Citation Nr: 9918573 Decision Date: 07/07/99 Archive Date: 07/15/99 DOCKET NO. 97-31 712 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for systemic lupus erythematosus. 2. Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. McGovern, Associate Counsel INTRODUCTION The veteran had active service from September 1965 to October 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from the August 1997 rating decision of the Los Angeles, California Department of Veterans Affairs (VA) Regional Office (RO), which denied entitlement to service connection for systemic lupus erythematosus and PTSD. In the October 1998 statement, the representative stated that "we are contending a clear and unmistakable error in the rating decision of March 30, 1982," which denied entitlement to service connection for a nervous disorder. The issue of whether the March 1982 rating decision contained clear and unmistakable error has not been addressed by the RO and this matter is referred to the RO for appropriate action. The issue of entitlement to service connection for systemic lupus erythematosus is addressed in the remand portion of this decision. Entitlement to service connection for a nervous disorder, to include depressive neurosis, was denied by unappealed rating decision of March 1982. The veteran was informed of this determination in April 1982. By letter dated in April 1983, the RO again informed the veteran that a claim for service connection for a nervous condition had been denied. The veteran did not appeal these decisions and they became final. 38 U.S.C.A. §§ 5108, 7105 (West 1991); 38 C.F.R. §§ 3.104, 20.1100 (1998). By rating decision dated in August 1997, the RO determined that new and material evidence had not been received to reopen the claim for service connection for depressive neurosis. The veteran again did not appeal this issue. Therefore, the issue of entitlement to service connection for a nervous disorder other than PTSD, to include depressive neurosis, has been finally denied; new and material evidence must be received to reopen the claim; and this issue is not currently before the Board. FINDINGS OF FACT 1. The veteran has a current medical diagnosis of PTSD and a treatment provider has related the diagnosis to her claimed inservice "personal trauma," "personal assault," and "sexual assault." 2. The veteran's claimed inservice stressors are not related to combat. 3. The veteran's report of inservice stressors, including an in-service sexual assault, variously described as a rape or attempted rape, sexual harassment, harassment by lesbians and harassment by federal investigators, are not sufficiently supported by credible evidence from any source and are deemed not credible. 4. Any stress that resulted from the veteran having been properly investigated during service for homosexual acts, which were the basis of her separation from service, would have been the result of her own misconduct. 5. There are no medical evaluations that have diagnosed PTSD based upon actual, corroborated, or credible experiences during active duty. CONCLUSION OF LAW PTSD was not incurred in or aggravated by active 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 Factual Background The veteran's service medical records show that her psychiatric status was noted to be normal at the September 1965 enlistment examination. In the September 1965 report of medical history, the veteran reported that she had never attempted suicide and that she did not have frequent trouble sleeping, frequent or terrifying nightmares, depression or excessive worry, nervous trouble of any sort, an excessive drinking habit, or homosexual tendencies. She acknowledged that she had had trouble with school studies or teachers in that her grades were not of the best and she had had difficulty studying. From September through November 1965, the veteran was treated for weight control, defective vision, swollen eyes with scleral injection, an ingrown nail, a fever blister, herpes simples on left lower lip, and a complaint of neck pain and vomiting after eating, assessed as mild gastroenteritis. In late November 1965, she sought treatment for bruises on her legs, claiming that she had had no injury and that she had had the bruises for a couple of weeks. The treating medical officer did not think that the bruises were significant. On January 3, 1966, the veteran reported that she had hit her head on a chair over the weekend "while visiting in Oceanside." She complained that her face was numb on the left side and that she had a headache. The treating medical officer noted that the veteran reported she had hit the left occipital region on a chair on Thursday, December 30th, and that she may have been unconscious for a few seconds. It was noted that she had numbness on the left side that went down the back of her neck and on the left side of her face, with intermittent headaches since the accident. There was had no change in appetite "altho anorexic," and no past history of trauma or epilepsy. It was also noted that she took Bonadaxin for nausea and nervousness because she had missed her menses but since then it had started. Physical examination was essentially negative except for pressure and a hematoma behind the left ear and the left pupil was larger than the right. The veteran was referred to a neurology clinic at a naval hospital. The referral indicates that she had tripped and struck her head and that she had a history of "passing out" two years earlier while in high school, possibly due to hyperventilation. It was also noted that there she had been given Bonadaxin for nausea and nervousness by her private doctor. The neurologist noted that the veteran had been briefly unconscious one year earlier and was told that she was hyperventilating. It was noted that she fell against a chair four days earlier and was "stunned? unconscious few seconds." The next day she reportedly noted aching pain in the left parietal region with intermittent tingling around the left ear; it was noted that she had been nervous, jittery, and nauseous. Neuro examination was essentially normal except for decreased sensation over the entire left side of the head, although the veteran noted tenderness in the right parietal region. The impression was mild residual, post-traumatic syndrome, suspect sensory changes largely functional. On January 4, 1966, it was noted that the veteran had put her fist through a window for "no apparent reason." She reported that she did not like her work section. It was noted that she was groggy and lackadaisical. She had a slight superficial abrasion over the right hand, with otherwise negative findings. She was given Meprobamate. A January 20-21, 1966, hospital record shows that the veteran had been drinking heavily on the night of admission, became belligerent and agitated, and was brought to the receiving ward of the hospital in a straitjacket where she was intermittently belligerent, combative, and sleeping. Physical examination was within normal limits except for alcoholic intoxication. The next day the symptoms and signs of intoxication had cleared. She was alert, cooperative, and motivated to return to duty. The diagnosis was simple drunkenness (alcohol). On March 5, 1966, the veteran was brought in for medical attention after a fight following an afternoon drinking session. She had no injuries. On March 18, 1966, she was referred to psychiatry, with a history of uncontrollable behavior following drinking bouts. It was reported in the referral that she became violent, could not understand herself or others; and would get drunk until she passed out or got into a fight. It was also noted that she had been belligerent for six months and that her parents, who were deceased, had had alcoholic tendencies. She denied previous trouble. She was oriented, had no hallucinations, and reportedly had put her fist through a window for no apparent reason. The provisional diagnosis was emotionally unstable personality. A March 22, 1966, report from the base psychiatrist shows that the veteran had been referred by a medical officer for rowdy behavior following episodes of drinking. The veteran reported that she had been drinking excessively since coming to Camp Pendleton about three months earlier. She stated that she was somewhat concerned about the disgusting morals exemplified by the other woman Marines and the other Marines' lack of responsibility. She did not like the fact that many of the other women were nosey and concerned themselves with her life and shortcomings. The examiner noted that the result had been that the veteran became disgusted and angry and resorted to drinking in order to temporarily alleviate her feelings. It was reported that when she drank she was easily irritated and her suppressed anger ventilated itself in stormy episodes; that she did not like her job, feeling she was learning little she could use after service; and that she had requested to be allowed to attend the personnel administration school or projection school in hopes of learning something more useful. She reported that she had had sleep disturbance for the past several months and a mild appetite disturbance, with a five pound weight loss, during that time. She reported dreaming about death and her 14 year old brother who was living with his adoptive parents. The psychiatrist noted that the veteran's father abandoned her mother when the veteran was several months of age. Her mother remarried, and both parents drank heavily and were away from home a great deal. The veteran reportedly had had to take over her mother's household responsibilities and became increasingly angry with her for not assuming her own responsibilities. The father and mother had both died in the early 1960's. Before her mother died, the veteran had been so angry with her that she left home. Although she returned briefly, she left again out of anger and now felt somewhat guilty for abandoning her mother, when staying and helping might have prolonged her life. It was noted that the veteran graduated from high school although she received poor grades from the tenth through twelfth grades after her mother died and that she joined the Marine Corps in order to avoid being further dependent on families and friends with whom she stayed after her mother's death. The base psychiatrist noted that the veteran presented no distortions of perception, was well orientated, and had above average intelligence. She was verbal and cooperative. The psychiatrist stated that the veteran showed no evidence of neurosis, psychosis, or psychotic depression but that she was chronically