Citation Nr: 9926931 Decision Date: 09/20/99 Archive Date: 09/28/99 DOCKET NO. 95-29 630 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to service connection for alcohol dependence. 2. Entitlement to service connection for post-traumatic stress disorder (PTSD). 3. Entitlement to service connection for a psychiatric disorder other than PTSD including paranoid schizophrenia and organic mood disorder. 4. Entitlement to service connection for left-sided generalized weakness secondary to brain injury associated with gunshot wound (GSW) to the right temple. REPRESENTATION Appellant represented by: Military Order of the Purple Heart WITNESSES AT HEARING ON APPEAL Appellant, his father and sister-in-law ATTORNEY FOR THE BOARD Christopher B. Moran, Counsel INTRODUCTION The appellant served on active duty from May 1990 to October 1992. The Board of Veterans' Appeals (Board) notes that the issues on appeal stem from a Department of Veteran's Affairs (VA) Regional Office (RO) rating decision dated in October 1994. The appellant filed a timely notice of disagreement in November 1994. A statement of the case was issued to the appellant and his representative in July 1995 and a timely substantive appeal was received in August 1995. In January 1996, the appellant, his father and sister-in-law attended a hearing before a hearing officer at the RO. A copy of the hearing transcript is on file. A supplemental statement of the case was issued to the appellant and his representative in April 1996. In mid 1996, the veteran withdrew his request for a hearing before a travel Member of the Board. FINDING OF FACT The claims for service connection for alcohol dependence, PTSD, a psychiatric disorder other than PTSD including paranoid schizophrenia and organic mood disorder and left- sided generalized weakness secondary to brain injury associated with GSW to the right temple are not supported by cognizable evidence showing that the claims are plausible or capable of substantiation. CONCLUSION OF LAW The claims for entitlement to service connection for alcohol dependence, PTSD, a psychiatric disorder other than PTSD including paranoid schizophrenia and organic mood disorder, and left-sided generalized weakness secondary to brain injury associated with GSW to the right temple are not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION Factual Background The veteran served on active duty from May 1990 to October 1992. He served in Southwest Asia from February 13, 1991 to May 1, 1991 and from August 27, 1991 to December 26, 1991. His primary military occupational specialty (MOS) was that of an M1 Abrams Armor Crewman. His awards and decorations consisted of an Army Commendation Medal, Army Achievement Medal, National Defense Service Medal, Army Service Ribbon, Overseas Service Ribbon, Southwest Asia Service Medal with 2 Bronze Star Devices, Expert Marksmanship Badge for M-16, Marksman Marksmanship Badge for Grenade, Marksman Marksmanship Badge for Pistol and Kuwaiti Liberation Medal. A service department record completed in March 1990 for purposes of expediting the processing of the service entrance physical examination by identifying possible medical problem areas shows that the veteran denied any psychiatric or neurologic disabilities as well as alcohol addiction. Alcohol and drug addiction testing was not shown to result in any positive finding. A report of a physical examination in March 1990 for service entry purposes was silent for any pertinent findings regarding a psychiatric disorder, however diagnosed, neurologic disability, however diagnosed or alcoholism. A report of medical history undertaken in connection with the physical examination shows that he denied nervousness or nervous trouble of any sort, depression or excessive worry, or neurologic disability. The appellant's service medical records are completely silent for any pertinent findings regarding the disabilities at issue. In September 1992 the appellant elected not to undergo a separation physical examination. It was noted that an examination would be scheduled if after a review of his service medical records a physician found an examination was warranted. There was no indication that any pertinent findings were noted upon a physician's review of the appellant's service medical records requiring a separation physical examination. The veteran completed a dental health questionnaire in August 1993 noting that he never had had any problems with nervousness, neurologic disability or alcoholism. Private hospital records dated in September 1993 show that the veteran was transported by ambulance under the influence of alcohol stating he shot himself over the right frontotemporal region. Surgery was performed. He was transferred to a VA hospital. A VA hospital summary of record referred to hospitalization from September 22, 1993 to February 9, 1994 for status post GSW to the head, status post craniotomy times two, status post endoscopic cerebrospinal fluid leak repair and history of alcohol abuse. Also noted were organic brain syndrome with history of alcohol abuse, probable dependence; rule out PTSD and major depressive episode. It was noted as history that he was admitted to VA hospitalization on September 22, 1993 status post self inflicted GSW to the right frontotemporal area on approximately September 17, 1993. He reported drinking large amounts of alcohol after returning from the Gulf war in which he served. While intoxicated on September 17, 1993, he shot himself in the right frontotemporal area, sustaining a serious life-threatening injury. While hospitalized, he was medically cleared after several complications and operations and transferred to Psychiatry in December 1993, for evaluation of organic brain syndrome versus organic mood disorder, depressed. He was noted to have a blunted affect and depressed mood; however, he denied any suicidal ideation or even attempts leading up to his self-inflicted GSW three months earlier. Reported medical history showed he began drinking alcohol in his teens. He looked forward to joining the Army and served from approximately "1980 to 1982" with combat experience in the Persian Gulf War. He reportedly saw lots of morbidity/mortality and was plagued by this. He reported drinking more and more alcohol on the end of his rotation in the Persian Gulf and was drinking large amounts of alcohol upon returning to the United States. He reported having a lot of problems after returning from the war with alcohol consumption being the major issue. It was noted that he had probable organic brain syndrome changes after his multiple head operations and complications. He reported having fears and problems related to his Persian Gulf war experiences. Psychological tests revealed mild depressive indices. He denied any suicidal or homicidal ideation, auditory