Citation Nr: 9907812 Decision Date: 03/23/99 Archive Date: 03/31/99 DOCKET NO. 96-09 410 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUE Whether new and material evidence has been submitted to reopen the veteran's claim of entitlement to service connection for a psychiatric disorder, to include post- traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Kenneth M. Carpenter, Attorney ATTORNEY FOR THE BOARD Thomas A. Yeager, Associate Counsel INTRODUCTION The veteran had active military service from October 1974 through August 1975. This appeal arises from a January 1995 rating decision by the Department of Veterans Affairs (VA) Medical and Regional Office Center (M&ROC) in Wichita, Kansas, which found that new and material evidence had not been submitted to reopen the veteran's claim for service connection for a psychiatric disorder, to include PTSD. In August 1997, the Board found that evidence submitted since a June 1991 Board decision denying service connection for a nervous disorder, to include PTSD, was not new and material because, inter alia, it did not raise a reasonable possibility of changing the outcome of the veteran's case on the merits. Accordingly, the veteran's appeal of the M&ROC's January 1995 decision was denied. The veteran appealed the Board's August 1997 decision to the United States Court of Veterans Appeals (Court or COVA). In a September 24, 1998 order, the Court vacated the Board's August 1997 decision, and remanded the matter to the Board for development consistent with the parties' "Joint Motion for Remand and to For Stay of Further Proceedings" (Joint Motion). FINDINGS OF FACT 1. A June 1991 decision by the Board of Veterans' Appeals denied service connection for nervous disorder, to include PTSD; the veteran was properly notified of the decision and of her appellate rights, and no motion for reconsideration has been made or granted. 2. Evidence submitted since the Board's June 1991 decision is so significant that it must be considered in order to fairly decide the merits of the claim. 3. All relevant evidence necessary for an equitable determination of the veteran's appeal has been obtained by the RO or submitted by the veteran's attorney. 4. The veteran has current medical diagnoses of PTSD, which are linked in pertinent part by competent medical evidence to her reports of an in-service personal assault (attempted rape). 5. The evidence in the claims file, including that which bears on the veteran's credibility, does not provide credible support for the veteran's claimed in-service stressors. CONCLUSIONS OF LAW 1. Evidence submitted since the Board's June 1991 decision denying service connection for a nervous disorder, including PTSD, is new and material, and the veteran's claim of entitlement to service connection for PTSD is reopened. 38 U.S.C.A. §§ 5108, 7103, 7104(b) (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.156, 20.1100, 20.1104, 20.1105 (1998). 2. A psychiatric disorder to include PTSD was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 501, 1110, 5107 (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.156, 3.303(c), 3.304(f), 4.9, 19.5, 20.1304(c) (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Whether New and Material Evidence Has Been Presented to Reopen the Veteran's Claim for Service Connection for PTSD As noted above, the Board issued a decision in June 1991 which denied the veteran's claim for service connection for a nervous disorder, to include PTSD. This decision became final in accordance with 38 U.S.C.A. § 7103; 38 C.F.R. §§ 20.1100, 20.1104. As such, the veteran's claim may only be reopened and considered on the merits if new and material evidence has been submitted. See 38 U.S.C.A. §§ 5108, 7104(b); 38 C.F.R. §§ 3.156(a), 20.1105; Barnett v. Brown, 83 F.3d 1380, 1384 (Fed. Cir. 1996). The issue of whether evidence is "new and material" is analyzed under 38 C.F.R. § 3.156(a), and requires a three- step analysis. The first step requires determining whether the newly presented evidence "bears directly and substantially upon the specific matter under consideration," i.e., whether it is probative of the issue at hand. Evans v. Brown, 9 Vet. App. 273, 283 (1996). Evidence is probative when it "tend[s] to prove, or actually prov[es] an issue." Routen v. Brown, 10 Vet. App. 183, 186 (1997), citing Black's Law Dictionary 1203 (6th ed. 1990). Secondly, the evidence must be shown to be actually "new," that is, not of record when the last final decision denying the claim was made. See Evans, 9 Vet. App. at 283; Struck v. Brown, 9 Vet. App. 145, 151 (1996). The final question is whether the evidence "is so significant that it must be considered in order to fairly decide the merits of the claim." Hodge v. West, 155 F.3d 1356, 1359 (Fed. Cir., 1998), citing 38 C.F.R. § 3.156(a). This need not mean that the evidence warrants a revision of the prior determination, but is intended to ensure the Board has all potentially relevant evidence before it. See Hodge, 155 F.3d at 1363, citing "Adjudication; Pensions, Compensation, Dependency: New and Material Evidence; Standard Definition," 55 Fed. Reg. 19088, 19089 (1990). New evidence will be presumed credible at this point solely for the purpose of determining whether a claim should be reopened. Justus v. Principi, 3 Vet. App. 510, 513 (1992). If all three tests are satisfied, the claim must be reopened. The Hodge standard, i.e., whether new evidence is "so significant that it must be considered in order to fairly decide the merits of the claim," essentially represents a restatement of the standard for reviewing new and material evidence claims and became effective after the Board's now- vacated August 1997 decision and COVA's September 1998 Order granting the Joint Motion for Remand in this case. The Board's August 1997 decision based its legal conclusion that the veteran's new evidence was not "material" on a factual finding that it did not "raise a reasonable possibility of changing the outcome of the case on the merits." See [redacted]. This standard for materiality was established by COVA's decision in Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991), but was explicitly disapproved by the Federal Circuit in Hodge. See 155 F.3d at 1360. At the time of the Board's June 1991 decision, the evidence of record included the veteran's Marine Corps administrative records, documenting an administrative discharge due to a diagnosis of passive-dependent personality disorder and conduct incompatible with continued effective military service. The veteran's service medical records, which were also in evidence, showed that she was hospitalized during service following a suicide attempt or gesture, and was reportedly confined to quarters for her own safety on several occasions. In-service diagnoses included situational reaction, and passive-dependent personality disorder, with depression. In addition, the June 1991 record contained numerous private and VA medical records, including hospital summaries and outpatient treatment records, dating from 1976 to 1990. These contain diagnoses of borderline personality disorder with histrionic and narcissistic features, anxiety disorder, adjustment disorder, hysterical neurosis, and obsessive- compulsive neurosis. A July 1990 "Medical Certificate" contains the veteran's report that she had been diagnosed with anxiety disorder and PTSD, but no independent diagnosis of PTSD was made by the examiner (who assessed the veteran's condition as "R[ule]/O[ut] Borderline Pers[onality] D[isorder] vs. anxiety disorder." The clinical record noted the veteran felt overwhelmed by a friend's death in May 1990. As of the Board's June 1991 decision denying service connection for a nervous disorder, including PTSD, therefore, no competent medical evidence of a clear diagnosis of PTSD existed, and a claim for service connection for PTSD, standing alone, could not have been well-grounded. See 38 C.F.R. § 3.304(f); see also Cohen v. Brown, 10 Vet. App. 128, 137 (1997). Since the June 1991 decision, the new evidence in the file includes extensive medical documentation of treatment for physical disorders not relevant to the veteran's current claim; medical records copied from the veteran's Social Security file, dated from 1976 to 1988; hospital summaries from Citizens Memorial Hospital, dated November 1995; and hospital summaries and outpatient treatment notes dating from July 1990 through November 1995 from the VA Medical Center (VAMC) at Topeka, Kansas. In pertinent part, the records submitted since June 1991 show that the veteran has received an array of psychiatric diagnoses ranging from schizophrenic disorder, paranoid type, to dysthymic disorder and borderline personality disorder. The November 1995 Citizens Memorial Hospital records (related to treatment for an ectopic pregnancy), include the notation "In Marines x 1 yr. Now has PTSD," as part of what clearly appears to be a medical history provided by the