Citation Nr: 18159557 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 14-35 159 DATE: December 20, 2018 ORDER The claim for entitlement to service connection for sleep apnea is dismissed. The claim for entitlement to service connection for a jaw disability is dismissed. The claim for entitlement to service connection for schizophrenia with episodes of psychosis is granted. The claim for entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. The claim for entitlement to service connection for an acquired psychiatric disorder other than schizophrenia and PTSD is denied. FINDINGS OF FACT 1. In August 2015, prior to the promulgation of a decision in the appeal, the appellant requested a withdrawal of the claims for entitlement to service connection for sleep apnea and a jaw disability. 2. The Veteran’s psychosis, associated with schizophrenia, manifested within a year of his separation from active duty service. 3. The Veteran’s PTSD was incurred due to verified in-service stressors. 4. An acquired psychiatric disorder, other than schizophrenia or PTSD, was not present in service or until years thereafter and is not etiologically related to any incident of service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal for entitlement to service connection for sleep apnea are met. 38 U.S.C. § 7105(b) (2), (d) (5); 38 C.F.R. § 20.204. 2. The criteria for withdrawal of the appeal for entitlement to service connection for a jaw disability are met. 38 U.S.C. § 7105(b) (2), (d) (5); 38 C.F.R. § 20.204. 3. Service connection is warranted for schizophrenia with episodes of psychosis. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. Service connection is warranted for PTSD. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 5. An acquired psychiatric disorder other than schizophrenia and PTSD was not incurred in or aggravated by active duty service. 38 U.S.C. § 1110; 38 C.F.R. §§ 33.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2007 to January 2011 with service in Iraq from December 2008 to December 2009. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in November 2017. A transcript of the hearing is of record. Withdrawn Claims The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. In August 2015 correspondence, the Veteran withdrew the appeals for service connection for sleep apnea and a jaw disability. Hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeal with respect to these claims and they are dismissed. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active 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). See also Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007). 1. Entitlement to service connection for schizophrenia with episodes of psychosis. 2. Entitlement to service connection for PTSD. 3. Entitlement to service connection for an acquired psychiatric disorder other than schizophrenia and PTSD. The Veteran contends that service connection is warranted for an acquired psychiatric disorder, to include PTSD and schizophrenia, as the condition was incurred due to traumatic events during service. He testified in November 2017 that he was exposed to mortar attacks and unexploded improvised explosive devices (IEDs) during his period of service in Iraq. He also testified that he experienced anger and depression which he did not recognize until after his return from his overseas deployment. The Board finds that service connection is warranted for PTSD as it was incurred directly due to the Veteran’s stressors during service. Service connection is also warranted for schizophrenia on a presumptive basis as the condition manifested psychosis within one year of the Veteran’s separation from active duty in January 2011. The Board will first address the Veteran’s contentions regarding schizophrenia. Service connection is warranted for certain chronic diseases on a presumptive basis if they manifest to a degree of 10 percent or more within one year from the date of separation from service. 38 C.F.R. § 3.307(a)(3). Psychoses is considered a chronic disease subject to presumptive service connection under 38 C.F.R. § 3.309(a). Service connection is therefore possible for schizophrenia on a presumptive basis if associated psychosis manifested within a year after the Veteran’s discharge from active duty. Post-service treatment records from the VA Medical Center (VAMC) establish that the Veteran’s first mental health treatment occurred in February 2012, 13 months after discharge from active duty. While initially seen in the emergency department (ED) with complaints of a right-hand skin problem, he was referred for a mental health evaluation after manifesting homicidal thoughts about an unnamed individual. He was diagnosed with an adjustment disorder with mixed anxiety and a depressed mood and referred for further treatment. He was seen again in the VAMC ED on March 13, 2013 after a serious motor vehicle accident (MVA) five weeks earlier when he sustained a head injury. A month later, the Veteran returned to the ED with his mother who stated that the Veteran was delusional and hearing voices. He was brought in by the police after acting combative in the parking lot and hospitalized. The Veteran’s mother reported that he was not the same since his deployment to Iraq and he returned with a lot of anger and an inability to hold a job or focus. She also stated that the Veteran’s behavior had been odd since his February 2013 MVA with delusional beliefs. In July 2018, a VA expert in psychiatry provided a medical opinion in support of service connection, finding that the Veteran manifested psychosis within a year from his separation from active service. Although the Veteran’s first post-service psychiatric treatment occurred 13 months after service, the VA expert found that the Veteran’s behavior immediately after service indicated a downward spiral that led to a loss of touch with reality. The medical and lay evidence established the Veteran’s clear departure from his usual pre-military behaviors and attitude immediately following the military and within a year from his separation from active duty service. The July 2018 VA expert also provided a medical opinion against service connection for schizophrenia on a direct basis; however, service connection is warranted on a presumptive basis as the condition manifested psychosis within a year from separation. 38 U.S.C. §§ 1101, 1131; 38 C.F.R. §§ 3.307(a), 3.309(a). The Board also finds that service connection is warranted for the Veteran’s PTSD as directly due to service. The medical evidence establishes a current diagnosis of PTSD and the Board finds that the Veteran’s testimony and statements regarding his in-service exposure to mortar attacks and IEDs are credible. Additionally, while service personnel records do not specifically document the Veteran’s participation in combat with the enemy, he received combat and hostile fire/imminent danger pay during his deployment. The record also contains two medical opinions in support of service connection: a VAMC provider issued a statement in favor of the claim for PTSD in April 2016 and the July 2018 VA expert also concluded that the Veteran’s PTSD was incurred due to stressors during service. The Board finds that these medical opinions outweigh the October 2013 VA examiner’s finding that the Veteran did not meet the criteria for PTSD. As all the elements for service connection are met, the claims for entitlement to service connection for schizophrenia with psychosis and PTSD are granted. As a final matter, the Board notes that the award of service connection in this decision is limited to schizophrenia and PTSD. To the extent the Veteran may allege service connection is warranted for other acquired psychiatric disorders, the record does not contain competent evidence establishing that the conditions are related to service. The Veteran’s treatment records document numerous psychiatric diagnoses including an adjustment disorder, generalized anxiety, and polysubstance abuse. However, the April 2016 and July 2018 medical opinions in support of the claim only identify PTSD and schizophrenia as related to service or manifesting within a year from the Veteran’s discharge. In addition, the award of service connection for schizophrenia and PTSD contemplates all the Veteran’s reported psychiatric symptomatology, including general anxiety and depression. With respect to the diagnosed polysubstance abuse, direct service connection for a disability that is a result of a claimant’s own abuse of alcohol or drugs (a substance abuse disability) is precluded for purposes of all VA benefits for claims filed after October 31, 1990. VAOPGCPREC 7-99, 64 Fed. Reg. 52,375 (1999); see also VAOPGCPREC 2-98, 63 Fed. Reg. 31,263 (1998). The July 2018 VA expert also noted that the Veteran’s problems with substance abuse began well before his enlistment into active service and there is no evidence service connection is   warranted for polysubstance abuse on a secondary basis. Thus, service connection is granted for schizophrenia and PTSD and denied for all other acquired psychiatric disorders. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Riley, Counsel