or visual hallucinations. It was noted he had some seizure activity in the context of alcohol abuse or withdrawal and/or interoperative neurosurgical procedures. A VA out-patient master summary treatment plan in March 1994 showed the appellant reported a history of heavy drinking. His last alcohol use was on September 17, 1993. At that time he shot himself in the head while intoxicated. He stated he became angry because he could not find his wallet. He denied that all his problems were related to alcohol abuse. He reported experiencing anxiety, flashbacks, hypervigilance and recurrent dreams as a result of his experiences in Desert Storm. Probable PTSD was indicated. It was indicated that his established diagnoses were alcohol dependence and organic brain syndrome. He noted drinking heavily from age 15 until the gunshot episode. He noted that his longest period of sobriety was for 6 months. He noted that while in the Persian Gulf war he saw no combat but was exposed to a lot of dead bodies and destroyed villages. He noted having nightmares and intrusive thoughts. A September 1994 VA psychiatric examination report shows the appellant was a 36 year old, never married, former Operation Desert Storm tank driver who was there for a 90 minute PTSD examination. It was noted as history that prior to joining the service, he worked in a bank as an accountant for nine years in Tijuana. The appellant served honorably in the United States Army as a tank driver from 1990 to 1992. He stated that he spent a period of seven months in the Persian War area in Saudi Arabia, Kuwait, and later Iraq beginning in October 1991. He was not wounded. His tank was not even hit by incoming fire of any type. He had no particular interpersonal conflicts. He was upset seeing some dead bodies, and some devastated homes and buildings, but he saw no atrocities, did no body bag work and did no graves registration work. The examiner noted it was his judgment that the appellant was not exposed to trauma that would have been beyond human endurance. There was one scud that went overhead and hit hundreds of yards away from him, but other than that it sounded like a relatively bland military experience. The appellant apparently returned home from that experience and began drinking extremely heavily. He stated that he had been in a bar almost all day and had had about a case of beer in September of 1993, when he, for reasons that were not at all clear to him, took a .38 caliber gun and pointed it at his right parietotemporal region, and pulled the trigger. He was treated briefly in Mexican hospitals and then transferred to the Veteran's Hospital here in La Jolla for ongoing therapy. The summary of that hospitalization is continued in his Claims (C)-file. He apparently underwent neurosurgical removal of the bullet and one of the impressions was organic mood disorder and possible schizophrenia. The appellant did not join the military until the age of 34 or so. He stated that at the age of 28, he began hearing the devil's voice talking to him very clearly. These voices were outside of his head and were basically critical of him but did not tell him what to do. This was a man's voice. He was still hearing it to the present. The appellant reported six or seven hours sleep per night. He did not have nightmares regarding the combat experiences, but he did have occasional bad dreams about every other day about the devil chasing him in these dreams. His appetite was good. His energy was low. He consistently had heard the devil speak to him about every other day since the age of 28. He gave very vague reasons about why he bothered joining the military after working for the Mexican bank for nine years as an accountant. He gave a history strongly suggestive of an isolated, withdrawn, schizoid, and avoidant life if not basically schizophrenic. He never felt he could get close to people. He stated, however, he was never psychiatrically hospitalized nor did he receive psychiatric consultation or medication prior to joining the U.S. military. It was noted that the appellant successfully graduated from high school. He was born in Mexico. He graduated from high with school A's and B's. He had four years of college following that. He then was on the accounting staff of a large bank in Mexico for nine years. He was the second of five siblings born to a tailor and a housewife in Mexico. He said he had a good relationship with all concerned in the family. He admitted to being a loner in high school and tended to activities. He did not play sports. His first alcohol was at 17. He denied any other substance abuse such as marijuana, methamphetamines, Seconal, etc. He stated that on September 17, 1993, after drinking about a case of beer, he apparently lost his wallet and so he decided to shoot himself in the head in order to remedy that situation. His description of himself as a child was shy and bashful, and never fitting in with other kids. He went to basic training at Fort Knox. He apparently went to Advanced Infantry Training (AIT) at Fort Knox, and then somehow stated he thought he was in Germany for two years and then spent seven months in Operation Desert Storm. It was noted that these numbers clearly did not add up and yet the appellant did not have the capacity to explain the apparent inconsistencies. It was noted that the appellant was a tank driver, not hit, not wounded, and probably did not kill anybody. He did not do body bag work, he did not do graves registration work or tunnel work. The examiner noted it sounded like a very benign experience in general and not one that, in his judgment, would be likely to cause PTSD. It was noted that the appellant heard the devil talk to him on a regular basis during the war. He had been unemployed ever since returning from the military. He was currently in classes at Mesa College. Prior to his service in the war, he had been employed as a bank accountant. Since service, he had not been employed. The appellant's major complaints were hearing the devil's voice at least every other day. He slept well. He heard the devil's voice at night, dreamed of the devil. He stated that he had numbness in the right arm and leg after the GSW. He did not give symptoms of hypervigilance, daily intrusive thoughts, night sweats, nightmares of combat experiences. He did not have significant avoidant behavior with regard to combat issues. He did not give a history suggestive of emotional blunting. He did not have an increased startle reaction. The general theme of the devil's conversation with him was that the devil tells him, "You belong to me." He did not have visual hallucinations. He did not have ideas of reference such as people whispering behind his back or the television or radio talking about him. His general isolation, withdrawal, and avoidant