Citation Nr: 22015331 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 16-20 899 DATE: March 17, 2022 REMANDED Entitlement to service connection for an acquired psychiatric disorder, claimed as schizophrenia, posttraumatic stress disorder (PTSD), and a neurobehavioral disorder, to include as secondary to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States army from June 1973 to August 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in January 2019 and March 2021. The RO completed additional development and issued a supplemental statement of the case (SSOC) in December 2021. Although further delay is regrettable, the Board finds that a remand is necessary in this case. 1. Entitlement to service-connection for an acquired psychiatric disorder. The Veteran contends that he is entitled to service-connection for an acquired psychiatric disorder to include schizophrenia, posttraumatic stress disorder (PTSD), and a neurobehavioral disorder, to include as secondary to exposure to contaminated water at Camp Lejeune The Veteran's claim was last remanded in March 2021. In the March 2021 Remand, the Board found that the prior VA examination was inadequate because the January 2020 VA examiner did not provide an adequate etiological opinion. The Board also found that the October 2020 addendum opinion was inadequate because the VA examiner failed to address the Veteran's possible psychiatric symptoms in service, including fighting a corporal and multiple issues with supervisors. The Veteran was afforded a new VA examination in October 2021. The October 2021 examiner determined that the Veteran's condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner confirmed that the Veteran does have a current diagnosis of schizophrenia since 1979. The examiner found that the Veteran did not have evidence of signs or symptoms of schizophrenia during his active-duty military service such that his service treatment records do not document symptoms meeting DSM criteria for schizophrenia throughout his military service. Upon review of the Veteran's military personnel record, the Board finds that there is evidence in the record that the Veteran was recommended for administrative discharge by reason of unsuitability for apathetic and defective attitude, immature attitude, and lack of responsibility. There are also notes that the Veteran did not have respect for authority, questioned orders, and requires close supervision. The examiner did not discuss these particular issues that are documented within the record and did not opine regarding the possible etiological relationship between the Veteran's behavior as possible symptoms to an acquired psychiatric disorder. The October 2021 examiner discussed the Veteran's medical examination conducted prior to discharge on June 10, 1974 which documented a normal psychiatric evaluation. The examiner noted that the Veteran did have behavioral problems while in service, including a fight with a corporal, which led to the Veteran's discharge. The examiner noted that the fighting behavior is not a symptom of schizophrenia nor is it a behavioral change compared to the Veteran's pre-military behavior. The examiner noted that there is evidence in the claims file that the Veteran has a history of fighting and other antisocial personality traits prior to enlisting in the military. The Veteran's fighting became more problematic after the onset of schizophrenia, but the examiner determined that this was observed in relation to delusional and paranoid thoughts after the onset of schizophrenia. The examiner noted that there is no documentation of delusional or paranoid thought process in relation to fighting during the Veteran's military service, which the examiner opined further supported that the fighting behavior in service was not related to symptoms of schizophrenia. While the examiner determined that the Veteran's schizophrenia is not related to service, the examiner failed to provide an etiological finding for schizophrenia. Furthermore, the examiner indicated that the Veteran had anti-social behavior and fighting prior to service, but the examiner failed to provide an opinion on whether the Veteran's acquired psychiatric disorder existed prior to service and was aggravated due to military service. The Board finds this issue to be of particular interest because the examiner acknowledges the Veteran's behavior worsened after service and upon diagnosis of schizophrenia. Finally, the Board finds that the examiner's opinion is conflicting as the examiner found that fighting and delusional thoughts after diagnosis of schizophrenia were symptoms of schizophrenia, but those same symptoms were not prior to the diagnosis of schizophrenia. The October 2021 examiner also determined that the Veteran is not currently diagnosed with or treated for post-traumatic stress disorder. The examiner also determined that there is no evidence of record that the Veteran had signs or symptoms of PTSD while in service or after service. The Board finds that the October 2021 examiner did provide an adequate rationale that indicated that scientific literature does not support an etiological relationship between neuropsychiatric conditions, such as the Veteran's Schizophrenia, Generalized Anxiety Disorder, Cannabis Use Disorder, or Opioid Use Disorder, and exposure to contaminated water at Camp Lejeune (e.g., National Research Council, Division on Earth and Life Studies, Board on Environmental Studies and Toxicology, & Committee on Contaminated Drinking Water at Camp Lejeune, 2009). The October 2021 examiner opined that there were no signs, symptoms, diagnoses, or treatment of any of the Veteran's current acquired psychiatric disorders during his active-duty military service or within one year of discharge from active-duty military service. The examiner commented that the Veteran's substance use began recreationally prior to his military service and developed into substance use disorders sometime after his military service, after the onset of schizophrenia. The examiner stated that there is no evidence of a cannabis use disorder or opioid use disorder during the Veteran's military service or within one year of discharging from the military. The examiner further stated that there are no signs or symptoms of continuous or chronic acquired psychiatric disorder symptoms from his military service until onset of these disorders several years after discharging from the military. Therefore, there is no nexus between the Veteran's Schizophrenia, Generalized Anxiety Disorder, Cannabis Use Disorder, and/or Opioid Use Disorder and his active-duty military service, to include exposure to contaminated water at Camp Lejeune. The Board has considered the entire claims file and finds that the October 2021 VA examination is inadequate. The Board finds that the October 2021 VA examiner particularly did discuss the Veteran's behavioral issues with fighting prior to service, fighting during service and fighting after service but determined that the Veteran's fighting behavior after diagnosis of schizophrenia was related to the schizophrenia and that all other behavioral issues prior to the diagnosis were not related to an acquired psychiatric disorder. The Board finds the examiner's opinion to be conflicting and that it fails address the etiology of the Veteran's schizophrenia. The October 2021 examiner is relying on the fact that the Veteran did not have a diagnosis of schizophrenia or any other acquired psychiatric disorder during service but did not consider or explain what the symptoms or signs of schizophrenia are and whether the behavior documented in the Veteran's personnel record could be a sign or symptom of the Veteran's acquired psychiatric disorder. Therefore, remand is necessary to determine the nature and etiology of his acquired psychiatric condition(s). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, obtain an addendum opinion, from an appropriate clinician, other than a clinician who previously provided an opinion on the Veteran's claim, to determine the nature and etiology of the Veteran's acquired psychiatric disorder(s). The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, military personnel records and assertions. The examiner must address the following: a) Is it at least as likely as not (50 percent probability or greater) that the Veteran's acquired psychiatric disorder, or any diagnosed psychiatric disorder, to include schizophrenia had its clinical onset during active service or is related to the Veteran's service. The examiner is asked to consider the Veteran's behavior and any possible symptoms during service. The examiner is also asked to consider the Veteran's entire claims file to include the Veteran's military personnel records, particularly the statements of the Veteran's superior officers describing the Veteran's behavior and whether such behavior exhibits onset or symptoms of his psychiatric disorder. Particularly the examiner is asked to consider the May 1974 to August 1974 notes in the Veteran's military personnel record indicating the Veteran's behavior, unsuitability, defective attitude, and lack of responsibility. b) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's acquired psychiatric disorder existed prior to service, evidenced by the Veteran's documented behavior prior to service and if so, was the Veteran's currently diagnosed schizophrenia aggravated beyond its natural progression by his military service? 3. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Hailu, 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.