mildly depressed, with her depression mostly centered around frustration of her own dependency needs which she did not recognize. It was reported that the veteran had difficulty asking for things from people and expected others to fulfill their responsibilities. Her anger, in part, stemmed from the fact that other people did not uphold their responsibilities as her mother failed to do, with the veteran then having to perform their work for them. It was noted that "she is asking for help now, however." The psychiatrist suggested that the veteran be sent to school as she requested, if this was at all possible, and concluded that the veteran displayed no significant psychiatric illness, although she was chronically depressed. She was to return in two weeks for re-evaluation. On April 15, 1966, the veteran was again seen by the base psychiatrist and stated that she was getting along quite well, drinking considerably less, and not letting others bother her with "their little nicknames and subtle remarks." She reported that she had been able to sleep better during the past several weeks and it was noted that she continued to display initiative regarding schooling in the service. She expressed considerable interest in furthering her knowledge and experience and felt that she could perform well if given the chance. The base psychiatrist concluded that there were no limitations of a psychiatric nature to full duty. A July 1966 treatment record states that the veteran took an overdose of Darvotran the night before. She was also drinking and did not remember. On September 23 and September 28, 1966, she complained of extreme nervousness. On the first occasion she complained of being unable to keep food down because of nervousness and of chest pain, and was given Compazine. On the second occasion she asked for more Compazine but was given Davotran. A psychiatric evaluation was requested in September 1966; however, the veteran refused to undergo the evaluation. The veteran was treated for various other disabilities on numerous occasions from January 1966 to October 1966, including fever and chills with body aches, left ear pain, a foot wart, lumbar pain, a cut on the right hand, reaction to a shot of Thorazine given on March 5, 1966, stiffness on the left side of neck, upset stomach and headache, viral enteritis, a twisted ankle, hemorrhoids, pneumonia, cramps, back pain, nose bleeds, sore throat, nasal congestion, tightness in the chest, right arm cuts, and irregular periods. She was also treated for an injured right hand, wrist, and thumb, and for nausea, vomiting, and generalized sharp pains especially after eating spicy foods. The October service discharge examination report shows that psychiatric examination was normal and that the veteran refused to have a pelvic examination. In June 1978, the veteran filed an application for review of discharge or dismissal from the Armed Forces of the United States and requested that her discharge be upgraded to an honorable discharge based on administrative irregularities and compassionate consideration. According to a Naval Discharge Review Board document in support of her claim, she submitted five letters attesting to good citizenship, a newspaper clipping describing the rescue of a lost child, a copy of a court case, and a May 1979 statement from Dr. R. Kaplan. In the May 1979 statement, R. Kaplan, M.D., stated he had been an Army staff psychiatrist for two years, that he first evaluated the veteran in January 1979, and that he had treated her since for an emotional illness, depressive neurosis (acute and chronic). He noted that the veteran had initially been given an undesirable discharge from the Marine Corps for reasons of unfitness (homosexual acts) in October 1966 and that she refused psychiatric evaluation at the time of discharge. Dr. Kaplan stated that he based this report on his review of the veteran's "mental and administrative military records," his impressions of the veteran, and the historical data provided by the veteran. It was noted that the veteran reported that she had refused legal representation and psychiatric evaluation because she "felt harassed by my interrogators," was so distraught that she desired to be separated from the service as quickly as possible, and was led to believe that medical evaluation would only delay the inevitable. Also, she had felt that a court martial would only increase already too painful feelings of shame and humiliation. Dr. Kaplan stated that during service the veteran had been seriously emotionally ill and had displayed symptoms of depressive neurosis, that she was in so much emotional pain at the time of her discharge she could think only in terms of immediate relief of that pain, and that her "consent to" an undesirable discharge was probably an extension of well-documented previous self- destructive behavior. Dr. Kaplan stated that the history of reactive excessive drinking, insomnia, weight loss, and morbid preoccupation with death, which were all shown in service, were a classic text book description of a moderately severe depressive neurosis. He opined that the veteran's complaints of nausea and vomiting in service in April 1966 showed that she had either continued to drink or probably had developed well- known gastrointestinal manifestations of depression and anxiety. Dr. Kaplan also indicated that the veteran was seen in July 1966 "following an impulsive suicide attempt" and that she had been drinking and overdosed on pain medication. Dr. Kaplan reported that, prior to service, the veteran had had a tragic family history and had admitted that, reactive to this, she did have mild recurring depressive symptoms; she described herself as moody, sullen, and quiet but that she had never had suicidal ideas and was never so depressed that she could not function prior to service. Dr. Kaplan noted that "in retrospect, she described personality features which characteristically predispose to severe emotional illness when under significant stress." She reported that her drinking before service was "like any stupid teenage kid" and that she did get drunk on beer on three to four occasions at parties with others but that alcohol never interfered with her daily functions. It was noted that her drinking dramatically increased in the military where she drank hard liquor, often alone, in response to stress, and to get to sleep. Dr. Kaplan stated that "clearly, her alcoholic consumption was a symptom of an underlying depressive illness." Dr. Kaplan also noted that the veteran admitted to homosexual activity while in the service. She had reported that she was aware of some homosexual feelings prior to service and had attended some gay parties. Dr. Kaplan found it significant that prior to service the veteran denied any homosexual relations; rather she had had heterosexual relations on three or four occasions and had had heterosexual relations several times while in the service. Dr. Kaplan stated that in service the veteran had been exposed to many women homosexuals and that her first homosexual acts occurred with a Woman Marine (WM) early during service. The veteran reportedly had been drinking at the time. Dr. Kaplan suggested that "her subsequent depression, anxiety, and drinking were reactive to this homosexual exposure" and that this was called "homosexual panic." Dr. Kaplan reported that it was not uncommon to see this in the military in individuals who did not have a strong sexual identity; after a casual homosexual act they would become frightened, depressed, anxious and generally develop symptoms like those of the veteran. Dr. Kaplan was of the opinion that the veteran had been denied the opportunity for help with her sexual identity problems because she was not properly diagnosed and treated when first seen by the base psychiatrist. He noted that at the time of discharge the veteran was not in her own mind an identified homosexual, citing her statement to Naval Intelligence in September 1966 that she hoped in the near future she would be able to eliminate her desires for sexual contact with women. Dr. Kaplan stated that the veteran's undesirable discharge had embittered her, that she had been branded a homosexual and now accepted this label, and that heterosexual relations had ceased since service. The veteran reportedly drank heavily on occasion and occasionally became seriously depressed, which is why she entered treatment. Dr. Kaplan concluded that the veteran entered service with factors predisposing to neurotic depression and with a borderline sexual identity; that she was exposed to many severe stresses in the military, including homosexual Women Marines; and that she responded to those stresses with symptoms of neurotic illness, including depression, anxiety, excessive drinking, and homosexual acting out. In June 1979, the veteran appeared at a hearing before the Naval Discharge Review Board, where she requested that the board consider the following contentions: (1) That her discharge was improper in that she experienced severe psychiatric problems in service which were misdiagnosed, that any and all misconduct (homosexual or otherwise) arose from these psychiatric problems (depressive neurosis), and that due to the misdiagnosis she was not properly treated or properly discharged; (2) that the aforementioned was true and, therefore, her discharge was improper because she could not have understood her rights or intelligently waived them; (3) that her discharge was inequitable and had to be upgraded to fully honorable in accordance with SECNAV Memo 1900.9C (January 20, 1978) (which states an individual administratively separated because of homosexuality should normally be given an honorable discharge unless the quality of service, as reflected by the official service record warrants otherwise); and (4) that her post-service meritorious conduct which was demonstrated by letters and documents constituted evidence in mitigation and had to be considered. At the hearing, she and her counsel discussed her inservice medical record, Dr. Kaplan's letter, and her pre-service, inservice, and post-service experiences which included extreme emotional problems and excessive use of alcohol. She admitted to inservice homosexual experiences, described herself as "not totally homosexual" while in service, and stated that she was currently "gay." In a separate document of contentions she asserted that Naval Intelligence had questioned her for at least six hours, that her personal effects were searched, and that she felt embarrassed and threatened. She contended that the Marine Corps had been "overly