Citation Nr: 0218167 Decision Date: 12/16/02 Archive Date: 12/24/02 DOCKET NO. 99-14 327 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Fleet Reserve Association WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Christopher Maynard, Counsel INTRODUCTION The veteran had active service from December 1952 to December 1955. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a February 1999 decision by the RO which denied service connection for PTSD. A personal hearing at the RO was held in March 2000. The Board remanded the appeal to the RO for additional development in November 2000. As indicated in the Board remand in November 2000, the veteran appears to have raised the additional issue of service connection for hypothyroidism. (See veteran's March 1999 statement). This issue is not inextricably intertwined with the issue on appeal and is not in appellate status. Accordingly, this matter is referred to the RO for appropriate action. FINDINGS OF FACT 1. All evidence necessary for adjudication of the claim of service connection for PTSD has been obtained by VA. 2. The veteran did not engage in combat with the enemy during military service. 3. Objective evidence of an in-service stressor has not been demonstrated. 4. The veteran does not currently have PTSD as a result of experiences in service. CONCLUSION OF LAW PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5100, 5102, 5103, 5103A, 5106, 5107, 5126, 7104 (West 1991 and Supp. 2002); 38 C.F.R. §§ 3.159, 3.303, 3.304(f) (2002). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that during the pendency of this appeal, the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), was signed into law. See 38 U.S.C.A. § 5100 et. seq. (West Supp. 2002). This liberalizing law is applicable to this appeal. See Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991). To implement the provisions of the law, the VA promulgated regulations published at 66 Fed. Reg. 45,620 (Aug. 29, 2001) (codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2002)). The Act and implementing regulations essentially provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. It also includes new notification provisions. The Board finds that the passage of the VCAA and implementing regulations does not prevent the Board from rendering a decision on the issue of service connection for PTSD at this time, and that all notification and development actions needed to render a fair decision on this issue has been accomplished. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). All required notice and development actions specified in this new statute and implementing regulations have been complied with. The veteran was informed of what evidence he was expected to provide VA and of the type of evidence needed to establish entitlement. By letters dated in August 1998 and again in September 2001, the veteran was asked to provide information concerning the claimed in-service stressors that have led to his current psychiatric problems. The veteran provided some stressor information in a PTSD Questionnaire received in September 1998. He also provided testimony at a personal hearing at the RO in March 2000. In various correspondence, including a letter dated in September 2001, the statement of the case (SOC) and supplemental statements of the case (SSOC), most recently in May 2002, the veteran was informed of what evidence had already been obtained, and what evidence was still needed to substantiate his claim. Every effort has been made assist the veteran to obtain evidence from all identified sources. The veteran was asked on several occasions to provide detailed information concerning the alleged stressors that he believes have caused his current psychiatric problems. While the veteran did provide some information, he did not provide the specific information necessary for VA to attempt to verify the claimed inservice combat stressors. Nonetheless, VA attempted to obtain relevant evidence from the Commandant of the Marine Corps in Quantico, Virginia. A response from that organization was to the effect that the veteran's claimed combat related stressors could not be verified. As to the claim of a personal assault, the veteran stated that he never reported the incident to anyone until some 43 years after he was discharged from service. He also stated that there were no witnesses to the incident. The Board is cognizant of the recent change in VA regulations pertaining to claims based on personal assault and the requirement to attempt to obtain relevant information from alternative sources. In this case, the Board finds that all potential avenues for information to substantiate the veteran's claim have been investigated to the extent possible. The veteran was notified that he could provide additional evidence from alternative sources in support his claim. Lay statements have been received from the veteran's wife and friends which provide a history of the veteran's behavior for various periods since his discharge from service. The veteran has indicated that there are no other sources from which additional information could be obtained. Where the appellant has been fully notified and is aware of the type of evidence required to substantiate his claim, and where there has been extensive factual development of the case which indicates that no additional assistance would aid in further developing the claim, no further development pursuant to the VCAA is required. Wensch v. Principi, 15 Vet. App. 362 (2001), (citing Dela Cruz v. Principi, 15 Vet. App. 143 (2001) (The Secretary is not required to provide assistance "if no reasonable possibility exists that such assistance would aid in substantiating the claim."). Accordingly, it is determined that the veteran will not be prejudiced by the Board proceeding with the adjudication of this case. See Bernard v. Brown, 4 Vet. App. 384 (1993). In this case, no reasonable possibility exists that any further assistance would aid the veteran in substantiating his claim. Thus, the VA has met its duty to assist under the VCAA. See 38 U.S.C.A. § 5103A(a)(2) (Secretary not required to provide assistance "if no reasonable possibility exists that such assistance would aid in substantiating the claim"). Factual Background The veteran's service medical records are negative for any complaints, findings, or diagnosis referable to any psychiatric problems. At his entrance examination in December 1955, the veteran specifically denied frequent trouble sleeping, nightmares, depression or excessive worry, memory problems, or nervous trouble of any sort. His psychiatric status on examination at entrance in December 1952, and on his separation in December 1955, was normal. The veteran's service personnel records show that he was authorized to wear the Korean Service Medal. His primary duty assignment in service was that of a radio operator, MOS 2531. The records show that he departed San Diego, California in May 1954 and arrived in Kobe, Japan on June 4 1954. At that time, he was assigned to Comm Co, HpBn, 3rd Mar Div. On July 28, 1954, he was assigned TAD to Camp Nara, Japan as a radio operator. On October 10, 1954, the veteran was hospitalized at the base dispensary and was subsequently transferred to a military hospital in Nagoya, Japan where he remained through December 1954. (Treatment was for accidental facial injuries). He was then transferred to a military hospital in Tokyo from January 1, to 17, 1955. The veteran was assigned to H/S Co, 7th MT Bn, SC, on January 20, 1955. From January 21 through March 1955, the veteran worked as a communications specialists and on mess duty. He departed Inchon, Korea for San Diego, CA on April 1, 1955. The veteran received disciplinary actions for an unauthorized absence (10 hours) in October 1953, and a second Article 109 UCMJ in September 1954, for destruction of private property (damaged a fence in Japan). The veteran's proficiency evaluations were between 5 and 6 throughout his military career. His conducted rating ranged from between 4.0 and 4.5, except for the rating periods immediately following his two disciplinary actions. At those times, he received a rating of 3.9. The evidentiary record shows that the veteran reported that he came under fire and fired at the enemy while in Korea, and that he lost "friends." (See July 1998 VA outpatient report). The diagnoses included PTSD - strong history, and depression and anxiety symptoms. When seen by VA in August 1998, the veteran reported that he called in air strikes as a forward observer 3/4 of a mile from the front lines. He said that he was never fired upon as a spotter, but that he came under sniper fire by infiltrators while in other positions. He also reported that he saw dead soldiers stacked in piles and not in body bags. He was a radio operator on trucks and picked up bodies from front line aid stations and brought them to rear areas. The veteran described an incident in boot camp when a jet was lined up to strafe troops during training. He reported that he saw the ground exploding as the jet came closer and closer when suddenly it exploded overhead. The veteran stated that he then searched the area for body parts and found a boot with a heel inside. The veteran also reported an incident that occurred at a YMCA where he was temporarily housed prior to his induction examination in December 1952. The veteran reported that he was assaulted and raped at knifepoint by an unknown assailant. The diagnosed included major depression with psychotic features, PTSD, and alcohol abuse in full remission. On VA psychiatric examination in November 1998, the veteran described the same stressor incidents as above. The veteran reported that he had no especially traumatic recollections of his experiences in Korea. The diagnosis was suspected PTSD. The examiner recommended that the veteran undergo psychological testing to help ascertain the true nature of his symptoms. (A subsequent handwritten notation changed the diagnosis to PTSD - mild. On VA psychological evaluation in December 1998, the veteran described the rape incident he experienced in service. The veteran reported that he was asleep in a large dormitory type room at a YMCA in North Carolina where he was temporarily housed prior to his induction examination. The veteran reported that someone put a towel over his mouth and a knife to his neck, and threatened to kill him if he told anyone what happened. The individual then proceeded to sexually assault the veteran. The veteran stated that he didn't report the incident to anyone at that time and that he never spoke of the assault until recently when he began to discuss it in therapy. The examiner reported that the veteran had recurrent intrusive thoughts and distressing dreams of the incident, that he experience persistent avoidance and arousal, and that his symptoms satisfied the criteria for a diagnosis of PTSD. However, the examiner stated that the veteran's test behaviors indicated signs and symptoms which were not consistent with PTSD. Specifically, the veteran's responses to psychometric testing resulted in an invalid profile. In particular, the veteran's Minnesota Multiphasic Personality Inventory II (MMPI - II) profile showed an extreme elevation of clinical scales which were inconsistent with the type of trauma he was reporting. In addition, the validity of index F-K was over 16 which was above the cut-off for "faking bad." Even allowing for the higher F scales typically seen in PTSD, since this veteran was not reporting combat-related PTSD, such findings were unusual. Because of the profile and validity, two test for malingering were administered. The examiner noted that the veteran had significant difficulty passing a 15 Item Test, twice. He indicated that this was quite surprising as the test should be passable by anyone who does not have gross organic impairment. On the second test for malingering, the veteran scored at the "0" percentile, meaning that his scores were so abysmally poor that no one could score lower. Such scores were only achieved on this very simple test by persons who were making an active effort to appear more disturbed or impaired than they actually were. A third test, the Trauma Symptom Inventory was also administered since the veteran's complaint concerned a sexual trauma. The validity scale on this test was also extremely elevated resulting in an invalid profile. The veteran endorsed a higher number of unusual and bizarre items which reflected either psychosis or an attempt to appear especially disturbed or dysfunctional. The examiner noted that the veteran showed no signs of being psychotic or of having organic brain damage. The diagnoses included PTSD, mild; malingering; depressive disorder, not otherwise specified, and alcohol dependence in remission. The examiner commented that although the veteran was able to describe symptoms of PTSD as the result of a sexual assault in service during the interview portion of the evaluation, psychometric testing did not support his claim. The testing suggested that the veteran might have been significantly exaggerating many of his symptoms. His scores on tests for malingering, which should be easily passed by a relatively intact, non-organically impaired subject fell into a range of functioning normally seen in persons who required locked ward environments to protect them due to their grossly impaired judgment, memory, and intellect. The examiner stated that while the benefit of doubt was given to the veteran regarding his stressors and his symptoms of PTSD, the tests suggested an effort to exaggerate his symptoms to a significant degree. The examiner also noted that at the end of the interview, the veteran suddenly described another traumatic event involving finding a piece of bone with human flesh on it, the remnants of a pilot killed in a fiery crash. The veteran went on to say that this man was a good friend of his, but that he was unable to recall his name. The examiner indicated that this seemed to be an attempt to add to the clinical trauma picture and bolster his PTSD claim. In a statement received in June 1999, the veteran stated that he did not find pieces of a human body and did not know the pilot who was killed in the plane crash that he witnessed during basic training. He said that the plane was not strafing U.S. troops but was conducting training exercises. The veteran indicated that there was no record of his rape in his service medical records because he never reported the incident to anyone. He also noted that he rode on a command truck and that he worked in communications as a radio operator. At a personal hearing at the RO in March 2000, the veteran testified that he did not know the pilot of the plane that exploded during training at Camp Lejeune in early 1953. He said that he never reported that he knew the pilot or that he found a human heel. He testified that a number of Marines were involved in searching the crash area and that they were later told that one of the pieces found and turned in was the heel of the pilot. (T p.4). The veteran testified that he was sexually assaulted while he was temporarily billeted at a YMCA on his way to basic training. While he was sleeping, the assailant put a towel over his face and a knife to his neck and threatened to kill him if he told anyone of the incident. The veteran was in a dormitory room with 18 to 25 other men who were sleeping at the time of the incident. (T p.5). He testified that he never told anyone about the incident until he talked to a VA psychiatrist [in 1998]. The veteran also testified that he served as a radio operator in the 1st and 2nd Marine Divisions and a little known outfit called "Anglico" while in Korea. During most of his time in Korea, he was temporarily assigned (TAD) to the 7th Motor Transport Battalion, and served as a forward observer calling in air strikes for various artillery units. The veteran asserted that the problem with being temporarily assigned (TAD) was that it often wasn't recorded in the individual's service records. The veteran reported that as a forward observer, he was behind enemy lines or in the middle of various battles most of the time. He stated that he could not recall the names of a single friend or comrade who was killed or wounded. The veteran remembered the name of his commanding officer in Korea, 1st Lt. [redacted]. (T ps.8-11). Additional records were submitted at the personal hearing that included a letter from a neighbor/social worker of the veteran, a report on the 4th Naval Gunfire Liaison