Citation Nr: 0023189 Decision Date: 08/31/00 Archive Date: 09/05/00 DOCKET NO. 97-11 944 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for residuals of a right foot injury. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and Spouse ATTORNEY FOR THE BOARD D. Odlum, Associate Counsel INTRODUCTION The veteran had active military service from October 1968 to September 1970. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 1996 rating decision from the Waco, Texas Department of Veterans Affairs (VA) Regional Office (RO). In his November 1996 Notice of Disagreement the veteran contended that he had been suffering from headaches and asthma since his service in Vietnam. The Board finds this statement sufficient to constitute an informal claim for service connection of headaches and asthma. As these issues have been neither procedurally developed nor certified for appellate review, the Board is referring them to the RO for initial consideration and appropriate action. Godfrey v. Brown, 7 Vet. App. 398 (1995). FINDINGS OF FACT 1. The claim of service connection for PTSD is supported by cognizable evidence showing that the claim is plausible or capable of substantiation. 2. The claim of entitlement to service connection for residuals of a right foot injury is not supported by cognizable evidence showing that the claim is plausible or capable of substantiation. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for PTSD is well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The claim of entitlement to service connection for residuals of a right foot injury is not well grounded. 38 U.S.C.A. § 5107(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background PTSD Service records indicate that the veteran served in the Republic of Vietnam from September 30, 1969 to September 1, 1970. The veteran's DD Form 215 indicates that the veteran received the National Defense Service Medal (NDSM), the Vietnam Service Medal with four bronze stars, the Republic of Vietnam Meritorious Unit Citation (Gallantry Cross color), the Republic of Vietnam Meritorious Unit Citation (Civil Actions color, 1st Class), and the Republic of Vietnam Campaign Medal. During his service in Vietnam (from September 1969 to September 1970), service records indicate that the veteran served as an electrician and "S-4 Maint" with "HqCo, HqBn (Rein), 1st MarDiv (Rein), FMF" from September 1969 to October 1969. From October 1969 to September 1970 the veteran's primary duty was mostly as "S-4 Maint" and an electrician in the "ServCo, HqBn (Rein), 1st MarDiv (Rein), FMF." Service medical records do not document references to any psychiatric diagnoses or treatment. Service records note multiple violations by the veteran. In July 1969 the veteran was cited for failing, without authority to be at his appointed place of duty. It was found that the veteran had been disrespectful in language toward a Corporal, telling him to, in effect, "get fucked" in December 1969. It was found that in February 1970 the veteran had failed to go at the time prescribed to his appointed place of duty. On May 20, 1970 the veteran was cited for a violation. It was noted that he had been a sentinel on Post #3 on Alpha Line Defensive Perimeter when he was found sleeping "upon his post." The sentence adjudged was reduced pay for one month and to be "restricted to the limits of Service Company, Headquarters Battalion (Rein)," except for "messing, billeting worshipping and working areas" for 45 days. It was found that in June 1970 the veteran, having knowledge of a lawful order issued by a Sergeant to go out on the "LP," failed to obey that same order. It was found that the veteran, at "Alpha Line" in June 1970 was derelict in the performance of his duties in that he willfully failed to get up for his guard watch. It was found that on the following day he failed to go at the prescribed time to his appointed place of duty. A few days later in June 1971, he again failed to go to his appointed place of duty. In July 1970 the veteran was formally charged with the following offenses: failed to report to the appointed place of duty at the prescribed time on or about July 18 1970; failed to report at the time prescribed to his appointed place of duty on or about July 21, 1970; disobeyed the order of a superior on or about July 18, 1970; and on or about July 19, 1970, wrongfully and willfully discharged an M16 A1 rifle in the cantonment under circumstances such as to endanger human life. In a medical record dated from August 1970 it was noted that the veteran had been placed in the brig because he was believed to be involved in a "fragging" on July 23, and because he allowed another man to use an M16 inappropriately. It was noted that he denied both charges. It was further noted that the veteran was very evasive, vague, and manipulative and that he had given a vague story of falling asleep because "all thought vanished." In August 1970 the veteran was given an undesirable discharge from the military. However, the