Citation Nr: 0010619 Decision Date: 04/21/00 Archive Date: 04/28/00 DOCKET NO. 97-17 299 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUE Whether new and material evidence has been presented to reopen the veteran's claim for service connection for post- traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Virginia Department of Veterans Affairs ATTORNEY FOR THE BOARD Richard Giannecchini, Associate Counsel INTRODUCTION The veteran had active military service from June 1980 to August 1980, from July 1981 to August 1981, and from May 1984 to December 1989. A perfected appeal to the Board of Veterans' Appeals (Board) of a particular decision entered by a Department of Veterans Affairs (VA) regional office (RO) consists of a Notice of Disagreement (NOD) in writing received within one year of the decision being appealed and, after a Statement of the Case (SOC) has been furnished, a substantive appeal (VA Form 9) received within 60 days of the issuance of the Statement of the Case or within the remainder of the one-year period following notification of the decision being appealed. The veteran's original claim of service connection for PTSD was denied in a February 1994 rating action. He was notified of the decision and did not perfect an appeal; under the law, the decision became final. The present appeal arises from a September 1996 rating action, which determined that new and material evidence had not been presented to reopen a claim for service connection for PTSD. The veteran filed an NOD in March 1997, and the RO issued an SOC in April 1997. The veteran filed a substantive appeal in May 1997. A supplemental statement of the case (SSOC) was issued in September 1998. FINDINGS OF FACT 1. The veteran was notified by the RO of the denial of his claim for service connection for PTSD in February 1994. The veteran did not initiate an appeal of that determination and, therefore, under the law, the decision became final. 2. New and material evidence, in the form of a March 1997 treatment report from the VA Medical Center (VAMC) in Richmond, reflecting the veteran's diagnosis of PTSD as a result of his claimed in-service stressor, has been introduced into the record since service connection was previously denied for PTSD; thus, the newly submitted evidence warrants reopening the veteran's claim. 3. The record contains medical evidence of a current diagnosis of PTSD, the veteran's own lay evidence regarding in-service stressors, and medical-nexus evidence linking his PTSD to his in-service stressor. CONCLUSION OF LAW 1. Evidence submitted since the previous final decision is new and material, and the veteran's claim of entitlement to service connection for PTSD is reopened. 38 U.S.C.A. §§ 7105(c), 5108 (West 1991); 38 C.F.R. §§ 3.104(a), 3.156(a) (1999). 2. The veteran has submitted a well-grounded claim of service connection for PTSD. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Basis A review of the veteran's service medical records does not reveal evidence of complaints or treatment referable to PTSD or any other psychiatric-related disorder. In May 1993, the veteran filed a claim for service connection for PTSD. Evidence of record at that time included a DA Form 1307 (Individual Jump Record) which reflected the veteran's participation in three jump exercises in Goloson, Honduras, on January 24, 1987. In addition, a DA Form 67-8 (U.S. Army Officer Evaluation Report), noted that the veteran was an intelligence officer in a Special Forces battalion. His primary function was the collection, processing, and dissemination of intelligence information to support and sustain Special Forces detachments. It was also noted in the evaluation report that the veteran had provided two OCONUS (Outside the Continental United States) deployments for training to Honduras with Order of Battle data and map support. In June 1993, the veteran submitted a statement to the RO concerning the stressors associated with his claimed PTSD. He reported that, in November 1986, he was a 1st Lieutenant assigned to a military intelligence company, 7th Special Forces Group (SFG), as the signals intelligence officer, and was the officer in charge of the ground sensor team. The veteran indicated that his NCOIC (non-commissioned officer in charge) was SFC (Sergeant First Class) [redacted]. In January 1987, the veteran indicated that his unit was deployed to Honduras. He reported that his team was attached to A Company, 1st Battalion, 7th SFG, from January 5, 1987, to February 27, 1987, for LEMPIRA 1-87. When A Company was to depart, the veteran reported his team was to remain in Honduras and become attached to B Company, 1st Battalion, 7th SFG, from February 28, 1987, to May 15, 1987. In his statement, the veteran discussed the various missions in which his team took part. In particular, he recounted an incident when the team, accompanied by some Honduran soldiers, was waiting at a predesignated landing zone (LZ) for a helicopter. The veteran noted that many civilians from a Honduran village began to congregate at the LZ, and that shots were fired at a Honduran soldier, who then returned fire. The incident did not escalate any further, but the veteran indicated that he was told by a Honduran soldier that, if the veteran or SFC [redacted] had been killed, civilians would