behavior had continued much like it did prior to his war experience and even his head injury. He no longer drank alcohol as a result of the catastrophic effects of his GSW. Basically, he could watch fireworks. He could watch television movies about Operation Desert Storm. The examiner stated that he heard no consistent symptoms suggestive of PTSD. The psychiatric examiner noted that no diagnostic studies were indicated. Psychiatric diagnoses were alcohol dependence in remission, organic mood disorder secondary to brain injury in September 1993. Also noted by the examiner was that in his judgment, the veteran did not suffer from PTSD. It was noted that the appellant most probably suffered from chronic paranoid schizophrenia that existed prior to service (EPTE). Also noted was a mixed personality disorder with schizoid, avoidant, and dependent features EPTE and status post GSW to right temple with left sided generalized weakness secondary to GSW. The examiner commented that the appellant's history suggested that he was most probably functioning on a psychotic level prior to joining the military based on a history of regular and consistent auditory hallucinations in which he heard the devil's voice talking to him from age 28. The examiner noted that since the appellant admitted to starting to drink alcohol at age 17, he may well have been an alcoholic prior to joining the military. The appellant admitted to drinking at least a case of beer on a regular basis for the year after Saudi Arabia, and it was during this mind set that he attempted to kill himself with a handgun shot to the head. In a statement dated in October 1994, a VA clinical social worker verified psychiatric treatment for PTSD at San Diego VAMC. It was noted that the appellant was given a complete psycho-social evaluation and psychiatric assessment. His initial psychiatric complaints included; sleep disorder, nightmares, flashbacks, intrusive thoughts, anxiety attacks, suicidal ideation, anhedonia, extreme occupational apathy and marital conflicts. It was reported that an assessment based on a complete battery of psychometric measures as well as individual psychiatric and social work group assessment provided the following diagnoses according to Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) criteria; organic mood disorder, PTSD and alcohol dependence. A VA outpatient clinical record in April 1995 for follow-up reported impressions of alcohol dependence, in remission, organic mood disorder and PTSD. In January 1996, the appellant, his father and his sister-in- law attended a hearing before a hearing officer at the RO. A copy of the hearing transcript is on file. The appellant noted that during the Gulf War, he did not fire the tank cannon nor was he exposed to any incoming rounds fired at him. He noted that seeing a lot of dead bodies and destruction upset him and made him angry. He noted that the people he saw dead were middle eastern personnel, not Americans . He noted that he did not drink over there because it was not permitted. He noted that he started drinking about one month following his return to Germany. He noted spending two years in Germany. One of those years was after the Gulf war. He noted drinking a lot in Germany. He noted having nightmares in Germany. The appellant's father noted the veteran had no psychiatric problems prior to service. He was happy and a good student before going in the Army. He did well in school and graduated from the University. The veteran noted that he graduated from high school and college. His grades were between A's and B's. The sister-in-law noted that the veteran studied accounting. He then worked for the Mexican government and in a bank doing accounting type work at night. He then went into the service because he always wanted to join as a little kid. In March 1996, the appellant underwent a special VA PTSD examination by a board of two psychiatrists at VAMC, San Diego, California. He tried to kill himself within one year of separation. He participated in Desert Storm. It was indicated that the psychiatric examiner in September 1994 found no PTSD, but felt the veteran probably suffered from chronic paranoid schizophrenia. He also diagnosed organic mood disorder secondary to the suicide attempt. It was a gunshot wound to the head. The veteran was being treated at the VAMC for PTSD. The mood disorder appeared to stem from the suicide attempt. It was pointed out that the RO needed to know if he had either PTSD or schizophrenia which may account for the suicide attempt. The appellant had not worked since he left the Army. He lived with his brother and sister-in-law. He lived a very dependent lifestyle. It was noted that the appellant's C file already had extensive details on the appellant's past history. The examiners noted that the current examination picked-up from areas that had already been covered in previous evaluations in regard to past history. The appellant had had a long history of excessive drinking, but he said he last drank in September of 1993 at the time of that suicide attempt. At his worst, he was drinking up to three to four six packs of beer per day. He was in treatment, as mentioned above. He apparently had had a problem with a seizure disorder in addition to his mental symptoms. The veteran said that he had joined the Army at age 32. He had been working in various types of jobs including a money exchange business and also working for a bank. He said that since he had been a child, he had wanted to have some opportunity to be involved in a war-type experience and gave that as the reason why he had joined the service. He went to basic training at Fort Knox, Kentucky and then had his AIT training in Fort Knox as well. He was trained with an MOS for armor. He said he had no problems in his basic or AIT experiences. He reported serving in Operation Desert Storm from January 17, 1991 to February 28, 1991 and again from September 1, 1991 to December 1, 1991. He said that he was with the 377th Armor Division and had served in an area near Riyadh, also by North Sea and King Khalid City. He reported that he had been exposed to various combat situations and had been suffering problems with anxiety, flashbacks, hypervigilance, and recurrent dreams as a result of Persian Gulf War experiences. He had served as a tank driver and a truck driver. He had reported those specific details about flashbacks and hypervigilance in the letter that was submitted, but in interviewing him, he did not really describe actual flashbacks and also did not have actual recurrent dreams that related to experiences in the war zone. The appellant noted that since he left the Army, he had not been able to work. He had been on unemployment for awhile afterwards, then he got onto SSI. He apparently had not functioned independently