BVA9408003 DOCKET NO. 93-09 783 ) DATE ) ) ) THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (hereinafter PTSD). 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for fibroma of the dorsal spine. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL Appellant, appellant's friend ATTORNEY FOR THE BOARD T. S. Kelly, Associate Counsel INTRODUCTION The veteran had active military service from July 1966 to April 1968. This appeal arises from a March 1990 rating determination of the Los Angeles, California, Regional Office (hereinafter, RO) which denied service connection for PTSD, a dorsal spine fibroma, hypertension and obesity, and granted service connection for a right hand laceration scar, which was assigned a noncompensable disability rating. In February 1991, the veteran filed a notice of disagreement for the issues of PTSD, hypertension and fibroma of the dorsal spine. The veteran appears to have raised the issue of entitlement to service connection for blood poisoning in a November 1991 letter. As this matter is not before the Board, it is referred to the RO for further development. In accordance with the provisions of Thurber v. Brown, 5 Vet.App. 119 (1993), the Disabled American Veterans was provided with a copy of the medical literature cited in this decision, in a letter dated in April 1994. In a letter dated in April 1994, additional written argument was presented by the veteran's representative, Disabled American Veterans. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his currently diagnosed PTSD arises out of and is related to his period of service. He further maintains that his present day hypertension is related to various incidents in service. Finally, the veteran contends that a cyst on his back had its origins in service. 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. 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 the claim of service connection for PTSD. It is further the decision of the Board that the preponderance of the evidence is against a claim of service connection for hypertension. It is further the decision of the Board that the preponderance of the evidence is against a claim of service connection for fibroma of the dorsal spine. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the instant appeal has been obtained by the RO. 2. The veteran did not experience a stressor during service which might lead to PTSD. 3. The veteran's hypertension was not present until many years after service, and is unrelated to any incidents of service. 4. The veteran's fibroma of the dorsal spine was not present until years after service, and is unrelated to any incidents of service. CONCLUSIONS OF LAW 1. Post-traumatic stress disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303(d), 3.304(f) (1993). 2. Hypertension was not incurred in or aggravated by service, nor can it be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). 3. A dorsal spine fibroma was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303(d) (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds initially that the veteran's claims are well-grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). That is, he has presented claims which are plausible and capable of substantiation. We are satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with a duty to assist him as mandated by 38 U.S.C.A. § 5107 (West 1991). I. PTSD Service connection may be granted for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1110 (West 1991). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1993). PTSD is an anxiety disorder, caused by a person experiencing a stressor, i.e., an event outside the range of usual human experience that would be markedly distressing to almost anyone. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders 247-251 (3d ed. rev. 1987). Service connection for PTSD requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantry Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. 38 C.F.R. § 3.304(f) (1993). As the United States Court of Veterans Appeals (hereinafter, the Court) pointed out in a recent decision, VA's Manual M21-1 provides that other supportive evidence includes, but is not limited to, plane crash, ship sinking, explosion, rape or assault, or duty on a burn ward or in graves registration unit. Zarycki v. Brown, No. 92-976 (U.S. Ct. Vet. App. Dec. 20, 1993), slip op. at 9. Service records must support the assertion that the veteran was subjected to a stressor of sufficient gravity to evoke the symptoms of PTSD in almost anyone. The existence of a recognizable stressor or accumulation of stressors must be supported. It is important the stressor be described as to its nature, severity and date of occurrence. In order to support a diagnosis of PTSD, a stressor must consist of an event during such service "that is outside of the range of usual human experience and that would be markedly distressing to almost any one," such as experiencing an immediate threat to one's life or witnessing another person being seriously injured or killed. It is the distressing event, rather than the mere presence in a "combat zone," which may constitute a valid stressor for purposes of supporting a diagnosis of PTSD. Wood v. Derwinski, 1 Vet.App. 190 (1991), reconsidered, 1 Vet.App. 406 (1991). The Board is not bound to accept the veteran's uncorroborated accounts of alleged stressors during service, nor is the Board required to accept psychiatrists' unsubstantiated opinions that the alleged PTSD had its origin in service. This is particularly true when there has been a considerable passage of time between putative stressful events encountered by a veteran and the onset of alleged PTSD. Wood at 406; Wilson v. Derwinski, 2 Vet.App. 614 (1992). Review of the service medical records indicates that the veteran reported