zealous" and that she should have been given a medical discharge instead of an undesirable discharge due to homosexual acts. The Naval Discharge Review Board noted that the veteran underwent neuropsychiatric evaluation in March and April 1966 and that the findings included no evidence of neurosis, psychosis, or psychotic depression and no limitations to full duty of a psychiatric nature. It was further noted that there were numerous sick call entries related to injuries, stomach problems, nervousness, and alcohol use. The summary of the evidence shows that the veteran entered service in September 1965 and was assigned to WM (Women Marine) Co., Hq Bn, MCB at Camp Pendleton, California, on December 23, 1965, after basic training. It was also reported that she had been charged with several violations of the Uniform Code of Military Justice (UCMJ) from February to October 1966 and received three nonjudicial punishments for these violations, which included assaulting another WM, use of threatening and obscene language toward another WM, unlawfully striking another WM in the chest and stomach, breaking a window in the barracks, violating a legal order, and fighting in the barracks. In September 1966, she signed a statement implicating other WMs and relating her own homosexual acts and knowledge of other homosexuals (hearsay in some cases). Also in September 1966 she refused psychiatric consultation and she accepted an undesirable discharge for the good of the service to escape trial by court-martial. In October 1966 she received an undesirable discharge/unfit (homosexual acts). The Naval Discharge Review Board found the veteran's first contention as stated above to be invalid because she received two neuropsychiatric evaluations which found her fit for duty and because the statement of her psychiatrist dated 13 years after discharge was insufficient to refute the service medical records. The veteran's second contention was also found to be invalid and it was concluded that she had the capacity to understand her rights and her waiver thereof was proper. The majority opinion of the Naval Discharge Review Board also concluded that her third contention was invalid because the violent nature of her offenses clearly documented a quality of service which could only be characterized as other than honorable. Finally, the veteran's fourth contention was found to be invalid because, although good post-service citizenship was acknowledged, it was not sufficient to overcome a record which included three nonjudicial punishments for offenses of assault and other offenses of a violent nature. The majority found that none of the veteran's assertions were valid and concluded that the veteran's discharge should not be changed. The majority noted that the basis for the discharge should not be changed because the veteran's admitted homosexual activities clearly demonstrated that she was unfit for retention in the naval service. The majority also concluded that the type of discharge should not be changed because her disciplinary record which included violations of the UCMJ, clearly demonstrates that the character of her service was other than honorable. The Director of the Naval Council of Personnel Boards, concurred with the conclusion of the Naval Discharge Review Board for the reasons stated by the majority in the Record of Review of Discharge. The minority findings included the fact that the veteran claimed that she was from an alcoholic family and that she herself was an alcoholic; that she claimed that she was in the active phase of alcoholism during service; and that she claimed that she was drinking a fifth of distilled liquor a day at the time of her disciplinary problems. The minority found that there were numerous entries in her service medical record which attested to her heavy use of alcohol. The minority noted that alcoholism and alcohol abuse were not in themselves offenses which constituted grounds for punishment; however, members who committed offenses while drinking were still responsible for their actions (SECNAVINSTR 5300.20 dated 18 May 1972). Finally, the minority opinion stated that "while the individual also bears primary responsibility for obtaining treatment...commanders will undertake to identify and treat such individuals...whether they seek treatment or not." (MCO 5370.6 dated 28 August 1972). The minority of the Naval Discharge Review Board concluded that the veteran's third contention, that her discharge must be upgraded in accordance with SECNAV MEMO 1900.9C (January 20, 1978), was valid because her record of service which included three non- judicial punishments was not sufficient aggravation to deny her an upgrade under SECNAV policy. The minority stated that it appeared that the veteran was suffering from an extenuating alcohol problem; that her medical record showed heavy use of alcohol; and that each of the offenses, in the opinion of the minority, was the direct result of excessive drinking. It was noted that while policy stated that individuals were responsible for their actions while drinking, there was also a command responsibility to identify and treat the individual who suffered with an alcohol problem. The minority concluded that her discharge should be changed to General/Unfit. The minority stated that the basis for the discharge should not be changed because the veteran's admitted homosexual activities clearly demonstrated that she was unfit for retention in the Naval Service. However, the minority concluded that the type of discharge should be changed because the SECNAV Memo of 20 January 1978 applied; because the three nonjudicial punishments were related to excessive alcohol consumption; because the command failed to properly identify and treat it; and because the alcohol problem was extenuating. It was further noted that, with only three alcohol-related nonjudicial punishments, her record of service was not considered to be sufficiently aggravating to deprive her of a discharge under honorable conditions. However, the minority found that the veteran's record of service, with three nonjudicial punishments and an average conduct mark of 3.4 was not sufficiently meritorious to warrant an honorable discharge. The veteran appealed the decision of the Naval Discharge Review Board. In September 1979, she and her counsel submitted a rebuttal in which they asserted that she should receive an honorable discharge. They contended that the cited inservice evaluations occurred prior to her July 1966 suicide attempt, prior to her last non-judicial punishment, and prior to numerous sick call entries for disorders such as nervousness and upset stomach, and were, therefore, insufficient to refute Dr. Kaplan's report. Additionally, they argued that she was not emotionally stable in service as was evidenced by actions including a suicide attempt, striking other people, putting her fist through a window, drinking a fifth of distilled liquor a day, and complaining of extreme nervousness, upset stomach, nausea and vomiting, and dreams about death. It was argued that she should not have been permitted to refuse evaluation or waive her rights in light of her medical and psychiatric history and the aforementioned events. They also asserted their strong belief that the misconduct she committed in service was "a result of her psychiatric problems of which her alcoholism was part of the symptoms" and that the command had the responsibility to identify her problems and treat her psychiatric and alcoholism problems. In February 1980, the Assistant Secretary of the Navy specifically adopted the statement of findings, conclusions, and reasons of the minority opinion of the Naval Discharge Review Board. In March 1980, the veteran was notified that her discharge would be changed to a general discharge. By a letter dated in January 1981, S. White, M.A., M.F.C.C., stated that she was a private psychotherapist who specialized in marriage, family, and child therapy and that she first evaluated the veteran in July 1980 for treatment of anxiety and depression. Ms. White stated that in her professional opinion, military service was a traumatic experience for the veteran due to psychiatric mishandling from which she had never recovered. Ms. White stated that sexual identity problems that could have been resolved at the time were exacerbated and that this "added to the stigma of an undesirable discharge, caused extreme mental stress and interfered with the veteran's ability to relate to society. It was noted that these areas of trauma were still being treated in order to attain resolution. Ms. White indicated that her statement was based on her clinical impressions of the veteran, the historical data provided by the veteran, and a review of the veteran's mental and administrative military records. In a January 1981 statement, the veteran reported that she refused final psychiatric evaluation in service because she felt that it would not be of any help to her since previous sessions had been of no help and because she felt that she was being harassed. She stated that she spent half of her time in service at the infirmary "for one thing or another" and that she had been trying to get some kind of attention. She reported that she began to drink heavily in service, got into fights, and had rages of anger; that she never drank before service; and that for several years after discharge she had nightmares, guilt feelings, and suicidal thoughts as a result of the way the military treated her at the time of her discharge. She asserted that, in service, the arresting personnel were very badgering and scared her; that she was followed, visited, and watched by the FBI; and that just seeing a government car sometimes still made her paranoid. At a December 1981 VA neuropsychiatric examination, the veteran reported that her mother had been an alcoholic and that her father deserted the family when she was two. Her mother remarried when the veteran was four, and her stepfather never showed her any love unless he was drunk. She reported that both parents and one brother were deceased; her mother and stepfather died when she was 14 and 15 years old and she then lived with nine different families in three years. She stated that she never drank while in high school. She reported that her stepbrother "induced her to have sexual intercourse, but she called raped (sic) when she was eleven years old." She reported it to her parents but they did nothing and her stepfather laughed, saying "Boys will be boys." She also stated that her stepbrother tried this again when she was 15 and he was 21 but that time she