Citation Nr: 21067860 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 16-40 787 DATE: November 5, 2021 ORDER Service connection for an acquired psychiatric disorder is granted. FINDINGS OF FACT 1. The Veteran served on active duty from June to October 1980. 2. Symptoms of an acquired psychiatric disorder, currently diagnosed as schizophrenia, were continuous since service. CONCLUSION OF LAW An acquired psychiatric disorder is presumed to have been incurred in service. 38 U.S.C. §§ 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, the Board granted an application to reopen the claim in September 2019 and denied the appeal on the merits. The Veteran appealed to the Veterans Claims Court. In April 2020, the Court Clerk granted a Joint Motion for Partial Remand (JMPR) and returned the appeal for schizophrenia to the Board for readjudication. The Board remanded the appeal again in January 2021 and July 2021 for further development. The claim is now ready for readjudication. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Turning to the medical evidence, a March 2019 VA examination reflected a diagnosis of unspecified schizophrenia spectrum and other psychotic disorder. As such, a current disorder has been shown and the first element of service connection has been met. As to in-service incurrence, the Veteran contends that he was treated harshly by a drill sergeant which led to his psychiatric issues. The June 1980 enlistment examination indicated a normal clinical psychiatric evaluation. Shortly after enlistment, August 1980 records indicated that he lacked self-confidence and was an immature, slow learner. The September 1980 Community Mental Health Activity records show that the Veteran was evaluated after poor performance and failure to adjust. It was recommended that he be administratively separated from service due to lack of intellectual functioning and skills necessary for active duty. However, the service treatment records (STRs) did not indicate any psychiatric disorders or incidents with a drill sergeant. As such, the medical evidence does not support the in-service incurrence of an acquired psychiatric disorder. As to nexus, a March 2019 VA examiner opined that a mental disorder was not at least as likely as not the result of a service-related event. Specifically, the examiner noted that even if there were evidence that the Veteran was treated harshly by his drill sergeant, the medical evidence does not support that harsh treatment leads to unspecified schizophrenia spectrum and other psychotic disorder. Further, a February 2021 VA examiner found it less likely than not that schizophrenia had its onset in service or was otherwise related to service, to include reported mistreatment by a drill sergeant. He explained that there are a number of factors which increase the incidence of schizophrenia, including genetic factors, pregnancy and birth complications, and greater paternal age. Further, he noted that mistreatment has not been shown to increase the incidence of undifferentiated schizophrenia or psychosis. In addition, the examiner explained that psychotic features of schizophrenia typically emerge between the late teens and mid 30's. Therefore, as the Veteran was discharged from service before his 19th birthday, it was more likely that the condition which led to his administrative discharge (slow learning and low intellectual functioning) was present, but symptoms of undifferentiated schizophrenia and psychosis had yet to emerge. This evidence does not support service connection on a direct basis. As to presumptive service connection, schizophrenia is a psychosis (as defined by 38 C.F.R. § 3.384), and therefore a chronic disease under 38 C.F.R. § 3.309, and presumptive service connection will be considered. However, no chronic disease or injury was shown in service. As noted above, the STRs are silent for complaints of, treatment for, or a diagnosis of schizoaffective disorder. Therefore, the medical evidence does not support presumptive service connection on a "chronic disease or injury shown in service" basis. Next, the first recorded treatment for a psychiatric disorder was in 1982 when the Veteran was referred for a psychiatric evaluation after a suicide attempt. As this is more than a year after discharge without evidence of care until 1982, this evidence does not a finding of psychiatric manifestations within one year of discharge. In addition, the August 2021 VA examiner noted that medical records did not reflect psychiatric care until 1982. While the Veteran reported hospitalizations dating back to the early 1980's, the examiner found him to be an unreliable historian. As such, based on the lack of objective records and the unreliable reporting, the examiner found it less likely than not that manifestations of psychosis began within one year of separation. Notwithstanding the above, as to continuity of symptomatology, the record contains self-reporting by the Veteran that he had a number of psychiatric hospitalizations after discharge in 1980. As noted above, the medical evidence does not show psychiatric treatment until 1982; however, the record reflects that he had legal problems after discharge. In support of continuity of symptomatology, a November 2020 private examiner opined that symptoms once considered to be evidence of intellectual impairment during service in 1980 should now be considered negative symptoms of psychotic prodrome which were continuous until the Veteran's diagnosis of psychotic disorder between 1982 and the present. Specifically, the clinician explained that schizophrenia and other psychotic spectrum disorders typically have three phases: prodromal, active, and residual. She opined that the apathetic and "slow" behavior which resulted in discharge from active duty was consistent with negative symptoms of schizophrenia, such as poverty of speech and thought, lack of interest in activities, reduced social drive, amotivation, and inattention to social or cognitive input. As such, she concluded that these symptoms were mistaken for intellectual deficits rather than early symptoms of psychotic prodrome. On the other hand, a February 2021 VA neuropsychiatrist found it less likely than not that symptoms of undifferentiated schizophrenia and psychosis had emerged at the time of the Veteran's administrative discharge from active duty. She based the opinion on statistics regarding the typical onset of psychotic features of schizophrenia. Further, an August 2021 VA addendum opinion, a VA clinical psychologist agreed that psychotic symptoms were first exhibited in March 1982; however, the clinician noted that the question regarding the onset of symptoms remained. The clinician explained that the Veteran's history of low intellectual functioning and slow learning in school seemed to support the original VA examiner's opinion, which found that the Veteran was discharged from service due to limited intellectual functioning rather than psychotic symptoms; however, the clinician also considered that behaviors related to poor motivation, difficulties learning, substance abuse, and emotional and cognitive deficits noted in the record could also represent the negative, prodromal symptoms that emerged before psychosis. Thus, the clinician concluded that it would be mere speculation to opine if the Veteran's struggles which led to discharge from active duty were related to intellectual functioning, prodromal symptoms of schizophrenia, substance abuse, or other unknown factors. Nonetheless, the clinician indicated that to some degree, prodromal and/or active phase symptoms were more likely than not continuous since service. She based this opinion on the continued legal problems, homelessness, and other struggles encountered by the Veteran after discharge. As such, the evidence is in equipoise as to whether symptoms of a psychotic disorder were continuous since service. Therefore, given the lay statements and conflicting medical evidence, the Board affords the benefit of the doubt to the Veteran and finds that symptoms of a current psychiatric disorder were continuous since service. Therefore, the appeal is granted. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, 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.