Citation Nr: 21015583 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-54 614 DATE: March 17, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include paranoid schizophrenia, is granted. FINDINGS OF FACT 1. The Veteran entered service without a diagnosed psychiatric disorder. 2. The Veteran does not have a current diagnosis of PTSD that conforms to the DSM-5 criteria. 3. The Veteran has a current diagnosis of paranoid schizophrenia. 4. Affording the Veteran the benefit of the doubt, the Board finds that the Veteran’s currently-diagnosed paranoid schizophrenia was at least as likely as not incurred in or caused by his active duty military service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disorder, diagnosed as paranoid schizophrenia, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served from October 1972 to April 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2017 rating decision by the Department of Veterans Affairs (VA), Veterans Benefits Administration, Regional Office (RO) in Wichita, Kansas. To begin, the Board will first reiterate the Veteran’s extensive and complicated procedural history regarding his claim for a psychiatric condition, to include schizophrenia and PTSD. The claim first came to the Board in December 2000 as a claim for service connection for schizophrenia and was remanded for further adjudication by the agency of original jurisdiction (AOJ). A second claim for service connection for PTSD was denied in July 2002 and was not timely appealed and is, therefore, final. The claim for service connection for schizophrenia then came before the Board a second time in August 2003 and was remanded for further development. The issue came before the Board again in February 2007 and was remanded in order for the Veteran to be afforded a hearing before a Veterans Law Judge. In June 2009, the Veteran testified at a Board hearing conducted by a Veterans Law Judge. A transcript of the hearing was associated with the Veteran’s VA claim file. The Veteran’s claim for entitlement to service connection for paranoid schizophrenia was denied in an October 2009 Board decision. The Board found the January 1995 and May 1995 rating decisions denying service connection for paranoid schizophrenia to be final, in addition to the February 2007 Board decision denying the Veteran’s attempt to reopen the claim for service connection. The October 2009 Board decision was then appealed by the Veteran to the United States Court of Appeals for Veterans Claims (Court). A Joint Motion to Vacate the Board’s denial of the Veteran’s request to reopen his claim for entitlement to service connection for paranoid schizophrenia was issued. It was remanded the claim for further development. The motion was granted by the Court in September 2010 and the case was returned to the Board for further consideration. In an April 2011 decision by the Board, the claim was reopened after a finding that evidence submitted subsequent to the February 2007 Board decision was new and material. Again, it was remanded for further adjudication. Subsequent to the Board’s remand directives, the RO issued a September 2011 supplemental statement of the claim (SSOC) wherein the Veteran’s claim for service connection was again denied. Following the issuance of the SSOC, the claim returned to the Board in June 2012. The Veterans Law Judge who conducted the June 2009 hearing retired and the issue was again remanded for the Veteran to be scheduled for an additional hearing with a Veterans Law Judge. The claim returned to the Board in November 2012 and was again remanded due to the inadequacy of the supporting medical opinion. The Veteran was provided a VA examination in June 2013 and the issue returned to the Board in July 2014. The Board denied the Veteran’s claim for service connection for paranoid schizophrenia and found his current condition did not manifest until many years after service and was not shown by medical evidence to be related to his service. In November 2016, the Veteran submitted a statement to reopen his claim for PTSD. In a June 2017 rating decision by the RO, his claim for PTSD was denied and the Veteran timely submitted a Notice of Disagreement (NOD) in the same month. In a December 2019 decision, the Board found that—since the last prior final denial—VA has received new and material evidence to reopen the claim for an acquired psychiatric disorder, to include PTSD and schizophrenia. 38 U.S.C. § 5108; Evans v. Brown, 9 Vet. App. 273, 285 (1996). New evidence included testimony from the hearing before the undersigned Veterans Law Judge in October 2019. Therefore, given the Veteran’s long-standing mental health treatment, his testimony, and the inadequate VA examination, the Board determined a remand was necessary in order for the Veteran to be provided an additional VA psychological examination and etiological opinion. See McLendon v. Nicholson, 20 Vet. App. 79, 8186 (2006); 38 U.S.C. § 5103(d)(2); 38 C.F.R. § 3.159(c)(4)(i). The requested development has been completed and the claim is before the Board for additional appellate consideration. 1. Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) and/or paranoid schizophrenia. In this post-remand case, the Veteran contends he is entitled to service connection for an acquired psychiatric disorder to include PTSD and paranoid schizophrenia. In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. To begin, the Board notes the Veteran has a long history of mental health treatment and diagnoses to include paranoid schizophrenia, PTSD symptoms, and cannabis use disorder. Per the Board’s December 2019 remand directives, the Veteran was afforded an additional VA psychological examination in March 2020 to determine the nature and etiology of his disability. Here, the VA examiner found the Veteran does not have a current diagnosis of PTSD that conforms to the statutorily required DSM-5 criteria. Specifically, the examiner found the Veteran’s symptoms do not meet the diagnostic criteria for PTSD. However, the VA examiner did find a current diagnosis of paranoid schizophrenia which includes occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, and/or mood. Therefore, the Board finds adequate evidence of a current disability for purposes of service connection. With regard to an in-service stressor, the Veteran was afforded a hearing before the undersigned Veterans Law Judge where he vividly recounted a number of in-service stressors primarily involving personal assault. The Veteran’s military records contain sudden requests for military occupational specialty (MOS) and duty reassignments corroborating his statements regarding his concern for his safety. The Board finds the Veteran competent and credible to discuss his in-service assaults, therefore, the Board finds adequate evidence of an in-service stressor satisfying the second element necessary for service connection. As it pertains to the final element necessary for service connection, a nexus, affording the Veteran the benefit of the doubt, the Board finds the Veteran’s paranoid schizophrenia was at least as likely as not incurred in or caused by his active duty service. First, the Board notes the inadequate June 2017 VA examination. Here, the examiner based the negative opinion on the lack of documented evidence of treatment in service and is, therefore, of little or no probative value. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Second, per the Board’s remand directives, an etiological opinion was obtained. Here, the examiner stated claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service stressor. However, in the rationale section of the opinion, the examiner contradicted this statement. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service stressor but noted the Veteran was asymptomatic prior to his service. The examiner focused the opinion primarily on the Veteran’s use of drugs and alcohol while in service and after his discharge. The examiner concluded that “[i]t cannot be substantiated that veteran’s schizophrenia started during service” but below, in response to a question regarding whether any acquired psychiatric disorder other than PTSD was at least as likely as not caused by his service, the examiner noted the Veteran’s paranoid schizophrenia was at least as likely as not caused by his service. Finally, an addendum opinion seeking clarification regarding the examiner’s opinion was sought and an additional opinion was provided by a separate VA examiner in August 2020. The examiner opined that, after a thorough review of the record and affording the Veteran the benefit of the doubt, “it is opined it is at least as likely as not, that the Veteran’s Schizophrenia, paranoid type incurred in or caused during his military service.” The examiner noted the Veteran’s record is silent for any mental health diagnoses or treatment prior to service and during service but stated the Veteran has a long history with drug and alcohol use. However, the examiner distinguished that studies have shown that the onset of schizophrenia is in adolescence or early adulthood with the median aged noted to be 31. Further, the examiner explained that there are multiple factors that may contribute to the causation of schizophrenia to include genetics, hormonal changes, biological factors, environmental factors, and more but, specifically, notes schizophrenia frequently occurs with other mental health disorders, such as substance abuse. Various alcohol and drugs can mimic a number of symptoms in schizophrenia and an accurate diagnosis cannot be made until substance abuse is ruled out. The examiner noted the Veteran’s military record reveals that during his service he was present with “what appears to be ‘delusional’ thoughts about others, poor judgment, and high-risk behaviors.” The examiner concluded, given the findings in their totality, that it is at least more likely than not that Veteran's onset of early symptoms of schizophrenia were incurred during the service, and at least more likely than not were masked by Veteran's substance use at the time. Therefore, given the Veteran’s current diagnosis, evidence of high-risk behaviors and personal assault in service, and the positive nexus opinion, the Board finds the Veteran’s acquired psychiatric disorder to include paranoid schizophrenia was at least as likely as not incurred in or caused by his active duty service. Entitlement to service connection is therefore warranted for this disorder. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. DeBoer, 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.