put him off. She reported that she became a severe alcoholic "as soon as she entered the service," indicating that she was depressed in the service and this led to her drinking; that she always wanted attention and affection which led to her drinking; and that she drank because she was scared and because she could not sleep without drinking. The veteran also reported that prior to service she had had no homosexual relationships or fantasies prior to service but she had had heterosexual relations. She stated that she was caught in a homosexual act by an undercover agent in service who was there to discover lesbians and who actually engaged in homosexual play with the veteran, then turning her in. The veteran signed a confession. She stated that, prior to that episode, she had had two other homosexual experiences, which amounted to no more than hugs and kisses. She reported that she became a she would get so belligerent and upset when she was drunk that she would smash her arm through windows, on one occasion cutting arteries in her right arm that required many stitches. She stated that she got into fights when she was drunk, but that she always did her work during the daytime. She stated that she had been depressed in service and had tried to kill herself on one occasion. She reported that she had been in psychotherapy for a number of years and had had a nervous breakdown in 1980 during which she had the same symptoms as in service. The veteran reported that she felt depressed, lost, angry and scared; that she felt unloved and misunderstood and wanted to be needed; and that she frequently vomited, and felt down in the dumps, lonesome and unhappy. Testing indicated that she had no trouble with concentration and that she had good ability to do abstract thinking. The initial diagnosis was depressive neurosis, moderately severe. The examiner noted that the veteran appeared to have developed depression in service that led to a great deal of her acting out and eventually led to her discharge. MMPI testing was done in early 1982. In an addendum to the December 1981 psychiatric examination report, the examiner noted that the MMPI results showed an invalid profile due to "tendency to emphasize her symptoms and minimize her strengths." The examiner noted that one interpretation of this was depression with severe confusion (i.e. psychotic depression), noting that such was contradicted by her mental status, which showed good concentration and abstract thinking. "Hence exaggeration is the necessary inference, and the severity of the depression is impossible to assess." The prior clinical diagnosis was then changed to depressive neurosis, severity unclear due to exaggeration. (The actual MMPI report notes the veteran's tendency to emphasize her symptoms while indicating that she did not exhibit the typical pattern for malingering.) VA outpatient treatment records dated from November 1994 to May 1997 include several records that show the veteran had a history of depression. In March 1995, she reported that she had had occasional bouts of depression secondary to a friend's death. A May 1995 treatment provider noted that the veteran was depressed. In February 1996 she was noted to have a history of depression which was currently under control; it was felt that this was related to her lupus. When the veteran was hospitalized in May 1996 for treatment of an unrelated disorder, it was noted that her past medical history included depression. Although there were no relevant complaints or findings, the discharge diagnosis included depression. An August 1995 treatment record shows that she sought treatment for right lower quadrant pain and nausea and vomiting. It was noted that she had a history of rape and that she refused rectal and pelvic examinations stating that she preferred examination at the Women's Health Clinic. In an August 1995 referral for consultation at the Women's Health Clinic, it was noted that the veteran had a history of rectal sexual assault. However, a September 1995 women's health clinic treatment record includes reference to rectal complaints but no mention of rape or other sexual assault. This record shows that the veteran had hemorrhoids and the assessment included rectal bleeding with fissure. In February 1997, the veteran requested copies of her service medical records which the RO mailed to her in April 1997. In March and October 1997 letters, a VA physician who was the Chief of Rheumatology at a VAMC and a professor of medicine at the University of California, Irvine, stated that the veteran's inservice treatment for nervousness could have been an early manifestation of lupus cerebritis and that "Clearly, her depression is a manifestation of her systemic lupus erythematosus today." In an undated statement, apparently received in 1997, A. L. E., M.A., a "sexual trauma counselor" at a Vet Center, stated that the veteran was in treatment for PTSD due to sexual assault. In a May 1997 statement in support of her claim for PTSD, the veteran reported that her stressors included having been called to the quarters of her female drill instructor, Corporal M.B., on the night of her graduation from boot camp in mid-December 1965. The drill instructor reportedly told the veteran that she was very special to her and that she was very proud of her and then put her hands on the veteran, but "there was no sexual act, just touching me." The veteran reported that this incident "really blew me away." She never saw the drill instructor again after that night, and had not told anyone of this incident until she began counseling at the Vet Center. She reported that another stressful inservice event was that she was sexually assaulted by a serviceman. She stated that she and another female went out with two men and proceeded to drink a lot. She went for a walk with one of the men, and when they reached a bushy area, he pushed her to the ground and forced himself on her sexually. She reported that she tried to scream but no one heard her and afterwards she felt real dirty and ashamed. In the May 1997 statement, the veteran further reported that she started drinking more, kept getting into trouble, and "for some reason there was a woman to comfort me." She stated that she sometimes became very violent, fought drinking every off duty hour, and started hanging out with gay women "because to me they were safer." She reported that she was then busted by military intelligence who followed her everywhere. Another stressor was that she reportedly had been under "constant sexual harassment by the military base." She stated that she was used as a scapegoat to get other women thrown out of service and that the service had failed her by looking the other way regarding her drinking and confusion regarding her sexual identity. She alleged that the military police did not stop "with the discharge" and continued to follow and harass her. Reportedly that they came looking for other females in her home and sat outside her home in a car watching her. She stated that after service she continued drinking, sometimes did not want to live, and took medication "to stay together." In a letter to the RO dated in June 1997, Ms. E. identified herself as a readjustment counseling therapist and stated that she had treated the veteran on a weekly basis since February 1997 for PTSD which was related to "Personal Trauma" that occurred in service. After explaining to the RO the nature and purpose of Vet Centers, she noted that the veteran had presented with a flat affect "in response to Jesse Brown's letter to women veterans regarding military sexual trauma experience." It was noted that the veteran reported having been exposed to constant, deliberate, and daily sexual harassment in service; that she experienced consistent daily sexual harassment by lesbians and "witch hunts" in service; and that she had been the victim of date rape by a serviceman. Ms. E. asserted that all of the aforementioned incidents directly impacted the veteran's current level of functioning and psychological well being. Ms. E. noted that the veteran had several psychiatric symptoms. At times during her weekly sessions she appeared to exhibit some cognitive impairment especially due to intrusive thoughts, flashbacks, insomnia and nightmares. She also exhibited mood swings and numbing. At times when discussing her military trauma, the veteran would avoid details and digress. The veteran reported that she "isolates" and that this isolation began shortly after the sexual assault in the military. Ms. E. stated that the veteran's isolation was part of her need to feel safe even though it impacted her interpersonal relationships; that she no longer was able to trust others; and that she continued to have great difficulty in trusting men, women, or those in authority and did not participate in social activities under any circumstances. It was also noted that she had had many personal losses throughout her life which had exacerbated her need to isolate. The veteran reported that "every time I get close to someone they either die or leave." Ms. E. stated that the veteran would continue to be seen to deal with the psychological aftermath of her military sexual trauma and major depression. In Ms. E.s' January 1998 letter to the RO, it was noted that since the last letter new issues had surfaced during the veteran's therapy sessions. Reportedly, the veteran relayed that she had withheld details of her trauma story due to issues with trust and the counselor's ethnicity. However, a therapeutic alliance had been formed and a clearer picture of the veteran's military traumatic experiences had become apparent. Ms. E. reiterated some of the material in her prior letter, although now stating that the incident of sexual assault had been an "attempted date rape/sexual battery" that occurred on December 30, 1965, at Camp Pendleton. According to Ms. E., the veteran reported that she and another female Marine were drinking at the noncommissioned officers' club on the base and met a couple of male Marines who suggested that they go for a ride. They drove to Carlsbad by the ocean, continued to drink, and began "petting." One of the men, who was approximately 6'2" and of a different race from the veteran, suggested that he and the veteran go for a walk. She agreed and the next thing she remembered was being on the ground screaming for her life; no one heard her screams as it was late and the area was isolated. She stated that she asked him to "please stop." He did not penetrate her and she was able to get away, thereafter asking "them" to take her home. She did not report