United States Army from July 1979 to July 1982 and had 1 year, 6 months and 19 days of prior active service. The veteran also served on active duty from December 27, 1990, to October 18, 1991 in support of Operation Desert Shield/Storm. The matter originally came to the Board of Veterans' Appeals (Board) on appeal from a December 1992 rating action of the RO. The Board remanded the case in January 1996 and January 1998. FINDING OF FACT The veteran is shown to have a clear diagnosis of PTSD due to stressful events, which as likely as not he experienced in service during the Persian Gulf War. CONCLUSION OF LAW By extending the benefit of the doubt to the veteran, his PTSD is due to disease or injury which was incurred in service. 38 U.S.C.A. § 1110, 5107, 7104 (West 1991 & Supp 1999); 38 C.F.R. §§ 3.303, 3.304 (1998). REASONS AND BASES FOR FINDING AND CONCLUSION The veteran is shown to have served in the Southwest Asia Theater of operations in support of Operation Desert Shield/Storm. The veteran claims that he was assigned to the 321st Medical Detachment. A careful review of the service medical records shows that, upon entry into active service in 1977, the veteran reported having a history of nervous trouble. No comment was made by an examiner about this history. However, treatment reports show that the veteran underwent Antabuse therapy; a January 18, 1982 examination report shows a history of drinking a 6- pack a day until the veteran started on Antabuse. In addition, a May 1982 examination report (the one dated most proximate to the veteran's discharge) shows that the veteran complained of frequent trouble sleeping. The medical records from the veteran's service in the Persian Gulf region do not include an entrance or separation examination. However, the veteran was discharged on recommendation of a Medical Board. The veteran's primary disability was that of a finger injury. The medical records regarding the injury indicate that the veteran injured his finger when it was jammed while unloading materials. Because of complaints of nightmares and difficulty sleeping, a psychosocial history was obtained in August 1991. The report mentions the veteran being pushed down steps during a Scud alert. It also shows that the veteran had acknowledged a driving under the influence (DUI) charge in 1985, but denied more than occasional drinking at the time that the history was taken. A diagnosis of an adjustment disorder with physical complaints was provided, and mild PTSD was cited as a condition to be ruled out. At a March 1993 VA examination, the veteran spoke of one instance in Saudi Arabia at the time he had deplaned when people were running to get to safety (presumably because they thought there would be gas attack). He stated that a friend had fallen going down a flight of stairs, when an explosion took place overhead. He claimed that he had assisted the friend in a state of panic, for fear that gases would be the fallout from this explosion. He then later stated that he was frightened all the time that he was in Saudi Arabia because of the risk of Scud attacks and exposure to harmful gases; he indicated that Scud missiles detonated above him on a few occasions. The veteran also stated that surgery on his finger (which occurred back in the United States in March 1990) had been stressful to him and that his mother had died while he was in the hospital. He denied a significant history of drinking and any drinking at the time of examination. He stated that he was taking Doxepin, Chlordiazepoxide and Haldol and that these medications prevented him from drinking. Based on these findings and asserted symptoms, the examiner diagnosed the veteran with having PTSD. The veteran underwent a psychiatric review by the Social Security Administration (SSA) in June 1992. Anxiety was checked off as a predominant disturbance or symptom. PTSD was noted to be present, but in remission. On the final page of the review, the examiner wrote, "primary diagnosis is chronic alcoholism!!" In August 1992, another VA psychiatric consultation was conducted. The doctor noted the veteran's complaints of insomnia. He observed dysphonia and hallucinations on the part of the veteran. His diagnosis was that of psychotic depression. He prescribed several medications, including Prozac and Haldol. A review of the record shows that the veteran continued to see this physician for prescribed medication until at least April 1996; the usual diagnosis was that of psychotic depression. During the same period of time, the veteran was seen at the VA facility by a licensed psychologist and assistant professor of neuropsychiatry. He opined in all of his treatment reports that the veteran suffered from very severe PTSD which was solely due to combat exposure. In a September 16, 1992, evaluative report, the examiner emphasized that the veteran's disorder was chronic and totally disabling and rendered him unemployable. He went on to say that the veteran served in Desert Storm where "he saw considerable death and destruction." He noted that the veteran was witness to one Scud missile attack which resulted in death and panic among members of his unit. A hearing was held before a Hearing Officer at the RO in June 1993. The veteran stated that he had been involved in only one Scud missile attack. He admitted that, during this incident, the missile was intercepted by a Patriot missile, and that those on the ground had to seek cover. He stated that he was under the impression that a few individuals were injured by debris. He did not know the identity of any of these individuals. He added that, after he was hospitalized for treatment of his hand injury, the fallout from another attack hit a barracks approximately one-half mile from his location. He stated that he was not ordered to assist in the clean up or with any casualties resulting from this fall-out. A VA examination was conducted in May 1996. The examiner, who evidently reviewed the veteran's claims file, diagnosed PTSD and considered him severely disabled from this disorder. The examiner noted that an extensive battery of psychological tests supported the diagnosis. An April 1997 letter from the U.S. Army & Joint Services Environmental Support Group (now U.S. Armed Services Center for Research of Unit Records (USASCRUR)) stated that the 321st Medical Detachment had been located in an area which had sustained numerous Scud attacks. A VA examination by a board of two psychiatrists was conducted in April 1998. The veteran described an incident in which a Scud missile had landed approximately less than 100 yards from him at the airport sometime around dusk between the middle and the end of his tour in the Persian Gulf. Reportedly, people were running over the top of him and yelling and screaming, debris was flying and he felt that he would be killed during the process. He described running for safety and encountering some badly burned and dead Saudi Arabians and that the images of the missile exploding were firmly implanted in his mind and in his nightmares. In addition, he described being shot at by snipers and related that it was a miracle that he got out of there alive. He denied ever having any other previous problems with his nerves. There was no history of family psychiatric problems. He kept reliving the events of the explosion, his injured hand, blood from others on him, bodies laying on the ground of the injured and the yelling and the screaming. He also described hearing voices particularly of people calling his name and seeing them laying out in front of him like the bodies during the explosion. He also stated that he hears the Scud missile going off inside his head over and over and that, because of his hand injury, he had been sent to a hospital and evacuated to Germany. He now spent his days in front of the television or attempting to sleep. He stated that he did have an occasional beer, but it had been several years since he had had any liquor. He was being seen at the local Mental Health Center and is taking Clonopin, Doxepin and Haldol. The veteran was noted to have a several year history of multiple in-patient hospitalizations with multiple diagnoses of PTSD by a number of psychiatrists both in and outside the VA system. The examination noted that the veteran's mood was depressed with a flattened affect. Speech was slow and soft. There was some psychomotor retardation. His appearance was somewhat unkempt. Thought processes were slowed. Thought content included some auditory and visual hallucinations. There was no evidence of any delusional system. There was suicidal ideation but no active plan. He denied any homicidal ideation. Memory was poor for immediate, recent and remote events. His intelligence was estimated in the below average range. The patient had little insight into his current condition. The Axis I diagnosis was that of PTSD, alcohol abuse by history. It was the opinion of examiners that the veteran suffered from significant PTSD associated with being in close proximity to a Scud missile landing at the airport on the night of his hand injury. The evidence indicated that the veteran's psychosis had begun some time after his return from the Persian Gulf. His social adaptability and interactions with others was severely impaired. His flexibility, reliability and efficiency in an industrial setting were completely impaired. An examiner estimated the veteran's level of disability to have been in the severe to total range and that he would need help in handling his own funds. In an addendum to the examination dated in June 1998, it was stated that the claims file and Board remand had been reviewed and it was noted that a nervous condition was diagnosed in 1977, the veteran was treated for alcohol abuse in 1982 and had a DUI in 1985. An examiner noted that the veteran had certainly had a long history of both alcohol abuse and dependence and believed that the patient's nervous condition in 1977 prior to entering to the service was been secondary to his alcohol abuse as withdrawal from alcohol tends to make one anxious and feel the need to drink more. The examiner also noted that many veterans with PTSD had self medicated their condition with alcohol and at times were not particularly truthful about their alcohol use. Thus, it would be common to see alcohol abuse and dependence as a secondary condition or an attempt to treat symptoms of PTSD. The examiner noted another physician's diagnosis of psychotic depression in 1992, and stated that opinions vary between professionals as to the correct diagnosis. The examiner also noted that he and another physician saw the patient at the same time and, after a review of the veteran's claims file, had diagnosed the veteran with PTSD and that the 1992 diagnosis of psychotic depression was incorrect. The examiner noted that the veteran had been giving conflicting reports about his condition. II. Legal Analysis The veteran's claim for service connection for PTSD is well grounded, meaning it is plausible. 38 U.S.C.A. § 5107(a). All pertinent evidence has been obtained to the extent possible, and there is no further duty on the VA to assist the veteran in the development of his claim. Id. Service connection may be granted for a disability resulting from a disease or injury that was incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection for PTSD requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressors. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or similar combat situation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed in-service stressor. 38 C.F.R. § 3.304(f). In the instant case, a review of the claims file shows that the veteran has been diagnosed with PTSD by medical personnel. The Board finds ample evidence has been presented in this case establishing a clear diagnosis of PTSD, and linking this psychiatric disorder to alleged events that occurred while the veteran was serving in the Persian Gulf. It is noted that the question of the sufficiency of the stressor is a medical determination, and doctors have apparently found that the alleged stressors are sufficient to support the diagnosis of PTSD. Cohen v. Brown, 10 Vet App 128 (1997). The existence of a valid stressor is a question of fact for VA adjudicators to decide. The Board is not bound to accept a veteran's uncorroborated account of alleged stressors or accept an unsubstantiated opinion of a psychologist or other health care professional that alleged PTSD had its origin in service. If a veteran did not engage in combat with the enemy, his bare assertions of service stressors are insufficient to establish his exposure to such stressors; rather, the stressors must be corroborated by official service records or other credible supporting evidence, particularly where, as here, there has been a considerable passage of time between putative stressful events recounted by the veteran and the onset of alleged PTSD. Doran v. Brown, 6 Vet. App. 283 (1994); Zarycki v. Brown, 6 Vet. App. 91 (1993); Wood v. Derwinski, 1 Vet. App. 190 (1991). A review of the veteran's service records shows that he did not receive any military citations demonstrating that he was engaged in combat with the enemy. His claimed PTSD stressors are noted hereinabove. A USASCRUR report reflects that the 321st Medical Detachment was in an area of numerous Scud attacks. The also Board notes an inservice report in which the veteran claims he had been pushed down steps during a Scud alert. With due regard to the benefit-of-the-doubt doctrine, 38 U.S.C.A. § 5107(b), the Board finds that there is credible supporting evidence to sustain a finding that, as likely as not, the veteran had been exposed to stressors to support the diagnosis of PTSD. Consequently, service connection for PTSD is warranted. ORDER Service connection for PTSD is granted. STEPHEN L. WILKINS Member, Board of Veterans' Appeals