Citation Nr: 9838152 Decision Date: 12/31/98 Archive Date: 01/05/99 DOCKET NO. 93-19 984 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Christopher Maynard, Counsel INTRODUCTION The veteran had active service from August 1969 to May 1973. This matter initially came before the Board of Veterans’ Appeals (Board) on appeal from a November 1992 decision by the RO. In August 1993, a hearing was held at the RO before D. Datlow, who was a member of the Board designated by the Chairman of the Board to conduct that hearing. In this regard, it is noted that the Board member who conducted the hearing is no longer at the Board. The veteran was notified of this and was given an opportunity to present testimony at another hearing. A Report of Contact dated in October 1998 indicated that the veteran had been contacted and declined another hearing. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he experiences PTSD as a result of exposure to traumatic events during service. The veteran asserts that he was exposed to sniper fire while on guard duty, and that his camp received numerous mortar attacks while he was in Vietnam. The veteran asserts that he killed as many as five “enemy”, including one female Vietcong that he shot in the chest, and later shot her in the head with his .45 caliber pistol to end her suffering. The veteran also contends that a fellow soldier that he had become friends with on the plane to Vietnam was killed shortly after they arrived when a can of soda exploded and decapitated him while the veteran was watching from only a few feet away. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1998), has reviewed and considered all of the evidence and material of record in the veteran’s claims files. 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 of service connection for PTSD. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran’s appeal has been obtained by the RO. 2. The veteran did not engage in combat with the enemy during military service. 3. Objective evidence of an in-service stressor has not been demonstrated. 4. The veteran does not currently have PTSD as a result of wartime experiences in Vietnam. CONCLUSION OF LAW PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.304(f) (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSION Background The veteran’s personnel records indicate that he reported to CDR, Naval Support Activity, DaNang, Vietnam on April 4, 1970 and was reassigned stateside on August 16, 1970. The evidentiary record indicates that the veteran’s military occupation was a store keeper (supply clerk), and he was authorized to wear the National Defense Service Medal, the Vietnam Service Medal with two bronze stars, and the Vietnam Campaign Medal. The veteran did not receive any combat action awards or decorations for valor. The veteran’s service medical records are negative for any complaints, findings or diagnosis referable to any psychiatric problems, and his psychiatric status on examination for separation in May 1973 was normal. The evidence of record shows that the veteran was first seen at a VA outpatient mental health clinic in November 1988 for treatment of alcohol abuse. At that time, the veteran indicated that he wished to attend the “Vietnam Group.” Subsequent clinical notes indicate veteran’s primary difficulties involved alcohol abuse, marital problems, family and work related stress and difficulty dealing with women in supervisory positions. Clinical notes in January 1990 indicated that the veteran requested to join a Vietnam Group, but the counselor indicated that he recommended against admitting the veteran to the group at that time. Progress notes in February 1990 reflect that the veteran attended his first PTSD group meeting that afternoon. When seen in March 1991, the veteran reported that he was in “active combat” for more than two months on his first tour of duty in Vietnam. The clinical notes for the veteran’s PTSD group meetings did not indicate a diagnosis nor were any specific events or traumatic incidents in Vietnam reported. Additional clinical notes show treatment for substances abuse and psychiatric problems through 1998, and include several diagnosis, such as, bipolar disorder and PTSD. When examined by VA in April 1992, the veteran reported that his emotional problems stemmed from alcohol abuse and PTSD. The examiner indicated that the veteran had been attending some type of group meetings for the past two years, and that the veteran felt that he was beginning to remember events that happened in Vietnam that he was formerly repressing. He reported that the sound of helicopters or certain smells brought back memories of Vietnam, both good and bad. The veteran described a particular recurrent dream of a situation in Vietnam when he was on guard duty. The veteran reported that they were ordered not to return fire from snipers unless the snipers were at the fence, but that he fired anyway and apparently hit someone, because he heard someone screaming. The veteran “climbed over the fence” and found a woman that had been shot and was dying. “She had a helmet on so she was Viet Cong, so [the veteran] took his .45 caliber pistol and shot her in the head.” The veteran reported that this event recurs periodically in his dreams and sometimes in his thinking, but that he can “turn it off and on like a faucet.” The veteran described another episode with a soldier he met on the flight to Vietnam, and with whom he had developed a “good bond”. The veteran reported that he was getting onto a truck and that the other soldier was buying a cold drink from a vendor on the side of the road when he heard an explosion and saw his friend’s head going in one direction and his body going in another. The veteran also described problems he had in boot camp with his drill instructor, and a situation in which a petty officer, a first lieutenant, and a couple of enlisted men beat him up and smashed his head into a concrete wall. The examiner noted that the veteran did not have any prior history of inpatient treatment for psychiatric problems. The veteran denied any suicidal ideations, but reported that four years earlier, he had overdosed on some medications and that his sister called the police, but that he was not hospitalized because he was able to convince the police that he was fine and that there were no problems. The veteran stated that he was drunk at the time; and when he was drunk, he could “snow people.” The examiner reported that the veteran worked as a respiratory therapist at a VA hospital until 1984, but had a conflict with a physician and was transferred to the psychiatric department where he worked as a nurse’s aid until 1988, when he injured his back. Since then, the veteran worked in the medical records department of a VA hospital. On mental status examination, the veteran was polite, cooperative and in no physical or emotional distress. The veteran spoke in detailed, circumstantial precise manner, and his thoughts were clear, coherent and non-tangential. His current mood was “blasé” and his affect was neutral, but full, with a full variation. The veteran admitted to continued irritability over being mistreated in boot camp, but did not present with a sense of hopelessness or worthlessness. He did not present with an overwhelming sense of anxiety, and while he described situations that reminded him of events in Vietnam, they were not described as intrusive as much as they were recollections and memories. He was well oriented and his memory, attention and concentration were intact. In his assessment, the examiner noted that the veteran had major problems with alcohol over the years, and had major problems on an interpersonal level, even in his school years according to the veteran’s mother. He was teased and “scapegoated”, and this