Citation Nr: 18150541 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-44 149 DATE: November 15, 2018 ORDER Service connection for an acquired psychiatric condition, to include schizophrenia, is granted. FINDING OF FACT With resolution of the doubt in his favor, the Veteran’s current psychiatric disability, alternatively diagnosed as schizotypal personal disorder, schizoaffective disorder or schizophrenia, had its initial onset during service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric condition have been met. 38 U.S.C. §§ 1131, 5107 (b) (West 2014); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1977 to July 1981. This matter was previously denied by the RO in a May 2006 rating decision. Generally, a finally adjudicated claim can be reopened only on the submission of new and material evidence. 38 C.F.R. § 3.156 (a). However, in contrast to the general rule, if, at any time after VA issues a decision on a claim, VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of the same section (which defines new and material evidence). 38 C.F.R. § 3.156 (c) (1); see also Blubaugh v. McDonald, 773 F. 3d 1310 (2014). Additional service department records were received by the RO since May 2006. Therefore, the Board will continue with this claim without determining whether new and material evidence was received. Entitlement to service connection for an acquired psychiatric condition, to include schizophrenia Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). “To establish a right to compensation for a present disability, a Veteran must show: ‘(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service’ - the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). VA treatment records indicate the Veteran has been treated for schizotypal personality disorder since at least August 2004. Treatment records also indicate the Veteran was diagnosed and treated for major depression in 1995. May 2013 VA treatment records indicate the Veteran’s primary mental health diagnosis was changed to schizoaffective disorder. In September 2018, a private psychiatrist diagnosed the Veteran with schizophrenia. Service treatment records indicate the Veteran’s July 1977 psychiatric examination at induction was clinically normal. The Veteran denied frequent trouble sleeping, depression or excessive worry, loss of memory or amnesia, and nervous trouble. In September 1977, the Veteran complained of nightmares and was assessed with mild anxiety and depression. In May 1980, the Veteran reenlisted. In May 1981, after several disciplinary actions, the Chief of Social Services interviewed the Veteran, and noted the Veteran articulated philosophically grandiose and abstract notions while failing to answer the presented questions. The Chief opined it was unlikely that the Veteran would respond successfully to further counseling or disciplinary actions, and that the Veteran’s problems were not situational but attitudinal and motivational in nature. In June 1981 the Veteran’s commander noted that the Veteran’s “apathy” towards his military duties was having an adverse effect on the Veteran’s unit, and recommended the Veteran be discharged due to unsuitability. At the Veteran’s June 1981 separation examination, the examiner noted the Veteran was unable to sleep at night, had problems with memory, had recent worry and depression, and that the Veteran was unhappy in the military because he thought he was misunderstood. On the Veteran’s June 1981 report of medical history, the Veteran endorsed frequent trouble sleeping, depression or excessive worry, and loss of memory or amnesia. He was discharged under honorable conditions. At the May 2006 VA medical examination, the examiner opined that the Veteran’s psychiatric condition was not schizophrenia but rather schizotypal personality disorder. The examiner explained that this type of disorder “is considered a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, closed relationship as well as by cognitive or perceptual distortion with eccentric behavior beginning in early adulthood.” The examiner opined that although the Veteran has continued to demonstrate this personality disorder since service, he could not link its onset to the Veteran’s service. At the March 2015 VA medical examination, the Veteran reported hallucinations and grandiose delusions, as well as being molested as a child. The examiner noted the Veteran had a current diagnosis of schizoaffective disorder that was treated with medication. The examiner concurred with the Veteran’s treating physicians that his current diagnosis was more accurately noted as schizoaffective disorder rather than schizotypal personality disorder. The examiner opined that because of a lack of medical records indicating treatment between the Veteran’s discharge from service and the mid-1990s, he could only speculate whether the Veteran’s current diagnosis initially demonstrated during service. The examiner noted that “from a clinical standpoint, it is likely that symptoms of his current disorder manifested around the time he was in the service as on the onset of psychotic symptoms is typically late adolescence[.]” In September 2018, a private psychiatrist reviewed the Veteran’s claims file, to include additional treatment and military personnel records, and conducted a 2-hour interview with the Veteran regarding his current psychiatric condition. He opined the Veteran’s diagnosis was “simple and unequivocally consistent with schizophrenia.” He noted the Veteran demonstrated symptoms of delusions, hallucinations, disorganized thoughts and behavior during service, and has continued to experience these symptoms with a precipitous deterioration in functional capacity since service. He noted that the Veteran’s symptoms have been present continuously since service with no period of remission, and distinguished the previous psychotic diagnoses of schizotypal personal disorder and schizoaffective disorder. (Continued on the next page)   Extensive medical and factual development has been considered and the Board presently finds that the evidence is in approximate balance whether the Veteran’s current psychiatric condition had its onset during service. Further medical inquiry would not substantially assist the Board in its determination and the claim for service connection for the Veteran’s psychiatric condition will be granted. The Board expresses no opinion regarding the severity of the disorder. The RO will assign an appropriate disability rating on receipt of this decision. Ferenc v. Nicholson, 20 Vet. App. 58 (2006) (discussing the distinction in the terms “compensation,” “rating,” and “service connection” as although related, each having a distinct meaning as specified by Congress). Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Anwar, Associate Counsel