veteran. Hospitalization summaries and treatment notes from the Topeka VAMC dated from April 1993 through August 1995 contain multiple diagnoses of PTSD and/or reports of diagnoses of PTSD. The most comprehensive and definitive of these reports is a May 1994 discharge summary (this hospitalization is discussed in greater detail below) with Axis I diagnoses of PTSD, psychotic disorder, depressive disorder, dissociative disorder, by history and an Axis II diagnosis of borderline personality. Axis IV stressors were described as extreme, and included chronic illness, "chaotic and traumatic childhood, unemployment, history of death of newborn infant, history of alleged assault in the military and history of conflictual relationships." The summary noted that the veteran felt her PTSD originated from incidents during her Marine Corps service, with the treating physician noting that "[t]hese incidents were originally reported as vague memories, but the patient stated that they included rape, physical abuse, and 'mental torture.'" The physician identified the post-service death of the veteran's newborn son and her (perceived) mistreatment by the delivering obstetrician and court system as additional traumatic events. The physician also indicated that a complete and reliable medical history was difficult to obtain because of the veteran's vagueness and inconsistency in her recollections. For example, the examiner stated that the veteran reported her number of pregnancies as varying from 4 to as many as 7 or 8, reported multiple ectopic pregnancies not verified in past medical records, claimed to believe that she was pregnant "most months," and "was known to have told staff members that she had undergone a hysterectomy in recent years," although she later denied having reported this. In its August 1997 analysis of the new evidence, the Board essentially conceded that clear diagnoses of PTSD had been presented, relating that condition in part to in-service stressors. The Board also noted, however, that corroborating evidence of the claimed non-combat stressors was required in cases such as the one under consideration. It observed that none of the medical evidence reporting the veteran's alleged in-service stressors was competent to serve as the necessary credible supporting evidence that the claimed in-service stressor actually occurred (citing Doran v. Brown, 6 Vet. App. 283, 289 (1994); Moreau v. Brown, 9 Vet. App. 389, 395 (1996)). With respect to corroboration of stressors, the Board noted that the veteran responded to a May 1990 letter, reporting stressors such as being held like a prisoner-of-war, confined by being kept away from her peers, and threats from her assigned Marine Corps legal advisor. The Board also noted, inter alia, the veteran's report that a fellow soldier attempted to rape her and that she completed a report on this matter at the time, together with her later assertions that records of her in-service complaints were destroyed in a fire. Based on this record, the Board determined that none of the veteran's "new" evidence provided sufficient specific information regarding her claimed in-service stressors to permit corroboration of their occurrence. The Board specifically found that "there is no record of physical or sexual assault in the veteran's service records," noting that the veteran had been confined to the barracks based on a psychiatric evaluation that she posed a danger to herself, but finding no evidence indicating that any claimed harassment or threats occurred in 1975. The Board also found "no other evidence corroborating the occurrence of the claimed in-service stressors in this case." With respect the other psychiatric diagnoses of record other than PTSD, the Board found that none of the evidence submitted since its 1991 decision "contains competent medical evidence that an acquired psychiatric disorder is of service origin, that a psychosis of service origin was manifest to a compensable degree within one year of service discharge, or that any preexisting personality disorder was aggravated in service." It observed that "much of the newly submitted evidence contains numerous references to non- service related traumatic or stressful events which have been associated with the veteran's various psychiatric disorders." In concluding that no new and material evidence had been submitted since its June 1991 decision, the Board assumed, arguendo, that the various post-1991 psychiatric diagnoses of PTSD discussed above were "made in accordance with the applicable DSM criteria as to both the adequacy of the symptomatology and the sufficiency of the variously reported in-service and post-service stressors." [redacted]. It then concluded that "the fact remains, as it did when the Board considered the veteran's claim in 1991[,] that there is no evidence corroborating the veteran's assertion that she experienced any traumatic events in service, including the alleged sexual assault or other unspecified physical or mental harassment." Id. After discussing the veteran's asserted stressors, and reviewing the RO's unsuccessful efforts to obtain corroborative information, the Board concluded that the new medical evidence, including PTSD diagnoses, "does not present a reasonable possibility of changing the outcome of this case." [redacted]. The "Basis For Remand" section of the Joint Motion approved by the Court in its September 1998 Order refers to the VA ADJUDICATION PROCEDURE MANUAL M21-1 (Manual M21-1) pertaining to the evaluation of PTSD claims secondary to in-service personal assault. See Manual M21-1, Part III, para. 5.14c (Change 47) (November 1, 1995). This section of the Manual notes that sexual assault, in particular, often goes unreported officially, and admonishes adjudicators that even if "the military record contains no documentation that personal assault occurred, alternative evidence might still establish an in-service stressful incident." Id. Such alternative evidence may include testimonial statements from confidants such as family members, room-mates, fellow service members or clergy. Manual M21-1, Part III, para 5.14c(5)(d). The Joint Motion advises that: . . . the Board did not provide an adequate statement of the reasons and bases analyzing the weight and credibility of all relevant evidence that supported the veteran's account that she was "confined by being kept away from peers"; threatened by her legal counsel; received substandard medical care; and was the victim of an attempted rape. Joint Remand at 8, citing YR v. West, 11 Vet. App. 393, 398- 99 (1998). On remand, the Board is directed to "give consideration to all the evidence supporting the Appellant's claim and provide reasons and bases analyzing the evidence's weight and credibility." Id. After review of the Court's order and the Joint Motion, together with the Federal Circuit's recent decision in Hodge, supra, it is clear that the answer to the question of whether new and material evidence has been submitted to justify reopening the Board's June 1991 decision now depends on whether or not the veteran's new evidence is "potentially relevant" for the Board's consideration, i.e., "so significant that it must be considered in order to fairly decide the merits of the claim." Hodge, 155 F.3d at 1359, 1363. This is a fundamentally different question than the one answered by the Board in August 1997: namely, whether the new evidence presents a reasonable possibility of a revision of the prior determination. See Hodge, 155 F.3d at 1363. Since some of the newly submitted medical evidence pertains directly to the issue of whether there is a nexus or link to active service (without assessing its probative value), and since the veteran's history as recorded in the medical reports and elsewhere must be presumed credible for the purpose of determining whether her claim should be reopened, Justus, 3 Vet. App. at 513, the Board concludes that under the Hodge standard the post-1991 evidence does provide a basis to reopen the veteran's claim for entitlement to service connection for PTSD. 38 U.S.C.A. § 5108. Having concluded that the veteran's claim should be reopened, before proceeding further the Board must determine whether rendering a decision on the veteran's service connection claim prior to consideration of the issue by the agency of original jurisdiction (the RO) will prejudice the veteran in the course of her appeal. See Bernard v. Brown, 4 Vet. App. 384, 393-94 (1993). In doing so, it must apply the binding precedent opinion of VAOPGCPREC 16-92 (57 Fed. Reg. 49,747 (1992)). See 38 U.S.C.A. § 7104(c); 38 C.F.R. § 19.5. That opinion observes that, "if the appellant has raised an argument or asserted the applicability of a law or [Court] analysis, it is unlikely that the appellant could be prejudiced if the Board proceeds to decision on the matter raised." VAOPGCPREC 16-92, para. 16. The Board notes that the veteran's attorney has clearly and explicitly addressed the question of the