Citation Nr: A21019449 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 210617-166915 DATE: December 7, 2021 ORDER Entitlement to service connection for schizophrenia is granted. FINDING OF FACT It is not established by clear and unmistakable evidence that there was no in-service increase of the Veteran's pre-existing schizophrenia or that such increase was due to natural progression of the disability. CONCLUSION OF LAW The criteria for service connection for schizophrenia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January to May 1978. In May 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the issue on appeal most recently addressed in a May 2020 higher-level review decision. In June 2021, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision. In the June 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. The June 2021 supplemental claim decision made favorable findings that the Veteran's schizophrenia existed prior to military service and was treated during military service. The June 2021 supplemental claim decision also found the Veteran had been diagnosed with a disability as the evidence shows a diagnosis of schizophrenia. The Board is bound by these favorable findings. 38 C.F.R. § 3.104 (c). Entitlement to service connection for schizophrenia. The Veteran contends that service connection for schizophrenia is warranted because the pre-existing disorder was aggravated by active duty. The Board finds that service connection for schizophrenia is warranted. Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may also 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. To substantiate a claim of service connection, there must be evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a nexus or causal relationship between the claimed disability and the disease, injury, or event in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it preexisted service. Gilbert v. Shinseki, 26 Vet. App. 48, 55 (2012), aff'd 749 F.3d 1370 (Fed. Cir. 2014). In this case, the June 2021 supplemental claim decision made a binding favorable finding that the Veteran's schizophrenia existed prior to military service. In Wagner v. Principi, 370 F.3d 1089, 1096 (2004), the United States Court of Appeals for the Federal Circuit held if a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but the veteran may bring a claim for service-connected aggravation of that disorder. In that case, 38 U.S.C. § 1153 applies and the burden falls on the veteran to establish an increase in disability during service. If the presumption of aggravation attaches, the burden shifts to the government to show by clear and unmistakable evidence that there has been no increase in the severity of the preexisting condition or that any increase was the result of natural progression. Id; see also 38 C.F.R. § 3.306 (b). In this case, the Veteran's service treatment records include a 7-page March 1978 Report of Medical Board that reviews the Veteran's pre-service and active service medical history in detail. The Medical Board concludes that the Veteran's schizophrenia had its onset prior to enlistment but as a result of conditions peculiar to the service had progressed at a rate greater than was usual for such disorders and, therefore, was considered to have been aggravated by a period of active duty. A subsequent March 1978 Physical Evaluation Board Proceedings and Findings provides a diagnosis of schizophrenia, chronic undifferentiated, EPTE (existed prior to entrance), not aggravated. This document provides no rationale or explanation, and makes no review of, or reference to, the Veteran's pre-service or active service medical history. The Board finds that the Report of Medical Board is probative evidence that the Veteran's active duty aggravated his schizophrenia. The Report of Medical Board is based on an accurate and detailed review of the Veteran's pre-service and active service medical history. It sets forth a clear, well-reasoned conclusion that specifically refers to the Veteran's detailed medical history. This fact is particularly important, in the Board's judgment, as the references to the Veteran's medical history make for a more convincing rationale that outweighs the bare assertion that no aggravation took place set forth in the Physical Evaluation Board document. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion"). See also Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion.); Elkins v. Brown, 5 Vet. App. 474, 478 (1993) (medical opinions as to a nexus may decline in probative value where the physician fails to discuss relevant medical history). As the evidence of record shows that there was an increase in the severity of schizophrenia during service, the presumption of aggravation attaches. Again, in order to rebut the presumption of aggravation, there must be clear and unmistakable evidence that there has been no increase in the severity of the preexisting condition or that any increase was the result of natural progression. 38 C.F.R. § 3.306. Clear and unmistakable evidence is defined as obvious or manifest. 38 C.F.R. § 3.306 (b). Clear and unmistakable evidence means that the evidence "'cannot be misinterpreted and misunderstood, i.e., it is undebatable.'" Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009) A June 2021 VA Medical Opinion, based on a June 2021 VA Mental Disorders examination report, provides that the Veteran's schizophrenia, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event or illness. The Medical Opinion cites the finding of no substantial aggravation by a Navy Medical Board evaluator, but does not address the finding of aggravation in the Report of Medical Board. Further, the Medical Opinion states that the Veteran did not currently demonstrate florid symptoms of schizophrenia, such as hallucination, and his mental health was approximately at the same level of severity or less than it was prior to military service. However, the corresponding June 2021 VA examination report plainly states that the Veteran's active symptoms included persistent delusions or hallucinations. The June 2021 VA examination report also plainly states that the Veteran's schizophrenia currently resulted in total occupational and social impairment, which the Board observes could not have been the case at entrance or the Veteran would not have been admitted to active duty in the first place. Indeed, the Report of Medical Board stated, in part, that after about one week of boot camp training, the Veteran began to manifest recurrence of his symptoms. The Board finds that the June 2021 VA Medical Opinion is based on an inaccurate and incomplete review of the Veteran's active service and post-service medical history, and is thus entitled to no probative weight. See Bloom, supra. See also Prejean, supra; Elkins, supra. As there is no clear and unmistakable evidence that there was no in-service increase of the Veteran's pre-existing schizophrenia or that such increase was due to natural progression of the disability, the presumption of aggravation has not been rebutted and service connection for schizophrenia based upon aggravation of a pre-existing disability is granted. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. M. ESPINOZA Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Davitian, 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.