behavior continued into the service and even escalated. The veteran’s self-esteem was poor, and he had difficulty handling authority figures. The veteran also had some rather obsessive/compulsive personality traits that contributed to a sense of needing to be in control. Since other people couldn’t be controlled, this affected his already impaired sense of self-worth and self-esteem. The examiner indicated that the veteran’s involvement in the PTSD group had given him a peer support group and a sense of identity. It also gave the veteran a sense of attachment to others that he otherwise probably would not have. The examiner opined that the veteran did not have PTSD. The veteran had some very negative recollections of events, most negative of which were the experiences he had in boot camp where he was demeaned, belittled and scapegoated. The veteran continued to carry this theme with him from childhood into an environment where all recruits were supposed to be equal and committed to the protection of his country. This ideal was shattered by the arbitrary and capricious mistreatment from individuals who had little regard for others and who could victimize someone who was gullible and easily led. While this victimization was very traumatic and contributed to his eventual alcohol use and further interfered with his self-identity and self-esteem, it was not an episode that created PTSD, nor were any of the other episodes described above. The veteran had some negative memories, but he did not have intrusive recollections. He reported occasional dreams about events. The examiner noted that “[s]ome of his dreams are going to be influenced by the content of his PTSD groups”, but that he did not “. . . present with physiologic manifestations of anxiety that one would see in PTSD.” The examiner indicated that past episodes, such as the one the veteran described where in the early 80’s he grabbed his girlfriend and thought he was back in Vietnam, were more likely to occur during an intoxicated state such as he was experiencing at the time and did not reflect a true dissociative reaction. The veteran has an obsessive/compulsive personality style which interfered with his interpersonal relationships. The examiner noted that while this afforded the veteran some distance from others and subsequently some protection from emotional hurts, it also contributed to his being quite lonely. The diagnoses on Axis I included alcohol dependence, in remission, and dysthymic disorder (chronic neurotic depression). On Axis II, the diagnosis was obsessive/compulsive personality disorder. The veteran testified at a personal hearing before a former member of the Board sitting at the RO in August 1993, that he was exposed to numerous stressors while in Vietnam. The veteran testified that he witnessed the decapitation of a fellow sailor from an explosion on his first day in Vietnam. The veteran testified that he rode shot gun on convoys in and around DaNang, inside the perimeter of the base, and that his base came under rocket attacks on a regular basis. The veteran also testified that while on guard duty one night, he and another soldier came under sniper fire. The veteran returned fire and then there was silence, followed by screaming. The veteran stated that he went over the fence and found someone lying on the ground, and when he took the helmet off this person, it was a woman. The veteran testified that she had a gaping wound in her chest and that “her whole front was just about gone”, so he took out his .45 caliber pistol and “finished her.” The veteran testified that “. . . for the last 20 some years I haven’t been able to get that out of my mind”, and that he has been bothered by recurring dreams of this incident ever since. The veteran also described problems that he had with other enlisted personnel and his drill instructors during boot camp, and he talked about personal and marital problems he had since leaving service. A copy of a letter from C. C. Brown, M.D., to the Department of Labor, dated in March 1988 and received in October 1994, indicated that the veteran was first seen by Dr. Brown a week earlier. The veteran reported that he feared he would lose control at work and was stressed by his contacts with the nursing staff because of difficulties he had dealing with women in authoritative positions. The veteran sought psychiatric care because he felt that he was unable to stand what he described as harassment from the nursing service since an injury in February 1988. The veteran reported that he had spent two tours of duty in Vietnam, and was diagnosed with delayed stress reaction with alcoholism and had been treated by a psychologist at the Fresno VA Hospital for six months in 1982. The veteran reported that he went through a “depression” when he was 12 years old, and that he had his head bashed into a wall by an officer while in boot camp. The veteran also reported that he had contacted an attorney a month prior to coming to see Dr. Brown because he felt threatened at work. Copies of progress notes from Dr. C. C. Brown, received in October 1994, indicated that the veteran was seen in March 1988 and reported that he was almost hit by a car a few nights before. The veteran felt that he “may hurt a patient” (at work) and was looking for a job in supply. The veteran indicated that he believed that his superiors at work were trying to get rid of him and wanted him to leave since he was released from respiratory therapy. A progress note dated in April 1988 indicated that the veteran was actively engaged in out patient alcohol treatment with Alcoholics Anonymous. Dr. Brown indicated that he would talk to Mr. Tow and would write a letter taking the veteran out of formal medical care. Dr. Brown’s notes indicated that the veteran was volatile and would be better off away from patients. At the direction of a March 1994 Board remand, the veteran was examined by a panel of two VA psychiatrist in February 1995 to determine the presence or absence of PTSD. The report indicated that the veteran was evaluated for 3½ to 4 hours, and that his claims file was reviewed. At that time, the veteran listed the following military stressors in the following order: 1. During the veteran’s basic training at the San Diego Naval Training Station, some three or four barracks mates of his group decided to throw him outside the barracks in his underwear or nude. In the scuffle the veteran got a bruised jaw and nose and a cut lip, but reported much greater damage to his opponents. The examiner noted that this incident was related by the veteran with the greatest heat and emotions seen in the examination. Such emotion was greater than that displayed during his description of the stressor events below. 2. The veteran arrived at Da Nang, Vietnam in April of 1970 and had a store keeper MOS. In the first day or two at Da Nang, a fellow sailor that he had met on the plane flying to Vietnam was killed in the veteran’s presence at a soft drink stand. The group of sailors was awaiting transport at that moment. The veteran reported that his acquaintance’s head was blown off. Further details are unknown to the veteran, as the groups transport arrived and promptly departed. The veteran was thereafter assigned to the warehouses at Camp Tien Sha. 3. The veteran reported spending his first month in Vietnam at Tien Sha, largely “riding shotgun” in convoys making short runs to nearby bases (around Marble and Monkey Mountains). The convoys received sniper fire on three or four occasions, apparently to little effect. 4. Thereafter, the veteran spent about three our four months on land as a security guard at the Tien Sha warehouses. On one occasion he related that there was sniper fire from across the perimeter. Despite orders not to return fire, the veteran fired his M-16 across the perimeter, apparently striking a Vietnamese sniper some yards away. The veteran stated that the sniper screamed for two or three hours, and that he eventually crossed the perimeter and on inspecting the wounded Vietnamese discovered that she was a woman. He stated that she had an anterior chest wound which was sufficient to insert two fists in the mid-chest. The veteran reported killing the sniper with a pistol as an act of mercy. The examiner commented that he wondered how the woman with the described wound could scream for several hours, and also how M-16 rounds inflicted the wound of the size reported? 5. Leaving Da Nang on the USS Gumpers (a naval tender ship) in September 1970, the veteran remained with that ship until March of 1971 with no further combat exposure experience on the Gumpers. The veteran was then assigned to the USS England in March of 1971 and remained so assigned until May of 1973. The England cruised the Atlantic Coast to Rio de Janeiro, then through the Panama Canal to San Diego, and finally in May of 1972 arrived in Haiphong Harbor in Vietnam. The England was one of about 10 ships blockading the harbor. The England was intermittently stationed at Haiphong, the veteran stated, over the next six months. The England’s longest time on station at the harbor was either 60 or 90 days. The England made cruises to other ports for re- supply or refit during the remaining time. During that six months intermittently at Haiphong, the 10 blockading ships received fire from two or three MIGS on two or three occasions. These aircraft were destroyed in the process. The veteran appeared to have been exposed to minimal hazard there. 6. The veteran listed as a final stressor that several fellow crewmen held him down and stained his shorts and inguinal area with India ink the night before they docked on the West Coast. The veteran was married at the time and expected to see his wife shortly after the docking. The veteran was not wounded in combat and received no unusual decorations. The veteran reported a single Captain’s Mast but evaded stating the punishment he received therefrom. The examiner noted that after service, the veteran completed an AA degree in general studies at Contra Costa College within about two and a half years after his discharge, and also worked as a bartender in 1977. The veteran then studied for a certificate as a respiratory therapist and was certified in 1978. He worked as a respiratory therapist from 1979 to 1981 in Coos Bay, and then entered the Federal Civil Service in 1981, continuing as a respiratory therapist until 1985 when he felt “burnt out”. Remaining in the Civil Service with the VA, the veteran worked as a psychiatric nurse’s aide at the Roseburg VA Hospital from 1985 to 1989. He injured his back in 1989, and felt unable to aid large patients because of his back problems and was transferred to the Record Room where he worked as a file clerk up to the present time. The examiner noted that there was some indication in the C file of a conflict with some supervisors, which the veteran minimized during the interview. The veteran was married briefly four times. He married the first time while in service, but lived with his wife for only a few months. He attributed the divorce to an interfering mother-in-law and his wife’s complaints that he spent too much time with his veteran buddies who came over to drink. The veteran’s second marriage was to a girl he met in a bar and lasted only 2½ months within the year or so after his discharge from the service. The veteran lost his job due to a work force roll back at the company employing him. The veteran’s wife apparently felt that the veteran was not a good risk for support and left him while he was on unemployment. The veteran indicated that his getting “drunk” with a buddy and getting into a bar fight might have contributed to her departure. This description is almost verbatim in the veteran’s words. The veteran married a third time in August of 1979 to another girl he encountered in a bar. In September of 1979, the girl called him while at work, informing him that she was leaving the marriage to return to a former boyfriend. The veteran’s fourth marriage occurred in June 1989 and lasted until April 1990. The veteran indicated that this wife also complained that he spent too much time talking with his buddies at work or drinking with them when they visited the house. The veteran complained of the fourth wife’s extravagance in generating $12,000 in credit card debts with a heavy buying of clothes for herself. The veteran stated that after his discharge, he drank quite heavily most of the time until around 1994. He did have several periods of six months or so when he was dry and sober. The veteran reported that he had a number of “blackouts” over the years while drinking and was involved in a number of physical altercations, several of which he could not remember. The veteran reported that his “first PTSD” trouble appeared in 1982, at which time he told his wife that the Vietcong were attacking the house; the veteran was drunk at the time. In 1988 he filed a false report that someone had entered his house because he felt his back door was disturbed. He slapped a bartender in 1993, and he was involved with a local hippy and drug dealer in a fight while drinking in November of 1994 and drew a knife. The veteran was convicted and ordered to attend AA and group therapy. The veteran had DUI’s in 1976 and 1981 and spent a few days in jail for fighting or being disorderly on several occasions. These admissions were prompted by rather pressing questioning. The veteran lived in the same neighborhood near Roseburg for the past 10 years, and had lived alone since his divorce in 1990. The veteran reported that he shopped by himself at a major and populous grocery store in Roseburg without apparent difficulty. He stated that he enjoyed the companionship at his AA group which he attended four to six nights a week and his additional court ordered therapy group which apparently dealt with some alcohol and “PTSD” issues at the Roseburg VA. The veteran went to the YMCA to swim and work out three times a week and lifted weights at home. The veteran also reported that he enjoyed fishing and performed small construction jobs at home, including building a high board fence around his house “to keep the local druggies out.” He denied any use of street drugs. The veteran also reported that he was in good contact with his sister, mother and his father, until the latter’s death. The veteran reported that he had disturbing dreams three or four times a week, with mixed civilian and military content. He stated that some of these dealt with the Vietnamese woman sniper whom he reportedly killed. The veteran’s affect did not change when discussing his dreams, and his account was not strikingly persuasive. The veteran claimed startle response to low flying planes appearing suddenly over head, and that in the past, he would get agitated and then drunk after viewing Vietnam movies. The veteran further stated that he had a habit of remaining angry for hours or days after disagreements in a process he referred to as “festering my anger.” The veteran claimed mood swings 10 or 12 times a day with some depressive feelings intermittently. He also indicated that he participated in veteran’s organizations, and for the past two years, he helped build floats for use in parades. On mental status examination it was noted that the veteran was interviewed by two examiners. The veteran arrived at his appointment on time and was dressed in clean, casual clothing and wore his baseball cap throughout the interview. The veteran was clean shaven with short hair, and he was muscular, stocky, and slightly obese, weighing about 180 pounds. The veteran’s memory was good for recent and remote events, and his ability to abstract from questions and comments was good. He was articulate and talkative, and there was no indication of clinical level brain syndrome. The examiner indicated that the veteran often chose to talk past or around the question, particularly when direct answers would indicate his coping ability or information about legal convictions. His tendency to gloss over such matters was sufficient to invite a label of evasiveness. The veteran’s concentration was adequate, and his associations were coherent and goal directed. There was no looseness, bizarreness, delusion, affect inappropriate to ideation or any other evidence of psychosis. His affect was generally pleasantly conversational in tone, and often marked with smiling or chuckling. There were no excursions into tears or anger, and his affect was felt to be well modulated in a normal flexibility. The veteran’s description of stressor events, other than for the scuffle to avoid being tossed out of the barracks during basic training, was carried out without any particular fluctuation of affect from the generally pleasant conversational level. There was no indication of flatness or affect loss, nor any erupting or emerging gross anxiety or sadness about the combat. The patient’s vocal tonality, facial expression, respiratory rate and rhythm, and pupillary activity remained unchanged throughout his description of combat events. His basic intelligence was estimated as bright to normal, and his reality testing was good. The veteran did not startle unusually to a sudden noise generated in the room during the interview, nor was he hypervigilant to hall noises or passers by. Some suggestion of the veteran’s use of covert agendas is hinted at in his statement that he “played games with AA for 15 or 20 years” till recently. Also pertinent is his statement that “I’m a Jekyll and Hyde.” The examiners commented that the veteran’s role model father had a service-connected disability, suffered from depression, felt abused by and angry at the US Government and had a problem with alcohol. Genetic and/or familial model contributions to the veteran’s behavior thereby appeared highly likely. The veteran’s pre military appeared to have been physically oriented and aggressive, with a choice of wrestling as his major indoor sport. The veteran continued to be interested in weight lifting and fishing as he did in his adolescence. The veteran had worked well and quite consistently since his discharge from service, and he had not been prevented from working by mental disability. He held jobs for several years at a time, including numerous years in the Civil Service with the VA, and he clearly did not avoid those sections of the mainstream society. As the veteran reported that he remained in good contact with his family throughout, he was clearly not strikingly alienated from his family. He recurrently spoke of several veteran friends whom he has enjoyed at several points of his life including the period of the first and fourth marriages, as well as currently, and he reported belonging to the same local church for some years. The history continues to not suggest any great alienation or social avoidance. The veteran also reported that he enjoyed AA groups and rap groups at the Roseburg Hospital. The veteran did not avoid paramilitary affairs or organizations, attested by his float building and did not disclaim owning any firearms. The examiners indicated that the veteran did not demonstrate gross hyper-irritability when not drinking and, during the interview, he appeared rather sociable. When he drank, the veteran becomes involved in altercations which, at times, resulted in arrest, and he also had some supervisory conflicts. The veteran appeared to have discussed his Vietnam experience with at least two of his wives to the point of their fatigue with listening (atypical of PTSD). The veteran also indicated that he related combat stories extensively to his parents. The examiners noted that the veteran claimed some nightmares, but his accounts were not particularly persuasive. Likewise, his accounts of memories of Vietnam recurring with passing planes or helicopters were not suggestive of true dissociation or a belief that he was again in Vietnam, and his claimed sudden onset of PTSD in 1982 in a drunken state was somewhat odd. Overall, the veteran appeared to have felt (perhaps realistically) that he had been the subject of teasing or abusive joking as a child and as young man in the service, but that his angry responses to these matters appeared to have been well prior to exposure to his minimal combat stressors. The examiners indicated that his stressors, overall, appeared rather minor when compared to those suffered by many combat veterans. The diagnoses included personality disorder, not otherwise specified, and history of alcoholism. The examiners indicated that the veteran displayed overt aggressiveness and physical fighting when drinking. He had unstable relationships and made poor choices of wives. The veteran’s personality was probably based partially on his father as a roll model. When sober, the veteran had some passive- aggressive responses with “anger stuffing.” The veteran reported rapidly fluctuant emotional states nowadays, and he had a habit of “game playing” with AA groups. He was also felt to be glib and evasive in regard to his legal records. The examiners also questioned the rationale for the use of Lithium by a physician at Roseburg. The examiners indicated that they had considered the diagnosis of post-traumatic stress disorder, but concluded that it was not appropriate. The combat stressors appeared to be quite minor when compared with those of many combat veterans, and there was no clear evidence of emotional upheaval during the veteran’s relating of combat stressors during the interview. The nightmare accounts were not striking, and gross social avoidance and alienation appeared absent, although some avoidance might be present. The examiners also indicated that the veteran’s socialization with the subculture of veterans was extensive, and that future long exposure to PTSD groups was likely to enhance his account of symptoms. A letter from the Director of the U.S. Armed Service Center for Research of Unit Records (USASCRUR) (formerly U.S. Army & Joint Services Environmental Support Group) in October 1995 was to the effect that verification of the veteran’s claimed stressors in Vietnam could not be determined based on the limited information provided to that organization. The Director indicated that in order to conduct further research concerning specific incidents and casualties, more specific information was required. A copy of a psychiatric examination report by L. R. Calderon, M.D., in May 1996, indicated that the veteran was being evaluated for medical retirement from his employment at a VA hospital. At that time the veteran indicated that his personality change developed during boot camp primarily because he was picked on as a “demonstrator.” The veteran described one occasion in which three to four fellow soldiers decided to throw him outside the barracks in his underwear. In the scuffle, he got a bruised jaw and nose and a cut on the lip, but he claimed that he caused greater damage to his opponents because of the fact that he used to be on the wrestling team in high school. His head was also hit against the wall by one officer who was a drill instructor. The veteran added that the drill instructor had him put a T-shirt in his mouth, and they forced to say bad words directed toward himself which he refused to do three times. However, he eventually gave in. The veteran reported that he arrived at Da Nang, Vietnam in April 1970 with an MOS as a Storekeeper, but that he ended up doing another MOS which was riding shotgun on a truck. On the first or second day in Da Nang, a fellow seaman whom he had met on the airplane flying to Vietnam and the veteran were assigned to do a job around the perimeter of the base as security guards. The veteran described several engagements that the two encountered. The veteran reported that a Viet Cong came to the wire and that his buddy, Mr. Wilcox, told him that they had an enemy on the line. They started getting sniper fire, and the veteran started firing back. Then, all of a sudden, everything became very quiet, and they heard one loud scream. The veteran stated that he went to see where the screaming was coming from and found a wounded Viet Cong with a large chest wound. The veteran stated that he brought out his .45 caliber hand gun and “finished it all.” Dr. Calderon noted that “luckily, the veteran was not wounded in Vietnam.” The veteran also reported that he received two Bronze Stars, a Combat Medal, a Vietnam Service Medal and a Vietnam Combat Medal. The veteran stated that after his discharge from service, he drank quite heavily most of the time through November 1994. He reported that his longest period of sobriety was six month. The veteran admitted to frequent fights, physical altercations and several incidents he could not even remember. The veteran reported that he drank alcohol continuously for six weeks after boot camp, mainly beer and whiskey or wine, anything that he could get hold of. He had a DUI in 1976 in Medford, and two in Fresno, California in 1981, but he indicated that he had been sober since November 1994 and was currently on Antabuse medication and Lithium carbonate. Dr. Calderon indicated that the veteran was seen initially by Dr. Hall in 1988 and 1989 at the Mental Hygiene Clinic with a primary issue of posttraumatic stress disorder and was also seen from April 1991 to 1993 by Mark Berenbach, who conducted the posttraumatic stress disorder group at the Mental Health Clinic. Dr. Calderon noted that the clinical records of Mr. Berenbach indicated that there was an exacerbation of his flashbacks and nightmares, especially by the fall of 1991 when his father’s death occurred. There were also periods of relapse and exacerbation of his alcohol problems at that time. It was also described, at that time, that the veteran had difficulty focusing his concentration. He became increasingly irritable, easily angered and short fused and had an inability to deal with groups of people. From October 1991 through September 1995, the veteran was under the care of a substance abuse counselor, who saw the veteran every Thursday night for substance abuse and maintenance of his sobriety, as well as anger therapy. Dr. Calderon indicated that the veteran had been under her care since 1992. Dr. Calderon noted that the veteran was seen on a regular basis for flashbacks, mood changes, periodic episodes of drinking and relapse and sobriety, as well as anger, initially on a monthly basis, then every two to three months when it was necessary. Due to categorizing patients on the basis of means test, the veteran could not afford to continue his regular appointments and decided to take it upon himself to deal with his symptoms and be off of the Lithium medication in early 1996; Dr. Calderon indicated that she agreed and discontinued his medications. The veteran also gave the reason that he wanted to try the spirituality approach or feeling reborn Christian again. Dr. Calderon indicated that in March 1996, the veteran started to come in as a walk in patient on repeated occasions. He was anxious and talkative and complained of increased problems of stress and problems at work. He described in detail what disturbed him. This included the telephone ringing and interruptions when filing the charts of patients. The veteran reported that he came to a point where he could not take it anymore. He complained of somatic problems and excessive chest pain, and he could not stand his job. He complained of aches and pains all over and of depressive symptoms and mood changes. It was pointed out to him that it was necessary for him to resume his Lithium carbonate, which he initially agreed to. The veteran returned to the clinic and complained of more aggregating symptoms. He was very upset and angry. He was tired of doing everything and wanted peace in his life The veteran was quite over talkative with flighty ideas and shallow mood and very rapid speech; a very classical example of mood disorder, for which he was not being treated. The veteran stated that he could not concentrate or focus on what he was doing and was falling apart. He was short fused, irritable and hyperactive. Dr. Calderon indicated that a coworker in the file room had been hinting to her examiner that things were falling apart for the veteran. Dr. Calderon concluded that the veteran was unfit to continue working. She suggested that the veteran take a time out for a few minutes in the mornings and afternoons, and that this was discussed with his supervisor. Another alternative suggested was a possible transfer to a lighter duty, so that the veteran would be relieved of the stress and pressure while trying to stabilize his condition of bipolar disorder. Unfortunately, it was relayed to him by the Chief of MAS and his direct supervisor that given the present state of insufficient VA funding, there was no opening in the last 8 years of any job that would be suitable for him. By April 10, the patient returned to the clinic again, as a walk-in and was devastated due to his current dilemma and position. He discussed the issue and stated that he could not go on working. Dr. Calderon indicated that with the loss of concentration and focus on the job, the veteran was deteriorating and was incapable of continuing his regular duty. On April 10, Dr. Calderon recommended that a medical retirement be expedited, as she considered the veteran unfit to return to work in view of his labile mood, unstable emotional condition, irritability, fluctuating concentration and inability to focus. She also resumed the veteran’s Lithium carbonate and a series of Lithium carbonate blood tests were ordered for April 12 and succeeding blood tests from then on. The diagnoses included bipolar disorder with depressed mood, possible PTSD with anxiety, alcohol dependence in remission since 1994 and maintenance on Antabuse medication. Dr. Calderon commented that the veteran was definitely suffering from a mental condition, bipolar disorder, and was now displaying a depressed mood, but that he was not a danger to himself or others. There were signs and symptoms of PTSD with anxiety, which the veteran had been dealing with since 1988. The veteran was currently on Lithium carbonate and Antabuse medication with Hydroxyzine medication. Dr. Calderon recommended that the veteran be relieved, permanently, of his duty as a file clerk, effective from May 3, 1996. In an Applicant’s Statement of Disability for retirement dated in April 1996 and received in July 1997, the veteran indicated that he was unable to perform the duties of his employment because the “workload in [the] department caused too much pressure and mental stress, much more that [he] could handle.” The veteran indicated that “along with [the] pressure of mental stress caused by excessive workload in [the] file room [he] had more episodes of angina requiring nitro pills on the job. More nightmares (PTSD) [of] Vietnam, breathing difficulties in close quarters . . .” The veteran indicated that the approximate date he became too disabled to perform the duties of his job was “within the past few months.” In a PTSD questionnaire received in April 1997, the veteran provided a narrative history of his stressors in service. The veteran could not provide any specific dates and his description of various events were, for the most part, reported in generalities. One incident was described with some degree of specificity and involved the death of a sailor he had made friends with on the plane to Vietnam. The veteran reported that on or about April 2, 1970, he arrived in Vietnam and was loaded onto a truck and driven to Camp Tien Sha. The truck stopped not far from the camp, and his “friend” went to buy a Coke nearby the truck and was killed when the bottle exploded. The veteran reported that the sailor was decapitated and his body and head flew in different directions. The veteran also reported that he killed five “Gooks” in the line of duty between May and August 1970. A report from the U.S. Armed Service Center for Research of Unit Records (USASCRUR), in July 1997 indicated that some members of the U.S. Naval Support Activity, DaNang were involved in combat activity during the veteran’s tour of duty in 1970. However, there were no American casualties reported from April through August 1970, nor were there any enemy kills reported. (One NAVSUPPFAC policeman was wounded in July 1970 trying to apprehend a suspected U.S. military deserter in Son Cha village near Camp Tien Sha). The report indicated that Camp Tien Sha came under rocket attack on one occasion (April 5, 1970) during the veteran’s tour of duty, and there were reported increased terrorist activities in DaNang in April 1970. When examined by VA in August 1997, the veteran denied having any psychiatric disorder prior to entering military service. The veteran claimed that he started drinking in boot camp, but had abstained since his last C&P examination. The examiner referred to the detailed report of his last C&P examination in February 1995 for a description of the veteran’s military history. The veteran reported the following combat experiences which caused intense fear and feelings of hopelessness in him: 1) The decapitation death of a buddy who was hit by an explosive projectile only hours after the veteran arrived in Da Nang. 2) Multiple, 3-4 weeks confinements in bunkers while under rocket attack in a time span of six months. 3) The assignment of “riding shotgun” on convoys and being involved in fire fights on four occasions, at which time he shot two or three Viet Cong without knowing whether or not they were killed. 4) The mercy killing of a female Viet Cong who was screaming and moaning for an hour after he had initially shot her and then putting her out of her misery. Also noted was that parts of her chest and abdomen were missing. 5) Mig and mortar attacks on the ship he was serving on during his second tour of duty. He also witnessed the rescue and death of a U.S. flyer. The diagnoses included PTSD, chronic; bipolar disorder currently hypomanic, and alcoholism, in alleged remission. The examiner indicated that based on the veteran’s complaints, he was suffering from PTSD. The examiner also indicated that it was not the scope of his examination to verify the veteran’s claims. The examiner noted that veteran presented himself as hypomanic when talking about his experiences and symptoms, sometimes in a light, humorous fashion, but that however inappropriate this might have appeared, it was congruent to his prevailing slightly euphoric mood. In September 1997, the RO found that the August 1997 VA examination did not comply with the instructions set out in the March 1994 Board remand and scheduled the veteran for a re-examination by a panel of two psychiatrists who were requested to evaluate the veteran under the guidelines of DSM-IV. In November 1997, the veteran was examined by a panel of two psychiatrists; the report indicated that the claims folders were made available for review at that time. The examiners noted that the examination focused solely on his claim of PTSD, the events that the veteran reported triggered this, and his symptomatology of PTSD. The veteran stated that his first significant episode of trauma was when he was in boot camp and one of the instructors threatened him because he dropped his rifle. The veteran reported that being short of stature, he was not able to hold his rifle at the prescribed angle during the lengthy time at attention. The instructor reportedly threatened to choke him if he dropped his rifle again, but he was unable to hold it and the instructor reportedly grabbed him by the throat and choked him on the floor until some of the other men in the barracks dragged the instructor off of him. The veteran also reported that he was harassed by a second class petty officer, who also tested him by making him hold his rifle out at arm’s length, and when he was not able to do this, the officer slammed his foot in a door as punishment. The veteran stated that his foot was evaluated by a physician on base at that time. The veteran reported that his first traumatic event in the war zone happened hours after landing in DaNang while he was on his way to Camp Tien Sha where he was to be stationed. The veteran reported that they were just a few “clicks” away from camp when they stopped and a sailor that he made friends with on the flight (whose name began with the letter J) asked him if he wanted a Coke. The veteran reported that the other sailor was approached by a boy selling the Coke; and when the sailor opened the bottle, it exploded and decapitated him and the boy. The veteran also mentioned that there were two or three other servicemen who were injured in this explosion. The examiners noted that the veteran’s story was somewhat inconsistent with the report in 1995 on this event. At that time, the veteran reported that his acquaintance went to a soft drink stand and had his head blown off but no other details were given. The veteran stated that one or two days later he was assigned with the U.S. Navy on cover storage in DaNang and was on gait guard with another friend of his named Wilcox. He stated that a fire fight broke out and snipers were firing at their position. He and Wilcox were armed with an M14 and MI6 and some explosives. The veteran stated that he radioed back to his commander and requested to return fire and was told no, that they could not fire until they crossed “the line”. The veteran reported that he was so scared that he began firing into the woods anyway, and that he apparently hit one of the snipers as the gunfire from the woods stopped. The veteran stated that he heard a loud screaming sound for about a ½ hour. When this became unbearable for him to listen to, he crawled out of his position and went into the woods. There, he found the sniper who turned out to be a North Vietnamese woman. He stated that she had a large hole in her chest from the wound and was barely alive, and that as he was taking her pulse, she died. The examiner noted that this was also inconsistent with the veteran’s description of this event in 1995 wherein he reported that there was two to three hours of screaming, and that he crossed the perimeter and shot her with a pistol as a mercy killing, something he did not mention during this evaluation. The veteran reported that his base sustained rocket attacks and that they had to get in and out of their bunkers throughout the night, and that he continues to have nightmares about rocket attacks. The veteran reported no direct hits during this time but felt that this was a significant stressor. In June 1970, the veteran reported that he helped load dead bodies off of helicopters in DaNang and was traumatized by witnessing all the casualties. The veteran reported the next stressor being in May and June of 1970 at Marble Mountain. The veteran reported that he was attached to an Army company and was helping load supplies with some friends. The cage of a cherry picker truck that some Vietnamese were in began dropping, and he had to push his friend out of the way as the cage came down. No one was injured during this incident, but the veteran felt that this was an attempted murder against his friend and that witnessing this was a significant stressor. The veteran also reported that he had significant stress while waiting to go home after his first tour. He stated that he was in his dress whites along with his comrades, and they were drinking whiskey when some of the air field came under fire. The veteran reported that they had to change out of their dress whites and into their camouflage gear several times while their flight was delayed four to five hours due to the continuing fire. The veteran felt that this was also a significant stressor. On his second tour of duty he was assigned in May of 1972 to the USS England which was guarding other ships in the harbor. The veteran stated that his ship was under fire on two occasions, and that the trauma that he felt was due to claustrophobia from being inside and under fire. He did not sustain any injuries, and his ship was not hit during this time. The veteran reported no other significant stressors. The examiners noted that the veteran complained of the following PTSD symptoms: Category A : The veteran had three reports as outlined above, of events outside the range of usual human experiences. Some of these appeared to be more traumatic than others. Category B: The veteran reported recurrent and intrusive distressing thoughts of these events approximately once a week. It is noted that in 1995, the veteran reported that he had intrusive thoughts of combat 10 to 12 times per week. The veteran’s statements concerning recurrent distressing dreams of the event 3 to 4 times a week with night sweats was consistent with his statements at the 1995 evaluation. The veteran reported flashbacks 4 to 5 times per week when watching war movies. He stated that he watched war movies frequently and that he did this in an effort to try to analyze what was happening on the screen to determine if he could have done things differently when he was in the service. The veteran also stated that the news and events that happened on television triggered flashbacks for him where he felt as though he were back in his combat experiences. He stated that even the mention of the word Vietnam sent him easily into a flashback. It was noted that the veteran was able to discuss his severe symptoms with the examiners for well over 1½ hours, giving great detail regarding his symptoms without sustaining any flashbacks. Category C: The veteran did not appear to avoid thoughts or feelings associated with the trauma as he stated that he watched movies, TV, and things that dealt with this and did not endorse marked diminished interest in significant activities, nor did he have psychogenic amnesia to these events. The veteran reported a restricted range of affect. The veteran was married four times and did not seem to isolate himself. He had no foreshortened sense of future or feelings of detachment or estrangement from others. Category D: The veteran reported difficulty falling and staying asleep. He also reported irritability and outbursts of anger and violence. He had had a number of tavern fights, seven from 1984 to 1994. He also reported a 27-year history of alcohol abuse, but had been clean and sober for just over three years. The veteran reported difficulty concentrating and hypervigilance, but did not show any evidence of this during the examination. The veteran also reported exaggerated startled response, but showed no evidence of this during the examination when a loud pager sounded on numerous occasions, or when there was noise in the hallways. The examiners concluded that the veteran did not have PTSD. They noted that there were multiple inconsistencies in his stories, and that he could not produce any significant documentation of the incidents which led them to believe that his diagnosis was that of a factitious disorder rather than PTSD. The examiners also noted that the veteran had a history of bipolar disorder, but that this was not substantiated through this examination as that was not the focus of the examination. The examiners commented that they believed the veteran’s inconsistencies with the significant events that he reported and his ability to relate those events to examiners on two different occasions would not support a diagnosis of PTSD at this time. A supplemental report to the November 1997 VA examination indicated that the veteran underwent diagnostic testing in October 1997. The examiner (one of the two psychiatrist that examined the veteran in November 1997) indicated that while the psychological tests were usually given at the time of a psychiatric examination, the veteran had started the tests when the examiner realized that the Board requested examination by a panel of two psychiatrist and only one was available at that time. However, the examiner indicated that the test was recent enough that the difference of a month was negligible. The examiner noted that on the day the veteran took the MCMI, he was on time for his appointment and casually but neatly dressed. The veteran was well oriented and cooperative, and his mood was very cheerful, joking, smiling and laughing. His thought content was normal, and no psychotic symptoms were noted. The examiner indicated that this information was important, and that he would explain why further on in his report. The results of the MCMI showed that the veteran maximized the scale on anxiety, as he did with the scale on somatoform testing, indicating that the veteran takes his stress out on his body. The veteran maximized the scales in dysthymia and on psychotic thinking and psychotic depression. In addition, there were elevations on the alcohol abuse scale, and the drug abuse scale presumably by history, as the veteran stated that he had been clean and sober for the last three years. However, when it came to personality disorders, there were five categories: One is schizoid or asocial: the second is avoidant; the third is passive-aggressive; then it goes back to the borderline personality disorders. The veteran maximized the scale on the schizoid borderline personality disorder and the scale on the “eyeloid” borderline personality disorder. There was also quite an elevation on the paranoid borderline personality scale and an elevation on the antisocial aggressive. The examiner indicated that even though the computer found that this profile was valid, the MCMI test had a very crude validity measure. The examiner indicated that it was his belief that, given the extreme elevations on so many different scales, the scores were directly inconsistent with the veteran’s behavior on that day. The scores were also inconsistent with the examiner’s personal knowledge of the veteran which he gained during an “EAP” program the veteran attended for a few years. The examiner concluded that the veteran exaggerated his responses to make himself appear more pathological than in fact he was. Analysis In order for consideration to be given to a claim of entitlement to service-connection, there must be a showing that a particular injury or disease resulting in disability was incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). In adjudicating a claim for service connection for PTSD, the Board is required to evaluate the supporting evidence in light of the places, types, and circumstances of service, as evidenced by the veteran’s military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f) (1998); see also Hayes v. Brown, 5 Vet. App. 60, 66 (1993). Additionally, VA regulations require three elements to establish service connection for PTSD: medical evidence establishing a clear diagnosis of the condition; credible evidence that an inservice stressor occurred; and a link, established by medical evidence, between the current symptoms and the inservice stressor. If a claimed inservice stressor is related to combat, service records showing combat service or a combat citation is conclusive evidence of a stressor, in the absence of evidence to the contrary. 