Vet Issues 18

#### PTSD and Dental Problems #####

VA Researchers Link PTSD to Tooth Erosion

Brushing after every meal may not be enough to prevent
tooth decay and gum disease for those diagnosed with Post
Traumatic Stress Disorder. A new study conducted by researchers
at the Buffalo, N.Y., VAMC shows the emotional toll
of PTSD can lead to episodes of teeth grinding and jawclenching,
both of which can cause serious tooth damage.

Dr. Sebastian Ciancio, a dentist at the Buffalo VAMC,
presented the findings in March at the annual meeting of the
American Association for Dental Research. By studying patients
previously diagnosed with PTSD and others who were not,
researchers discovered those with PTSD had greater erosion of
the surface of their teeth, more plaque and an increased
likelihood of getting the gum disease gingivitis.

According to Ciancio, people diagnosed with PTSD should avoid acidy foods and be gentle when brushing to ward off erosion on the surface of their teeth.

H.R. 801, the Veterans' Survivor Benefits Improvements Act of 2001 Passed

 From:  House Committee on Veterans' Affairs


 May 25, 2001


 Bill headed to White House for President's signature

 WASHINGTON, D.C. - Just before Memorial Day was a fitting time for the
 to pass a "family-friendly" benefits bill
 expanding health and insurance coverage for surviving dependents of
 and servicemembers, House VA Committee
 Chairman Chris Smith (NJ-4) said Thursday.

 "This bill is a reminder of what is owed to the survivors of our
 and women, and although much remains to be done
 by this Congress, it is a harbinger of what we can accomplish to keep our
 commitment to veterans," he said after passage of the
  Senate-amended H.R. 801, the Veterans' Survivor Benefits Improvements Act
 of 2001.

 The amended H.R. 801, now on its way to the White House for the
 signature, would:

  Expand health coverage under the Civilian Health and Medical
 Program-Veterans Affairs (CHAMPVA) for
 survivors of veterans who died from a service-connected disability. Under
 this measure, CHAMPVA beneficiaries
 who are Medicare-eligible would receive coverage similar to "TRICARE for
 Life" improvements Congress gave to
 Department of Defense beneficiaries last year. Such coverage would be
 automatic for CHAMPVA beneficiaries
 already eligible for Medicare on the date of enactment. Future
 Medicare-eligible CHAMPVA beneficiaries would
 have to obtain Medicare Part B coverage before receiving the new benefit.

  Expand the Servicemembers Group Life Insurance (SGLI) program to include
 spouses and children. Spousal
 coverage could not exceed $100,000 and child coverage could not exceed
 $10,000. Upon termination of SGLI, the
 spouse's policy could be converted to a private life insurance policy.

  Make the effective date of increased maximum SGLI coverage from $200,000
 to $250,000 retroactive to October
 1, 2000. This would provide increased benefits to survivors of
 servicemembers who died in recent training accidents
 or acts of terrorism while on duty.

  Require the VA to make eligible dependents aware of VA services through
 the media and other outreach efforts

 "Memorial Day is a day of national remembrance for the sacrifices made by
 our veterans to keep this nation free," Chairman
 Smith said. "The enactment of HR 801 will not only help the thousands of
 families who need our compassion and assistance; it
 is part of a growing recognition by our country that our veterans are not
 forgotten, and that we need to remember and pay
 tribute to their service 365 days a year, not just on holidays and

 "I want to thank Ranking Member Lane Evans (IL-17) for all of his work and
 support for this legislation," Smith added.
 "Bipartisanship is alive and well on the House Veterans' Affairs

if you can't
 work, apply for soc sec regardless of VA%

 I wonder how many out there realize that because they receive 100% VA
 Compensation they can also receive Social Security Disability Benefits and
 Medicare?  The requirements are slightly different for some reason but it
 can be done.  I'm a 47 year old that has lost my Navy retirement pay (I
 completed 20 years in 1972 but was retired unfit for full duty due to a
 seizure disorder and other disabilities) because I receive the 100% VA
 Compensation.  The Navy originally put me on the Temporary Disability
 Retirement List and after five years (that's how long one is normally on
 that list unless 100% is determined prior) and was finally retired by the
 Navy as 100% disabled.  While doing the paperwork and appointment gambit
 with the VA I was also doing the same thing with Social Security.  I was
 approved for Social Security Administration before I was given the 100% by
 the VA and part of the paperwork I had in front of the VA hearing officer
 was the Social Security Award.  Both the VA compensation and Social
 Disability benefits were dated prior to the Navy's 100% disability
 around the 3 and 1/2 year date after actual discharge).  I pay for
 part B but rarely use it as I usually go the VA Hospital in Albany, NY -
 although I've considered seeing local doctors as it would save the trip
 the long waits.  Just want to keep it in case I get seriously hurt in the
 middle of a seizure and make a trip to the local hospital.  It can be done
 and if you're under 65 and 100% disabled, while grant it it's more
 you're entitled.  Go for it.

VA Disability Rating Benefits:


1.      Military ID card - 100% other than a temporary IU & SC 100% qualifies you for a commissary letter from VA to obtain the ID card.
2.      DVA fee basis outpatient medical card applicable for any compensable SC disability if the situation warrants. Issuance is up to the local VA medical center.
3.      Dental treatment  IU & SC 100% qualifies. Others less than 100% do qualify in some circumstances
4.      Champva medical card for dependents  IU & SC 100% qualifies.
5.      Aid and attendance allowance  must have a scheduler 100% for consideration of A&A.
6.      Additional compensation for dependents  rating of 30% or more.
7.      Aid and attendance allowance for disabled spouse  rating of 30% or more.
8.      Annual clothing allowance (prosthetic/wheelchair/skin condition) - any SC condition that requires it.
9.      Special adaptive home modification allowance - dependent on the actual disability such as loss or loss of use of both lower extremities, blindness in both eyes, loss of one lower extremity plus some other condition that effects balance or propulsion.
10.     HISA grant for home modification  depends on the type of disability. SC are eligible up to $4100 and NSC veterans are eligible for up to $1200.
11.     Auto purchase allowance (one time) - type of SC disability matters more than percentage. Loss or loss of use of one or both hands or feet. Loss of vision in both eyes to a certain degree.
12.     Auto adaptive modification allowance - same as above plus SC ankylosis of one or both knees, one or both hips also qualifies
13.     Service-disabled veteran's insurance (RH)  any rating for a SC disability. You have two years to apply from date SC was granted.
14.     Home mortgage life insurance  must have a specially adapted house.
15.     Waiver of VA insurance premium  IU &SC 100% would qualify. NSC total disability could qualify.
16.     Vocational rehabilitation educational training for the veteran - a SC disability that causes an employment handicap to potentially qualify. 10% need serious employment handicap, 20%+ only need employment handicaps.
17.     Withdrawal from SBP (after 5 or 10 years)  IU & SC 100% would qualify but with no futures.
18.     DVA sponsored education for dependents  IU & SC100% will qualify as long as there are no future VA examinations scheduled
19.     10-point preference for civil service employment (veteran/spouse).
20.     Lifetime Golden access pass for federal parks  any rating as long as vet can show an ID card and paperwork identifying him as a disabled vet at the gate entrance to the park. The pass covers the fee for the vehicle and all parties therein.
21.     Eligibility for children to compete for admission to military academies



Vets should check with their local VARO to see if any of the below state benefits are available to them:
1.      Waiver of home disability insurance (CAL-Vet)
2.      Property tax exemptions - In California call the LA County Tax Office (213) 974-3399 and ask for the "Veterans Exemption for Property Tax" and the forms to apply for the exemption.
3.      DMV fee exemption and parking decal
4.      State EDC for dependents
5.      Waiver of registration fees at State colleges/universities (for vet/dependents)
6.      State park permit
7.      Basic sport fishing license

___________________________________________ Veterans Travel Fairness ActRepresentative Bart Stupak of Michigan last
 introduced a bill to increase travel reimbursement from 11 cents a mile to
 32.5 cents a mile, the same rate allotted federal employees and the IRS.
 veterans and their families must travel great distances to get medical
 treatment at VA hospitals.The proposed act is part of the Congressional
 Record Online, A
HREF="" , document title,
 (gov/us/fed/congress/record/2000/jun/21/2000CRE1072) .

The VA Secretary most likely has an email, but it is not public.  You can
write or fax him at:
VA Secretary Anthony Principi, Department of Veterans Affairs, 810
Vermont Avenue, Washington, DC 20420.
Fax: 1-202-275-5947

At the VA website you can contact VA, and ask that they forward a message
to Principi.  They may or may not?

(From a VA Training and Information Hotline)
On one other issue, we just received a decision on Paul R. Hayes (Hayes v.
Brown, U.S. Vet. App. No. 90-1306 (4/28/93)). It is an excellent recitation
of how to handle Post-Traumatic Stress disorder claims, both with regard to
development of stressors and to acceptance or challenge of a diagnosis,
even when made by our own medical staff. I am having that decision
transcribed into a word processing format, and I will have that attached as
an addendum to the transcript of this hotline. I encourage all Rating
Specialists and Hearing Officers to read it - it's a good example to follow.


No. 90-1306

Paul R. Hayes, Appellant,


Jesse Brown,
Secretary of Veterans Affairs, Appellee.

On Appeal from the Board of Veterans' Appeals

(Argued January 29, 1993                              Decided  April 28, 1993 )

         Keith D. Snyder, for appellant.

         Pamela L. Wood, Deputy Assistant General Counsel, with whom James
A. Endicott, Jr., General Counsel, David T. Landers, Acting Assistant
General Counsel, and John D. McNamee were on the brief for appellee.

         Before NEBEKER, Chief Judge, and KRAMER* and FARLEY, Associate

         FARLEY, Associate Judge:  Appellant, Paul R. Hayes, appeals a
November 26, 1991, decision of the Board of Veterans' Appeals (BVA or
Board) which denied service connection for post-traumatic stress disorder
(PTSD) and a panic disorder.  The Court has jurisdiction of the case
pursuant to 38 U.S.C.A. 7252(a) (West 1991).  The BVA rendered its
decision on the following grounds:  (1) that the evidence of record did not
objectively support the diagnosis of PTSD; (2) that no independent evidence
was shown to corroborate the veteran's claimed stressors during service;
(3) that, although the veteran had a few panic attacks during service, the
symptoms and frequency did not meet the diagnostic criteria for panic
disorder and the veteran had had similar attacks prior to service; and (4)
that appellant's current chronic psychiatric disorder, panic disorder, was
first manifested many years after service and is not related to
service.  Because we find that the Board applied the proper statutory and
regulatory standards and that the findings of fact made by the Board are
"plausible," the BVA decision will be AFFIRMED.