veteran's character of discharge was subsequently upgraded to 'under honorable conditions." Medical records from the Amarillo VA Medical Center (VAMC) show treatment from September 1990 to March 1996. Progress notes through October 1995 primarily document treatment of alcohol dependence and depression. In a progress note dated from November 1995 it was indicated that the veteran had begun treatment for PTSD. In a progress note from December 1995 it was confirmed that the veteran had entered treatment for PTSD. The assessment was PTSD with a history of "ETOH." A subsequent December 1995 progress note indicated that he was free of alcohol. The veteran was admitted to the VAMC in Waco on a voluntary basis into the PTSD unit from January 1996 to April 1996. A history of multiple traumatic experiences was documented. It was reported that his best friend was killed and that he saw many soldiers getting killed. Since returning he reported sleep disturbance, nightmares, depression, panic attacks, guilt, and outbursts of anger. He also reported episodes of isolation, intrusive thoughts, and occasional flashbacks. The final diagnosis was, in pertinent part, PTSD. In February 1996 the veteran submitted a claim for entitlement to service connection of PTSD. In March 1996 the RO sent a notice to the veteran asking that he provide a detailed description of specific traumatic event(s), including dates, places, and unit assignment(s). In March 1996 the veteran submitted a stressor letter. He reported a friend of his killed or wounded in action in February 1969; however, the veteran was not in Vietnam at this time, and he made no reference to this as being a traumatic event leading to PTSD in the letter that followed. The veteran listed a variety of stressors in his letter. He reported coming under fire in May or June while on Hill 327 that knocked him out of an observation tower causing him to injure his back. He also reported that two men were wounded during this incident. He reported coming under small arms fire while in the S-4 maintenance area in June. He reported shooting two people he thought were the enemy, but in fact turned out to be children. He reported coming under rocket attacks around the same time. He reported that a rumor had been going around that he wanted to marry a Vietnamese girl, and that, because of this, the "Captain" wanted him dead. He indicated that he was sent into a valley of Hill 327 with three others for an "LP." He stated that he was awakened by the sound of incoming mortars and found himself alone. He indicated that he was disciplined for the events surrounding this incident. The veteran stated that shortly thereafter he was singled out to repair communication lines during a rocket attack. After this incident, he reported being on watch on Hill 327. He stated that he went to sleep after waking up his partner for his watch. He indicated that he was unjustifiably charged with falling asleep at his post, when in fact it was his partner who had fallen asleep. He reported that he was hitching a ride in July when he saw two men rape and kill a Vietnamese woman. The veteran reported being cited with a number of unfounded Article 15's. In this regard, he reported that someone threw a hand grenade in a rice paddy and that it exploded. He reported being surrounded by Military Police (MP) and taken into custody. He contended that he was placed in the brig for an incident he had nothing to do with. The veteran reported that a rocket attack occurred while he was in the brig and that he feared for his life. In April 1996 a VA PTSD examination was conducted. The veteran reported nightmares, intrusive thoughts, isolative behavior, and depression. He stated that he had not used alcohol for about ten years. On examination, affect was constricted and the mood seemed chronically depressed. The veteran admitted to attempting suicide on at least two occasions. It was noted that he was of high average intelligence and had done some reading about PTSD. It was further noted that he described his emotional problems in very clinical terms. No definite psychiatric diagnosis was made. In June 1996 the RO sent a request to the Commandant of the Marine Corps requesting verification of the veteran's reported stressors. In August 1996 the Marine Corps responded that a search of the unit diaries of Service Company, HQ Battalion dated from April to June 1970 had failed to show any evidence of casualties. It went on to find that anecdotal incidents are not researchable without knowing the specific dates of each attack and the names of casualties, if any casualties were involved. In September 1996 the RO denied the veteran's claim of service connection for PTSD. In his Notice of Disagreement (NOD), the veteran stated that he was placed in the brig for the purpose of getting him away from a Vietnamese girl he had intended to marry. He stated that this woman was pregnant with his child. While in the brig, the veteran stated that he suffered from gross pain