Citation Nr: 21042366 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 17-54 052 DATE: July 12, 2021 ORDER Service connection for a psychiatric disorder, variously diagnosed as schizophrenia, bipolar disorder, schizoaffective disorder, and atypical psychosis, is granted. REMANDED The issue of entitlement to compensation under 38 U.S.C. § 1151 for additional disability as a result of VA treatment, to include a burn injury of the right hand and bruise of the left shoulder resulting from November 2010 VA treatment, is remanded. VETERAN'S CONTENTIONS The Veteran contends that his currently diagnosed psychiatric disorder first began in service. Specifically, he asserts that he first began to experience symptoms of paranoia and anxiety in service and that those symptoms were manifestations of his current psychiatric disorder. He contends that the psychiatric symptoms continued after service to the present, prevented him from maintaining a steady job, and resulted in numerous psychiatric hospitalizations. FINDINGS OF FACT 1. The evidence establishes a current psychiatric disorder, as clinical evidence dating through August 2020 shows treatment for psychosis, chronic schizophrenia, and/or schizoaffective disorder bipolar type, including August 2019, February 2020, and August 2020 VA treatment notes. 2. The Veteran has provided competent lay evidence of an onset of psychiatric symptoms in service, including paranoia and anxiety, and there is no probative evidence that contradicts his assertions. 3. A positive nexus between the Veteran's current psychiatric disorder and his in-service psychiatric symptoms is established by a November 2018 opinion from a private psychologist indicating that the Veteran's currently diagnosed psychiatric disorder was at least as likely as not incurred during service. CONCLUSION OF LAW The criteria for establishing service connection for a psychiatric disorder are met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from August 1966 to July 1968. This matter is before the Board following his appeal of March 2015 and July 2017 rating decisions. Although the Veteran requested a Board videoconference hearing on his March 2019 substantive appeal, his attorney withdrew that request in May 2021 correspondence. Service Connection for a Psychiatric Disorder Generally, in order to prove service connection, there must be competent, credible evidence of 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). As noted in the factual findings above, the Board finds that the record establishes a current psychiatric disability, in-service incurrence of a psychiatric disorder, and competent and credible evidence of a nexus between the two. Specifically, in a November 2018 opinion, a private psychologist found that the Veteran had a long history of schizophrenia that as likely as not began over the course of his military service. The psychologist found that the Veteran's report of an insidious onset of paranoia in service was consistent with evidence of record, including May 1976 treatment records documenting a history of anxiety at that time, and subsequent records documenting various hospitalizations for psychosis or psychiatric symptoms. The examiner also found to be probative the Veteran's inability to stay employed for any length of time post service. The examiner explained that it was common for persons with psychotic disorders with an insidious onset to be able to hide or avoid coming to the attention of psychiatrists for several years, especially if they isolate or move frequently. In that vein, the psychologist noted that in switching jobs frequently, there was a limited likelihood that community members would become involved with the Veteran's psychiatric state and pressure him into treatment, thereby accounting for the absence of treatment immediately following service. The November 2018 opinion was based on an interview of the Veteran, a review of the claims file, and was supported by rationale; thus, it is deemed probative and, significantly, there is no contrary opinion of record. Moreover, the opinion is consistent with post-service clinical evidence showing treatment for psychiatric problems variously diagnosed as manic depression, atypical psychosis, psychotic disorder NOS, schizophrenia, schizoaffective disorder, and/or bipolar disorder from as early as 1976, at which time a history of psychiatric symptoms and treatment with medication were already noted. Additionally, the opinion is consistent with the Veteran's post-service reports that he had been unable to hold a job for more than a period of months since leaving service, which he attributed to his mental health. See August 1981 Private Clinical Admission; April 1984 Private Appraisal Note; October 1987 Correspondence; February 1988 VA Form 9; March 1988 Former Employer Statements; June 1988 Hearing Testimony. Given the foregoing, the Board finds that the requirements for establishing service connection for a psychiatric disorder have been met and to the extent that any reasonable doubt remains, the Board resolves all such doubt in the Veteran's favor. See 38 C.F.R. § 3.102. Therefore, the Board finds that the Veteran's current psychiatric disorder had its onset during his active duty service. Accordingly, service connection for a psychiatric disorder is warranted. REASONS FOR REMAND The issue of entitlement to compensation under 38 U.S.C. § 1151 for additional disability as a result of VA treatment is remanded. In a June 2021 memorandum, the Veteran's attorney raised the argument that the Veteran's claim for benefits under section 1151 was intertwined with his psychiatric disorder, though the nature of claim remains somewhat unclear to the Board. The Veteran initially claimed additional disability in the form of a burn on the right finger or hand and a bruise on the left shoulder as a result of VA treatment in November 2010. He has also asserted that various "marks" were placed on him during the November 2010 VA treatment, and that he was sexually and/or physically assaulted during various VA hospitalizations following service. However, it unclear whether the Veteran is claiming additional disability as a result of the alleged assaults, and if so, the nature of any additional disability. As such, the Board finds that remand is necessary for clarification as to the exact nature of the Veteran's contentions regarding benefits under section 1151, as well as an examination to assess whether the Veteran has any additional disability as a result of the November 2010 VA treatment. The matter is REMANDED for the following action: 1. Request from the Veteran and/or his attorney representative clarification as to the exact nature of the Veteran's contentions regarding entitlement to benefits under 38 U.S.C. § 1151. 2. Schedule the Veteran for an examination to determine whether he has any additional disability as a result of VA treatment. The claims file must be reviewed by the examiner in conjunction with the examination. All indicated tests should be conducted and the results reported. After reviewing the claims file and examining the Veteran, the examiner should respond to the following: (a.) Did the Veteran sustain any additional disability as a result of November 2020 VA treatment, or any prior VA psychiatric hospitalizations? To determine whether the Veteran had additional disability, the examiner should compare the Veteran's condition before the treatment, to the Veteran's condition after the treatment, including his reports of symptoms (right hand/finger burn, left shoulder bruise, and marks places on his body) and his treatment records. (b.) If the Veteran sustained additional disability, was the additional disability caused by or contributed to by VA treatment? (c.) If the Veteran sustained additional disability caused or made worse by November 2010 VA treatment or a prior VA psychiatric hospitalization, did the additional disability result from carelessness, negligence, lack of proper skill, error in judgement, or similar instance of fault on the part of VA? (d.) If the Veteran sustained additional disability caused or made worse by VA treatment, notwithstanding any informed consent documents of record, based upon the specific facts and circumstances of this Veteran's case, was the additional disability a reasonably foreseeable outcome of the VA treatment? Please provide thorough explanations and support for any opinions expressed, with a discussion of any relevant peer-reviewed literature referenced in formulating the requested opinion. If you cannot provide the requested opinions without resorting to speculation, please expressly indicate this and provide a supporting rationale as to why that is so. S. C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Fagan 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.