I.  Background
         Appellant had active service in the United States Army from April
1968 to November 1969, including a tour of duty in Vietnam from November
1968 to November 1969.  He was assigned to the 497th Engineering Company
where his job specialty was plumber.  Appellant's service medical records
(SMRs) indicate that he was treated for anxiety-related symptoms in June
1968, before his tour of duty in Vietnam.  These symptoms included passing
out, seizures followed by combative behavior, cramping of the stomach,
tightness in the chest, paresthesia of the fingers, and anxious
hyperventilation.  A neurology clinic report listed appellant's symptoms as
dizziness, becoming sweaty, and losing consciousness; according to the
report, appellant claimed that he had experienced these latter symptoms on
several occasions since age seventeen and that anger and anxiety had
preceded each of the episodes.  The examining physician's impression was
vasodepression syncope for which he prescribed Librium.  (Vasodepression is
defined as a "decrease in vascular resistance with hypotension," see
Dorland's Illustrated Medical Dictionary 1809 (27th ed. 1988) [hereinafter
Dorland's].  Syncope is defined as "a temporary suspension of consciousness
due to generalized cerebral ischemia; a faint or swoon."  See Dorland's, at
1628.)  The SMRs indicate that in December 1968 and January 1969, during
his period of service in Vietnam, appellant was treated for dizzy spells,
headaches, and hyperventilation, which were apparently related to tension
and anxiety.  He was prescribed Librium and Dramamine to treat these symptoms.
         In a statement dated December 21, 1986, Mr. Charles G. Bearce,
A.C.S.W., a private social worker, noted that he had been counseling
appellant since March 13, 1986, and discussed at length the stressors
alleged by appellant.  According to Mr. Bearce, appellant reported that,
prior to being assigned to the Vietnam theatre, he had been promised "duty
in school" where he would be taught to read and write and that during his
service in Vietnam, he experienced conflict with other soldiers and
alienation from his family due to his illiteracy.  Mr. Bearce also noted
that appellant reported feeling a great deal of anxiety around rocket
attacks, and that since returning from Vietnam appellant had suffered two
to three years of nightmares which had stabilized until 1979, when
appellant's current psychiatric disorders began to slowly develop.  Mr.
Bearce concluded that appellant's present psychiatric disorders, which he
diagnosed as including anxiety, depression, and agoraphobia, were clearly
connected to his experiences in Vietnam and the stress from exposure to war
trauma which was exacerbated by his illiteracy problems and social
         In March 1987, appellant filed a claim with the Veterans'
Administration (now Department of Veterans Affairs) (VA) for service
connection for PTSD and hearing loss. (Appellant's hearing loss claim is
not before this Court.)  He reported various events as stressors related to
his service in Vietnam.  Appellant noted that, because he was illiterate,
he was unable to communicate with his family and was subjected to teasing
from his fellow servicemen, resulting in loneliness and
alienation.  Appellant also contended that he had witnessed rocket attacks,
nightly fire fights, and mass burials of dead Vietnamese by
bulldozers.  Appellant stated that he had witnessed the deaths of several
friends during the rocket attacks, including Joseph Murphy.  As a result of
the stressors related to his service in Vietnam, he claimed to be currently
experiencing recurring nightmares, shaking, cold sweats, pounding
heartbeat, a fear of travelling or being enclosed, and frequent panic
attacks.  In support of his claim, appellant submitted various statements
from friends and family who described changes in appellant's condition
since returning from Vietnam, including nervousness, frequent crying,
nausea, and fear of travelling outside the home.
         In March 1987, the VA furnished information regarding appellant's
claimed stressors to the United States Army and Joint Services
Environmental Support Group (ESG) and requested that the ESG attempt to
verify the stressors in connection with appellant's claim for service
connection for PTSD.  In June 1987, appellant was examined by a VA
fee-based psychiatrist, Dr. Patricia Lillquist.  After noting the stressors
and symptoms provided in appellant's own account of his history, Dr.
Lillquist diagnosed appellant as having two distinct psychiatric
disabilities:  PTSD and panic disorder.
         In a letter dated September 1987, the ESG responded to the VA's
request for information regarding appellant's claim and enclosed extracts
of the activity reports of the 35th Engineer Group and the 87th Engineer
Battalion describing the 497th Engineer Company's operations during
appellant's period of Vietnam service.  These extracts did reveal that a
diver support group of the 497th Engineering Company recovered three bodies
from the Rach Thi Tinh River on July 9, 1969, but did not corroborate
whether appellant took part in this operation.  The ESG noted that it was
unable to locate information confirming the stressors claimed by
         In a decision dated March 1988, the VA Regional Office (RO)
deferred rating appellant's claim.  The RO noted that appellant claimed
that he was involved in a rocket attack, during which several of his fellow
servicemen were killed, including his buddy Joseph Murphy, and required
further corroboration of appellant's alleged stressors pursuant to VA
Adjudication Manual M21-1 (Manual M21-1), paragraph 50.45(e).  In a letter
dated June 20, 1988, the ESG confirmed that a serviceman, Joseph T. Murphy,
was killed on May 4, 1969; however, the ESG could not confirm that
appellant was in Mr. Murphy's unit or that appellant witnessed Mr. Murphy's
death.  The ESG noted that the information provided was general in nature
due to the lack of specific information or specific stress indicators
provided by appellant.  The ESG stated that more detailed information was
needed in order to provide any further research into appellant's claim,
including a brief description of the specific combat incidents, including
dates, places and types, and the full names of friends in appellant's unit,
killed or missing in action.
         In a decision dated October 4, 1988, the RO denied service
connection for PTSD.  In adjudicating the claim, the RO relied on the SMRs,
the December 1986 statement from Mr. Bearce, the statements from
appellant's friends and family, a personal statement by appellant dated
October 1986, the letter from the ESG dated June 1968, and the psychiatric
report by Dr. Lillquist dated June 1987.  After discussing all of the
evidence, the RO noted that although a diagnosis of PTSD was provided,
there was no evidence of a specific objective stressor which would warrant
entitlement to service connection for PTSD.  The RO also stated that the
death of a serviceman known to appellant was not sufficient corroborative
evidence of a stressor.  Finally, the RO noted that there was no evidence
of a panic disorder in appellant's SMRs.
         On November 23, 1988, appellant filed a Notice of Disagreement.  A
Statement of the Case was provided to appellant in December 1988.  In
February 1989, appellant filed a VA Form 1-9 (Appeal to Board of Veterans
Appeals); on the form, appellant expressed his disagreement with the RO's
finding that there was no objective evidence of stressors which caused his
PTSD.  Appellant noted that he was treated for anxiety while in Vietnam and
submitted duplicate copies of his SMRs to support this
statement.  Appellant also stated that he was involved in an operation to
remove dead bodies from the Rach Thi Tinh River and that the documentation
provided by the ESG corroborated this fact.  In a decision dated March
1989, the RO confirmed the previous rating decision; as a basis for its
decision, the RO found that there was no evidence presented to corroborate
appellant's claimed stressors during service in Vietnam.
         On March 16, 1989, appellant was provided with a Supplemental
Statement of the Case (SSOC).  Thereafter, appellant submitted a letter,
dated April 1989, from Denise Eno, a literacy volunteer who had been
tutoring appellant.  Ms. Eno noted that appellant was still illiterate and
that he was having difficulty learning due to his present anxiety state
which she related to his experiences in Vietnam.  Appellant also submitted
a personal statement (transcribed by Ms. Eno) which reiterated his Vietnam
experiences and his current anxiety symptoms.  In May 1989, the RO
confirmed the previous rating decision.  Another SSOC was provided to
appellant in May 1989.
         In a July 1990 decision, the BVA denied service connection for
PTSD.  In the "Items Relating to Present Appellate Status" section of its
decision, the Board noted that it was limiting its consideration and
decision to the issue of service connection for PTSD as the issue of
service connection for panic disorder had not been developed for appellate
review.  Appellant appealed the Board's decision to this Court.  By order
dated September 5, 1991, this Court vacated the Board's July 1990 decision
and remanded the case to the Board; on remand, the Board was directed to
address the matters of service connection for both PTSD and a panic
disorder, to provide reasons or bases for its conclusions, and to discuss
any relationship which might exist between the two psychiatric
disorders.  Hayes v. Derwinski, No. 90-1306 (U.S. Vet. App. Sep. 5, 1991)
(single judge order).
         On remand, the VA referred appellant's claim to Eugene M. Caffey,
Jr., M.D., a VA Medical Advisor.  Dr. Caffey was asked to give his opinion
on, inter alia, whether appellant had a chronic psychiatric disorder during
service and, if so, whether such disorder preexisted service and was
aggravated during service.  In his response dated October 1991, Dr. Caffey
noted that appellant's SMRs did not support a conclusion that a chronic
psychiatric disorder was shown during service.  Dr. Caffey found that
appellant had symptoms typical of "panic attacks," which began at age
seventeen (prior to service) and that appellant had a tendency to react to
life stress with panicky manifestations.  Based on the infrequency of the
episodes, Dr. Caffey opined that appellant's symptoms during service did
not satisfy the criteria for panic disorder.  Dr. Caffey also determined
that the diagnosis of PTSD was not well supported, noting that the expected
specificity of the relationship between past events and current intrusive
thoughts was not well demonstrated and that appellant's reported stress
events were not the type generally associated with PTSD.  Dr. Caffey
concluded that appellant currently had panic disorder with agoraphobia,
which began to manifest in the form of excessive anxiety and fear of
travelling in 1979, without particular reference to appellant's experiences
in Vietnam.  He also noted that it was correct to discern that this panic
disorder represented the return of panic attacks experienced during his
period of service in Vietnam since the panic pattern can be recurrent.
         Apellant, in turn, submitted another letter from his social
worker, Mr. Bearce, dated November 6, 1991.  Mr. Bearce noted that he
continued to see appellant on a weekly basis in individual and group
therapy for the treatment of panic disorder and PTSD, and reiterated
appellant's claimed stressors and symptoms.  Appellant also submitted a
psychiatric evaluation prepared by Julia M. Soler, M.D., dated November 1,
1991, who reviewed the evidence of record in light of the standard
diagnostic criteria found in the Diagnostic and Statistical Manual of
Mental Disorders (DSM-III-R) published
by the American Psychiatric Association and concluded that the diagnosis of
the VA fee-based psychiatrist, Dr. Lillquist, that appellant had both PTSD
and panic disorder, was well supported by the record.
         In a decision dated November 26, 1991, the Board denied
appellant's claims for entitlement to service connection for PTSD and for
panic disorder.  Paul R. Hayes, BVA _____ (Nov. 26, 1991).  A timely appeal
to this Court followed.  The case was argued before this Court on January
29, 1993.

