Citation Nr: 21002279 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 181221-2698 DATE: January 13, 2021 REMANDED Entitlement to service connection for schizophrenia and other psychotic disorder is remanded. REASONS FOR REMAND On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. The Board is honoring the Veteran's choice to participate in VA's test program, RAMP, the Rapid Appeals Modernization Program. The Veteran served on active duty for training in the United States Coast Guard Reserves from June 1975 to August 1975 and from June 1976 to September 1976. By way of background, the Veteran selected the Higher-Level Review lane when he opted in to the AMA review system in November 2018 by submitting a Rapid Appeals Modernization Program (RAMP) election form. Thereafter, the November 2018 higher level review rating decision considered the evidence of record as of the date VA received the RAMP election form and denied entitlement to service connection for PTSD and schizophrenia. In December 2018, the Veteran submitted a RAMP appeal (VA Form 21-4138) and requested the evidence submission review lane. In a decision issued in October 2019, the Board, in pertinent part, determined that it did not have jurisdiction to adjudicate the issue of service connection for schizophrenia and other psychotic disorder. The Veteran appealed that determination to the United States Court of Appeals for Veterans Claims (Court). In August 2020, the Court issued an Order that vacated the Board's October 2019 determination with respect to whether it had jurisdiction to adjudicate service connection for schizophrenia and other psychotic disorder and remanded the matter on appeal for adjudication consistent with the instructions outlined in an August 2020 Joint Motion for Partial Remand (JMPR) by the parties. The JMPR specifically instructed the Board to determine whether it has jurisdiction over the Veteran's claim for service connection for schizophrenia and other psychotic disorder. In consideration of this, the Board finds that it has proper jurisdiction over the claim for service connection for schizophrenia and other psychotic disorder. In that regard, the Board has construed the Veteran’s December 2018 RAMP appeal (VA Form 21-4138) to the November 2018 Higher Level Review rating decision to encompass all mental health disorders on appeal, to include his schizophrenia and other psychotic disorder. Accordingly, the Board will adjudicate this claim herein. Entitlement to service connection for schizophrenia and other psychotic disorder is remanded. In May 2017, the Veteran underwent a VA examination to evaluate his psychiatric disorder. The examiner diagnosed schizophrenia, paranoid type and stated that the Veteran’s symptoms of schizophrenia likely developed in early adulthood, as is typical and coincided with his enlistment and service in the United States Coast Guard. The examiner also stated that the stresses inherent in military enlistment and service were likely to have contributed to or exacerbated early symptoms of his chronic mental illness. Thereafter, in October 2018, another VA examination was provided to ascertain the etiology of his psychiatric disorder. The examiner diagnosed the Veteran with paranoid schizophrenia and rendered a negative nexus opinion. The examiner explained that the Veteran’s paranoid schizophrenia had a likely onset of early childhood and his reports of in-service stressor events were not based in reality. In spite of these examinations, the Board finds that VA examinations conducted prior to the issuance of the rating decision on appeal are insufficient for rating purposes and, therefore, remand is warranted to correct this pre-decisional duty to assist error. In pertinent part, while the May 2017 VA examiner suggested that the Veteran’s military service contributed to and/or exacerbated his schizophrenia, the examiner did not offer a rationale for his opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Furthermore, the October 2018 VA examiner appears to have suggested that the Veteran’s schizophrenia existed prior to service but did not otherwise address the possibility of aggravation due to military service. Accordingly, on remand, a new VA medical opinion is required consistent with the directives herein. The matter is REMANDED for the following action: Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's schizophrenia and other psychotic disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished and all clinical findings reported in detail. a) The examiner must identify whether there is clear and unmistakable (obvious, manifest, or undebatable) evidence that the Veteran’s schizophrenia and other psychotic disorder preexisted his active duty service. b) If it is determined that the Veteran’s schizophrenia and other psychotic disorder clearly and unmistakably preexisted service, the examiner must state whether there is clear and unmistakable (obvious, manifest, or undebatable) evidence that the preexisting disorder was not aggravated beyond the natural progression of the condition during his active duty service? Note that the term "aggravated" in the above context refers to a permanent worsening of the underlying condition, as contrasted to temporary or intermittent flare-ups of symptomatology which resolve with return to the baseline level of disability. c) If schizophrenia and other psychotic disorder is determined not to preexist service, the examiner must state whether it is at least as likely as not (i.e., 50 percent or greater probability) that such disorder is otherwise related to the Veteran's active duty service. In rendering the above opinions, the VA examiner must specifically consider and discuss the May 2017 VA examiner’s statements that the Veteran's symptoms of schizophrenia likely developed in early adulthood, as is typical, and coincided with his enlistment and service in the U.S. Coast Guard and that the stresses inherent in military enlistment and service are likely to have contributed to or exacerbated early symptoms of this chronic mental illness. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. If the examiner determines that physical/mental examination of the Veteran is necessary in order to provide the requested opinion, such should be scheduled. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. E. Metzner, Associate 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.