Citation Nr: 0813423 Decision Date: 04/23/08 Archive Date: 05/01/08 DOCKET NO. 03-19 532 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to compensation under 38 U.S.C.A. § 1151 for residuals of medication prescribed by VA for a psychiatric disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD W. Yates, Counsel INTRODUCTION The veteran served on active duty from May 1986 to May 1989. This case comes to the Board of Veterans' Appeals (Board) on appeal from a December 2002 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. FINDING OF FACT The veteran's self-mutilating behavior was not the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing hospital care, medical or surgical treatment, or examination, or was the result of an event not reasonably foreseeable in furnishing his medical treatment. CONCLUSION OF LAW The criteria for entitlement to compensation pursuant to 38 U.S.C.A. § 1151 for residuals of medication prescribed by VA for a psychiatric disability are not met. 38 U.S.C.A. §§ 1151, 5107 (West 2002); 38 C.F.R. §§ 3.358, 3.361 (2007). REASONS AND BASES FOR FINDING AND CONCLUSION VA has certain notice and assistance requirements. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2006); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2007). Upon receipt of a substantially complete application for benefits, VA must notify the claimant what information or evidence is needed in order to substantiate the claim and it must assist the claimant by making reasonable efforts to get the evidence needed. 38 U.S.C.A. §§ 5103(a), 5103A; 38 C.F.R. § 3.159(b); see Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). In letters, dated in July 2004 and February 2007, which were followed by a supplemental statement of the case in January 2008, the veteran was properly notified as to the elements of his claim in this matter. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (noting that a VCAA defect may be cured by issuance of a fully compliant notification followed by a re-adjudication of the claim); see also Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Moreover, there is no prejudice to the veteran as to these considerations because the claim for entitlement to compensation under 38 U.S.C.A. § 1151 for residuals of medication prescribed by VA for a psychiatric disability has been denied. Further, the purpose behind the notice requirement has been satisfied because the veteran has been afforded a meaningful opportunity to participate effectively in the processing of his claim, to include the opportunity to present pertinent evidence. Thus, the Board finds that the content requirements of the notice VA is to provide have been met. See Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). In addition, the duty to assist the appellant has also been satisfied in this case. The RO has obtained all of the veteran's service medical records, as well as his identified VA medical treatment records and private treatment records. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The veteran has also been provided with a VA examination addressing the relationship of his claimed condition (residuals of self- mutilation) and the medical treatment he received from VA. Finally, there is no indication in the record that additional evidence relevant to the issue being decided herein is available and not part of the record. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). In making its determination herein, a request for additional information was sent to the veteran in February 2007. The information identified as needed from the veteran was also cited in the Board's remand earlier that same month. Since that time, however, no response from the veteran has since been received. As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 20 Vet. App. 537 (2006); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The veteran asserts that medication prescribed by VA to treat his psychiatric disability resulted in a self-mutilation disorder. Specifically, he testified that this condition was caused by clonazepam, which he indicated contains the active ingredient of benzodiazepine. At his informal hearing before the RO in August 2002, the veteran indicated that his self- mutilating behavior resulted in damage and scars to his left arm and shoulder area. A review of the veteran's VA treatment records beginning in 1996, revealed that he had been treated for a variety of psychiatric disorders over the years, including bipolar disorder, schizoaffective disorder, depression, obsessive compulsive disorder, panic disorder, mixed personality disorder, and alcohol abuse. These VA records further reveal that the veteran was treated during certain times with clonazepam. The veteran's private and VA treatment records revealed treatment for self-mutilation to the left chest and arm beginning in approximately 1997. A treatment report dated in June 1997, noted the veteran's treatment for self-induced lacerations. The treatment report indicated that the veteran stated that he "just started this." A treatment report dated in January 1998, noted that the veteran had a long history of psychiatric disease and self-mutilation. A treatment report, dated in December 1998, noted that the veteran began cutting himself three years earlier. Subsequent treatment reports show ongoing treatment for injuries caused by self-mutilation to the left arm and chest. In general, when a claimant experiences additional disability as the result of hospital care, medical or surgical treatment, or examination furnished by VA, disability compensation shall be awarded in the same manner as if such additional disability or death were service-connected. 