Citation NR: 9607671 Decision Date: 03/21/96 Archive Date: 04/02/96 DOCKET NO. 94-14 279 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. REPRESENTATION Appellant represented by: Alvin D. Wax, Esquire WITNESSES AT HEARING ON APPEAL The veteran and [redacted] ATTORNEY FOR THE BOARD John D. Nachmann, Associate Counsel INTRODUCTION The veteran had active naval service from July 1971 to September 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of March 1992 by the Department of Veterans Affairs (VA) Louisville, Kentucky, Regional Office (RO). CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO was incorrect in not granting his claim of entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. He maintains that service connection for an acquired psychiatric disorder is warranted because his current psychiatric disorder developed as a result of his experiences during active service. Therefore, he requests a favorable determination by the Board. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1995), 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 veteran’s claim of entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran’s appeal has been obtained by the RO. 2. An acquired psychiatric disorder was not clinically manifested during active service or within one year following the veteran’s separation from service. 3. The veteran did not engage in combat with the enemy during his active naval service. 4. During service, the veteran was not exposed to an event of sufficient gravity to evoke symptoms in almost anyone which would constitute a stressor sufficient to support a diagnosis of post-traumatic stress disorder for VA purposes. CONCLUSION OF LAW An acquired psychiatric disorder, to include post-traumatic stress disorder, was not incurred in or aggravated by the veteran’s active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1133, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.304(f), 3.307, 3.309 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran has submitted a well-grounded claim within the meaning of 38 U.S.C.A. § 5107(a). See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). That is, the Board finds that he has submitted a claim which is plausible. The Board is also satisfied that all relevant evidence necessary for an equitable disposition of the veteran’s appeal has been obtained and that no further assistance is required to comply with the duty to assist him mandated by 38 U.S.C.A. § 5107(a). Under the law, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. In addition, where a psychosis becomes manifest to a degree of ten percent within one year from date of termination of service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1133; 38 C.F.R. §§ 3.307, 3.309. Lastly, service connection for post-traumatic stress disorder may be granted only upon a clear diagnosis of the condition, credible supporting evidence of the claimed in-service stressor, and a link between the current symptomatology and the in-service stressor. 38 C.F.R. § 3.304(f). Further, in Zarycki v. Brown, 6 Vet.App. 91 (1993), the United States Court of Veterans Appeals (Court) determined that a multi-step process must be employed when evaluating post-traumatic stress disorder claims of those who engaged in combat with the enemy but whose alleged stressor was not related to such combat or of those who were not engaged in combat. First, a determination must be made as to whether the claimed stressor is sufficiently corroborated by service records. Next, a determination must be made as to whether the claimed stressor is sufficient to support a diagnosis of post-traumatic stress disorder. Finally, a determination must be made as to whether the claimant’s currently diagnosed post-traumatic stress disorder is causally related to the stressor. The service records indicate that although the veteran had active naval duty during the Vietnam War, he did not engage in combat with the enemy at that time. In this regard, the Board notes that there is no service department evidence that the veteran engaged in combat or that he was awarded the Purple Heart, the Combat Infantryman Badge, or other similar combat citation. In addition, the veteran’s service records reveal that his principal duty was as an electrician’s mate, a position which is not ordinarily involved in combat. The service medical records reveal that in April 1977, the veteran reported that he had previously experienced alternating periods of euphoria and depression and that he had a depressive episode with a suicidal gesture when his wife left him in 1974. In addition, the veteran stated that he did not have any psychiatric problems at that time. A diagnosis of “manic depressive type mood swings (cyclothymic personality?)” was recorded. In June 1977, the veteran reported that he had been raised by his grandmother until the age of eight and that he felt deprived of parental interest as a child. Upon examination, the veteran’s mood was normal and his affect was labile. In addition, the veteran showed minimal insight into his difficulties, he was not suicidal, and he did not report any delusions. An impression of mild to moderate emotionally unstable personality disorder was recorded. The examiner noted that the veteran’s disorder was manifested by emotional lability under stress, feelings of inferiority and inadequacy to his peers as well feelings of an inability to lead them, impulsiveness, and overindulgence in food and drink. Upon examination in October 1977, the veteran’s mood was highly anxious and his affect was markedly constricted. In addition, his sensorium was clear, his intellect was intact, and he was not suicidal. A diagnosis was deferred at that time. The veteran was hospitalized for approximately six weeks beginning in June 1979 due to chronic alcoholism. A discharge diagnosis of alcoholism in remission was recorded. The report of an August 1979 service medical examination, which was conducted approximately two weeks prior to the veteran’s separation from service, reveals that the veteran did not have a psychiatric abnormality. VA medical records show that the veteran complained of experiencing mood changes, paranoid feelings, low self concept, and interpersonal relationship problems in June 1984. Upon examination, the