this incident to anyone or see the perpetrator again, but the next day she went to sick call for some bruises, telling the corpsman that she fell out of a chair. Ms. E. noted that "this is consistent with the presentation of other trauma survivor [sic], presenting with issues not related to assault or misrepresent [sic] what the physical evidence shows. In this veteran's case she explains away her bruises." Ms. E. noted that the veteran indicated that she did not report this incident out of fear that it might "look unfavorable [sic] on her and possibility [sic] cost her military career which she so desperately wanted." The veteran reported that she had a tremendous amount of guilt, shame, and victim blame; she felt shame and guilt for going for a ride with a stranger and for having been under the influence of alcohol. She reportedly began experiencing difficulty with her judgment and perceptions about herself and her environment. The veteran stated that her symptoms began to increase and were exacerbated by the "witch hunts" and her struggle with her sexual identity, stating that her many sick call visits were a way of seeking help for her psychological pain. Ms. E. noted that, according to the service medical records, the veteran sought treatment for nervousness, nausea and vomiting, and gastrointestinal problems which gave "validity and validation of her trauma." The veteran reported that she increased her alcohol consumption to numb her feelings regarding the attempted rape, the insensitivity of the military toward her medical and psychological problems, and the re-traumatization in the form of the "witch hunts." Ms. E. stated that the drinking was used as a means to numb and cope with her traumatic experiences and emerging PTSD symptoms. According to Ms. E., the veteran stated that she began drinking alcohol prior to enlistment but that, after the in- service assault, her drinking escalated to the point where she got into trouble. She reported that she continued to drink large amounts of alcohol daily and went to bars seeking fights until age 43. She had been involved in a car accident while drunk in 1973, when she broadsided a car that had run a stop sign. The other driver died at the scene, and the veteran then "went cold turkey" and had been clean and sober since. Ms. E. reported that the veteran had a tremendous amount of guilt feelings regarding the "victim," and that she still experienced survivor's guilt and continued to grapple with this issue in therapy. The veteran reported that "immediately upon her discharge" she began six years of counseling with Dr. White, who was now deceased. The veteran related that she was able to deal with her childhood trauma but had not resolved her military trauma issues and their impact on her psychological and physical well being. Ms. E. also noted that the veteran was unable to work due to lupus, which was very debilitating and limited her socially, emotionally, and physically, and that she had unresolved issues with grief due to the loss of her career. Ms. E.'s assessment was PTSD, secondary to personal assault. Pertinent Law and Regulations Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a pre-existing injury suffered, or disease contracted, in the line of duty. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1998). Where a veteran served ninety days or more during a period of war or during peacetime service after December 31, 1946, and a psychosis becomes manifest to a degree of ten percent within one year of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.307, 3.309 (1998). This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Under the provisions of 38 C.F.R. § 3.304(f), service connection for PTSD requires (1) medical evidence establishing a clear diagnosis of the condition, (2) credible supporting evidence that the claimed inservice stressor(s) actually occurred, and (3) a link, established by medical evidence, between current symptomatology and a claimed inservice stressor. 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128 (1997); Moreau v. Brown, 9 Vet. App. 389 (1996). If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that she was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. 38 C.F.R. § 3.304(f). The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") has set forth the analytical framework for establishing the presence of a recognizable stressor, the essential prerequisite to support a diagnosis of PTSD and entitlement to service connection. There are two major components to this analysis: first, it must be established whether the evidence demonstrates that stressful events occurred and, second, it must be established whether the stressful events are sufficient to support a diagnosis of PTSD. Cohen; Moreau; Zarycki v. Brown, 6 Vet. App. 91 (1993). Regarding combat-related service, the Court articulated a two-step process of determining whether a veteran "engaged in combat with the enemy." However, there is no allegation or evidence in this case that the veteran served in combat. If the evidence does not show that the veteran was engaged in combat, there must be corroborative evidence of the claimed stressor(s). See 38 U.S.C.A. § 1154(b) (West 1991); Zarycki. The Court has recently held that "credible supporting evidence" means that the veteran's testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor. See Cohen, supra; Moreau; and Dizoglio v. Brown, 9 Vet. App. 163 (1996). Veterans who claim service connection for disabilities due to an in-service personal assault face unique problems documenting their claims. A stressor development letter specifically tailored for personal assault cases should be sent to the veteran. The Board is aware that many incidents of personal assault are not officially reported and that victims of this type of in-service trauma may find it difficult to produce evidence to support the occurrence of the stressor. However, alternate sources are available that may provide credible support to a claim of an inservice personal assault. These include medical or counseling treatment records following the incident, military or civilian police reports, reports from crisis intervention or other emergency centers, statements from confidants such as family members, roommates, clergy, or fellow service members, or copies of personal diaries or journals. VA Adjudication Manual M21-1 (M21-1), Part III, 5.14(c) (February 20, 1996); and former M21-1, Part III, 7.46c(2) (October 11, 1995). It is noted that behavior changes that occurred at the time of the incident may indicate the occurrence of an in-service stressor. Examples of such behavior changes include, but are note limited to: visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment; sudden requests that the veteran's military occupational series or duty assignment be changed without other justification; lay statements indicating increased use or abuse of leave without an apparent reason such as family obligations or family illnesses; changes in performance and performance evaluations; lay statements describing episodes of depression, panic attacks, or anxiety with no identifiable reasons for the episodes; increased or decreased use of prescription medications; increased use of over-the-counter medications; evidence of substance abuse such as alcohol or drugs; increased disregard for military or civilian authority; obsessive behavior such as overeating or undereating; pregnancy tests at the time of the incident; increased interest in test for sexually transmitted diseases, unexplained economic or social behavior changes; treatment for physical injuries around the time of the claimed trauma but not reported as a result of the trauma; or breakup of a primary relationship. In personal assault claims, secondary evidence may need interpretation by a clinician, especially if it involves behavior changes. Evidence that documents such behavior changes may require interpretation in relationship to the medical diagnosis by a VA neuropsychiatric physician. VA Adjudication Manual M21-1 (M21-1), Part III, 5.14(c); and former M21-1, Part III, 7.46c(2) (October 11, 1995). The Court has held that the Manual M21-1 provisions in Manual M21-1, part III, 7.46 and 5.14(c), dealing with PTSD are substantive rules that are the equivalent of VA regulations. Cohen; YR v. West, 11 Vet. App. 393, 398-99 (1998). In West v. Brown, 7 Vet. App. 70 (1994), the Court held that the sufficiency of a stressor is a medical determination. Adjudicators may not make a determination on this point in the absence of independent medical evidence. Colvin v. Derwinski, 1 Vet. App. 171 (1991). In Cohen, the Court pointed out that the VA had adopted the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM- IV) in amending 38 C.F.R. §§ 4.125, 4.126, and that the standard regarding assessing the sufficiency of a stressor was now a more subjective one. See 61 Fed. Reg. 52695-52702 (1996). The Court took judicial notice of the fact that the shift in diagnostic criteria changed from an objective ("would evoke ... in almost anyone") standard in assessing whether a stressor is sufficient to trigger PTSD to a subjective standard. The criteria now require exposure to a traumatic event and response involving intense fear, helplessness, or horror. A more susceptible individual may have PTSD based on exposure to a stressor that would not necessarily have the same effect on "almost everyone." The sufficiency of a stressor is, accordingly, now a clinical determination for the examining mental health professional. Cohen, at 153. The Court also noted that where "there has been an 'unequivocal' diagnosis of PTSD by mental heath professionals, the adjudicators must presume that the diagnosis was made in accordance with the applicable DSM criteria as to both adequacy of symptomatology and sufficiency of the stressor (or stressors)." Cohen, at 153. In a more recent case, the Court noted that although it had previously stated that "'something more than medical nexus evidence is required to fulfill the requirement for 'credible supporting evidence' and that '[a]n opinion by a mental health professional based on a post service examination of the veteran cannot be used to establish the occurrence of a stressor,'" those statements did not apply to PTSD arising from personal assault. Patton v. West, 12 Vet.App. 272, 280 (1999) (citations omitted). In that decision the Court also stated that the RO was responsible for assisting a claimant in a personal-assault claim by, in part, furnishing a clinical evaluation of behavior evidence. Analysis Well Groundedness and Duty to