being nervous and having difficulty sleeping in August 1966 which led to a diagnosis of anxiety reaction at that time. The veteran reported difficulty in sleeping again in January 1967. No further difficulties with sleeping were reported during the veteran's remaining period of active service. At the time of service separation, the veteran's clinical psychiatric evaluation was normal and there was no indication of any nervousness or sleeplessness reported by the veteran in his report of medical history. The veteran served one tour of duty in Vietnam from March 1967 to April 1968. A review of the veteran's DD Form 214 indicates that he served in the 1097th Transportation Company as a harbor craft boatman. While the veteran was issued several decorations, medals, badges, citations and campaign ribbons as a result of his active military service, none were indicative of combat exposure. A further review of the DA Form 20 indicated that the veteran also performed the duties of a cook in March 1967. At his initial personal hearing in October 1991, before a hearing officer at the regional office, the veteran testified that his company was considered a noncombat company. Transcript, page 1 (hereinafter T. 1). He further indicated that he performed the duties of a cook for a total of one week during his tour of Vietnam. (T. 2). The veteran indicated that the duties performed by the 1097th Transportation Company mainly consisted of hauling artillery pieces down the Mekong Delta. He testified that at one point, while traveling down the Delta, his ship was fired upon and he heard a round ricochet off an armored plate. He indicated that he returned fire with a machine gun and waited until artillery opened up which occurred approximately 2 to 3 seconds later. The veteran further indicated that on one occasion he performed a reconnaissance mission after his company had fired on a village where he found many dead women and children that had been killed in the firefight. The veteran then reported that they were relieved by the 9th Infantry Division and he continued on with his duties with the 1097th. In March 1993, the veteran appeared before Harry M. McAllister, M.D., who was appointed by the Chairman pursuant to 38 U.S.C.A. § 7102(b) to oversee a hearing in Los Angeles, California. At the personal hearing, the veteran testified as to having frequently been under attack by enemy or snipers who would randomly fire shots and quickly leave the area. (T. 4). The veteran further testified that on December 4, 1967, the 1097th ran into a firefight between a North Vietnamese Army battalion and the Infantry and the veteran immediately grabbed the ammunition for a .50 caliber machine gun and began firing at least a full case of ammunition. The veteran also testified that he began to notice an inability to fall asleep at night. (T. 6). He further indicated that while he heard that quite a few friends were injured in combat he only saw one actual wounded person. He also testified that he was exposed to mortar fire while in a bunker. He indicated that the bunker took a direct hit and the whole wall of the bunker was wiped out and he ended up lying in a lot of dust. (T. 14). He further testified as to having recurring nightmares of different ambushes that occurred right before Christmas in 1967. He reported having a nightmare of a particular incident where his boat was ambushed by a battalion of North Vietnamese Army troops. The veteran indicated a rocket-propelled grenade hit the edge of a 70-foot barge and bounced off. He recalled opening fire with a .50 caliber machine gun and going through a case of ammunition before he realized what was going on. He also indicated having dreams that several of the Navy boats had gotten hit severely with rocket-propelled grenades and several individuals were killed. Testimony was also received from a friend of the veteran, Mr. [redacted], who indicated that the veteran was in an extremely dangerous area during his tour of Vietnam. He indicated that the area that the veteran was in was below surface level and could be ambushed very, very easily. (T. 13). The veteran was diagnosed as having PTSD in both the psychological and psychiatric VA examinations performed in 1989. In determining that the veteran had PTSD, the examiners relied upon the reports of the veteran as to the incidents in service which he claimed attributed to his PTSD. At the time of the examination, the veteran reported that his military occupational specialty was artillery support and he spent much time as a rifleman. He indicated that he arrived in-country at Cam Ranh Bay and was quickly transported to the Mekong Delta. He reported spending much time at Dong Tam, the southern most United States Army base in Vietnam, but also indicated having operated on the Cambodian border in the area of Parrot's Beak. He indicated that he had helped in the transportation of artillery pieces to various fire bases as well as constructing and guarding the perimeters of the fire base. His unit served 8 to 10 artillery batteries and although he was shot at a great deal, he was never hit. He further reported that his unit at one time came upon a village in which the children were armed and that he and his comrades had no choice but to gun down the children. He reported that this scene was frequently repeated in nightmares from which he would awake feeling startled and anxious and unable to fall back asleep. In December 1989, the RO requested from the United States Army and Joint Services Environmental Support Group information which would support the veteran's claim for PTSD. The RO forwarded the veteran's Social Security and military service number as well as units of assignment, company, battalion, regiment and division in which he served. They further indicated that the