and had been living with his brother and sister-in-law. The sister-in-law did the cooking and the major management of the household. He said that he tried to be of some help with some of the chores. He had been living kind of a socially isolated existence, did not date and did not have many friends. It was noted that the veteran was discharged from the service on October 5, 1992. He reported varying degrees of problems with emotional symptoms prior to discharge. Following discharge, he reported continued problems with varying degrees of depression, various anxiety-related symptoms, and excessive use of alcohol. On September 17, 1993, he made a suicide attempt by shooting himself over the head over the right frontal temporal region. He was treated surgically initially. The majority of the treatment was at the VA Hospital in San Diego, California. He was discharged in December of 1993. He had severe insults to the brain. Thus, since the time that he had been there, there had been issues of prior problems such as anxiety, depression, alcoholism, and other problems he related to Persian Gulf War experience. The appellant continued to complain of problems with depression and anxiety. He described feelings of feeling guilty and preoccupied about having "been on the side that had killed many people" in the Persian Gulf War. The appellant said that it bothered him to think about the dead bodies and the destroyed towns that he had seen and the burning oil wells. He had not had any symptoms of delirium or dementia or significant amnestic syndromes. He did complain of some problems with not being able to remember well. He had also had the problems with seizures and he said that he had problems with feeling easily irritated. He described his general functioning as involving staying pretty much at his brother's place taking care of some of the things around the house. Overall, he had not been able to hold down any jobs and basically had no independent functioning. He described himself being very dependent still on his mother. He said that his mother would spend a lot of time reading the Bible with him. He said that he had been able to provide adequate personal care and hygiene for himself. He was pretty much socially isolated. It was noted that the appellant went to the VA Clinic for some medical care. He had not really had problems with dreams or nightmares particularly since he had the GSW to the head. He also did not complain of what were truly flashbacks. He did not have true sense of experiences that kept coming back and haunting him in which he was trying to somehow hide himself. It appeared that it was primarily a problem with a basic personality style that he had had even prior to going into the service and probably the stresses of being in the service aggravated these particular characteristics and led to his being more impaired following his involvement in the military. He denied any further suicidal ideation since the gunshot wound. There was no evidence of his being a danger to others. He gave a history of having an experience with auditory-type hallucinations, where he sensed the devil was trying to tell him things. It was this kind of hallucination, he said, that in a state of being intoxicated was a part of how he had gone about shooting himself in that suicide attempt. There was inconsistency in what he said as compared to what he had apparently told the psychiatric examiner back in 1994. In the report of 1994, he apparently had said he had these hallucinations many, many times over the years. In the current evaluation, he said he had the hallucinations only on three occasions. Once maybe a year before he went into the service, once shortly after the service, and then one more time at the time when he shot himself in the head. The appellant complained of feeling guilty about his involvement in the war. He had had problems with low self-esteem. It was noted that his impulse control could be decreased, but this may also have had something to do with the fact that he had had the head injury. There was no indication of actual hypervigilance or startle response to excess. On objective mental status the appellant related in a somewhat distant manner. He had a mood of moderate depression and mild anxiety. He spoke very slowly, he thought slowly. He had a flattened affect. There was a moderate degree of psychomotor retardation present. He admitted to hearing voices at times, as described above, but there was no evidence of current responding to internal stimuli. There was no evidence of any delusional thinking at the present time. His mood was currently depressed and anxious to a moderate degree. There was no evidence of his having any particular posttraumatic symptoms in the classic sense. There were aspects of concerns about the past experiences and some things that were related to posttraumatic themes, at the same time, there was not a classic picture of it. There was no evidence of any increased startle response. There was the aspect of his feelings of guilt, but it wasn't a survival guilt. The general functioning demonstrated compromised attention and concentration. There was nothing to suggest any malingering. There was no evidence of his being a danger to self or others. He was oriented to time, place, and person. His remote memory, his recent memory was impaired with his being able to only remember two of three objects after five minutes. The appellant was considered capable of managing his own benefits in his own best interest. The examiner indicated that no diagnostic tests were needed. Diagnoses were anxiety disorder not otherwise specified with some features of generalized anxiety disorder and some aspects of PTSD symptoms, but not a full-blown picture of PTSD. Also noted was depressive disorder not otherwise specified, with elements of major depression and dysthymia and organic brain syndrome, chronic, secondary to gunshot wound. Alcoholism, in remission, and schizotypal personality disorder aggravated by stressors in the service, probable, were noted. The examiner's discussion noted that the appellant currently had problems with significant degrees of anxiety, depression, some symptoms of a PTSD, but not a full-blown classical picture. There was also the additional complications of some organicity secondary to the gunshot wound to the head in September of 1993. It was noted that in terms of the questions raised by the RO, the appellant did not show evidence of a schizophrenia, however, the picture of how he functioned prior to the service and how he had been functioning since the service and also looking how he appeared in the clinical setting, schizotypal personality disorder appeared to be the most accurate description of the kind of situation that exists. He had a picture of flattened affect, being a person