Citation Nr: 0015561 Decision Date: 06/13/00 Archive Date: 06/22/00 DOCKET NO. 96-16 760 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for an acquired psychiatric disorder to include post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Barbara J. Cook, Attorney ATTORNEY FOR THE BOARD K. J. Loring, Counsel INTRODUCTION The veteran had active military service from March 1970 to January 1972. This matter arises from a February 1996 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio, which denied the benefit sought on appeal. The case was appealed to the Board of Veterans' Appeals (Board), and the Board denied the appeal. The veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In an Order dated October 6, 1999, the Court granted a joint motion by the appellant and VA, and vacated the Board's January 29, 1999, decision and remanded the case to the Board for readjudication of the claim consistent with considerations discussed in the joint motion. As a preliminary matter, the Board notes that the veteran's attorney requested that this case be remanded for the RO to obtain Social Security Administration (SSA) records, and to review a recently submitted SSA award letter which indicated that the veteran received SSA benefits "due[,] in part[,] to her PTSD." The attorney further asserted that the VA "should try to obtain additional evidence" from two friends of the veteran who provided statements that the veteran "told them about the problems she was having while in the service." The Board finds that a remand for these purposes is unnecessary and would contravene the best interests of the veteran in further delaying a decision on this matter. The SSA award letter the attorney mentions is essentially duplicative. It continues the veteran's granted benefit based upon psychiatric disability and refers to evidence previously considered by the RO, with the exception of a September 1999 report of Peter Rock, M.D., which "states [that] the veteran has been diagnosed with post-traumatic stress disorder and she [sic] is in need of further evaluation." The Board finds no need to remand for consideration of this evidence by the RO as it is not pertinent to the issue of whether the veteran has verified stressors related to service. The deficiency that was pointed out in the Joint Motion for Remand that was granted by the Court in its Order of October 6, 1999, was the Board's failure to discuss the provisions of the VA Adjudication Procedure Manual M21-1 (M21-1), Part III, 5.14, which provides procedural considerations in evaluating PTSD claims based upon personal assault. The Board's failure to discuss relevant Manual provisions can be cured at the appellate level. There is no additional development to be provided by the RO based upon the SSA award letter of October 1999 or additional SSA records. The pertinent evidence has already been considered, and the record is complete. See Hasty v. West 13 Vet. App. 230, 235 (1999), wherein the Court found that the Board's failure to comply with a request for remand to the RO, in a case remanded by the Court to the Board, was not erroneous when the record was complete and there was no reason for the remand. . In addition, the Board finds that the VA has met its duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a) in its repeated requests to the veteran to provide additional evidence to support her contentions that she was assaulted during service, and that she served in Vietnam. As recently as April 1998, the RO again requested that the veteran submit evidence to verify her service in Vietnam and she failed to provide other than her personal statements. The duty to assist is not a one-way street. Warmhoff v. Brown, 8 Vet. App. 517, 522 (1996). If there are additional witness statements of relevance, it is incumbent upon the veteran or her attorney to provide that information. FINDINGS OF FACT 1. Service medical records reveal no complaints, clinical findings, or noted abnormalities regarding the veteran's mental health. 2. The veteran was a clerk typist during service and did not serve in Vietnam, or engage in combat. 3. There is no objective lay or medical evidence to verify the veteran's reported assaults during service. 4. The veteran was separated from service in 1972; she was diagnosed with a generalized anxiety disorder in 1987, and with bipolar disorder in 1991. 5. There is no medical evidence to show that the veteran's acquired psychiatric disorder began during service. 6. The veteran's August 1996 diagnosis of PTSD was based upon her uncorroborated report of trauma during service. 7. The veteran's November 1996 diagnosis of PTSD was not based upon any identifiable stressors related to service. 8. A private psychiatric evaluation conducted in June and July of 1997 found no evidence of PTSD. 9. There is no objective evidence of verified stressors during service, including personal assault, that would serve as a basis for a diagnosis of PTSD. 10. The veteran does not have PTSD related to military service. CONCLUSION OF LAW An acquired psychiatric disorder, to include PTSD, was not incurred during service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Generally, service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted within the line of duty if the disability is not a result of the veteran's own willful misconduct. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a) (1999). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). With respect to establishing a well-grounded claim for PTSD, there must be medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (1999), 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). In the instant case, the veteran has established the presence of a well-grounded claim, as she has a current diagnosis of PTSD that has been related to service. However, she must further provide credible evidence to support her contentions that the stressors occurred, although, at this point, the veteran's statements regarding the presence of in-service stressors are presumed credible for the purpose of well grounding her claim. See King v. Brown, 5 Vet. App. 19, 21 (1993), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992); Tirpak v. Derwinski, 2 Vet. App. 609 (1992). As the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a), the VA's duty to assist applies. See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). As noted earlier, in this regard, the Board is satisfied that all relevant facts have been properly and sufficiently developed and that no further assistance to the veteran is required in order to comply with the duty to assist her mandated by 38 U.S.C.A. § 5107(a). Since the veteran has a PTSD diagnosis linking her condition to service, the critical question is whether there is sufficient evidence of the claimed inservice stressors. 38 C.F.R. § 3.304(f). The evidence necessary to establish the occurrence of a recognizable stressor during service to support a diagnosis of PTSD will vary depending upon whether or not the veteran engaged in combat with the enemy. 38 U.S.C.A. § 1154(b); 38 C.F.R. §§ 3.303, 3.304(f); West v. Brown, 7 Vet. App. 70, 75 (1994). If there is no combat experience, or if there is a determination that the veteran engaged in combat but the claimed stressor is not related to such combat, there must be independent evidence to corroborate the veteran's statement as to the occurrence of the claimed stressor. Mere service in a combat zone is not sufficient. Zarycki v. Brown, 6 Vet. App. 91, 99 (1993). In the instant case, the veteran does not allege that she engaged in combat, but two of her several reported stressors are related to alleged trips to Vietnam. She contends that her initial stressor occurred during basic training when she encountered two lesbians in the shower who approached her, making suggestive remarks. She contends that her hospitalization in July 1970 (for pneumonia) further supports that she was subjected to traumatic events during service. She maintains that the hospital record is proof that she was made sick by the harassment she faced from other enlisted women. She also asserted that an enlisted man grabbed her from behind and fondled her breasts one evening at a service club, sometime in March 1971. With regard to stressors related to Vietnam, she reported that she assisted in processing veterans who were returning from Vietnam by flying over to Vietnam on at least two occasions. During one flight in 1970, she stated that she saw a young child alive and then shortly thereafter saw the same child dead in the road. The child reminded her of her own daughter. She also reported that during another trip to Vietnam in 1971, she was assaulted by a Republic of Vietnam soldier (or a civilian) who attempted to rape her. She stated that she shot and killed him and the incident was "covered up" by the officers in charge. Her reported final stressful incident during service was an abusive marriage. Her husband, an enlisted man, physically and verbally abused her between 1971 and 1972. She stated that he assaulted her causing her to suffer a miscarriage. Service medical records reveal no complaints, clinical abnormalities, or diagnostic findings regarding the veteran's mental health. A December 1971 note referenced that she was having marital problems but there was no indication of any mental health disorder. Her separation examination report indicated a normal psychiatric evaluation. The veteran asserts that she was seen immediately after service for her psychiatric disorder. However, her claims files, which are voluminous and contain many copies of both private and VA medical records, reflect no reference to psychiatric treatment during the 1970's and there is no record of any psychiatric disorder until a diagnosis of generalized anxiety disorder in 1987. The veteran stated that she was seen by an osteopathic doctor for psychiatric problems right after service, but he is deceased, and his records are not available. Private treatment records from 1974 through 1977 reflect treatment for gastritis, a recurrent Bartholin's cyst in the vagina, bad dreams, and tension headaches. A private physician noted that the veteran tended to be nervous. There is no psychiatric diagnosis. Records from two private hospital admissions in August 1986 and July 1987 show treatment for an aspirin