92 Decision Citation: BVA 92-05466 Y92 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 90-41 666 ) DATE ) ) ) THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder. 2. Entitlement to an increased evaluation for residuals of second degree burns of the left arm, forearm, hand and axilla, currently evaluated at 10 percent. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD Raymond F. Ferner, Counsel INTRODUCTION This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from the Department of Veterans Affairs (VA) Regional Office in Louisville, Kentucky (RO). The veteran had active service from July 1966 to July 1968. A January 1990 rating decision denied service connection for post-traumatic stress disorder (PTSD) and for an increased evaluation for the veteran's left upper extremity second degree burn residuals. A notice of disagreement was received in May 1990, and a statement of the case issued in June 1990. A VA Form 1-9 (Appeal to Board of Veterans' Appeals) was received in July 1990. The RO certified the issues on appeal and the case was received at the BVA in August 1990. The case was referred to the veteran's representative from the Paralyzed Veterans of America, Inc., and additional written argument was presented to the Board in November 1990. By a decision dated in April 1991, the BVA remanded this case for further development. Following that development, the RO issued a supplemental statement of the case in October 1991. The RO recertified the issues on appeal in December 1991, and the case was again received at the BVA in January 1992. The veteran's representative presented further additional written argument to the Board in January 1992. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that the RO was incorrect in not granting service connection for PTSD and in not granting a higher evaluation for his service-connected burn residuals. He maintains, in substance, that he has PTSD due to his experiences in Vietnam, and more particularly, the burn he sustained while in Vietnam and his subsequent hospital treatment. It was related that his burn was incurred when he was running across a compound which he believed was under attack, and that following his injury he was hospitalized and observed mutilated bodies and dying servicemen. He asserts that he is reminded of his Vietnam experiences and subsequent hospital stay on a daily basis due to the presence of his burn residuals. With respect to his left arm burn residuals, the veteran contends, in substance, that the current evaluation assigned to that disability does not accurately reflect the severity of that disability. He asserts that there is definitely worsening of the arm movement and that there are times he has had to leave his job because of pain and trauma in his arm. It has been requested that this case be remanded to afford the veteran a thorough VA examination, noting that it appeared obvious that the areas involved would approximate 2 square feet and, although the areas were not separated, it was believed that the criteria should be applied as for separate scars as provided in M21-1, par. 50.32. DECISION OF THE BOARD For the reasons and bases to be explained, it is the decision of the Board that the record supports the claim for service connection for PTSD, but does not support the claim for an evaluation in excess of 10 percent for residuals of second degree burns of the left arm, forearm, hand and axilla. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Resolving reasonable doubt in the veteran's favor, the veteran is shown to have been exposed to a recognizable stressor to support the current diagnosis of PTSD. 3. The veteran's left upper extremity second degree burn residuals involve an area approximating 1 square foot, and do not involve widely separated areas, as on two or more extremities or on anterior and posterior surfaces of extremities or trunk. CONCLUSIONS OF LAW 1. Post-traumatic stress disorder was incurred during service. 38 U.S.C. §§ 1110, 5107 (1989) (formerly §§ 310, 3007, recodified in 1991). 2. The schedular criteria for an evaluation in excess of 10 percent for residuals of second degree burns of the left arm, forearm, hand and axilla have not been met. 38 U.S.C. §§ 1155, 5107 (1989) (formerly §§ 355, 3007, recodified in 1991); 38 C.F.R. §§ 4.7, 4.48, 4.118, Diagnostic Code 7802 (1990). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a preliminary matter, we find that the veteran's claims are "well grounded" within the meaning of 38 U.S.C. § 5107(a) (1989). That is, we find that he has presented claims which are not implausible, when the veteran's contentions and the evidence of record are viewed in the light most favorable to that claim. We are also satisfied that all relevant facts have been properly and sufficiently developed. While we acknowledge that the veteran's representative has requested this case be remanded to afford the veteran another examination of his left upper extremity burn residuals, we are satisfied that the record contains sufficient evidence with respect to the size and location of the areas involved, as well as the functional limitations of the left upper extremity, for purposes of this appeal. In this regard, there are for consideration a series of VA examinations beginning in 1968, as well as private medical evidence submitted by the veteran in connection with his current claim and a recent VA examination. Therefore, we are of the opinion that no further development is necessary to comply with the duty to assist the veteran mandated by 38 U.S.C. § 5107(a). With respect to the veteran's claim for service connection for PTSD, our review of the record discloses that the veteran served in Vietnam for 16 days in July and August 1967 when he sustained second degree burns to his left upper extremity and was subsequently evacuated for medical treatment. The veteran's participation in combat has not been alleged; however, it has been suggested that the veteran's base was under attack when he sustained his left upper extremity burns. The record also suggests that his base was not under attack when he sustained the burns. In any event, it is the actual incurrence of the burn, and the veteran's subsequent hospital treatment, which are claimed to provide the stressor to support the diagnosis of PTSD. The RO has denied the veteran's claim based on the lack of a recognizable stressor. In this regard, the criteria generally utilized are contained in American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (1987) (DSM-III-R). The criteria for a stressor are that: The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e.g., serious threat to one's life or physical integrity; serious threat or harm to one's children, spouse, or other close relatives and friends; sudden destruction of one's home or community; or seeing another person who has recently been, or is being, seriously injured or killed as a result of an accident or physical violence. In this case, the purpose of the prior remand was for an examination by a board of two psychiatrists specifically to assess whether the stressors reported by the veteran were adequate for a diagnosis of post-traumatic stress disorder. Since that question was answered in the affirmative, we therefore conclude, without further comment, that service connection for PTSD has been established. As for the evaluation for the veteran's left upper extremity second degree burn residuals, 38 C.F.R. § 4.118, Diagnostic Code 7802, indicates that a 10 percent evaluation is warranted for an "area or areas approximating 1 square foot (0.1 m.2)" or for widely separate areas. See also M21-1, par. 50.32. Diagnostic Code 7805 would also permit the disability to be rated on the limitation of the function of the left arm. However, VA examinations performed in 1968, 1973, 1980 and 1986 all demonstrate that the area of the veteran's left arm approximates 1 square foot, does not involve the entire surface of the arm, and has not caused any limitation of left arm function. A private medical record dated in September 1989 described "scaling slightly erythematous skin primarily in the anticubital fossa on the left and on the volar aspect of the forearm, adequate ROM [range of motion] of the fingers is noted, adequate ROM of the wrist." Another private medical statement dated in September 1989 reports that "he has medial upper scar formation beginning just distal to the axilla and extending to the mid forearm area. The skin along the medial arm in the area demonstrates scarring within the elbow and although full extension is permitted, skin does tighten appreciably." Similarly, a VA examination performed in 1989 revealed a full range of motion of the upper extremities with minimal scar formation of the medial surface of the left forearm and upper arm with a small patch in the left axilla. The scar areas were hyperesthetic and tender to palpation. Based on this evidence, we conclude that the currently assigned 10 percent evaluation most nearly approximates the veteran's overall disability picture, and that the schedular criteria for a higher evaluation under the Schedule for Rating Disabilities have not been met. 38 C.F.R. § 4.7; M21-1, par. 50.32. ORDER Service connection for PTSD is granted. An evaluation in excess of 10 percent for residuals of second degree burns of the left arm, forearm, hand and axilla is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 WARREN W. RICE, JR. ROBERT D. PHILIPP FRANCIS F. TALBOT (CONTINUED ON NEXT PAGE) NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C. § 7266 (1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a notice of disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.