Company, a history of the 2nd Anglico Association Charter, and a report from the Commanding General of the air unit at Cherry Point, NC. The letter from the veteran's neighbor/social worker, dated in February 2000, was to the effect that she had known the veteran for over 15 years, and had observed that he was plainly troubled, irritable, and short tempered with no outward reason to be so. The social worker stated that when she recently learned of the veteran's history, "everything fell into place." The information pertaining to the 4th Naval Gunfire Liaison Company indicated that from time to time, small teams from the 1st Naval Gunfire Liaison Company were sent TAD with the 1st Marine Division in Korea. This was in addition to those teams from ANGLICO, 1st Signal Battalion, which was normally part of the 1st Marine Division. The cover letter from SSGT [redacted] indicated that the MOS for a radio operator was 2531 and that a forward observer was 0861. The copy of a history of the 2nd Anglico Association Charter did not provide any probative information pertaining to the veteran or the units that his service records show that he was assigned to during service. The letter from the Office of the Commanding General, MCAS Cherry Point, NC was in response to the veteran's inquiry about the air training accident while he was stationed at Camp Lejeune in 1953. The letter indicated that training records from 1953 and 1954 were poor or non-existent. The available records showed that there was an air training accident in November 1952. The letter did not include any records showing any training accidents after November 1952. Additional VA medical records were obtained from several VA medical facilities identified by the veteran. These records showed treatment for various maladies, including psychiatric problems from 1999 to 2001. The medical records pertinent to the veteran's claim of service connection included the diagnosis of PTSD. These records will not be discussed in detail, as they do not provide any additional information not already discussed. An August 2000 statement from a VA psychiatrist indicated that he was treating the veteran for dysthymic disorder and PTSD. The physician stated that he had no reason not to believe the veteran's allegations of sexual abuse that occurred during military service and that his severe PTSD was directly related to the sexual assault. A letter from L. S. Fulmer, a specialist in administering polygraph examinations was received in August 2000. Mr. Fuller stated that the veteran voluntarily agreed to take a polygraph examination concerning the sexual assault incident in service. Mr. Fuller included a sample of relevant test questions about the incident and stated that the veteran was truthful in his responses and that no deception was indicated. In December 2000, the veteran was asked to provide the RO with detailed information concerning all of the incidents in service that he believes have caused his current psychiatric problems. The letter advised the veteran that he could submit evidence from alternative sources, such as, police reports, statements from friends or family that he may have discussed the incident with, or letters about the various incidents that he may have sent to friends or family members. Received in February 2001, were letters from the veteran's wife, son, and friends. His current wife of 19 years stated that their marriage was good for the first 10 years, although the veteran did experience periods of depression/sadness several times a year lasting 2 to 3 days each time. His symptoms increased over the years to the point that he was totally withdrawn from her and their children. The veteran started several businesses which were promising and went very well, sometimes for a few years, but then the veteran would loose interest in running them and they eventually failed. The veteran's youngest son described what it was like to grow up with his father and his deteriorating mental health problems. The friend described her observations of the veteran for the past 13 years and how he had changed from a relatively nice outgoing person to someone she seldom saw anymore. A statement from a friend/coworker who had known the veteran from 1990 to 1996 was to the effect that he noticed a change in the veteran's personality and behavior during the time that he worked with him. Statement furnished by the veteran concerning the stressful events he experienced in service along with a copy of his service personnel records and other documents developed in connection with his appeal were forwarded to the Commandant of the Marine Corps, in Quantico, Virginia in January 2002. A response from that organization later in January 2002, was to the effect that the information provided by the veteran was insufficient for purposes of conducting a meaningful research of his alleged stressors. In order to research, the incidents must be reported and documented. Service Connection Under the applicable criteria, service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war. 38 U.S.C.A. § 1110 (West 1991). In adjudicating a claim for service connection for PTSD, the Board is required to evaluate the supporting evidence in light of the places, types, and circumstances of service, as evidenced by the veteran's military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f) (2002); see also Hayes v. Brown, 5 Vet. App. 60, 66 (1993). In June 1999, revised regulations concerning post traumatic stress disorder were published in the Federal Register which reflected the decision in Cohen v. Brown, 10 Vet. App. 128 (1997). The regulations were made effective from the date of the Cohen decision. The regulations provide as follows: (f) Post-traumatic stress disorder. Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with Sec. 4.125(a) of this chapter; 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 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 clamed 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. If the evidence establishes that the veteran was a prisoner-of-war under the provisions of Sec. 3.1(y) of this part and the claimed stressor is related to that prisoner-of-war experience, 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) (as in effect prior to March 7, 2002). An additional amendment to 38 C.F.R. § 3.304(f) was enacted, effective from March 7, 2002. The regulatory changes were primarily directed at claims involving service connection for PTSD due to personal assault. The changes in the regulation pertaining to PTSD, as pertinent to this claim, were not substantive in nature. Furthermore, the provision was substantially complied with in the actions of the RO following the manual provisions. As such, the veteran would not be prejudiced by the Board completing appellate action at this time. The revised regulations provide as follows: (f) Post-traumatic stress disorder. Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with Sec. 4.125(a) of this chapter; 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. Although service connection may be established based on other in-service stressors, the following provisions apply for specified in-service stressors as set forth below: (1) If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that 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. (2) If the evidence establishes that the veteran was a prisoner-of-war under the provisions of Sec. 3.1(y) of this part and the claimed stressor is related to that prisoner-of-war experience, 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. (3) If a post-traumatic stress disorder claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. VA will not deny a post- traumatic stress disorder claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f) (effective from March 7, 2002). Where the claimed stressor is not related to combat, "credible supporting evidence" is required and "the appellant's testimony, by itself, cannot as a matter of law, establish the occurrence of a noncombat stressor." See Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). The requisite additional evidence may be obtained from sources other than the veteran's service records. See Moreau v. Brown, 9 Vet. App. 389, 395 (1996), aff'd, 124 F.3d 228 (Fed. Cir. 1997) (table). In Cohen v. Brown, 10 Vet. App. 128 (1997), the United States Court of Appeals for Veterans Claims (hereinafter, "the Court") clarified the analysis to be followed in adjudicating a claim for service connection for PTSD. The Court pointed out that the VA has adopted the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) in amending 38 C.F.R. §§ 4.125 and 4.126. See 61 Fed. Reg. 52695-52702 (1996). Therefore, the Court took judicial notice of the effect of the shift in diagnostic criteria. The major effect is that the criteria have changed from an objective ("would evoke ... in almost anyone") standard in assessing whether a stressor is sufficient to trigger PTSD, to a subjective standard. The criteria now require exposure to a traumatic event and response involving intense fear, helplessness, or horror. The question of whether a claimed stressor was severe enough to cause PTSD in a particular individual is now a clinical determination for the examining mental health professional. See Cohen, supra. Nothing in Cohen, however, negates the need for a noncombat veteran to produce credible corroborating and supporting evidence of any claimed stressor used in supporting a diagnosis of PTSD. Id.; Moreau v. Brown, 9 Vet. App. 389, 395 (1996). The corroboration may be by service records or other satisfactory evidence. See Doran v. Brown, 6 Vet. App. 283, 289 (1994). In Doran, a veteran's service records had been lost due to fire; however, his account of in-service stressors was corroborated by statements from fellow servicemen. Analysis The veteran contends that he has incurred PTSD as a result of both combat and noncombat experiences during service. Specifically, the veteran contends that he was involved in combat action as a radio operator. The veteran asserts that he was TAD with various front line units as a forward observer, and that he called in air strikes on enemy positions. The veteran reported that he saw dead bodies of U.S. soldiers stacked in piles and not in body bags, and that he was the radio man in a command truck which picked up bodies from frontline aid stations and delivered them to the rear. The veteran also reported seeing an American jet explode during training. Lastly, the veteran asserts that he was assaulted and raped by an unknown assailant at a YMCA in North Carolina where he was temporarily billeted prior to his induction physical in December 1952. It is from this last incident that the veteran now experiences flashbacks, intrusive thoughts, and other symptoms related to PTSD. After carefully considering the evidence of record in light of the above criteria, the Board finds that the evidence does not support a finding of service connection for PTSD, based on his claim of combat