mrkman12

you know you are right. It is just amazing!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

have been awarded 5 honorable discharges and have been seeing va psychologist last 5 years for ptsd, was first diagnosed in 1992 one month after service seperation. have been on meds since beginning treatment, social security disabled, submitted c-file and 6 weeks later approved, reason ptsd. still va refused to acknowledge service connection. medical records show attempted suicide, explosion, eletricution, personal assaults, and concussion w/ ptsd symptoms. psychiatric c&p took all of 7 minutes and states personality disorder, and that the explosion and assaults during service were not of a significant value as to have caused ptsd. now have a lawyer, board certified and a counsel member of NOVA. (national organization of veteran affairs). she submitted a claim for an aquired psychiatric disorder including ptsd. She states, the lawyer, baby steps are what we are taking and forcing the RO to do thier jobs.. and I feel everything is on hold and placed in limbo....any advice?

John999, thanks bud, I sent an e-mail to testvet, and hopefully he will reply. I see what you are attempting to say, and will take this into consideration. I am from the old school, and find it extremely difficult to ask for help from others. Yet, everytime I go to the va, I am constantly reminded that this assistance was earned, and that veterans should not be ashamed to ask for this help... correct?

Yes Maam, I am claiming both stressors. smr, show treatment to the eyes for flashburns as a result of the ships' external power cable exploding in my face, resulting in burned hair, flashburns to the face and arms with particulate particles of metal and rubber embedded in the skin. The main concern was the eyes, which were stained with moderate scarring, eyes were flushed and medicated and covered for 24 hours. Testing the next day, showed no lasting permanent injury. Flash burns were treated, and placed on light duty. Doc, could not explain futher symptons of unconscienceness, or battle fatigue symptoms.... VA shrink wrote nexus letter, which was placed in the claims file, diagnosing both incidents as A-1 criteria, as per DSM-IV. Neuropsychologists also wrote nexus to the two TBI injuries noted and believes there are executive/functioning problems concerning processing speed, and inprogress ptsd symptoms...

Thank you, John. I know you are not trying to offend me and the inputs recieved at hadit.com are rest assurdiedly most appreciated. I am just trying to understand the proper procedures in this all mighty hamster wheel process, to get the assistance needed to help combat the symptoms of the ptsd/mdd. So that I can get my life back, and be independant again. Whether or not I am compensated really holds no ethical value to me but justice and reinstatement of my good name is... And as miss carlie states, I will go to the grave with a claim form in my cold dead hands....You see john, the money is not the object, I am trying to correct a grave injustice done to me at the hands of the military and the freakin VA.......To be honest w/ you, I frankly do not care what my VSO thinks. After all he is just another hurdle to overcome. I do have to give him credit though, He did take the time to read the draft to the BVA. He (VSO) stated it was a good brief, and submitted it to the VARO in HOUSTON....So now I wait.....mark

VACOLS Appealed Issues issues currently on appeal. 1. Left talus chip fracture 10% service connected 2. Right knee patellofemoral joint syndrome 0% service connected 3. Left knee patellofemoral joint syndrome 0% service connected 4. left foot bunion 0% service connected 5. right ankle degenerative joint disease not service connected 6. disc compression l1/l2 w/ lower back condition not service connected 7. psychoneurotic disorder not service connected 8. brain disease due to trauma/concussion not service connected post concussion syndrome (TBI injury) not service connected Most of the confusion of these issues will be addressed at the DRO interview, and will drop certain issues until futher medical evidence is aquired and the three elements have been established. Does this clarify what I am attempting somewhat?

presently maam, 10%, fractured left tallus that has never healed and was found still to be fractured when given a QTC, examination here in SA.

This is a draft given to my VSO, to assist and clarify my contentions submitted. Any replies will be greatly appreciated.....mark citation Nr: Decision Date: Archive Date: DOCKET NO. ) DATE ) ) On appeal from the Department of veterans Affairs Regional office Center in Houston Texas THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: TEXAS VETERANS COMMISSION. WITNESS AT HEARINGS ON APPEAL The Veteran-Appellant ATTORNEY FOR THE BOARD counsel INTRODUCTION The veteran (also referred to as "appellant" or "claimant") served on active duty from November 1974 to March 1992. This matter comes before the Board of veterans' Appeals (Board) on appeal from a rating decision issued in August 1992 by the Department of veterans Affairs (VA) Medical and Regional office Center (RO) in Houston, Texas, which denied service connection for PTSD. The veteran entered new and material evidence to reopen this claim, September, 2007. page 1 Findings OF FACT 1. All evidence necessary to decide the issue on appeal is of record. 2. The veteran did not engage in combat with the enemy. 3. The record includes a medical diagnosis of PTSD, competent evidence which supports the veteran's assertion of in-service incurrence of the stressful events of a personal assault, and near fatal electrocution. medical evidence of a nexus between diagnosed PTsD and the stressful events of personal assault, and near fatal electrocution in service. CONCLUSION OF LAW The board will find with the resolution of reasonable doubt in the veteran's favor, PTsD was incurred in service. 38 U.s.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (west 1991 & Supp. 2001); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125(a) (2001); 66 Fed. Reg. 45,630-32 (Aug. 29, 2001) (to be codified as amended at 38 C.F.R. § 3.159). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veterans claims Assistance Act of 2000, Pub. L. NO. 106- 475, 114 Stat. 2096 (2000), now requires VA to assist a claimant in developing all facts pertinent to a claim for VA benefits, including a medical opinion and notice to the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the VA secretary, that is necessary to substantiate the claim. VA has issued regulations to implement the Veterans claims Assistance Act of 2000. 66 Fed. Reg. 45,620 (Aug. 29, 2001) (to be codified as amended . at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a)). The Board will find that, in this appellant's case, the requirements of the Veterans claims Assistance Act of 2000 and implementing regulations have not been met. The appellant was not afforded personal hearings at the RO and before the undersigned acting member of the Board. In the rating decision, statement of the case, and supplemental statements of the case, the RO did not advised the appellant of what must be demonstrated to establish service connection for PTSD. A personal assault development questionnaire was not sent to assist in developing the claim. See Patton v. west, 12 Vet. App. bva compensation 272 (1999). page 2 The Board will note, further notice or assistance to the veteran is necessary in order to decide the claim for service connection for PTSD currently on appeal; there is reasonable possibility that further assistance in attempting to obtain such verifying information or current examination or medical opinion would aid in substantiating the claim. 38 U.S.C.A. §§ 5103, 5103A (west Supp. 2001). Accordingly, further notice to the appellant or assistance in acquiring additional evidence is required by the new statute and regulations. The veteran contends that he currently suffers from PTSD as a direct result of a personal assault, by an unknown assailant on March, 27 1991, and a near fatal electrocution, May 16, 1983. During his active military service. He specifica11y contends that he sought medica1 attention ten days later and informed the medical provider that he had no recollection of being assualted, yet complained of various other symptoms, and did not mention of the personal assault. The veteran contends that he did not tell his commanding officer of the assault, but was told in essence by TM1 Thomas, (chief Master At Arms) "due to lack of evidence or witnesses not to mention it again", so he did not tell anyone else about the assault until after service. The veteran further contends that his alcohol problems in service are a manifestation of this assault, and a near fatal electrocution. That he experienced other behavioral problems in service and soon after service. service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 38 C.F.R. § 3.303(a) (2001). FOr the showing of chronic disease in service, there is required a combinatlon of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303( (2001). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. service connection may also be granted for any disease diagnosed after discharge when all of the evidence establlshes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2001). Service connection for PTSD now requires: medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (conforming to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). Prior to the effective date of 38 C.F.R. § 3.304(f) on June 18, 1992, and at the time of the veteran's claim for service connection for PTSD, the requirements for service connection for PTSD were: medical evidence establishing a clear diagnosis of the condition; credible supporting evidence that the claimed stressor actually occurred; and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f) (1998). Generally, when a law or regulation changes while a case is pending, the version most favorable to the claimant applies, absent congressional intent to the contrary. Karnas v. Derwinski, 1 vet. App. 308, 312-13 (1991). page 3 In this case, the Board will find that the new regulation is potentially more beneficial in this veteran's bva compensation case because it only requires medical evidence of a current diagnosis of PTsD in accordance with DsM-IV, but no longer requires a "clear" diagnosis of PTsD (which could include a diagnosis based on a version of DsM prior to the DsM-IV). However, in light of the Board's grant of the appeal, the Board will find that the veteran was prejudiced by not being notified of the change in the regulation. see Bernard v. Brown, 4 Vet. App. 384 (1993). with regard to the claimed stressor involving allegations of personal assault, VA recognizes that veterans claiming service connection for disability due to an in-service personal assault~face unique problems documenting their claims. Personal assault is an event of human design that threatens or inflicts harm. Although these incidents are most often thought of as involving female veterans, male veterans may also be involved. These incidents are often violent and may lead to the development of PTsD secondary to personal assault. VA ADJUDICATION PROCEDURE MANUAL M21-1, Part III, 5.14 (April 30, 1999) (hereinafter M21-1). Because assault is an extremely personal and sensitive issue, many incidents of personal assault are not officially reported, and victims of this type of in-service trauma may find it difficult to produce evidence to support the occurrence of the stressor. Therefore, alternative evidence must be sought. The M21-1 includes a sample letter to be sent to the veteran, asking him to provide detail as to any treatment he had received, any family or friends he had communicated with concerning this claimed personal assault, and any law enforcement or medical records pertaining to the alleged assault. M21-1, Part III, 5.14 (April 30, 1999). see also YR v. west, 11 Vet. App. 393 (1998) (5.14 is a substantive rule and the equivalent of a VA regulation). with respect to claims involving personal assault, all available evidence must be carefully evaluated. If the military records do not document that a personal assault occurred, alternative evidence might still establish an in- service stressful incident. Behavior changes that occurred at the time of the incident may indicate the occurrence of an in-service stressor. Examples of behavior changes that might indicate a stressor are (but are not limited to): (a) visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment; (B) sudden requests that the veteran's military occupational series or duty assignment be changed without other justification; © lay statements indicatlng increased use or abuse of leave without an apparent reason such as family obligations or family illness; (d) changes in performance and performance evaluations; (e) lay statements describing episodes of depression, panic attacks, or anxiety but no identifiable reasons for the episodes; (f) increased or decreased use of prescription medications; (g) increased use of over-the- . counter medications; (h) evldence of substance abuse such as alcohol or drugs; (i) increased disregard for military or civilian authority; (j) obsessive behavior such as overeating or undereating; (k) Ipregnancy tests around the time of the incident; (1) increased interest in tests for HIV or sexually transmitted ; diseases; (m) unexplained economic or social behavior changes; (n) treatment for physical injuries around the time of the claimed trauma but not reported as a result of the trauma; (0) breakup of a primary relationship. Page 4 M21-1, Part III, 5.14(7). 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. M21-1, Part III, 5.14(8). In adjudicating a claim for service connection for PTSD, the evidence necessary to establish the incurrence of a stressor during service to support a claim of entitlement to service connection for PTSD will vary depending on whether or not the veteran was "engaged in combat with the enemy." see Hayes v. Brown, 5 Vet. App. 60, 66 (1993). If it is determined through military citation or other supportive evidence that a veteran engaged in combat with the enemy, and the claimed stressors are related to combat, the veteran's lay testimony regarding the reported stressors must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary, provided that the testimony is found to be satisfactory, that is, not contradicted by service records, and "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C.A. § 1154( (west Supp. 2001); 38 C.F.R. § 3.304(d),(f) (2001); Doran v. Brown, 6 Vet. App. 283, 289 (1994). . However, if it is determined that a veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, the veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. In such cases, the record must contain service records or other corroborative evidence which substantiates or verifies the veteran's testimony or statements as to the occurrence of the claimed stressors. See zarycki v. Brown, 6 Vet. App. 91, 98 (1993). In this case, there is no objective evidence that the veteran "engaged in combat with the enemy." See VAOPGCPREC 12-99. The veteran's DD Form 214 does not indicate references to combat, but reflects that the veteran was an operations specialist, was stationed at san Diego, Naval Base. Aboard the USS COOK (FF-1083) from 1987 to March 1992, and earned no decorations, medals, badges, ribbons, or awards. Moreover, the veteran does not even allege that the claimed in-service stressful event of a personal assault was related to combat with the enemy in service. For these reasons, the Board will find that the veteran did not engage in combat with the enemy and that the reported stressor 1S not claimed to be related to combat. Because the veteran did not engage in combat with the enemy, his lay testimony alone is not enough tO estab1ish the occurrence of the alleged stressor of personal assault. However, after a review of the evidence, the Board will find that. the service records and other evidence of record is sufficient to raise a reasonable doubt as to whether the alleged stressors of a personal assault in 27 March 1991, and a near fatal electrocution which occurred May 16 1983 during the veteran's active duty service did occurr. The Board should specifically consider medical and personell records reflecting behavior changes that occurred at the time of the incidents, or soon thereafter, as indicated by the M21-1, which may indicate the occurrence of an in-service stressor. page 5 The M21-1 contemplates that visits to a medical clinic without a specific diagnosis or specific ailment is a behavior change occurrlng at the time of the incident that might indicate a stressor. In this veteran's case, in service on April 06, 1991, the veteran reported that ten days after he sustained an injury to the left side of his head. His specific complaints included blurred vision, left-sided headaches, feelings of dissassociation from self, vertigo and nausea without vomiting, short term memory loss. NO diagnosed disability was entered at that time, while further observation was indicated. About three weeks later, on April 27, 1991, the veteran reported that he felt about the same. still no diagnosis was rendered to account for the reported symptoms. By November 09, 1991, the veteran also complained of nausea, irratibility, every other day for the previous month; an assessment regarding this complaint was deferred. while the veteran reported specific ailments, it is of note that his reported complaints affecting both his abdomen and head, and reported several other symptoms. These entries are some evidence of initial visits to a medical facility without a specific diagnosis. The record also reflects that by May 1991 the veteran indicated that he was unhappy in service and was anxious to be transferred or released from his present command duty station. This reflects the veteran's desire not to remain in service, which includes a desire not to remain on the same base or in the same command. This is analogous to the M21-1 behavior change of a sudden request for a change of duty assignment. changes in performance and performance evaluations are behavior changes contemplated by M21-1 that might indicate a stressor. The only specific or quantified measures of the veteran's performance during the period following the alleged personal assault is a December 1990/November 1991, performance Report which reflects that the veteran's performance steadily deteriorated throughout the reporting period. Recieving c.o.'s NJP 91OCT 10 for Article 86, and 91 NOV 20 for Article 92. Both NJP'S resulted in reductions in rank, from a senior E-6 recommended for advancement, and retention to chief petty officer, to E-4. Evaluation comments state; The veteran, fails to conform to military standards and abuses authority, and is Not recommended for retention and or advancement. The veteran is being processed for administative seperation, based on high year tenure. while this report is indicated to have been based on the previous one year period beginning in December 1990, and ending November 1991. There are a number of previous evaluation reports to provide a baseline for comparison. This comparison demonstrates a drastic change in the veterans behavior, personality, and performance. such poor performance is also indicated by the veteran's spouse's statement submitted October 2007. That the veteran's behavior, personality, and characture was drastically different than observed six months previously when home on leave. And that the veteran was discharged from service in March 1992 well before the end of his four year service agreement. While it is clear when a change in behavior in service occurred, the record reflects that the veteran's personal conduct toward the end of service indicated low adaptability, functionality, and acceptability to military life. Thus, indication of a stressor by m21-1. page 6 bva compensation obsessive behavior is a change contemplated by M21-1 that might indicate a stressor. His spouse wrote in October 2007 that when she went to visit the veteran in service she found the veteran to be angry and irritable and refused to talk to her. The veteran's