Decision Date: 11/30/95 Archive Date: 12/01/95 DOCKET NO. 92-00 545 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to an increased rating for residuals of compression fractures of T11-L4, currently evaluated as 50 percent disabling. 2. Entitlement to service connection for gout as being proximately due to or the result of service connected splenectomy. 3. Entitlement to service connection for post traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Brad Hillyer, Attorney WITNESS AT HEARINGS ON APPEAL The appellant ATTORNEY FOR THE BOARD Jeffrey A. Pisaro, Counsel INTRODUCTION The veteran had active service from July 1969 to July 1971. This appeal arises from a December 1990 rating decision of the Cleveland, Ohio, Regional Office (RO). The case was remanded by the Board of Veterans' Appeals (Board) to the RO in August 1992 for additional development of the evidence. By rating action in April 1993, the evaluation for low back disability was increased from 20 percent to 30 percent disabling. As part of the April 1993 rating decision, the additional issue of entitlement to service connection for gout secondary to a service connected disability was denied. Subsequently, that issue has been fully developed on appeal, and it is currently before the Board for adjudication. By rating decision in August 1994, a combined 50 percent evaluation was assigned for low back disability to include a 40 percent rating under Diagnostic Code (DC) 5293 for intervertebral disc syndrome, with an additional 10 percent for demonstrable deformity of a vertebral body under DC 5285. By rating action in June 1995, entitlement to a total disability rating based on individual unemployability due to service connected disabilities was granted, effective from June 1993. The Board also notes that in May 1994, the veteran submitted an executed power of attorney in favor of Brad Hillyer, Attorney at Law. At a May 1994 personal hearing, the veteran stated that Brad Hillyer was representing him to the conclusion of his current appeal, at which time representation would revert back to Disabled American Veterans. (T-1) In a June 1995 Board letter to Brad Hillyer, receipt of his declaration of representation was acknowledged, and based on his declaration, it was noted that all other powers of attorney had been revoked. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO erred by failing to grant service connection for PTSD and gout, and by failing to grant a higher evaluation for low back disability. The appellant maintains that he experienced a severe stressor event during service when he was in a jeep accident, and that he currently suffers from PTSD as a result. It is maintained that the veteran has developed gout post service as a direct result of an inservice splenectomy. It is further asserted that low back disability has increased in severity due to spinal stenosis with symptoms such as an inability to bend, constant pain, and lower extremity radiculopathy to include right foot drop. 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 supports the claim for a combined 70 percent rating for low back disability; that the claim for entitlement to service connection for gout is not well grounded and must be dismissed; and that the preponderance of the evidence is against the claim for entitlement to service connection for PTSD. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran's residuals of compression fracture of T11- L4 are manifested by complaints of unremitting pain, with clinical findings showing pronounced intervertebral disc syndrome with persistent sciatic neuropathy in the form of reduced sensory and pin sensation of the lower extremities, decreased deep tendon reflexes and motor strength, right foot drop, and a CT scan showing mild spinal stenosis. 3. The veteran's service connected low back disorder has not resulted in such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards. 4. The claim for entitlement to service connection for gout as being secondary to a service connected disability is not accompanied by any medical evidence to support that allegation. 5. The claim for entitlement to service connection for gout is not plausible. 6. The veteran was not engaged in combat during his military service. 7. Objective demonstration of a medically sufficient non- combat stressor has not been shown. 8. The veteran does not currently suffer from PTSD. CONCLUSIONS OF LAW 1. The criteria for a combined 70 percent rating for residuals of compression fractures of T11-L4 have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 3.321, Part 4 to include 4.1, 4.2, 4.7, 4.10, 4.40, Diagnostic Codes 5285, 5292, 5293 (1994). 