Citation Nr: 21073580 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 16-41 587 DATE: December 9, 2021 ORDER Entitlement to service connection for an acquired psychiatric condition, including post-traumatic stress disorder (PTSD) and schizophrenia, is granted. FINDING OF FACT Resolving all reasonable doubt in his favor, Veteran's PTSD and schizophrenia had their onset during or are otherwise etiologically related to his service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric condition, to include PTSD and schizophrenia, have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from July 1984 to September 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office. In August 2021, the Veteran testified before the undersigned at a hearing. A transcript of his testimony has been associated with the claims file. At the outset, the Board notes that although the Veteran filed a claim for PTSD, the record also reflects diagnoses of various other mental health conditions, including schizophrenia. As such, the Board has broadened the characterization of her claim on appeal to entitlement to service connection for an acquired psychiatric condition to recognize this fact. See Clemons v. Shinseki, 23 Vet. App. 1 (2009); Brokowski v. Shinseki, 23 Vet. App. 79 (2009). Service Connection Generally, the Veteran contends that his acquired psychiatric condition had its onset during service and that his symptoms have continued up until the present. More specifically, he contends that he was stationed aboard Navy ships in the Persian Gulf and that he was constantly afraid that the ships would be attacked. Additionally, the record illustrates that he has reported to medical treatment providers that he began hearing voices and feeling increasingly paranoid towards others while he was in the Navy. Service connection may be granted if there is a disability resulting from personal injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish service connection, the evidence must show (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). With respect to PTSD specifically, establishing service connection for PTSD requires (1) a current medical diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. See 38 C.F.R. § 3.304(f). Additionally, service connection for certain chronic diseases, such as psychoses, may be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307 (a). The term "chronic disease" refers to those diseases listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C. § 1101 (3); 38 C.F.R. § 3.309 (a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where a chronic disease under 3.309(a) is shown as such in service or in the presumptive period so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). In cases where a chronic disease is "shown as such in service," the Veteran is "relieved of the requirement to show a causal relationship between the condition in service and the condition for which service-connected disability compensation is sought." Walker, 708 F.3d at 1336. Instead, service connection may be granted for subsequent manifestations of the same chronic disease without any evidence of link or connection between the chronic disease shown in service and manifestations of the same disease at a later time. In other words, "there is no 'nexus' requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease." Id. If evidence of a chronic disease is noted during service or during the presumptive period, but the chronic condition is not "shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned," i.e., "when the fact of chronicity in service is not adequately supported," then a showing of continuity of symptomatology after discharge is required to support a claim for disability compensation for the chronic disease. Proven continuity of symptomatology establishes the link, or nexus, between the current disease and serves as the evidentiary tool to confirm the existence of the chronic disease while in service or a presumptive period during which existence in service is presumed. Id. at 1339. Turning to the first element of the service connection framework, a current disability, the record contains diagnoses for schizophrenia and PTSD. For instance, in a July 2021 private psychological evaluation, Dr. F.P. diagnosed chronic and severe PTSD, as well as schizophrenia. These diagnoses were based on the history of symptoms reported during a clinical interview with the Veteran, as well as Dr. F.P.'s observations during the clinical interview, a detailed assessment of post-traumatic stress, and other psychological tests that were administered. Additionally, the claims file contains multiple records that reflect diagnoses of schizophrenia, including a December 1998 VA examination, a November 2012 VA examination, medical treatment records from New Horizons of the Treasure Coast, and VA treatment records. Although a July 2016 VA examiner opined that no mental health diagnosis could be made rendered without resorting to mere speculation because the Veteran was likely overreporting his symptoms, the Board finds this examiner's opinion has limited probative value. This is because the July 2016 VA examiner did not provide a detailed explanation or attempt to reconcile his opinion with the various other medical records diagnosing schizophrenia. The preponderance of the evidence thus weighs in favor of finding that the Veteran has current diagnoses of PTSD and schizophrenia. Regarding the second element of the service connection framework, an in-service incurrence of an injury or disease, the Board notes that VA has conceded that the Veteran experienced a stressor due to his fear of hostile military or terrorist activity during service. To that end, the records indicate that he was stationed aboard the U.S.S. McClusky from January 1985 to January 1989 and the U.S.S. Truxtun from March 1992 to September 1993 during service. During that time, he