spouse wrote that after service he seemed distant, incoherent, and shallow, and would stare aimlessly in a corner of a room or at a paticular object. The veteran's spouse also wrote that soon after service the veteran developed the obsessive behavior of constantl¥ locking and checking doors multiple times daily, to the polnt of dlstraction or leaving other activities unfinished. Another of the behavior changes indicated by the M21-1 is treatment for physical injurles around the time of the claimed trauma but not reported as a result of the trauma. service medical records reflect that on April 06, 1991 the veteran reported injury to the head but did not report a personal assault which he later alleged was the source of such complaints. The Board will also find it significant that at the first opportunity after service (the veteran filed his claim for service connection for post concussion syndrome and for ptsd within one month of service separation). That the veteran also sought out assistance and counseling from the Veterans Center located at 231 W. Cypress Ave. San Antonio, Tx. March 04, 1992. With complaints of depression, irratability, anxiety, hopelessness, nightmares, and hypervigilance. DIAGNOSTIC IMPRESSION: POSSIBLE PTSD / rEQUEST FOLLOW UP SCREENING, AND EXAMS. REFER TO: AUDIE MURPHY VA HOSPITAL sA TX. That no VA examination in April through August 1992, was ever afforded to the veteran. And after being told; "Since your injuries were not caused by, or in actual combat. The VA cannot assist you, in your claims for pension and or compensionsation". Apperantly and reluctently the Veteran gave up seeking any assistance from the veterans administration, for needed medical help for his non-combat service related injuries. The veteran has not yet testified under oath at a personal hearing regarding the incurrence of personl assualt, or near fatal electrocution in service as of August 2009. The Board will find that, although the veteran does not consistently recall dates of occurrence of events, including the in-service assualt, his essential testimony regarding this event, as well as other significant facts he reported, are consistent with the service medical record evidence and other corroborative evidence. The veteran's testimony includes that he did not have a problem with alcohol prior to service, that he was assaulted in service on March 27, 1991, that he reported for medical treatment ten days later but did not mention the assault, that his behavior changed in service, prior to discharge, that he mentioned the assault at a VA examination in 2007. The other evidence of record does not otherwise demonstrate that the veteran's essential testimony is not credible. The post-service medical evidence of record tends to corroborate the veteran's testimony as it reflects that from 1991 the veteran has reported the occurrence of unexplained medical conditions not related to an in-service assault on numerous occasions, solely for treatment purposes. Based on this evidence, the Board will find that the service records and other evidence of record is sufficient to raise a reasonable doubt as to whether the alleged stressor of a personal assault occurred in March 27, 1991. And a near fatal electrocution on May 16,1983 during the veteran's active duty service. Resolving reasonable doubt on this question in the veteran's favor. the Board will find that the reported stressor of a personal assault occurred in military service, March 27, 1991. The Board will find also that the reported stressor of a near fatal electrocution occurred in military service, May 16, 1983. 38 C.F.R. § 3.102. page 7 bva compensation The record includes a medical diagnosis of PTSD and medical evidence of a nexus between diagnosed PTSD and the stressful event of a TBI/injury, diagnosed post concussion syndrome and a near fatal electrocution. The two additional elements required to establish a claim for service connection for PTSD. 38 C.F.R. § 3.304(f). For example, a september 2007 VA progress note records the veteran's reported history of a personal assualt during active service by an unknown assailant, with a diagnosis of post-traumatic stress reaction to assault, with major depressive disorder severe, chronic. A VA hospital summary in April 2008 reflects a history which included the report of in-service assault, and resulted in diagnoses which included a history of non-combat PTSD. The progress notes reflect consideration of PTSD as the primary diagnosis. VA outpatient treatment records from 2007 to 2008 reflect a continued diagnosis of PTSD based on reports of a personal assault, and near fatal electrocution in service with a G.A.F. of ( 39 ). However, in a Febuary 2008 letter, A private psychologist Dr. F.E. wrote that the veteran was suffering from Axis I: Post Traumatic Stress disorder, Major Depressive disorder, Dysthymic disorder, Generalized Aniexty disorder, Alcohol Dependence. Axis II: personality disorder, NOS with schizotypal, schizoid, Borderline, Depressive, and passive-Aggressive features. PTSD, severe, chronic, as a result of being assaulted while in service, and a near fatal electrocution in active military service. The record includes: Febuary 6, 2009. A general base line summary, from staff neuropsychologist, Kristin R. Krueger, PhD. Dept. of Veterans Affairs, Audie L. Murphy Memorial Veterans Hospital Division, S.A., Tx. Which states; Veteran is a 51-year old, right-handed, married Caucasian man with 11 years of formal education. He was referred by psychologist, Timothy Rentz, PhD for evaluation of cognitive status to aid in differential diagnosis and treatment planning. The pt completed a neurocognitive status exam (1 Hour) with Kristin R. Krueger, PhD and face-to-face neurobehavioral testing (3 hours) conducted by Kimberly Van Buren, M.A. Pt was evaluated in April 2008. Summary and Impressions: Veteran reported dramatic changes in his character and cognitive functioning as a result of a TBI in 1991. Medical history is significant for hypertension, post concussive syndrome, sleep apnea, possible stroke, substance abuse and multiple surgeries. Veteran has an extensive history of psychiatric illness that was first treated during military service. Veteran is currently being treated for Major Depressive Disorder and Post Traumatic Stress Disorder. Psychosocial history is positive for child abuse and subsequent placement in a series of foster homes and institutions. Occupational history is positive for dismissal due to inability to get along with others. Interview and testing revealed a severely inhibited and cautious man, with a overall intact cognitive profile, with the exception of slowed processing speed and variable attention/executive functioning. Veterans Memory is within normal limits, with visual memory better than verbal memory. Veterans slow processing speed and difficulties with attention/executive functioning may be influencing his ability to encode information in a timely fashion and he is consequently experiencing memory difficulties. IT IS LIKELY THAT THE VETERANS ABILITY TO PERFORM THESE TASKS IS INFLUENCED BY BOTH REPORTED TBI's AS WELL AS SYMPTOMS OF PTSD. Given the Veterans acute distress and his difficulty with processing speed and attention/executive functioning. And the time since his TBI's, addressing his psyciatric issues at this time is likely to be of most benefit to the veteran. Summary report from dr rentz va pyscologist Frank Tejeda vet svcs ctr dated 04/27/2009 states: Veteran reported two traumatic events during active duty military service that meet Posttraumatic Stress Disorder (PTSD diagnostic criteria A1) (exposure to a traumatic event). The first event was in the US Navy aboard the USS Illusive: veteran recieved a severe, potentially fatal electric shock/explosion while working on a 300kw ship-to shore power cable which had mistakenly not been turned off. He was thrown about 10 feet into a bulkhead, suffered loss of consciousness, burns to his eyes and temporary neurological blindness. The second event was when the veteran was assaulted from behind while serving aboard the USS Cook. Veteran suffered loss of consciousness, awoke in a pool of blood due to head injury (being struck on the head), and subsequently displayed symptoms of post-concussive syndrome, and changes in behavior consistent with Posttraumatic Stress Disorder. Veteran reacted to these events with feelings of terror, "Being scared to death," confusion, and helplessness. Both of these incidents are life-threatening events, the first due to a near fatal electrocution, the second due to severe interpersonal trauma in the form of an assault. Both of these incidents occured in a non-combat environment during active-duty service in the U.S. Navy. (IT IS MORE LIKELY THAN NOT, THAT HIS CURRENT SYMPTOMS OF PTSD ARE RELATED TO THESE EVENTS DURING ACTIVE-DUTY MILITARY SERVICE.) The veteran has provided copies of medical records and personnel records that are consistent with these events. He has continued to re-experience these events in the forms of intrusive thoughts and images, replaying the events in his mind, and feels unable to block it out. He has frequent nightmares and experiences emotional and physiological symptoms of sympathetic nervous system activation (fight-or-flight response) when reminded of these events. He has symptoms of avoidance including attempts to put thoughts and memories of the traumatic events out of his mind, avoids people, public places, electric cords & cables, and has used alcohol (binge drinking patterns) to avoid emotional re-experiencing. He has lost interest in most activities he used to enjoy, such as gardening, baseball, boxing, and socializing. He feels detached and numb much of the time, has restricted range of emotions, e.g. cannot feel happiness, is emotionally distant in his relationship with his wife, has lost almost all other relationships, and has a fore-shorteded sense of the future. The veteran experiences symptoms of hyperarousal including insomnia, frequent irritability and anger outbursts triggered by both interpersonal and inanimated routine stressors, cannot concentrate for more than a few