adequacy of the evidence of in-service stressors to support a diagnosis of PTSD, and argued for service connection on the basis of pertinent law, regulations VA internal manuals and Court precedent. Moreover, in her December 1998 brief, the veteran (through her attorney) specifically waived consideration by the RO of any new evidence pursuant to 38 C.F.R. § 20.1304(c), and asked that all the evidence of record be considered by the Board. Accordingly, because the veteran and her attorney have identified and argued apparently appropriate legal authority with respect to the issue on appeal, the Board finds no prejudice in its rendering of a decision on this issue, and it is not required to remand this case to the RO for additional consideration. Entitlement to Service Connection for PTSD As a preliminary matter, the Board notes that the although there are numerous psychiatric diagnoses of record, the Joint Motion in this case indicated that the deficiencies in the Board's now-vacated decision centered around the adjudication of the veteran's claim for service-connected for PTSD. In the pleadings associated with the appeal, the veteran's attorney limited his discussion to the factors that establish service connection for PTSD based on personal assault and he neither contended nor it is demonstrated by the record that any of the other psychiatric disorders are of service origin. In this regard, the Board finds that the veteran's claim of entitlement to service connection for PTSD to be "well- grounded" within the meaning of 38 U.S.C.A. § 5107(a). A well-grounded service connection claim for PTSD has been submitted when there is "[1] medical evidence of a current [PTSD] disability; [2] lay evidence (presumed to be credible for these purposes) of an in-service stressor, which in a PTSD case is the equivalent of in-service incurrence or aggravation; and [3] medical evidence of a nexus between service and the current PTSD disability." Cohen v. Brown, 10 Vet. App. at 137 (citations omitted); 38 C.F.R. § 3.304(f). The determination of the sufficiency (but not the existence) of a stressor is subsumed in the PTSD diagnosis, and is exclusively a medical determination for mental-health professionals, who are "experts" and "presumed to know the DSM requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis." Cohen, 10 Vet. App. at 140. The record contains apparently complete copies of the veteran's U. S. Marine Corps personnel file and her service medical records. Neither the veteran's August 1974 pre- enlistment physical examination report nor the medical history provided by the veteran at that time indicate the existence or history of any psychological condition. The first indication in the medical records of any behavioral disturbance appears to be in May 1975, when the veteran complained of depression of about three months' duration, with crying, sleep and eating disturbances, accompanied by difficulties at home and at work. The veteran reported "much turmoil in childhood." The examining psychologist described the veteran's presentation as "rather immature, hysterical personality type 'artistic temperament.' Somewhat dependent - dissatisfied with job, feels incompetent in it, although obviously intelligent, etc." The veteran's symptoms were based on a situational reaction, with no specific neuropsychiatric disease noted. Based on this report, it appears that the veteran's symptoms began shortly before or after her transfer to her first "regular" job in the Marine Corps following boot camp. There was no indication of any physical or mental abuse in the report. The veteran was next seen in July 1975, when she was admitted to the Naval Regional Medical Center at Camp Lejeune, following an overdose with Librium. The treating psychiatrist reported, "[s]he described herself as being dissatisfied with her life. At present her marriage is somewhat chaotic, she is dissatisfied with her duty in the Marine Corps, and she feels that military life has nothing to offer her. She feels that the Marines are not catering to her needs and the only way she could be heard is by doing something dramatic." The veteran was also seen twice in August 1975, with no specific diagnoses offered. On one occasion, the veteran refused to return to her unit after her appointment, as ordered, and was physically removed from the hospital and returned to her duty station by military police. As noted above, the medical records indicate that the veteran's diagnoses included situational reaction, and passive-dependent personality disorder with depression. There is no indication that the veteran reported an unlawful confinement, personal assault or attempted rape to medical personnel at any time. There are no diagnoses of PTSD, acute stress disorder, or of any other Axis I psychiatric condition. The veteran's pre-separation physical examination, conducted in August 1975, notes a passive- dependent personality by history, but contains a "normal" psychiatric evaluation. The veteran's administrative records indicate that she was counseled for performance deficiencies in April and May 1975. She is also shown to have disobeyed a lawful order to perform certain duties in May 1975, and to have been confined to her unit area for 14 days as the result of non-judicial punishment (NJP) imposed for this violation of the UCMJ by her unit commanding officer. Subsequently, she was absent from her unit without authority for a period of 12 days from July 15 - 27, 1975, and again received NJP which resulted in her restriction to her unit area until her discharge, and in forfeiture of $100 of pay. The veteran's administrative discharge proceeding records contain often highly-detailed statements from the veteran's then-commanding officer (CO) and executive officer (XO), and from her then-First Sergeant, which describe her personal and military behavior from March 1975 (the date of her assignment to the Woman Marine Company, H&S Battalion, Marine Corps Base Camp Lejeune, North Carolina, following boot camp and initial training at Marine Corps Recruit Depot, Parris Island, South Carolina), through the period immediately prior to her discharge in August 1975. The veteran's XO reported that her performance was consistently poor, and that the veteran had shown a "complete inability to behave as a self-responsible, well disciplined Marine," since her assignment to Camp Lejeune in March 1975. She noted that the veteran had engaged in "bizarre" or "hysterical" conduct, following her return from unauthorized absence in July 1975, requiring "24 hours a day" supervision. The veteran also reported having attacked her husband (a fellow active duty Marine) with a metal chair. However, there is no indication that the veteran ever reported an assault or attempted rape by any individual assigned to her for legal assistance or advice (as the veteran later alleges). The veteran's First Sergeant apparently had an opportunity to observe her for only a few days. She indicated that the veteran "has threatened physical violence by stating that she has thrown a metal chair at her husband and that she may do the same to the duty personnel. When this Private is told to follow regulations and she does not wish to comply; she will perform anyone (sic) of several childish antics - become sullen, pulls the 'I don't want to eat routine', or threatens you with 'I will call the Commandant', or 'I just can't be held responsible for what I may do'." The veteran's company commander apparently had at least two extensive discussions with the veteran, in an attempt to determine what might be causing her behavior. She reports that during one such conversation, the veteran stated "that she finally understood that almost all her problems were caused by her husband." The veteran's husband (whom she married in January 1975, approximately two weeks after her completion of boot camp), reportedly loitered around the Woman Marine Company barracks during one period when the veteran was restricted to that location, ultimately being removed by the base Provost Marshall's Office after attempting to break into the barracks in the early morning. The veteran reportedly threatened suicide on several occasions through such means as lying in her rack with an unopened package of razor blades, or drawing a tombstone and epitaph on a note, although when the veteran was being taken to the base hospital following one of these gestures, she was reported by a company sergeant as apparently "quite amused by the whole incident." The company commander also noted in his August 1975 report that the veteran had been counseled over the past few months by himself, two First Sergeants, and the Chaplain for whom the veteran worked, and that most of the counseling sessions were personal rather than military in nature and were therefore, not recorded in her service record book. None of the veteran's supervisors note any reports or suggestions of a personal assault (other than by the veteran on