who kind of tended to stay to himself. He had the hallucinatory-like experiences, but it was not a situation that any frank psychosis had ever been present from any of the information available. The problems with excessive drinking had predated the service, but it appeared it may have become worse as a part of the stress that he experienced. He did work prior to being in the service and since he had left the service, he had been unable to work. These things were suggestive of some service aggravation of pre-existing problems with his personality disorder. The record shows that service connection has not been established for any disability. Criteria 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 preexisting injury suffered or disease contracted in line of duty. 38 U.S.C.A. §§ 1110, 1131 (West 1991). If the disability is a psychosis or other organic disease of the central nervous system and manifested to a compensable degree within one year following separation from active duty, service connection may be granted. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991 & Supp. 1999); 38 C.F.R. 3.307, 3.309 (1998). Service connection may be granted for any 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) (1998). The provisions of 38 C.F.R. § 3.303(c) specifically note that personality disorders are not diseases or injuries within the meaning of applicable legislation. Congenital or developmental defects and personality disorders as such are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 4.9 (1998). The VA General Counsel has held that service connection may not be granted for a congenital or developmental defect, although service connection may be granted for a disability which is shown by the evidence to have resulted from a defect which was subject to a superimposed disease or injury during service. VAOPGCPREC 82-90. Even where there is a lack of official records to corroborate that an injury or disease was incurred or aggravated during service (including a period of combat), VA is required to accept as sufficient proof of service connection satisfactory lay or other evidence that an injury or disease was incurred or aggravated during such period of service, if the evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. §§ 3.303(a), 3.304 (1998); Collette v. Brown, 82nd F.3d, 389 (Fed. Cir. 1996). The threshold question that must be resolved with regard to each claim is whether the claimant has presented evidence that the claim is well grounded; that is, that the claim is plausible. If he has not, his appeal fails as to that claim, and VA is under no duty to assist him in any further development of that claim. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78 (1990). Case law provides that, although a claim need not be conclusive to be well grounded, it must be accompanied by evidence. A claimant must submit some supporting evidence that justifies a belief by a fair and impartial individual that the claim is plausible. Dixon v. Derwinski, 3 Vet. App. 261, 262 (1992); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In order for service connection to be warranted, there must be evidence of present disability which is attributable to a disease or injury incurred in or aggravated by service. See Brammer v. Derwinski, 2 Vet. App. 23 (1992); Rabideau v. Derwinski, 2 Vet. App 141, 143 (1992). In order for a claim to be well grounded, there must be competent evidence of a current disability (a medical diagnosis), of an incurrence or aggravation of a disease or injury in service (lay or medical evidence), and a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). The United States Court of Appeals for Veterans Claims (Court) has held that the three elements of a well grounded claim of service connection for PTSD are: 1) a current, clear medical diagnosis of PTSD; 2) credible supporting evidence that the claimed in-service stressor actually occurred; and 3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. Cohen v. Brown, 10 Vet. App. 128, 129 (1997). The quality and quantity of evidence required to meet the statutory burden for establishing a well-grounded claim depends upon the issue presented by the claim. Where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence that the claim is plausible is required. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Additionally, adjudication of well grounded claims of service connection for PTSD requires evaluation of the evidence in light of places, types, and circumstances of service, as indicated by service records, the official history of each organization in which the veteran served, the veteran's military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a) (West 1991); 38 C.F.R. §§ 3.303(a), 3.304(f) (1998); Cohen, 10 Vet. App. at 129. The regulations governing service connection for PTSD differ from those governing service connection for other conditions because they require evidence of an inservice stressor rather than evidence of "incurrence or aggravation" of a disease or injury in service or within a post-service presumptive period. The Court's case law allows a physician's opinion of causal nexus, in certain circumstances, to establish inservice or presumptive-period incurrence or aggravation, even when the examination on which the opinion was based was made many years after service. See e.g., Moreau v. Brown, 9 Vet. App. 389 (1996). Where the determinative issue involves the question of a medical diagnosis or causation, only individuals possessing specialized training and knowledge are competent to render a medical opinion. Espiritu v. Derwinski, 2 Vet. App. 192 (1992). The Court has held that if the veteran fails to submit a well-grounded claim, VA is under no duty to assist him in any further development of the claim. 38 U.S.C.A. § 5107(a); see Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); 38 C.F.R. § 3.159(a) (1997). In LeShore v. Brown, 8 Vet. App. 406 (1995), the Court held that: Evidence which is simply information recorded by a medical examiner, unenhanced by any additional medical comment by the examiner, does not constitute "competent medical evidence" satisfying the Grottveit v. Brown, 5 Vet. App. 91 (1993), requirement. Such evidence cannot enjoy the presumption of truthfulness recorded by Robinette v. Brown, 8 Vet. App. 69, 75-76 (1995) (as to the determination of well-groundedness), and Justus v. Principi, 3 Vet. App. 510, 512 (1992) (as to determination of whether there is new and material evidence for purposes of reopening a claim), because a medical professional is not competent to opine as to matters outside the scope of his or her expertise, and a bare transcription of a lay history is not transformed into "competent medical evidence" merely because the transcriber happens to be a medical professional. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). I. Service connection for alcohol dependence. Analysis The Board recognizes that in addition to the above cited laws and regulations, applicable regulation provides that the simple drinking of alcoholic beverages is not of itself willful misconduct. The deliberate drinking of a known poisonous substance or under conditions which would raise a presumption to that effect will be considered willful misconduct. If, in the drinking of a beverage to enjoy its intoxicating effects, intoxication results proximately and immediately in disability or death, the disability or death will be considered the result of the person's willful misconduct. 38 C.F.R. § 3.301 (c)(2) (1998). The Board notes that under the provisions of 38 U.S.C.A. § 1110, VA compensation cannot be paid for disability due to the abuse of alcohol or drugs. In a precedent opinion, dated January 16, 1997, the General Counsel of VA concluded that Section 8052 of the Omnibus Budget Reconciliation Act of 1990, Pub.L.No. 101-508, § 8052, 104 Stat. 1388, 1388-351, prohibits, effective for claims filed after October 31, 1990, the payment of compensation for a disability that is a result of a veteran's own alcohol or drug abuse. It was noted that the payment of compensation was prohibited whether the claim was based on direct service connection or, under 38 C.F.R. § 3.310(a) (1998), for secondary service connection for a disability proximately due to or the result of a service- connected disorder. Further, compensation was noted to be prohibited regardless of whether compensation is claimed on the basis that a service-connected disease or injury caused the disability or on the basis that a service-connected disease or injury aggravated the disability. See VAOPGPREC 2-98. However, it has been held that while compensation may not be paid for any disability resulting from abuse of alcohol or drugs, the plain language of 38 U.S.C.A. § 1110 did not preclude the granting of service connection for the abuse of alcohol or drugs. Barela v. West, 11 Vet. App. 280 (1998). The Board, therefore, must first determine whether the claim for service connection for alcoholism is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the claim must be plausible before the Board will consider the claim on the merits. A comprehensive review of the appellant's service medical record discloses they are silent for any complaint, finding or diagnosis of alcoholism to include any relevant preservice history. Pertinent alcohol testing at entry onto active duty was nonrevealing for any positive finding of alcohol. In September 1992, the appellant elected not to undergo an examination for separation from active duty. His election was authorized following a review of his service medical records by a medical doctor as the review did not reflect any significant findings otherwise warranting a separation physical examination. The Board also notes that even when the veteran was reporting pertinent medical history on a postservice dental treatment form in August 1993, he continued to deny any problems with alcohol abuse. Clearly, the first medical evidence of any alcohol dependence dates from mid September 1993. Recent post service medical records essentially reflect diagnostic findings of alcoholism, now in remission. Importantly, the Board notes that the appellant's argument that he essentially developed a dependency on alcohol or for that matter an increased dependency on alcohol associated with his Persian Gulf War experience is unsubstantiated by the record including his service medical records. Additionally, there is evidence in the record from the veteran himself that he had already begun to drink as a teenager prior to entrance in service. Moreover, aside from any opinion based upon the veteran's unsubstantiated history of alcohol dependence, there is no competent medical evidence in the record demonstrating a nexus between the appellant's alcohol dependency as first identified in September 1993, and any incident of active service. The Court has held that an assessment based solely on history provided by the veteran is of no probative value. Reonal v. Brown, 5 Vet. App 458 (1993). Moreover, the Board notes that any evidence of alcohol dependence in the record that is simply information recorded by a physician without additional medical comment is not transformed into competent medical evidence because the transcriber of the appellant's history happens to be a physician. LeShore v. Brown, 8 Vet. App. 406 (1995). Overall, there is no competent medical evidence of a nexus between the appellant's alcohol dependence and active duty. Therefore, absent competent medical evidence of a nexus, or link, between the veteran's alcohol dependence and events in service, the appellant has not submitted a well-grounded claim of entitlement to service connection for alcohol dependence. See Caluza v. Brown, supra. The Board has considered the appellant's arguments as well as the lay testimony at a hearing before a hearing officer at the RO, however, the Court has held that while a lay person is competent to testify as to facts within his or her own observation and recollection, such as visible symptoms, a lay party is not competent to provide probative evidence as to matters requiring expertise derived from specialized medical education, training or experience, such as matters relating to a diagnosis or medical causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). As competent medical evidence of alcohol dependence with a nexus to the appellant's recognized active service has not been presented, the appellant's claim is not well grounded. If the claim is not well grounded, the Board does not have jurisdiction to adjudicate the claim. Boeck v. Brown, 6 Vet. App. 14, 17 (1993). Accordingly, the claim for entitlement to service connection for alcohol dependence is denied. Edenfield v. Brown, 6 Vet. App. 432 (1994). Although the Board considered and denied the appellant's claim on a ground different from that of the RO, which denied the claim on the merits, the appellant has not been prejudiced by the decision. This is because in assuming that the claim was well grounded, the RO accorded the appellant greater consideration than his claim in fact warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384 (1993). In light of the implausibility of the veteran's claim and the failure to meet his initial burden in the adjudication process, the Board concludes that he has not been prejudiced by the decision to deny his appeal for service connection for alcohol dependence. Application of the rule regarding benefit of the doubt is not required, as the appellant has not met his burden of submitting a well grounded claim. 38 U.S.C.A. § 5107(b) (West 1991) 38 C.F.R. §§ 3.102, 4.3. The Board further finds that the RO has advised the appellant of the evidence necessary to establish a well grounded claim, and the veteran has not indicated the existence of any post service medical evidence that has not already been obtained that would well ground his claim. McKnight v. Gober, 131 F.3d 1483 (Fed.Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed.Cir. 1997). II. Entitlement to service connection for PTSD. Analysis A comprehensive review of the record essentially shows that while in the Persian Gulf war the appellant saw no combat. He never fired a weapon nor was ever fired upon. He saw no atrocities, did no body bag work and did no graves registration work. He notes that his exposure to a lot of dead bodies (non-American) and destroyed foreign villages and buildings upset him. He still had nightmares and intrusive thoughts. Importantly, the Board notes that a Special VA PTSD psychiatric examination in September 1994 found no findings supporting a diagnosis of PTSD. While a VA clinical social worker in September 1994 referred to a diagnosis of PTSD based on psychiatric assessment using DSM-IV at San Diego VAMC, the Board points out no causal nexus was provided between symptomatology attributed to PTSD at that time and the specific claimed in-service stress. More importantly the Board points out that on a subsequent special VA PTSD examination in March 1996, by a board of two psychiatrists, also at VAMC San Diego, no clear diagnosis of PTSD was found based upon the appellant's overall symptoms associated with his claimed in-service stressors. In the absence of a clear or unequivocal diagnosis of PTSD, a critical element in the well groundedness determination, is not satisfied in the record. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). "Service connection for post-traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition." 38 C.F.R. § 3.305(f) (1998); The Board has considered the appellant's arguments as well as the lay testimony at a hearing before a hearing officer at the RO; however, the Court has held that while a lay person is competent to testify as to facts within his or her own observation and recollection, such as visible symptoms, a lay party is not competent to provide probative evidence as to matters requiring expertise derived from specialized medical education, training or experience, such as matters relating to a diagnosis or medical causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). As competent medical evidence of a clear diagnosis of PTSD with a nexus to the veteran's recognized active service has not been presented, the veteran's claim is not well grounded. If the claim is not well grounded, the Board does not have jurisdiction to adjudicate the claim. Boeck v. Brown, 6 Vet. App. 14, 17 (1993). Accordingly, the claim for entitlement to service connection for PTSD is denied. Edenfield v. Brown, 6 Vet. App. 432 (1994). Although the Board considered and denied the appellant's claim on a ground different from that of the RO, which denied the claim on the merits, the appellant has not been prejudiced by the decision. This is because in assuming that the claim was well grounded, the RO accorded the appellant greater consideration than his claim in fact warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384 (1993). In light of the implausibility of the appellant's claim and the failure to meet his initial burden in the adjudication process, the Board concludes that he has not been prejudiced by the decision to deny his appeal. The Board further finds that the RO has advised the appellant of the evidence necessary to establish a well grounded claim, and the veteran has not indicated the existence of any post service medical evidence that has not already been obtained that would be probative of a well grounded claim. McKnight v. Gober, 131 F.3d 1483 (Fed.Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed.Cir. 1997). The Court has held that if the veteran fails to submit a well grounded claim, VA is under no duty to assist in any further development of the claim. 38 U.S.C.A. § 5107(a); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); 38 C.F.R. § 3.159(a) (1996). Application of the rule regarding benefit of the doubt is not required, as the appellant has not met his burden of submitting a well grounded claim. 38 U.S.C.A. § 5107(b) (West 1991) 38 C.F.R. §§ 3.102, 4.3. III. Service connection for a psychiatric disorder other than PTSD, including paranoid schizophrenia and organic mood disorder, and left-sided generalized weakness secondary to brain injury associated with GSW to the right temple. Analysis A comprehensive review of the appellant's service medical records discloses they are silent for any complaint, finding, or diagnosis of psychiatric or neurologic disability, however diagnosed, to include any relevant preservice history. Pertinent evaluations at service entry were normal. In September 1992, the appellant elected not to undergo an examination for separation from active duty. His election was authorized following a review of his service medical records by a medical doctor as the review did not reflect any significant findings otherwise warranting a separation physical examination. The Board also notes that even when the appellant was reporting his pertinent medical history on a postservice dental treatment form in August 1993, he continued to deny any problems with nervousness or neurologic disability. Clearly, the first medical evidence of pertinent psychiatric and neurologic disability dates from approximately September 17, 1993, and surrounds the veteran's self inflicted GSW to the right frontotemporal area at that time. Importantly, the Board recognizes that the competent medical evidence of record solely relates a nexus between the appellant's organic mood disorder or organic brain syndrome, and generalized left sided weakness, to the postservice self inflicted GSW to the right frontotemporal area in September 1993, and not any pertinent occurrence or incident of active duty. There is no competent medical evidence of an acquired psychiatric disorder with nexus to service that might have contributed to the appellant's self-inflicted GSW in September 1993. See Brammer v. Derwinski, 2 Vet. App. 23 (1992); Rabideau v. Derwinski, 2 Vet. App 141, 143 (1992); Caluza v. Brown, 7 Vet. App. 498 (1995). The Board points out that on a recent VA special psychiatric examination in March 1996, by a board of two psychiatrists, the presence of acquired psychoneuroses characterized as anxiety disorder not otherwise specified and depressive disorder not otherwise specified were identified for the first time. Importantly, the record is without competent medical evidence of a nexus between the clinically confirmed acquired psychoneurosis as first noted