minutes, is hypervigilant for signs of threat or danger, e.g. always watches what people are doing, always feels on guard, is aware of small sounds and movements, and is "jumpy" and easily startled by sudden or loud noises. The veteran first sought treatment for PTSD in 1992 from the Vet Center, initial assessment evaluation; Possible PTSD, patient referred to Audie Murphy Veterans Hospital, San Antonio, tx. But was told at VA hospital, he did not qualify for treatment there because his traumatic experiences were non-combat related. He again sought treatment in 2007 and was evaluated and diagnosed with PTSD in the VA PTSD Clinic, Frank Tejeda Outpatient Clinic in San Antonio. Since that time he has remained active in individual treatment, and has made some guarded progress in managing emotions through cognitive restructuring, improving assertiveness skills, anger management, and confronting memories of traumatic events. This veterans symptoms of PTSD remain at a HIGH LEVEL, despite some modest improvement. His prognosis for improved symptom management is fair/good. His prognosis for return to normal functioning is POOR. This veteran continues to have extreme difficulty with interpersonal stressors and has subsequent occupational impairment. He is able to work at some temporary and part-time jobs, but tolerates high levels of distress to do this. Axis I: PTSD, Severe, Chronic, Major Depressive Disorder, Severe, recurrent. Axis V: 40. In summary, his alleged stressors are verifiable to the Board's satisfaction and his lay evidence is deemed credible. The credibility to be accorded to the appellant's lay testimony or written statements is within the province of the adjudicators and is not a matter of medical expertise. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Here, there exists no doubt that the veteran has been diagnosed with PTSD. The documentation from the service department is extensive and the record does tend to corroborate events associated with both near fatal electricution, and TBI, which he has related as the stressors since 1992, veterans initial claim to support service connection. As the VA examiner in 2009 implied, the veteran has given a reliable version of events which weighs in favor of his credibility with respect to the events clinicians have noted to support the PTSD diagnosis in the personal assault and near fatal electricution context. Thus, having accorded due consideration to the veteran's statements, lay statements, medical reports, and to official records, the Board will conclude there are corroborated military stressors of a non-combat nature. In light of the above, there is an approximate balance of positive and negative evidence to which the benefit-of-the-doubt standard applies. Accordingly, service connection for PTSD should be granted. AS indicated, the record includes a medical diagnosis of PTSD, competent evidence which supports the veteran's assertion of in-service incurrence of the stressful events of a personal assault, and near fatal electrocution and medical evidence of a nexus between diagnosed PTSD and the stressful events of personal assault, and a near fatal electrocution in service. For these reasons, and with the resolution of reasonable doubt in the veteran's favor, the Board will find that the veteran's diagnosed PTSD was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107, 5103, 5103A (west 1991 & west Supp. 2001); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125(a); 66 Fed. Reg. 45,630-32 (Aug. 29, 2001) (to be codifled as amended at 38 C.F.R. § 3.159). REQUESTED ORDER The appeal for service connection for PTSD should be granted. That 100% disability should be assigned and granted. page 8

pete, I drafted this to assist my VSO on the matter of my claim. Do you think this helps clarify the issues? mark citation Nr: Decision Date: Archive Date: DOCKET NO. ) DATE ) ) On appeal from the Department of veterans Affairs Regional office Center in Houston Texas THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: TEXAS VETERANS COMMISSION. WITNESS AT HEARINGS ON APPEAL The Veteran-Appellant ATTORNEY FOR THE BOARD counsel INTRODUCTION The veteran (also referred to as "appellant" or "claimant") served on active duty from November 1974 to March 1992. This matter comes before the Board of veterans' Appeals (Board) on appeal from a rating decision issued in August 1992 by the Department of veterans Affairs (VA) Medical and Regional office Center (RO) in Houston, Texas, which denied service connection for PTSD. The veteran entered new and material evidence to reopen this claim, September, 2007. page 1 Findings OF FACT 1. All evidence necessary to decide the issue on appeal is of record. 2. The veteran did not engage in combat with the enemy. 3. The record includes a medical diagnosis of PTSD, competent evidence which supports the veteran's assertion of in-service incurrence of the stressful events of a personal assault, and near fatal electrocution. medical evidence of a nexus between diagnosed PTsD and the stressful events of personal assault, and near fatal electrocution in service. CONCLUSION OF LAW The board will find with the resolution of reasonable doubt in the veteran's favor, PTsD was incurred in service. 38 U.s.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (west 1991 & Supp. 2001); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125(a) (2001); 66 Fed. Reg. 45,630-32 (Aug. 29, 2001) (to be codified as amended at 38 C.F.R. § 3.159). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veterans claims Assistance Act of 2000, Pub. L. NO. 106- 475, 114 Stat. 2096 (2000), now requires VA to assist a claimant in developing all facts pertinent to a claim for VA benefits, including a medical opinion and notice to the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the VA secretary, that is necessary to substantiate the claim. VA has issued regulations to implement the Veterans claims Assistance Act of 2000. 66 Fed. Reg. 45,620 (Aug. 29, 2001) (to be codified as amended . at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a)). The Board will find that, in this appellant's case, the requirements of the Veterans claims Assistance Act of 2000 and implementing regulations have not been met. The appellant was not afforded personal hearings at the RO and before the undersigned acting member of the Board. In the rating decision, statement of the case, and supplemental statements of the case, the RO did not advised the appellant of what must be demonstrated to establish service connection for PTSD. A personal assault development questionnaire was not sent to assist in developing the claim. See Patton v. west, 12 Vet. App. bva compensation 272 (1999). page 2 The Board will note, further notice or assistance to the veteran is necessary in order to decide the claim for service connection for PTSD currently on appeal; there is reasonable possibility that further assistance in attempting to obtain such verifying information or current examination or medical opinion would aid in substantiating the claim. 38 U.S.C.A. §§ 5103, 5103A (west Supp. 2001). Accordingly, further notice to the appellant or assistance in acquiring additional evidence is required by the new statute and regulations. The veteran contends that he currently suffers from PTSD as a direct result of a personal assault, by an unknown assailant on March, 27 1991, and a near fatal electrocution, May 16, 1983. During his active military service. He specifica11y contends that he sought medica1 attention ten days later and informed the medical provider that he had no recollection of being assualted, yet complained of various other symptoms, and did not mention of the personal assault. The veteran contends that he did not tell his commanding officer of the assault, but was told in essence by TM1 Thomas, (chief Master At Arms) "due to lack of evidence or witnesses not to mention it again", so he did not tell anyone else about the assault until after service. The veteran further contends that his alcohol problems in service are a manifestation of this assault, and a near fatal electrocution. That he experienced other behavioral problems in service and soon after service. service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 38 C.F.R. § 3.303(a) (2001). FOr the showing of chronic disease in service, there is required a combinatlon of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303( (2001). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. service connection may also be granted for any disease diagnosed after discharge when all of the evidence establlshes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2001). Service connection for PTSD now requires: medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (conforming to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). Prior to the effective date of 38 C.F.R. § 3.304(f) on June 18, 1992, and at the time of the veteran's claim for service connection for PTSD, the requirements for service connection for PTSD were: medical evidence establishing a clear diagnosis of the condition; credible supporting evidence that the claimed stressor actually occurred; and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f) (1998). Generally, when a law or regulation changes while a case is pending, the version most favorable to the claimant applies, absent congressional intent to the contrary. Karnas v. Derwinski, 1 vet. App. 308, 312-13 (1991). page 3 In this case, the Board will find that the new regulation is potentially more beneficial in this veteran's bva compensation case because it only requires medical evidence of a current diagnosis of PTsD in accordance with DsM-IV, but no longer requires a "clear" diagnosis of PTsD (which could include a diagnosis based on a version of DsM prior to the DsM-IV). However, in light of the Board's grant of the appeal, the Board will find that the veteran was prejudiced by not being notified of the change in the regulation. see Bernard v. Brown, 4 Vet. App. 384 (1993). with regard to the claimed stressor involving allegations of personal assault, VA recognizes that veterans claiming service connection for disability due to an in-service personal assault~face unique problems documenting their claims. Personal assault is an event of human design that threatens or inflicts harm. Although these incidents are most often thought of as involving female veterans, male veterans may also be involved. These incidents are often violent and may lead to the development of PTsD secondary to personal assault. VA ADJUDICATION PROCEDURE MANUAL M21-1, Part III, 5.14 (April 30, 1999) (hereinafter M21-1). Because assault is an extremely personal and sensitive issue, many incidents of personal assault are not officially reported, and victims of this type of in-service trauma may find it difficult to produce evidence to support the occurrence of the stressor. Therefore, alternative evidence must be sought. The M21-1 includes a sample letter to be sent to the veteran, asking him to provide detail as to any treatment he had received, any family or friends he had communicated with concerning this claimed personal assault, and any law enforcement or medical records pertaining to the alleged assault. M21-1, Part III, 5.14 (April 30, 1999). see also YR v. west, 11 Vet. App. 393 (1998) (5.14 is a substantive rule and the equivalent of a VA regulation). with respect to claims involving personal assault, all available evidence must be carefully evaluated. If the military records do not document that a personal assault occurred, alternative evidence might still establish an in- service stressful incident. Behavior changes that occurred at the time of the incident may indicate the occurrence of an in-service stressor. Examples of behavior changes that might indicate a stressor are (but are not limited to): (a) visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment; (B) sudden requests that the veteran's military occupational series or duty assignment be changed without other justification; © lay statements indicatlng increased use or abuse of leave without an apparent reason such as family obligations or family illness; (d) changes in performance and performance evaluations; (e) lay statements describing episodes of depression, panic attacks, or anxiety but no identifiable reasons for the episodes; (f) increased or decreased use of prescription medications; (g) increased use of over-the- . counter medications; (h) evldence of substance abuse such as alcohol or drugs; (i) increased disregard for military or civilian authority; (j) obsessive behavior such as overeating or undereating; (k) Ipregnancy tests around the time of the incident; (1) increased interest in tests for HIV or sexually transmitted ; diseases; (m) unexplained economic or social behavior changes; (n) treatment for physical injuries around the time of the claimed trauma but not reported as a result of the trauma; (0) breakup of a primary relationship. Page 4 M21-1, Part III, 5.14(7). 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. M21-1, Part III, 5.14(8). In adjudicating a claim for service connection for PTSD, the evidence necessary to establish the incurrence of a stressor during service to support a claim of entitlement to service connection for PTSD will vary depending on whether or not the veteran was "engaged in combat with the enemy." see Hayes v. Brown, 5 Vet. App. 60, 66 (1993). If it is determined through military citation or other supportive evidence that a veteran engaged in combat with the enemy, and the claimed stressors are related to combat, the veteran's lay testimony regarding the reported stressors must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary, provided that the testimony is found to be satisfactory, that is, not contradicted by service records, and "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C.A. § 1154( (west Supp. 2001); 38 C.F.R. § 3.304(d),(f) (2001); Doran v. Brown, 6 Vet. App. 283, 289 (1994). . However, if it is determined that a veteran did not engage in combat with the enemy, or the claimed stressor is not related to combat, the veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. In such cases, the record must contain service records or other corroborative evidence which substantiates or verifies the veteran's testimony or statements as to the occurrence of the claimed stressors. See zarycki v. Brown, 6 Vet. App. 91, 98 (1993). In this case, there is no objective evidence that the veteran "engaged in combat with the enemy." See VAOPGCPREC 12-99. The veteran's DD Form 214 does not indicate references to combat, but reflects that the veteran was an operations specialist, was stationed at san Diego, Naval Base. Aboard the USS COOK (FF-1083) from 1987 to March 1992, and earned no decorations, medals, badges, ribbons, or awards. Moreover, the veteran does not even allege that the claimed in-service stressful event of a personal assault was related to combat with the enemy in service. For these reasons, the Board will find that the veteran did not engage in combat with the enemy and that the reported stressor 1S not claimed to be related to combat. Because the veteran did not engage in combat with the enemy, his lay testimony alone is not enough tO estab1ish the occurrence of the alleged stressor of personal assault. However, after a review of the evidence, the Board will find that. the service records and other evidence of record is sufficient to raise a reasonable doubt as to whether the alleged stressors of a personal assault in 27 March 1991, and a near fatal electrocution which occurred May 16 1983 during the veteran's active duty service did occurr. The Board should specifically consider medical and personell records reflecting behavior changes that occurred at the time of the incidents, or soon thereafter, as indicated by the M21-1, which may indicate the occurrence of an in-service stressor. page 5 The M21-1 contemplates that visits to a medical clinic without a specific diagnosis or specific ailment is a behavior change occurrlng at the time of the incident that might indicate a stressor. In this veteran's case, in service on April 06, 1991, the veteran reported that ten days after he sustained an injury to the left side of his head. His specific complaints included blurred vision, left-sided headaches, feelings of dissassociation from self, vertigo and nausea without vomiting, short term memory loss. NO diagnosed disability was entered at that time, while further observation was indicated. About three weeks later, on April 27, 1991, the veteran reported that he felt about the same. still no diagnosis was rendered to account for the reported symptoms. By November 09, 1991, the veteran also complained of nausea, irratibility, every other day for the previous month; an assessment regarding this complaint was deferred. while the veteran reported specific ailments, it is of note that his reported complaints affecting both his abdomen and head, and reported several other symptoms. These entries are some evidence of initial visits to a medical facility without a specific diagnosis. The record also reflects that by May 1991 the veteran indicated that he was unhappy in service and was anxious to be transferred or released from his present command duty station. This reflects the veteran's desire not to remain in service, which includes a desire not to remain on the same base or in the same command. This is analogous to the M21-1 behavior change of a sudden request for a change of duty assignment. changes in performance and performance evaluations are behavior changes contemplated by M21-1 that might indicate a stressor. The only specific or quantified measures of the veteran's performance during the period following the alleged personal assault is a December 1990/November 1991, performance Report which reflects that the veteran's performance steadily deteriorated throughout the reporting period. Recieving c.o.'s NJP 91OCT 10 for Article 86, and 91 NOV 20 for Article 92. Both NJP'S resulted in reductions in rank, from a senior E-6 recommended for advancement, and retention to chief petty officer, to E-4. Evaluation comments state; The veteran, fails to conform to military standards and abuses authority, and is Not recommended for retention and or advancement. The veteran is being processed for administative seperation, based on high year tenure. while this report is indicated to have been based on the previous one year period beginning in December 1990, and ending November 1991. There are a number of previous evaluation reports to provide a baseline for comparison. This comparison demonstrates a drastic change in the veterans behavior, personality, and performance. such poor performance is also indicated by the veteran's spouse's statement submitted October 2007. That the veteran's behavior, personality, and characture was drastically different than observed six months previously when home on leave. And that the veteran was discharged from service in March 1992 well before the end of his four year service agreement. While it is clear when a change in behavior in service occurred, the record reflects that the veteran's personal conduct toward the end of service indicated low adaptability, functionality, and acceptability to military life. Thus, indication of a stressor by m21-1. page 6 bva compensation obsessive behavior is a change contemplated by M21-1 that might indicate a stressor. His spouse wrote in October 2007 that when she went to visit the veteran in service she found the veteran to be angry and irritable and refused to talk to her. The veteran's spouse wrote that after service he seemed distant, incoherent, and shallow, and would stare aimlessly in a corner of a room or at a paticular object. The veteran's spouse also wrote that soon after service the veteran developed the obsessive behavior of constantl¥ locking and checking doors multiple times daily, to the polnt of dlstraction or leaving other activities unfinished. Another of the behavior changes indicated by the M21-1 is treatment for physical injurles around the time of the claimed trauma but not reported as a result of the trauma. service medical records reflect that on April 06, 1991 the veteran reported injury to the head but did not report a