2. The claim for entitlement to service connection for gout as being proximately due to or the result of a service connected disability is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 1991); 38 C.F.R. § 3.304 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to an increased rating for low back disability. The Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed and that no further development is required to comply with the duty to assist the veteran under 38 U.S.C.A. § 5107(a). In that regard, development in conformity with the Board's August 1992 remand was accomplished. Residuals of compression fractures of T11 through L4 are currently evaluated as 50 percent disabling under the provisions of DC's 5285 and 5293 of VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4. Under the applicable criteria, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. The Department of Veterans Affairs (VA) has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. §§ 4.1 and 4.2. Also, 38 C.F.R. § 4.10 provides that, in cases of functional impairment, evaluations must be based upon lack of usefulness of the affected part or systems, and medical examiners must furnish, in addition to the etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of the disability upon the person's ordinary activity. These requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based upon a single, incomplete, or inaccurate report, and to enable the VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath, 1 Vet.App. at 594. When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Under applicable criteria, a 60 percent rating is warranted for pronounced intervertebral disc syndrome with persistent symptoms compatible with sciatic neuropathy with characteristic pain and demonstrable muscle spasm, absent ankle jerk, or other neurological findings appropriate to the site of diseased disc, with little intermittent relief. 38 C.F.R. Part 4, DC 5293. On VA orthopedic examination in December 1992, the veteran complained of chronic mid and low back pain which radiated into both legs. He also complained of numbness and tingling into the right leg from the hip to the foot. On examination, there was L1 right radiculopathy and L4-L5 right radiculopathy. On the right, there was paresthesia to the posterior right hip, thigh, and lower extremity to the dorsum of the right foot. Deep tendon reflexes were intact. The impressions included chronic low back pain with evidence of a right L1 radiculopathy and right L4-L5 radiculopathy and paresthesias to the right lower extremity. X-rays of the lumbar spine showed a minimal compression fracture of L1 vertebral body and slight old compression fracture of the L2 vertebral body. A May 1993 report from Glenn Blankenhorn, D.O., indicates that the veteran complained of low back and lower extremity pain. Exacerbation was reported with any activity, to include standing, lifting, bending, or riding. On examination, deep tendon reflexes were 2 plus/5 and symmetrical at the patella. He had bilaterally absent Achilles tendons. The veteran seemed to have subjective sensory changes bilaterally in a stocking like distribution. Easy fatigue of the dorsiflexors of the right ankle was indicated. Electrodiagnostic testing revealed a proximal S1 lesion. The impression was degenerative disc disease of the lumbar spine, mechanically unstable lower back with multiple compression fractures. The examiner noted that the veteran's symptoms and diagnostic testing were compatible with lumbar spinal stenosis. On VA orthopedic examination in July 1993, there was forward flexion of the low back to 30 degrees, backward extension to 10 degrees, right and left lateral flexion to 10 degrees, and bilateral rotation to 20 degrees. There was objective evidence of pain on motion. There was an abnormal neurological examination with diminished pin and light touch sensation over the right lower extremity in a stocking like distribution with right foot drop. The impression was chronic low back pain secondary to multiple compression fractures with clinical evidence of radiculopathy involving L1 and L4-L5 on the right indicative of pin and light touch sensation of the right foot and right foot drop syndrome. The veteran testified at a May 1994 hearing that he wore a back brace, that he had radiating pain into the right leg, that he was unable to bend, that his right ankle was often weak or limp with occasional foot drop, and that his physician suspected that he suffered from spinal stenosis. On VA neurology examination in June 1994, the veteran complained of bilateral pain radiating to both legs. He reported having numbness and tingling of the right lower leg, hip and foot. He also reported diminished sensation of the lower extremities, the right far worse than the left, and having recently developed right foot drop. On examination, there was severe pain on movement of the back. There was diminished pin and light touch sensation of the dorsal aspect of the right foot with right foot drop syndrome. A CT scan of the lumbar spine revealed mild central spinal stenosis at L1-L-2. At L4-L5 and L5-S1 there were diffuse disc bulges, with moderate degenerative hypertrophic changes at all levels. The impression was severe