following separation from active duty with any incident of active service. See Caluza v. Brown, 7 Vet. App. 498 (1995). The Board reemphasizes the Court has held that an assessment based solely on history provided by the veteran is of no probative value. Reonal v. Brown, 5 Vet. App 458 (1993). Moreover, the Board notes that any evidence in the record that is simply information recorded by a physician without additional medical comment is not transformed into competent medical evidence because the transcriber of the appellant's history happens to be a physician. LeShore v. Brown, 8 Vet. App. 406 (1995). The Board may not overlook the fact that that based upon the veteran's history and postservice VA examinations, the presence of a personality disorder verified as schizotypal personality disorder has been identified. While the examiners on the recent VA psychiatric examination in March 1996 opined that the appellant's schizotypal personality was aggravated by in-service stresses that led to him being more impaired following his involvement in the military, the Board notes that a personality disorder is not considered a disease or injury within the meaning of applicable legislation. The VA General Counsel has held that service connection may not be granted for a congenital or developmental defect, although service connection may be granted for a disability which is shown by the evidence to have resulted from a defect which was subject to a superimposed disease or injury during service. VAOPGCPREC 82-90. With respect to the veteran's recently identified personality disorder, the record clearly lacks competent medical evidence of an identifiable disability which is shown by the evidence to have resulted from a defect which was subject to a superimposed disease or injury during service. See Caluza v. Brown, 7 Vet. App. 498 (1995). It appears that the examiners were measuring the impact of inservice stressors claimed by the appellant for PTSD, which was not found, on his personality disorder as first noted following separation and essentially thought to be his primary problem. The Board points out that regulations governing service connection for PTSD differ from those governing service connection for other conditions because they require evidence of an inservice stressor rather than evidence of "incurrence or aggravation" of a disease or injury in service or within a post-service presumptive period. The Court's case law allows a physician's opinion of causal nexus, in certain circumstances, to establish inservice or presumptive-period incurrence or aggravation, even when the examination on which the opinion was based was made many years after service. See e.g., Moreau v. Brown, 9 Vet. App. 389 (1996). Importantly, personality disorders are not considered under the guidelines for establishing service connection for PTSD due to inservice stressors. Moreover, the Board notes that any evidence in the record that is simply information recorded by a physician without additional medical comment is not transformed into competent medical evidence because the transcriber of the appellant's history happens to be a physician. LeShore v. Brown, 8 Vet. App. 406 (1995). The Board also recognizes the Court has held that an assessment based solely on unsubstantiated history provided by the veteran is of no probative value. Reonal v. Brown, 5 Vet. App 458 (1993). The Board has considered the appellant's arguments as well as the lay testimony at a hearing before a hearing officer at the RO. However, the Court has held that while a lay person is competent to testify as to facts within his or her own observation and recollection, such as visible symptoms, a lay party is not competent to provide probative evidence as to matters requiring expertise derived from specialized medical education, training or experience, such as matters relating to a diagnosis or medical causation. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Overall, there is no competent medical evidence of a link between a psychiatric disorder other than PTSD including paranoid schizophrenia and organic mood disorder and left- sided generalized weakness secondary to brain injury associated with GSW to the right temple to active duty. See Caluza v. Brown, 7 Vet. App. 498 (1995); Brammer v. Derwinski, 2 Vet. App. 23 (1992); Rabideau v. Derwinski; As competent medical evidence of a psychiatric disorder other than PTSD including paranoid schizophrenia and organic mood disorder, and left-sided generalized weakness secondary to brain injury associated with GSW to the right temple, with a nexus to the appellant's recognized active service has not been presented, the appellant's claim is not well grounded. If the claim is not well grounded, the Board does not have jurisdiction to adjudicate the claim. Boeck v. Brown, 6 Vet. App. 14, 17 (1993). Accordingly, the claim for entitlement to service connection for a psychiatric disorder other than PTSD including paranoid schizophrenia and organic mood disorder and left-sided generalized weakness secondary to brain injury associated with GSW to the right temple is denied. Edenfield v. Brown, 6 Vet. App. 432 (1994). Although the Board considered and denied the appellant's claim on a ground different from that of the RO, which denied the claim on the merits, the appellant has not been prejudiced by the decision. This is because in assuming that the claim was well grounded, the RO accorded the appellant greater consideration than his claim in fact warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384 (1993). In light of the implausibility of the veteran's claim and the failure to meet his initial burden in the adjudication process, the Board concludes that he has not been prejudiced by the decision to deny his appeal for service connection for the disorders at issue. Application of the rule regarding benefit of the doubt is not required, as the appellant has not met his burden of submitting a well grounded claim. 38 U.S.C.A. § 5107(b) (West 1991) 38 C.F.R. §§ 3.102, 4.3. The Board further finds that the RO has advised the appellant of the evidence necessary to establish a well grounded claim, and the veteran has not indicated the existence of any post service medical evidence that has not already been obtained that would well ground his claim. McKnight v. Gober, 131 F.3d 1483 (Fed.Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed.Cir. 1997). ORDER The veteran not having submitted well-grounded claims of entitlement to service connection for alcohol dependence, PTSD, a psychiatric disorder other than PTSD including paranoid schizophrenia and organic mood disorder and left- sided generalized weakness secondary to brain injury associated with GSW to the right temple, the appeal is denied. RONALD R. BOSCH Member, Board of Veterans' Appeals