have been shot in retaliation. The veteran reported that later events resulted in his being relieved of his position in Honduras, and he returned to Fort Bragg, NC. Thereafter, the veteran reported that he developed emotional problems associated with his service in Honduras, and he ultimately separated from active service. Since that time, the veteran noted, he had suffered from anxiety when hearing helicopters, and become fearful when he heard people talking about war. He also suffered from panic attacks, had difficulty concentrating, and felt socially isolated from his peers. In July 1993, the veteran submitted additional information to the RO, and incorporated his previously submitted stressor statement by reference therein. With regard to the period from January to March 1987, he noted his temporary duty assignment to Honduras. He included no specific description of events during that time, but instead described his problems afterward, beginning with the period from March to April 1987, during which he said he had "nightmares about being overrun and firefights, being followed," and complained of knots in his stomach, heartburn, and stomach distress. He also stated that later, in October 1987, he had experienced an "anxiety attack/flashback during airborne operation resulting in disabling injuries" and stomach distress. With this information, he enclosed a map of Honduras, and stated that he had circled in red the areas in which he had operated in January to March 1987. The map has several areas marked in red; all are in the northern region of the country, near the coast of the Gulf of Honduras. In December 1993, the RO received an additional statement from the veteran, and a statement from his wife. Both statements noted the effects of the veteran's emotional distress and the impact it had on the lives of the veteran and his wife. That same month, December 1993, the veteran was medically examined for VA purposes. The examiner noted the veteran's report of being exposed to severe stressors in Honduras. In particular, the veteran reported that the primary stressor involved remembering a Honduran soldier's report that he had planned on killing civilians if anything had happened to the veteran and SFC [redacted]. The veteran reported that since he had returned from Honduras he had been experiencing symptoms of anger, anxiety, and depression. The examiner reported that the veteran's history and mental status examination were consistent with the diagnosis of chronic dysthymia. It was also reported that the veteran's symptoms and stressors did not fulfill the criteria for PTSD. In May 1996, the veteran submitted to the RO a statement from Leonore Wald, P.A., dated in April 1996. Dr. Wald reported that he had been treating the veteran for stress with short acting hypnotics and with Alprazolam. The veteran was noted to have responded well to the medication. Dr. Wald further reported that he had seen the veteran in March 1996 in the afternoon, and found his behavior and affect as that of someone who was "shell-shocked". It was noted that the veteran had remembered that morning an experience in Honduras involving SFC [redacted]. Dr. Wald recounted that reportedly SFC [redacted] had been told that someone was to get the veteran out of the country, and that SFC [redacted] interpreted this as meaning that someone was to assassinate the veteran. SFC [redacted] reportedly pulled a gun on the veteran, and the veteran believed he was about to be shot, but this never occurred. The veteran indicated to Dr. Wald that he experienced a flash back stress reaction of this incident when he heard the noise of helicopters. In June 1996, the RO received medical records from the Sacramento Vet Center, dated from June 1992 to January 1994. These records reflected the veteran's complaints of intrusive memories both of Honduras and of being physically and sexually abused as a child. Diagnosis included PTSD, and PTSD related to childhood. Also in June 1996, the veteran submitted to the RO a statement from Vincent Giuliano, M.D., dated in May 1996. Dr. Giuliano noted that the veteran was a 2nd grade school teacher, and had volunteered that he might have seen children killed in Honduras and that he felt a need to be with children. This was noted as conjecture, and the veteran reportedly emphasized that he did not recall any specific instance of civilian causalities. Dr. Giuliano noted that the veteran possibly had a combat related post-traumatic stress syndrome. Also that month, the veteran submitted a statement to the RO in which he reported that, through recent flashbacks and insights gained as a result of counseling, he had retrieved repressed memories about the killing of civilian men, women, and children in mid-February 1987 while conducting a Special Forces mission in Honduras. The veteran recounted that the mission had been in two phases, and after completing the first phase, a National Guard UH-1 helicopter had picked up him, SFC [redacted], and a Sergeant [redacted] (U.S. Army), a Specialist [redacted] (U.S. Army), as well as a Honduran sergeant and corporal, and dropped them off in some hills near a village. The veteran indicated that the mission was top secret and being done to support signal intelligence collection efforts of the National Security Agency (NSA). The veteran noted that his team was dropped off first, and the helicopter took off to go pick up a radio monitoring team and return with them to the LZ. The veteran noted that, while waiting for the helicopter to return he sent Sergeant [redacted] and the Honduran sergeant to patrol the immediate area. The veteran reported that 200 civilians came out and surrounded the landing zone. Subsequently, the helicopter returned, and the veteran told the Honduran corporal to notify Sergeant [redacted] and the Honduran Sergeant to return. The Honduran corporal moved away to a small hill and fired a few shots into the air. Immediately shots were fired back at him, and he returned fire. The veteran noted that a large Honduran women in a white dress then ran towards the corporal screaming. The corporal turned and shot her in the stomach. He subsequently shot a group of men and children who had begun screaming and waving their arms after the woman was shot. This then precipitated chaos, with people running and screaming. The veteran further noted that Sergeant [redacted] came on the scene after the shooting had taken place, and immediately got on the helicopter. Specialist [redacted] had been on the helicopter during the incident and heard and saw nothing. The helicopter pilots were reported to have witnessed the shooting. In July 1996, the veteran submitted to the RO a statement from John Honeywell, of Community Outreach to Vietnam Era Returnees (COVER), dated in June 1996. Mr. Honeywell noted that events in Honduras had apparently caused a major memory impairment of amnesic reaction in the veteran. The veteran was noted to be recalling the events of the incident, and was receiving counseling to cope with the intrusive recollections. In May 1997, the veteran submitted a statement to the RO in which he discussed particular details of his claim, and also reported that any records that existed of the atrocities that he witnessed in Honduras were classified by both the U.S. and Honduran governments, and that he could not obtain them. In addition, the veteran submitted copies of outpatient treatment reports from the Richmond VAMC, dated in March 1997. These records note a diagnosis of PTSD with depression. In August 1998, the RO received a report from the U.S. Armed Services Center for Research of Unit Records (USASCRUR). The report noted that, after extensive research and coordination with the U.S. Army Center of Military History as well as Fort Bragg, USASCRUR was unable to verify any combat incidents that had occurred in Honduras during January and February 1987. It did, however, enclose a document submitted by Fort Bragg reflecting that two Honduran soldiers and three Salvadoran guerillas had been killed in an armed clash near the Salvadoran border in May 1987. II. Analysis The veteran was previously denied service connection for PTSD, in a February 1994 rating decision. The veteran did not file an appeal, and the decision became final. In order to reopen his claim, the veteran must present new and material evidence with respect thereto. 38 U.S.C.A. § 5108. Because the present appeal does not arise from an original claim, but rather comes from an attempt to reopen a claim which was previously denied, the Board must bear in mind the important distinctions between those two types of claims. Prior to our discussion of the evidence which has been submitted since the February 1994 RO decision, we must first note that the United States Court of Appeals for Veterans Claims had previously held that the Secretary of Veterans Affairs, and, on appeal, the Board, were required to perform a two-step analysis when a claimant sought to reopen a claim based upon new evidence. First, it was to be determined whether the evidence was "new and material." Second, if the Board determined that the claimant had produced new and material evidence, the claim was reopened and the Board evaluated the merits of the veteran's claim in light of all the evidence, both old and new. Manio v. Derwinski, 1 Vet.App. 144 (1991). Whether the new evidence was "material" turned essentially upon the reasonable possibility that, when viewed in the context of all the evidence, it would change the outcome. Colvin v. Derwinski, 1 Vet.App. 171, 174 (1991). The Court more recently held that the two-step Manio process has been replaced with 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). 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 and, if ripe for decision, adjudicated. Winters v. West, 12 Vet.App. 203, 206 (1999) (en banc). In addition, Hodge overruled Colvin and its progeny as to the materiality element of the new-and-material-evidence test. See Elkins, supra, at 214. As defined by regulation, new and material evidence means evidence not previously submitted 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). The Federal Circuit Court has held that the regulatory standard alone must be the test of materiality. Hodge, supra. In determining whether new and material evidence has been presented, VA must initially decide whether evidence submitted since the prior final denial is, in fact, new. As indicated by the regulation cited above, and by judicial caselaw, "new" evidence is that which was not of record at the time of the last final disallowance ("on any basis" - merits