Citation Nr: 20056836 Decision Date: 08/27/20 Archive Date: 08/27/20 DOCKET NO. 10-43 524 DATE: August 27, 2020 ORDER Service connection for a psychiatric disorder, diagnosed as schizophrenia, is granted. FINDING OF FACT The competent evidence is in equipoise as to whether the Veteran’s diagnosed schizophrenia is secondary to his service-connected tinnitus. CONCLUSION OF LAW The criteria for establishing service connection for a psychiatric disorder, diagnosed as schizophrenia, have been met. 38 U.S.C. §§ 101, 1131, 5107 (2012); 38 C.F.R. §§ 3.6, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty for training (ACDUTRA) from July 1983 to February 1984. He also had additional Army Reserve service until May 1992. This matter comes before the Board of Veterans Appeals (Board) on appeal from a December 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2015, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In March 2018, the Board denied the claim for service connection for a psychiatric disorder, to include as secondary to service-connected disabilities. The Veteran appealed the Board’s March 2018 decision to the United States Court of Appeals for Veterans Claims (Court). In a June 2019 Memorandum Decision, the Court vacated the March 2018 Board decision and remanded it to the Board for further development and readjudication. 1. Entitlement to service connection for a psychiatric disorder, diagnosed as schizophrenia, as secondary to service-connected disabilities The Veteran, through his attorney, presently contends that his psychiatric disability was caused or aggravated by his service-connected conditions. Previously, the Veteran had alleged that he experienced a mental breakdown while on ACDUTRA and was diagnosed with a psychiatric disorder about one week thereafter. See August 2015 Board video conference hearing. As an initial matter, although the Veteran had alleged first having psychiatric problems during his military service, the evidence does not support this contention. In this regard, the Veteran’s contentions as to the timing of his psychiatric symptoms are inconsistent and not probative. Although he claims that the psychiatric symptoms which resulted in his first psychiatric hospitalization occurred in 1985 to 1986, the earliest two psychiatric hospitalizations are documented to have taken place in February 1989 and September 1989. Moreover, these records are completely silent as to any involvement or relationship to the Veteran’s military service or any related stressful activities. In addition, there are no service treatment reports noting the Veteran’s treatment for a psychiatric disorder. In sum, the Veteran’s current assertions of continued psychiatric problems which began during and continued since ACDUTRA to be less persuasive than other evidence of record. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). Moreover, the Board notes that before the Court and following Court remand, the Veteran’s attorney has argued only for service connection on a secondary basis. No challenge to the prior Board decision denying direct and presumptive service connection was made, and there has been no argument challenging the adequacy of the 2016 VA examiner’s opinion on direct service connection. Rather, the attorney’s arguments pertained only to the question of secondary service connection. Thus, as there was no challenge to the denial of direct or presumptive service connection on appeal to the Court or presently before the Board, there is no competent and credible evidence of a chronic psychiatric disorder during active service or the year following active service, and the only medical opinion of record concerning direct service connection is against the claim, service connection on a direct or presumptive basis is not warranted. 38 U.S.C. §§ 1110, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Turning to the claim for service connection on a secondary basis, the Board finds the evidence to be in equipoise as to whether the Veteran’s psychiatric disability was caused or aggravated by a service-connected disability. Service connection may be established for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability that is aggravated by a service-connected disability may be service connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). To substantiate a secondary service connection claim, the Veteran must show a present disability; a service-connected disability; and competent evidence that the service-connected disability caused or aggravated the disability for which service connection is sought. Here, the Veteran is service connected, in pertinent part, for hearing loss and tinnitus. The first evidence of treatment for a psychiatric disorder is a private hospitalization report, which indicated that the Veteran was involuntarily hospitalized at Montana State Hospital form March 4, 1989 to April 21, 1989. The report noted that he had been incarcerated with delusions of having a listening device implanted into his abdomen, and that he was threatening to tear it out. The report listed a diagnosis of schizophrenia, paranoid, unspecified. The Veteran was involuntarily admitted for a second time on September 6, 1989. The report noted that the Veteran had been observed banging his ears and head and it was noted that he had sores and scabs around both ears. A September 1989 psychiatric evaluation concluded with diagnoses of paranoid type schizophrenia. Turning to the question of a nexus between the Veteran’s psychiatric disability and his service connected hearing loss and/or tinnitus, there are competent opinions in favor of and against the claim. Specifically, in a September 2016 opinion, the VA examiner opined that the Veteran’s current psychiatric disability was less likely as not caused by or aggravated beyond normal progression by his service-connected disabilities. In support of this opinion, the VA examiner noted that medical literature revealed that there is a strong contribution for genetic factors in determining risk for schizoaffective disorder, and that the Veteran reported that his mother had a psychiatric history. The VA examiner also noted that there was no medical literature to suggest a causal, associative, or other relationship between bilateral hearing loss and schizoaffective disorder. In a June 2020 opinion, a private psychologist, after claims file review, noted the Veteran had a high degree of tinnitus and opined that the Veteran’s tinnitus at least as likely as not caused the development of the Veteran’s psychotic symptoms. She noted that the average age of onset for a psychotic disorder in males is the late teens to early twenties, and that the onset of the Veteran's psychotic symptoms was relatively late, suggesting the presence of other factors. She further noted recurrent documentation in medical records of co-occurring hallucinating with loud ringing in ears and cited research addressing the relationship between tinnitus and hallucinations whereby tinnitus may exacerbate the distress and increase the intensity of the hallucinations. Upon review of these opinions in conjunction with the other evidence of record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current psychiatric disability is proximately due to/aggravated by his service-connected tinnitus. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. C. Birder 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.