veteran alleged his military occupational specialty was for artillery support and that he spent much time as a rifleman, reporting one incident in which he and several others shot at several armed children. The veteran did not supply the names of other individuals involved. Copies of the veteran's Department of Veterans Affairs psychiatric examination, DD Form 214 and DD Form 20 were also sent to the Environmental Support Group. In response, the Environmental Support Group indicated that the information supplied was insufficient and that the PTSD division could verify only specific combat incidents as recalled by the veteran. In order to conduct meaningful research, the veteran had to provide the who, what, where and when of each stressor. Thus, after reviewing the correspondence, the Environmental Support Group determined that the information received was insufficient for the purpose of conducting meaningful research on the veteran's behalf due to the lack of specific combat incidents including the date, place and type; and the lack of names of friends in units killed or wounded in action, if applicable. A January 1990 social work survey also determined that the veteran had PTSD. The social survey examiner indicated that following boot camp, the veteran was sent for several months to harbor craft training and thereafter sent to Vietnam and placed upon a harbor craft that was hauling artillery to shore. After approximately three months, the veteran was stationed in a support system group which periodically received fire. The veteran indicated that most of the time he was out of the direct line of combat. He further reported the while he had heard from men returning from the front about many incidents that were similar to My Lai and about the killing of civilians and children, that he of course was not involved in any of this. The one incident which repeated for him in nightmares was the time that they had a severe mortar attack and were in the dugout and one of the men in the dugout with him was severely injured and died. He reported that this incident came back to him in nightmares, especially when he was under stress. A May 1991 VA examination also diagnosed the veteran as having PTSD. At the time of the examination, the veteran reported that although he was assigned as a harbor boatman, he was part of an Infantry division and he operated as support toward artillery groups and transported artillery pieces to the Mekong Delta. He also indicated that he worked as a cook for a short period of time, but that was six months after he was in Vietnam. He stated that during his course of duty in Vietnam he had many traumatic experiences which he had previously related to a VA psychiatric examiner in 1989 and the social survey worker in 1990. However, at the time of the May 1991 examination he stated that he was involved in clearing the parimeter where he was ordered along with other people in the same company to shoot a 50-millimeter gun and heavy artillery into a village and then go to the village to make sure that it was safe. He indicated seeing many bodies of children and civilians cut to pieces and reported having frequent nightmares about this incident. The veteran also reported that on one occasion he was in a bunker which was shelled and blown up and that another person in the bunker was severely injured. He stated that he was not injured as a result of the explosion, but reported being fearful at that time because his unit was on the verge of being overrun by the enemy. He described this as a scary experience. While the May 1991 examiners diagnosed the veteran as having PTSD, they requested that the RO review the case due to conflicting stories of stressors and combat experiences or lack of the same. The examiners were particularly concerned about the report of the history of the veteran being a cook and the apparent conflict with his being involved in many combat experiences. The examiners indicated that they did not have any objective material concerning the veteran's military experience to verify the stressors he claimed at the time of the examination. As previously noted, if the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that he was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. A review of the DD Form 214 as well as the DD Form 20 does not indicate that the veteran was engaged in combat. A veteran's lay testimony regarding claimed stressors must only be accepted as conclusive as to the actual incurrence when it has been determined through recognized military citations or other supportive evidence that the veteran was engaged in combat with the enemy and the claimed stressors are related to such combat. As the veteran has presented no evidence other than his own testimony which would corroborate the claimed stressors in service, and no other supportive evidence exists to support the veteran's claims of stressors in service, his testimony alone is insufficient to verify exposure to a stressor in service. Moreover, while the veteran reports exposure to stressors in service, the facts surrounding these claimed stressors have been inconsistent as reported by the veteran in various medical evaluations, social surveys and actual testimony. In particular, we note that the veteran indicated in his January 1990 social survey as to having been out of the direct line of combat most of the time during his period of service. He further indicated that while he had heard from men returning from the front about many incidents that were similar to My Lai and about the killing of civilians and children, he was not involved in any of this himself. In contrast, in the May 1991 VA psychiatric examination report, the veteran indicated that he was involved in clearing a parimeter and was ordered along with other people in the same company