or otherwise) of the claim, and is not "merely cumulative" of other evidence that was then of record. See Evans v. Brown, 9 Vet.App. 273, 283-285 (1996). This analysis is undertaken by comparing newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. Although, as noted above, Hodge overruled Colvin and its progeny as to the materiality test, it does not appear that the analysis as to what is new evidence has been overruled. See Vargas-Gonzalez v. West, 12 Vet.App. 321, 326 (1999), noting that Hodge did not deal with the test for determining whether evidence is new, which is a separate decision from whether it is material. See also Anglin v. West, ___ F.3d ___, No 99-7019, slip op. at 7 (Fed. Cir. Feb. 15, 2000) ("nothing in Hodge suggests that the understanding of "newness" as embodied in the first prong of the Colvin test is inadequate or in conflict with the regulatory definition of new and material evidence"). As to the materiality standard, the Federal Circuit's holding in Hodge has been interpreted by a panel of the Court of Appeals for Veterans Claims: "Hodge provides for a reopening standard which calls for judgments as to whether new evidence (1) bears directly or substantially on the specific matter, and (2) is so significant that it must be considered to fairly decide the merits of the claim." Fossie v. West, 12 Vet.App. 1, 4 (1998), motion for recon/review denied, 12 Vet. App. 234 (1999). In determining whether newly submitted evidence is material under the caselaw discussed above, we are further guided by the Federal Circuit Court's discussion of the "uniquely pro-claimant" quality of the veterans' benefits system such that, although "not every piece of new evidence is 'material' . . . we are concerned . . . that some new evidence may well contribute to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it will not eventually convince the Board to alter its ratings decision." Hodge v. West, supra, at 1363. The credibility of new evidence is assumed for the limited purpose of determining whether it is material. Justus v. Principi, 3 Vet.App. 510 (1992). As noted above, under the precedent decision of the Court in the Evans case, supra, in order to reopen a previously and finally denied claim there must be new and material evidence entered into the record since the most recent denial on any basis, either on the merits or on an attempted reopening. Id. at 285. To briefly summarize the law regarding service connection for PTSD, adjudication of such a claim requires consideration of evidence regarding the places, types, and circumstances of the veteran's service as shown by service records, official histories of organizations in which he served, and pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a); Cohen v. Brown, 10 Vet.App. 128 (1997). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) (1999). The question of whether a veteran was exposed to a stressor in service is a factual determination, and VA adjudicators are not bound to accept a veteran's stressor statements simply because treating medical providers did so. Wood v. Derwinski, 1 Vet.App. 190 (1991) aff'd on reconsideration, 1 Vet.App. 406 (1991); Wilson v. Derwinski, 2 Vet.App. 614 (1992). If claimed stressors are related to combat, and service department records establish that the veteran engaged in combat (e.g., by showing issuance of awards or decorations for valor, the Combat Infantryman's Badge, the Combat Action Ribbon, or the Purple Heart), and the veteran's testimony regarding the alleged stressors is satisfactory (i.e., credible and consistent with the circumstances, conditions, and hardships of such service), then the veteran's testimony regarding the stressors is accepted as conclusive as to their occurrence, and no further development or corroborative evidence is required. In VAOPGCPREC 12-99 (Oct. 18, 1999), the VA General Counsel addressed the subject of determinations as to whether a veteran "engaged in combat with the enemy" for purposes of 38 U.S.C. § 1154(b). The General Counsel held that the ordinary meaning of the phrase "engaged in combat with the enemy," as used in 38 U.S.C. § 1154(b), required that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. Nothing in the language or history of the statute or any Department of Veterans Affairs regulation suggests a more specific definition. The issue of whether any particular set of circumstances constitutes engagement in combat with the enemy for purposes of section 1154(b) must be resolved on a case-by-case basis. However, if it is determined that the veteran did not engage in combat with the enemy, or the claimed stressors are not related to combat, the veteran's testimony, by itself, will not establish the occurrence of the claimed stressors. Zarycki v. Brown, 6 Vet.App. 91 (1993). In such a case, credible supporting evidence from the service department or other sources is required to establish occurrence of the claimed in-service stressors. Moreau v. Brown, 9 Vet.App. 389 (1996). Once it is established that the claimed inservice stressors actually occurred, their sufficiency must be clinically established. West v. Brown, 7 Vet.App. 70 (1994). As noted above, the existence of a valid service stressor is a factual question for VA adjudicators, who are not bound to accept a veteran's uncorroborated accounts of alleged stressors, particularly where there has been a considerable passage of time between putative stressful events recounted by the veteran and the onset of alleged PTSD. Wilson, Wood, supra. Thus, the evidence which must be considered at this time, in connection with the veteran's claim of service connection for PTSD, is that which has been submitted since the RO entered its decision on this matter in February 1994. Evidence submitted since the final RO decision entered in 1994 includes: 1. Statement from Leonore Wald, P.A., dated in April 1996. 