Assist The initial question before the Board is whether the veteran has submitted a well grounded claim as required by 38 U.S.C.A. § 5107. A well-grounded claim is one which is plausible or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78 (1990). More specifically, the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") has indicated that a veteran seeking service connection for PTSD must satisfy the initial burden of submitting a well grounded claim by furnishing (1) medical evidence of a current disability, (2) medical or lay evidence of an in-service stressor, and (3) medical evidence of a nexus between service and the current PTSD disability. See Cohen v. Brown, 10 Vet. App. 128 (1997). Here, the veteran has submitted (1) medical evidence, in the form of three statements from a Vet Center counselor, of a current diagnosis of PTSD (presumed to include the adequacy of the PTSD symptomatology and the sufficiency of the claimed in-service stressor), (2) the veteran's own testimony of inservice stressors (which the Board presumes to be true for purposes of determining whether her claim is well-grounded, see King v. Brown, 5 Vet. App. 19 (1993)), and (3) medical evidence of a nexus between service and the current PTSD disability, in the form of two of the letters from the Vet Center counselor relating PTSD to one or more of the claimed in-service stressors. Based on the foregoing, the Board concludes that the veteran has submitted a well-grounded claim for service connection for PTSD. Because the veteran has submitted a well-grounded claim, VA has a duty to assist in the development of facts pertinent to her claim. 38 U.S.C.A. § 5107(a). In an April 1997 letter, the RO requested that the veteran provide a personal description of the traumatic event(s) and of subsequent changes in her behavior and that she indicate whether she reported the event(s) to military or to civilian authorities and, if so, if an investigation was conducted and the date of any such investigation. The RO informed the veteran that the fact that she might not have reported the event(s) to an official would not be a basis for an unfavorable decision. The RO stated that to grant her claim, it must be established that the event(s) she described occurred while she was on active military duty and that official service department records or civilian authority records would be the best type of evidence. It was noted that if she did not make an official report, other evidence was needed to support her claim such as statements from other people who saw the event(s) or statements from someone who knew of the event(s) such as a roommate, friend, church official, family member, or anyone else she may have told about the event(s). It was noted that copies of correspondence sent to someone such as a close friend or relative, in which she related information about the incident should be submitted. The RO stated that she should provide as much detail as possible about each event, including the date, time, and place where each event occurred. It was noted that it would also be helpful if she could list other people who were nearby and if there were any related events such as base parties when the event(s) occurred. The RO also asked her to describe what happened and what she did immediately before, during, and after the event(s) and to explain the physical and mental effects of the event(s). The RO reiterated that the veteran should be as specific as possible. The RO informed the veteran that it must be established that she had a disability that is the result of the event(s) described. The RO also requested that the veteran provide the dates of any post-service psychiatric treatment and the name and address of the treatment provider(s). It was noted that it would be helpful if she could provide copies of the records and that she could complete the enclosed VA Forms 21-4142, Release of Medical Information, if she wanted the RO to obtain these records. In May 1997, the veteran reported that her relevant post- service treatment included treatment by (now deceased) Ms. White from 1980 to 1986 for depressive neurosis; by Dr. Kaplan from January to May 1979 for depressive neurosis; and at the Vet Center from February 1997 to present for "sexual trauma." The VA has received evidence from each of these providers and there is no indication that any other records, if available, would contain additional relevant information. In mid-1996 and mid-1997 the RO, pursuant to its requests for the veteran's medical records, received copies of her records from the Long Beach VAMC. It appears that the veteran has been treated there primarily for her physical disorders. Although Ms. E. has stated that the veteran was being referred to the Long Beach VAMC for PTSD testing and the results of any such testing, if conducted, are not of record, the question in the case is whether the veteran has a service related stressor, a question that would not be answer by test results. Thus, the case need not be remanded for the results of any testing. In this case, the alleged inservice stressors reported by the veteran are attempted sexual assault/rape, an incident involving being touched by a female drill instructor, and harassment/sexual harassment by the military and lesbians, appear unverifiable based on the information provided by the veteran. The veteran has stated that she did not report the alleged attempted sexual assault/rape or the touching by the drill instructor to anyone until long after service. Although she has provided some details of the alleged incident with the drill instructor, there is no indication that the diagnosis of PTSD of record was based in any part on that claimed incident. Thus, no additional development with respect to this alleged stressor is necessary and this incident will not be discussed further. Although the veteran has provided the date of the alleged attempted rape and the general location of the incident, she has furnished no specifics that are capable of verification. She has not identified the female Marine or either of the two servicemen (the alleged assailant and the other man) who were with her the night of the alleged incident. She did not report the incident to civilian or military police, and she has identified no one who would have any knowledge, as a witness, confidant or otherwise, of the incident. She also has identified no specifics capable of verification regarding the allegations of sexual harassment and allegations that she was harassed and followed by the military/government investigators. The record is otherwise devoid of any indication that there is other relevant evidence available, such as letters to relatives or friends, potential corroborating testimony from such individuals, or the like, which might assist the Board in reaching a decision on the claim of service connection for PTSD or that there are other possible sources for corroboration of the stressors. In light of the foregoing, the Board is satisfied that all relevant facts have been adequately developed to the extent possible and that no further assistance to the veteran in developing the facts pertinent to this claim is required to comply with the duty to assist the veteran as mandated by 38 U.S.C.A. § 5107(a). Entitlement to Service Connection for PTSD At the outset, it must be reiterated that the only issue now before the Board regarding a psychiatric disorder is entitlement to service connection for PTSD. Accordingly, this decision will not adjudicate service connection for any other psychiatric disorder. The starting point for any determination with regard to PTSD is whether there is a "stressor." Under the controlling regulation, there must be credible supporting evidence that the claimed inservice stressor(s) actually occurred. 38 C.F.R. § 3.304(f). The existence of an event alleged as a "stressor" that results in PTSD, though not the adequacy of the alleged event to cause PTSD, is an adjudicative, not a medical determination. Zarycki. As the veteran did not engage in combat and as her reported stressors are not related to combat, her assertions, standing alone, cannot as a matter of law provide evidence to establish that an inservice event claimed as a stressor occurred. See Dizoglio. This does not mean that she cannot establish that the alleged inservice events occurred, it only means that other "credible supporting evidence from any source" is necessary. See Cohen. Since there is a clear diagnosis of PTSD, it must then be determined whether there is "credible supporting evidence from any source" of the veteran's alleged stressors. Ms. E., the Vet Center counselor, has made the only diagnoses of PTSD reflected in the record. Although her professional credentials are unknown, it is assumed for the purpose of this decision that she is qualified to diagnose psychiatric disorders. In a June 1997 letter Ms. E. referred to the stressor for PTSD as "personal trauma," also referring to sexual harassment, date rape by a serviceman, sexual harassment by lesbians, and "witch hunts." In a January 1998 letter, Ms. E. reported that a therapeutic alliance had been established with the veteran and that a clearer picture had been obtained of her traumatic military experiences. Ms. E. noted that the veteran reported having experienced "constant, deliberate, daily, sexual harassment, an attempted date rape by a male active duty member, sexual harassment by Lesbians and Witch Hunts" while in service. The first and most distressing incident had been "an attempted rape/sexual battery," which, the Board notes, had previously been reported as a date rape. Ms. E. stated that the attempted date rape had occurred on December 30, 1965 and that "the next day" the veteran went to sick call, telling the corpsman that she had fallen from a chair to account for her bruises. The service medical records, however, show that the veteran was seen on January 3 (not December 31) and that she was complaining of facial numbness, which she attributed to having fallen from a chair and striking her head. She did not complain of bruises as suggested by Ms. E. and, while not impossible, it certainly would have been difficult for her to see the only bruise noted by the medical officer, one behind the left ear. Additionally, when the veteran was seen at sick call she stated that she had been visiting at Oceanside when she was injured, whereas she told Ms. E. that she had been at Carlsbad. In a statement to the VA in support of her claim for PTSD, the veteran reported the incident as one in which the male service member pushed her to the ground and "forced