and chronic mid and low back pain with moderately severe degenerative arthritis, and clinical evidence of a right L4-L5 radiculopathy which accounted for the paresthesia of the right lower extremity and right foot drop. It was noted that the CT scan failed to demonstrate a significant central spinal canal stenosis. On VA examination in April 1995, range of motion of the lumbar spine included 10 degrees of forward flexion, extension, left and right rotation, and flexion right and left, with severe pain on all movements. There was Grade IV/V motor strength of the lower extremities. Deep tendon reflexes were intact, symmetrical, and physiologic. Diminished pin and light touch sensation was noted of the dorsal aspect of the right foot with right foot drop. There was diminished pin and light touch sensation from the left foot to the mid calf. The impressions included chronic low back pain, moderately severe degenerative osteoarthritis of the lumbar spine, right L4-L5 radiculopathy with right foot drop syndrome, and central spinal stenosis of L1-L2. Recent clinical findings support the veteran's claim for a 60 percent rating under DC 5293 for pronounced intervertebral disc syndrome. On VA examinations in December 1992, July 1993, June 1994, and April 1995, as well as on the May 1993 examination report from Dr. Blankenhorn, persistent sciatic neuropathy in the form of diminished pin and light touch sensation of the lower extremities has been reported. Decreased deep tendon reflexes, and motor strength, combined with constant pain have also been exhibited. The recent development of right foot drop and the 1994 CT testing which showed mild spinal stenosis are of significant probative value. Testimony adduced at the May 1994 personal hearing underscored the unremitting nature of the above symptomatology. The preponderance of the evidence demonstrates that the veteran's low back disability picture more nearly approximates the criteria for a 60 percent rating under DC 5293 and 38 C.F.R. § 4.7. As the veteran has already been accorded an additional 10 percent rating for low back disability under DC 5285 for demonstrable deformity of a vertebral body, a combined 70 percent rating is currently assignable for the veteran's low back disability. The veteran's disability picture does not present such an exceptional or unusual disability picture with such related factors as frequent periods of hospitalization as to render impractical the application of the regular schedular standards. Accordingly, the degree to which the veteran's service connected low back disability impairs him industrially has been adequately contemplated in the percentage evaluation assigned. Thus, the Board finds that an extraschedular evaluation is not warranted. II. Factual background for service connection claims. The service medical records reveal that the veteran was in a jeep accident in May 1970. Diagnoses included a ruptured spleen. Later that month, a splenectomy was performed, and on hospital discharge in July 1970, the diagnoses included status post splenectomy. On the June 1971 separation examination, the veteran was clinically evaluated as normal psychiatrically. No complaints, findings or diagnoses of psychiatric disability or gout are found in the service medical records. On April 1972 VA general medical and urology examinations, no complaints, findings or diagnoses of psychiatric disability or gout were recorded. The veteran's DD-214, indicates that the veteran had four months and 11 days of foreign service, that he was stationed in Vietnam from January 19, 1970 to May 29, 1970, that his military occupational specialty (MOS) was a medical specialist, and that he received the National Defense Service Medal, the Vietnam Service Medal, and the Vietnam Campaign Medal with device. VA outpatient records include a May 1986 diagnosis of questionable gout, and an assessment in September 1986 of gout. In November 1989, the veteran submitted a claim for entitlement to service connection for PTSD. He indicated that he was a medic in Vietnam, that his experiences as a front line medic contributed to his PTSD, and that he was in a jeep accident in Vietnam when he was thrown from the vehicle. The veteran's service personnel records show that he was educated as a medical corpsman, that he was in Vietnam from January 19, 1970 to May 29, 1970 as a medical specialist with the 12th Evacuation Hospital, and that he received the National Defense Service Medal, the Vietnam Campaign Medal, and the Vietnam Service Medal. In a January 1990 stressor statement, the veteran indicated that his condition was so serious after the jeep accident that he was given last rites by a Catholic priest, and he believed that he was going to die. On VA psychiatric examination in June 1990, the veteran reported experiencing recurrent nightmares with aggressive behavior upon awakening, anxiety, difficulty concentrating, shortness of temper, and aggressive outbursts