and humiliation from the guards. He stated that these guards beat him with billy clubs and that this experience was psychologically crippling. He reported being taken in shackles and flown back to the "MCRD" in San Diego to await discharge. He reported that he tried to commit suicide while at the "MCRD" and later woke up in Balboa Naval Hospital. He stated that he was "smuggled" out of the hospital a few days later by a lady friend. He again stated that he killed two children while in Vietnam after coming under fire. He stated that he was on Hill 327 and that he was in an observation tower operating a Mills Board. He stated that he came under fire while in the tower and that he was knocked out of the tower and injured his back. In February 1997 the veteran was admitted to the Big Spring VAMC in an agitated state, paranoia, complaining of nightmares, threatening violence, and reporting lack of sleep. It was noted that he had recently been involved in some marital discord, including possible separation. It was also noted that he had stopped taking his medication. The veteran was treated and rapidly recovered. The pertinent discharge diagnoses were bipolar disorder, hypomanic reaction and PTSD by history. In June 1997 a local hearing was conducted. During the hearing the veteran testified that he was involved in combat, including several fire fights and on Hill 327. Transcript, p. 4. He reported coming under incoming rocket and mortar fire on several occasions. Tr., pp. 4-5. He denied ever seeing anyone get killed while involved in such fire fights; however, he did report seeing two individuals get injured while they were coming under artillery fire. Tr., p. 5. He again reported hearing machine gun fire and shooting two people he thought were the enemy, but turned out to be children. Id. The veteran testified to witnessing the rape and murder of a Vietnamese woman. Tr., p. 6. The veteran again testified to being imprisoned while in Vietnam, but that no specific charges had ever been brought against him. Tr., pp. 6-7. He also testified that he was occasionally beaten by guards while he was imprisoned. Tr., p. 7. In a letter dated from June 1997, Dr. QVN of the Amarillo VAMC wrote that the veteran had been treated at the VAMC since 1986. He opined that the veteran had severe PTSD and that his experiences in Vietnam contributed to his current symptoms of PTSD. In September 1997, a VA PTSD examination was conducted. The examination was conducted by Dr. QVN. The veteran reported that he worked in a maintenance unit while in Vietnam and that his duties included the maintenance and repair of generators, perimeter electric lines, and communication lines. He reported that he was imprisoned for an allegation of attempted murder of his superior but he denied that allegation. He again reported killing two children after coming under small arms fire, and that he saw two soldiers rape and cut the throat of a Vietnamese woman. Symptoms reported on examination included flashbacks, nightmares, intrusive thoughts, and poor sleep. The examiner concluded that the veteran had experienced traumatic events in Vietnam and that he had a bipolar disorder and chronic, severe PTSD. Amarillo VAMC records dated from December 1995 to March 1998 show continued treatment of PTSD and bipolar disorder. In June 1998 a VA PTSD examination was conducted. The veteran again reported that his stressors included killing two children while in Vietnam and witnessing the rape and murder of a Vietnamese woman. He also reported that he was traumatized by his unjustified imprisonment for attempted murder and possession of drugs. The veteran was diagnosed with PTSD. Residuals of a Right Foot Injury Service medical records reveal that the veteran was seen for painful pes planus bilaterally in October 1968. In November 1968 he was seen for complaints of right heel pain. Examination revealed a heel contusion. Follow-up notes document treatment and improvement of the heel contusion. In December 1968 the veteran was seen for pain in the metatarsal heads bilaterally. In June 1969 he was seen for a blister on his right little toe. In July 1969 the veteran was seen in the sick bay after dropping a can on the dorsal side of his right foot. X-rays were noted as revealing no evidence of a fracture. The impression was a contusion of the right foot. The lower extremities were described as being normal on separation examination in September 1970. VA medical records from the Amarillo VAMC document no references to a right foot impairment from September 1990 to March 1996. In February 1996 the veteran submitted a claim for, in pertinent part, service connection of a right foot disability. Private medical records submitted with the claim primarily document treatment of a back disability and secondary radiation into the legs from 1986 to October 1988. They do not document a diagnosis of a right foot disorder. In April 1996 a VA examination of the feet was conducted. The veteran reported breaking the right