himself" on her sexually, not stating whether this was a rape or an attempted rape and not indicating that she had received any injuries from having been pushed to the ground or that she was struck in the head by the serviceman. There is no mention whatsoever of an in-service heterosexual assault in the service medical records, the extensive reports by Dr. Kaplan, or the statement from Ms. White. At the time of a VA examination in 1982, during which the veteran related her sexual experiences, including sexual intercourse with her stepbrother when she was only eleven, she said nothing of any in-service rape or attempted rape by a serviceman. In fact she said nothing of having been forced to have sex or having been sexually assaulted by anyone, male or female, during service. The veteran and her representative assert that this alleged stressor is supported by the service medical and personnel records which show that she underwent behavior changes following the alleged inservice personal assault, to include increased alcohol abuse, violent behavior, increased attempts to obtain medical treatment, nervousness, a suicide attempt, and psychological problems. The veteran has also reported that her numerous inservice sick call visits were a way of seeking help for her psychological pain resulting from her inservice stressors. First of all, it must be remembered that the veteran had been in service for only three months prior to the claimed sexual assault; thus she had not established a substantial history of in-service behavior with which to compare her post-assault behavior. However, the service medical records show that even prior to the alleged December 30, 1965, sexual assault, the veteran had sought treatment for numerous complaints including bruises on her legs and gastrointestinal symptoms. (This pre-December 30 evidence was omitted from a handwritten summary of in-service medical visits, which appears to have been prepared by the veteran.) Additionally, as to any increased alcohol consumption subsequent to December 1965, it must be noted that the veteran she had been in recruit training until shortly before the claimed (attempted) rape; thus any increased drinking also coincided with the completion of recruit training and relaxation of restrictions. The record also shows that veteran has given conflicting accounts of her drinking habits, which will be discussed further below. In March and April 1966, when the veteran was seen by the base psychiatrist, she reported drinking excessively since coming to Camp Pendleton, with no mention of any of her claimed stressors. Although she asked for a transfer, it was to attend a school that she felt would permit her to learn something more useful than her present job. The psychiatrist noted that the veteran displayed no significant psychiatric illness, and that although she was chronically depressed, there were no psychiatric limitations to full duty. A July 1966 treatment record shows that she took an overdose of Darvetran when she was drunk. From February 1966 to separation from service, the veteran received three nonjudicial punishments for violations of the UCMJ, which included assaulting another WM, using threatening and obscene language toward another WM, unlawfully striking another WM in the chest and stomach, breaking a window in the barracks, violating a legal order, and fighting in the barracks. In September 1966, she refused psychiatric evaluation and, in October 1966, she received an undesirable discharge/unfit due to homosexual activity. The extensive record, including the reports by Dr. Kaplan and Ms. White, a VA examination report, and the records relating to the veteran's petition for an upgrade of her discharge, is entirely silent for any reference to the claimed sexual assault by a serviceman, other than as noted by Ms. E. The undersigned finds it implausible that the veteran would have discussed and admitted to homosexual behavior and to having been sexually molested as a child by a relative and yet would not have mentioned a traumatic heterosexual assault had it occurred. According to Ms. E., during service the veteran did not report the attempted rape because she feared that it would adversely effect her military career, she felt shame and guilt for going for a ride with a stranger, and she had been drinking; however, this does not explain why, after she had already been discharged for sexual misconduct, she did not raise this matter (of which she was a purported victim) before the Naval Discharge Review Board, as a mitigating or extenuating circumstance. Additionally, as this veteran engaged in prohibited sexual conduct for which she ultimately was discharged from service, drank excessively, and engaged in other behavior resulting in multiple nonjudicial punishments, her behavior in general was not career enhancing, so her claimed concern about reporting the sexual assault is not convincing. In 1979 Dr. Kaplan assessed the veteran's situation, noting that she had been exposed to many severe "stresses" in the military, such as homosexual women marines. Dr. Kaplan also reported that the veteran had depressive symptoms prior to service, that she drank prior to service; and that she had had homosexual feelings prior to service. Dr. Kaplan attributed her increased in-service symptoms of depression, anxiety, and drinking to a reaction to her inservice homosexual acts, not to any heterosexual assault or to the other currently claimed stressors. In her January 1981 statement Ms. White indicated that "psychiatric mishandling" in service had exacerbated the veteran's sexual identity problems and that this and the stigma of an undesirable discharge caused extreme mental stress and interfered with her ability to relate to society. This statement also provides no support to the currently alleged in-service stressors. When the veteran applied for an upgrade of her discharge in the late 1970s she alleged, in essence, that she had depressive neurosis during service and that any misbehavior had been a manifestation of her psychiatric illness. As already noted, she did not claim a date rape or attempted rape as a mitigating factor. It was not until 1997, when she filed her claim for PTSD and submitted a note by Ms. E. indicating that she was in treatment for PTSD due to "sexual assault," that PTSD or the claimed sexual assault was first mentioned. Nor did the veteran claim to the Naval Discharge Review Board that she had been constantly harassed by lesbians or by the military, other than her complaints about the investigation of her offenses. The veteran has provided no specific details with respect to the reported stressors of having been relentlessly followed and harassed by military intelligence, subjected to "witch hunts," and the subject of constant sexual harassment by the military and lesbians. At the Naval Discharge Review Board proceedings, she asserted that Naval Intelligence had questioned her for at least six hours, that her personal effects were searched, and that she felt embarrassed and threatened by the overzealous acts of the Marine Corps. Additionally, in a January 1981 statement she alleged that the arresting personnel in service were very badgering and frightened her and that she had been followed, visited, and watched by the FBI. Reportedly, just seeing a government car sometimes still made her paranoid. The military records indicate that the veteran was the subject of an investigation of homosexual activity during service and that she was given an undesirable discharge based on unfitness due to homosexual acts. The fact that her discharge was subsequently upgraded does not mean that she was found not to have engaged in such acts or that any investigation was improper. Rather, the record shows that on her petition to the Naval Discharge Review Board, a minority of the members concluded that during service she had been suffering from an extenuating "alcohol problem" and that there was a command responsibility to identify and treat such a problem. The minority opinion was adopted by the Assistant Secretary of the Navy; hence, the upgraded discharge. The veteran had made no allegation of sexual harassment by lesbians or anyone else. There was no finding that the Navy's investigation had been improper or that she had been the victim of sexual harassment or any witch-hunt. While a Statement of Facts submitted on her behalf alleged that the military had acted in a way "reminiscent of a Salem Witch Hunt," in that the veteran had been questioned for several hours by Naval Intelligence and her personnel effects had been searched, there is no evidence that such was improper or beyond the authority of the investigators. Additionally, trauma resulting from the proper investigation of her voluntary homosexual activities in service (which constituted misconduct) cannot provide the basis for VA compensation as this alleged trauma is the direct result of misconduct on the part of the veteran. See 38 C.F.R. § 3.1 (1998). Although Ms. E. reported that the veteran's PTSD was related to inservice personal assault, personal trauma, and sexual trauma, it seems that the diagnosis of PTSD is based primarily on the alleged sexual assault and not on the alleged stressors of harassment/sexual harassment by the military and lesbians. As noted, to the extent that the veteran perceived herself as being harassed by Naval Intelligence, such was the result of her own behavior, and she has provided no evidence that any investigation was conducted improperly. Although today, thirty years later, such an investigation might be handled differently, there is no probative and competent evidence that the investigation exceeded then permissible limits or was otherwise improper. The Board notes that the veteran has not asserted that PTSD is due to stressors of exposure to homosexual women marines, inservice psychiatric mishandling, sexual identity problems, or in-service homosexual activities. It is also noted that there is no diagnosis of PTSD based on these reported occurrences. In March 1981 and February 1983, the veteran filed a claim for service connection for a nervous disorder, to include depressive neurosis. She underwent VA neuropsychiatric examination in December 1981 and reported numerous pre- service personal events including that she had had sexual relations with her stepbrother when she was 11, which she considered rape, and that her stepbrother tried this again when she was 15 but she "put him off." Inexplicably, she did not mention any of the currently alleged stressors. She also reported that she had required stitches in her