Citation NR: 9628921 Decision Date: 10/10/96 Archive Date: 10/25/96 DOCKET NO. 91-42 783 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Gregory W. Fortsch, Associate Counsel INTRODUCTION The veteran served on active duty from August 1967 to August 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating actions by the St. Petersburg, Florida, Regional Office (RO) of the Department of Veterans Affairs (VA). In January 1995, a hearing was held at the RO before a hearing officer. A transcript of that hearing is of record. CONTENTIONS OF APPELLANT ON APPEAL The veteran generally contends that he has post-traumatic stress disorder (PTSD) and it is related to particularly stressful events that he experienced while serving as an air courier in Vietnam during the war. He contends that the disability first manifested itself in the service when he had unexplained severe headaches and was referred to a psychiatrist who prescribed Mellaril. Currently, he claims that he has problems sleeping, suicidal thoughts, and difficulty dealing with anything related to Vietnam. He mentions the guilt and stigma that are attached to being a Vietnam veteran. The veteran also claims that he avoids crowds and has difficulty dealing with people. He adds that he makes an effort to avoid anyplace where there are helicopters, guns, or anything related to the military because these items bring back memories of Vietnam. 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 claim for service connection for post-traumatic stress disorder (PTSD). FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. There is no indication that the veteran had engaged in combat. 3 The evidence of record shows various psychiatric diagnoses, including PTSD. The diagnoses of PTSD, however, are based on unsubstantiated reports of stressors as provided by the veteran. There is no credible supporting evidence that the claimed in-service stressors that had resulted in the diagnoses of PTSD, actually occurred. CONCLUSION OF LAW The veteran’s claimed PTSD was neither incurred in nor aggravated by service. 38 U.S.C.A. §§ 1110, 1153, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.304(f) (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION Under the law, service connection can be granted for any disability resulting from disease or injury incurred in or aggravated during active military service in wartime. 38 U.S.C.A. § 1110 (West 1991). In a claim to establish service connection, a claimant is always obliged to present evidence of a well-grounded claim. 38 U.S.C.A. § 5107(a) (West 1991). A well-grounded claim is simply a plausible one, which means that it is either meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990). Service connection for PTSD requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link established by medical evidence between current symptomatology and the claimed in-service stressor. See 38 C.F.R. § 3.304(f) (1995); see also VA Adjudication Procedure Manual M21-1 (hereinafter M21-1), Part VI, paragraph 7.46 (first sentence) (Oct. 11, 1995). 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 in-service stressor. Id.; see also M21-1, Part VI, paragraph 7.46(c)(1). Initially, the Board notes that the veteran’s claim is well- grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, based on February and June 1992 statements from VA physicians, the veteran has presented a claim which is plausible. Murphy v. Derwinski, 1 Vet.App. 78 (1990). We are also satisfied that all relevant facts have been properly developed with respect to the claim, and that no further assistance to the veteran is required in order to comply with the VA’s duty to assist him in the development of his claim, as required by 38 U.S.C.A. § 5107(a). Service records, which include the veteran’s DD-214, indicate that the veteran served in Vietnam from April 1968 to April 1969 and was a communications center specialist. He received a number of awards, including the Army Commendation and Air Medals. A review of the veteran’s service medical records reveals that the veteran was treated on several occasions in 1969 for headaches, which were described as severe and often accompanied by nausea. According to a September 1969 entry, the veteran stated that he had experienced similar headaches since he had been a child. On a June 1970 separation examination, the veteran was given a normal clinical psychiatric evaluation. In his own report of medical history dated in June 1970, the veteran indicated that he had experienced depression, excessive worry, and nervous trouble; the examiner commented on the report that the veteran had anxiety due to family problems. The examiner also wrote that the veteran had headaches which had occurred in childhood. In May 1989, the RO wrote to the veteran in an attempt to assemble all pertinent information relevant to his PTSD claim. The RO asked the veteran to provide the name of the specific unit to which he was assigned at the time of the alleged stressful incident(s), his special duty assignments, a description of the stressful events or incidents to include names and other identifying information concerning any other individuals involved, any medals, decorations, or commendations received, and whether he received any wounds. The RO also asked the veteran if he had been a prisoner of war and how his nervous condition affected his daily life as well as the dates and places where he had received treatment for the condition since discharge. In an October 1990 letter, the veteran responded that he had been assigned to Company A of the 34th Signal Battalion at Can Tho, Vietnam, and that he had been an air courier who flew from place to place carrying classified material. He added that he logged 356 hours of time in the air, and rode “shotgun” on convoy. He also wrote that he performed guard details for Vietnamese prisoners. The veteran related that the plane on which he traveled as an air courier was shot up several times while he was aboard, and that the tail rotor “went bad” on one occasion just before landing which resulted in a controlled crash landing. He also wrote that his home airfield was attacked and under fire a number of times when he stayed overnight in the field. The veteran explained that he was in Bung Taw during the TET Offensive and it was pretty much destroyed. He noted that, on one occasion, he was thrown through the air by the concussion from a mortar explosion, although he was never treated for any injury. In October 1990, the veteran underwent VA psychiatric and psychological testing. A VA psychologist conducted an MMPI profile and stated that the profile was not valid since gross elevations suggested an exaggerating response pattern in all clinical scales. The psychologist added that the veteran’s observed behavior could not be reconciled in the extreme profile elevation, and that the veteran did not relate any symptoms of PTSD in his complaints except the abuse of alcohol and drugs. At the VA examination, the examiner diagnosed rule out PTSD, rule out dysthymic disorder, mixed substance abuse in remission, and a mixed personality disorder. At the examination, the veteran related that he functioned as an air courier in Vietnam and did not see much direct ground action, but was a witness to extensive death and destruction which left a lasting impact on his mind. He added that he had experienced mortar attacks and had been shot at, and also noted that he had been a witness to death at a close range in Vietnam. The veteran was hospitalized at a VA facility from December 1991 to February 1992. Discharge diagnoses included chronic PTSD evinced by survivor guilt, impacted grief, isolation, avoidance, emotional numbing and anhedonia, recurrent intrusive memories and images of Vietnam combat and casualties, a sense of futility, and a sense of a foreshortened life. The examiner noted the veteran’s history of polysubstance abuse and dependence, and also diagnosed a borderline personality disorder. The examiner wrote in the hospital record that the veteran had stated his most hazardous duty in Vietnam involved being a flight courier. The veteran stated at the time that he was haunted and plagued by stressors such as being present when his helicopter picked up three Vietnamese prisoners of war and his service colleagues subsequently beat them and threw one out of the helicopter. He added that there were other missions in which the helicopter in which he was riding also picked up dead and dying GIs. The veteran explained that he felt like a “sitting duck” in the service when he was on flying missions, and also described the images and memories of rocket and mortar attacks at night. In January 1992, the veteran had another VA examination. The examiners diagnosed rule out PTSD. They added that the veteran had some PTSD symptoms, but that they were not sure that he met the complete protocol and criteria for the disorder. With regard to his service in Vietnam, the veteran related to the examiners that, as an air courier, he saw quite a few wounded people and casualties but was never really a participant. He added that one of the events that really came to his mind was seeing a Vietnamese soldier thrown out of a helicopter in which he was traveling. He explained that he was constantly haunted by the face of that soldier since discharge from the service. In February 1992, the veteran’s mother and sister submitted statements in support of his claim. His mother and sister both generally stated that they had observed a noticeable difference in the veteran’s personality upon his return from Vietnam. In June 1992, a VA physician, after conducting psychiatric, social and psychological testing, confirmed the earlier diagnosis of PTSD. Regarding the veteran’s service, the examining physician noted that the veteran arrived in Vietnam during the TET Offensive and was initially assigned to a Communications Center in a “safe” area that was soon hit by rockets and mortars. He reported his first recognition of the possibility of his own death at that point and reacted with serious anxiety. He was then sent to Can Tho where he was assigned to work as an air courier. The most striking and debilitating part of his job was that he was often alone in performing his duties. The veteran again related the incident in which he was aboard a helicopter as a courier when he witnessed a service colleague throw a Vietnamese soldier from the helicopter. The veteran also described seeing many sometimes severely wounded individuals who were picked up on the plane in which he was traveling. In July 1992, the RO asked the veteran to provide further information regarding the stressful events he experienced in the service so as to attempt to verify these occurrences. The veteran responded in a late July 1992 letter that he had been assigned to A Company of the 52nd Signal Battalion at Can Tho, Vietnam, and “the area of operations covered the whole of the IV Corps area.” He explained that many of the flights were regularly scheduled on Air America routes within the IV Corps area, and there were also many flights on unscheduled hops on any available military flight. These flights, he related, were on all types of aircraft, but most of them were on “choppers.” He stated that he always flew alone and never got to know any one crew or aircraft because he was on so many different aircraft during that period. He wrote that the episodes he described in his earlier letter all occurred on these chopper flights between the months of May 1968 to January or February 1969. He added that all of these episodes took place over 20 years ago. He stated that his recollection of exact dates and places was not possible for him as he had been trying to forget these incidents. With the information provided by the veteran in his letters, the RO wrote to the United States Army and Joint Services Environmental Group (ESG) in September 1992 in an attempt to verify the veteran’s claimed stressors. The ESG responded in March 1993 with a history of the 52nd Signal Battalion. The ESG responded that more information was needed, however, and asked for dates of specific combat incidents to within seven days as well as the type and location of each incident, number and full names of casualties, and units involved. In its letter, the ESG explained that Vietnam war records were often incomplete and seldom contained information about civilian incidents. The ESG further explained that the killing, accidentally or in combat, of civilians was extremely difficult to verify and incidents involving civilians or civilian establishments were not normally found in combat records. Generally, the ESG wrote that an incident could not be verified unless an it had been reported, and noted that the veteran would have to provide the “who, what, where and when” of each stressor. In response to the ESG’s letter, the RO wrote to the veteran again in May 1993 in an attempt to elicit more specific information from the veteran. The veteran’s representative responded that the veteran had already submitted information in October 1990. She added that examples of specific places were that the veteran served as a guard of Viet Cong in Can Tho, Vietnam, during 1969, and as a courier who traveled in a plane that was frequently under fire from the ground. The representative added that the plane trips in which the veteran participated left and returned from Can Tho, and that the veteran’s base in Can Tho was also under fire from the enemy on numerous occasions during 1968 and 1969. She explained that the veteran was also involved in the TET Offensive in Bung Taw in 1968. The veteran, she noted, participated mostly as a courier who flew in or around “hot” combat areas, even though his military occupational specialty was a communication center specialist. In July 1993, November 1993, and March 1994, the RO again wrote to the ESG in a further attempt to verify the veteran’s stressors. The ESG responded in late March 1994 with various enclosures pertaining the 52nd Signal Battalion. The ESG stated that its review of the record revealed enemy activities and casualties sustained in the unit’s area of operations during the 1968 TET Offensive. Review of other records from the 41st and 52nd Signal Battalions showed that enemy incidents increased in the Can Tho area after the 1969 TET Offensive. The ESG noted that a terrorist action in April 1969 caused three casualties. The ESG concluded that the veteran would have to provide more specific information in order to further research the incidents he described, including when his helicopter received ground fire and the TET offensive incidents. The ESG stated that it was unable to document that the veteran performed duties as a courier or that he guarded Viet Cong. The ESG was only able to verify that the veteran was a communication center specialist assigned to the signal units during his Vietnam tour. In August 1994, one of the veteran’s service colleagues stated that he had been assigned to the 52nd Signal Battalion in Can Tho with the veteran. He explained that both he and the veteran had the same military occupational specialty and that the 52nd Signal Battalion was responsible for much of the communication network in the IV Corps. Because transmission of information over the air waves was often time-consuming and not always desired, he explained, the unit dispatched an air courier unit in which he and the veteran were involved, even though their military occupational specialties were not changed. In summary, the veteran’s service colleague explained that the air courier assignment was a mixture of “some contentment and a notable amount of apprehension and sometimes trepidation.” He added that there was often a high level of tension when hand-delivering material to remote locations. Many of the regular flights were on Air America or U.S. Army aircrafts, and unfriendly fire was often encountered both on the ground and in landing and take-off sequences. He noted that daily flying activity became more and more stressful after a period of months. The veteran’s service colleague explained that he and the veteran were also often called to the Can Tho perimeter to defend against Viet Cong incursion. He also mentioned that the veteran guarded prisoners on work duty, and there was a notable amount of antagonism in the activity. In January 1995, a hearing was held at the RO before a hearing officer. The veteran’s representative stated that he received a variety a medals after service, and that his military occupational specialty was a communications center specialist. See Hearing Transcript (T), p. 1. The representative reiterated the veteran’s responses to the RO’s October 1990 PTSD claim development letter. T at 1, 2. The veteran testified that the first two or three months of his duty in Vietnam were in Bung Taw in which his job was to change the cryptoblocks in the machines. T at 2. During that time, he stated that he was frequently under fire and mortar attack. Id. He also stated that the building next to his barracks was destroyed in a mortar attack. Id. The veteran explained that he was an air courier in the service and worked almost everyday, but also performed guard duty which was mandatory. T at 3. The veteran testified about the frequent gun fire aimed at the aircraft on which he was traveling as a courier, and repeated the incident in which he saw a Vietnamese soldier thrown out of the aircraft. Id. The veteran mentioned that his home airfield was attacked several times by mortar as well as sniper. Id. In response to a question about whether he was involved in combat, he stated that he fired his rifle at flashes of light in the night and heard bullets going by his head. Id. He stated that he was wounded, but it had not been reported. Id. With regard to a question about stressors, the veteran stated that guarding Vietnamese prisoners was not easy, because he knew many of them had killed his friends and countrymen. Id. Based on the evidence described above, the Board has determined that, although the veteran’s claim is well- grounded, it must be denied. The Board first concludes that the veteran was not involved in combat during his time in the service. While he undoubtedly received numerous meritorious awards, he did not receive any that indicate participation in combat. He did receive both the Army Commendation and Air Medals, but “V” devices were not awarded along with them. Without such accompanying devices, these medals are not conclusive evidence of a claimed stressor during combat. See M21-2, Part VI, paragraph 7.46(c)(1). Furthermore, a review of the service records does not reveal evidence that the veteran engaged in combat. The incidents the veteran cites as stressors include (1) being an air courier and having the plane he was in shot at by enemy fire; (2) watching a service colleague throw a Vietnamese soldier out of a flying plane; (3) having to guard Vietnamese prisoners of war; (4) being on base during sniper fire and mortar attacks; (5) witnessing the destruction of a barracks next to his own; (6) seeing dead bodies and wounded soldiers brought on to the plane on which he was traveling as an air courier; and, (7) being on perimeter guard duty with bullets flying by his head. While some of these events are arguably related to combat, the preponderance of the evidence, including service records and the aforementioned lack of combat-related awards, is against finding that the events described above were related to combat. As a result, the Board rejects the assertion that the alleged stressors were combat-related. In light of the fact that the Board finds that the veteran did not engage in combat with the enemy, the record must contain credible supporting evidence that the claimed in- service stressor actually occurred. See 38 C.F.R. § 3.304(f). In this case, the veteran submitted as evidence of his in-service stressors his own testimony, a statement from a service colleague, and medical records, some of which contain diagnoses of PTSD. With regard to the stressors described above, the ESG, after several attempts, has been unable to verify any of the specific events claimed to be stressors by the veteran. In fact, the veteran never mentioned several of the claimed stressors listed above when he answered the RO’s questions and letters about his PTSD symptoms and stressors. With respect to the stressors he did mention in response to the RO’s inquiries, his responses lacked the specificity required by the ESG for further research. Although the RO attempted to retrieve more specific answers from the veteran, the veteran, in fact, noted in his July 1992 letter that his recollection of exact dates and places was poor. It is true, however, that any evidence from the service department or any other evidence supporting a description of the event is sufficient to establish the occurrence of a stressor. See M21-2, Part VI, paragraph 5.14(a). The Board notes that the veteran’s service colleague’s August 1994 statements attest to events 1, 3 and 7. The veteran’s service colleague’s statements do not verify, however, the other events described by the veteran. Of those events not verified by the veteran’s service colleagues, all that remains in support of them is the veteran’s testimony and statements. Of those events that were verified by the veteran’s service colleague, they were not mentioned in the January and June 1992 VA examinations in which the veteran was diagnosed with PTSD. Rather, these examination reports mentioned events 2 and 6, which have not been verified by either the veteran’s service colleague or any other source. Other VA examinations, as noted earlier, failed to reach a diagnosis of PTSD. In this case, while the veteran’s service colleague attested to several events and thereby verified their existence, there is no clear diagnosis of PTSD based on these verified stressors as required by 38 C.F.R. § 3.304(f). Rather, the diagnoses of PTSD in the record are based on unverified stressors provided to the examiner by the veteran. As the United States Court of Veterans Appeals has stated, neither the appellant’s testimony or after-the-fact medical nexus evidence is sufficient “credible supporting evidence” of the actual occurrence of an in-service stressor. See Moreau v. Brown, No. 94-883 (U.S. Vet. App. Sept. 12, 1996); Dizoglio v. Brown, 9 Vet.App. 163 (1996). In other words, neither the veteran’s written and oral statements nor the medical opinions of PTSD based on the veteran’s history establish the actual occurrence of an in-service stressor. There has been presented no credible supporting evidence that the claimed in-service stressors that had resulted in the diagnoses of PTSD, actually occurred. In the absence of diagnosis that is based on verifiable stressors, therefore, the Board is constrained to deny the veteran’s claim for service connection for PTSD. The preponderance of the evidence is against the claim. ORDER The appeal for service connection for PTSD is denied. MICHAEL A. PAPPAS Acting 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 -