38 C.F.R. § 3.304(f) (1998); see also Zarycki v. Brown, 6 Vet. App. 91, 97 (1993). As an initial matter, the Board finds that the veteran’s claim for service connection for PTSD is well-grounded. The veteran has a medical diagnosis of the disability; there is lay evidence of stressors in service, which are presumed credible for the purpose of determining whether his claim is well-grounded; and a medical professional has connected his current disability to his service, again presuming the credibility of the stressors he has recounted. Cohen v. Brown, 10 Vet. App. 128 (1997). If the veteran satisfies the initial burden of setting forth a well-grounded claim, VA is required to assist in developing the facts pertinent to that claim. 38 U.S.C.A. § 5107(a) (West 1991); Zarycki v. Brown, 6 Vet. App. 91, 96 (1993). In this case, the veteran has been afforded several VA examinations, and the RO has obtained medical records as well as two reports from USASCRUR. The veteran also provided testimony at a personal hearing before a former member of the Board at the RO. Therefore, the Board finds that the record is complete and that there is no further duty on the part of VA to assist the veteran in developing his well-grounded claim, as mandated by 38 U.S.C.A. § 5107(a). The first element required to support a claim of service connection for PTSD is medical evidence establishing a clear diagnosis. As noted above, the evidentiary record includes several diagnosis of PTSD. However, while the various medical opinions are sufficient to justify a finding that the veteran’s claim is well-grounded, they cannot be used to establish the occurrence of the stressors. In this regard, the Board notes that all of the diagnoses of PTSD were based entirely on the veteran’s self-described history of events in service. As was pointed out by several VA psychiatrist’s who examined the veteran and the entire claims folder, there were numerous inconsistencies in the veteran’s stories concerning his traumatic experiences in service and no documentation to support them. Medical health providers who rendered a diagnosis of PTSD failed to address any of the inconsistencies in the veteran’s stories, nor did they offer any explanation or discussion as to the basis for their conclusions. In fact, the August 1997 examiner who rendered a diagnosis of PTSD indicated that it was based on the veteran’s self-described history, and that it was not within the scope of his examination to determine the veracity of the veteran’s claim. A diagnosis such as the one offered by the examiner in August 1997 raises serious questions as to the validity or value of the opinion rendered. In any event, in this case, the outcome of the veteran’s claim does not rest on the weight assigned to the medical opinions offered in the record, although the Board finds ample credible evidence to conclude that the veteran does not have PTSD. Rather, his claim fails for lack of credible supporting evidence that the claimed in-service stressors actually occurred. An opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of the stressor, and the veteran’s lay testimony regarding the stressors is insufficient, standing alone, to establish service-connection. As pointed out by the Court, the existence of a valid service stressor is a factual question for VA adjudicators, based on an assessment of the credibility and probative weight of all the evidence. The Board is not bound to accept the veteran’s uncorroborated accounts of alleged stressors during service, nor is the Board required to accept the unsubstantiated opinions of psychiatrists that alleged PTSD had its origins in service. This is particularly true where there has been a considerable passage of time between punitive stressful events recounted by a veteran and the onset of alleged PTSD. Wood v. Derwinski, 1 Vet. App. 190, 192 (1991), reconsidered, 1 Vet. App. 406 (1991). An attempt to obtain independent verification of the stressor incidents from the USASCRUR was accomplished, but they were unable to confirm the stressors. The major precipitating events the veteran reported as having caused his PTSD involved the death of a fellow sailor on the veteran’s first day in Vietnam, and the killing of a “Viet Cong woman” while on guard duty. However, a review of the history of the unit the veteran was assigned to in Vietnam shows that there were no American or enemy casualties during his tour of duty from April 2 through August 1970. Furthermore, the veteran was not able to provide the names of any witnesses to either event, even though he has indicated at various times that there were other people around when the events occurred. Moreover, the veteran’s military personnel records indicate that he was in Vietnam for less than five months and that his duty assignment was that of stock clerk for a naval group. As such, his duties were not combat related and his work details would not necessitate exposure to combat. To that extent, the veteran has not furnished the VA with any objective evidence to show the contrary. Although a report from USASCRUR indicated that some members of the veteran’s unit in Vietnam were involved in combat activity, those records do not indicate that the veteran engaged in combat. Despite the veteran’s assertions to the contrary, he was not awarded any medals for valor or any citations indicating that he was exposed to situations involving combat with the enemy. Regarding the veteran’s alleged non-combat service stressors of being mistreated by superiors in basic training, the Board notes that official service records give no support to his allegations of in-service stressors. Nor is there any reasonable possibility that his generic allegations of mistreatment by superiors during service could be verified by the service department. The claims folder contains no other independent credible evidence, such as statements from fellow soldiers, as to the occurrence of the alleged stressors. Furthermore, the service medical records are silent for any medical treatment or findings concerning a foot injury during basic training when, he claims, one of his drill instructors slammed a door on his heels as punishment. In short, the veteran’s alleged non-combat service stressors have not been verified by credible supporting evidence, as required for a grant of service connection for PTSD. Since the veteran did not engage in combat with the enemy, his bare allegations of service stressors are insufficient; the stressors must be corroborated by official service records or other credible supporting evidence. Zarycki v. Brown, 6 Vet. App. 91 (1993); Doran v. Brown, 6 Vet. App. 283 (1994). The veteran’s official service records do not verify the alleged stressors, and he failed to provide detailed information, requested by the RO in March 1997, which could be used to attempt verification of alleged stressors through USASCRUR. In his January 1992 and April 1997 statements, the veteran acknowledged that he was unable to remember specific names or dates concerning his claimed Vietnam stressors; without such information, there is nothing the VA can do to assist with verification of stressors. The duty to assist is not a one-way street. Wood, supra. Inasmuch as there is no credible supporting evidence to corroborate the occurrence of the alleged stressors, the claim must be denied. ORDER Service connection for PTSD is denied. Iris S. Sherman Member, Board of Veterans’ Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1998), 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 -