foot bone on the top while in the service. He currently reported pain in his right foot. Examination revealed mild to moderate hallux valgus bilaterally. X-rays were taken. The x-ray report noted arthritic change involving the proximal articular surface of the first metatarsal on the right side. Also noted was a bunion of the great toe of the left foot. The diagnosis was osteoarthritis of the mid-tarsal joints. Amarillo VAMC records from December 1995 to March 1998, document no reference to the veteran's right foot, aside from the April 1996 x-ray report and VA examination. In April 1998 a VA foot examination was conducted. The veteran reported pain and some swelling in the right foot. He reported injuring the foot in 1970, stating that a canister was dropped on the dorsal side of the right foot. He also reported dropping a 155 millimeter Howitzer on his foot. Examination revealed no gross deformities of the foot, although bilateral hallux valgus deformities were noted. There was no evidence of flat foot or hammer toes, high arch, claw foot, or other deformity. X-rays of the feet were interpreted as revealing only bilateral hallux valgus deformities. The diagnosis was bilateral hallux valgus deformities. The examiner concluded that there did not appear to be any residual or any problems associated with the veteran's initial injury. In June 1998 the RO received records from the SSA. These records contain private medical records; however, none of these records document a diagnosis of a right foot disorder. Criteria Pursuant to 38 U.S.C.A. § 5107(a), a person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded. The United States Court of Appeals for Veterans Claims (Court) has held that a well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § [5107(a)]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The Court has also held that although a claim need not be conclusive, the statute provides that it must be accompanied by evidence that justifies a "belief by a fair and impartial individual" that the claim is plausible. Tirpak v. Derwinski, 2 Vet. App. 609, 610 (1992). The Court has held that "where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is 'plausible' or 'possible' is required." Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993) (citing Murphy, at 81). The Court has held that a well-grounded claim requires competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). See Epps v. Brown, 126 F.3d. 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed.Cir. 1996). The Court has held that a well grounded claim for PTSD requires (1) medical evidence of a current PTSD disability; (2) medical or lay evidence (presumed credible for these purposes) of an in-service stressor; and (3) medical evidence of a link between service and the current PTSD disability. Cohen v. Brown, 10 Vet. App. 128, 137 (1997); see Epps v. Brown, 9 Vet. App. 341, 343-44 (1996); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed.Cir. 1996). Evidence submitted in support of the claim must be accepted as true for the purpose of determining whether the claim is well grounded, except when the evidentiary assertion (other than in a government record) is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. Hensley v. West, No. 99-7029 (Fed. Cir. May 12, 2000). If the claim is not well grounded, the appellant cannot invoke VA's duty to assist in the development of the claim. See 38 U.S.C.A. § 5107(a); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). In order to establish service connection for a claimed disability the facts must demonstrate that a disease or injury resulting in current disability was incurred in active military service or, if pre-existing active service, was aggravated therein. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). Service connection may 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) (1999). Eligibility for service connection of a well-grounded PTSD claim 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. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to this combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (1999) (emphasis added); see 38 U.S.C.A. § 1154(b) (West 1991); see also Cohen v. Brown, 10 Vet. App. at 138; Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). However, a veteran is still required to show evidence of a current disability and a link between that current disability and service. See Kessel v. West 13 Vet. App. 9, 17-19 (1999) (holding that section 1154(b) does not obviate the requirement that the veteran submit evidence of a current disability and evidence of a nexus between the current disability and service); see also Clyburn v. West, 12 Vet. App. 296, 303 (1999). "Engaged in combat" requires that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. However, the issue of whether any particular set of circumstances constitutes engagement in combat with the enemy must be resolved on a case-by-case basis based on the facts of each case. Any evidence which is probative