Cosman v. Principi
1992 WL 349390, 3 Vet. App. 503, 1992 U.S. Vet. App. LEXIS 384 (1992)
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Rule of Law:
The Board of Veterans’ Appeals (BVA) must consider all relevant evidence, including 38 C.F.R. § 3.303(d) for diseases diagnosed post-service, and apply the equipoise rule under 38 U.S.C. § 5107(b) when evaluating claims for service connection for Posttraumatic Stress Disorder (PTSD); the BVA may not substitute its own medical judgment for independent medical evidence.
Facts:
- Robert Cosman served in the United States Army from April 1968 to April 1970, including combat service in Vietnam where he experienced a series of psychological stressors.
- After being discharged from service, Robert Cosman tried to suppress symptoms related to his Vietnam experiences by drinking heavily and became alcoholic.
- In September 1988, while at work, Robert Cosman was knocked down and rendered unconscious by an electrical flash explosion.
- Following the work-site accident, Robert Cosman suffered various psychological symptoms and sought treatment.
- Robert Cosman's therapist, Ms. Elizabeth Rice-Smith, diagnosed him with acute PTSD resulting from the work-site accident and suggested he may have 'shifted from earlier ptsd numbed status as sequelae to Vietnam combat exposure.'
- Department of Veterans Affairs (VA) examiners diagnosed Robert Cosman with generalized anxiety disorder, noting that significant combat action in Vietnam led to a 'longstanding syndrome of post-traumatic stress disorder symptoms' and the electrical explosion 'brought back all the old memories.'
- Dr. Bessel A. van der Kolk, a psychiatrist, opined that Robert Cosman suffered from 'severe Post Traumatic Stress Disorder (PTSD) — Acute ... precipitated by an on-the-job electrical explosion, complicated by a 'double barreled' severe Post Traumatic Stress Disorder — Delayed Onset as sequelae to Viet Nam exposure to combat and atrocity.'
Procedural Posture:
- Robert Cosman applied to the Department of Veterans Affairs (VA) for service connection for his Posttraumatic Stress Disorder (PTSD).
- The VA denied Robert Cosman's application.
- Robert Cosman appealed the VA's denial to the Board of Veterans’ Appeals (BVA).
- On April 5, 1991, the Board of Veterans’ Appeals denied Robert Cosman's claim for service-connected PTSD.
- Robert Cosman (Appellant) appealed the BVA's decision to the United States Court of Veterans Appeals.
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Issue:
Did the Board of Veterans' Appeals err by failing to consider 38 C.F.R. § 3.303(d) and 38 U.S.C. § 5107(b), and by substituting its own unsubstantiated medical judgment for independent medical evidence, when denying service connection for Posttraumatic Stress Disorder (PTSD) based on combat exposure and later-onset symptoms?
Opinions:
Majority - Nebeker, Chief Judge
Yes, the Board of Veterans' Appeals (BVA) erred by failing to consider 38 C.F.R. § 3.303(d) and 38 U.S.C. § 5107(b), and by substituting its own medical judgment for independent medical evidence, when denying Robert Cosman service connection for PTSD. The court determined that the Board improperly focused on the lack of in-service diagnosis or continuity of symptomatology under § 3.303(b), overlooking § 3.303(d), which allows for service connection when a disease is diagnosed after discharge if 'all the evidence' establishes it was incurred in service. This principle is particularly relevant for PTSD, where, as stated in the VA’s Adjudication Procedure Manual, continuity is not a requirement and a long latency period between the stressor and symptoms is possible. The BVA also erred by employing its own unsubstantiated medical opinion regarding Robert Cosman's alcoholism and by selectively interpreting medical evidence without providing adequate reasons or bases for accepting or rejecting physicians' opinions, a practice prohibited by Colvin v. Derwinski and Gilbert v. Derwinski. The court clarified that 'all the evidence' in § 3.303(d) requires all evidence to be considered, and the equipoise rule of 38 U.S.C. § 5107(b) applies, meaning if the evidence for and against a claim is equally balanced, the veteran must prevail.
Analysis:
This case significantly clarifies the standards for adjudicating service connection for PTSD, particularly for delayed-onset symptoms. It reinforces the principle that the Board of Veterans’ Appeals is bound by its own regulations and cannot substitute its medical judgment for that of qualified professionals. The ruling has a broad impact on veterans' claims, ensuring a more comprehensive review of all evidence, especially for conditions like PTSD that may manifest long after service. By emphasizing the application of the pro-veteran equipoise rule, the decision mandates that the benefit of the doubt be given to the claimant when evidence is equally balanced, promoting a fairer and more thorough adjudication process for veterans seeking benefits.