at home, work and socially. He reporting that he had refused seeking psychiatric help until 1989. Sleep was described as restless, he avoided crowds, and he had entertained suicidal ideation. Reportedly, the veteran was a medic in Vietnam and dealt daily with injured people and dead bodies. The veteran had startle reaction, and daily flashbacks concerning Vietnam. On examination, mood was anxious, and affect was constricted. He showed severe obsessive preoccupation with Vietnam and his experiences there. The impression was PTSD, chronic, severe. It was noted that the veteran's mental status was consistent with PTSD which caused marked difficulties in his interpersonal relationships. On the February 1991 substantive appeal, the veteran indicated that his secondary MOS was a truck driver, and that he never worked as a medic in Vietnam. At a March 1991 personal hearing, the veteran testified that his right leg got caught between the seat and the side of the jeep during the May 1970 accident, that his M16 was lost, that the jeep continued for 60 to 80 yards, that he was medivaced by helicopter, that he was scared to death (T- 5), that last rites were administered at the hospital (T-6), that as early as 1971 when working at a hospital he noticed that everything critical bothered him (T-8), that later he experienced bad dreams dealing with an accident, and that he had a bad temper. A service comrade submitted a statement in February 1991 indicating that he had been in the jeep with the veteran in Vietnam, that on impact the veteran caught his ankle, and that the veteran was bleeding all over. In May 1992, the veteran filed a claim for entitlement to service connection for gout secondary to his service connected splenectomy. On VA psychiatric examination in December 1992, the veteran reported having been in a vehicle accident in Vietnam. The veteran remembered body parts being strewn all over. His medical history included gout. Presenting symptoms included depression, sadness, hopelessness, suicidal ideation, sleep disturbance, irritability, nightmares, flashbacks and being short tempered. Reportedly, when the hood of his car came up one time, the veteran had a flashback to the inservice accident. The examiner felt that the veteran had some features of PTSD, but not enough to meet a full diagnosis based on major diagnostic criteria. The diagnoses were generalized anxiety disorder, dysthymia, and impulse control disorder. There were no immediate stressors identified; however, there was some enduring stress associated with the vehicle accident in service. A VA consultation psychiatric examination report of December 1992 indicates that the veteran reported having bad dreams and a quick temper. He described his bad dreams as driving off a cliff and seeing people die who he did not know. Based on the veteran's history, his behavior and mental status examination, no psychiatric diagnosis was offered. The veteran was considered to be capable of managing his own finances. In a May 1993 statement, the veteran indicated that there was a direct relationship between the removal of his spleen and uric acid levels, which in turn caused his gout. He also stated that he had symptoms of gout in service even though he wasn't aware of it at the time. After service, his toes ached, which was a symptom of gout. On a July 1993 VA hematology examination, the veteran complained of joint pain, especially his feet. Attacks affected both big toes with swelling, redness, and being hot. On examination, there was some prominence of the bilateral bunions with a little redness. During attacks which lasted for four to five days, he reported an inability to wear shoes. Disability was currently under control with daily medication, and the last real bad attack was during Easter of 1992. Acute attacks were from gout and gouty arthritis principally in the great toes. There was no evidence of sickling, and a splenectomy was reported. The diagnosis was frequent episodes of gout with pain and discomfort of the right and left metatarsophalangeal joints. On VA psychiatric examination in September 1993, the examiner noted that the veteran's claims folder was not available, and all information came directly from the veteran. The veteran reported that he did not serve in Vietnam as a medic, but that he was a driver for the company commander. He described a May 1970 vehicular accident with resulting hospitalization. Although he had been having bad dreams since the accident, post service treatment began in 1989 due to increasing severity of the bad dreams. The veteran reported having recurrent intrusive recollections of the jeep accident, and nightmares two to three times a week. Sleep disturbance and hypervigilance were reported. The tentative diagnosis was PTSD, and it was stressed by the examiner that he did not have the veteran's medical record, and that he was depending solely on the veteran's statements. Psychological testing was