personal assault which he later alleged was the source of such complaints. The Board will also find it significant that at the first opportunity after service (the veteran filed his claim for service connection for post concussion syndrome and for ptsd within one month of service separation). That the veteran also sought out assistance and counseling from the Veterans Center located at 231 W. Cypress Ave. San Antonio, Tx. March 04, 1992. With complaints of depression, irratability, anxiety, hopelessness, nightmares, and hypervigilance. DIAGNOSTIC IMPRESSION: POSSIBLE PTSD / rEQUEST FOLLOW UP SCREENING, AND EXAMS. REFER TO: AUDIE MURPHY VA HOSPITAL sA TX. That no VA examination in April through August 1992, was ever afforded to the veteran. And after being told; "Since your injuries were not caused by, or in actual combat. The VA cannot assist you, in your claims for pension and or compensionsation". Apperantly and reluctently the Veteran gave up seeking any assistance from the veterans administration, for needed medical help for his non-combat service related injuries. The veteran has not yet testified under oath at a personal hearing regarding the incurrence of personl assualt, or near fatal electrocution in service as of August 2009. The Board will find that, although the veteran does not consistently recall dates of occurrence of events, including the in-service assualt, his essential testimony regarding this event, as well as other significant facts he reported, are consistent with the service medical record evidence and other corroborative evidence. The veteran's testimony includes that he did not have a problem with alcohol prior to service, that he was assaulted in service on March 27, 1991, that he reported for medical treatment ten days later but did not mention the assault, that his behavior changed in service, prior to discharge, that he mentioned the assault at a VA examination in 2007. The other evidence of record does not otherwise demonstrate that the veteran's essential testimony is not credible. The post-service medical evidence of record tends to corroborate the veteran's testimony as it reflects that from 1991 the veteran has reported the occurrence of unexplained medical conditions not related to an in-service assault on numerous occasions, solely for treatment purposes. Based on this evidence, the Board will find that the service records and other evidence of record is sufficient to raise a reasonable doubt as to whether the alleged stressor of a personal assault occurred in March 27, 1991. And a near fatal electrocution on May 16,1983 during the veteran's active duty service. Resolving reasonable doubt on this question in the veteran's favor. the Board will find that the reported stressor of a personal assault occurred in military service, March 27, 1991. The Board will find also that the reported stressor of a near fatal electrocution occurred in military service, May 16, 1983. 38 C.F.R. § 3.102. page 7 bva compensation The record includes a medical diagnosis of PTSD and medical evidence of a nexus between diagnosed PTSD and the stressful event of a TBI/injury, diagnosed post concussion syndrome and a near fatal electrocution. The two additional elements required to establish a claim for service connection for PTSD. 38 C.F.R. § 3.304(f). For example, a september 2007 VA progress note records the veteran's reported history of a personal assualt during active service by an unknown assailant, with a diagnosis of post-traumatic stress reaction to assault, with major depressive disorder severe, chronic. A VA hospital summary in April 2008 reflects a history which included the report of in-service assault, and resulted in diagnoses which included a history of non-combat PTSD. The progress notes reflect consideration of PTSD as the primary diagnosis. VA outpatient treatment records from 2007 to 2008 reflect a continued diagnosis of PTSD based on reports of a personal assault, and near fatal electrocution in service with a G.A.F. of ( 39 ). However, in a Febuary 2008 letter, A private psychologist Dr. F.E. wrote that the veteran was suffering from Axis I: Post Traumatic Stress disorder, Major Depressive disorder, Dysthymic disorder, Generalized Aniexty disorder, Alcohol Dependence. Axis II: personality disorder, NOS with schizotypal, schizoid, Borderline, Depressive, and passive-Aggressive features. PTSD, severe, chronic, as a result of being assaulted while in service, and a near fatal electrocution in active military service. The record includes: Febuary 6, 2009. A general base line summary, from staff neuropsychologist, Kristin R. Krueger, PhD. Dept. of Veterans Affairs, Audie L. Murphy Memorial Veterans Hospital Division, S.A., Tx. Which states; Veteran is a 51-year old, right-handed, married Caucasian man with 11 years of formal education. He was referred by psychologist, Timothy Rentz, PhD for evaluation of cognitive status to aid in differential diagnosis and treatment planning. The pt completed a neurocognitive status exam (1 Hour) with Kristin R. Krueger, PhD and face-to-face neurobehavioral testing (3 hours) conducted by Kimberly Van Buren, M.A. Pt was evaluated in April 2008. Summary and Impressions: Veteran reported dramatic changes in his character and cognitive functioning as a result of a TBI in 1991. Medical history is significant for hypertension, post concussive syndrome, sleep apnea, possible stroke, substance abuse and multiple surgeries. Veteran has an extensive history of psychiatric illness that was first treated during military service. Veteran is currently being treated for Major Depressive Disorder and Post Traumatic Stress Disorder. Psychosocial history is positive for child abuse and subsequent placement in a series of foster homes and institutions. Occupational history is positive for dismissal due to inability to get along with others. Interview and testing revealed a severely inhibited and cautious man, with a overall intact cognitive profile, with the exception of slowed processing speed and variable attention/executive functioning. Veterans Memory is within normal limits, with visual memory better than verbal memory. Veterans slow processing speed and difficulties with attention/executive functioning may be influencing his ability to encode information in a timely fashion and he is consequently experiencing memory difficulties. IT IS LIKELY THAT THE VETERANS ABILITY TO PERFORM THESE TASKS IS INFLUENCED BY BOTH REPORTED TBI's AS WELL AS SYMPTOMS OF PTSD. Given the Veterans acute distress and his difficulty with processing speed and attention/executive functioning. And the time since his TBI's, addressing his psyciatric issues at this time is likely to be of most benefit to the veteran. Summary report from dr rentz va pyscologist Frank Tejeda vet svcs ctr dated 04/27/2009 states: Veteran reported two traumatic events during active duty military service that meet Posttraumatic Stress Disorder (PTSD diagnostic criteria A1) (exposure to a traumatic event). The first event was in the US Navy aboard the USS Illusive: veteran recieved a severe, potentially fatal electric shock/explosion while working on a 300kw ship-to shore power cable which had mistakenly not been turned off. He was thrown about 10 feet into a bulkhead, suffered loss of consciousness, burns to his eyes and temporary neurological blindness. The second event was when the veteran was assaulted from behind while serving aboard the USS Cook. Veteran suffered loss of consciousness, awoke in a pool of blood due to head injury (being struck on the head), and subsequently displayed symptoms of post-concussive syndrome, and changes in behavior consistent with Posttraumatic Stress Disorder. Veteran reacted to these events with feelings of terror, "Being scared to death," confusion, and helplessness. Both of these incidents are life-threatening events, the first due to a near fatal electrocution, the second due to severe interpersonal trauma in the form of an assault. Both of these incidents occured in a non-combat environment during active-duty service in the U.S. Navy. (IT IS MORE LIKELY THAN NOT, THAT HIS CURRENT SYMPTOMS OF PTSD ARE RELATED TO THESE EVENTS DURING ACTIVE-DUTY MILITARY SERVICE.) The veteran has provided copies of medical records and personnel records that are consistent with these events. He has continued to re-experience these events in the forms of intrusive thoughts and images, replaying the events in his mind, and feels unable to block it out. He has frequent nightmares and experiences emotional and physiological symptoms of sympathetic nervous system activation (fight-or-flight response) when reminded of these events. He has symptoms of avoidance including attempts to put thoughts and memories of the traumatic events out of his mind, avoids people, public places, electric cords & cables, and has used alcohol (binge drinking patterns) to avoid emotional re-experiencing. He has lost interest in most activities he used to enjoy, such as gardening, baseball, boxing, and socializing. He feels detached and numb much of the time, has restricted range of emotions, e.g. cannot feel happiness, is emotionally distant in his relationship with his wife, has lost almost all other relationships, and has a fore-shorteded sense of the future. The veteran experiences symptoms of hyperarousal including insomnia, frequent irritability and anger outbursts triggered by both interpersonal and inanimated routine stressors, cannot concentrate for more than a few minutes, is hypervigilant for signs of threat or danger, e.g. always watches what people are doing, always feels on guard, is aware of small sounds and movements, and is "jumpy" and easily startled by sudden or loud noises. The veteran first sought treatment for PTSD in 1992 from the Vet Center, initial assessment evaluation; Possible PTSD, patient referred to Audie Murphy Veterans Hospital, San Antonio, tx. But was told at VA hospital, he did not qualify for treatment there because his traumatic experiences were non-combat related. He again sought treatment in 2007 and was evaluated and diagnosed with PTSD in the VA PTSD Clinic, Frank Tejeda Outpatient Clinic in San Antonio. Since that time he has remained active in individual treatment, and has made some guarded progress in managing emotions through cognitive restructuring, improving assertiveness skills, anger management, and confronting memories of traumatic events. This veterans symptoms of PTSD remain at a HIGH LEVEL, despite some modest improvement. His prognosis for improved symptom management is fair/good. His prognosis for return to normal functioning is POOR. This veteran continues to have extreme difficulty with interpersonal stressors and has subsequent occupational impairment. He is able to work at some temporary and part-time jobs, but tolerates high levels of distress to do this. Axis I: PTSD, Severe, Chronic, Major Depressive Disorder, Severe, recurrent. Axis V: 40. In summary, his alleged stressors are verifiable to the Board's satisfaction and his lay evidence is deemed credible. The credibility to be accorded to the appellant's lay testimony or written statements is within the province of the adjudicators and is not a matter of medical expertise. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Here, there exists no doubt that the veteran has been diagnosed with PTSD. The documentation from the service department is extensive and the record does tend to corroborate events associated with both near fatal electricution, and TBI, which he has related as the stressors since 1992, veterans initial claim to support service connection. As the VA examiner in 2009 implied, the veteran has given a reliable version of events which weighs in favor of his credibility with respect to the events clinicians have noted to support the PTSD diagnosis in the personal assault and near fatal electricution context. Thus, having accorded due consideration to the veteran's statements, lay statements, medical reports, and to official records, the Board will conclude there are corroborated military stressors of a non-combat nature. In light of the above, there is an approximate balance of positive and negative evidence to which the benefit-of-the-doubt standard applies. Accordingly, service connection for PTSD should be granted. AS indicated, the record includes a medical diagnosis of PTSD, competent evidence which supports the veteran's assertion of in-service incurrence of the stressful events of a personal assault, and near fatal electrocution and medical evidence of a nexus between diagnosed PTSD and the stressful events of personal assault, and a near fatal electrocution in service. For these reasons, and with the resolution of reasonable doubt in the veteran's favor, the Board will find that the veteran's diagnosed PTSD was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107, 5103, 5103A (west 1991 & west Supp. 2001); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125(a); 66 Fed. Reg. 45,630-32 (Aug. 29, 2001) (to be codifled as amended at 38 C.F.R. § 3.159). REQUESTED ORDER The appeal for service connection for PTSD should be granted. That 100% disability should be assigned and granted. page 8

Now this is funny, please people let us have a few laughs........mark

1. HAVE BEEN DIAGNOSED BY THE VA AS HAVING PTSD, AND MDD. HAVE BEEN IN INDIVIDUAL THERAPY FOR APPROX. TWO YEARS, AND ON MEDICATIONS TO ASSIST IN THE THERAPY. HAVE REQUESTED A C&P EXAMINATION VIA TEXAS VETERANS COMMISSION, WITH SUBMISSION OF REQUIRED VA FORM 21-4138 ON NUMEROUS OCCASSIONS. AND HAVE NOT RECIEVED ANY REPLY FROM HOUSTON CONCERNING THIS ISSUE. 2. HAVE A PENDING APPEAL ON 7 ISSUES. THE NOTICE OF DISAGREEMENT WAS RECEIVED BY THE VA ON 2/13/2008. REQUEST TO KNOW THE STATUS OF THESE CLAIMS, AND I REALIZE THE CASE LOAD AT HOUSTON IS EXTREMELY HEAVY. IF YOU ARE WORKING ON CLAIMS PREVIOUS TO MINE, COULD YOU STATE WHAT MONTH AND YEAR. SO THAT I MAY INTERPERATE AN APPROXIMATE TIME LINE FOR THE REQUESTED DRO INTERVIEW. I APOLOGIZE, IF THIS REQUEST FOR A C&P OR STATUS OF THE ISSUES ARE IN ANYWAY INCONVINEANT TO YOUR AGENCY. 3. I AGAIN STATE, THAT MY INJURIES ARE NON-COMBAT RELATED, AND REQUEST CONSIDERATION CONCERNING THOSE ISSUES ALONG THOSE LINES. PLEASE INFORM ME AND MY VSO IF YOU CAN ASAP....

thanks pete, I read this some where while working on my informal appeal and copied it, was just reading it before signing on and wanted to know it this information is some what accurate, will remember to add the link next time and not waste the members time.... mark

Establishing Service Connection For Veterans Affairs Disability Compensation Before November 2000, when the VCAA was enacted, veterans had to obtain a medical diagnosis of a current disability on their own. The VA was not generally obligated to help them in obtaining this medical evidence. Some veterans, who could not afford a private doctor, were placed in a no win situation. They could not receive disability compensation until they submitted a medical diagnosis of their current disability; they could not get the VA to provide them with a free medical examination to obtain this diagnosis because veterans who already had service-connected disabilities were more likely to receive free VA medical care; and they could not obtain a medical diagnosis from a private doctor because they could not afford to pay for the private doctor. As a result of the VCAA, most veterans who file an original claim for disability compensation do not need to obtain a medical diagnosis on their own. The VA is generally obligated to provide veterans with a VA medical examination to diagnose the current medical condition. There are only a few legitimate reasons for which VA may refuse to schedule a VA medical examination." Veterans Benefits Manual 2007 and a medical nexus connecting 1 and 2. An in-service injury/disease means that for the most part it must be documented in the veteran’s service medical records (SMR’s). One thing to keep in mind is that, generally, the in-service injury/disease must be shown to be “chronic” while in-service. If it is not shown to be a “chronic” condition while in-service, then you’ll more than likely need an Independent Medical Opinion (IMO) to substantiate the claim. If a veteran doesn’t have either a documented “chronic” condition, or an IMO, the VA will more than likely state that the claimed condition is “Acute and Transitory,” meaning that the injury/disease resolved itself and there is no residuals. A current condition with a medical diagnosis means that the claimed condition has to show current residuals from that in-service-injury, and it must have a current diagnosis from a physician.. A lot of times the diagnosis can and will be obtained from the VA C&P exam. If the VA sees that your condition was “chronic” while in the service, or that you have medical documentation of continuity of treatment since discharge, more often than not they will schedule the veteran for a C&P exam to obtain the needed diagnosis and current disabling affects of the claimed disability. Something connecting the two means either continuity of treatment of the claimed disability from time of discharge to the present, or, if this is not the case, then an IMO will be needed from a physician. A lot of times an IMO is a critical part of the veterans claim. An IMO can sway the benefit of the doubt in the veteran’s favor if the claim is borderline, or it can flat out prove service-connection when one of the three components of establishing service-connection aren’t met! For example, by borderline I mean let’s say that a veteran was seen for lower back pain once while on active duty over a period of a five year enlistment. And now it is ten years since his discharge and the veteran hasn’t been seen for the lower back until recently, or only had one episode of back pain within those ten years since getting out of the military. The veteran will need an IMO stating something to the affect that his current lower back condition is some how related to the episode while on active duty. If the RVSR (Rating Veteran Service Representative, or “Rating Specialist”) is very liberal in applying the regulation, he/she may award service-connection without the IMO. However, if the RVSR is “by the book,” then he/she may deny service-connection in the absence of a good IMO. An example of where an IMO can establish service-connection with which one or more of the three criteria listed above are absent would be, let’s say that a veteran was seen one time for a knee condition while on active duty and this incident is noted in his SMR’s. Ten years later the veteran is experiencing pain in that same knee but didn’t have any type of treatment since his discharge, he would need a really good IMO to establish that his current disability is somehow related to the in-service episode. As far as presumptive service-connection is concerned, a veteran needs to be able to show that a condition listed in §3.307, §3.308, and §3.309 has manifested itself within the prescribed time limits after separation from the service. A presumptive condition does not need to be noted in a veteran’s SMR’s, hence presumptive, or it’s presumed that the said disability/disease occurred while in the service. There are some presumptive disabilities that do need to have manifested themselves within the first year after separation and to degree of 10% disabling in order to warrant presumptive service-connection. One common one is Arthritis. Filing the claim: Once you have determined that you have met three basic criteria of disability compensation, you should then file the claim with your local Regional Office. There are two types of claims for initial service-connection; an Informal claim and a Formal claim. An Informal claim is some type of communication to your local regional office in which you state you intend to apply for disability compensation. This communication can be a written letter, or fax, a telephone call or even an email. The best way, however, is something in writing. When a claimant makes an informal claim with VA, they need to clearly identify the disability for which they intend to apply for, give the VA your SSN and dates and branch of service, and make sure you send it via certified mail with return receipt! After you have sent your informal claim