of the issue of whether a veteran engaged in combat may be used by a veteran to support a veteran's assertion that he was engaged in combat. The benefit of the doubt rule applies to determinations of whether a veteran engaged in combat with the enemy. If there is a balance of positive and negative evidence, the issue must then be resolved in the veteran's favor. VAOPGCPREC 12-99; see 38 U.S.C.A. § 1154(b) (West 1991); Gaines v. West, 11 Vet. App. 353, 359 (1998). Where the claimed stressor is not related to combat, the veteran's lay testimony, by itself, will not be enough to establish the occurrence of the alleged stressor. Instead, the record must contain evidence which corroborates the veteran's testimony as to the occurrence of the claimed stressor. See Moreau v. Brown, 9 Vet. App. 389, 395-396 (1996); see Dizoglio v. Brown, 9 Vet. App. 163 (1996); Zarycki, supra. The requisite additional evidence needed for corroboration may be obtained from sources other than the veteran's service medical records. Moreau, supra; see also Patton v. West, 12 Vet. App. 272, 277 (1999). Continuous service for 90 days or more during a period of war, and post-service development of a presumptive disease to a degree of 10 percent within one year from the date of termination of such service, establishes a presumption that the disease was incurred in service. 38 C.F.R. §§ 3.307, 3.309 (1999). If not shown in service, service connection may be granted for arthritis if shown disabling to a compensable degree during the first post service year. 38 U.S.C.A. §§ 1101, 1112, 1113, (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.307, 3.309 (1999). Where there is a chronic disease shown as such in service or within the presumptive period under § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (1999). This rule does not mean that any manifestation in service will permit service connection. To show chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established, there is no requirement of evidentiary showing of continuity. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1999). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When, after consideration of all of the evidence and material of record in an appropriate case before VA, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt doctrine in resolving each such issue shall be given to the veteran. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 4.3 (1999). Analysis PTSD The Board finds that the veteran's claim for service connection for PTSD is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). The veteran has presented lay testimony of in- service stressors, both combat and non-combat-related (including an allegation of personal assault while imprisoned); he has a current diagnosis of PTSD; and a VA physician has attributed his current PTSD disability to Vietnam-related stressors. Therefore, the claim of service connection for PTSD is found to be well-grounded, and is further addressed in the remand portion of this decision. See Hensley, Patton, supra. Right Foot Disability Section 5107 of Title 38, United States Code unequivocally places an initial burden upon the veteran to produce evidence that his claim is well grounded; that is, that his claim is plausible. Grivois v. Brown, 6 Vet. App. 136, 139 (1994); Grottveit v. Brown, 5 Vet. App. 91, 92 (1993). Because the veteran has failed to meet this burden, the Board finds that his claim of entitlement to service connection for a right foot disability must be denied as not well grounded. The Board reiterates the three requirements for a well grounded claim: (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and, (3) medical evidence of a nexus between the claimed inservice injury or disease and a current disability. See Caluza, supra. The record shows that the veteran was treated for right foot problems in service, in particular, a right foot injury in 1969. The record has documented a possible current diagnosis of osteoarthritis, although this is not entirely clear, as a more recent x-ray report did not find arthritic change. Regardless, the veteran has failed to provide medical evidence of a nexus between a current right foot disability and military service. There are no documented medical opinions or other competent evidence of record linking a current right foot disability to service. In fact, the only competent evidence of record is against his claim. The April 1998 VA examiner indicated in the assessment that the veteran did not have any residual or any problems associated with his initial foot injury. Id. In addition, there is no evidence that any chronic disease, such as arthritis, was shown in service or during an applicable presumption period. Nor is there medical evidence of a relationship between a current right foot disability and any alleged continuity of symptomatology. See Voerth v. West, 13 Vet. App. 117 (1999); McManaway v. West, 13 Vet. App. 60 (1999); Savage v. Gober, 10 Vet. App. 488 (1997). The veteran's own opinions and statements will not suffice to well-ground his claim. While a lay person is competent to provide evidence on the occurrence of observable symptoms during and following service, such a lay person is not competent to make a medical diagnosis or render a medical opinion, which relates a medical disorder to a specific cause. Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992). Neither is the Board competent to supplement the record with its own unsubstantiated medical conclusions as to whether a right foot disability is related to a disease or injury incurred during service. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board further finds that the veteran has not indicated the existence of any evidence that has not already been requested and/or obtained that would well ground his claim. 38 U.S.C.A. § 5103(a) (West 1991); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Brown, 9 Vet. App. 341, 344 (1996), aff'd sub nom. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). For these reasons, the Board finds that the veteran has not presented or identified probative medical evidence of a link between a current right foot disability and service. Consequently, the Board concludes that the veteran's claim of entitlement to service connection for a right foot disability is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). The Board views its foregoing discussion as sufficient to inform the veteran of the elements necessary to complete his application to reopen this claim. See Graves v. Brown, 8 Vet. App. 522 (1996); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). As the veteran's claim for service connection of a right foot disability is not well grounded, the doctrine of reasonable doubt has no application to his claim. ORDER The veteran's claim of entitlement to service connection for PTSD is well-grounded. The veteran, not having submitted a well grounded claim of entitlement to service connection for a right foot disability, the appeal is denied. REMAND This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or by the Court 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. 2000) (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. As the veteran has established a well-grounded claim of service connection for PTSD, the duty to assist attaches. VA has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991). The Board is of the opinion that further development is required. In this case, the veteran has alleged a variety of combat and non-combat-related stressors that he experienced while he was in Vietnam. With respect to combat-related stressors, the RO sent a request to the Marine Corps requesting verification of his reported stressors. The Marine Corps responded that his reported stressors were not researchable because he had not provided the specific dates of each attack and the names of the casualties. It appears that a search of diaries of the veteran's unit was made for the period from April to June 1970, and that this search was conducted for the purpose of finding casualties. It does not appear that any other research was conducted concerning the veteran's stressors. This conclusion is based on the Commandant's finding that his stressors were not researchable. The veteran's report of stressors was non-specific in terms of the dates of the alleged stressors. Some only provided the approximate month in which they occurred, while others provide no date at all. However, a careful review of the veteran's service records, in concert with his stressor letter does allow for an approximate estimate of the dates of many of these stressors. Service records show that the veteran was in Vietnam from September 1969 to September 1970. In his letter, the veteran stated that he came under fire in May or June while in an observation tower on Hill 327, and that he was knocked from this tower. He also has reported seeing two soldiers get injured during this incident. Since the veteran did not arrive in Vietnam until September 1969, it can rather easily be deduced that the veteran was referring to May or June of 1970. Therefore, the record establishes that the veteran's reported stressor on Hill 327 involving the observation tower and artillery fire allegedly occurred in May or June of 1970. The veteran specifically reported coming under small arms fire while located at the S-4 maintenance area in June. He reported sending up a flare and seeing two people running whom he fired upon, and then saw them go down. He reported finding out the next morning that he had actually shot two children. As with the previous stressor, the veteran's report that this incident occurred in June can deduced to be June 1970 since he could not have been in Vietnam in June in any other year other than 1970. Therefore he has provided an approximate date (June 1970) and a specific location and description of the stressful event. The veteran has more generally reported other stressors that occurred on Hill 327, including coming under rocket and mortar fire. A careful reading of his statement suggests that these events occurred around June or July 1970. His reported witnessing of a rape and murder is indicated in his statement to have occurred in July 1970. As a minimum, the veteran must indicate the location and approximate time of the stressful event(s) in question. See VA ADJUDICATION PROCEDURE MANUAL M21-1 (M21-1), Part III, Paragraph 5.14(b)(2)(a). The Board is of the opinion that the veteran has already provided information with respect to at least two alleged combat-related stressors (namely, the observation tower incident and his reported killing of two children) that should be sufficient for purposes of research by the Marine Corps. Regardless, the Board notes that the veteran was never requested to clarify his stressors or to provide more specific dates or other information regarding his stressors after the Marine Corps informed the RO that his stressor information was not specific enough. It is unclear as to whether the veteran was even notified of this negative response. The veteran should be given the opportunity to clarify his combat-related stressors and provide more specific dates as to the time when such stressors occurred. See M21-1, Part III, Paragraph 5.14(b)(6). Another stressor reported by the veteran involves his imprisonment while in the service. The veteran has not been entirely consistent in his description of what was traumatic about his imprisonment. He initially reported experiencing a rocket attack while in prison. He subsequently reported being beaten while in prison, and he has also generally reported being traumatized by his imprisonment. While service records document the veteran's imprisonment, they do not document the instances of assault as contended by the veteran. The Court has held that VA has undertaken a special obligation to assist a claimant who has submitted a well- grounded claim in producing corroborating evidence of an inservice stressor involving personal assault. Patton v. West, 12 Vet. App. 272, 280 (1999). In this regard, behavior changes that occurred at the time of the incident may indicate the occurrence of an inservice stressor. See M21-1, Part III, para. 5.14(c)(7). The M21-1 provisions provide that secondary evidence may need to be interpreted by a clinician especially if it involves behavior changes. Evidence that documents such behavior changes may require interpretation in relationship to the medical diagnosis by a VA neuropsychiatric physician. See M21-1, Part III, para. 5.14(c)(8). The Court held that the RO is responsible for assisting the claimant in gathering, from sources in addition to in-service records, evidence corroborating an in-service stressor, by sending a special letter and questionnaire, by carefully evaluating that evidence including behavior changes, and by furnishing a clinical evaluation of behavior evidence. Patton at 281-282. It does not appear that the RO performed such assistance, including providing the veteran with a special PTSD personal assault letter, evaluating the evidence including behavior changes, and by furnishing a clinical evaluation of behavior evidence. Id. This assistance should be performed. In addition, on remand the RO should request the veteran to clarify and specify the nature of the stressor(s) during his imprisonment. In light of the above, this case is remanded for the following: 1. The RO should request the veteran to identify the names, addresses, and approximate dates of treatment for all health care providers, VA and non-VA, inpatient and outpatient, who may possess additional records pertinent to his claim. Kutscherousky v. West, 12 Vet. App. 369 (1999). After securing any necessary authorization or medical releases, the RO should attempt to obtain legible copies of the veteran's complete treatment records from all sources identified whose records have not previously been secured. Regardless of the veteran's response, the RO should secure all outstanding VA treatment reports. All information which is not duplicative of evidence already received should be associated with the claims file. 2. The RO should request the veteran to provide more specific details regarding his alleged in-service stressors, including his imprisonment. He should be asked to provide, as specifically as possible, the dates and locations of these alleged stressors and any other information pertinent to verification. 3. With respect to his claim that he was assaulted while in prison, the RO should afford the veteran the opportunity to submit any alternate available sources that may provide credible support to the inservice personal assaults to support his claim for service connection for PTSD, as provided in M21-1, Part III, para. 5.14(c). The veteran should be asked to provide any additional information possible regarding his imprisonment and reported assaults and to identify potential alternative sources for supporting evidence of such reports. In particular, the veteran should provide as much detailed information as possible including the dates, places, names of people present, and detailed descriptions of events. The veteran is advised that this information is necessary to obtain supportive evidence of the stressful events and that he must be as specific as possible because without such details an adequate search for verifying information can not be conducted. 