Citation NR: 9630581 Decision Date: 10/29/96 Archive Date: 11/08/96 DOCKET NO. 93-21 073 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. Spear Ethridge, Associate Counsel INTRODUCTION The veteran had active duty from November 1967 to May 1969. This appeal arises from a February 1991 rating decision of the Department of Veterans Affairs in Seattle, Washington regional office (RO) which denied the veteran's petition to reopen his claim of entitlement to service connection for post-traumatic stress disorder (or PTSD). In a November 1992 Hearing Officer’s Decision, the RO determined that the veteran had submitted evidence which was new and material to reopen the claim, and that the claim remained denied. As the decision on the merits of the case remains adverse to the veteran, this appeal is properly before the Board of Veterans’ Appeals (Board). The veteran has also initiated claims for service connection for depression, alcohol dependence as secondary to PTSD, and a total disability rating based on individual unemployability. These issues have not been developed for appellate review and are referred to the RO for further development. CONTENTIONS OF APPELLANT ON APPEAL Essentially, the veteran contends that PTSD began in service and persists to the present. 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 evidence supports the claim for service-connection for post-traumatic stress disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's claim has been obtained insofar as possible. 2. A medical diagnosis of PTSD was shown on VA examination in 1992. 3. The veteran had no combat experience in service. 4. Credible supporting evidence of an inservice stressor has been corroborated by the Environmental Support Group; and the disorder of PTSD resulted from the veteran’s inservice stressor. CONCLUSION OF LAW The veteran’s disability of post-traumatic stress disorder was incurred in service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. §§ 3.304 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duty to Assist Initially, the Board notes that the provisions of 38 U.S.C.A. § 5107 have been met, in that the claim is well grounded and adequately developed. In a statement dated in October 1996, the representative argues that some of the veteran’s private and Department of Veterans Affairs (VA) treatment records were not obtained by the RO during the development of the veteran’s claim for PTSD. The Board has reviewed the claims file and determines that the missing records purportedly relate to treatment that the veteran received for PTSD during the 1960’s. Since there are more current documents on file, showing diagnoses and treatment for PTSD, the Board does not find it necessary to obtain the missing medical records in order to adjudicate the merits of this claim. Therefore, no further assistance to the veteran is required at this time to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Murphy v. Derwinski, 1 Vet.App. 78 (1990). II. Pertinent Law and Regulations 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 (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). More specifically, the Court of Veterans Appeals (the Court) has articulated a number of considerations that must be addressed in claims of service connection for post-traumatic stress disorder. In the case of Zarycki v. Brown, 6 Vet.App. 91 (1993), the Court set forth the framework for establishing the presence of a recognizable stressor, which is the essential prerequisite to support the diagnosis of post- traumatic stress disorder. Regarding combat related service, the Court articulated a two-step process of determining whether a veteran “engaged in combat with the enemy.” First, it must be 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. If the determination with respect to this step is affirmative, then a second step requires that the veteran’s lay testimony regarding claimed stressors must be accepted as conclusive after the actual occurrence and no further development or corroborative evidence will be required. Regarding noncombat stressors, the Court has most recently held that “credible supporting evidence” means that the veteran’s testimony, by itself, cannot, as a matter of law, establish the occurrence of a noncombat stressor; nor can credible supporting evidence of the actual occurrence of an inservice stressor consist solely of after-the-fact medical nexus evidence. See Moreau v. Brown, No. 94-883 (U.S. Vet.App. Sept. 12, 1996); Dizoglio v. Brown, 9 Vet.App. 163, 166 (1996). Additionally, the Court held that 38 C.F.R. § 3.304(f), and M21-1, Part VI, paragraph 7.46(c)(1), allow for a more favorable method of demonstrating the existence of inservice stressors. Marcoux v. Brown, No. 95-52 (U.S. Vet.App. Aug. 5, 1996). III. Evidence of Record The veteran asserts that PTSD began in service and persists to the present. The service department records show that the veteran received a National Defense Service Medal, and a Vietnamese Service Medal. He served one year, one month and nineteen days of foreign service. In an undated letter, probably received in 1986, the veteran stated that he witnessed a friend get killed in service while bringing in landing craft. The evidence of record reveals that in June 1988, the veteran reported having a “nervous breakdown” during a VA group therapy session. The veteran received Social Security Administration disability benefits in October 1988. A corresponding report indicated that the veteran was seen in 1985 by a private physician, and that the diagnosis was PTSD. In November 1991, the veteran was seen at the VA Mental Health Center. A counselor and medical psychiatrist rendered a diagnostic history of chronic and delayed PTSD; and extreme psychological and social stressors made up of traumatic Navy experiences including death and dying of others. At a personal hearing in August 1992, the veteran testified that he was a deck hand in the Navy and that he helped to bring in landing craft. Hearing Transcript (T.) at 2. He was stationed aboard the vessel Vancouver, where he would make sure that the landing air craft were secure and ready to be pulled out of the water. T. 3. The Vancouver carried a number of detachment Marines aboard, and the Marines were used for search and destroy missions on the beaches of Vietnam. T. 4. The veteran testified that he saw Marines in head bandages, and with wounded soldiers, when they returned from their missions. T. 4. He stated that in June or July of 1968, he witnessed a fellow comrade get killed. T. 5. The veteran described that it was a stormy night at sea, that they were bringing in landing craft, and that the “line snapped,” and killed the comrade. T. 5-6. The veteran indicated that he was positioned “across the catwalk” from where the comrade was killed. The veteran testified that he saw the cable hit the comrade and that there were sparks thereafter. T. 7. The veteran testified to the name of the comrade killed from a list of names published for the casualties of the Vietnam war. T. 7. Following the personal hearing, the veteran was seen at VA for psychiatric counseling. The veteran underwent an extensive VA examination for PTSD in September 1992. The VA psychiatric examiner reviewed the veteran’s claims folder, which included a Social and Industrial Survey, done by a VA social worker a few days earlier. The examiner noted that the veteran gave a history of having a traumatic early life, including problems with an abusive step father and a institutionalized mother. On his first day in Vietnam, the air field was evacuated because of the threat of an attack. The veteran did not have a weapon, although he was told to watch out for sniper fire. Later he was assigned to the USS Vancouver, which was described as a 500 foot ship that carried a number of smaller landing craft, as well as a compliment of Marines. The ship was armed and had helicopters. The veteran reported that he was a gunner when he was on general quarters. His job was to help secure the landing craft that came into the open stern of the Vancouver. In pertinent part, the veteran stated that he was on a cat-walk on one side of that opening when a man across from him was killed. The man was helping to tie up the landing craft during stormy seas, when a cable snapped, hit the man in the head and killed him. The incident was something that the veteran witnessed on the other side of the ship and it happened to someone who was doing the same job that he was doing at the time. The veteran felt that it just as easily could have been himself who was killed. The veteran further reported on his lifestyle after service separation, to include drug and alcohol usage, and a broken marriage. The examiner reported that the veteran had intrusive thoughts about Vietnam, with dreams related to Vietnam. He had anger and rage, he startled easily, and he had hypervigilent behavior. The veteran reported that he had feelings of guilt because he was still alive and many veterans had committed suicide, and because his duties aboard the ship were easy as compared to the men who served in the bush. The mental status portion of the examination revealed that hygiene and grooming were fair. The examiner noted that the veteran’s affect appeared depressed with underlying anger. He spoke in a clear voice, and his manner was cooperative but somewhat detached. It was noted that the posture was tense, that the veteran indicated that he “was not real happy,” and that he had "peace with his alcoholism.” The veteran was alert and oriented to person, place and time, and there was no delusional thinking evident. The examiner noted that there were no hallucinations or thought disorders, and that psychological insight seemed poor as did the veteran’s judgment. Recent and remote memory and recall were grossly intact and the veteran appeared to be of average intelligence. The assessment was that the veteran had received various diagnoses over the years, that he had a traumatic childhood where he was frequently beaten and threatened by his stepfather, and that he clearly had difficulties adjusting to the Navy before he wen to Vietnam. He had a difficult time in boot camp and wen AWOL. The examiner stated that “[g]iven his traumatic background, the veteran certainly would be more sensitive to traumatic stressors in Vietnam.” The examiner also opined that the only incidents that the veteran mentioned that might qualify as traumatic stressors were when he discovered a bunkmate dead one morning and an incident where he saw a man doing his same duty be killed by a snapping cable. The examiner felt that those would qualify as experiences that were outside of the usual range of human experience and therefore were traumatic stressors. The examiner further opined that the veteran lived a very dysfunctional life since service separation, but that not all of his difficulties were attributable to his experiences in Vietnam; some were related to a traumatic childhood. In pertinent part, the diagnoses were Axis I, PTSD, dysthymia, and alcohol dependence in remission. The veteran was hospitalized at VA from October 1992 to November 1992, for treatment and diagnosis of PTSD. During his hospital course the veteran was admitted to the PTSD program, where he remained quite anxious. It was noted that he responded poorly to medication, and that he did not verbalize despondency, depression or thoughts of suicide during the hospital stay. VA outpatient treatment records dated from August 1992 to April 1993 show that he veteran received therapy at the VA Mental Health Clinic. In November 1993, the Environmental Support Group (ESG) verified that on July 29, 1968, a soldier died from a massive intracranial trauma sustained from a parted line while handling boats in the well deck aboard the Vancouver. The record includes a copy of the Vancouver’s July 29, 1968 deck log entry which described the accident. IV. Analysis The Board has reviewed the evidence relevant to this claim, and determines that the legal tests required to show service connection for PTSD are supported by the evidence of record. Namely, that medical evidence shown by VA examination in September 1992 establishes a clear diagnosis of PTSD. The veteran related an account of his inservice stressor to the examiner, as well stating the stressor situation during a personal hearing in August 1992. While the veteran does not have combat service, the Board finds that his inservice stressor is supported by credible evidence. Namely the veteran claims to have witnessed the death of a fellow comrade who was killed by a cable line while doing the same job as the veteran. The ESG verified that the accident described by the veteran occurred in July 1968, and that in fact, the soldier died as a result of injuries sustained therein. It is recognized that a link between the current symptomatology of PTSD and the veteran’s statements regarding his stressor experience in service is established by the medical evidence of record. A thorough medical examination in 1992 showed that the veteran experienced incidents in service that were considered outside the range of usual experience. The veteran was hospitalized during 1992 for PTSD treatment. Currently, the veteran manifests symptoms of panic attacks, feelings of isolation, distressing dreams, occasional startle reaction, and guilt of survival, all symptomatology consistent with the diagnosis of PTSD. For the foregoing reasons, the Board finds that the evidence supports a grant of service connection for post-traumatic stress disorder. ORDER The claim for service connection for post-traumatic stress disorder is granted. V. L. JORDAN 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 -