Citation Nr: 1321850 Decision Date: 07/09/13 Archive Date: 07/18/13 DOCKET NO. 10-08 267A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disability, to include schizophrenia, cannabis delusional disorder, and posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for scars of the shoulders. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD K. Hudson, Counsel INTRODUCTION The Veteran had active service from June 1981 to December 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a regional office (RO) rating decision of April 2009. In May 2012, the appellant appeared at a videoconference hearing held before the undersigned. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required on his part. REMAND The Veteran's initial claim for service connection for a psychiatric disorder referred only to schizophrenia, but was later expanded to include cannabis delusional disorder, PTSD, and any acquired psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (scope of mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record). However, the addition of cannabis delusional disorder was based on the in-service diagnosis and not the Veteran's claim. In this regard, no compensation shall be paid if the disability resulting from injury or disease in service is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C.A. §§ 105, 1110 (West 2002); 38 C.F.R. § 3.301 (2012). Drug abuse means the use of illegal drugs (including prescription drugs illegally or illicitly obtained), the intentional use of prescription or non-prescription drugs for a purpose other than the medically intended use, or the use of substances other than alcohol to enjoy their intoxicating effects. 38 C.F.R. § 3.301(d) (2012); see also 38 U.S.C.A. § 105 (West 2002); 38 C.F.R. § 3.1(m) (2012). VA's General Counsel has confirmed that direct service connection for disability resulting from a claimant's own drug or alcohol abuse is precluded for all VA benefit claims filed after October 31, 1990. See VAOPGCPREC 7-99; VAOPGCPREC 2-98. Service treatment records show that in August 1982, the Veteran suffered an acute psychotic break while aboard the U.S.S. HUNLEY, during which he removed his clothing and ran through the berthing deck screaming that he was Jesus and was here to change the world. He exhibited symptoms including loose associations, agitation, and hallucinations. He was subdued, and Haldol was administered. Two days later, he was transferred to a hospital for neuropsychiatric observation. There was a question as to whether the use of illegal drugs was involved in the episode. When seen initially, he claimed that he did not use any drugs except hash, and said he had used some that day. During the subsequent hospitalization, the Veteran admitted to smoking hashish with some friends a few hours before the episode. He admitted to smoking marijuana in the past, but this was the first time for hashish. Laboratory data, including urinalysis, were noted to be negative, although it is not known whether these tests were for substances such as cannabis. The final diagnosis was cannabis (hashish) delusional disorder manifested by delusions of grandeur, marked anxiety, and emotional lability, and subsequent amnesia for the episode. It was commented that the diagnosis was a substance-induced organic mental disorder and the direct effect of cannabis hashish on the nervous system. He was no longer exhibiting any psychotic manifestations at the time of his discharge from the hospital, and he was returned to duty. At his hearing, the Veteran testified that his reference to "smoking hash" in service was a well-known slang term for stoking the boiler of the ship with coal. However, the Veteran's admission to the use of hashish noted in the service treatment records was clearly in the context of drug usage, as can be seen above, where he distinguished it from marijuana use, and said it was the first time he had used hashish. Therefore, his hearing testimony regarding the meaning of "smoking hash" is not credible. There is, however, no evidence that the presence of any drug was confirmed by laboratory studies, although the Veteran admitted to having smoked hashish a short time before the psychotic incident, and the treating physician was of the opinion that the psychotic episode was due to the drug. P. Robbins, M.D., when first evaluating the Veteran in June 2009, noted that he complained of chronic guilt after an affair in 2003. He reported depressed mood and decreased concentration since 2003. He also reported that he had been hospitalized in service for an episode when he believed he was Jesus, which had resolved. He had been discharged from the military, and came home and became involved in alcohol and numerous drugs, receiving two DUI's. He had not used any drugs for 15 years. He complained of intrusive thoughts of being punished by having to feed the boiler in the Navy. In 1984 or 1994, he again thought he was Jesus while using alcohol and cannabis, which resolved. He denied any subsequent episodes. The diagnoses were ADHD (attention-deficit/hyperactivity disorder), anxiety, and alcohol dependence, in partial remission. In addition, bipolar disorder was to be ruled out. Later, however, in March 2010 and June 2012, Dr. Robbins wrote a letter stating, in pertinent part, that the Veteran as likely as not suffered from ADHD and anxiety disorder throughout his lifetime, and that the anxiety disorder may have been intensified by his time in the Navy. A veteran is presumed to be in sound condition when entering into military service except for conditions noted on the entrance examination or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto, and that the disease or injury was not aggravated by service. 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304(b); Cotant v. Principi, 17 Vet. App. 116 (2003); VAOPGCPREC 3-2003 (2003). Here, Dr. Robbins stated that ADHD and anxiety were "as likely as not" present throughout the Veteran's lifetime, and, thus, the statement does not rebut the presumption of soundness. Moreover, the presumption of soundness applies only where there is evidence that a disease or injury not noted upon entry into service manifested or was incurred in service. Gilbert v. Shinseki, 26 Vet. App. 48 (2012). VA medical records show that the Veteran has more recently been diagnosed as having ADHD, anxiety disorder, and depression. Several records show bipolar disorder to be ruled out. A VA evaluation in June 2012 resulted in a provisional diagnosis of psychotic disorder, not otherwise specified, and found that the criteria for PTSD were not met. However, symptoms he described as related to an in-service fire aboard ship during service were thought to be consistent with adjustment disorder. In view of these factors, additional development must be undertaken prior to an appellate decision, to include verifying the claimed fire, providing the Veteran with a PTSD questionnaire to complete and return, obtaining recent treatment records, and scheduling an examination. Concerning the claim for service connection for scars of the shoulders, the Veteran states that he has scars due to the use of restraints in service during his psychotic break. The separation examination in December 1982 noted striae on the anterior shoulders. Striae are typically stretch marks, but the Veteran states he has scars, which are symptomatic and due to restraints. He must be afforded an examination to determine whether he in fact has a skin disability of the shoulders, manifested by scars or striae, and if so, whether the cause was restraints used in service. Accordingly, the case is REMANDED for the following action: 1. Send the Veteran a PTSD questionnaire form, and ask him to return the completed form. 2. The Veteran states that two sailors were killed by fire in the engine room aboard the U.S.S. HUNLEY (AS-31) in January 1982. He joined the ship on January 4, 1982. Make all necessary attempts to verify whether this incident occurred, and, if so, obtain available details of the incident. Specifically, the United States Army and Joint Services Records Research Center (JSRRC), the Naval Historical Center, and/or any other appropriate organization should be asked to verify, through deck logs and/or other appropriate documentation, whether a fire in the engine room, killing two sailors, occurred aboard the U.S.S. HUNLEY in January or February, 1982. 3. Obtain records of the Veteran's VA mental health and/or psychiatric treatment dated from June 2012 to the present. 4. Thereafter, schedule the Veteran for a VA psychiatric examination to determine whether the Veteran currently manifests a chronic acquired psychiatric disability, under Axis I of the DSM-IV, which at least as likely as not (50 percent or greater probability) had its onset during service, or is related to any events which occurred in service. If PTSD is diagnosed, the examiner must identify the specific stressor or stressors upon which the diagnosis is based. The examiner should also express an opinion as to whether the psychotic episode shown in August 1982 was more likely than not (greater than 50 percent probability) due to alcohol or drugs. The entire claims folder and a copy of this remand must be made available to the examiner in connection with the examination. A rationale for any opinion reached must be provided. 5. Schedule the Veteran for an appropriate examination to determine whether he has scarring and/or striae of both shoulders which constitute a disability, and, if so, whether such are at least as likely as not (50 percent or greater probability) residuals of the use of restraints (if used) in service during the Veteran's psychotic episode. 6. After completion of the above and any additional development deemed necessary, the RO should review the claims for service connection for a psychiatric disability, to include schizophrenia, cannabis delusional disorder, and PTSD, and for scars of both shoulders. If either claim is denied, the Veteran and his representative should be provided with a supplemental statement of the case, and given an opportunity to respond, before the case is returned to the Board. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).