Citation Nr: 21012743 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-05 006 DATE: March 5, 2021 ORDER Entitlement to service connection for insomnia is denied. FINDING OF FACT The preponderance of the evidence indicates that the Veteran’s chronic insomnia is a symptom of his service-connected schizophrenia and not a separate diagnosis. CONCLUSION OF LAW The criteria for entitlement to service connection for insomnia have not been met. U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty from June 1989 to December 1991. 1. Entitlement to service connection for insomnia. To establish service connection for a disability, 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 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran claims entitlement to service connection for insomnia. Here, the medical evidence consistently shows complaints of sleep disturbance and insomnia in connection with his mental health treatment. See October 2014 Private Psychiatric Assessment. However, a symptom or a finding, without a diagnosed or identifiable underlying malady or condition, does not, in and of itself, constitute a “disability” for which service connection may be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). Thus, the issue that remains disputed is whether the Veteran’s sleep disturbance is a separate diagnosis or a symptom of his service-connected schizophrenia. The preponderance of the evidence is against the claim. During a September 2018 VA psychiatric assessment, the examiner noted that the Veteran had a diagnosis of undifferentiated schizophrenia and noted that he experienced chronic sleep impairment as a symptom of the disability. In a November 2020 medical opinion, the examiner noted that the Veteran’s schizophrenia, “takes precedence over an insomnia diagnosis. The schizophrenia will cause severe sleep deficits and will affect the sleeping as the patient is responding to internal stimuli. Diagnosing a separate insomnia disorder is not possible as all of the issues of insomnia will have an etiology encapsulated in the schizophrenia.” The examiner further explained that the due to the Veteran’s schizophrenia the internal stimuli will cause restlessness and an inability to sleep. In addition, the paranoia and internal stimuli will impede sleep patterns. The poor sleep is inherent to schizophrenia. Because the sleep issues are part of the schizophrenia, a separate insomnia diagnosis is not warranted. Regarding secondary service connection, the examiner stated that all the Veteran’s sleep issues are part of his schizophrenia and a baseline level of sleep is not possible to ascertain because sleep issues are part of the schizophrenia and not a separate issue. Thus, the sleep disorder was not aggravated beyond the natural progression by schizophrenia. The Board finds the VA examiner’s opinions adequate and probative to the question at hand. The examiner possessed the necessary education, training, and expertise to provide the requested opinions. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In addition, the VA examiner provided a detailed rationale for the opinions, which was based on an examination and interview of the Veteran, a review of the service treatment records, post-service treatment records, and the lay statements of the Veteran. The opinion considered an accurate history, were definitive and supported by a detailed rationale that considered the lay and medical evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Significantly, the Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). Veterans are entitled to have all symptoms of their disabilities rated, and separate ratings may be available for different symptoms of disability. Esteban v. Brown, 6 Vet. App. 259 (1994). However, the rating of the same symptomatology under different Diagnostic Codes, known as pyramiding, is prohibited. 38 C.F.R. § 4.14. Here, the Veteran is assigned a 100 percent rating for his service-connected schizophrenia. The criteria for rating mental disorders consider “chronic sleep impairment.” 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. Therefore, the Board finds the Veteran’s sleep impairment has been considered in his evaluation for schizophrenia and there is not a separate diagnosed disability for which service connection can be established. (Continued on the next page)   As the preponderance of the evidence is against the Veteran’s claim, the doctrine of reasonable doubt does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.A. Williams, 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.