was stationed aboard the U.S.S. McClusky while it participated in minesweeping operations in the coastal waters of Kuwait and the Gulf of Oman during Operation Earnest Will. The Board takes judicial notice that Operation Earnest Will lasted from 1987 to 1988. As such, the evidence indicates he experienced an in-service stressor. Additionally, although his separation examination did not indicate that he was diagnosed with any mental health conditions such as schizophrenia at the time of his discharge, his service records reflect a history of behavioral issues that began shortly after Operation Earnest Will concluded. For instance, in November 1988 he was placed on restriction pending disciplinary action in connection with violating the Uniform Code of Military Justice (UCMJ) for providing alcoholic beverages to underage people. In January 1989, his enlisted performance evaluation report was referred due to derogatory comments. A January 1990 record indicates additional misconduct in the form of alcohol abuse. Subsequently, he was found to have violated the UCMJ due to unauthorized absences and for being incapacitated for the proper performance of duty, resulting in a reduction in paygrade from E-4 to E-2 and restriction/extra duty for 30 days in November 1990. In February 1992, he was advised that his record reflected additional alcohol-related incidents. Later, in February 1993, he was found to have violated the UCMJ due to simple assault and placed on restriction and extra duty for 45 days. Although he received alcohol abuse rehabilitation education, he failed to meet the requirements of the program and was found to have failed alcohol abuse rehabilitation in August 1993. For this reason, he was recommended for separation by reason of alcohol abuse rehabilitation failure and discharged in September 1993. This evidence corroborates the Veteran's testimony that his performance began to suffer during service due to the onset of mental health issues. Regarding the third element of the service connection framework, a causal nexus between in-service events and a current disability, the Board finds that the evidence is at least evenly balanced with respect to whether the Veteran's PTSD is related to his military service. To that end, the Veteran reported experiencing various psychiatric symptoms, such as anxiety and difficulty sleeping, since being discharged from service. He testified that, although he was commended for good conduct during the first portion of his service, something about him changed during the second half of his service and his performance began to suffer. As set forth above, his service records indicate that he began experiencing issues such as alcohol abuse beginning in 1988 following Operation Earnest Will. The short gap in time between his reported stressor and the onset of his behavioral and disciplinary issues is highly probative. Additionally, Dr. F.P. opined in his July 2021 psychological report that the Veteran's clinical profile indicated significant PTSD symptomatology due to his military service. The report stated that he exhibited problems in his relationships with others and "in general manifests more problems in his life" since his service, such as problems concentrating, restlessness, difficulty concentrating, jumpiness, hypervigilance, a heightened startle response, forgetfulness, depressed mood, isolating from others, avoiding upsetting thoughts or feelings regarding his military experience, a foreshortened sense of the future, and nightmares. Although Dr. F.P.'s opinion is somewhat conclusory, it is generally supported by the other evidence of record, such as the Veteran's testimony, and there are no opinions in the record that directly contradict it. As such, the Board finds that the Veteran's current diagnosis of PTSD at least as likely as not is related to his in-service stressors. Additionally, although service records did not specifically address whether he had a diagnosis of schizophrenia or psychotic symptoms during service, the Board finds that the evidence is at least in equipoise with respect to whether there has been a continuity of psychotic symptoms since that time. In this regard, the Veteran reported at a general VA examination in December 1998 that he felt like people were always talking about him or trying to kill him and that he had experienced these feelings for "a long time." The VA examiner indicated that he experienced auditory hallucinations, ideas of reference, and paranoid delusions. The Veteran also endorsed similar feelings while he was in the Navy, such as feelings that he was not being treated fairly but could not talk with anyone about it because "everyone on the ship was in on the conspiracy." His statements regarding the onset of his symptoms are considered exceptionally trustworthy, as they were made prior to the filing of a claim for an acquired psychiatric condition. See White v. Illinois, 502 U.S. 346, 356 (1992). Likewise, he reported paranoia for most of his adult life in a December 2012 private treatment record and that he had been hearing voices since he was in the Navy in a February 2014 private treatment record. Although no chronic mental health condition was diagnosed during service, the evidence shows that he has continuously experienced schizophrenia symptoms since that time. This continuity of his psychotic symptomatology establishes the link between his current schizophrenia and his military service. As such, the Board finds that the evidence is at least in equipoise with respect to the continuity of his psychotic symptomatology since service. Resolving all reasonable doubt in the Veteran's favor, the Board thus finds that service connection for an acquired psychiatric condition, including PTSD and schizophrenia, has been established. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Rademacher, 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.