II.  Analysis
A.  Duty to Assist
         At the outset of its decision, the BVA found that appellant's
claims for service connection for PTSD and a panic disorder were well
grounded, triggering the VA's duty to assist appellant in developing his
claims, and that "this duty ha[d] been substantially fulfilled."  Hayes,
BVA _____, at 4; see 38 U.S.C.A. 5107(a) (West 1991).  After careful
examination of the evidence of record, this Court is convinced that the VA
adequately fulfilled its duty to assist appellant in developing his claims
for service connection for both PTSD and a panic disorder.
         In order for service connection to be granted, the facts of the
case must establish that a particular injury or disease was incurred or
aggravated during service.  38 U.S.C.A. 1131, 1154(b) (West 1991); 38
C.F.R. 3.303(a) (1992).  In determining whether an injury or disease was
incurred or aggravated in service, the governing statutory and regulatory
law requires the RO to evaluate the evidence in support of the claim based
on the places, types, and circumstances of service, as shown by service
records, the official history of each organization in which the veteran
served, the veteran's medical records, and all pertinent medical and lay
evidence.  38 U.S.C.A. 1154(b); 38 C.F.R. 3.303(a), 3.304
(1992).  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), the Secretary of Veterans Affairs (Secretary) 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); 38 C.F.R. 3.304(d).
         With respect to the evidence needed to establish service
connection for PTSD, VA's Manual M21-1 sets forth procedures that VA should
undertake uniformly in evaluating such claims.  Prior to March 26, 1991,
Manual M21-1 directed the RO, under all circumstances, to require
supportive evidence of stressors in the veteran's service records; a
history of a stressor as related by the veteran was insufficient to
establish service connection for PTSD.  Manual M21-1, para.
50.45(e).  Subparagraph (e) of paragraph 50.45 was subsequently changed, on
March 26, 1991, to remove the requirement that a veteran provide evidence
of stressors if the veteran could establish that he or she was "engaged in
combat with the enemy."  Under the amended paragraph 50.45(e), if the
evidence showed the veteran was engaged in combat with the enemy and the
claimed stressor was related to combat, no further development was
necessary; however, if the claimed stressor was not combat related, the
veteran was required to provide reasonable supportive evidence of stressors
during service to support his claim.
         Since the appeal of this case to this Court, paragraph 50.45 of
Manual M21-1  has been rescinded and replaced by paragraph 7.46 of a new
Part VI; the new manual provision retains the requirement for supportive
evidence of stressors during service if the claim is not combat related:
e.  Reasonably Supportive Evidence of Stressors in Service.  Any evidence
available from the service department indicating that the veteran served in
the area in which the stressful event is alleged to have occurred and any
evidence supporting the description of the event are to be made part of the
record.  If the claimed stressor is related to combat, in the absence of
information to the contrary, receipt of the Purple Heart, Combat
Infantryman Badge, Bronze Star, and other similar citations is considered
supportive evidence of participation in a stressful episode.  Other
supportive evidence includes, but is not limited to, plane crash, ship
sinking, explosion, rape or assault, duty on a burn ward or in graves
registration unit.  POW status is conclusive evidence of an inservice stressor.
f.  Development for PTSD.  If the evidence shows the veteran engaged in
combat with the enemy and the claimed stressor is related to combat, no
further development for evidence of a stressor is necessary.  See
subparagraph e above.  If the claimed stressor is not combat related, a
history of a stressor as related by the veteran is, in itself,
insufficient.  Service records must support the assertion that the veteran
was subjected to a stressor of sufficient gravity to evoke the symptoms in
almost anyone.  The existence of a recognizable stressor or accumulation of
stressors must be supported.  It is important the stressor be described as
to its nature, severity and date of outcome.

Manual M21-1, Part VI, para. 7.46(e), (f) (September 21, 1992).  This new
provision became effective after the date on which the veteran filed his
appeal with this Court.  In Karnas v. Derwinski, 1 Vet.App. 308, 313
(1991), this Court held:
[W]here the law or regulation changes after a claim has been filed or
reopened but before the administrative or judicial appeal process has been
concluded, the version most favorable to appellant should and . . . will
apply unless Congress provided otherwise or permitted the Secretary of
Veterans Affairs . . . to do otherwise and the Secretary did so.
This Court also has held that "[s]ubstantive rules, those which have the
force of law and narrowly limit administrative action, in the VA
Adjudication Procedure Manual are the equivalent of Department Regulations"
and that "[u]nder Karnas, the Court is required to apply the change to
[the] substantive rule to the appellant's claim. . . ."  Hamilton v.
Derwinski, 2 Vet.App. 671, 675 (1992) (citing Fugere v. Derwinski, 1
Vet.App. 103, 107 (1990).  Due to a VA General Counsel Opinion of March 17,
1992, O.G.C. Prec. 07-92, which found the manual provision to be a
substantive provision, the VA has issued a proposed rule which would
convert paragraph 7.46 of Manual M21-1 from a manual provision to a
regulation.  57 Fed. Reg. 34536, 34537 (1992), amended 57 Fed.Reg. 38095
(1992).  Based on Karnas and Hamilton and VA's proposed rule, the Court
finds that Manual M21-1, paragraph 7.46, is applicable to the instant appeal.
         Although appellant's appeal was filed with this Court after Manual
M21-1, paragraph 7.46, went into effect, the Court's review of the BVA
decision reveals that the BVA satisfactorily complied with the new
requirements.  In its decision the BVA noted in pertinent part:
While serving in Vietnam, the veteran was assigned to a construction
engineering company (port construction), as opposed to a combat engineering
company.  He did not have a combat military occupational specialty, and his
medals and decorations do not include any that are generally awarded in
recognition of significant combat participation or acts of valor.  While
these facts do not preclude the presence of post-traumatic stress disorder
of service origin, they are for consideration along with the other evidence
of record. . . .
Hayes, BVA _____, at 6.  As neither appellant's military specialty nor his
service records indicates that he was "engaged in combat with the enemy" or
that his duties involved more than the ordinary stressful environment
experienced by all those who served in Vietnam, the Court finds that it was
reasonable for the BVA to require some corroboration of the stressors
claimed by appellant in support of his claims for service connection for
PTSD.  See Wood v. Derwinski, 1 Vet.App. 190, 192-93 (1991), reconsidered 1
Vet.App. 406 (1991).  See also Wilson v. Derwinski, 2 Vet.App. 614, 618
         The record reveals that the VA has made several attempts to obtain
all evidence in support of appellant's claims for service connection for
both PTSD and a panic disorder.  The record includes, inter alia,
appellant's SMRs, personal statements by appellant, statements by
appellant's family and friends, records of private medical examinations,
reports of VA physical and psychiatric examinations, statements from
appellant's private social worker, a statement from a private psychiatrist,
a statement from a literacy volunteer, and an evaluation by a Board medical
advisor.  In addition, after obtaining preliminary information from
appellant regarding his alleged stressors during service in Vietnam, the RO
provided such information to the ESG on at least two occasions in order to
verify the stressors.  Although the ESG was unable to corroborate
appellant's alleged stressors after attempting twice to do so, the record
reveals that appellant failed to provide the specific information requested
by the ESG to complete its inquiry.  Upon review of the record, the Court
finds that appellant was adequately notified of the additional information
required for a successful search for the necessary evidence, i.e., the
specific combat incidents, including dates, places, and types, and the
names of friends in his unit killed or wounded in action, including their
full names.  The record reveals that appellant provided only limited
information to the ESG; he did not provide the dates and places of most of
the alleged stressors and did not provide the names of fellow servicemen
who could corroborate his allegations.
         The question of whether or not the VA has fulfilled its duty to
assist will not be judged in a vacuum; in deciding the issue, this Court
will focus on several factors, including the VA's access to the necessary
information and the attempts made by the VA to obtain relevant information,
as well as the cooperation of the veteran in providing information within
his control.  As this Court noted in Wood, supra:
The duty to assist is not always a one-way street.  If a veteran wishes
help, he cannot passively wait for it in those circumstances where he may
or should have information that is essential in obtaining the putative
1 Vet.App. at 193.  Based on our review of the record and in consideration
of (1) the information at the VA's disposal, (2) the VA's attempts to
obtain all necessary information, and (3) the limited information provided
to the VA by appellant, we find that the VA satisfactorily fulfilled its
duty to assist appellant in developing his claims for service connection
for both PTSD and a panic disorder.

         B.  Service Connection for PTSD and for a Panic Disorder
         In order for a veteran to be entitled to receive compensation for
PTSD or a panic disorder, it must have been incurred in or aggravated by
military service.  38 U.S.C.A. 1131.  The determination of whether a
disability was incurred in or aggravated by service is a question of
fact.  Mense v. Derwinski, 1 Vet.App. 354, 356 (1991).  The function of
this Court in reviewing findings of fact by the BVA is limited to deciding
whether or not such factual decisions constituted clear error.  Wood, 1
Vet.App. at 192; Gilbert v. Derwinski, 1 Vet.App. 49, 52-53 (1990); Sanders
v. Derwinski, 1 Vet.App. 88 (1990).  "In practical terms, under the
'clearly erroneous' rule, this Court is not permitted to substitute its
judgment for that of the BVA on issues of material fact; if there is a
'plausible' basis in the record for the factual determinations of the BVA,
even if this Court might not have reached the same factual determinations,
we cannot overturn them."  Gilbert, 1 Vet.App. at 53.
         In determining that service connection for PTSD is not warranted,
the Board considered and weighed all of the evidence and then noted in
pertinent part:
In summary, we conclude that the evidence does not support a reliable
diagnosis of PTSD.  For the reasons explained above, we find the evidence
of a stressor to be tenuous; more importantly, the evidence of symptoms
satisfying the diagnostic criteria is weak, at best.  The preponderance of
the evidence, which includes the veteran's own statement of April 1989
articulating his symptoms, their onset and their progression, is against
the claim of service connection for PTSD.  Although PTSD and panic disorder
are separate disorders that can exist simultaneously in an individual, the
weight of the evidence shows that the veteran has the latter but not the
former.  We reach this conclusion while acknowledging the dual diagnoses
made by the VA and private psychiatrists.  However, in keeping with the
analysis and discussion above, we find that the opinion of the Board
Medical Advisor, who reviewed the entire record, is more consistent with
the facts and the diagnostic criteria stated in DSM-III-R.  Accordingly,
service connection for PTSD is not warranted.
Hayes, BVA _____, at 12 (underscoring in original).  In determining that
panic disorder was not incurred in or aggravated by service and that
service connection is not warranted, the Board considered and weighed all
the evidence of record and noted in pertinent part:
To summarize, although there is evidence of preservice episodes that likely
constituted panic attacks (as distinguished from panic disorder), the
evidence does not show a chronic psychiatric disorder prior to
service.  Based on a comparison of the service medical record entries with
the diagnostic criteria for panic disorder, both of which are reported in
detail above, the symptoms in service also did not reflect a chronic
psychiatric disorder including panic disorder.  While it can not [sic] be
shown with precision when the veteran actually developed panic disorder,
the evidence clearly indicates that it was not during service or for
several years thereafter.  The evidence overwhelmingly shows that the few
episodes of panic symptoms noted in service subsided, that they do not meet
the criteria for a diagnosis of panic disorder under DSM-III-R, and that,
in spite of any nervousness or nightmares the veteran may have experienced
shortly after discharge, chronic symptoms of panic disorder did not develop
until about 10 years after service. . . .
Id. at 18-19 (underscoring in original).  Based on the evidence of record,
we find the BVA's decision denying entitlement to service connection for
both PTSD and a panic disorder to be plausible.  See Wood, supra; Gilbert,
supra.  See also Colvin v. Derwinski, 1 Vet.App. 171, 175 (1991); Murphy v.
Derwinski, 1 Vet.App. 78, 81 (1990).
         Appellant has asserted that the Board erred in failing to accept
the VA fee-based psychiatrist's judgment as to the presence of symptoms of
PTSD and in failing to accept the evidence of stressors which he proffered
in support of his claim.  Contrary to appellant's contentions, while the
Board is not free to ignore a VA physician's opinion regarding service
connection or an appellant's allegation of stressors related to PTSD, the
Board is not required to accept a VA examining physician's opinion, a
private physician's opinion, a social worker's opinion, or the opinions or
contentions offered by any other source for that matter.  See Wood, 1
Vet.App. at 192-93; see also Wilson, 2 Vet.App. at 618.  It is the
responsibility of the BVA, not this Court, to assess the credibility and
weight to be given to the evidence.  Wood, 1 Vet.App. at 192-93; Sanden v.
Derwinski, 2 Vet.App. 97, 100 (1992).  Such assessments by the BVA will be
overturned by this Court only if they are "clearly erroneous."  Wood, 1
Vet.App. at 192-93; Sanden, 2 Vet.App. at 101; Gilbert, at 52.  "Of course,
if the BVA decision fails to give sufficient 'reasons or bases' for
accepting or rejecting critical evidence, expert or otherwise, then a
remand for further proceedings may be appropriate."  Wood, supra.  See also
Gilbert, at 55-59.
         Further, and again contrary to appellant's contentions, the Board
did not err in not according appellant the "benefit of the doubt" with
respect to his claims for service connection for PTSD and a panic
disorder.  A veteran is entitled to the "benefit of the doubt" when there
is an approximate balance of positive and negative evidence regarding the
merits of an issue material to the determination of a matter.  See 38
U.S.C.A. 5107(b) (West 1991); Gilbert, 1 Vet.App. at 53-55.  If a fair
preponderance of the evidence supports a veteran's claim, the claim will be
granted and the rule has no application.  Gilbert, 1 Vet.App. at
55.  Similarly, if a fair preponderance of the evidence is against a
veteran's claim, the claim will be denied, and the rule has no
application.  Id.  Where the Board makes a finding of fact adverse to a
claimant, it has necessarily concluded that the fact is established by a
fair preponderance of the evidence.

Where findings of material fact by the Board are properly supported and
reasoned, and the Board concludes that a fair preponderance of the evidence
weighs against the claim of the veteran, it would not be error for the
Board to deny the veteran the benefit of the doubt.  Such a denial would
not be subject to reversal under [7261(a)(3)(A)] as "arbitrary,
capricious, an abuse of discretion, or otherwise not in accordance with
law" because it was premised upon a rational basis and supported by
appropriate and relevant factors which were properly articulated.

Id. at 58.

         Because there is a plausible basis in the record for the Board's
determinations here that the preponderance of the evidence was against
appellant's claims for service connection for both PTSD and a panic
disorder and because the Board provided adequate reasons or bases, these
determinations are not clearly erroneous.  For this reason, we are unable
to say that the Board's conclusions that appellant was not entitled to the
benefit of the doubt on the issues of service connection for PTSD and a
panic disorder were "arbitrary, capricious, an abuse of discretion, or
otherwise not in accordance with law."  38 U.S.C.A. 7261(a)(3)(A) (West
1991).  See also Gilbert, 1 Vet.App. at 56; Cartright, 2 Vet.App. at 26.

III.  Conclusion
         The BVA's decision serves as a model for how facts should be
evaluated and weighed and for how the reasons or bases for such factual
determinations should be articulated.  Because the BVA decision with
respect to the issues of service connection for both PTSD and a panic
disorder is "plausible," it cannot be overturned.  Accordingly, the Court
holds that the BVA's November 26, 1991, decision is AFFIRMED.*Subsequent to
oral argument, Judge Kramer excused himself and did not take part in the


The U.S. Public Health Service's Agency for Toxic Substances and Disease
Registry and the U.S. Marine Corps are trying to locate families in which
wife was pregnant while living in on-base housing at Camp Lejeune, N.C.,
between 1968 and 1985 to participate in a health survey.

Environmental and health officials have found that Camp Lejeune water
distribution systems contained low levels of compounds used in dry cleaning
as degreasers during that 17-year period. All wells supplying the base found
contain these substances were closed in 1985. The health survey is being
conducted by the Agency for Toxic Substances and Disease Registry of the
Public Health Service to improve understanding about the effects these
compounds have on children exposed prior to birth.

Researchers estimate that about 16,500 former residents of Camp Lejeune are
eligible for this survey. They say they still need about 4,000 more
participants to achieve the 80 percent participation rate necessary for a
successful survey.

Anyone who lived at Camp Lejeune between 1968 and 1985 who qualifies, or who
knows others who qualify, should contact the National Opinion Research
at (800) 639-4270 to participate. To get more information, interested
can call the Marine Corps toll-free at (877) 261-9782 or the Agency for
Substances and Disease Registry toll-free at (888) 422-8737. Information
the health survey can also be found on the following web sites:

Camp Lejeune Area Water Survey at

Camp Lejeune Area Water Survey Information at

Agency for Toxic Substances and Disease Registry (ATSDR) at




 head, and regardless of how many times you think you have chopped it off,
 resurfaces again.  There is no reduction in military retired pay when one
 commences to receive Social Security benefits.  Social Security benefits
 not reduced because a person is in receipt of military retired pay.  The
 worst part of this whole affair, is that a lot of times it's retirees who
 are spreading this false information.  They scare other
 retirees who are about to receive Social Security benefits.  There are
 probably some retirees and spouses who have not applied for Social
 benefits because they believed these misinformed people.  I received this
 question from a retiree who was told by another retiree about a reduction.
 The worse part is the retiree passing on the false information was in
 receipt of full military retired pay and full Social Security benefits.

 SOCIAL SECURITY BENEFITS - Because the retire and spouse relationship is
 the most prevalent in the retired community, it is this relationship that
 want to concentrate on here and not on children or former spouse Social
 Security benefits.  They are in a category by themselves.   Nor am I going
 to cover disability benefits payable under Social Security.  Finally,
 certain federal, state, and other government workers, because of other
 aspects of the Social Security law, are also not covered in this

      In the simplest of forms, a worker's Social Security covered

      1.  A retirement benefit for the worker.
      2.  A retirement benefit for the spouse, usually 50% of the workers
 retirement benefit.
      3.  A survivor benefit for their surviving spouse, usually 100% of
 workers retirement benefit.

      First, lets look at a case where only one of the spouses had Social
 Security covered employment and the other spouse never worked outside the
 home. The worker will receive a retirement benefit and the spouse will
 receive a spouses retirement benefit.  Upon the death of the worker, the
 spouse loses the spouse retirement benefit and gains the surviving spouse
 benefit.  If the spouse dies, the worker continues to receive their worker
 retirement benefit.

      Second, lets look at a case where both spouses had Social Security
 covered employment.  The working spouse with the highest lifetime earnings
 and therefore the greater Social Security benefit will receive a
 benefit.  The other spouse with lower lifetime earnings, will receive
 their own retirement benefit or a spouses retirement benefit, which ever
 greater.  Upon the death of either spouse, the surviving spouse will
 continue to receive their own retirement benefit or the surviving spouses
 benefit based on the other spouses work record, which ever is the greater.

      Third, lets try to look at what this means in dollar amounts.  Again,
 this is in it's simplest form, and I have not gone into in-depth
 explanations or minute details of the law.  It's the final amounts of
 received that I am trying to convey without making this more complex than
 need to be.

      In the first case, the worker has worked and earned a $1,000.00
 Security retirement benefit.  The non-working spouse receives a spouse
 benefit of $500.00.  Upon the death of the worker, the spouse loses the
 $500.00 spouse benefit and receives the $1,000.00 surviving spouse

      In the second case, the first worker has earned a $1,000.00 Social
 Security retirement benefit.  The second worker has earned a $600.00
 retirement benefit.  The first worker will receive their retirement
 The second worker will also receive their retirement benefit, because it
 greater than what a spouses benefit  would be, in this case $500.00.  (Had
 their retirement benefit been only $400.00,  they would have received the
 spouse benefit of $500.00) Upon the death of the first worker, the second
 worker would receive a surviving spouse benefit of $1,000.00 because it is
 greater than their $600.00 retirement benefit.  If the second worker dies,
 the first worker will continue to receive their $1,000.00 retirement

      While multiple benefits may be an entitlement under the Social
 law, the law prevents receipt of two benefits simultaneously that would
 exceed the amount of the greater single benefit.

Federal property and VA homes for disposal


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