4. The RO should then request any supporting evidence from alternative sources identified by the veteran and any additional alternative sources deemed appropriate, if the veteran has provided sufficiently detailed information to make such a request feasible. The RO should request military police reports for the military installation where the incident(s) was reported and the records from the social actions office at that installation. The RO should specifically attempt to obtain records from "MCRD" in San Diego and Balboa Naval Hospital pertaining to his reported suicide attempt (see the veteran's November 1996 Notice of Disagreement). 5. The RO should review the entire claims file and prepare a summary of the unverified claimed stressors based on review of all pertinent documents, to include the veteran's PTSD Questionnaire and all medical records. The summary and all associated documents, including a copy of this remand, all available service records, and any written stressor statements should then be sent to the Commandant of the Marine Corps, Headquarters United States Marine Corps in Quantico, Virginia to obtain verification of the claimed stressors. The Marine Corps should be requested to provide any information which might corroborate any of the veteran's alleged combat experience and stressors. 6. Thereafter, if any alleged stressor(s) is or are verified, the RO should afford the veteran a VA psychiatric examination by a specialist who has not previously examined or treated him. The claims file, a separate copy of this remand, the stressor list compiled by the RO, any information provided by the Marine Corps, and copies of the pertinent M21-1 criteria with respect to personal assault claims must be provided to the examiner for review prior and pursuant to conduction and completion of the examination and the examination report must be annotated in this regard. Any further indicated special studies, including psychological studies, should be accomplished. The examiner must determine whether the veteran has PTSD and, if so, whether the inservice stressor(s) are sufficient to produce PTSD. The examiner should utilize the DSM-IV in arriving at diagnoses and identify all existing psychiatric diagnoses. If PTSD is diagnosed, the examiner should explain whether and how each of the diagnostic criteria is or is not satisfied. Again, if PTSD is diagnosed, the examiner must identify the verified stressor(s), combat, and/or non-combat-related, supporting the diagnosis. With respect to his reported personal assault while imprisoned, the examiner is requested to analyze the service personnel records in light of the examples listed in M21-1, Part III, para. 5.14(c)(7). Specifically, the examiner should determine whether there is inservice and/or post-service evidence of behavior changes at the time of alleged stressor incident, which might indicate their occurrence. See M21-1, Part III, 5.14(c)(7), (8). In doing so, the examiner should carefully review all of the veteran's statements and hearing testimony dating back to his original stressor letter regarding the events of his imprisonment, as well as the secondary evidence and evidence of behavior changes shown in the service personnel records. It is requested that the examiner interpret the behavior changes and evidence pertaining thereto and render an opinion whether the behavior changes are related to the claimed stressors. Any opinions expressed must be accompanied by a complete rationale. 7. Thereafter, the RO should review the claims file to ensure that all of the foregoing requested development has been completed. In particular, the RO should review the requested examination report(s) to ensure that they are responsive to and in complete compliance with the directives of this remand, and if they are not, the RO should implement corrective procedures. Stegall v. West, 11 Vet. App. 268 (1998). 8. After undertaking any necessary development in addition to that specified above, the RO should readjudicate the issue of service connection for PTSD. If the benefit requested on appeal is not granted to the appellant's satisfaction, the RO should issue a supplemental statement of the case containing all applicable criteria pertinent to the appellant's claim. A reasonable period of time for a response should be afforded. Thereafter, the case should be returned to the Board for final appellate review, if otherwise in order. By this remand, the Board intimates no opinion as to any final outcome warranted. No action is required of the appellant until he is notified by the RO. RONALD R. BOSCH Member, Board of Veterans' Appeals