38 U.S.C.A. § 1151. The provisions of 38 U.S.C.A. § 1151 provide that when there is no willful misconduct by a veteran, disability resulting from VA hospital care furnished the veteran will be compensated in the same manner as if service-connected, if the disability was caused by (A) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing hospital care or (B) an event which is not reasonably foreseeable. See also 38 C.F.R. § 3.358. While there is evidence that the veteran has exhibited self- mutilating behavior, the evidence does not show that this condition and its residuals are the result of careless or negligent VA hospitalization or treatment, or caused by an event that was not reasonably foreseeable. In support of his claim, the veteran has submitted medical articles relating to the use and side-effects of benzodiazepines in clinical medicine. Although the Board has reviewed each of these articles, it finds them to be of little probative value in this case. In making this determination, the Board notes that the articles are generic in nature and do not relate to the veteran's situation in particular. The Court has consistently held that a medical statement and/or treatise evidence that was too generic and inconclusive as to the specific facts in a case was insufficient to establish causal link. See Mattern v. West, 12 Vet. App. 222 (1999); Sacks v. West, 11 Vet. App. 314 (1998); Libertine v. Brown, 9 Vet. App. 521 (1996); Beausoleil v. Brown, 8 Vet. App. 459 (1996). Moreover, none of these articles support the veteran's underlying contention of a causal link between the use of clonazepam and self- mutilation behavior. In a summary of the article entitled, "Comparison of the Frequency of Behavioral Disinhibition on Alprazolam, Clonazepam or no Benzodiazepine in Hospitalized Psychiatric Patients," the authors concluded that the design of the study did not allow one to establish a relationship between the prescription of the benzodiazepine and worsening behaviors. A VA medical opinion dated in September 2002, reported the veteran's contention that the VA prescribed him klonopin (clonazepam) and that the drug interacted with his other medications causing self-mutilation behavior. The VA psychiatrist noted that he reviewed the veteran's claims folder in detail, and that this "review took approximately 7 hours." The report included a detailed history of medical treatment received by the veteran. The report also included a review of medical literature on the topic, which included reference to isolated reports suggesting that benzodiazepines such as alprazolam may cause disinhibition, including self-injurious behavior in patients with borderline personality disorder. Based upon the review of the medical record and the pertinent medical literature, the VA psychiatrist concluded that it was extremely unlikely that the induction and maintenance of the veteran's self- mutilating behavior was related to his clonazepam use. In support of his opinion, the VA psychiatrist noted that the cessation of self-mutilating behavior over one year ago was most likely related to other factors, such as sobriety and compliance with treatment medications. The VA psychiatrist also noted that in the largest study of its kind, acts of self-injury were less common in psychiatric patients treated with clonazepam than in patients not treated with benzodiazepines. Thus, the VA psychiatrist concluded that the scientific data did not support the hypothesis that clonazepam caused self-mutilation. The VA psychiatrist also indicated that the record unequivocally revealed numerous documented acts of self-mutilating behavior during clonazepam-free periods. In addition, a VA psychiatrist in a treatment report dated in April 2003, opined that he "did not believe we can pinpoint klonopin as the reason [the veteran] cut himself in the past." Finally, despite the statements from the veteran as to the reasons for the self-mutilating behavior he developed following his use of VA-prescribed psychiatric medications, it is well established that a layperson without medical training, such as the veteran, is not qualified to render medical opinions regarding the etiology of disorders and disabilities. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992); see also 38 C.F.R. § 3.159(a)(1). Accordingly, the medical evidence of record does not show that the veteran incurred residuals of medication prescribed by VA for a psychiatric disorder. Therefore, the evidence of record does not show that there are residuals caused by medication prescribed by VA for a psychiatric disability that were the result of careless or negligent VA hospitalization or treatment, or caused by an event that was not reasonably foreseeable, and the preponderance of the evidence is against his claim. As such, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Compensation under 38 U.S.C.A. § 1151 for residuals of medication prescribed by VA for a psychiatric disability is denied. ____________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs