BVA9404208 DOCKET NO. 91-46 961 ) DATE ) ) ) THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder. 2. Entitlement to service connection for the residuals of frozen hands and feet. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD M. L. Schwartz, Associate Counsel INTRODUCTION This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of June 1991, from the Nashville, Tennessee, regional office (RO). The notice of disagreement was received in July 1991. The statement of the case was issued in August 1991. The substantive appeal was received in September 1991. The appeal was transferred to the Board which entered a remand determination in May 1992. After completion of the requested action, the RO issued supplemental statements of the case in April 1993 and August 1993. The case was then returned to the Board on October 15, 1993, and docketed on October 20, 1993. The appellant is represented by the Veterans of Foreign Wars of the United States in this matter, which provided additional written argument to the Board dated in October 1993. The veteran had active military service in the United States Marine Corps from August 1951 to August 1953. He was awarded the Korean Service Medal and the United Nations Service Medal. This case is now ready for final appellate consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has been diagnosed with post-traumatic stress disorder which he avers developed as a consequence of his exposure to life-threatening and traumatic combat stressors during his service in Korea. He also contends that he suffered frostbite of the hands and feet during this service, noting that he continues to have residual disability associated with this condition. Accordingly, he asserts that service connection is warranted for post-traumatic stress disorder and frostbite residuals of the hands and feet. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. The Board has determined that only those items listed in the "Certified List" attached to this decision and incorporated by reference herein are relevant evidence in the consideration of the veteran's claim. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against each of the veteran's claims in this matter. FINDINGS OF FACT 1. A well-grounded claim has been presented, and the duty to develop has been satisfied. 2. Psychiatric symptomatology was not present during service, nor at all proximate to service. 3. Post-traumatic stress disorder was first clinically demonstrated many years after service, and cannot be causally related to life threatening stressors, given the absence of verified stressors during active military service. 4. Symptomatology suggestive of frostbite of the hands and feet was not present during service, nor at the time of discharge. 5. Frostbite residuals were first clinically demonstrated many years after service and cannot be causally related to the veteran's military service. CONCLUSIONS OF LAW 1. Post-traumatic stress disorder was not incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303. 2. The residuals of frostbite of the hands and feet were not incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is well-grounded because he has presented a claim which is plausible. We are also satisfied that no further development is required. The RO has completed the action requested by the Board in the May 1992 remand, including the development of supportive evidence of combat stressors as required by the Court of Veterans' Appeals in Wood v. Derwinski, 1 Vet.App. 190 (1991), as set forth in the Department of Veterans Affairs Adjudication Procedure Manual, M21-1. Accordingly, we find that the evidence of record is adequate for the purpose of the instant adjudication, and that no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107 (West 1991). 1. Entitlement to service connection for post-traumatic stress disorder. In order to establish service connection for post-traumatic stress disorder, it must be shown that the disorder was incurred in or aggravated by service. As a threshold consideration, this requires evidence which demonstrates that the veteran does, in fact, have post-traumatic stress disorder. Once this is established, it must then be shown that this disorder developed as a the result of "stressors" encountered during active military service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303. The veteran's service medical records fail to reveal even a single instance of psychiatric symptomatology, and he reported no psychiatric difficulties at the time of his discharge examination in August 1953. The post-service clinical record is devoid of any indication of treatment for psychiatric problems until the late 1980's, when Department of Veterans Affairs (VA) medical records show complaints of anxiety. Thereafter, outpatient records show that the veteran was a frequent participant in the "Korean War Veterans Group" "Post- traumatic Stress Program," from 1991 to 1993, and reports of VA psychiatric evaluations dated in April 1991, September 1992, and January 1993, each reflect a diagnosis of post-traumatic stress disorder. Based on the above clinical evidence, it is clear that the veteran has met the threshold requirement in this case by demonstrating that he does, in fact, have a diagnosis of post-traumatic stress disorder. However, as to the second element which must be established, namely that "stressors" encountered during active military service are responsible for the development of the currently diagnosed post- traumatic stress disorder, we find that the evidence preponderates against this aspect of the claim, so that this petition ultimately fails. The veteran has submitted into evidence several written statements identifying his unit and describing "heavy" combat experiences while serving in Korea, noting that he had seen many killed, and that he himself had killed many of the enemy. In particular, he stated that he had participated in the "Battle of the Hook," where a close friend, whom he named, was killed in his presence. He also submitted into evidence a "buddy statement," from [redacted], dated in July 1991, who indicated that the veteran's unit had come under attack by the Chinese, and was over-run, noting that he and the veteran went on "many" combat patrols together, experiencing artillery and mortar fire. However, he did not indicate that he observed that the veteran was actually engaged in direct combat involving the witnessing of killing, or that the veteran had killed many enemy soldiers. He did not describe the veteran's alleged witnessing of the death of his friend, nor did he indicate that the veteran's unit was engaged in the Battle of the Hook. Pursuant to the Board's May 1992 remand, the RO twice contacted the Records Correspondence Section of the Personnel Management Support Branch of the Department of the Navy (Headquarters United States Marine Corps), and requested verification of the "stressors" alleged by the veteran, supplying pertinent identifying information. In its July 1993 response to the second inquiry, the above records section was unable to recover a record of the veteran's deceased friend, noting that there was insufficient information because the veteran was unable to provide the full name of his friend who was killed, as well as the unit and specific date of the incident. Additionally, this response also revealed that the veteran's unit had not been involved in the Battle of the Hook, and also that [redacted] was not a member of the veteran's unit. However, as to the last item, we note that Mr. [redacted]'s statement acknowledges this, explaining that his unit was attached to the veteran's during the time of the events he was describing in his statement. However, in neither of the responses to the RO's request for information, dated in April 1993 and July 1993, did the above records section indicate that the veteran's unit was engaged in any sort of combat, including "combat patrols" during the time the veteran was assigned to that unit in Korea. Moreover, we note that the veteran was awarded the Korean Service Medal and the United Nations Service Medal, signifying only that he served in Korea during the Korean Conflict, but his service records show that he was not awarded a ribbon or medal signifying that he was involved in a combat situation during the time of this service. Accordingly, given the lack of verification of the combat stressors alleged by the veteran, we cannot, as a matter of law, associate the currently diagnosed post-traumatic stress disorder with his active military service in Korea. We are compelled in this determination by the lack of any supportive evidence to corroborate the veteran's allegations regarding combat experience, as well as those in the buddy statement. In particular, we find that the lack of an award of a medal or ribbon signifying involvement in combat, along with the U.S. Marine Corps' response that the veteran's unit was not involved in the Battle of the Hook, and that, in fact, no combat activity for this unit was reported in this response, to preponderate against the veteran's claim in this matter. In conclusion, we find that the preponderance of the evidence is against the veteran's claim in this matter, and that service connection for post-traumatic stress disorder is not warranted. 2. Entitlement to service connection for the residuals of frozen hands and feet. As noted above, the threshold consideration in all claims where service connection is requested for a particular disorder, is whether the veteran does, in fact, have the claimed disorder. Once a contemporary diagnosis of the claimed disorder is established, the next requirement is that the evidence must show that this disability is the result of a disease or injury that the veteran had in service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303. We find that the clinical evidence in this case demonstrates that the veteran has frostbite residuals affecting his feet and hands. In particular, the September 1992 VA examination report reveals that the veteran had paresthesia of the lateral metatarsal area bilaterally, secondary to frostbite, noted to be constant and persistent through the years. Dorsalis pedis pulses were noted to be somewhat diminished, and some loss of hair was indicated. Hyperkeratotic toenails were noted. Neurologically, sensory changes of the lateral metatarsal area of the feet secondary to frostbite with peripheral neuritis was assessed. Although the examination report does not include an assessment of the veteran's hands, the diagnostic impression was stated as frostbite of both feet and, to a lesser degree, the hands. Based on this evidence, we find that the veteran has satisfied the threshold requirement of providing evidence demonstrating that he does have a contemporary diagnosis of the claimed disorder. However, as to the second element of proof in this claim, we find that the preponderance of the evidence is against the claim that the current frostbite residuals were incurred as a result of a disease or injury during the veteran's active military service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303. The veteran's service medical records fail to reveal any complaints or treatment suggestive of frostbite of the hands or feet. Moreover, his discharge examination report, dated in August 1953, indicated that the veteran's hands and feet were assessed as "normal" and there is no indication that the veteran had any complaints of any sort regarding his hands or feet. Post-service clinical records show that the veteran was treated at VA facilities in 1953 and 1955, but neither of these reports reveal symptomatology concerning frostbite. In fact, exclusive of the September 1992 VA examination report discussed above, and a VA hospital report dated in April 1991 showing a "questionable" history of frostbite, none of the VA outpatient, hospital, or examination reports in evidence reflect treatment for frostbite. In support of this claim the veteran has also submitted into evidence a "buddy statement," dated in July 1991, which indicated that the veteran experienced temperatures of 20 to 30 degrees below zero while in Korea and that he had frostbite of the feet, noting also that it was common for service medical records not to show treatment for frostbite. Although we acknowledge that the veteran's service in Korea was during the winter, and that this alone makes his claim regarding frostbite credible, we nevertheless find that the evidence fails to demonstrate that the veteran actually did suffer from frostbite as alleged. As noted, service medical records are devoid of any reference to frostbite, and there is essentially no post-service treatment of frostbite, with the only clinical assessment of this condition seen in the September 1992 VA examination report. Although the buddy statement declares that the veteran had frostbite, we find this statement to have little probative value in this regard because it lacks a description of the veteran's feet or hands, nor any explanation of how this witness determined that the veteran had frostbite, including his own ability to "diagnose" this condition. Accordingly, this lay evidence, though credible, is not probative in establishing the veteran's claim. See Espiritu v. Derwinski, 2 Vet.App.492 (1992) (A person untrained in medicine can describe symptoms but cannot make diagnoses.) Therefore, with no evidence of inservice symptomatology, and no assessment of frostbite of the feet and hands until nearly 40 years after discharge from service, we find that service connection for the disorder in issue is not warranted. ORDER 1. Entitlement to service connection for post-traumatic stress disorder is denied. 2. Entitlement to service connection for the residuals of frozen hands and feet is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 * W. H. YEAGER, JR., M.D. JACK W. BLASINGAME *38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans' Appeals Section, upon direction of the Chairman of the Board, to proceed with the transaction of business without awaiting assignment of an additional member to the Section when the Section is composed of fewer than three Members due to absence of a Member, vacancy on the Board or inability of the Member assigned to the Section to serve on the panel. The Chairman has directed that the Section proceed with the transaction of business, including the issuance of decisions, without awaiting the assignment of a third Member. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 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.