her husband) or attempted rape, although all observe bizarre and nonconformist behavior. Private medical records show that the veteran was admitted to Western Missouri State Hospital (WMSH [name later changed to Western Missouri Mental Health Center]) in January 1976, about two-and-one-half months following her administrative separation from the Marine Corps, with "some suicidal ideation." She was accompanied by her husband. The examining psychiatrist indicated that "[d]uring joint conferences [with the veteran] and her husband it became obvious that there were some marital problems resulting from immaturity and insecurity on the part of both partners." She reported having been "overly dramatic" at times, having "thrown wedding ring away 5 times announcing that she has 'dissolved' the marriage." She was diagnosed as suffering from hysterical neurosis in an obsessive-compulsive personality. She was discharged briefly from WMSH, but returned four days later after an argument with her husband, refusing to open her eyes and asserting that she would become corrupted by "evil out there" if she did so. She reportedly projected all blame for marital problems on her husband. Again, the examiner's diagnosis was hysterical neurosis with depressive features. In April 1976, the veteran returned to WMSH, "depressed about fight she had [with] husband," with apparent bruises and a black eye. During this period of treatment, the veteran reported "earlier relationship problems with parents," and also reported that she felt the military did not provide her with the "legal, medical psychological help" she needed to overcome this. She reported having nightmares about being separated "from what I considered my personal life, which was in disarray," by her commanding officer. The diagnosis at this time was hysterical personality. In July 1976, the veteran was again admitted to WMSH, where she remained hospitalized for three days. The day prior to her hospitalization, she had seen a hospital psychiatrist for outpatient marital counseling. The notes from this session indicate she expressed a feeling of rejection by the Marine Corps, and also described traumatic childhood experiences with "strong catharsis attached towards father." This was described as in the nature of an Oedipal conflict, Freudian in nature, and not centered on recent trauma. She also reported having recently divorced her husband. A marginal note in the progress notes indicates "PTSD," but there is no indication that this was offered as a diagnosis at this time, and the veteran's discharge summary contains a primary diagnosis of hysterical personality disorder, with no secondary diagnosis offered. The veteran returned to WMSH in September 1976, depressed and reportedly desiring to talk to her former therapist about an abortion. However, the reason for this visit was not clearly determined by the intake counselor, and the veteran left after rejecting several suggestions for intervention. In September and October 1976, the veteran received medical treatment at Kansas City General Hospital and Medical Center (KCGH) with complaints of unusual vaginal discharge, bleeding and pain, of 3-4 weeks duration. No conclusive diagnosis was offered, but various medications to alleviate the veteran's symptomatology were prescribed, along with birth control pills. In June 1978 she presented to WMSH and stated that she had been referred by her current boyfriend's psychoanalyst due to a "hypnogenic altered state of consciousness she had experienced." During her interview, the veteran expressed "her total commitment to the arts (dance, acting, painting, writing, etc.) [and] her intense aversion to ordinary employment to support herself [and] her more basic needs." She reported periods of depression and suicidal ideation, and claimed a history "of being a victim of child abuse from mother," expressing conflicts regarding her parents "[and] what they instilled in her." The veteran was said to be conversant with terms from metaphysics and the psychology of Carl Jung, but unwilling to "discuss problems at a concrete realistic level where she might be able to do something about them." Objectively, she did not appear to be depressed, suicidal, delusional or suffering from hallucinations. The examiner's assessment was of "hysterical personality structure with possible underlying schizophrenic processes, especially at times of stress." She was said to be "[e]motionally immature [and] vulnerable," lacking an adequate sense of self or her convictions. This condition reportedly made the veteran "overly susceptible to psychological stress." The veteran's record also contains records of medical for a series of gynecological complaints treatment at the Truman Medical Center (TMC), Kansas City, Missouri, from March 1978 through March 1980. The records indicate that the veteran experienced an incomplete spontaneous abortion at approximately six weeks of gestation in March 1980, and was required to undergo uterine curettage. In July 1982, the veteran returned to WMSH for psychiatric treatment, reporting she was depressed and angry, with suicidal thoughts. The intake note records the veteran's report of "increased feelings of anger and sadness since her 5-day-old baby's death in April of 1982." The veteran attributed her child's death to medical negligence and was suing the physician involved. The veteran stated that she had become increasingly preoccupied with hatred toward this doctor, and had experienced nightmares, difficulty sleeping and lack of appetite. Her admitting diagnoses for this hospitalization were adjustment disorder with depressed mood, dysthymic disorder and histrionic personality disorder. During her treatment at TSH, stressors precipitating her condition were identified as "(1) [d]eath of baby in March [sic?] which [she] views as 'murder,' (2) stress from boyfriend's wife (3) preoccupation with the past [and] (4) poor self image." After an apparently extensive interview, however, the veteran and her boyfriend decided against receiving services at WMSH and elected to "continue with her own therapist." Accordingly, no diagnosis of the veteran's condition was entered. The veteran told WMSH caregivers during the July 1982 admission that the private psychiatrist ("her own therapist") who had been treating her was a Dr. Fred Grossman, although in 1984, while under Dr. Thomas LeCroy's care (discussed below), she reported that the psychiatrist she saw at the time of her child's death was a Dr. Gerald Rosen. Neither psychiatrist has been reported by the veteran or her attorney to have treated her for PTSD related to her Marine Corps active duty, or any other claimed service- connected condition. The VA has a duty to assist veterans who have submitted a well-grounded claim in the development of facts pertinent to their claim. 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.103(a); Epps v. Gober, 126 F.3d 1464, 1468-1469 (Fed. Cir. 1997). This duty to assist includes the duty to develop facts if the record before the Board is "clearly inadequate." EF v. Derwinski, 1 Vet. App. 324 (1991); Littke v. Derwinski, 1 Vet. App. 90 (1990). Given the completeness of the remainder of this medical record, however, the Board finds no reason to believe that a remand to obtain the treatment records of these physicians would produce additional relevant medical evidence which is neither cumulative or redundant. See 38 U.S.C.A. § 5103(a); McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997) (per curiam) (identifying circumstances when VA must notify veteran of evidence required to complete application for benefits); see also 38 C.F.R. § 3.156 and discussion, supra, regarding new and material evidence. In July 1984, the veteran referred herself to a mental health center in Manhattan, Kansas, where she was treated by Thomas LeCroy, M.D., a psychiatrist. The intake interview reports that the veteran was depressed and anxious due to problems arising from the medical malpractice lawsuit she had filed regarding the death of her infant son in 1982. She was reportedly still upset, angry and sorrowful over her son's death, and also referred to problems in her relationship with her boyfriend, which were causing additional stress. Her enlistment in the Marine Corps was reported in her history, but no problems related to that period were identified. Her treatment by Dr. LeCroy and associated psychologists continued through October 1984. Other stressors discussed during this treatment included conflicts in her relationship with her mother, and reported abuse by her first husband "when she became pregnant." The medical record indicates that the veteran was not pregnant when she left the Marine Corps in August 1975. Discharge diagnoses included adjustment disorder with mixed disturbance of emotions and conduct on Axis I, and borderline personality disorder on Axis II. No Axis IV stressors were specifically enumerated. However, in his prognosis, Dr. LeCroy