Citation Nr: 18157913 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 17-04 646 DATE: December 13, 2018 ORDER Service connection for headaches is denied. Service connection for an acquired psychiatric disorder, to include schizophrenia, schizoaffective disorder, depression, and lack of sleep, is denied. FINDINGS OF FACT 1. A headache disability did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 2. Schizophrenia did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established for any acquired psychiatric disorder; and an acquired psychiatric disorder is not otherwise etiologically related to an in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a headache disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a) (2017). 2. The criteria for service connection for an acquired psychiatric disorder, to include schizophrenia, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection Entitlement to VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110 (wartime service), 1131 (peacetime service); 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service incurrence or aggravation of diseases of the central nervous system and psychosis may be presumed to have been incurred or aggravated if the disability is manifested to a compensable degree within one year of the Veteran’s discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). However, “[a] determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service.” Watson v. Brown, 4 Vet. App. 309, 314 (1993). Service personnel records reflect that the Veteran was counseled on various occasions for failing to make satisfactory progress in his training program, and that efforts to improve his performance were met with negative results. Following disenrollment from his technical training course, the Veteran was found to have violated Air Force Instructions for offenses such as failing to shine his boots and press his uniform, for disobeying lawful orders, and dereliction of duty. He was recommended for entry level separation, which was ultimately carried out in July 1999. As part of the separation process, the Veteran underwent medical assessment in July 1999. He denied illness or injury causing him to miss duty for more than three days, medical treatment or hospitalization, injury or illness on active duty for which he did not seek care, and taking any medications. He denied any condition that currently limited his ability to work in his primary specialty or required assignment limitations. He indicated that he did not intend to seek VA disability. The provider noted that the Veteran’s separation was nonmedical, and that he had never been seen in the clinic. In his November 2012 claim for benefits, the Veteran identified treatment in April 1999 at Mercy McKeesport Hospital; however, the release he provided for records pertaining to treatment did not specify dates of treatment. A report from Mercy Behavioral Health indicates that the Veteran was treated for alcohol use on an outpatient basis in 2000, that he admitted to depression while receiving outpatient treatment through Mon-Yough Services in 2001, and that he underwent inpatient treatment at UPMC McKeesport in November 2002 for medication management. The narrative assessment dated in November 2002 indicates that the Veteran had a history of treatment through Mon-Yough community services, and that he complained of depression. Medical records from a private provider identified by the Veteran show complaints of headaches dating to 2005. On VA examination in December 2016, the diagnosis was schizophrenia. The examiner indicated that the Veteran’s symptoms included depressed mood and chronic sleep impairment. The Veteran’s history was reviewed. The examiner noted that the Veteran failed numerous tests and was unable to complete training, which upset him, so he engaged in inappropriate behaviors to avoid being recycled. She acknowledged that the Veteran was treated in 2000 for alcohol abuse. She noted the Veteran’s report of being treated for a psychotic disorder since December 2001. She indicated that entrance and exit examinations in service were negative for any mental health problems or diagnosis. She stated that the Veteran struggled in school academically and he became upset in service when he failed several tests and would need to be "washed out" and reclassed, so he began acting in ways to get out of the military. She pointed out that these behaviors were logical and understandable and did not represent a mental disorder or a psychotic process. She indicated that there was no record of mental health diagnosis prior to service, but that the Veteran reported in 2001 during an evaluation at Mon-Yough Community Services that he thought he heard voices before entering service but joined anyway. She noted that this was the Veteran’s self report only, and there was no evidence of any mental health disorder before or during service, or any behaviors that would be indicative of a mental disorder either before or during service. She concluded that the self-report to a doctor in 2001 that he "thinks" he might have heard voices before service was not a reliable piece of information and did not constitute medical evidence of a mental disorder existing prior to service. She opined that his active schizophrenia at that moment likely impaired his recall and ability to clearly remember his symptom history. She pointed out that the Veteran had been diagnosed with schizophrenia or schizoaffective disorder and been in treatment on and off since 2001, which was more than one year after discharge from service. She concluded that schizophrenia was not caused by service, stating that the Veteran's symptoms and mental disorder did not appear until December 2001, which was more than two years after his discharge from service. She indicated that schizophrenia was not caused by an event or circumstance, but related to an imbalance of neurotransmitters in the brain and had a strong family component. She concluded that there was nothing that occurred during the service that caused schizophrenia to develop. Service connection for headaches The Board concludes that, while the Veteran has been treated for headaches, as indicated by the evidence cited above, a headache disability did not manifest in service or to a compensable degree within the applicable presumptive period, and continuity of symptomatology is not established. 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Indeed, the Veteran’s STRs are negative for complaint or treatment of a headache condition. The Veteran himself indicated in a July 1999 medical assessment that he did not suffer from an illness on active duty for which he did not seek medical care. He further indicated that he had no concerns about his health. Indeed, the Veteran did not seek treatment for headaches until years after service. To the extent that the Veteran asserts that he has a headache disability that is related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the claimed headache disability because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record contains evidence of current treatment for headaches, it does not contain reliable evidence which indicates that the claimed headache disability may be related to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for a headache disability must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection for an acquired psychiatric disorder Upon review of the evidence the Board concludes that, while the Veteran has a diagnosis of schizophrenia, as indicated by the evidence cited above, it did not manifest to a compensable degree in service or within the applicable presumptive period, and continuity of symptomatology is not established. 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). To the extent that the Veteran asserts that he has a psychiatric disability that is related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnosis because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. On the other hand, the VA examiner considered the Veteran’s documented history, but ultimately concluded that the current schizophrenia is not related to service. The Board finds the most probative evidence of record to be this opinion by the competent VA health care provider. The opinion was provided by a clinician who reviewed the history, interviewed the Veteran, and provided opinions supported by rationale. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record demonstrates a diagnosis of schizophrenia, it does not contain reliable evidence which relates this claimed disability to any incident of service. (Continued on the next page)   For these reasons, the Board concludes that the claim of entitlement to service connection for an acquired psychiatric disorder must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Barone, Counsel