recommended. An October 1993 addendum to the September 1993 examination report indicates that the examiner had reviewed the veteran's claims folder. The examiner noted that there was no information available to corroborate a severe stressor that could have caused PTSD. The only stressor information came from the veteran. The examiner again stated that evidence for a sufficient stressor could not be found. An October 1993 VA psychological report indicates that the veteran's mood was depressed and affect was subdued. A tendency to exaggerate symptoms perhaps in an effort to obtain help was reported. The veteran's profile showed an individual who complained excessively of pain and somatic illnesses. The veteran was somewhat passive-dependent and required a great deal of emotional support. Many individuals with profiles similar to the veteran's were typically described as maladjusted. A probable diagnosis was somatoform disorder and there was a strong likelihood of passive aggressive or dependent personality. A VA psychiatric examination was conducted in October 1993 by another examiner, and the report was based on an interview with the veteran, a review of his claims folder, and a review of the recent psychological evaluation report. The veteran reported almost weekly dreams of the jeep accident. He denied any change in severity or frequency of the dreams over the past 20 years. Speech and thought processes were coherent, but the veteran had a great tendency to dramatize and exaggerate his physical symptoms. The veteran denied any wartime experience or having received injuries from enemy fire or receiving specific medals. The veteran was involved in a jeep accident in Vietnam, but he continued to drive cars to the present time. He also was employed for a number of years operating heavy road equipment for the state until receiving a back injury in 1989. A review of the claims folder and the veteran's personal account, did not reveal any life threatening experiences or the witnessing of any catastrophic event during service in Vietnam. The veteran's account of his involvement in an automobile accident was not considered to be a life threatening event based upon the injuries he received and the subsequent recovery and level of functioning. The psychological profile revealed an individual who had a tendency to dramatize and exaggerate symptoms, and he had a tendency to regress under psychosocial stressors. No psychiatric diagnosis was offered, and the veteran was deemed capable of managing his own finances. On VA general medical examination in April 1995, the diagnoses include gout, asymptomatic. It was noted that the veteran was on medications. VA outpatient treatment records from 1989 to 1994 are consistent with the above examination reports. III. Entitlement to secondary service connection for gout. Service connection will be granted for a disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). A claimant seeking benefits under a law administered by the Secretary of the Department of Veteran Affairs (VA) shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. The Secretary has the duty to assist a claimant in developing facts pertinent to the claim if the claim is determined to be well grounded. 38 U.S.C.A. § 5107(a). Thus, the threshold question to be answered is whether the veteran has presented a well grounded claim; that is, a claim which is plausible. If he has not presented a well grounded claim, his appeal must fail, and there is no duty to assist him further in the development of his claim as any such additional development would be futile. Murphy v. Derwinski, 1 Vet.App. 78 (1990). As explained below, the Board finds that the appellant's claim for gout secondary to the service connected splenectomy is not well grounded. To sustain a well grounded claim, the claimant must provide evidence demonstrating that the claim is plausible; mere allegation is insufficient. Tirpak v. Derwinski, 2 Vet.App. 609 (1992). The determination of whether a claim is well grounded is legal in nature. King v. Brown, 5 Vet.App. 19 (1993). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of 38 U.S.C.A. § 5107(a). Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). To be well grounded, a claim must be accompanied by supportive evidence, and such evidence must justify a belief by a fair and impartial individual that the claim is plausible. Where the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is required to fulfill the well-grounded claim requirement of 38 U.S.C.A. § 5107(a). Lathan v. Brown, 7 Vet.App. 359 (1995). In order for a claim for service connection to be well grounded, there must be competent evidence of a current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence) and of a nexus between the in service injury or disease and the current disability (medical evidence.) The nexus requirement may be satisfied by a presumption that certain diseases manifesting themselves within certain prescribed