2. Treatment records from the Sacramento Vet Center, dated from June 1992 to January 1994. 3. Statement from Vincent Giuliano, M.D., dated in May 1996. 4. Statement from John Honeywell, dated in June 1996. 5. Treatment records from the Richmond VAMC, dated in March 1997. 6. Letter from USASCRUR dated in August 1998. 7. Statements from the veteran. With respect to the veteran's claim for service connection for PTSD, the evidentiary items submitted by the veteran are new, in that they were not considered in the RO's final decision in February 1994. As to the "new" items of evidence, the remaining questions are whether they are probative of the issue at hand and are so significant that they must be considered in order to fairly decide the merits of the veteran's claim. In this instance, the most significant new evidence consists of treatment records from the VAMC in Richmond, which note a clinical diagnosis of PTSD related to the veteran's claimed stressor, the shooting of civilians in Honduras. The veteran has also provided names of U.S. Army personnel who were at the scene of the alleged stressor incident. We are not unmindful of the mandate in the recent Hodge precedent, discussed above, in which the Federal Circuit Court declared: We certainly agree with the Court of Veterans Appeals that not every piece of new evidence is "material"; we are concerned, however, that some new evidence may well contribute to a more complete picture of the circumstances surrounding the origin of a veteran's injury or disability, even where it will not eventually convince the Board to alter its ratings decision. Where so much of the evidence regarding the veterans' claims for service connection and compensation is circumstantial at best, the need for a complete and accurate record takes on even greater importance. Hodge v. West, supra, 155 F.3d at 1363. In view of the change in course dictated by the Federal Circuit Court, the Board concludes that the threshold for reopening a previously denied claim has been lowered somewhat. Accordingly, and resolving any reasonable doubt in favor of the veteran, we find the medical evidence reflecting a diagnosis of PTSD and the submission of additional names of military personnel who were reportedly at the scene when the claimed stressor incident took place, meet the regulatory standard of evidence "which by itself or in connection with 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) (1999). Accordingly, the Board concludes that the veteran has submitted evidence that is new and material, and the claim for service connection for PTSD is reopened. In addition, we find 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). The record contains medical evidence of a current diagnosis of PTSD, the veteran's own lay evidence regarding an in-service stressor, and medical- nexus evidence linking his PTSD to his in-service stressor. See Patton v. West, 12 Vet.App. 272, 276-77 (1999); Cohen v. Brown, 10 Vet.App. 128 (1997). This, of course, does not mean the claim will be granted, but the RO will conduct a new adjudication, following additional development outlined below, and determine whether service connection should be granted. ORDER To the extent the Board has determined that new and material evidence has been submitted to reopen the veteran's claim for service connection for PTSD, and that the reopened claim is well grounded, the appeal is granted. REMAND For the reasons briefly set forth above, the Board has found the veteran's claim to be well grounded. However, once a PTSD claim has been determined to be well grounded, that does not necessarily mean the claim will be granted. The United States Court of Appeals for Veterans Claims has emphasized that - even though . . . the appellant has presented a well-grounded claim for service connection for PTSD, "eligibility for a PTSD service-connection award requires" more; specifically, "(1) [a] current . . . medical diagnosis of PTSD . . . ; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor." Gaines v. West, 11 Vet.App. 353, 357 (1998), citing Cohen, supra, and Suozzi v. Brown, 10 Vet.App. 307 (1997) (emphasis in original). The evidence required to warrant a grant of disability benefits does not have to be conclusive. The question is whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). In finding the veteran's claim well grounded, we note that he has claimed to have witnessed the killing of Honduran civilians by a Honduran soldier while deployed to that nation with an Army Special Forces unit as an intelligence officer. In addition, a VAMC Richmond treatment report has noted the veteran as suffering from PTSD with depression, and has related that diagnosis to the veteran's reported experience