Citation NR: 9738065 Decision Date: 11/14/97 Archive Date: 11/19/97 DOCKET NO. 94-20 817 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Character of service from September 25, 1975 to April 22, 1977. 2. Entitlement to service connection for chronic headaches. 3. Entitlement to service connection for drug dependency. 4. Entitlement to service connection for post traumatic stress disorder (PTSD). 5. Entitlement to service connection for a skin disorder secondary to Agent Orange exposure. 6. Entitlement to service connection for sinusitis and bronchitis. 7. Entitlement to service connection for a stomach disorder to include gastroenteritis. 8. Entitlement to an increased (compensable) disability evaluation for residuals of hepatitis A. 9. Entitlement to an increased (compensable) disability evaluation for alopecia areata. 10. Entitlement to a 10 percent disability evaluation based upon multiple noncompensable disability evaluations. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J.W. Engle, Counsel INTRODUCTION This matter comes before the Board of Veterans’ Appeals (Board) on appeal from decisions by the Nashville, Tennessee, Department of Veterans Affairs (VA) Regional Office (RO). CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that his period of service from September 25, 1975 to April 22, 1977, should be considered as qualifying service for VA compensation purposes. He further argues that his service-connected alopecia and residuals of hepatitis A warrant compensable disability evaluations. Alternatively, he contends that his multiple noncompensable disability evaluations combine to impair his daily functioning and as such a 10 percent disability evaluation is warranted pursuant to 38 C.F.R. § 3.324 (1996). In addition, he argues that he has developed a skin disorder secondary to Agent Orange exposure and that a chronic headache disorder, drug dependency, sinusitis/bronchitis and a stomach disorder had their onset during service. Finally, he asserts that as a result of his experiences in Vietnam, he has developed PTSD. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), has reviewed and considered all of the evidence and material of record in the veteran’s claims file(s). 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 appellant has failed to submit evidence of well grounded claims for service connection for a skin disorder secondary to Agent Orange exposure, a chronic headache disorder, sinusitis/bronchitis, a chronic stomach disorder to include gastroenteritis and PTSD. Furthermore, consideration of VA compensation benefits for the period of service from September 25, 1975 to April 22, 1977, is barred by statute and VA compensation benefits are not available for drug dependency. In addition, the preponderance of the evidence is against entitlement to compensable disability evaluations for residuals of hepatitis A and alopecia areata and for a 10 percent disability evaluation based upon multiple noncompensable disability evaluations. FINDINGS OF FACT 1. There is no evidence of compelling reasons to warrant the appellant’s 204 day absence without leave and there is no evidence that the appellant was insane during this time period. 2. There is no competent evidence of record to establish the presence of a chronic skin disorder which is due to Agent Orange exposure. 3. There is no competent evidence of record to establish the presence of a chronic headache disorder, sinusitis, bronchitis, or a chronic stomach disorder to include gastroenteritis which are related to the appellant’s period of active duty. 4. The appellant reported that he used illicit drugs during service. The evidence of record reflects a diagnosis of polysubstance dependence, in full remission. 5. The record does not reflect that the appellant engaged in combat with the enemy during his period of active duty. 6. Although PTSD has been diagnosed, the occurrences of the appellant’s claimed Vietnam service stressor incidents are not corroborated by credible supporting evidence. 7. The appellant’s hepatitis A is manifested by a history of active infection with no current evidence of chronic liver disease with associated mild gastrointestinal disturbance. 8. The appellant’s alopecia areata is manifested by spots 3 cm. across on his crown and 2 cm. in diameter on the chin in the beard area and is not shown to be disfiguring. 9. The appellant’s noncompensable service-connected disabilities are not shown to interfere with normal employability. CONCLUSIONS OF LAW 1. The appellant’s 204 day period of absence without leave is a bar to consideration of VA compensation benefits for the period of service from September 25, 1975 to April 22, 1977. 38 C.F.R. § 3.12 (1996). 2. The claims to service connection for a skin disorder secondary to Agent Orange exposure, a chronic headache disorder, sinusitis/bronchitis, and a chronic stomach disorder to include gastroenteritis are not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The appellant’s polysubstance abuse is the result of his own willful misconduct. 38 U.S.C.A. §§ 105, 1110 (West 1991); 38 C.F.R. §§ 3.1(n), 3.301(c) (1996). 4. The claim to service connection for PTSD is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 5. The schedular criteria for a compensable disability evaluation for hepatitis A are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, Diagnostic Code 7345 (1996). 6. The schedular criteria for a compensable disability evaluation for alopecia areata are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, Diagnostic Code 7817 (1996). 7. A 10 percent disability rating is not warranted for the appellant's noncompensable service-connected disabilities. 38 C.F.R. § 3.324 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Character of Service Review of the record reveals that on August 19, 1976, the appellant went absent without leave (AWOL) until the Federal Bureau of Investigation recovered him on March 10, 1977. The total number of days the appellant was found to be AWOL was 204. In October 1991, an Army Discharge Review Board upgraded the appellant’s discharge from under other than honorable conditions to under honorable conditions (general). In March 1994, the RO rendered an Administrative Decision regarding the character of the appellant’s service. It was noted that the appellant’s period of service from September 25, 1972 to September 24, 1975 was under honorable conditions pursuant to 38 C.F.R. § 3.13(c), and that the appellant is entitled to all applicable benefits for this period of service for which he may be eligible. However, it was further determined that the appellant’s service from September 25, 1975 to April 22, 1977, was dishonorable and as such is a statutory bar to VA benefits pursuant to 38 C.F.R. § 3.12(c) (6), due to his period of absence without leave for a period of 180 days of more without evidence of compelling reasons. 38 C.F.R. § 3.12 provides the following: (a) If the former service member did not die in service, pension, compensation, or dependency and indemnity compensation is not payable unless the period of service on which the claim is based was terminated by discharge or release under conditions other than dishonorable. (38 U.S.C. 101(2)). A discharge under honorable conditions is binding on the Department of Veterans Affairs as to character of discharge. (b) A discharge or release from service under one of the conditions specified in this section is a bar to the payment of benefits unless it is found that the person was insane at the time of committing the offense causing such discharge or release or unless otherwise specifically provided (38 U.S.C. 5303(b)). (c) Benefits are not payable where the former service member was discharged or released under one of the following conditions: (1) As a conscientious objector who refused to perform military duty, wear the uniform, or comply with lawful order of competent military authorities. (2) By reason of the sentence of a general court- martial. (3) Resignation by an officer for the good of the service. (4) As a deserter. (5) As an alien during a period of hostilities, where it is affirmatively shown that the former service member requested his or her release. See § 3.7(b). (6) By reason of a discharge under other than honorable conditions issued as a result of an absence without official leave (AWOL) for a continuous period of at least 180 days. This bar to benefit entitlement does not apply if there are compelling circumstances to warrant the prolonged unauthorized absence. This bar applies to any person awarded an honorable or general discharge prior to October 8, 1977, under one of the programs listed in paragraph (h) of this section, and to any person who prior to October 8, 1977, had not otherwise established basic eligibility to receive Department of Veterans Affairs benefits. The term established basic eligibility to receive Department of Veterans Affairs benefits means either a Department of Veterans Affairs determination that an other than honorable discharge was issued under conditions other than dishonorable, or an upgraded honorable or general discharge issued prior to October 8, 1977, under criteria other than those prescribed by one of the programs listed in paragraph (h) of this section. However, if a person was discharged or released by reason of the sentence of a general court-martial, only a finding of insanity (paragraph (b) of this section) or a decision of a board of correction of records established under 10 U.S.C. 1552 can establish basic eligibility to receive Department of Veterans Affairs benefits. The following factors will be considered in determining whether there are compelling circumstances to warrant the prolonged unauthorized absence. (i) Length and character of service exclusive of the period of prolonged AWOL. Service exclusive of the period of prolonged AWOL should generally be of such quality and length that it can be characterized as honest, faithful and meritorious and of benefit to the Nation. (ii) Reasons for going AWOL. Reasons which are entitled to be given consideration when offered by the claimant include family emergencies or obligations, or similar types of obligations or duties owed to third parties. The reasons for going AWOL should be evaluated in terms of the person's age, cultural background, educational level and judgmental maturity. Consideration should be given to how the situation appeared to the person himself or herself, and not how the adjudicator might have reacted. Hardship or suffering incurred during overseas service, or as a result of combat wounds of other service-incurred or aggravated disability, is to be carefully and sympathetically considered in evaluating the person's state of mind at the time the prolonged AWOL period began. (iii) A valid legal defense exists for the absence which would have precluded a conviction for AWOL. Compelling circumstances could occur as a matter of law if the absence could not validly be charged as, or lead to a conviction of, an offense under the Uniform Code of Military Justice. For purposes of this paragraph the defense must go directly to the substantive issue of absence rather than to procedures, technicalities or formalities. (d) A discharge or release because of one of the offenses specified in this paragraph is considered to have been issued under dishonorable conditions. (1) Acceptance of an undesirable discharge to escape trial by general court-martial. (2) Mutiny or spying. (3) An offense involving moral turpitude. This includes, generally, conviction of a felony. (4) Willful and persistent misconduct. This includes a discharge under other than honorable conditions, if it is determined that it was issued because of willful and persistent misconduct. A discharge because of a minor offense will not, however, be considered willful and persistent misconduct if service was otherwise honest, faithful and meritorious. (5) Homosexual acts involving aggravating circumstances or other factors affecting the performance of duty. Examples of homosexual acts involving aggravating circumstances or other factors affecting the performance of duty include child molestation, homosexual prostitution, homosexual acts or conduct accompanied by assault or coercion, and homosexual acts or conduct taking place between service members of disparate rank, grade, or status when a service member has taken advantage of his or her superior rank, grade, or status. (e) An honorable discharge or discharge under honorable conditions issued through a board for correction of records established under authority of 10 U.S.C. 1552 is final and conclusive on the Department of Veterans Affairs. The action of the board sets aside any prior bar to benefits imposed under paragraph (c) or (d) of this section. (f) An honorable or general discharge issued prior to October 8, 1977, under authority other than that listed in paragraphs (h) (1), (2) and (3) of this section by a discharge review board established under 10 U.S.C. 1553 set aside any bar to benefits imposed under paragraph (c) or (d) of this section except the bar contained in paragraph (c)(2) of this section. FR Update 3/28/97 (g) An honorable or general discharge issued on or after October 8, 1977, by a discharge review board established under 10 U.S.C. 1553, sets aside a bar to benefits imposed under paragraph (d), but not paragraph (c), of this section provided that: (1) The discharge is upgraded as a result of an individual case review; (2) The discharge is upgraded under uniform published standards and procedures that generally apply to all persons administratively discharged or released from active military, naval or air service under conditions other than honorable; and (3) Such standards are consistent with historical standards for determining honorable service and do not contain any provision for automatically granting or denying an upgraded discharge. (h) Unless a discharge review board established under 10 U.S.C. 1553 determines on an individual case basis that the discharge would be upgraded under uniform standards meeting the requirements set forth in paragraph (g) of this section, an honorable or general discharge awarded under one of the following programs does not remove any bar to benefits imposed under this section: (1) The President's directive of January 19, 1977, implementing Presidential Proclamation 4313 of September 16, 1974; or (2) The Department of Defense's special discharge review program effective April 5, 1977; or (3) Any discharge review program implemented after April 5, 1977, that does not apply to all persons administratively discharged or released from active military service under other than honorable conditions. (Authority: 38 U.S.C. 5303 (e)) The Board has carefully considered the record including the appellant’s testimony at his hearings in July 1995 and May 1997. However, there is no evidence of record which the Board finds persuasive and such to remove the statutory bar to VA benefits for the period of service from September 25, 1975 to April 22, 1977. Although the appellant has made vague arguments regarding depression, polysubstance abuse and that he was married with a child when he was transferred to Germany, there is no corroborative documentation of record contemporaneous with these events such to provide a basis to conclude that compelling reasons were present at that time. Furthermore, while the appellant has argued that the period of time during which he was confined after being returned to military control should not be considered as part of his period of being AWOL, and therefore his total period of being AWOL should only be 155 days, the appellant has not submitted any authority for this proposition and the Board finds no supporting authority within the applicable law or regulations. In fact, the service department concluded that the appellant was AWOL for 204 days and absent clear evidence to the contrary, the VA is bound by these findings. See Duro v. Derwinski, 2 Vet. App. 530 (1992). In addition, the Board notes that with respect to “lost time”, an enlisted member of an armed force who is absent from his organization, station, or duty for more than one day without proper authority, as determined by competent authority, or is confined for more than one day while awaiting trial and disposition of his case, and whose conviction has become final, is liable, after his return to full duty, to serve for a period that, when added to the period that he served before his absence from duty, amounts to the term for which he was enlisted or inducted. See 10 U.S.C.A. § 972 (West 1991). Thus, the Board finds that the appellant’s period of confinement while awaiting disposition of his case is not considered to be a return to his duty status. Accordingly, in view of the above, and the lack of any additional evidence to the contrary, the Board concludes that the appellant’s period of service from September 25, 1975 to April 22, 1977, was dishonorable and as such is a statutory bar to VA benefits. II. Service Connection for Drug Dependency Service connection essentially requires that the facts, as shown by the evidence, establish that a particular injury or disease resulting in chronic disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C.A. § 111o (West 1991); 38 C.F.R. § 3.303 (1996). Service connection may also be established where there is additional disability which is proximately due to or the result of a service-connected disorder. 38 C.F.R. § 3.310(a) (1996). However, a disability will not be considered to have been incurred or aggravated in the line of duty, if the disability was the result of the veteran’s willful misconduct. 38 U.S.C.A. § 105 (West 1991). Primary alcoholism and drug abuse are considered, by regulation, the result of willful misconduct. 38 C.F.R. § 3.301(c)(2), (3) (1996). The evidence of record in this case reflects that the appellant has reported a long history of alcohol and polysubstance abuse during and after service discharge. Various diagnoses are of record including alcohol dependence and cocaine abuse, reportedly in remission, and polysubstance dependence, in full remission. However, in view of the above applicable regulations, the undersigned concludes that service connection for drug dependence is precluded as such behavior is deemed to be willful misconduct. 38 U.S.C.A. §§ 105, 1110 (West 1991); 38 C.F.R. §§ 3.1(n), 3.301(c) (1996); Hayward v. Derwinski, U.S. Vet. App. No. 90-159 (1991), see also VA O.G.C. Prec. op. 11-96 (Nov. 15, 1996). III. Well Grounded Claims Skin Disorder Secondary to Agent Orange Exposure, a Chronic Headache Disorder, Sinusitis/Bronchitis, and a Chronic Stomach Disorder to include Gastroenteritis The threshold question to be answered at the outset of the analysis of any case is whether the appellant’s claims are well grounded; that is, whether they are plausible, meritorious on their own, or otherwise capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78 (1990). If a particular claim is not well-grounded, then the appeal fails and there is no further duty to assist in developing facts pertinent to the claim since such development would be futile. 38 U.S.C.A. § 5107(a) (West 1991). An appellant has, by statute, the duty to submit evidence that a claim is well grounded. The evidence must “justify a belief by a fair and impartial individual” that the claim is plausible. 38 U.S.C.A. § 5107(a) (West 1991). Where such evidence is not submitted, the claim is not well grounded, and the initial burden placed on the appellant is not met. See Tirpak v. Derwinski, 2 Vet. App. 609 (1992). For service connection to be granted as noted above, it is required that the facts, as shown by the evidence, establish that a particular injury or disease resulting in chronic disability was incurred in service, or, if pre-existing service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1996). Furthermore, with chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (1996). This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, etc., in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, etc., first shown as a clear-cut clinical entity, at some later date. Idem. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Id. (emphasis added) Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. In addition, service may be warranted where the evidence of record establishes the presence of disability which is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310 (1996). In reviewing the appellant’s claims, the Board has considered the guidelines for well-grounded claims as set forth in Caluza v Brown, 7 Vet. App. 498 (1995), specifically, that there must be: (1) evidence of a current disability as provided by a medical diagnosis; (2) evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, (3) a nexus, or link, between the in-service disease or injury and the current disability as provided by competent medical evidence. See also 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1996); Layno v. Brown, 6 Vet. App. 465, 470 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). With respect to Agent Orange claims, a veteran who served on active duty in the Republic of Vietnam during the Vietnam era and has a disease listed in § 3.309(e), shall be presumed to have been exposed during such service to a herbicide agent (Agent Orange), unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii) (1996). If a veteran was exposed to a herbicide agent during active service, the following diseases shall be service-connected, if the requirements of 38 C.F.R. § 3.307(a) (1996) are met, even if there is no record of such disease during service: chloracne or other acneform diseases consistent with chloracne, Hodgkin’s disease, multiple myeloma, non-Hodgkin’s lymphoma, porphyria cutanea tarda, respiratory cancers, and soft-tissue sarcomas. 38 C.F.R. § 3.309(e) (1996). The term “soft- tissue sarcoma” includes the following: adult fibrosarcoma; dermatofibrosarcoma protuberans; malignant fibrous histiocytoma; liposarcoma; leiomyosarcoma; epithelioid leiomyosarcoma (malignant leiomyoblastoma); rhabdomyosarcoma; ectomesenchymoma; angiosarcoma (hemangiosarcoma and lymphangiosarcoma); proliferating (systemic) angioendotheliomatosis; malignant glomus tumor; malignant hemangiopericytoma; synovial sarcoma (malignant synovioma); malignant giant cell tumor of tendon sheath; malignant schwannoma, including malignant schwannoma with rhabdomyoblastic differentiation (malignant Triton tumor), glandular and epithelioid malignant schwannomas; malignant mesenchymoma; malignant granular cell tumor; alveolar soft part sarcoma; epithelioid sarcoma; clear cell sarcoma of tendons and aponeuroses; extraskeletal Ewing's sarcoma; congenital and infantile fibrosarcoma; and malignant ganglioneuroma. 38 C.F.R. § 3.309(e) (1996). The Secretary of the VA has determined that a presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See Notice, 59 Fed.Reg. 341 (1994). Notwithstanding the foregoing, the United States Court of Appeals for the Federal Circuit has determined that the Veterans’ Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, Pub. L. No. 98-542, § 5, 98 Stat. 2724, 2727- 29 (1984), does not preclude a veteran from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed.Cir. 1994). However, the United States Court of Veterans Appeals has held that where the issue involves medical causation, competent medical evidence that shows that the claim is plausible or possible is required to set forth a well-grounded claim. Caluza v. Brown, 7 Vet. App. 498 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). After review of the evidence of record, the Board concludes that the appellant’s claims to service connection for a skin disorder secondary to Agent Orange exposure, a chronic headache disorder, sinusitis/bronchitis, and a chronic stomach disorder to include gastroenteritis are not well grounded. While the service medical records reflect that the appellant was seen for bronchitis, gastroenteritis and tension headaches, none of these findings were considered to be representative of chronic disorders during service. Furthermore, there were no significant findings on examination in July 1976. The post service medical evidence is significant for the lack of pertinent findings on VA examination in May 1992. At that time, the appellant’s sinuses, respiratory system, and skin other than the service-connected alopecia areata, were normal. Furthermore, on special digestive system examination, the examiner commented that the appellant’s reported nausea and vomiting are most likely neurogenic and/or psychogenic and stress related and that his complaints do not follow a typical physiologic pattern for traditional organic gastrointestinal disease. On subsequent VA digestive system examination in January 1993, the examiner indicated that it was his opinion that the occasional nausea and vomiting were probably related to the appellant’s chronic depression. With respect to all of the above claims, there is no additional evidence of record to meet the first requirement of a well grounded claim, specifically, evidence of current disability as provided by a medical diagnosis. Accordingly, in view of the lack of current diagnoses of chronic disorders, the appellant’s claims to service connection for service connection for a skin disorder secondary to Agent Orange exposure, a chronic headache disorder, sinusitis/bronchitis, and a chronic stomach disorder to include gastroenteritis are not well grounded In reaching this conclusion, the Board has carefully considered the appellant’s contentions and testimony regarding the onset and presence of the disabilities which are the subject of his claims. Although evidentiary assertions by the appellant must be accepted as true for the purposes of determining whether a claim is well grounded, these assertions do not have to be accepted where they are found to be inherently incredible. See King v. Brown, 5 Vet. App. 19 (1993). In this case, the appellant’s evidentiary assertions regarding the presence of disability associated with the above claims are found to be inherently incredible when viewed in the context of the total record as summarized above. The Board notes that the quality and quantity of the evidence required to meet the statutory burden of submitting evidence of a well-grounded claim will depend upon the issue presented by the claim. Where the issue is factual in nature, e.g., whether an incident or injury occurred in service, competent lay testimony, including a veteran’s solitary testimony, may constitute sufficient evidence to establish a well-grounded claim under 38 U.S.C.A. § 5107(a). See Cartright v. Derwinski, 2 Vet. App. 24 (1991). However, where as in this case, the determinative issue involves a medical diagnosis, competent medical evidence to the effect that the claim is “plausible” or “possible” is required. See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). As noted above, the Board has carefully considered the appellant’s statements and contentions with respect to his claims; however, through these statements alone, he cannot meet the burden imposed by section 5107(a) merely by presenting lay beliefs as to his current diagnoses and their relationship to service because his current diagnoses and their relationship to any time period or other disability are medical conclusions and lay persons are not competent to offer medical opinions. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Consequently, lay assertions of medical etiology or diagnosis cannot constitute evidence to render a claim well grounded under section 5107(a). The Board notes that where the appellant has not met the burden of submitting evidence of a well-grounded claim, the VA has no duty to assist him in developing facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). Although where claims are not well grounded VA does not have a statutory duty to assist a claimant in developing facts pertinent to his claims, VA may be obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of evidence needed to complete his application. This obligation depends upon the particular facts of the case and the extent to which the Secretary of the Department of Veterans Affairs has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69 (1995). The appellant has not asserted that there is pertinent evidence available which, if obtained, could serve to make these claims well grounded. See Epps v. Brown, 9 Vet. App. 341, 344 (1996). While the RO did not specifically state that it denied the appellant’s claim for service connection for ulcer disease on the basis that it was not well-grounded, the Board concludes that this error was harmless. See Edenfield v. Brown, 8 Vet. App. 384 (1995) (en banc). The Board acknowledges that it has decided the above claims for service connection on a different basis than did the RO. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the appellant has been given adequate notice and opportunity to respond and, if not, whether he will be prejudiced thereby. See Bernard v. Brown, 4 Vet. App. 384 (1993). The Board concludes that he has not been prejudiced by the decision herein as his claims were based upon the merits of the issues which inherently includes the assertion that they meet the threshold requirement of being well grounded. See Meyer v. Brown, 9 Vet. App. 425 (1996 IV. PTSD Service connection for PTSD requires (1) medical evidence establishing a clear diagnosis of the condition; (2) credible supporting evidence that the claimed inservice stressor actually occurred; and (3) a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. 38 C.F.R. § 3.304(f) (1996); see also VA ADJUDICATION PROCEDURE MANUAL M21-1 (MANUAL M21-1), Part VI, 11.38 (Aug. 26, 1996) (reiterating the three PTSD service- connection requirements set forth in regulation § 3.304(f) and specifically requiring “credible supporting evidence that the claimed in-service stressor actually occurred”). The MANUAL M21-1 provisions in paragraph 11.38 are substantive rules which are “the equivalent of [VA] [r]egulations”. See Hayes v. Brown, 5 Vet. App. 60, 67 (1993) (citing Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991)). With regard to the second criterion, the evidence necessary to establish that the claimed stressor actually occurred varies depending on whether it can be determined that the veteran “engaged in combat with the enemy.” 38 U.S.C.A. § 1154(b) (West 1991); see also Gregory v. Brown, 8 Vet. App. 563 (1996); Collette v. Brown, 82 F.3d 389 (Fed.Cir. 1996). The United States Court of Veterans Appeals (the Court) has held that “[w]here it is 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, the veteran’s lay testimony regarding claimed stressors must be accepted as conclusive as to their actual occurrence and no further development for corroborative evidence will be required, provided that the veteran’s testimony is found to be ‘satisfactory,’ e.g., credible, and ‘consistent with the circumstances, conditions, or hardships of [combat] service.’” Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). However, where VA determines from the evidence that the veteran did not engage in combat with the enemy or where the veteran, even if he did engage in combat, is claiming stressors not related to combat, his lay testimony alone is not enough to establish that the stressors actually occurred. West (Carleton) v. Brown, 7 Vet. App. 70, 76 (1994); see also, Zarycki, 6 Vet. App. at 98. The MANUAL M21-1, as recently revised, provides that the required “credible supporting evidence” of a combat stressor “may be obtained from” service records or “other sources.” See Moreau v. Brown, 9 Vet. App. 389 (1996); see also Doran v. Brown, 6 Vet. App. 283 (1994). However, although corroborating evidence of a stressor is not restricted to service records, if the claimed stressor is related to combat, and in the absence of information to the contrary, receipt of any of the following individual decorations will be considered evidence of participation in a stressful episode: Air Force Cross Air Medal with “V” Device Army Commendation Medal with “V” Device Bronze Star Medal with “V” Device Combat Action Ribbon Combat Infantryman Badge Combat Medical Badge Distinguished Flying Cross Distinguished Service Cross Joint Service Commendation Medal with “V” Device Medal of Honor Navy Commendation Medal with “V” Device Navy Cross Purple Heart Silver Star See MANUAL M21-1, paragraph 11.38(c) (1). The regulations governing service connection for PTSD differ from those governing service connection for other conditions because they require evidence of an in-service stressor rather than evidence of “incurrence or aggravation” of a disease or injury in service or within a post-service presumptive period. The Court’s caselaw allows a physician’s opinion of causal nexus, in certain circumstances, to establish in-service or presumptive-period incurrence or aggravation even when the examination on which the opinion was based was made many years after service. See e.g., ZN v. Brown, 6 Vet. App. 183 (1994). However, since the requirements in § 3.304(f) for a “link, established by medical evidence, between current symptomatology and the claimed inservice stressor” and for “credible supporting evidence that the claimed in[-]service stressor actually occurred,” indicate that something more than medical nexus is required, the Court recently held in Moreau, supra, that “credible supporting evidence of the actual occurrence of an in-service stressor cannot consist solely of after-the-fact medical nexus evidence.” In addition, although the above-cited legal criteria may sometimes be at odds with the medical findings of an individual physician, the Board may disregard such medical findings if it determines on a factual basis that the alleged event (or series of events) is not of sufficient gravity or severity to qualify as a stressor. West, 7 Vet. App. 70, 78- 79 (1994) (noting that a significant diagnostic feature of PTSD requires that the sufficiency of the stressor be clinically established but not holding that this matter is purely a medical question in every case); Wilson v. Derwinski, 2 Vet. App. 614, 616-18 (1992) (affirming a Board decision which noted that whether an alleged event is a stressor is a question of fact for the Board to decide involving factors as much historical as psychological); see also Swann v. Brown, 5 Vet. App. 229 (1993) (holding that veteran’s descriptions of experiences in service “are not beyond the ordinary, i.e., they would not, in and of themselves, evoke symptoms in ‘almost everyone.’”); and, Wood v. Derwinski, 1 Vet. App. 190 (1991) (noting that service in a combat zone is stressful in some degree to all who are there, whatever their duties and experiences). Turning to the facts in this case, the Board notes that the appellant was diagnosed with PTSD on a VA psychiatric examination conducted in May 1993. This diagnosis was based on his reported complaints of recurrent intrusive thoughts, daydreams, flashbacks, and nightmares of the events he claimed to have experienced in Vietnam in 1969-70. He related these symptoms to various incidents including duty involving inspecting bodies, seeing a lot of “death and destruction” and being under fire. However, the Board also notes that the appellant has been diagnosed with various other disorders including alcohol dependence, cocaine abuse, in remission, adjustment disorder with mixed emotional features secondary to withdrawal from drug abuse and personality disorder on private psychiatric and psychological examination in March 1988. Additional diagnoses of personality disorder and chemical substance abuse, alcohol and drug addiction were noted on private examination in December 1992. Notwithstanding the May 1993, diagnosis of PTSD, the appellant’s available service department records do not corroborate the above-cited stressor accounts. Corroboration that he engaged in combat activity is not apparent from careful scrutiny of his official service records relating to his Vietnam tour of duty. Neither a combat citation listed under paragraph 11.38(c) (1) of the MANUAL M21-1 nor his military occupational specialty (clerk typist) indicates that he was exposed to more than the ordinary stressful environment in a combat zone in Vietnam, even given the fact that service in a combat zone is stressful in some degree to all who are there, whatever their duties and experiences. Wood, 1 Vet. App. 190 (1991). Moreover, development efforts undertaken by the RO in connection with the appellant’s claim are also essentially noncontributory. Inquiries to the United States Army and Joint Services Environmental Support Group (ESG), received in March 1994, while providing what would seem to be corroboration of one of the appellant’s reported stressor incidents in the documentation of the death of an individual the appellant indicated was a friend while he was in Vietnam, failed to corroborate the appellant’s stressor accounts which were reported either during the May 1993 examination or at any other instance in which the diagnosis of PTSD was discussed. Thus, other than the appellant’s own testimony and contentions on appeal, there is no service department or evidence from “other sources” which objectively verifies combat status or any of his stressors which were considered at the time the diagnosis was rendered. Accordingly, the Board concludes that in this case, where the question of whether credible supporting evidence that the claimed inservice stressor actually occurred is factual in nature, and not a medical question, the Board may therefore resolve this matter by applying the criteria adopted by the VA for this purpose from the MANUAL M21-1 and by referring to the above-cited cases where the Court has found, without recourse to medical evidence, that uncorroborated events do not constitute sufficient stressors to support a diagnosis of PTSD for the purposes of service connection. Since it has not been established that the appellant engaged in combat with the enemy during his tour of duty in Vietnam, his lay testimony, by itself, will not corroborate the occurrence of alleged stressors; instead, either his service records or evidence from “other sources” that is credible on its own terms must corroborate his stressors. However, as stated above, the evidence in this case is devoid of any service department or other credible evidence which supports the appellant’s description of his Vietnam service. In view of these findings, the Board concludes that a nexus between the May 1993 diagnosis of PTSD and “credible supporting evidence that the claimed in[-]service stressor actually occurred,” has not been established in this case. Furthermore, the Board concludes that the in view of the various psychiatric diagnoses of record, including the diagnosis of alcohol dependence, cocaine abuse reportedly in remission and adjustment disorder with mixed emotional features, secondary to withdrawal from drug abuse after detailed psychological evaluation to include psychological testing, the diagnosis of PTSD in May 1993 is not representative of a clear diagnosis of the condition to serve as the basis for service connection. 38 C.F.R. § 3.304(f) (1996). Considering the foregoing, the Board concludes that the appellant’s claim for service connection for PTSD is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); see Caluza v. Brown, 7 Vet. App. 498 (1995) (a “well grounded” claim for service connection requires evidence of a current disability as provided by a medical diagnosis; evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, a nexus, or link, between the in-service disease or injury and the current disability as provided by competent medical evidence). In this case, it is not shown that the appellant engaged in combat with the enemy during his war period service and there is no credible supporting evidence to corroborate the occurrence of the combat stressors that he claims to have experienced in Vietnam, nor is there a clear diagnosis of PTSD of record. In view of the above, the Board concludes that a remand is not required to take steps to verify the appellant’s exposure to these stressors, including another request for information from the ESG. A remand would serve no useful purpose in this case because the events do not meet the criteria which VA has adopted from the MANUAL M21-1 and against which the sufficiency of the evidence in individual cases must be weighed in determining whether service connection for PTSD may be granted. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided); cf. Brady v. Brown, 4 Vet. App. 203, 207 (1993) (a remand is unnecessary even where there is error on the part of VA, where such error was not ultimately prejudicial to the veteran’s claim). Where the veteran has not met this burden, the VA has no further duty to assist him in developing facts pertinent to his claim, including no duty to provide him with another medical examination. 38 U.S.C.A. § 5107(a); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992) (where the claim was not well grounded, VA was under no duty to provide the veteran with an examination). Although where a claim is not well grounded VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim, VA may be obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of evidence needed to complete his application. This obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69 (1995). In this respect, the Board is satisfied that the obligation imposed by section 5103(a) has been satisfied. See Franzen v. Brown, 9 Vet. App. 235 (1996) (VA’s obligation under sec. 5103(a) to assist claimant in filing his claim pertains to relevant evidence which may exist or could be obtained). See also Epps v. Brown, 9 Vet. App. 341 (1996) (sec. 5103(a) duty attaches only where there is an incomplete application which references other known and existing evidence that pertains to the claim under consideration) and Wood, 1 Vet. App. 190 (1991) (VA’s “duty” is just what it states, a duty to assist, not a duty to prove a claim). Although the RO did not specifically state that it denied the appellant’s service connection claim on the basis that it was not well grounded, the Board concludes that this error was harmless. See Edenfield v. Brown, 8 Vet. App. 384 (1995) (en banc). Accordingly, the Board must deny the appellant’s claim of service connection for PTSD as not well grounded. Edenfield, 8 Vet. App. at 390 (disallowance of a claim as not well grounded amounts to a disallowance of the claim on the merits based on insufficiency of evidence). The Board acknowledges that it has decided the present appeal on a different basis than the RO did. When the Board addresses in a decision a question that has not been addressed by the RO, it must be considered whether the claimant has been given adequate notice and opportunity to respond and, if not, whether the claimant will be prejudiced thereby. See Bernard v. Brown, 4 Vet. App. 384 (1993). However, the Board concludes that the appellant has not been prejudiced by the decision herein. The RO has denied service connection for PTSD on the basis that the post service diagnoses of this disorder are not supported by credible evidence of the occurrence of the alleged inservice stressor incidents. The Board has considered the same law and regulations. The Board merely concludes that the appellant did not meet the initial threshold evidentiary requirements of a well-grounded claim under the standards set forth in Caluza v. Brown, 7 Vet. App. 498 (1995). The result is the same. V. Increased Disability Evaluations Service-connected disabilities are rated in accordance with a schedule of rating disabilities which are based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. Schedule for Rating Disabilities (Schedule), 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1996). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the veteran’s disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Residuals of Hepatitis A and Alopecia Areata In March 1993, the RO granted service connection for residuals of hepatitis A and alopecia areata. Noncompensable disability evaluations were assigned effective from November 29, 1992. The rating board noted that clinical studies conducted during VA examination in December 1992, revealed a positive result for the hepatitis A antibody. However, it was further noted that an IGM test was negative indicating no active infection. The hepatitis B surface antigen, hepatitis C and the Australian antibody were negative. The VA examiner commented that the appellant clearly had an episode of hepatitis A while in the service but that he had completely recovered from that as demonstrated by the negative hepatitis A IGM. It was further noted that hepatitis A does not result in chronic hepatitis and that the reported occasional nausea and vomiting could be related to the reported depression or the appellant’s occasional alcoholic binges. The diagnosis was previous episode of hepatitis A with complete recovery and no evidence of chronic liver disease. With respect to alopecia areata, it was noted that on VA examination in January 1993, hair loss was noted in spots measuring 3 cm. across the appellant’s crown and 2 cm. in diameter on the chin in the beard. The diagnoses included active alopecia areata. Based upon these findings the rating board concluded that a noncompensable disability evaluation was warranted due to the lack of evidence of disfigurement associated with this disorder. The appellant’s residuals of hepatitis A are currently evaluated pursuant to Diagnostic Code 7345 which provides that healed, nonsymptomatic infectious hepatitis warrants a noncompensable disability evaluation. Where there is demonstrable liver damage with mild gastrointestinal disturbance, a 10 percent disability evaluation is warranted. Where there is minimal liver damage with associated fatigue, anxiety, and gastrointestinal disturbance of lesser degree and frequency but necessitating dietary restriction or other therapeutic measures, a 30 percent disability evaluation is warranted. While the appellant has testified that he experiences fatigue which he associates with his residuals of hepatitis A, the VA examiner in December 1992, noted that he had completely recovered from his bout of hepatitis A in 1970, and that there was no evidence of chronic liver disease. In addition, it was noted that the appellant’s occasional nausea and vomiting were associated to other unrelated causes. Furthermore, there is no additional competent evidence of record since the December 1992 VA examination to establish the presence of symptomatology such to meet the criteria for an increased disability evaluation. Accordingly, in view of the above, and the lack of medical evidence to establish the presence of demonstrable liver damage with mild gastrointestinal disturbance or other more severe symptomatology, entitlement to an increased disability evaluation is not warranted. The appellant’s alopecia areata is currently evaluated as analogous to dermatitis exfoliativa which is rated as for eczema. Where there is slight, if any, exfoliation, exudation or itching on a nonexposed surface or small area, a noncompensable disability evaluation is warranted. Where there is exfoliation, exudation or itching involving an exposed surface or extensive area a 10 percent disability evaluation is warranted. In this case, while the presence of active alopecia areata has been shown on the appellant’s scalp and in one spot in his beard, these were noted to consist of a 3 cm and a 2 cm area, which are not found to be extensive in nature. Furthermore, there is no additional evidence to support the presence of exfoliation, exudation or itching involving an exposed surface or extensive area or other functional impairment attributable to the alopecia areata. The appellant’s contentions and testimony have been carefully considered; however, his reports of occasional flare ups and itching are not deemed to be reflective of sufficient symptomatology to support a finding analogous to exfoliation, exudation or itching involving an exposed surface or extensive area without additional objective evidence. Accordingly, entitlement to an increased disability evaluation for alopecia areata has not been shown. VI. 10 Percent Disability Evaluation for Multiple Noncompensable Disabilities Also under present consideration, is the appellant's assertion that he is entitled to a 10 percent rating because he presently suffers from two separate noncompensable service connected disabilities which interfere with normal employability: residuals of hepatitis A and alopecia areata. See 38 C.F.R. § 3.324 (1996); Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Section 3.324 directs that: [w]henever a veteran is suffering from two or more separate permanent service connected disabilities of such character as clearly to interfere with normal employability, even though none of the disabilities may be of compensable degree under the 1945 Schedule of Rating Disabilities, the rating agency is authorized to apply a 10 percent rating, but not in combination with any other rating. After review of the evidence of record, the Board finds that a 10 percent evaluation under 38 C.F.R. § 3.324 is not in order. The basis of disability evaluations is the ability of the body as a whole to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10 (1996). While the appellant has argued that his residuals of hepatitis A cause him to be tired, there is no competent evidence of record to establish the presence of any residual disability attributable to the hepatitis A infection in 1970. In fact, on VA examination in January 1993, the examiner indicated that the appellant had completely recovered from the initial infection and that there was no evidence of chronic liver disease. Furthermore, there is no objective evidence to establish that the appellant’s alopecia areata is of such severity as to be productive of compensable functional impairment. The reported flare-ups are noted; however, the record does not demonstrate that the appellant’s loss of hair in a 3 cm. area over the crown of his head and over a 2 cm. area in his beard are such to impair his employability. Accordingly, entitlement to a 10 percent disability evaluation based upon multiple noncompensable disability evaluations has not been shown. ORDER The appeal is denied. BETTINA S. CALLAWAY Member, Board of Veterans’ Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), 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 -