Citation Nr: 21024675 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 15-03 285 DATE: April 23, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, including schizophrenia with depression, is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran’s diagnosed acquired psychiatric disorder, including schizophrenia with depression, had its onset in service or is etiologically related to his active service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disorder, including schizophrenia with depression, are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 2001 to July 2007. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2018, a Board hearing was held before the undersigned. A transcript of the hearing is of record. The Veteran waived RO consideration of any additional evidence added to his file. The appeal was remanded by the Board in July 2018 for additional development, to include affording the Veteran a VA examination and obtaining an opinion as to the etiology of his psychiatric disorder. After review of the development accomplished by the AOJ, the Board concludes there has been substantial compliance with the July 2018 Board remand and no further development is necessary as to this appeal. See Donnellan v. Shinseki, 24 Vet. App. 167, 176 (2010) (“It is substantial compliance, not absolute compliance, that is required” under Stegall v. West) (citing Dyment v. West, 13 Vet. App. 141, 146-47 (1999)). Service Connection The Veteran claims the initial onset of his psychiatric disorder, diagnosed as schizophrenia with depression, was during his period of active duty service. See, e.g., January 2015 VA Form 9, Appeal to Board of Veterans Appeals, and April 2018 Board hearing transcript. Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. § 1110. Service connection may 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(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999); see 38 C.F.R. § 3.303(a). Finally, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Specifically, “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). 1. Acquired Psychiatric Disorder Certain chronic diseases (including psychoses (but not PTSD)) may be presumed to have been incurred in service if they become manifest to a degree of 10 percent or more within a specified period of time post-service (one year for the aforementioned disease). 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The record reflects current diagnoses of schizophrenia, paranoid type, and depression. Thus, the question for the Board is whether there exists an in-service event, injury, or disease relevant to an acquired psychiatric disorder, and whether there is a nexus between a current psychiatric disorder and military service, or whether a psychosis manifested to a compensable degree within the first post-service year. See Holton, 557 F.3d at 1167. The Veteran’s service treatment records (STRs) are silent as to findings of or treatment for mental health symptoms. His April 2001 enlistment examination shows he was clinically normal on psychiatric evaluation. These records show the Veteran elected not to undergo a service separation examination. Post service records include an October 2007 report of VA General Medical Examination which shows the Veteran reported “some mild depression which he states is situational because of the stresses of college.” Private treatment records include a July 2011 discharge summary which notes this was the Veteran’s first psychiatric admission. He reported he had a “top secret code and that the military put a device in his wisdom tooth.” VA treatment records include a February 2012 mental health assessment which notes the Veteran reported being diagnosed with ADHD as a child in second grade and recalled hearing “rare voices when in the USAF, he started having more voices last summer.” An October 2012 Discharge Summary (for private mental health treatment) notes the Veteran had been admitted in September 2011 after he had been found incompetent to stand trial (he had been charged with robbing a gas station). It is noted the Veteran reported he had started hearing voices when he was in the military (one time) and the voices had come back (more frequent, 24 hours a day) in the last 9 months (he was also seeing things, talking to himself, stated Satan was controlling him and was delusional). During his April 2018 Board hearing, the Veteran recalled that he heard voices during service which increased in frequency after separation. In addition, his father recalled being concerned about the Veteran during his active duty service because the Veteran whispered while talking on the telephone and seemed nervous about his surroundings. A July 2018 statement from the Veteran’s treating physician, received after the claim was remanded, notes that the Veteran “reports some paranoia and auditory hallucinations while in the military which is consistent with the normal history of schizophrenia which usually has an onset in the late teens or early twenties precipitated by a stressor like military service.” The physician opined that “it appears [the Veteran’s] symptoms first started while he was in the military and have continued to have a negative impact on his life.” An April 2019 VA examination report includes diagnoses of cannabis