Citation Nr: 21008207 Decision Date: 02/12/21 Archive Date: 02/12/21 DOCKET NO. 15-06 477A DATE: February 12, 2021 ORDER Service connection for schizoaffective disorder is denied. FINDING OF FACT The Veteran’s schizoaffective disorder did not have onset during active service, was not caused by service, did not manifest within one year of separation from active service, and is not otherwise causally or etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, to include schizoaffective disorder, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1984 to August 1986. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. This matter was previously before the Board in November 2018. At that time, the Board denied the Veteran’s application to reopen his claim for service connection for an acquired psychiatric disorder, to include major depressive episode without psychotic features, drug/alcohol abuse, depression, bipolar disorder, and schizoaffective disorder. The Veteran’s claim for service connection for major depressive episode, severe without psychotic features, had been denied in a May 2005 rating decision that became final. The Board concluded that the evidence submitted since that decision was new but not material, and thus did not warrant reopening of the claim. The Veteran appealed to the Court of Appeals for Veterans Claims (CAVC), which vacated the November 2018 decision pursuant to a Joint Motion for Remand (JMR) entered into by the Veteran and VA. Pursuant to the terms of the JMR, the parties agreed that the earliest diagnosis of record for schizoaffective disorder was November 2006, more than a year after the May 2005 decision. The JMR noted that the Board did not address the evidence of a new diagnosis or determine whether it was a distinctly diagnosed condition from those previously denied, such that the claimant was entitled to benefit from the notice and assistance procedures applicable to newly filed claims without having to prove that the evidence submitted is both new and material. Following the JMR, the Board found that the claim for service connection for schizoaffective disorder represented a distinctly diagnosed condition that has a medical cause that is separate from that associated with the diagnoses for major depressive episode without psychotic features considered in the May 2005 rating decision. The RO was directed on Remand to afford the Veteran an examination to determine the nature and etiology of his schizoaffective disorder. In relation thereto, the examiner was also asked to consider whether the Veteran’s reports of depression and substance abuse were related to or precursors to his later diagnosed schizoaffective disorder. The Board has considered whether, consistent with the Veterans statements, his treatment records, and Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Veteran’s claim for service connection for schizoaffective disorder should be expanded to include any acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and other information of record). However, in this case, the Veteran’s claims for service connection for other psychiatric disorders have already been adjudicated. The scope of this appeal is limited to entitlement to service connection for schizoaffective disorder. Entitlement to Service Connection for Schizoaffective Disorder. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active duty service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Generally, to establish service connection, the evidence must show (1) the existence of a present disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury (or an in-service aggravation). Shedden v. Principi, 381 F.3d 1163, 1168 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, such as psychoses, are subject to presumptive service connection if manifested to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).   If there is at least an approximate balance of positive and negative evidence regarding any issue material to the claim, the Veteran shall be given the benefit of the doubt in resolving each such issue. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). The question for the Board is whether the Veteran has a current acquired psychiatric disorder that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has current psychiatric disorders, the preponderance of the evidence weighs against the contention that disorders began during service or ar otherwise related to an in-service injury, event, or disease. The Veteran was first diagnosed with schizoaffective disorder in November 2006, and VA treatment records reflect that the Veteran was diagnosed with schizoaffective disorder during the claim period. Specifically, the Veteran was admitted for inpatient mental health treatment and received treatment for mental health issues throughout 2013 and 2014 with a diagnosis of schizoaffective disorder. The diagnosis of schizoaffective disorder meets Shedden element (1) with respect to current disability. The Board now turns to the question of nexus. Service treatment records are silent regarding complaints, treatment, or diagnosis of a schizoaffective disorder during the Veteran’s service. and post-service treatment records do not show a diagnosis for schizoaffective disorder during the presumptive period after service. The Veteran’s May 1986 separation examination included a note of situational depression but did not afford any psychiatric diagnosis at that time. The Veteran contends his schizoaffective disorder is related to a head trauma sustained in service, but there are no service records nor post-service records that substantiate a head injury during service. January 2014 medical records do reflect the Veteran being followed by psychiatry for over 15 years