periods are related to service. Caluza v. Brown, 7 Vet.App. 498 (1995). In this case, the service medical records show that a splenectomy was performed following a jeep accident. The veteran currently has gout which first appeared in the medical record during the mid-1980's, at least 15 years following separation from service. Although the veteran does not request consideration of service connection on a direct incurrence basis, he does assert that his gout is the direct result of his splenectomy. The only evidence which would support the veteran's secondary service connection claim are his statements and testimony; however, lay evidence is inadequate to establish a medical claim. The record is devoid of medical authority or opinion which would corroborate the veteran's claim regarding a putative nexus between the splenectomy and the post service development of gout. Consequently, the veteran has not met the initial burden under 38 U.S.C.A. § 5107(a); his claim lacks plausibility, and is not well grounded. When a claim is not well grounded, the Board does not have jurisdiction to adjudicate that issue. Boeck v. Brown, 6 Vet.App. 14 (1993). IV. Entitlement to service connection for PTSD. The veteran has presented a claim which is plausible and well grounded. In addition, all available evidence has been developed and there is no further duty to assist the veteran under the 38 U.S.C.A. § 5107(a) mandate. Service connection will be granted for a disability resulting from disease or injury which was incurred in or aggravated by service. 38 U.S.C.A. § 1110. 38 C.F.R. § 3.304(f) provides: Service connection for post-traumatic stress disorder 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 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. Adjudication of a claim for service connection for PTSD requires evaluation of the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the official history of each organization in which the veteran served, the veteran's military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(b). In Smith v. Derwinski, 2 Vet.App. 137, 140 (1992), in reviewing the legislative history of 38 U.S.C.A. § 1154, the Court stated that "...the matter of service connection is a factual determination which must be made by the Secretary based upon the evidence in each individual case..." VA Adjudication Procedure Manual, M21-1, Part VI, provides: If the evidence shows the veteran engaged in combat with the enemy and the claimed stressor is related to combat, no further development for evidence of a stressor is necessary...If the claimed stressor is not combat related, a history of a stressor as related by the veteran is, in itself, insufficient. Service records must support the assertion that the veteran was subjected to a stressor of sufficient gravity to evoke symptoms 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. Relevant statutes and regulations, to include 38 U.S.C.A. § 1154 and 38 C.F.R. § 3.304, in addition to Manual M21-1, mandate an initial determination as to whether a veteran was engaged in combat. See also Hayes v. Brown, 5 Vet.App. 60 (1993). If it is determined that a veteran was engaged in combat, lay testimony from the veteran regarding putative stressors must be accepted as conclusive, provided that the testimony is satisfactorily credible; however, if VA determines that a veteran did not engage in combat, lay testimony by the veteran by itself is not sufficient to establish that a putative stressor occurred. West v. Brown, 7 Vet.App. 70 (1994). If the veteran was not engaged in combat, the service records must corroborate lay testimony as to the facts and circumstances of an alleged stressor. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d); Manual M21-1, Part VI. The veteran's DA-Form 20 and DD-214 show that he was in Vietnam from January to May 1970. His MOS during his tour of duty in Vietnam was a medical specialist with the 12th Evacuation Hospital. The veteran was awarded the National Defense Service Medal, the Vietnam Service Medal, and the Vietnam Campaign Medal with device. Notwithstanding the above military records, there is a conflict in the evidence regarding the veteran's MOS during Vietnam. Although his military history shows that he was a medical specialist, the veteran contends that he spent his entire tour in Vietnam as a driver. Regardless of whether the veteran was a medical specialist or driver, it has not been contended by the veteran, or demonstrated by the evidence, that the veteran was engaged in combat in Vietnam. On the other hand, it is significant that the veteran initially asserted in November 1989 that he was a front line medic in Vietnam, and during an early VA psychiatric examination in June 1990, he reported that he dealt with injured people and dead bodies every day in Vietnam as a medic. Subsequently, on the February 1991 substantive appeal, the veteran indicated that his secondary MOS was a truck driver and that he never worked as a medic in Vietnam. The variant reporting of his MOS and experiences in Vietnam severely affects the veteran's credibility. Nonetheless, the uncontroverted evidence shows that the veteran was not engaged in combat in Vietnam. Accordingly, it must be determined whether service records corroborate the veteran's lay testimony regarding specific non-combat putative stressors. On all recent VA psychiatric examinations, the veteran has centered his claim on a single putative stressor event: the May 1970 jeep accident. The service medical records show that the veteran was involved in an accident, and the February 1991 service comrade statement also corroborates that the accident occurred. In West v. Brown, 7 Vet.App. 70 (1994), the Court held that the Board may question whether a putative stressor exists, but it may not reject, based on its own medical conclusion, a medical diagnosis of record that found that a stressor was sufficient to support a diagnosis of PTSD. In this case, as described above, it is not contested that the May 1970 jeep accident occurred; however, whether that incident may serve as a stressor is at issue. The veteran has written and testified that he was severely traumatized by the accident and that he was given last rites by a priest at the evacuation hospital. The only diagnosis of PTSD is found in the June 1990 VA examination report. Of significance is the fact that the veteran gave a history at the June 1990 examination of being a medic in Vietnam and dealing daily with the dead and injured. The Court has determined that medical evidence is inadequate where medical opinions consist of general conclusions based on history provided by the appellant and on unsupported clinical evidence. Black v. Brown, 5 Vet.App. 177 (1993). As the veteran has discarded the history of having served as a medic, the June 1990 diagnosis of PTSD has been compromised. In addition, the tentative diagnosis on examination in September 1993 was PTSD; however, it was stressed by the examiner that he did not have the veteran's claims folder. An addendum in October 1993, following a review of the veteran's claims folder, indicated that that there was no information available to corroborate a severe stressor, thereby rendering the September 1993 diagnosis of PTSD null and void. Psychological testing was recommended. VA psychological testing in October 1993 showed a tendency by the veteran to exaggerate symptoms, and his psychological profile showed a somatoform disorder, not a PTSD profile. A final VA psychiatric examination in October 1993, which was based on an interview, the claims folder, and the veteran's psychological testing, concluded that the jeep accident in service was not considered to be a life threatening event based on the veteran's injuries and by his subsequent ability to function as a civilian driver and operate large road machinery. In view of the above, the Board finds that there is no evidence of a medically sufficient non-combat stressor. Moreover, in Wood v. Derwinski, 1 Vet.App. 190 (1991), the Court stated that the Board was not bound to accept uncorroborated accounts of stressors, or medical opinions which were based on such accounts. That principal was especially true when there was a considerable passage of time between the putative stressors and the onset of the alleged PTSD. In this case, more than 15 years transpired before the record first shows that the veteran reporting having PTSD like symptoms. As a result, the Board finds that the veteran's claim for PTSD is deficient in that a valid diagnosis of PTSD based on a medically sufficient stressor is not found in the record. In summary, the veteran was not engaged in combat in Vietnam, his MOS (by any account) did not entail more than an ordinary stressful environment, there was a considerable passage of time between the veteran's putative stressors and the onset of PTSD like symptoms, and a medical sufficient non-combat stressor and a verifiable diagnosis of PTSD are absent from the record. Moreover, the veteran's credibility has been compromised by his inconsistent reporting of his MOS and his experiences in Vietnam, and by the fact that multiple examiners have concluded that the veteran exaggerated and dramatized his symptoms. Accordingly, the Board concludes that the preponderance of the evidence is against the veteran's claim for entitlement to service connection for PTSD. ORDER Entitlement to a combined 70 percent rating for residuals of compression fractures of T11-L4 is granted, subject to the controlling regulations applicable to the payment of monetary benefits. The claim for entitlement to service connection for gout as being proximately due to or the result of a service connected splenectomy is dismissed. Entitlement to service connection for PTSD is denied. C.W. SYMANSKI Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. 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. - 2 -