veteran reported that he previously had many contacts with mental health professionals regarding his emotional instability. The veteran further stated that both of his parents were alcoholics and that they physically abused him when he was a child. In addition, the veteran noted that his sister was addicted to heroin and that she had attempted to commit suicide on four different occasions. The veteran’s mother also attempted to commit suicide following an affair with the veteran’s best friend. A diagnosis of depressive neurosis was recorded. Approximately two weeks later, the veteran sought treatment for a burning sensation down the middle of his chest, pain on the left side of his chest that radiated to his left arm, and shortness of breath. A diagnosis of probable anxiety attack was recorded. During a December 1991 VA psychological examination, the veteran reported that he traveled with his parents for the first six years of his life and that after that time he was raised with some of his siblings. The veteran also stated that although he had a history of multiple arrests for drinking, his alcoholism was in remission at that time. The veteran noted that he experienced “overwhelming dread,” labile moods, insomnia, compulsiveness, impulsiveness, affective instability, intense and inappropriate anger, lack of self control, marked and persistent identity disturbance, and social anxiety. Upon examination, the veteran described his mood as “anxious, agitated and angry.” The veteran’s affect, however, was reasonable, pleasant, and cooperative. The veteran was oriented in all spheres and he knew the reason he was being evaluated. His language and speech was rapid, pressured, and very tangential in content and his stream of thought was described as overabundant with flight of ideas. Although the veteran denied any suicidal ideation, he reported a history of homicidal thoughts, paranoia, and auditory as well as visual hallucinations. No clouding of the veteran’s consciousness was evident and his judgment was appropriate. Cognitive testing appeared to be intact and the veteran’s concentration as well as memory was excellent. Axis I diagnoses of polysubstance abuse and dependence in remission, alcohol abuse and dependence in remission, mixed bipolar disorder with psychotic features, and rule out delusional (paranoid) disorder were recorded. In addition, Axis II diagnoses of borderline personality disorder and schizotypal traits were recorded. VA outpatient treatment records disclose that the veteran sought treatment in March 1992 due to feelings of depression. At that time, the veteran was talkative with flight of ideas and overly assertive with a high degree of anxiety and irritability. In addition, the veteran denied homicidal or suicidal thoughts. The veteran continued to seek outpatient treatment on a number of occasions through October 1992. During his January 1993 personal hearing, the veteran testified that shortly after he entered active service, he was selected to go to nuclear power school and he felt a great deal of pressure to succeed there because he was told that if he did not do well, he would be sent to Vietnam. The veteran further stated that this stress put a strain on his marital relationship and he began to “act out” with his wife. The veteran noted that his wife attempted to commit suicide in 1974 and that as a result, he also attempted to commit suicide. This “overt psychotic break” was expunged from the veteran’s record so that he could continue to work in the nuclear power field. After his “psychotic break,” the veteran returned to school for one year and was subsequently assigned to another nuclear carrier where he was given a supervisory role that required him to work 12 to 18 hours a day. The veteran indicated that during this time, he was concerned that he would make a mistake and kill not only the carrier’s entire crew but also civilians. In April 1978, the veteran had a “psychotic breakdown” when he was qualified as a propulsion plant watch supervisor. The veteran testified that after his discharge from service, he experienced problems with drinking, nightmares, and day dreams. In addition, the veteran disclosed that he experienced a “personality shift” when he was under stress during which he believed that he was still in the Navy. The veteran also revealed that he had held 30 jobs since his discharge from service due to his inability to deal with his supervisors as well as other employees. The veteran noted that he had also had 26 relationships since his separation from service and that he was seeking treatment for his psychiatric problems at that time. Lastly, the veteran testified that he had received treatment for psychiatric problems since his discharge from service, but records of the treatment that he received shortly following his separation from service were not available. Mr. [redacted] testified that the veteran reacted improperly to loud noises and belligerent people. In addition, he stated that the veteran was afraid to sleep, experienced nightmares, did not have many friends, and was not comfortable if there were many people around him. During a February 1993 VA examination, the veteran reported that he was nervous, very sad, unable to sleep for more than six hours a night, and experiencing nightmares. In addition, the veteran stated that his parents were alcoholics and that they sexually abused him as a child. Upon examination, the veteran was oriented to three spheres, very talkative, tangential, and wanted to give a lot of information. His memory was intact and his judgment was good. No hallucinations or delusions were noted and the veteran was not suicidal or homicidal. The veteran knew that he was nervous and that he had problems with his emotions. Axis I diagnoses of non-combat related post-traumatic stress disorder and alcohol and drug dependence in remission since 1980 were recorded. In addition, an Axis II diagnosis of atypical personality disorder was recorded. During a February 1993 VA psychological evaluation, the veteran reported that his family was very dysfunctional and that he had experienced physical and sexual abuse from both of his parents, who were alcoholics. The veteran further noted that he was a social outcast as a child and that