Citation Nr: 0810059 Decision Date: 03/26/08 Archive Date: 04/09/08 DOCKET NO. 04-28 746 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for alcohol abuse disorder. 3. Entitlement to service connection for gastrointestinal disability, to include acid reflux and indigestion. 4. Entitlement to service connection for headaches. 5. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU). REPRESENTATION Appellant represented by: John S. Berry, Attorney at Law ATTORNEY FOR THE BOARD A. Cryan, Associate Counsel INTRODUCTION The veteran served on active duty from March 1969 to December 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2004 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. The veteran's case was remanded for additional development in January 2006 and March 2007. The case is again before the Board for appellate review. FINDINGS OF FACT 1. The veteran does not have PTSD attributable to military service. 2. An alcohol abuse disorder was not caused or made worse by service-connected disability. 3. The veteran does not have a gastrointestinal disorder, including acid reflux and indigestion, that is attributable to military service; a gastrointestinal disorder was not caused or made worse by service-connected disability. 4. The veteran does not have headaches that are attributable to military service; headaches were not caused or made worse by service-connected disability. 5. The veteran's service-connected disabilities do not combine to preclude substantially gainful employment. CONCLUSIONS OF LAW 1. The veteran does not have PTSD that is the result of disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125(a) (2007). 2. Primary alcohol abuse disorder is not a disability for which service connection may be granted; alcohol abuse is not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 105(a), 1101, 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.301(d), 3.303, 3.304, 3.307, 3.309, 3.310 (2007), 71 Fed. Reg. 52744-47 (Sept. 7, 2006). 3. The veteran does not have a gastrointestinal disability, to include acid reflux and indigestion, that is the result of disease or injury incurred in or aggravated by active military service; a gastrointestinal disability is not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2007); 71 Fed. Reg. 52744-47 (Sept. 7, 2006). 4. The veteran does not have headaches that are the result of disease or injury incurred in or aggravated by active military service; headaches are not proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2007); 71 Fed. Reg. 52744-47 (Sept. 7, 2006). 5. The criteria for an award of TDIU have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Background The veteran claims entitlement to service connection for PTSD, alcohol abuse disorder secondary to PTSD, a gastrointestinal disability secondary to PTSD, headaches secondary to PTSD, and TDIU. Because of the manner in which the RO developed the appeal, the Board will also consider the claims of entitlement to alcohol abuse, a gastrointestinal disability, and headaches on a direct basis. The veteran is currently service connected for tinea cruris evaluated as 10 percent disabling since March 24, 1997, diabetes mellitus type 2 evaluated as 20 percent disabling since September 11, 2003, tinnitus evaluated as 10 percent disabling since September 11, 2003, and erectile dysfunction associated with diabetes mellitus evaluated as noncompensably disabling since September 25, 2007. He has been awarded special monthly compensation in accordance with 38 U.S.C.A. § 1114(k) for loss of use of a creative organ. The veteran served on active duty from March 1969 to December 1970. Service personnel records associated with the claims file reveal that the veteran served in the Republic of Vietnam from January 1970 to December 1970. The veteran served with the 13th Quartermaster Platoon in Vietnam from January 19, 1970, to February 9, 1970. The personnel records and the veteran's DD 214 reflect that the veteran received the National Defense Service Medal, Vietnam Service Medal, and the Vietnam Campaign Medal. The veteran's military occupation specialty (MOS) was noted to be a petroleum storage specialist. The veteran's service medical records are negative for any indication of evaluation or treatment for any psychiatric disabilities, alcohol abuse, gastrointestinal disabilities, or headaches. The veteran's December 1970 separation physical examination is negative for any psychiatric, gastrointestinal, or neurological findings. Associated with the claims file are VA outpatient treatment reports dated from April 1997 to October 2007. The records reveal treatment for and diagnoses of PTSD, alcohol dependence, and gastroesophageal reflux disease (GERD). In a November 1999 letter, a VA therapist reported that the veteran was in treatment for PTSD since October 1997. She said he was exposed to a traumatic event that involved threatened injury and death. The veteran submitted a stressor statement in September 2003. He said he worked as a petroleum specialist in Vietnam. He said the pipeline required constant repairs of leaks due to enemy rockets, mortars, and other explosive devices. He reported that he was also required to shoot any debris that floated by the pumping station. He said occasionally he was required to retrieve bodies from the river. He said working on the pipeline itself was hazardous work and that he was exposed to sniper fire, enemy rockets and mortars while working on the pipeline. The veteran was afforded a general medical examination in October 2003. He was diagnosed with GERD, hiatal hernia, irritable bowel syndrome (IBS), headaches, and PTSD, among other things. The veteran was afforded a VA examination in October 2003. The veteran reported that he was driving a tanker truck in Vietnam and the truck in front of him hit a mine and exploded. He said his unit came under fire and he was responsible for pulling dead bodies out of the river. He also said on another occasion he was walking down the street past an abortion clinic and there were body parts of babies in the streets, which dogs were eating. The examiner said the veteran met the criteria for PTSD if his claimed stressors could be verified. He also reported that the veteran had alcohol abuse disorder secondary to PTSD. The veteran was afforded a VA examination in October 2003. The examiner diagnosed the veteran with GERD and a hiatal hernia. He opined that it was less likely than not that the veteran's reflux disease and hiatal hernia were secondary to his PTSD. The veteran was afforded a VA neurological examination in October 2003. The veteran was diagnosed with headaches. Also associated with the claims file is a buddy statement from B.G., a fellow soldier who served with the veteran in Vietnam. B.G. reported that he remembered a shooting on the Saigon River and he said the pipeline exploded. He said he served in 1970 in Tonsonut with the Quartermaster Unit. Several lay statements from the veteran's ex-spouse, mother, and friends received in October 2003, November 2003, and September 2004 indicated that the veteran was a changed person after he returned from Vietnam. A lay statement received in September 2004 from E.N., dated in November 1997, indicated that the veteran worked as a long-distance truck driver. She said the last time she spoke to the veteran he was in great pain due to swollen arms, hands, legs, and ankles. E.N. said she believed the veteran was unable to perform any gainful employment. She concluded that the veteran applied for Social Security disability benefits in September 1996. The veteran was last afforded a VA examination in September 2007. The examiner noted that the veteran was service connected for diabetes mellitus, tinea cruris, and tinnitus. He opined that taking account of the veteran's service- connected disabilities collectively there would not likely be a significant loss of function with typical occupational duties or activities of daily living secondary to any of the veteran's disabilities separately or as a whole. The examiner concluded that the veteran's service-connected disabilities would not likely result in the inability to secure and maintain gainful employment. He noted that the veteran has significant nonservice-connected disabilities of the cervical and lumbar spine. Associated with the claims file is a response from the United States Army and Joint Services Records Research Center (JSRRC) received in September 2007. The RO requested the JSSRC to verify a pipeline explosion in January 1970 while the veteran was assigned to the 13th Quartermaster Platoon. The JSRRC reported that the Operational Report Lessons Learned (OR-LL) were reviewed for the period ending January 31, 1970. The OR-LL verified that on January 10, 1970, a section of a triple pipeline carrying JP-4 mogas and diesel was destroyed by Viet Cong saboteurs. The RO issued a formal finding of lack of information required to corroborate stressors associated with a claim for PTSD in October 2007. The RO noted that the veteran was requested to provide additional information regarding his stressors in letters dated in May 2007 and July 2007. The veteran failed to respond to either letter. Finally, the RO noted that the JSRRC verified a pipeline explosion on January 10, 1970; however the evidence of record showed that the veteran's unit was not present until January 19, 1970, nine days after the pipeline explosion. II. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2007). The chronicity provisions of 38 C.F.R. § 3.303(b) are applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service, or during an applicable presumptive period, and still has such condition. Such evidence must be medical unless it relates to a condition as to which under case law of the United States Court of Appeals for Veterans Claims (Court) lay observation is competent. If chronicity is not shown, service connection may still be established on the basis of 38 C.F.R. §3.303(b) if the condition is noted during service or during an applicable presumptive period, and if competent evidence, either medical or lay, depending on the circumstances, relates the present disability to pertinent symptomatology experienced since service. Savage v. Gober, 10 Vet. App. 488 (1997). Generally, service connection requires (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. Pond v. West, 12 Vet. App. 341, 346 (1999); accord Caluza v. Brown, 7 Vet. App. 498 (1995). A. PTSD Establishing service connection for PTSD requires that there be medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (2007); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor actually occurred. 38 C.F.R. § 3.304(f) (2007). In this case the veteran's service personnel records and service medical records do not document combat service. Furthermore, the service medical records do not document treatment for any psychiatric disorders. The only stressor the veteran reported that was capable of verification was the pipeline explosion in Vietnam. As reported above, the JSRRC reported that the OR-LL verified that on January 10, 1970, a section of a triple pipeline carrying JP-4 mogas and diesel was destroyed by Viet Cong saboteurs. However, the veteran's unit was not present until January 19, 1970, nine days after the pipeline explosion. The veteran failed to provide any further information regarding his claimed stressors. A salient point to be made is that the veteran does not have a diagnosis of PTSD specifically linked to a verified stressor. The VA outpatient treatment reports document a diagnosis of PTSD but none of the diagnoses was linked to a verified stressor. Similarly the November 1999 letter from the veteran's treating therapist at VA failed to link the PTSD diagnosis to a verified stressor. Finally, the October 2003 VA examiner also diagnosed the veteran with PTSD but specifically noted that the veteran's stressors were unconfirmed. Consequently, absent a diagnosis of PTSD linked to a verified stressor, service connection must be denied. 38 C.F.R. § 3.304(f). B. Other Service Connection Claims A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (2007). The Court has held that when aggravation of a veteran's non-service connected disability is proximately due to or the result of a service- connected disease or injury, it too shall be service connected to the extent of the aggravation. See Allen v. Brown, 7 Vet. App. 439, 446 (1995). The provisions of 38 C.F.R. § 3.310 were amended to provide that VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected one unless the baseline level of severity of the nonservice-connected disability is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disability. 71 Fed. Reg. 52744- 47 (Sept. 7, 2006). However, as will be explained below, this change does not affect the analysis in this case because the preponderance of the evidence shows that there is no relationship. Alcohol Abuse A disability incurred during active military service shall not be deemed to have been incurred in line of duty if such disability was a result of the abuse of alcohol or drugs by the person on whose service benefits are claimed. Alcohol abuse means the use of alcoholic beverages over time, or such excessive use at any one time, sufficient to cause disability to or death of the user. Drug abuse means the use of illegal drugs, the intentional use of prescriptions drugs or nonprescription drugs for a purpose other than the medically intended use, or the use of substances other than alcohol to enjoy their intoxicating effects. 38 C.F.R. § 3.301(d) (2007). See also 38 U.S.C.A. §§ 105(a), 1110 (West 2002); VAOPGCPREC 7-99 (June 9, 1999) (confirming that direct service connection for a disability that is a result of a claimant's own abuse of alcohol or drugs is precluded for claims filed after October 31, 1990). As a result, service connection for alcohol abuse on a direct basis is barred by law. The Court has held that there can be service connection for a substance abuse disorder acquired as secondary to, or as symptoms of, service-connected disability. Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). In this case, the veteran claimed service connection for alcohol abuse disorder as secondary to PTSD. Although claimants can be service connected for alcohol and drug abuse on a secondary basis pursuant to 38 C.F.R. § 3.310(a) for purposes of VA benefits other than compensation, as noted above, a grant of service connection for PTSD is not warranted. Consequently, because his alcohol abuse disorder has not been linked to any other service-connected disabilities, he cannot obtain service connection for alcohol abuse under the provisions of section 3.310(a). As there is no other legal vehicle whereby he can now obtain service connection, his claim must be denied. Gastrointestinal Disability The medical evidence reveals a diagnosis of IBS and GERD. However, there is no showing of a relationship to the veteran's period of military service. The veteran's service medical records did not document any evidence of treatment for a gastrointestinal disorder and the veteran was not diagnosed with a gastrointestinal disability at his discharge from service. None of the treatment records associated with the claims file includes an opinion linking any current gastrointestinal disorder to the veteran's period of service. In short, there is no competent evidence of a gastrointestinal disability during service, and no competent evidence linking any current gastrointestinal disorder to service. In fact, the veteran has contended that a gastrointestinal disability is due to PTSD, not directly traceable to service. As noted in the analysis above, service connection for PTSD is not warranted and consequently service connection for a gastrointestinal disorder secondary to PTSD is consequently not warranted. The preponderance of the evidence is against the claim. Headaches The medical evidence reveals a diagnosis of headaches. However, there is no showing of a relationship to the veteran's period of military service. The veteran's service medical records did not document any evidence of treatment for headaches and the veteran was not diagnosed with a headache disorder at his discharge from service. None of the treatment records associated with the claims file includes an opinion linking any current headache disorder to the veteran's period of service. In short, there is no competent evidence of headaches during service, and no competent evidence linking any current headache disorder to service. As with the gastrointestinal disability claim, the veteran's contention is that his headaches are due to PTSD, not directly attributable to military service. As noted in the analysis above, service connection for PTSD is not warranted and consequently service connection for headaches secondary to PTSD is consequently not warranted. The preponderance of the evidence is against the claim. III. TDIU The veteran has claimed that his service-connected disabilities render him unemployable. Total disability is considered to exist when there is any impairment that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1) (2007). Total ratings are authorized for any disability or combination of disabilities for which the VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4, prescribes a 100 percent evaluation. 38 C.F.R. § 3.340(a)(2). The law also provides that a total disability rating based on individual unemployability due to service-connected disability may be assigned where the veteran is rated at 60 percent or more for a single service-connected disability, or rated at 70 percent for two or more service-connected disabilities and at least one disability is rated at least at 40 percent, and when the disabled person is unable to secure or follow a substantially gainful occupation as a result of the service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). Factors to be considered are the veteran's education and employment history and loss of work-related functions due to pain. Ferraro v. Derwinski, 1 Vet. App. 326, 330, 332 (1991). Individual unemployability must be determined without regard to any non-service-connected disabilities or the veteran's advancing age. 38 C.F.R. § 3.341(a); see 38 C.F.R. § 4.19 (2007) (age may not be a factor in evaluating service- connected disability or unemployability); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Here, the veteran is currently service connected for tinea cruris evaluated as 10 percent disabling, type II diabetes mellitus evaluated as 20 percent disabling, tinnitus evaluated as 10 percent disabling, and erectile dysfunction associated with diabetes mellitus evaluated as noncompensably disabling. He is in receipt of special monthly compensation on account of loss of use of a creative organ. The combined level of the veteran's service-connected disabilities is 40 percent. Thus, with the veteran's highest rated service- connected disability, rated at 20 percent, and the combined disabilities evaluated as 40 percent, award of TDIU can not be predicated on disability percentages under 38 C.F.R. § 4.16(a). It is also the policy of the VA, however, that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b). Where the veteran fails to meet the applicable percentage standards enunciated in 38 C.F.R. § 4.16(a), an extra-schedular rating is for consideration where the veteran is unemployable due to service-connected disability. 38 C.F.R. § 4.16(b); see also Fanning v. Brown, 4 Vet. App. 225 (1993). Thus, the Board must evaluate whether there are circumstances in the veteran's case, apart from any non-service connected conditions and advancing age, which would justify a total rating, based on unemployability. Van Hoose, 4 Vet. App. at 363; see also Hodges v. Brown, 5 Vet. App. 375 (1993); Blackburn v. Brown, 4 Vet. App. 395 (1993). The fact that a veteran may be unemployed or has difficulty obtaining employment is not determinative. The ultimate question is whether the veteran, because of service-connected disabilities, is incapable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose, supra. Moreover, as already noted, an inability to work due to non-service-connected disabilities or age may not be considered. 38 C.F.R. §§ 4.14, 4.19. In making its determination, VA considers such factors as the extent of the service-connected disabilities, and employment and educational background. 38 C.F.R. §§ 3.321(b), 3.340, 3.341, 4.16(b), 4.19. Here, the preponderance of the evidence of record is that the veteran is not unemployable due to his service-connected disabilities. The September 2007 VA examiner opined that taking account of the veteran's service-connected disabilities collectively there would not likely be a significant loss of function with typical occupational duties or activities of daily living secondary to any of the veteran's disabilities separately or as a whole. The examiner concluded that the veteran's service-connected disabilities would not likely result in the inability to secure and maintain gainful employment. He noted that the veteran has significant nonservice-connected disabilities of the cervical and lumbar spine. The Board recognizes that the veteran may have been awarded Social Security Administration (SSA) disability benefits, but notes that the laws and regulations governing award of SSA benefits are not the same as those governing award of VA benefits. The receipt of SSA benefits based on a combination of all disabilities, service-connected and nonservice- connected alike, is not determinative. In light of the foregoing, the Board finds that award of individual unemployability by reason of service-connected disability is not warranted, including on an extra-schedular basis. The Board has considered the doctrine of reasonable doubt, but finds that the record does not provide an approximate balance of negative and positive evidence on the merits. The Board is unable to identify a reasonable basis for granting service connection for PTSD, alcohol abuse disorder, a gastrointestinal disorder, or headaches, or for granting TDIU. Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2007). The Board notes that the veteran has alleged that he has PTSD, alcohol abuse disorder, a gastrointestinal disorder, and headaches that are related, directly or indirectly, to his military service. He also asserts that he can not work because of service-connected disability. While the veteran is capable of providing information regarding his symptoms, as a layperson, he is not qualified to offer medical opinions. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). IV. Veteran's Claims Assistance Act of 2000 In deciding the issues in this case, the Board has considered the applicability of the Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2007). The Board has also considered the implementing regulations. 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Under 38 U.S.C.A. § 5103, the Secretary is required to provide certain notices when in receipt of a complete or substantially complete application. The purpose of the first notice is to advise the claimant of any information, or any medical or lay evidence not previously provided to the Secretary that is necessary to substantiate the claim. The Secretary is to advise the claimant of the information and evidence that is to be provided by the claimant and that which is to be provided by the Secretary. 38 U.S.C.A. § 5103(a) (West 2002). In addition, 38 C.F.R. § 3.159(b), details the procedures by which VA will carry out its duty to notify. The RO notified the veteran of the evidence/information required to substantiate his claims in September 2003. He was informed of the elements to satisfy in order to establish service connection. He was advised to submit any evidence he had to show that he had current disabilities and to identify sources of evidence/information that he wanted the RO to obtain on his behalf. The RO also notified the veteran of the evidence/information required to substantiate his claim for TDIU in October 2003. In reviewing the requirements regarding notice found at 38 U.S.C.A. § 5103 and 38 C.F.R. § 3.159(b), the Board cannot find any absence of notice in this case. As reviewed above, the veteran has been provided notice regarding the type of evidence needed to substantiate his claim, what VA would do to assist, and what was expected of him, including the presentation of all pertinent evidence he was aware of. In summary, the Board finds that no additional notice is required under the provisions of 38 U.S.C.A. § 5103 as enacted by the VCAA and 38 C.F.R. § 3.159(b). See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Additionally, by way of a March 2006 letter, the veteran was told of the criteria used to award disability ratings and the criteria for assigning an effective date. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Because neither issue is before the Board, further action with respect to either is not required. The record also indicates that the veteran may be receiving Social Security disability benefits; however, the duty to obtain records only applies to records that are "relevant" to the claim. See 38 U.S.C.A. § 5103A(b)(1); see also Counts v. Brown, 6 Vet. App. 473, 476 (1994) (citing the Federal Rule of Evidence 401 defining "relevant evidence" as "evidence having any tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence."). The lay statement from E.N. indicated that the veteran was in great pain due to swollen arms, hands, legs, and ankles. She said that the veteran applied for Social Security disability benefits in September 1996. It is not clear whether the veteran is in receipt of any Social Security benefits. Furthermore, the veteran has not suggested that any such records would show that his currently claimed disabilities were traceable to his military service or that they relate to the effects of his service-connected disabilities. There is no indication that the records would be relevant to these claims. Remanding the case to obtain such records would serve no useful purpose. Regarding VA's duty to assist under 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c)(1)-(3), the Board notes that the RO has obtained service medical records, private treatment reports, and VA treatment reports. The veteran was afforded several VA examinations. As for whether further action should have been undertaken by way of obtaining additional medical opinion on the question of whether any gastrointestinal disability or headaches are traceable to military service, the Board notes that such development is to be considered necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but contains: 1) competent evidence of diagnosed disability or symptoms of disability, 2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and 3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4) (2007). In this case, the veteran has had post- service treatment for his claimed disabilities, but there is no indication, except by way of unsupported allegation, that any gastrointestinal disability or headaches are traceable to military service. Consequently, given the standard of the regulation, the Board finds that VA did not have a duty to assist that was unmet. ORDER Entitlement to service connection for PTSD is denied. Entitlement to service connection for alcohol abuse disorder is denied. Entitlement to service connection for gastrointestinal disability, to include acid reflux and indigestion, is denied. Entitlement to service connection for headaches is denied. Entitlement to a total rating based on individual unemployability due to service-connected disability is denied. ________________________________ MARK F. HALSEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs