Citation Nr: 21065949 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 15-31 131 DATE: October 28, 2021 ORDER Service connection for paranoid type schizophrenia is granted. REMANDED The issue of entitlement to compensation under 38 U.S.C. § 1151 for left knee disability is remanded. The issue of service connection for coronary artery disease (CAD) is remanded. The issue of service connection for a cerebral vascular accident is remanded. The issue of service connection for hypertension is remanded. FINDING OF FACT The Veteran's paranoid type schizophrenia began in service. CONCLUSION OF LAW The criteria for service connection for paranoid type schizophrenia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from March 1965 to March 1967 with service in the Republic of Korea. The Veteran died in August 2016. His spouse was substituted in this appeal in January 2021. Entitlement to service connection for an acquired psychiatric disorder. Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. § 1110. Service connection may be granted for any disease diagnosed after discharge 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 connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). In December 2014, the Veteran underwent a private psychological examination. The psychologist diagnosed the Veteran with paranoid type schizophrenia. The clinician stated that the Veteran had an adjustment disorder with mixed disturbance of emotions and conduct related to an episode in Korea when the Veteran had the delusion that other soldiers on guard duty were going to attack or kill him. The examiner noted that this diagnosis "went through a natural progression to frank paranoid delusional ideation and he was treated for paranoid schizophrenia for over 25 years. He continues to be delusional and hallucinating and this is more than at least as likely as not directly related to the onset of delusional symptoms on guard duty in Korea." The Veteran testified in a January 2015 hearing with a VA Decision Review Officer (DRO) that he was on guard duty at the 38th parallel in Korea and that it was "very scary, very scary," and that he started to struggle with paranoia when he was in Korea and it had continued ever since that time. As the private examiner stated that the Veteran had paranoid type schizophrenia which was caused by service, service connection is warranted and the appeal is granted. REASONS FOR REMAND 1. The issue of entitlement to compensation under 38 U.S.C. § 1151 for left knee disability is remanded. 2. The issue of service connection for CAD is remanded. 3. The issue of service connection for a cerebral vascular accident is remanded. 4. The issue of service connection for hypertension is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: The Veteran underwent left knee arthroplasty in April 2005 at the VA Medical Center (VAMC) in Huntington, West Virginia. He required a second left knee surgery in May 2007. At that time, his pre-operative diagnosis was "failed arthroplasty secondary to mechanical complications of the left knee." In a June 2012 VA medical opinion, the examiner determined that it was not carelessness, negligence or lack of proper skill, error in judgment or similar instance of fault on the part of the VAMC, but the examiner did not explain the reasoning for this conclusion or address the assertions that improper placement during the arthroplasty procedure caused bone on bone rubbing in the Veteran's left knee. Therefore, this opinion is inadequate and a new opinion is necessary. Remand of the issues of service connection for CAD and for hypertension is necessary to attempt to determine whether the Veteran was exposed to herbicide agents while serving in the Korean demilitarized zone (DMZ). The Veteran served at Camp Casey and Camp Page from August 1965 to October 1966. Although VA determined that the Veteran did not have exposure to herbicide agents in Vietnam, the Veteran did not serve in Vietnam. The RO has not made a determination regarding his exposure to herbicide agents in Korea. Remand of the issues of service connection for CAD, hypertension, and a cerebral vascular accident are also necessary to obtain VA medical opinions. Although the Veteran was afforded a VA hypertension examination in April 2012, no opinion was provided. He was not afforded examinations for CAD or a cerebral vascular accident and no opinions were obtained as to those issues. 2. Obtain a VA medical opinion from an orthopedic physician regarding additional disability following the April 2005 VA left knee surgery. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Whether the additional disability which followed the Veteran's April 2005 left knee surgery was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the hospital care, medical treatment, or surgical treatment. (b.) Whether the additional disability which followed the Veteran's April 2005 left knee surgery was not reasonably foreseeable. 3. Take all appropriate steps to attempt to verify the Veteran's asserted in-service exposure to herbicide agents while serving at the DMZ in Korea. All steps taken must be documented in the record. If exposure to herbicide agents cannot be verified, a formal finding must be issued. 4. AFTER COMPLETION OF STEP 3, obtain VA medical opinions from a physician as to the issues of service connection for CAD, hypertension, and a cerebral vascular accident, if service connection cannot be granted on a presumptive basis. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Whether CAD was caused by any in-service event, injury, disease, or disorder, or in any way originated during service. (b.) Whether a cerebral vascular accident was caused by any in service event, injury, disease, or disorder, or in any way originated during service, including as a result of exposure to herbicide agents if the Veteran was determined to have been so exposed. (c.) Whether a cerebral vascular accident was caused by CAD or by service-connected paranoid type schizophrenia. (d.) Whether a cerebral vascular accident was aggravated by CAD or by service-connected paranoid type schizophrenia. (e.) Whether hypertension was caused by any in service event, injury, disease, or disorder, or in any way originated during service, including as a result of exposure to herbicide agents if the Veteran was determined to have been so exposed. (Continued on the next page) (f.) Whether hypertension was caused by the Veteran's service-connected paranoid type schizophrenia. (g.) Whether hypertension was aggravated by the Veteran's service-connected paranoid type schizophrenia. Jacqueline E. Miller Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Nelson 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.