to VA, you have up to one year to send the VA your Formal Claim. In this one year period, I would recommend that you get together all of your medical records and so forth that will support your claim. If you send the VA your formal claim within the one year time period of the informal claim and VA grants your claim, the effective date, or the day you start to receive disability compensation, is the date of your informal claim. This could mean a lot of money in retro! A Formal Claim for disability compensation is the VA Form 21-526. You should fill this out to the best of your ability. You should attach any Service Medical Records, Private Treatment records relevant to your claimed disability(ies), certified copy of your DD 214, copies of marriage certificates divorce decrees and dependent birth certificates. By attaching these documents, you’ll speed up the processing of your claim quite a bit. However, you do not need to attach those documents if you do not have them in your possession. If you do not have any of those medical records, the VA will assist you in obtaining those by asking you to fill out VA Form 21-4142 for each facility were those records are located. One important side note; make sure you sign the VA Form 21-526! Important: You do not need to submit an Informal claim. You can file VA form 21-526 without informing VA of your intention to file for disability compensation. What happens after I file my Formal claim? After you send VA your Formal claim, there are a number of “teams” at your local regional office that process your application. There are essentially six "teams" at a Regional office that make up the "process." When a veteran files a claim for benefits with VA, it is received at what is called a 'Triage Team.' This is where the incoming mail is sorted and routed to the different sections or other "teams" to be worked. Picture this as a Triage unit at a Hospital. There they decide who goes where according to the injury/condition involved. This is the way it works at VA too. The main function of the Triage Team is to screen all incoming mail. Within the Triage Team there are other sub components; the Mail Control Point, Mail Processing Point, and to a certain extent supervision of the files activity. The mail control point is staffed with VSR (Veteran Service Representatives) who are actually trained in claims processing. This is also where they receive and answer the IRIS inquiries. The mail processing point is where chapter 29/30 claims (a bit later on theses types of claims) are processed/awarded, and to a certain extent dependency issues are resolved. The next step is the "Pre-Determination Team." This is where your claim for benefits is sent to be developed, meaning verification of service from the Service Department if a certified copy of the DD 214 is not submitted by the veteran, SMR's are obtained from St. Louis if they weren’t sent in already by the veteran, any CURR verifications are done for PTSD stressors, any private treatment records are obtained under the "Duty to Assist," and inferred issued are identified. Once the Pre-Determination Team figures out what you’re claiming, they’ll send you what’s known as a “Duty to Assist” letter. This letter states what type of claim you are filing, what conditions you are claiming, and what the regulations say you must show to have your claim granted. It will also state the evidence needed by VA to support your claim, and what VA is doing or has done. The letter will also explain VA's “Duty to Assist” you in obtaining the evidence to support your claim. There will also be a response form that you should fill out and return. If you do not return this form or mark the box that you have additional evidence to submit, the VA must wait 60 days to further process your claim. As your claim progresses further though the Pre-Determination Team, you may or may not receive other letters. Examples of those letters include: follow-up letters to let you know VA requested something from a third party and there is a delay in their reply, letters requesting that you provide something to VA to support your claim. The Pre-Determination Team may also send you a computer generated letter telling you they are still working on your claim. That letter is pretty interesting because it means a couple of things have happened with your claim; 1) your claim was reviewed by someone recently or 2) your claim has aged where the computer system is telling the regional office that they must look at your claim. One thing to keep in mind is that every time VA sends you a letter, regardless if it’s for information you already sent them, you should always respond with a letter via certified Mail with return receipt. If you already sent something to VA that they previously requested, just send them a letter stating that you already submitted the information and when you sent it. Once all the developmental work has been done on a claim, it is then designated as "Ready to Rate" and sent to the Rating Activity. The Rating Activity or “Rating Board” is where most veterans want to have their claim. This is where the claim for benefits is decided. The RVSR (Rating Veteran Service Representative, or “Rating Specialist”) is the person who rates a veteran's claim. They review the entire C-file to insure it is ready to be rated, and schedule any C&P exams that may be needed if not already done so by the Pre-Determination Team. If a C&P exam is needed they go ahead and do the paperwork to schedule this. Once the RVSR has all the needed paperwork to rate the claim, they make their decision. If the RVSR determines that there is something missing from the claim to make a decision, they send the claim back to the Pre-Determination Team for further development. Once they have reached their determination, they produce a rating decision with their decision and forward the C-file to the Post-Determination Team. The Post-Determination Team is where the rating decision is promulgated. In other words, it is where the decision gets entered into the system and the rating decision is prepared and sent out to the veteran. If the veteran has a Power of Attorney (POA), they give a heads up to them as to what the decision was. If a claim has been granted and the retro involves over $25,000.00, it is sent to the VSCM (Veterans Service Center Manager) or their assistant for a third signature. The Post Determination Team also does the following action; accrued benefits claims not requiring a rating, apportionment decisions, competency issues not requiring a rating, original pension claims not requiring a rating, dependency issues, burials, death pension, and specially adapted housing and initial CHAMPVA eligibility determinations when a pertinent rating is already of record. The Appeals Team handles appeals in which the veteran has elected the DRO review. They also handle any remands that have been sent back from the BVA and the Court. The Appeal Team is a self containing unit within the Regional office. They make determinations on appeal, make rating decisions that are on appeal, do any developmental work on any issue that may be on appeal, and issue any SOC's and SSOC's in conjunction with their review. The Public Contact Team’s primary functions are to conduct personal interviews with, and answer telephone calls from veterans and beneficiaries seeking information regarding benefits and claims. In some regional offices, depending on their workload, also handles IRIS inquiries and fiduciary issues. As one can see the VA claims process can be complex. In essence a veteran’s claim is continuously going from one team to another until it has been decided. This process can be rather lengthy depending on what regional office has jurisdiction over your claim and their pending workload. During this process a veteran may want to find out the status of their claim. This should be done through the VA’s IRIS website inquiry system. Through this inquiry system, the veteran will get much more accurate information then by calling the 1-800 number. The 1-800 will only connect you to the regional offices “Public Contact team.” These employees aren’t really trained to deal with the different processing stages and so forth and aren’t able to give very accurate information in that regard. The intention of the 1-800 number and the Public Contact team is really to give general benefits information and send out forms to claimants, not to try and track a veterans claim. Furthermore, veterans’ claims aren’t like tracking a UPS package where it travels in a straight line to its end destination. Veterans’ claims will end up bouncing from team to team at the regional office until all of the work required to make a decision is done.

Maam, The 1st, stressor was a 330KW ship/shore power cable blowing up in my face, causing burns to the eyes, face, and arms with neurological blindness lasting for 27 hours. As indicated by service medical records, and personell performance reports state; severe personality and characture changes after the explosion, with visits to a mental health facility for not being right in the head and no known complaint of the near fatal electrocution. consistent verifiable stressor as per; (M21-1mr) in 1983. The 2nd stressor was a near fatal head injury caused by an unknown attacker aboard a navy ship in 1991, diagnosis concussion due to closed head injury (TBI) with severe post concussion symptoms. Severe personality and character changes resulting from senior E-6, recommended for advancement to E-7, plummetting to an E-4, and a honorable admin. seperation after 18 and a half years of military service. consistent verifible stressor as per; (M21-1mr). I understand that the VA docs' summary letters are (nexus) statements comorbidding, correalating, or verifiying the present symptoms to the inservice military stressors. It is odd to be dx with ptsd/mdd and a nexus verified by the VA hahahs, that the stressors are not only in service members medical records, but also his personel records demonstrating two clear stressors via (M21-1mr) with in the confinds of 38cfr... Is this understandable or am I confusing the issues?