discussed the veteran's need for psychotherapy for "help in coping with the rather intense anger and the equally intense sense of loss she feels over the death of her baby two years ago." Unidentified treatment notes in the claims file, apparently dated in January 1987, refer to the veteran being seen by a Dr. Chediak, and note the veteran's report that she "freaks out at times" and suffered from nightmares related to the death of her child in 1982. A diagnosis of "[r]esidual stress trauma" was offered. Treatment notes from the Lawrence (Kansas) Memorial Hospital (LMH) in April 1987, indicate that the veteran was admitted there at that time due to depression and suicidal expressions. The veteran's treating physician was Elias Chediak, M.D. The veteran complained of difficulty dealing with past stresses, which were reported by Dr. Chediak as perceived poor medical treatment related to the death of her child and the subsequent lawsuit. The veteran also stated that "she was having different types of medical problems that made her very angry and she felt she was not getting the care that was needed." A more extensive treatment note by Dr. Chediak records the veteran's description of her Marine Corps service, indicating "[s]he stayed in the Military for 11 months and then got out. She was unhappy because of poor leadership, there were a lot of pressures and she felt they were doing the wrong thing." There is no report or suggestion of any personal assault, attempted rape, or any other in-service trauma. A February 1988 letter from Donald Fallon, a Lutheran Campus Ministry pastor at Kansas State University, indicates that he saw the veteran on a weekly basis from September through November 1983, and periodically thereafter through May 1984. Pastor Fallon stated that the veteran appeared to be under extreme emotional stress from "the loss of her child at birth at the KU Medical Center," with behaviors ranging from "severe depression and suicidal thoughts to inability to work and concentrate, uncontrollable crying and excessive rage and obsession with the loss." The veteran also reported to Pastor Fallon "a history of family trauma, and unresolved emotional conflicts leading to desperate attempts to relate interpersonally. She experienced difficult adjustments in the military and other work areas of dance and art." These difficult adjustments are not enumerated. A March 1988 letter from Sheldon K. Edelman, Ph.D., a clinical psychologist, reports that a psychological evaluation undertaken in November 1986 at the request of the veteran's lawyer revealed intense turmoil and high anxiety, with thought processes approaching schizoid disorder. Dr. Edelman reported that the veteran "was totally disabled because of emotional factors" at the time of his evaluation. He expressed his opinion that "she had been severely disabled for at least 3 years prior to my evaluation, and it is very probable that her disability extended many years prior to that time." However, Dr. Edelman did not provide any explanation of his basis for determining the duration of the veteran's disability or symptomatology. No specific diagnosis of the veteran's condition was offered, other than to note "the level of disorder is borderline or schizoid character disorder." All the above records (save for the veteran's service administrative and medical records) were submitted to the U. S. Social Security Administration (SSA) for a disability determination in 1988. In April 1988, SSA found that the veteran became disabled as of May 1982 (the month following the reported date of death of her infant child). The veteran's primary disability was administratively assessed as severe depression with psychotic features and her secondary diagnosis was found to be borderline personality. The veteran's initial SSA payment appears to have been made in May 1988, including back payments due as a result of the award and the current month's payment. The veteran's apparent first contact with VA occurred in June 1988, when her then-service representative submitted an informal claim for nonservice-connected pension benefits. This was followed in August 1988 by the submission of a formal application for benefits. The claims form completed by the veteran in August 1988 makes no reference to in- service incurrence or aggravation of any disability, but refers to a mental disorder which is shown as having begun in "1977(?)." In October 1988, the veteran filed a second claim, which refers to a "nervous condition" alleged to have begun in "July 1975, approx.," which was the last full month of the veteran's active service. Medical records were obtained from the Topeka State Hospital (TSH) evidencing admission for treatment in April 1988 under a court order after expressing suicide threats to a newspaper reporter. The discharge summary notes a history of suicide attempts since the veteran's 20s, including the overdose reported in the veteran's service medical records. The treating physician stated that the veteran's thoughts were "based on a presumption that society had wronged her in the circumstances around birth and death of her infant son six years ago in Kansas City. She claims that she was turned away from one hospital and then went to the indigent hospital where she believes the staff deliberately killed her baby with poor medical care." She also complained of poor legal representation in a subsequent lawsuit, and focused on "the insensitivity and injustices that are present in 'society'." She denied visual or auditory hallucinations, but stated, without explanation, that she believed she could detect earthquakes in California or Alaska. The veteran's discharge diagnosis was Axis I: Cannabis abuse; Axis II: Borderline personality disorder (principal); Axis III: Healthy adult female; Axis IV: Moderate symptoms, difficulty with lawsuit against hospitals; and an Axis V GAF (General Assessment of Functioning) score of 50, moderate symptoms, with chronic suicidal ideation and anxiety. From April 1988 through November 1988, the veteran received outpatient treatment at the Bert Nash Mental Health facility in Lawrence, Kansas. These notes record her desire to "bring the medical community to account for the death of her newborn in 1981" and relationship problems with her then- husband. Alternately with suicidal periods, the veteran is reported to have "reconstituted her artistic persona," at which times she is noted to become less mindful of the death of her child. Her psychologist reported in May 1988 that "through [sessions with] her Sufi master she has come to a new understanding of her lost child," and she no longer felt guilt or anger at the child's death. In July 1988, the veteran was said to be disturbed over the dissolution of her marriage and reported upcoming trial date for the medical malpractice suit. In August 1988, the veteran called to advise her psychologist that she had settled her malpractice suit, but felt she had lost "her day in court" as a result, and would also lose her "med card." In October 1988, the veteran called and advised her psychologist that she had hospitalized herself at the VA Medical Center (VAMC) in Leavenworth, Kansas, for a "recurrence of her [illegible] P[ost] T[raumatic] S[tress] issues: she had gotten $ in 8/88 and is reacting to the loss of her baby, I assume." In October 1988, the veteran was admitted to the Leavenworth VAMC for a period of ten days, for depression, a history of suicidal thoughts and poor social support system. The veteran mentioned "many legal problems" and difficulties in interpersonal relationships, but no did not relate any of these problems to her Marine Corps service. The treating physician remarked that "the patient's main problem appears to be in terms of social support system and also she had some legal problems. She wants justice to be done." An Axis I diagnosis of adjustment disorder with mixed emotion features was entered, with Axis II diagnoses of borderline personality disorder, rule out; and rule out histrionic personality disorder. In November 1988, the veteran again called her psychologist at Bert Nash Mental Health, and advised that she was again suicidal because of her inability to obtain a legal remedy for the "murder" of her child. She stated that she left the VAMC because she felt the VAMC was "interested only in putting her on drugs so she'll accept the injustice, not make waves." In February 1989, the RO granted the veteran's request for nonservice-connected pension benefits, but denied service connection for a nervous condition, since it found that the veteran suffered from borderline personality disorder, a constitutional or developmental abnormality for which service connection may not be granted. See 38 C.F.R. §§ 3.303(c), 4.9. The veteran appealed this determination. Records from the Topeka, Kansas, VAMC show that the veteran was hospitalized at that facility from June through August 1989. The veteran's discharge summary indicates that she