in Honduras as he described it. As held in the Court's caselaw, above, the veteran's lay evidence, which is presumed to be credible at the initial stage of the claim, in conjunction with the diagnosis of PTSD in the record and the examiners' nexus statements, is sufficient for the purpose of determining well-groundedness. With respect to the veteran's claim, we note that the evidence does not support that his reported stressor is the result of combat. Service department records do not reflect that the veteran engaged in combat or was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation(s). Furthermore, the veteran's reports about his stressor reflect that it is not related to combat. Therefore, for the veteran to verify a non combat-related stressor, credible supporting evidence from the service department or other sources is required. Moreau, supra. In this instance, the circumstances surrounding the veteran's alleged non-combat related stressor incident during service make confirmation of that event extremely difficult. USASCRUR was not able to identify the reported incident, and, in fact, the only incidents documented by USASCRUR occurred after the veteran left Honduras, and occurred near the border with El Salvador, far from the areas where the veteran has indicated he was operating. Given the sensitivity of the veteran's specialty as an intelligence officer, documents pertaining to missions in Honduras may be classified. However, the veteran has reported that other American soldiers were present when the claimed shooting of the Honduran civilians took place, and has reported them as SFC [redacted], Sergeant [redacted], and Specialist [redacted]. We are cognizent that VA has a duty to assist the veteran. 38 U.S.C.A. § 5107 (West 1991). That duty to assist includes suggesting to the veteran that he write to fellow soldiers asking for letters supporting his claim. Garlejo v. Derwinski, 2 Vet. App. 619, 620 (1992). Under the circumstances of this case, given the threshold legal plausibility of the veteran's contentions, the Board believes that additional effort should be undertaken to allow the veteran to submit any corroborating evidence of his claimed stressor, to include supportive statements from those individuals identified by the veteran as having been at the scene of the reported shooting of Honduran civilians, or any other individual who may be able to provide corroborative evidence of the veteran's claimed stressor. In addition, in view of the fact that the veteran has not undergone a formal VA psychiatric examination since 1993 (which examination did not diagnose PTSD), and in view of the intervening medical records indicating the possibility that childhood trauma may have precipitated PTSD, it may be necessary to conduct a new VA examination of the veteran. Accordingly, the case is REMANDED to the RO for the following action: 1. The veteran should be invited to provide verifying statements from those military personnel identified by him as being at the scene of his reported stressor incident in which Honduran civilians were shot and killed, or any other individuals who may be able to provide direct corroborative evidence of the claimed in-service stressor. If the veteran furnishes additional evidence which warrants further inquiry of USASCRUR for an attempt at stressor verification, the RO should make such referral. 2. In the event that additional evidence furnished by the veteran, or developed as a result of his additional submission, does provide satisfactory verification of his claimed in-service stressor, he should undergo a new VA examination, the purpose of which would be to determine whether the complete record supports a current diagnosis of PTSD. If the veteran is found to have PTSD, the examiner should express an opinion for the record as to whether the veteran's claimed stressor(s) from his military service are etiologically related to any current PTSD. The examining physician should specifically identify which stressors are linked to any diagnosed PTSD, with reference to the stressor(s) determined by the RO to be established by the record. All tests deemed necessary by the examiner must be conducted, and the clinical findings and reasoning which form the basis of the opinions requested should be clearly set forth. The claims folder and a copy of this Remand must be made available to the examiner prior to the examination, in order that he or she may review pertinent aspects of the veteran's service and medical history. A notation to the effect that this record review took place should be included in the examination report. 3. Upon completion of the above, the RO should review the evidence of record and enter its determination with respect to service connection for PTSD. If the decision remains adverse to the veteran, the RO should issue an SSOC, a copy of which should be provided to the veteran and his representative. Thereafter, the veteran and his representative should be given the opportunity to respond. The case should 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 and ensure due process of law. No action is required by the veteran until he receives further notice. The veteran 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. ANDREW J. MULLEN Member, Board of Veterans' Appeals - 18 - - 1 -