overdose and a prescription drug overdose. The August 1986 discharge summary stated no cause for the overdose, but the veteran was noted to have grandiose ideas, and was referred to psychiatric counseling. The July 1987 discharge summary indicated that the overdose was related to domestic problems. There was a notation that the veteran had not followed up on previous recommendation for therapy. There was no diagnosis of a psychiatric disorder in either discharge summary. VA outpatient treatment records of 1987 and 1988 reflect a diagnosis of generalized anxiety disorder. VA Medical Center (VAMC) records show that the veteran was admitted for treatment of depression in 1990 and 1991 with an initial diagnosis of bipolar manic disorder in January 1991. She had many subsequent VAMC psychiatric admissions from 1992 through September 1995, all with primary diagnoses of bipolar disorder and a variety of other psychiatric diagnoses including depression and personality disorder. There is no diagnosis of PTSD. An August 1995 letter to the veteran from the VAMC noted that despite her reported trauma, she did not have the clinical symptoms of PTSD. A subsequent September 1995 VAMC discharge summary included with the bipolar diagnosis the following diagnoses: rule out pathological gambling; rule out PTSD versus malingering; personality disorder not otherwise specified with histrionic and narcissistic features. The veteran enrolled in the Women Vets Recovery Program after her discharge from the hospital and continued with mental health treatment. In August 1996, the veteran was afforded a VA examination for PTSD based upon her claim for service connection. The veteran reported that her most traumatic experiences occurred during her service in Vietnam. She reported that she flew to Vietnam in September or October 1970 and saw a young child dead in the road, with flies all over her. Her final trip to Vietnam occurred in late 1971, just before she separated from service. She reported that a man who looked like a Vietnamese civilian worker for the U.S. Army approached her with a gun and pushed her down. She stated that when she fell, a gun that she had pulled from her bag was fired, and she killed him. She stated that her superiors refused to report the incident. She reported that a third trauma involved physical abuse by her husband during service. The veteran stated that her husband, who was also a Vietnam veteran, abused drugs and beat her every weekend. The VA examiner noted that the reported traumatic events were persistently re-experienced by the veteran through recollections, dreams, illusions, and intense psychological distress, although she did not appear to have "true flashbacks." The examiner noted that the duration of these symptoms had lasted many years. The veteran reported that they began in 1972, immediately after service. The VA examiner also administered several tests, including the Minnesota Multiphasic Personality Inventory (MMPI-2), the Mississippi Scale for Combat Related PTSD, and the Exner Rorschach. The examiner noted that the Rorschach appeared valid but the MMPI was only possibly valid, which also called into question the elevation on the Mississippi Scale. The examiner stated that the MMPI profile was fairly diverse and not that definite regarding any particular diagnostic conclusion. She did have elevations on the PTSD scale that would fit with the possibly valid conclusion, but the scale was not really elevated over and above several scales which would also relate to various types of disorders involving problems with alienation, depression, extreme suspiciousness, and problems with anger. Despite the questionable validity of the test scores, the examiner found that the veteran had experienced three major events that qualified as traumatic according to PTSD criteria, the two most traumatic involving the alleged events in Vietnam. Her Axis I diagnosis was reported as PTSD with no diagnosis reported on Axis II. A November 1996 psychological evaluation was conducted by the Ohio State Department of Vocational Rehabilitation. The veteran reported that she had a previous diagnosis of bipolar disorder but that she believed she had PTSD. The psychologist administered a battery of tests and found that the veteran's MMPI-2 profile was "highly elevated with depression being the most prominent emotional characteristic." Her diagnosis was reported as: Axis I - major depression, PTSD; Axis II - personality disorder, not otherwise specified. The psychologist provided no explanation or rationale for the PTSD diagnosis, and did not recount any stressful event that would serve as a basis for the diagnosis. In June 1997, the veteran submitted a statement from a clinical social worker who saw the veteran from April 1993 to February 1994. The social worker reported that she saw the veteran for abusive domestic relationships and did not treat her for any PTSD related disorders. She noted that while the veteran did talk about her service career, the social worker's focus was the veteran's current relationship which was dangerous to her. The veteran had reported to the social worker at that time that she had manic depressive