was admitted after a suicide gesture (drinking alcohol with over the counter medication). When she arrived at the VAMC, she stated that she was "glad to be back" and that "I feel secure here." The veteran gave a history indicating herself to be "the victim of a variety of social injustices," including child abuse by her mother, "being persecuted and victimized by unjust authority figures" in the Marine Corps and "compelled to accept a general discharge," having an "unwanted abortion" in an unhappy first marriage, being "the victim of 'torture and malpractice' by a lady obstetrician in Kansas City 'who killed my son'," being forced to accept a settlement of a medical malpractice suit by her attorneys, having her attorney's perceived misconduct "swept under the rug and hushed up" by a legal review panel after she reportedly sued her attorneys, and being evicted from her apartment. In discussing her Marine Corps history, the veteran indicated that she enlisted "because of a felt need for structure and discipline." Upon her arrival at Camp Lejeune, after boot camp and initial training, "she quickly perceived herself as the victim of persecution by unjust authority figures and soon was in rather chronic conflict with her superiors." The veteran did not report any instance of personal or sexual assault during this time. The veteran's diagnoses on discharge included in pertinent part an Axis I assessment of anxiety disorder, not otherwise specified, with depressive and somatiform features, and an Axis II assessment of borderline personality disorder with histrionic and narcissistic features, which was said to be the principal diagnosis. As noted above, the veteran filed an amendment to her claim in April 1990 to include PTSD, stating that PTSD "should be my primary condition considered for service connection, all other nervous conditions previously considered are adjunct to [PTSD]." The veteran also reported being hospitalized at the Topeka VAMC that month. The veteran's admission was verified with the VAMC, which reported a diagnosis of borderline personality disorder. In May or June of 1990, in response to a letter from the RO asking her to provide additional information regarding any stressful in-service events, the veteran described a number of events. She stated that she was "confined" by being kept away from peers, restricted to her barracks, and "guarded by armed guards." She alleged that a Staff Sergeant Bell (or "Bess"), who was assigned as legal counsel to her, threatened her and later attempted to rape her at an ammunition dump. She stated that she reported the attempted rape to competent military authority, by completing "an eleven page report at the Ammunition Dump for the MP," and indicated that a subsequent investigation was conducted. However, she reports in the same statement that this "[e]vidence was destroyed" by the Marine Corps and that she was given "substandard medical & psychological care" for this incident. She also stated that another female Marine was harassed and later listed as missing from the Woman Marine barracks, and that she heard of deaths occurred during "war games" at Camp Lejeune. She advised that "[a] friend[']s friend was killed," but did not respond to adjacent questions which asked for names or other identifying information for her friend. By the time of a July 1990 admission to the Topeka VAMC, the veteran had accumulated "6 previous admission to VA psychiatry for treatment of anxiety disorder NOS and borderline personality disorder with histrionic and narcissistic features." She continued to feel "angry and frustrated about numerous 'injustices' in her life including alleged sexual abuse [rape] in the Marine [C]orps, 'torture' by an OB-Gyn, the 'murder of her baby by the same MD, [and] receipt of 'blood money' as a settlement for the medical lawsuit." One medical certificate prepared during this hospitalization notes that the "pt. states dx of anxiety disorder & PTSD," and reported that the veteran "feel overwhelmed by friend's death in May & life problems." However, the pertinent psychiatric discharge diagnoses at the time of this admission included only an Axis I impression of a history of anxiety disorder, not otherwise specified, with depressive and somatiform features, and Axis II diagnosis of borderline personality disorder with histrionic and narcissistic features. In June 1991, the Board denied the veteran's appeal of her claim for service connection for a nervous disorder, to include PTSD, as reported above. The new evidence submitted by the veteran since that time consists essentially of the medical documents associated with her SSA award, which have been discussed above, VA medical treatment notes from 1991 through November 1995, and a VA examination conducted in November 1994. In April 1993, the veteran was again admitted to the Topeka VAMC, where she remained through the month of May. The event reported to have precipitated her readmission was the suicide of a male patient known to her at the VAMC the evening prior to her admission. The discharge summary from this admission contains an Axis I diagnosis of PTSD. Treatment notes from this hospitalization indicate that the veteran talked about numerous events she felt victimized by, including "an incident involving an officer in the Marines, concerning threats on her person and rape or fear of being raped or killed." She also reported being beaten by her mother and sister when young and "sexual abuse at the hand of family members." She told a social worker on April 13th, that "the military was the cause of loosing (sic) her reproductive capability by mistreatment for ectopic pregnancies and complications." This allegation is not substantiated by her service medical records or other medical treatment records. In early summer 1993, the veteran was placed in the VAMC mental health center (MHC) "anger group." She was also interviewed for the MHC's "survivors group for women veterans" to discuss her reports of sexual trauma. She was declined admission to this group, as it was felt by the therapists that such discussion would cause increased dysfunction. A medical certificate prepared in October 1993 shows a history of PTSD and reproductive disorder, but no relevant diagnostic impressions. In November 1993, she was brought to the MHC by Topeka police, after a suicide threat. She reported wanting to kill herself because an inpatient at the VAMC had been "terrorizing" her. A medical certificate prepared in December 1993 shows a history of PTSD, but no relevant diagnostic impressions. In February 1994, the veteran contacted a VA social worker who she had previously worked with, and expressed anger at doctors generally, claiming "'[t]hey will not help me, and the VA killed my baby.'" In March 1994, the veteran was readmitted to the Topeka VAMC, on an emergency basis, after threatening to stab herself with a fork. She remained hospitalized for about two months. Stressors reported by the veteran at this time related to a former boyfriend, who she alleged was sadistic, threatened to kill her cats, and would not leave her alone. The veteran was violent and often yelled or screamed during the initial portion of this admission, and had to be placed in restraints. She reported being tied to a tree and left along by her brothers at age 5, and beaten by her mother after running away the following day. Later in her hospitalization, she reported being assaulted by a hospital staff member. The veteran also reportedly told VA caregivers that she had been subject to "rape, physical abuse and 'mental torture'" during her Marine Corps service, and, although she reported no clear recollection of most events, she described memory "flashes" of being wrapped in a blanket and forcibly taken somewhere, having her mouth pried open and having a gun placed to her head. She also reported a separate incident of an attempted rape during her active duty, and indicated that while she filed a report, no action against the perpetrator was taken. The discharge summary from her March through May 1994 hospitalization contains a primary Axis I diagnosis of PTSD, with additional Axis I diagnoses of psychotic disorder, not otherwise specified, depressive disorder, not otherwise specified, and dissociative disorder, not otherwise specified, by history. An Axis II diagnosis of borderline personality disorder was also entered. The "extreme" Axis IV stressors were identified, in order, as chronic illness in self, chaotic and traumatic childhood, unemployment, history of death of newborn infant, history of alleged assault in the military and history of conflictual relationships. The veteran's GAF was reported as 30, with her highest GAF in the prior year assessed as 45. June 1994, outpatient notes from the VAMC's MHC show diagnoses (by history) of PTSD and borderline personality disorder. In December 1994, the veteran received a mental disorders examination from a psychiatrist at the Topeka VAMC. The