Citation Nr: 20037556 Decision Date: 06/02/20 Archive Date: 06/02/20 DOCKET NO. 15-35 381A DATE: June 2, 2020 ORDER Service connection for schizoaffective disorder, to include as secondary to service-connected posttraumatic stress disorder (PTSD) and polysubstance abuse, is denied. FINDING OF FACT The Veteran’s schizoaffective disorder is not caused or aggravated by service-connected PTSD and polysubstance abuse, is not otherwise related to an in-service injury or disease and psychosis did not manifest to a compensable degree within year of service discharge. CONCLUSION OF LAW The criteria for service connection for schizoaffective disorder due to service or service-connected PTSD and polysubstance abuse are not met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.655. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1987 to October 1991. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2013 rating decision from the Department of Veterans Affairs (VA) Regional office (RO) in Muskogee, Oklahoma. The issue was previously remanded by the Board in September 2018. The Board notes that the Veteran's former attorney withdrew his power of attorney in October 2019, prior to certification of this appeal. This withdraw letter indicated that the Veteran had been notified of the former attorney’s withdraw from his representation. The Veteran has not appointed another representative and therefore proceeding pro se in this appeal. 1. Schizoaffective Disorder The Veteran seeks service connection for schizoaffective disorder as due to service, or, alternatively, as caused or aggravated by his service-connected PTSD. For the reasons that follow, the Board finds service-connection is not warranted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d). Service connection may be granted for an existing present disability first diagnosed after discharge, when the evidence shows that an underlying disease or injury resulting in the present disability was incurred in service. 38 C.F.R. § 3.303(d). In the alternative, service connection may be granted on secondary basis for the disability that is proximately due to or the result of an existing service-connected disability. 38 C.F.R. § 3.310(a). Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as psychoses, are presumed to have been incurred in service if manifested to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. As relevant to the current claim, the term "psychosis" includes a brief psychotic disorder; delusional disorder; psychotic disorder due to general medical condition; psychotic disorder, not otherwise specified (NOS); schizoaffective disorder; schizophrenia; schizophreniform disorder; shared psychotic disorder; and substance-induced psychotic disorder. 38 C.F.R. § 3.384. Establishing service connection on secondary basis requires evidence showing that the claimed disability exists and that such disability was proximately caused by an existing service-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). In cases, such as this, where the Board has to decide a legal issue involving etiology of a medically complex disability, a medical opinion is necessary. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As an initial matter, the Board notes it remanded this appeal for a VA examination in September 2018. In compliance with the September 2018 Board remand directives, the RO requested an additional examination addressing whether the Veteran’s schizoaffective disorder was caused or aggravated by his service-connected disabilities. The record indicates the Veteran failed to report for the scheduled examination in January 2020. The record does not indicate that the Veteran provided any reasoning for missing the examination. Pursuant to 38 C.F.R. § 3.655, when entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. The Veteran failed to cooperate with reporting for the scheduled examination, the Board finds that he failed to report to the scheduled VA examination without good cause and the claim shall be rated based on the evidence of record. See 38 C.F.R. § 3.655. The Veteran’s service treatment (STRs), including an October 1991 separation examination report, are negative to complaints or treatment of nervous trouble. Additionally, in a July 1990 STR, the Veteran specifically denied paranoid thoughts and homicidal and suicidal ideations. The Veteran asserted service connection for a mental disorder was warranted as due to stressful situations in service. A September 2018 Board decision expanded the Veteran’s claim for a mental disorder to include PTSD, schizoaffective disorder and polysubstance abuse, and granted service connection for PTSD. An October 2018 decision effectuated the Board decision. A March 2020 decision granted service connection for polysubstance abuse. A July 2015 VA examiner reported a diagnosis of schizoaffective disorder, and stated the Veteran’s schizoaffective disorder but found that as the examiner could not determine whether the Veteran’s stressor took place it is less likely as not the result of military sexual trauma (MST). The examiner noted that the nature of the Veteran’s persecutory delusions and auditory hallucinations lends question to the reliability and accuracy of his report of events that occurred to him while in military service. In a May 2016 VA examination, the examiner also indicated a diagnosis of schizoaffective disorder, depressive type. After an examination, the examiner noted that he could not say that the schizoaffective disorder is related to the Veteran’s military experiences or his PTSD. Further, he indicated that there is insufficient evidence in the literature to suggest alcohol abuse can cause schizophrenia or schizoaffective disorder. In a December 2016 VA opinion, the examiner stated that while it is possible there is insufficient evidence in the Veteran’s history to state without pure speculation that in-service drug and alcohol abuse were the first manifestations/symptoms of the subsequently diagnosed schizoaffective disorder. The examiner reasoned that the record shows that the Veteran was admitted to the Naval Hospital in July 1990 for alcohol dependence and discharged in August 1990 and there is no mention of any psychiatric diagnoses, and therefore no evidence that schizoaffective disorder preceded the alcohol abuse. During an April 2109 VA examination, the examiner reported a diagnosis of schizoaffective disorder, bipolar type. He noted the Veteran has a long history of being diagnosed and treated for schizoaffective disorder. After an examination, the examiner opined that the Veteran’s disorder is less likely than not proximately due to or the result of the Veteran’ service-connected PTSD. The examiner noted there is insufficient reason to conclude schizoaffective disorder is at least as likely as not proximately due to or the result of PTSD. VA progress also include treatment for schizoaffective disorder since February 2012. In this case, the Board concludes that, while the Veteran has a current diagnosis of schizoaffective disorder, the preponderance of the evidence is against finding that the Veteran’s schizoaffective disorder is incurred in or caused by service, manifested to a compensable degree within one year of service discharge or proximately due to, the result of, or aggravated beyond its natural progression by his service-connected PTSD and polysubstance abuse. The Board has first considered whether service connection for psychosis is warranted on a presumptive basis, to include on the basis of continuity of symptomatology. In this regard, the clinical evidence of record fails to show that the Veteran manifested such disease to a compensable degree within the year following his discharge from active duty service. Rather, the first diagnosis of record of a psychosis is from a February 2012 VA treatment record. Consequently, as the evidence of record fails to show that the Veteran manifested a psychosis to a compensable degree within a year of service, the Board finds that presumptive service connection for such disease, to include on the basis of continuity of symptomatology, is not warranted. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. With regard to service connection on a direct basis, after careful review of all the evidence, the Board finds that the preponderance of evidence is against the Veteran’s claim for service connection for schizoaffective disorder. As noted above, the STRs are negative of any findings associated with any of this claimed disorder. Following service, there is a considerable gap between separation and the initial documented complaints related to schizoaffective disorder. The initial objective evidence of schizoaffective disorder was February 2012. Moreover, there has been no medical evidence of record to suggest a nexus between the Veteran’s schizoaffective disorder and his period of active service. With regard to service connection on a secondary basis, the Board finds the VA opinions of record to be probative in finding less likely than not that the Veteran’s schizoaffective disorder was caused by the Veteran’s service connected PTSD. The examiners’ opinions were based upon examination of the Veteran and rationale was that there was insufficient reason to conclude schizoaffective disorder is at least as likely as not proximately due to or the result of PTSD. The Board again notes that the case was remanded for the Veteran to attend an examination. Although he attended the first scheduled examination, the Veteran failed to report the examination for an additional opinion and did not reschedule. The claim was remanded for an examination and opinion as to whether the Veteran’s schizoaffective disorder was aggravated by his service connected PTSD. The Veteran underwent a VA examination in April 2019; however, the examiner failed to provide an aggravation opinion. An addendum opinion was requested, but it was indicated that as the examiner was unavailable, a new VA examination was necessary in order to obtain a new opinion. The Veteran failed to report for the January 2020 examination. As such, an aggravation opinion could not be obtained. The Veteran cannot passively await VA’s assistance in circumstances where his proactive involvement is essential to the further development of his own claim. See Wood v. Derwinski, 1 Vet. App. 190 (1991). The Veteran’s unwillingness to participate in the remand directives has left the evidentiary field unchanged, meaning that the evidence of record continues to be insufficient to link the Veteran’s schizoaffective disorder to his service connected PTSD. 38 C.F.R. § 3.655 The Veteran believes his schizoaffective disorder is proximately due to or aggravated by service and/or service-connected PTSD. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as the observable symptoms are common and overlap with many other disorders and providing such symptoms and knowledge of factors that differentiate one from another. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA opinions of record. As discussed, the evidence of record does not show that the Veteran’s schizoaffective disorder either began during or was otherwise caused by his military service or that it was caused or aggravated by his service-connected PTSD and polysubstance abuse. As such, service connection is denied. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. M. Donahue Boushehri, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.