his parents placed extreme pressure on him to do well in school. The veteran stated that when he entered the Navy, his duties included management of an entire nuclear reactor which he found to be so distressing that he experienced panic attacks, chest pain, and gastrointestinal problems. Upon examination, the veteran was oriented to three spheres and his speech was pressured. His mood was “ok” on the surface, but the veteran reported feeling angry, anxious, and depressed. The veteran did not have any suicidal or homicidal ideation or intent, but he did describe an on-going “hostile fantasy life.” The veteran also stated that he had trouble sleeping, anhedonia, and racing thoughts. No psychotic symptoms were observed and the veteran denied auditory hallucinations. The veteran did describe visual hallucinations as well as feelings of depersonalization and derealization. The veteran stated that he felt that he might experience dissociative states and that he might have multiple personalities. Nightmares, intrusive thoughts, flashbacks, hypervigilance, and increased startle reaction were also reported by the veteran. The examiner concluded that the veteran did not have post-traumatic stress disorder related to his active service. In fact, the examiner noted that if the veteran did have post-traumatic stress disorder, it was secondary to his history of childhood abuse. While the pressure and stress of the work that the veteran performed during active service may have exacerbated his difficulties, the examiner did not feel that service in that capacity qualified as “an event outside the range of usual human experience.” An Axis I diagnosis of bipolar schizoaffective disorder and an Axis II diagnosis of strong antisocial features were recorded. The report of a March 1993 VA examination discloses that the veteran’s speech was pressured but logical, his mood was agitated, and his affect was anxious as well as tense. No hallucinations, delusions, suicidal ideation, homicidal ideation, or suicidal or homicidal intentions were noted. In addition, no evidence of any gross impairment of judgment was found and the veteran’s memory was adequate. The examiner noted that based upon the veteran’s claims of multiple previous psychological traumas due to his involvement with his parents, his exposure to a nuclear reactor, and severe disciplinary conditions while in service, as well as his nightmares and flashbacks regarding these episodes, he would qualify for a diagnosis of post-traumatic stress disorder. The examiner further noted that the veteran’s symptoms interfered with his relationships, his ability to work, and his ability in school. Axis I diagnoses of non-combat related post-traumatic stress disorder and alcohol and drug dependence in remission since 1980 were recorded. An Axis II diagnosis of personality disorder was also recorded. Based upon a thorough review of the evidence of record, the Board concludes that service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder is not warranted. In this regard, the Board notes that an acquired psychiatric disorder was not manifested during active service or within one year following the veteran’s separation from service. Although diagnoses of questionable cyclothymic personality and emotionally unstable personality disorder were recorded during active service, these disorders do not constitute a disease or injury for which VA disability benefits can be awarded. See 38 C.F.R. § 4.9 (1995). The Board acknowledges that the record contains conflicting diagnoses as to whether the veteran, in fact, has post- traumatic stress disorder. However, even assuming, arguendo, that the veteran has post-traumatic stress disorder, the evidence of record, including the veteran’s own contentions, fails to identify and establish that the veteran experienced a specific, service-related stressor to support a diagnosis of post-traumatic stress disorder for purposes of entitlement to VA benefits. (Emphasis added). In this regard, the Board would point out that “[s]ervice records must support the assertion that the veteran was subjected to a stressor of sufficient gravity to evoke symptoms in almost anyone.” Veterans Benefits Administration Manual, M21-1, Part VI, Paragraph 7.46(f). “For example, vehicular or airplane crashes, large fires, floods, earthquakes, and certain other disasters would evoke significant stress in most involved persons.” Id. at Paragraph 7.46(g). There is no evidence of record that the veteran experienced any such event. As noted by the February 1993 examiner, the veteran’s claimed in- service stressor of having to work long hours at a responsible job is not of a sufficient gravity to evoke symptoms in almost anyone. Moreover, although the veteran has related that he had memories of a nuclear reactor out of control and of people dying, there is no evidence of record that such event actually took place. The Board would further point out that, notwithstanding the veteran’s claims of having experienced a service-related stressor, the sexual and physical abuse that the veteran experienced as a child is a stressor of a sufficient gravity to evoke symptoms in almost anyone, and referenced by a number of examiners as a precipitating factor in the veteran’s psychiatric illness, including, where diagnosed, post-traumatic stress disorder. However, such event not occur during active service and therefore fails to meet the requirements of 38 C.F.R. § 3.304(f). Given all of the foregoing, the Board finds that the preponderance of the evidence is against the veteran’s claim of entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. As such, there is not an approximate balance of positive and negative evidence regarding the merits of the veteran’s claim which would give rise to a reasonable doubt which could be resolved in the veteran’s favor. 38 U.S.C.A. § 5107(b). ORDER Service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder is denied. JACQUELINE E. MONROE Member, Board of Veterans’ Appeals The Board of Veterans’ Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 (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 & Supp. 1995), 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, 102 Stat. 4105, 4122 (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 -