induced psychotic disorder with hallucinations, amphetamine induced bipolar and related disorders, moderate cannabis use disorder and mild amphetamine type substance use disorder. The examiner referred to a December 2018 treatment report noting “initially hearing voices in 2nd grade” would indicate the Veteran’s psychotic disorder preceded military service. Notwithstanding this finding, after interview and examination of the Veteran and review of his claims file, the examiner opined, “given extensive documentation of substance dependence in concert with both mood and psychotic symptoms leading to both arrest and psychiatric hospitalization, the most likely etiology is substance abuse. Given the above, I cannot provide a nexus between his diagnoses, and military service.” In support of his appeal, in December 2019 and February 2020, VA received numerous statements from the Veteran’s family, friends and fellow service members recalling his behavior prior to enlistment, the changes during active duty service and since service separation. These statements include a December 2019 statement from a fellow service member with whom the Veteran served from August 2001 to 2006. The fellow service member recalls noticing the Veteran’s “behavior had become ‘off,’” the Veteran felt “someone was always listening to us everywhere we went,” sometimes referred to himself in the third person and once “took someone’s food without asking and started eating it and sat down on a chair and started spinning around and around.” The fellow service member recalled that the Veteran exhibited “odd behavior” and “people just didn’t know what he was doing or how to react.” A December 2019 statement from the Veteran’s college roommate, from late 2007 or early 2008, recalls the Veteran’s sensitivity to noise, paranoia and seeing thing that weren’t there. In a February 2020 statement, another service member recalls knowing the Veteran between 2002 and 2004 and not being surprised to hear the Veteran had been diagnosed with a mental illness. This service member recalls the Veteran was “very skittish, very paranoid. He had mood swings. He had a very short attention span.” Similar statements have been provided by family members of the Veteran. A March 2020 independent medical opinion shows clinical videoconference interview of the Veteran and review of his medical history and includes the assessment that the “record since discharge clearly shows the classic course of Schizophrenia with onset in service.” After discussion of the Veteran’s medical history and consideration of the July 2018 statement in support of the claim as well as the April 2019 VA opinion that the examiner was unable to find a nexus between the Veteran’s psychiatric diagnoses and his military service, the independent medical examiner opined that the Veteran’s “schizophrenia began while he was on active duty and has continued to the present time.” Initially, it is noted that the Veteran’s April 2001 enlistment examination is negative for an acquired psychiatric disorder, let alone a psychosis. The Board recognizes the medical and lay evidence reflecting the Veteran’s reports that he had ADHD (attention deficit hyperactivity disorder) and heard voices in 2nd grade. The Board however finds that these reports alone do not amount to clear and unmistakable evidence that a psychiatric disorder pre-existed the Veteran’s active duty service. Absent clear and unmistakable evidence showing that the Veteran had an acquired psychiatric disorder, including schizophrenia with depression, prior to service entrance, he is presumed to have been mentally sound upon his service entrance. As described above, the record includes multiple VA and private opinions addressing the etiology of the Veteran’s acquired psychiatric disorder. The Board has considered in detail the medical opinions of record and finds that no one opinion is any more probative than the other. The opinions are in relative equipoise. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990) (holding that an appellant need only demonstrate that there is an “approximate balance of positive and negative evidence” in order to prevail). Therefore, resolving all doubt in favor to the Veteran, the Board finds that the evidence supports a nexus between the Veteran’s current acquired psychiatric disorder, including schizophrenia with depression, and his military service. As all elements of service connection have been satisfied, service connection for an acquired psychiatric disorder, including schizophrenia with depression, is granted. See 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(d). Additionally, to the extent that the record contains differing psychiatric diagnoses, this represents a full grant of the benefit sought on appeal and is intended to encompass all psychiatric symptomatology of record. See Mittleider v. West, 11 Vet. App. 181 (1998) (holding that the Board is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and a service-connected disability in the absence of medical evidence that does so). Notably, the extent of the Veteran’s now service-connected acquired psychiatric disorder is not before the Board at this time. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K Hughes 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.