or on the basis of a personal assault. There is no objective evidence to show that the veteran engaged in combat with the enemy during his period of active service. His service personnel records show that he was assigned to a communications battalion while in the Far East, and that his principal duty assignment was that of a radio operator. The veteran was never classified as a forward observer, as he claims to have been when he saw combat action. While the veteran asserts that he called in air strikes on enemy targets, that he was assigned to a command truck as a radio operator which, while not moving behind enemy lines, transported dead soldiers from aid stations to the rear, and that he also served with an ANGLICO unit which, is not confirmed by the record. His service personnel records show that he only arrived in Far East at the very end of the Korean Conflict. It is rather unlikely that, as a radio operator with no combat experience and no time in country, the veteran would be assigned, even temporarily, as a forward observer calling in air strikes for not only U.S. Forces, but for artillery units from other UN Nations participating in the Conflict. (See T p.9). Furthermore, while not essential to his claim of having seen combat action, the Board finds it interesting that that the veteran failed to qualify on the M-1 rifle, the primary weapon used by U.S. ground forces in Korea, at the time he departed for the Far East in April 1954. In any event, the service personnel records appear complete and show all of the veteran's various duty assignments during his 3 years of military service right down to being detailed to mess duty (several times), sick call, and leave. The records show only two TAD assignments, both, which were to Camp Nara, Japan. The veteran's assertion that not all of his duty assignments were recorded in his service personnel records is without merit, and he has offered no persuasive explanation for the claimed discrepancy in his records. While the veteran claims to have been in combat, to have seen dead soldiers stacked atop one another, that he transported the dead to rear holding areas, and that he lost several friends in Korea, events which would be distressing to almost anyone, the veteran reported on VA examination in November 1998, that he had no "especially traumatic recollections" of his experiences in Korea. In fact, at the personal hearing the veteran testified that his experiences in Korea were not so significant that they, alone, would have triggered or caused his current psychiatric problems. Furthermore, while the veteran described the "combat" events as having occurred in the presence of others, he has not been able to remember the name of a single person who could verify any of the incidents. The only name he could recall was a Lt. [redacted], who he identified as having been his Commanding Officer (CO) in Korea. The veteran's personnel records do not show an officer of any rank named [redacted] who was listed as his CO, at least not for evaluation purposes. The Board points out that an attempt was made by the RO to obtain independent verification of the stressor incidents from the Commandant of the Marine Corps in Quantico, Virginia. However, that agency indicated that the information provided by the veteran was insufficient to conduct any meaningful research of his claimed stressors. Without specific information from the veteran as to the dates, places, battles, or names of individuals involved, further attempts to verify his claimed combat stressors is not possible. There is no evidence of record that verifies that the veteran was exposed to situations involving combat with the enemy nor was he awarded any medals for valor. Since he did not engage in combat with the enemy, his bare allegations of service stressors are insufficient; the stressors must be corroborated by official service records or other credible supporting evidence. Zarycki v. Brown, 6 Vet. App. 91 (1993); Doran v. Brown, 6 Vet. App. 283 (1994). While the evidence of record includes a diagnosis of PTSD by VA examiners, the diagnoses were based entirely on the veteran's self-described history of events in service. However, the objective evidence of record does not show that the veteran was involved in any of the reported combat incidents that may have led or otherwise contributed to the diagnosis of PTSD. The Board is not bound to accept a diagnosis based solely on an unsubstantiated history as provided by the veteran. Wood v. Derwinski, 1 Vet. App. 190 (1990). Personal Assault The Board notes that, in Patton v. West, 12 Vet. App. 272 (1999), the Court held that special consideration must be given to claims for PTSD based on sexual assault. In particular, the Court held that the provisions in M21-1, Part III, 5.14(c), which address PTSD claims based on personal assault are substantive rules which are the equivalent of VA regulations and must be considered. See also YR v. West, 11 Vet. App. 393, 398-99 (1998). Paragraph 5.14c states that, in cases of sexual assault, development to alternate sources for information is critical. There is provided an extensive list of alternative sources competent to provide credible evidence that may support the conclusion that the event occurred, to include medical records, military or civilian police reports, reports from crisis intervention centers, testimonial statements from confidants, and copies of personal diaries or journals. See M21-1, Part III, 5.14(c)(8). Also in Patton, the Court qualified