after a head trauma; however, this incident is noted have taken place well after the Veteran’s period of service. Nevertheless, the Veteran is competent to report that he had some type of head trauma in service. Consideration has been given to the Veteran’s lay statements, including regarding his contention that his psychiatric disorders are connected to a head injury sustained during service. As a lay person, the Veteran is competent to report what comes to him through his senses, such as reporting head trauma, but he lacks the medical training and expertise to provide a complex medical opinion as to the etiology of a mental disorder. See Layno v. Brown, 6 Vet. App. 465 (1994), Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). His opinion is insufficient to provide the requisite nexus. It is also significantly outweighed by the August 2020 examination report discussed below. The Veteran’s medical records reflect recurring documentations of schizoaffective disorder, including inpatient and emergency mental health hospitalization and treatment reports spanning from 2006 to 2014. Those records do not provide nexus opinions linking the Veteran’s disorder to his service. In August 2020, the Veteran was afforded a VA examination to address the nature and etiology of the claimed schizoaffective disorder. There, the VA examiner assigned diagnoses of severe stimulant use disorder, cannabis use disorder, substance-induced mood disorder, antisocial personality disorder and unspecified mood disorder, but not schizoaffective disorder. The examiner explained that the Veteran did not meet criteria for schizoaffective disorder at the time of the exam, and that the records better support that any psychotic and mood symptoms experienced by the Veteran are substance induced. Further, in a broader context, the examiner determined the Veteran’s mental health disorders are less likely than not related to a head injury or traumatic brain injury incurred in service as there is no record of such an event. He also emphasized that the Veteran was not diagnosed with schizoaffective disorder during service, that the separation exam does not support the presence of a schizoaffective disorder upon exiting service, and the records do not suggest the Veteran was suffering with schizoaffective disorder during the presumptive period after service. Rather, the examiner found that the Veteran’s psychotic symptoms emerged many years after service as the result of substance abuse. The examiner also noted the Veteran denied any history of psychosis at the time of the exam aside from that occurring during drug-induced sleep deprivation. The examiner acknowledged that the separation examination indicate situational depressive symptoms. However, it was determined that this notation did not support the presence of schizoaffective disorder or a depressive disorder upon exiting service. The examiner pointed to a mental status exam in May 1986 that was normal, with a clarifying statement noting the absence of a thought disorder. The examiner noted that psychiatric records over the past few decades suggest a long history of polysubstance abuse with mood and psychotic symptoms during periods of heightened use. In that regard, he cited to a 2004 medical note wherein it was indicated that the Veteran developed auditory hallucinations during an 8-day period of cocaine-induced sleep deprivation. He added that, when sober from substances, the Veteran reportedly suffers depressive symptoms related to life consequences of severe drug abuse. Similarly, some depressive symptoms were observed to represent a motivational syndrome related to chronic marijuana use and/or lingering effects of substance abuse. Reference was made to research studies that supported this premise. In short, the examiner found that the records tie the Veteran’s mood and psychotic symptoms to chronic drug abuse, not a head injury or any other stressful event during military service. The August 2020 VA medical opinions is found to be persuasive and based upon adequate rationale. The examiner is shown to have reviewed of the evidence of record and to have adequately considered the credible lay statements and reported symptom manifestation history of record. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). There is no competent opinion to the contrary. As to the Veteran’s diagnoses relating to substance abuse disorders, and to the extent that he relates that diagnosis to service to being the cause of his schizoaffective disorder, service connection is generally denied to any disability that is a result of a veteran’s willful misconduct or abuse of drugs or alcohol. 38 U.S.C. § 1110; 38 C.F.R. § 3.301. For service connection to be granted for drug abuse, it must be established as secondary to, or a component of, a service-connected disability. The Board has found that the Veteran is not entitled to service connection for an acquired psychiatric disorder and the record does not support a secondary service connection for any psychiatric diagnoses. Indeed, the record shows instead that the Veteran’s substance dependence history pre-dated his schizoaffective by many years and may have even pre-dated his active service. Accordingly, service connection for his diagnosed substance abuse disorders is precluded. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (holding that where the law and not the evidence is dispositive, the Board should deny the claim based on a lack of legal merit). The Board finds there is no nexus between the Veteran’s schizoaffective disorder and his active service, and service connection for schizoaffective disorder is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.N. Bush, 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.