disorder. Thus, the social worker reported a diagnosis of bipolar disorder. VA outpatient treatment notes of April 1997 reflect a diagnosis of bipolar disorder and note that the veteran wanted specific tests to support a diagnosis of PTSD. In June and July 1997, she obtained a private evaluation through the psychology department of Wright State University. She requested a psychological evaluation "to confirm that her only psychological problem [was] post-traumatic stress disorder (PTSD)." She reported that she wanted previous diagnoses of bipolar disorder and borderline personality disorder removed from her records at the Dayton, Ohio, VA Medical Center. The veteran "requested an assessment of the extent to which she [was] disabled by post-traumatic stress disorder." The psychologist recounted the veteran's history and noted her report that during service she worked with Vietnam veterans in a "Returnee Reassignment Center" and at a "Military Information Booth." The veteran reiterated the multiple traumatic events she experienced during service, beginning with basic training. She stated that she was "cornered by lesbians [in the shower] who talked suggestively to her and touched her in an inappropriate manner." She reported that she was "rescued" when another recruit came into the showers. She also reported having been approached by lesbians on another occasion, causing her fear and sleeplessness. Another incident involved having been sexually assaulted by a male whom she managed to fight off. The Vietnam incidents were also reported. The veteran recounted that she was recruited as a re-assignment specialist and taken on a "secret" flight to Vietnam to pick up returnees. She was reportedly taken by helicopter from Pleiku to ChuLai. She saw a young Vietnamese girl, dead, and lying in the middle of the road, and she was prevented from moving her or covering her up. She also reported a second flight to Vietnam to bring home returning soldiers. She said that she flew to Cam Ranh Bay and took a helicopter to ChuChi, near Monkey Mountain. She reported that she was at a firebase when she fell asleep next to a building. As she awakened, a Cambodian officer walked around the corner of the building. She felt he was going to attack her and she froze. She reported that she "had her .45 out" and when he pushed her down and was on top of her, the gun went off, "taking off half of his head." She reported that she was cleaned up by Vietnamese women, and then told by an officer to never mention the incident. The veteran stated that none of her traumatic experiences were ever reported. She stated that in each instance someone she knew, or an officer, told her not to report the incident. She noted further that she was on "secret" flights to Vietnam and thus there is no record of the flights that she knows of. In addition, the evaluator found that "her recollection of where she was seems confused, because Monkey Mountain was on the coast near the South China Sea, near DaNang and Camp Tienshaw." The veteran reported that her major problems of sleeplessness and flashbacks, were the result of the trauma in Vietnam. She reported staying awake 2-3 days at a time because of nightmares related to the traumas, with flashbacks of the Vietnam incidents. The veteran reported 11 marriages, all of them abusive, and indicated that she had held multiple short-term jobs. She was involved in a PTSD group, but reported no other social supports. The psychologist noted that the veteran had a history of emotional problems dating back to 1989. She was diagnosed as having bipolar disorder in 1991 and prescribed Lithium Carbonate twice a day, although she reportedly only took it once a day. The veteran appeared neat, clean and well groomed for each of her appointments. The mental status evaluation revealed that she was fully oriented and cooperative. Her mood/affect were slightly flat, her memory and immediate recall were good, and her though processes were coherent, logical, relevant and sequential. There was no evidence of hallucinations, delusions, or paranoia. However, feelings of frustration and hopelessness were observed. Her insight and judgment were limited as evidenced by her limited awareness of her illness. She was administered several tests, including the MMPI-2, the Million Clinical Multiaxial Inventory-III, and the Rorschach. Test results indicated valid results on 3 of the four instruments, with invalid results on one instrument, exaggerating her distress. The psychologist found the veteran to be depressed and frustrated with impaired coping skills due to overwhelming emotions. The psychologist reported that the veteran suffered from a chronic and serious affective disorder, likely a unipolar depression. He noted, however, that a bipolar disorder may also be present. The veteran's long-term interpersonal difficulties appeared to be the result of a characterological disorder. The psychologist also noted a similarity of themes between the veteran's reported war traumas and later reported domestic traumas. He stated that: "While this may be purely coincidental, [the veteran's] stories of her war traumas appear to be metaphors for her domestic trauma, and a way to deal with painful material at a comfortable distance." The psychologist reported an Axis I diagnosis of major depressive disorder; R/O bipolar II disorder, and an Axis II diagnosis of personality disorder, NOS, with borderline and obsessive compulsive features. The psychologist found no evidence of PTSD. In reviewing the veteran's claim for service connection for an acquired psychiatric disorder, the Board finds that the medical evidence of record does not support her claim. Her service medical records are completely devoid of any complaints or clinical findings regarding a psychiatric disorder, indeed her psychiatric evaluation at separation was negative. Her initial psychiatric diagnosis of a generalized anxiety disorder occurred in 1987, more than fifteen years after separation from service. Her initial bipolar disorder diagnosis occurred in 1991, nearly twenty years after separation from service. There is no medical evidence to show that any psychiatric disorder began during service. With respect to her claim for PTSD, the Board concludes that the veteran's diagnosis of PTSD due to trauma during service is not supported by the evidence of record. Clearly, the veteran did not engage in combat with the enemy. Her military occupational specialty (MOS) was that of clerk typist, and she does not dispute that MOS, or allege that she was involved in combat. Therefore, any diagnosis of PTSD, including that as a result of personal assault, must be supported by credible evidence that corroborates the occurrence of the claimed stressors. There is no such credible corroboration or verification of the veteran's alleged stressors associated with the claims file. The Board acknowledges that in personal assault cases such as this, the VA has "undertaken a special obligation to assist a veteran with a well-grounded claim in producing corroborating evidence of an in-service stressor." Patton v. West, 12 Vet. App. 272, 280 (1999). However, there must still be credible supporting evidence that the claimed stressor occurred, notwithstanding that such credible supporting evidence may only be available from outside sources in a personal assault case. YR v. West, 11 Vet. App. 393, 397-398 (1998); Cohen v. Brown, 10 Vet. App. 128, 138 (1997). In the instant case, VA has diligently pursued its obligation as demonstrated by affording the veteran examinations, searching records, and requesting on numerous occasions that the veteran provide evidence to support her allegations of assault and her service in Vietnam. As evidenced by the record, the veteran responded regularly in submitting multiple statements of her experience. However, she was not able to provide witness statements in support of the alleged lesbian incidents during basic training, or statements from the women who accompanied her to her barracks after she was allegedly assaulted at a service club. She was likewise unable to provide the name of the military officer who insisted she "cover up" the killing of the Vietnamese man, and she admitted that she never reported any of the incidents at, or near, the time they occurred. In reaching this determination that the veteran does not have PTSD related to service, the Board considered the special provisions of VA Adjudication Procedure Manual M21-1 (M21-1), Part III, regarding personal assault. The M21-1 notes that: "Personal assault is an event of human design that threatens or inflicts harm. Examples of this are rape, physical assault, domestic battering, robbery, mugging, and stalking." M21-1, Part III, 5.14c (1999). The M21-1 further identifies alternative sources for developing evidence of personal assault, including private medical records, civilian police reports, reports from crisis intervention centers, testimonial statements from confidants such as family members, roommates, fellow service members, or clergy, and personal diaries or journals. M21-1, Part III, 5.14c(4)(a). When there is no indication in the military record that a personal assault occurred, M21-1 indicates that alternative evidence might still establish an in-service stressful incident, such as behavior changes that occurred at the time of the incident. Examples of behavior changes that might indicate a stressor include: visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment; sudden requests that the veteran's military occupational series or duty assignment be changed without other justification; lay statements indicating increased use or abuse of leave without apparent reason; changes in performance or performance evaluations; lay statements describing episodes of depression, panic attacks or anxiety with no identifiable reasons for the episodes; increased or decreased use of prescription medication; evidence of substance abuse; obsessive behavior such as overeating or undereating; pregnancy tests around the time of the incident; increased interest in tests for HIV or sexually transmitted diseases; unexplained economic or social behavior changes; treatment for physical injuries around the time of the claimed trauma but not reported as a result of the trauma; breakup of a primary relationship. M21-1, Part III, 5.14c(7)(a)-(o). However, after extensive and careful review of the evidence of record, the Board concludes that there is no credible documented evidence to indicate that the veteran experienced any of the identified behavior changes, or any other unusual behaviors during her active military service. Her service medical records show a hospitalization for pneumonia in July 1970, a normal pelvic and pap examination in January 1971, and incision and drainage of a Bartholin's cyst in her vagina in March 1971. (The Bartholin's cyst recurred in August and October 1973). While the treatment of the Bartholin's cyst occurred at the time of the alleged sexual assault at the service club, there is no indication in the record of unusual behavior on the veteran's part. The service medical records show regular gynecological appointments throughout the veteran's active duty, including reissuance of oral contraceptives every three months. In August 1971 she complained of vaginal bleeding between her menstrual cycles, but a pelvic examination was normal. In September 1971 her oral contraceptives were changed to address "breakthrough" bleeding although her present cycle was noted to be normal. In October 1971, subsequent to complaints of swelling and itching and onset of perivulvar lesions, she was evaluated for a urinary tract infection, herpes progenitalis, and venereal disease. The laboratory reports were negative for venereal disease. In December 1971 she was referred to counseling for marital problems. She was noted to be anxious without further reference or clinical finding. Her separation examination report of January 1972 was normal. There were no reports of gynecological problems or difficulties that were nonspecific or attributable to an unidentified personal assault. Notwithstanding the veteran's assertion that she participated in "top secret" missions to Vietnam to process and question soldiers between September 1971 and January 1972, service personnel records reflect no requests to change duty, and there are no unusual performance changes or evaluations during this time. On the contrary, she requested an early separation from service in November 1971 because of her marriage to an enlisted man. Moreover, her service personnel records reflect promotions from Private E-1 to Specialist 4 E-4 between March 1970 and January 1971. Her request for early separation was honored and she was separated in January 1972 with an excellent efficiency rating. While there are multiple lay statements from the veteran herself describing episodes of depression, panic attacks or anxiety, accompanied by medical evidence of diagnosed psychiatric disorders, these reports all occur more than fifteen years after separation from service, there is no evidence of episodes of depression, panic attacks or anxiety during service. The veteran did submit many lay statements, including a June 1998 statement which attested to the changes in the veteran since her return from Vietnam. The affiant reported that he had known the veteran since childhood. He stated that she was now different, not just because of Vietnam, but in addition to her service, he believed that something had happened to change her from who she had been prior to service because she had a "distant look," and "fear in her eyes." He did not provide any information to corroborate specific events or incidences as reported by the veteran. The veteran's reports of domestic violence in her relationship with her husband during service are also unverified. There are no corroborating lay statements or medical findings regarding physical abuse. Service personnel records show that the veteran requested an early discharge due to marriage in November 1971, which was subsequently granted. The service medical records contain a December 1971 reference to the veteran being anxious due to marital problems and referral to a counselor without any indication of the nature of the marriage relationship. There is no medical or lay evidence to corroborate her September 1997 statement that in late 1971, her husband "punched" her in the stomach causing her to have a miscarriage. As noted previously, her separation examination report of January 1972 noted no physical abnormalities other than requiring glasses for hyperopia. The Board finds no evidence in the claims file, other than the veteran's own statements, to verify the occurrence of a traumatic or stressful event during service. There is likewise no evidence to show that the veteran was involved in substance abuse during service, or at any time remotely following service. Thus, the Board finds no credible support evidence to support any of the possible alternative methods of verifying personal assault noted previously. Id. With regard to the veteran's statements about Vietnam service, while her testimony about the incidents that occurred in Vietnam is presumed credible for purposes of establishing a well-grounded claim, it is insufficient to establish the presence of a stressor to support a diagnosis of PTSD in a non-combat situation. Although the veteran submitted a March 1996 lay statement from a friend who attested that the veteran wrote to her