prior statements contained in other Court decisions indicating that "something more than medical nexus evidence is required to fulfill the requirement for 'credible supporting evidence'," and that "[a]n opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of the stressor." The Court stated that these quoted categorical statements were made in the context of discussing PTSD diagnoses other than those arising from personal assault. See Cohen, supra; Moreau, 9 Vet. App. 389 (1996). To that extent, the Court found that the above categorical statements in Cohen and Moreau, and other cases where that may have been in accordance, are not operative. In addition, the Court noted that in two places MANUAL M21-1, Part III, 5.14 appeared improperly to require that the existence of an in-service stressor be shown by "the preponderance of the evidence." The Court clearly stated that any such requirement would be inconsistent with the benefit of the doubt doctrine which is applicable where the evidence is in equipoise. Patton, 12 Vet. App. at 280. In this case, the veteran testified that he never reported the sexual assault incident to anyone during service or until 1998, some 43 years after his discharge from military service. Consequently, there are no formal records of the claimed incident, such as a police report, which could be obtained. The veteran was notified by VA in a letter dated in September 2001, that he could obtain alternative sources of information to support his claim, including "buddy" certificates or affidavits, letters written to loved ones or friends during service, or employment records. The evidentiary record includes statements from his current (third) wife, his son, and two friends. However, none of these people knew the veteran when he was in the service or until many years after his discharge from service. Furthermore, these people were not even aware of his claimed sexual assault until recently. While his wife and a neighbor/social worker now believe that the veteran's behavioral changes over the years were due to a sexual assault in service, they are unable to provide any probative information which would help to corroborate the claimed event. The Board also notes that the veteran has not cited any alternative sources of evidence which could provide such corroboration. Therefore, a remand of this issue for additional development is not warranted. See Winters v. West, 12 Vet. App. 203 (1999) (en banc); Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994); MANUAL M21-1, Part III, 5.14(c). Lastly, the Board notes that while a diagnosis of mild PTSD was offered on VA examination in December 1998, the clinical psychologist stated that his diagnosis was based entirely on the premise of giving the veteran the benefit of doubt. The examiner noted in detail, the inconsistencies in the veteran's responses to a battery of psychological tests. Even on the most simplest of tests for malingering, which the examiner pointed out, should be easily passed by a relatively intact, non-organically impaired subject as in the case of the veteran, his scores fell into the range of functioning normally seen in a person who required a locked ward environment to protect them due to their grossly impaired judgment, memory, and intellect. Overall, the psychometric tests did not support the diagnosis of PTSD. The Court has held on a number of occasions that a medical opinion premised upon an unsubstantiated account of a claimant is of no probative value. See, e.g., Swann v. Brown, 5 Vet. App. 229, 233 (1993) [generally observing that a medical opinion premised upon an unsubstantiated account is of no probative value, and does not serve to verify the occurrences described]; Reonal v. Brown, 5 Vet. App. 458, 461 (1993) [the Board is not bound to accept a physician's opinion when it is based exclusively on the recitations of a claimant]. The existence of a valid service stressor is a factual question for VA adjudicators, based on an assessment of the credibility and probative weight of all the evidence. The Board is not bound to accept the veteran's uncorroborated accounts of alleged stressors during service, nor is the Board required to accept the unsubstantiated opinions of psychiatrists that alleged PTSD had its origins in service. This is particularly true where there has been a considerable passage of time between punitive stressful events recounted by a veteran and the onset of alleged PTSD. Wood v. Derwinski, 1 Vet. App. 190, 192 (1991), reconsidered, 1 Vet. App. 406 (1991). In the absence of a verified stressor, the diagnosis of PTSD is not sufficient to support the claim. An opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of the stressor. See Cohen 10 Vet. App. at 145 (citing Moreau v. Brown, 9 Vet. App. 389, 394-95 (1996)). The only exception to this rule, namely an opinion pursuant to MANUAL M21-1, Part III, 5.14(c) that a personal assault occurred in service based on the presence of behavior changes at the time of the claimed incident, is not applicable as there is no evidence of such behavioral changes. The veteran's service personnel records show that his proficiency and conduct ratings during service were all evaluated at an above average level. Inasmuch as there is no credible supporting evidence to corroborate the occurrence of the alleged combat and non-combat (sexual assault) stressors, the veteran's claim is denied. ORDER Service connection for PTSD is denied. MICHAEL D. LYON Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.