to fire upon a village by shooting a 50-millimeter gun and heavy artillery. He then indicated going to the village to make sure that it was safe. He reported that he saw many bodies of the children and civilians cut to pieces and he had frequent nightmares about this incident. As the veteran's military records do not show any exposure to combat service, and the veteran's detail as to the particular incidents surrounding claimed stressors in service vary in great detail, we do not find his testimony to be "satisfactory", e.g., credible and "consistent with the circumstances, conditions or hardships of such service." Zarycki v. Brown, No. 92-976 (U.S. Ct. Vet.App. Dec. 20, 1993). While the Board does not make light of the dangerousness of the area in which the veteran served during his tour of duty in Vietnam, it is a distressing event, rather than the mere presence in a "combat zone," which may constitute a valid stressor for purposes of supporting a diagnosis of PTSD. Wood at 193. As service connection for PTSD requires a diagnosis of the disorder as well as the establishment that the veteran had a requisite stressor in service which might reasonably lead to the disorder, and as a stressor in service has not been verified, service connection for PTSD is not warranted. We will again point out here that the diagnoses of PTSD in this case were based on stressors reported by the veteran and which have not been verified. As noted earlier, the examiners, themselves, stated that they had no verification of the veteran's claimed stressors. II. Hypertension Service connection may be granted for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1110 (West 1991). In addition, where a veteran served ninety (90) days or more during a period of war and cardiovascular-renal disease, including hypertension, becomes manifest to a degree of 10 percent within one year from date of termination of such service, such a disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). A review of the veteran's service medical records indicate that at the time of his preinduction examination, the veteran had a blood pressure reading of 133/80. No notations of hypertension or high blood pressure were noted in service, and the veteran's blood pressure readings at the time of service separation were 133/80. Both systolic and diastolic arterial pressure levels with values of less than 140/90 mmHg are considered normal; 140/90 to 160/95 mmHg, are considered borderline hypertension and more than 160/95 is considered definite hypertension. J. W. Hurst, M.D., The Heart, Arteries and Veins 1042 (6th ed. 1986). Subsequent to service separation, the first notation of an increased blood pressure reading does not occur until December 1982. At his October 1991 personal hearing, the veteran testified that his hypertension did not start in service and did not begin until 1989. While a diagnosis of hypertension was rendered at the time of the August 1989 VA compensation and pension examination, the veteran's service medical record separation examination reported a normal blood pressure reading of 133/80. Moreover, the first elevated blood pressure reading subsequent to service separation did not occur until December 1982, more than 13 years subsequent to service separation, and any clinical diagnosis of hypertension was not related until December 1988, more than 20 years following service separation. As such, service connection for hypertension is not warranted as it was not shown during service or within the one-year presumptive period following service. III. Fibroma, Dorsal Spine Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110 (West 1991). By review of the service medical records, there is no indication that the veteran had any type of growth in the dorsal spine region during service. At the time of the service separation examination normal clinical evaluations of the skin and spine were noted. On his report of medical history, the veteran had not indicated having tumor growths, cysts or cancer. A 1 centimeter fibroma over the dorsal spine was reported in August 1989. By April 1990, the fibroma had increased to 3 centimeters in length and an incision drainage was performed. The wound was found to be cystic in nature and grossly purulent. The wound was packed and a sterile bandage was placed upon the wound. At his personal hearing, the veteran testified that while he was being treated for a back injury in service, a company doctor looked at his back and noticed a blackhead. The veteran further testified that the physician indicated that the blackhead could eventually cause problems. (T. 11). The veteran also testified that the cyst did not begin to give him problems until approximately eight months prior to the time of the March 1991 personal hearing. As there was no report of treatment for a cyst or a possible precursor of a cyst during service, and as the service separation examination indicated normal clinical findings of the spine and other musculoskeletal systems as well as normal clinical findings of the skin, and as the veteran's report of medical history did not indicate any tumors, growths or cysts, and with the first clinical diagnosis of a fibroma of the dorsal spine not occurring until 1989, more than 20 years following service separation, and with the veteran's testimony at his October 1991 personal hearing indicating that the cyst only began to bother him eight months prior to the time of the hearing, service connection for a dorsal spine fibroma is not in order. ORDER Service connection for PTSD is denied. Service connection for hypertension is denied. Service connection for a dorsal spine fibroma is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 * HARRY M. McALLISTER, M.D. WILLIAM J. REDDY *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.