examiner reviewed the veteran's prior medical history, including her claims file and treatment records. During the interview, the veteran told the examiner that during Marine boot camp she "always felt that 'I was a covert leader,'" but that afterwards she developed nervous problems, weight gain, bruxism, pain in the arms due to work at "computer terminals." She stated that she reported these problems to her "commanding officers," but they did not believe her. The veteran reported that she was initially supposed to receive a dishonorable discharge from the Marine Corps, but was "asked to write her own discharge" after the alleged attempted rape. She described this assault as occurring after a sergeant assigned to counsel her on her legal rights invited her to discuss the situation during a ride in his truck. She stated that the truck was driven to a remote area, where the attempted assault reportedly occurred. She stated that she jumped out of the truck and ran away, hiding in an ammunition dump until she was found by military police. She reported that her superiors were afraid of her because "I sent a letter to a Congressman telling them that they couldn't kill more civilians." After two separate interviews with the veteran, the examiner noted that "she changes her story continually and seems to be inconsistent." When the examiner presented the veteran with inconsistencies in between the two interviews, the veteran's reaction was that the examiner was unable to "take good notes," which she stated was "typical of the VA system." The veteran reported nightmares related to a car going over a cliff, and said she had "flashbacks," but refused to discuss the content of the flashbacks. The veteran did not complete psychological testing, initially failing to report as scheduled, then, when rescheduled, refusing to answer any questions, instead writing complaints about how she had been treated by the "VA system." The examiner's diagnoses on Axis I were cannabis abuse and "rule out post traumatic stress disorder." An Axis II diagnosis of borderline personality disorder was entered, which the examiner indicated was the principal diagnosis. Axis IV stressors were shown as chronic illness in self, unemployment, and a history of death of newborn infant. The veteran's GAF was assessed as 45, equal to her highest GAF in the past year. The examiner indicated that his reason for reporting borderline personality disorder as the principal diagnosis was that it was more compatible with the veteran's "go[ing] in and out of psychosis during the two interviews." In August 1995, the veteran was seen by a psychiatrist at the Topeka VAMC, on referral from a physician who requested that the psychiatry service "evaluate and recommend treatment for this patient PTSD. Personality disorder." The history prepared by the evaluating psychiatrist notes the veteran's numerous hospitalizations "for PTSD," and reports that her symptoms included intrusive, obsessive thought, fits of despair and anger and hypervigilance. The veteran denied nightmares or flashbacks. Objectively, the examiner found no evidence for a history of mania. The veteran stated her belief that she had been mistreated by doctors and nurses from previous hospitals and the Topeka VAMC, who she felt had "distortions" and "deliberately have wanted to cause her harm." The psychiatrist's diagnoses were PTSD and borderline personality disorder, with the notation that the veteran's symptoms of PTSD were "quiescent at present." In November 1995, the veteran was seen at a private medical facility with complaints of abdominal pain. Notably, the veteran reported a history of acute pelvic inflammatory disease at the age of 19. She also gave a history of alleged sexual assault at the age of 18, and reported that her husband at that time sexually assaulted her during their marriage. She also indicated earlier that she was a retired Marine, had spent one year in the service, and was under treatment for PTSD. It is undisputed that the veteran suffers from serious psychiatric disability, which the RO determined in February 1989 was both total and permanent. The issue before the Board is whether the veteran's diagnosed PTSD was incurred during her active military service. Service connection for PTSD requires "competent medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor." 38 C.F.R. § 3.304(f). The determination of the sufficiency (but not the existence) of a stressor is exclusively a medical determination for mental-health professionals, who are "experts" and "presumed to know the DSM requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis." Cohen, 10 Vet. App. at 140. The veteran has multiple such PTSD diagnoses which, however, refer to a variety of stressors, some reported to have occurred during her active duty and others not. In December 1998, after the Court's order granting the parties' Joint Motion for Remand, the veteran's attorney filed a brief with the Board which reviews the factual and procedural background and argues for award of service connection for PTSD on the merits. The brief, after noting "numerous diagnoses of PTSD, as the Board has already acknowledged," focuses primarily on the type of evidence necessary to corroborate the veteran's claim that she was subjected to an in-service personal assault. Citing the Manual M21-1, appellant notes that "examples of evidence that might indicate [such a stressor] include lay statements describing episodes of depression, panic attacks or anxiety but no identifiable reasons for the episodes; visits to medical clinics without a specific ailment; evidence of substance abuse; and increased disregard for military or civilian authority," and avers that "the veteran in this case has demonstrated such behavior." In addition to those identified by the veteran, the Manual M21-1 also lists behaviors such as requests for change of MOS or duty assignment, increased use or abuse of leave, changes in performance and performance evaluations, increased use of over-the-counter medications, unexplained economic or social behavior changes and breakup of a primary relationship as possibly indicative of a personal assault, provided that such changes occurred at the time of the incident. See Manual M21-1, Part XII, para 11.38b(2) (Change 55). The Board acknowledges that evidence corroborating the existence of a stressor need not be limited to that which is available in service department records. See Doran v. Brown, 6 Vet. App. 283, 288-291 (1994); Moran, 9 Vet. App. at 395. A recent Court of Veterans Appeals decision pertaining to corroboration of stressors related to a sexual assault contains a factual situation broadly similar to that under consideration by the Board in this case. In YR v. West, 11 Vet. App. 393 (1998), the appellant served for more than three years in the U. S. Air Force, but did not complete her enlistment. More than 20 years after her separation from active duty, YR advised a VA doctor that she had been raped in service, but had never reported what had occurred. The doctor diagnosed PTSD which "'seem[ed] related to difficulties she had while in service.'" Thereafter, additional diagnoses of PTSD related to in-service sexual assault followed. YR, 11 Vet. App. at 395. In addition the evidence included YR's sister's report that she had seen YR two days after the assault, had observed bruises, abrasions, swollen lips and other injuries, and had been told by YR of the sexual assault. YR was also placed under hypnosis, where she reportedly relieved the event. YR, at 396. The Board found that this evidence did not establish that an in-service assault had occurred and denied service connection for PTSD. It based this finding, in part, on the absence of any mention of sexual assault in either service or post-service medical records. However, the Board did not discuss the weight and credibility of YR's sister's testimony and "entirely failed to consider" the hypnosis evidence. YR, at 398. Accordingly, the Court found that the Board had not provided adequate reasons and bases for its decision, frustrating judicial review. Id. In its remand to the Board, the Court advised that the portions of VA's Manual M21-1 cited above provided "guidance on the types of evidence that may serve as 'credible supporting evidence' for establishing service connection of PTSD which allegedly was precipitated by a personal assault during military service. YR, at 399. The appeal presently before the Board differs somewhat from YR, in that there are no other witnesses who claim to have heard the veteran describe an in-service personal assault at any near-contemporaneous time either before or after her release from active duty, and there is no putatively scientific evidence, such as hypnosis, sought to be offered as an objective validation of the veteran's later statements regarding the claimed assault. The Board must therefore focus on the credibility and reliability of the veteran's testimony itself, and on whether any of the behavior exhibited by the veteran in service may reasonably be accepted as corroboration of her claims, made long after service, that she was sexually assaulted while on active duty in the Marine Corps. In its review of the veteran's testimony, the Board has compared her statements with the comprehensive and detailed reports provided by the veteran's superior officers and NCO at the time of her administrative separation, and the record afforded by the administrative remarks and record of offenses and punishments contained in her service record. These reports clearly demonstrate a course of what was essentially described as immature and unreliable conduct beginning with the veteran's assignment to the Woman Marine barracks at Camp Lejeune - well prior to the alleged sexual assault. The record of offenses and punishments shows repeated unauthorized absence (UA) and other minor disciplinary infractions. It demonstrates that the veteran was apprehended or surrendered to authorities at Brooklyn, New York, after one period of UA, and at the Naval Regional Medical Center at Camp Lejeune after another period. There is no record of the veteran having been apprehended at an ammunition dump aboard Camp Lejeune, which is the location she stated that she was taken into custody by MPs following the alleged sexual assault. In the closest parallel to the veteran's description of events surrounding the assault, the veteran's XO's statement indicates that she was "placed on restriction on 6 August 1975 when she left W[oman] M[arine] Co[mpany] area in a van with two male Marines; she later surrendered to the Area Guard at Courthouse Bay. The following day, according to her XO, she was "found in her rack, in an hysterical state, with an unopened package of razor blades and a note requesting psychiatric help." It is possible that the veteran would have been assigned a legal assistance NCO at this time, since she apparently had been placed on report after her return from two weeks unauthorized absence in late July. However, the XO's report states that the veteran was "immediately placed on restriction" after (and, by implication, as a result of) leaving with the two Marines, which should not have been the case if one was her assigned legal adviser. The report also refers to two Marines, not one, which would be inconsistent with the veteran's report of the assault. The veteran's apparent suicide gesture the following day is not compelling evidence of attempted rape, since the veteran had previously made a suicide gesture in late July, prior to the time any sexual assault is reported to have occurred. Similarly, the veteran's unauthorized absences and disregard of military orders and authority do not appear to have been caused by the trauma of a sexual assault, since this behavior also began well prior to the purported date of the assault, not "at the time of the incident," as required by the Manual M21-1. The veteran's XO's report dates the veteran's "complete inability to behave as a self-responsible, well-disciplined Marine" to the time of her initial assignment to the Woman Marine Company. Further, to the extent that the veteran has recently indicated in a November 1995 report that she was sexually assaulted by her first husband apparently while she was in service, the veteran has provided no meaningful information regarding the details surrounding this claimed incident. She has never reported such an incident to any health care provider as a claimed stressor related to her military service and as such, this purported incident has not been reported as a stressor related to the diagnosis of PTSD. Further, the veteran has never claimed that such an incident is related to her diagnosis of PTSD. In addition to the claimed sexual assault, the veteran has identified being confined in her barracks under guard as a potential stressor. The record shows that the veteran was so confined, during her restriction, as authorized by the Uniform Code of Military Justice. However, none of the medical evidence reviewed above specifically cites her restriction as a potential stressor. Even assuming that her restriction constitutes part of the "conflictual relationships" in the military cited as an Axis IV stressor in the March 1994 primary diagnosis of PTSD, the Board notes that the restriction was the direct result of the veteran's own willful misconduct (i.e., unauthorized absence from her place of duty). Other stressors suggested by the veteran include unspecified "deaths" during "war games," and the death of a friend of a friend. The veteran has not provided any detail in either of these instances, after repeated requests by the RO, which would identify the circumstances of these deaths or permit attempted verification. Absent cooperation from the veteran in obtaining these details, the Board finds no further duty to attempt corroboration. As the Court has noted, "[t]he duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). See also Zarycki v. Brown, 6 Vet. App. 91, 100 (1993). Finally, the veteran has alleged substandard medical and psychological care at the Naval Regional Medical Center, Camp Lejeune. No such substandard care is apparent from the service medical records, or noted in any subsequent medical reports. A finding that medical care was "substandard" is, itself, a determination requiring medical expertise, and is beyond the veteran's testimonial competence. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); Fluker v. Brown, 5 Vet. App. 296, 299 (1993); Moray v. Brown, 5 Vet. App. 211, 214 (1993); Cox v. Brown, 5 Vet. App. 93, 95 (1993); Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993); Clarkson v. Brown, 4 Vet. App. 565, 567 (1993). The veteran's reports of stressors appear to be inconsistent and unreliable, and unrelated to her initial diagnoses of PTSD. The medical evidence reviewed above shows that no diagnoses of PTSD entered until after the veteran's infant child's death. The initial clear diagnoses of PTSD clearly identify this unmistakably traumatic experience as the stressor precipitating first, the veteran's depression and anxiety, and later, "residual stress trauma" and PTSD. Previously, service medical records noted only a passive dependent personality disorder with depression, while post- service private medical records from WMSH referred to hysterical neurosis in an obsessive-compulsive personality and hysterical personality disorder. Neither the veteran nor her caregivers discussed an in-service sexual assault (or any other in-service trauma) in any of the medical evidence submitted to support her SSA claim, nor is an in-service assault reported by the veteran's Pastor in his February 1988 letter, which refers only to "difficult adjustments in the military and other work areas of dance and art." The veteran's first apparent reference to an in-service assault occurs in her May 1990 response to the RO's letter requesting identification of stressors. The Board finds it significant that no such reports or allegations were made during her hospitalization at the Topeka VAMC from June through August 1989. Although subsequent medical reports include the veteran's reports of an in-service assault in their list of stressors potentially contributing to her diagnosed PTSD, the mere transcription of a history provided by the veteran does not transform that information into competent medical evidence simply because the transcriber happens to be a medical professional. See Leshore v. Brown, 8 Vet. App. 406, 409 (1995). The veteran's recent medical records describe multiple accusations of mistreatment and/or abuse by doctors generally, the "legal system," ex-boyfriends, and VAMC staff members. More currently, the veteran has been diagnosed with a psychotic disorder and dissociative disorder, and was, for a time, involuntarily committed for psychiatric care by a court of competent jurisdiction which determined that she was not capable or competent to make her own treatment decisions. In view of all the factors discussed above, the Board finds that the veteran's testimony is not reliable, and of little evidentiary weight. In the absence of any credible supporting evidence that the claimed inservice stressors actually occurred, therefore, service connection for a psychiatric disorder claimed as PTSD must be denied. 38 C.F.R. § 3.304(f). The Board finds that the preponderance of the evidence is against the claim for service connection in this case, and the claim is therefore, denied. Since the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C.A. § 5107(b) (West 1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER New and material evidence having been submitted by the veteran, her claim for service connection for a nervous disorder, to include PTSD, is reopened. The appeal is granted to this extent only. Service connection for a psychiatric disorder, to include PTSD, is denied. S. L. KENNEDY Member, Board of Veterans' Appeals - 33 -