from Vietnam, there is absolutely no verifiable evidence of record to show that the veteran was ever in Vietnam. As previously noted, her service personnel records show that her MOS was a clerk typist and there is no indication whatsoever of any duty overseas. Moreover, service medical records show that she was seen every three months for oral contraceptives at her home base during the time she asserted she was flying to Vietnam. The veteran stated that the shooting of the Vietnamese soldier or civilian was "covered up" and was not of record, and she acknowledged that she never reported any of the alleged incidents. The veteran's friend's statement that the veteran wrote from Vietnam did not provide any corroboration of the veteran's specific assertions that she saw a deceased child in the road, or that she was sexually assaulted by a Vietnamese soldier or civilian. See YR v. West, 11 Vet. App. 393, 398 (1998). None of the witness statements offer more than a repeat of the veteran's testimony that she was in Vietnam. The Board acknowledges that two different psychologists have reported a diagnosis of PTSD for the veteran. However, they are the only independent diagnoses of PTSD among multiple diagnoses of major depression and bipolar disorder, beginning in 1991. In reviewing the medical records, the Board finds that the evidence which indicates primary diagnoses of major depression and bipolar disorder is of more weight and probative value than the two psychologists' PTSD diagnoses. The August 1996 diagnosis from the VA psychologist was based upon the veteran's report of unverified stressors. This diagnosis was reported despite his own evaluation of a questionable MMPI-2 profile and elevated PTSD scores that were also questionable. The private psychologist who reported a PTSD diagnosis provided no explanation at all for his determination. He described the various testing instruments he used, but he never outlined the stressors that were the basis of his diagnosis. It is well settled that the Board need not accept a medical diagnosis that is based upon an uncorroborated history as reported by the veteran. See Boggs v. West, 11 Vet. App. 334, 340 (1998); Swann v. Brown, 5 Vet. App. 229, 233 (1993). The Board finds that the four or five diagnoses of bipolar manic disorder prior to 1996, which were based upon multiple hospital admissions of several days with evaluation by different psychiatrists and clinicians, of more probative value than two PTSD diagnoses, standing alone. In addition, a VA psychiatrist noted in September 1995, that the veteran was an "unreliable historian." The Board also looks to the private psychological evaluation of June and July 1997 which found no evidence of PTSD related to service. This evaluator spent five days with the veteran and examined her extensively. He found that the veteran's report of Vietnam traumas appeared to be metaphors for her domestic traumas, all of which occurred well after separation from service. It is noteworthy also that this particular evaluation was requested by the veteran specifically for the purposes of establishing that PTSD was her only psychiatric diagnosis. Accordingly, the Board concludes that the preponderance of the evidence is against the veteran's claim. Despite the additional consideration and review provided to this claim under the provisions applicable to claims based on personal assault, there is still no credible evidence to support the veteran's contentions. The statements from witnesses are all dated in the late 1990's, more than 20 years after the veteran's separation from service. Indeed, the veteran's initial report of the traumas that are the basis of her claim was in 1996, more than 20 years after service. While the length of time between the occurrence of the alleged traumas and the date of reporting is not of primary consequence, it is important. It is particularly significant in the instant case where there is absolutely no evidence contemporaneous with the alleged traumas to indicate that there was anything unusual occurring in the veteran's life. The Board also notes that the veteran has submitted for consideration several journal articles and treatise excerpts regarding PTSD, as well as a clinical handbook on PTSD. Although the evidence outlines various clinical signs, symptoms, and causes for PTSD, particularly in women, there is no evidence to show that the veteran's diagnosed PTSD is related to her military service. See Libertine v. Brown, 9 Vet. App. 521, 523 (1996). In summary, the Board concludes that as there is no medical evidence of a psychiatric disorder during service, and no credible supporting evidence that a personal assault, or other claimed in-service stressor actually occurred, to support a diagnosis of PTSD, the claim must be denied. As the preponderance of the evidence is against the veteran's claim, it follows that there is no evidence of record that is in relative equipoise. Thus, the doctrine of reasonable doubt is not for application. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). ORDER Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is denied. BRUCE KANNEE Member, Board of Veterans' Appeals