right arm when she put it through a window during service and cut an artery. However, service medical records only show that she punched her fist through a window, with no evidence of at that or any other time of cut arteries or the need for stitches. There is no indication that Ms. E. reviewed the entire record in conjunction with diagnosing PTSD. For example, while indicating that the service medical records show the veteran sought treatment for several problems including nervousness, nausea and vomiting, which gave "validity and validation of her trauma," Ms. E. failed to note that the veteran had already sought medical attention for weight control, defective vision, swollen eyes, an ingrown nail, a fever blister, neck pain, vomiting, and bruises on her legs, prior to December 30, 1985. Additionally, there is evidence that prior to December 30 (and likely prior to service) the veteran had been given medication by a private doctor for nausea and nervousness. Ms. E. did not mention the statements from Dr. Kaplan and Ms. White noting that the veteran had had depressive symptoms, alcohol use, and homosexual feelings prior to service, and that related the inservice symptoms and treatment to her homosexual experiences, exacerbation of her sexual identity problems, and the stigma of an undesirable discharge. Ms. E. also did not mention the December 1981 VA examination report, the pre- service sexual relations with the veteran's step-brother, or the veteran's failure to mention the currently alleged stressors to the Naval Discharge Review Board even though her emotional problems and alcohol use in service were central issues at those proceedings. Additionally, the veteran reported to Ms. E. that she began counseling with Ms. White "immediately upon her discharge" and continued for six years thereafter, although Ms. White reported first evaluating the veteran in July 1980, more than 10 years after service. Ms. E. also did not address the service department evidence that in March 1966, the veteran was noted to have been belligerent for six months, proceeding the alleged December 30, 1965 attempted rape by three months, or that at the December 1981 VA examination, the veteran reported having become a severe alcoholic "as soon as she entered the service." Nor did Ms. E. acknowledge the veteran's history of rape and/or rectal sexual assault, noted in August 1995 VA medical records. There is no allegation that those incidents were service related, in view of the veteran's revised claim of only "attempted" rape. Various clinicians, including Ms. E. have acknowledged the veteran's traumatic childhood - which included her father's desertion of the family when she was young, alcoholic parents, and the death of her parents during her teens. The record includes evidence of numerous pre-service and post- service symptoms and traumatic and stressful events. Although, Ms. E. diagnosed PTSD secondary to personal and sexual assault during service, her statements regarding the veteran completely overlook certain traumas clearly not related to service and are not entirely accurate as to various aspects of the veteran's history. Based on a review of the entire record in this case and in view of the factors discussed above, the Board finds that the veteran's allegation of a rape or attempted rape during service is not credible and can not be afforded credibility merely by virtue of being believed by Ms. E. The veteran had multiple occasions, after service and in appropriate settings, to relate her story of the in-service assault. She failed to do so and has identified no other evidence, even unofficial and not contemporaneous with service, which would help to corroborate her claim. In regard to the other claimed stressors, again the only supporting evidence are the veteran's allegations to Ms. E., who has not reviewed the complete record and apparently believed the veteran's wholly unsupported allegations of having experienced "consistent, deliberate, daily sexual harassment by lesbians and "Witch Hunts." Strikingly, Ms. E.'s statements are totally devoid of any reference to the circumstances of the veteran's discharge from service or to any specific in-service trauma other than the claimed attempted rape. The "Witch Hunt" presumably refers to the in-service investigation, which has already been rejected as a qualifying stressor due to the fact that it was a consequence of the veteran's own misconduct. The alleged daily sexual harassment and harassment by lesbians is totally lacking in details and was never mentioned by any of the medical professionals by whom the veteran was seen/evaluated for emotional problems prior to Ms. E. Moreover, no such allegations were raised in the context of the veteran's petition for upgrading of her discharge. Lacking any evidence tending to corroborate these incidents other than the recitation of her allegations to Ms. E., 30 years after service, the Board finds that the incidents are unsupported by credible evidence. Thus, while the veteran does have a diagnosis of PTSD related to purported in-service stressors, those stressors are not shown by satisfactory evidence to have occurred. Having so concluded, the Board finds a preponderance of the credible evidence is against the claim and that neither a VA psychiatric examination nor further interpretation by a clinician (beyond that already provided by Ms. E., Dr. Kaplan and Mr. White) of the inservice symptoms/behavior is necessary. See M21-1, Part III, 5.14(c); Patton. ORDER Entitlement to service connection for PTSD is denied. REMAND With respect to the claim for service connection for systemic lupus erythematosus, the record indicates and the veteran has reported that this was first diagnosed in 1978, more than ten years after service. The claims file includes relevant VA treatment records dated from November 1994 to October 1997; however any earlier records relevant to systemic lupus erythematosus or any disorder that was allegedly an early manifestation of systemic lupus erythematosus should be obtained. In March and October 1997, a VA physician reported that she had treated the veteran for the past six years for systemic lupus erythematosus and that pneumonia and subsequent cough for which the veteran was treated in service "clearly could have been a manifestation of the pleuritis" of systemic lupus erythematosus. The VA physician also stated that a rash, dysthymia, nervousness and an episode of epistaxis treated in service could have been early manifestations of lupus. The physician also stated that, although the service medical records were negative for a biologic false positive VDRL or leukopenia or a positive ANA, it is well known that symptoms can precede serology in systemic lupus erythematosus patients. Additionally, the Board notes that, in June 1996, the veteran reported that she is receiving state disability benefits. Those records should be obtained. In order to ensure that the record is fully developed, this case is REMANDED to the RO for the following: 1. The veteran should be asked to identify all private, state, VA or other physicians and medical facilities where she has been treated since service for systemic lupus erythematosus and any alleged early manifestations thereof. Specifically, she should identify when, when and by whom lupus was diagnosed and identify any treatment received for symptoms that eventually led to the diagnosis of lupus. She should also identify all treatment providers since the diagnosis was made. Additionally, the veteran should identify all physicians or other medical care providers by whom she received any treatment or evaluation during the two year prior to entering service. After obtaining appropriate authorization, the RO should attempt to obtain all pertinent records not already obtained. The RO also should specifically attempt to obtain all relevant records (not already on file) from the Long Beach, California, VAMC and from the state agency from which the veteran receives disability benefits. She should also be asked whether she has ever applied for Social Security disability benefits and, if so, the RO should obtain all relevant records from Social Security. 2. After the above has been completed to the extent possible, the RO should obtain a VA medical opinion from an appropriate specialist who has not previously examined or treated the veteran, to determine the etiology and any relationship of systemic lupus erythematosus to service. The veteran's claims folder and a separate copy of this remand must be made available to the physician, the receipt of which should be acknowledged in the medical report. The physician must review the entire record, specifically to include the March and October 1997 VA physician's statements, the service medical records, any pre- service medical evidence and the initial medical evidence regarding lupus. The physician should specifically express an opinion as to whether it is at least as likely as not that the veteran's current systemic lupus erythematosus had its onset during service as manifested by in- service medical findings such as pneumonia, cough, rash, dysthymia, nervousness, and epistaxis. If such an opinion can not be given without resort to speculation, the physician should so state. A complete rationale must be given for any opinion expressed, and the foundation for all conclusions should be clearly set forth. If deemed necessary by the physician, the veteran should be afforded an examination. 3. The RO should ensure that the aforementioned development has been completed to the extent possible. See Stegall v. West, 11 Vet. App. 268 (1998). The claim should then be readjudicated with consideration of all pertinent law, regulations, and Court decisions. If the claim remains in a denied status, the veteran and her representative should be provided with a supplemental statement of the case which includes any additional pertinent law and regulations and a full discussion of action taken on the veteran's claim, consistent with the Court's instructions in Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The applicable response time should be allowed. This case should then be returned to the Board, if in order, after compliance with the customary appellate procedures. No action is required of the veteran until she is so informed. The Board intimates no opinion as to the ultimate decision warranted in this case, pending completion of the requested development. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1998) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. JANE E. SHARP Member, Board of Veterans' Appeals