Citation Nr: 22016309 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 14-06 958 DATE: March 21, 2022 ORDER Entitlement to service connection for a psychiatric disorder is denied. FINDING OF FACT The Veteran has a personality disorder, with no superimposed psychiatric disability. CONCLUSION OF LAW The criteria for service connection for a personality disorder have not been met. 38 U.S.C. §§ 1110, 5107 (b); 38 C.F.R. § 3.102, 3.303, 4.9, 4.127. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1977 to June 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran had a Board hearing before the undersigned in March 2017. The transcript is of the record. A November 2017 prior Board decision determined the Veteran presented new and material evidence to reopen the claim. The Board remanded for any additional medical records regarding the Veteran's mental health and to provide the Veteran with a VA examination for a nexus opinion. The RO readjudicated the claim within the Supplemental Statement of the Claim (SSOC) received September 2019. The Board finds that there has been substantial compliance with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998) (finding that a remand by the Board confers on the appellant the right to compliance with the remand orders). Service connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) evidence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also 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). Continuity of symptomatology may also provide a basis for a grant of service connection for diseases, such as tinnitus and bilateral hearing loss, defined as "chronic" by VA. 38 C.F.R. § 3.303(b), 3.307(a)(3), 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015). After careful consideration of the evidence, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, any reasonable doubt is resolved in favor of the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. However, congenital or developmental defects, to include personality disorders, are not diseases or injuries within the meaning of applicable law. 38 C.F.R. §§ 3.303(c), 4.9, 4.127; see also Terry v. Principi, 340 F.3d 1378, 1384 (Fed. Cir. 2003) (upholding VA's regulation that a congenital disorder is not a disease or injury as contemplated by 38 U.S.C. § 1110). However, service connection may be granted for congenital diseases, as opposed to congenital defects. See 38 C.F.R. § 3.303(c); VAOPGCPREC 67-90, VAOPGCPREC 82-90. The Veteran has been diagnosed with a personality disorder. Although a character or personality disorder may be a diagnosable psychiatric disability, it is not a disability for which service connection may be granted. See 38 C.F.R. § 3.303 (c) ("personality disorders... are not diseases or injuries within the meaning of applicable legislation"); 38 C.F.R. §§ 4.9, 4.127 ("personality disorders are not diseases or injuries for compensation purposes"); see also O'Bryan v. McDonald, 771 F.3d 1376, 1380-81 (Fed. Cir. 2014) (a personality disorder is an exclusion in § 3.303(c) and is excluded as noncompensable). Therefore, as a matter of law, service connection for personality disorder, NOS with schizoid, antisocial, and borderline personality features, is denied, regardless of whether it is alleged on a direct or aggravation basis. See Sabonis v. Brown, 6 Vet. App. 426, 42930 (1994). Service connection is, however, warranted only if there is evidence of additional disability due to aggravation during service of the congenital defect by superimposed disease or injury. See VAOPGCPREC 82-90; Monroe v. Brown, 4 Vet. App. 513, 51415 (1993); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); VAOPGCPREC 6790; and VAOPGCPREC 1199. Entitlement to service connection for a psychiatric disorder The Veteran contends that he has paranoid schizophrenia which originated in service. The Veteran believes he did not have any mental health issues prior to enlistment nor had any run ins with the law. He was first treated for mental health in-service. The Veteran denied having suffered any traumatic events since discharge. Within one year from separation, the Veteran was court ordered to enter a mental health facility and received a diagnosis of acute schizophrenia, which the Veteran contends should be service connected. The Board notes that a review of the Veteran's STRs shows that during his February 1977 enlistment report of medical history, the Veteran had indicated he experienced, or had experienced "nervous trouble of any sort." However, during the February 1977 enlistment report of medical examination, the Veteran was noted as normal upon clinical evaluation, to include his "psychiatric" condition. As such, the Veteran is presumed sound at service entrance. The Veteran's service treatment records (STRs) show that in May 1978, there was a psychiatric evaluation because the serviceman had reported that he developed problems in adjusting to the Air Force and had severe problems with his self-concept and in dealing with pressures in the environment. The Veteran was diagnosed with inadequate personality and paranoid personality. In the Veteran's June 1978 separation report of medical history, the Veteran had indicated he experienced, or had experienced "depression or excessive worry." Within one year from separation, the Veteran sought treatment through mental health services and was subsequently admitted into mental hospital facilities. In a November 1978 Disallowance form, the VA examiner determined the Veteran's disability is not due to service. No rationale was provided. In January 1979, the Veteran's mother filed in county probate court to have the Veteran hospitalized due to mental illness. The Veteran's mother stated that he has violent tendencies with unprovoked fits of anger and is unable to get along well with others. The mother stated that the Veteran thinks he has superpowers and believes people are out to get him. The mother described the Veteran having inappropriate fits of laughter while smiling when he is mad followed by attempts at destroying property around him. The mother believed the Veteran to be an imminent threat to himself and others and recalled the Veteran getting into physical altercations with others causing severe bodily harm. The probate court provided the Veteran with a mental evaluation and diagnosed the Veteran with paranoid schizophrenia. The treating physician reported the following symptomatology: depressed mood; inappropriate affect; hallucinations and delusions; poor judgment; poor insight; unpredictability; and insomnia. The Veteran was discharged within 5 days. The examining psychiatrist stated that the Veteran was in good control of himself and had adequate control of his temper. In a November 1979 VA examination, the examiner observed the Veteran to be in good control; well oriented to time, place, and person; reality contact seemed to be good; and a good insight and judgment. The Veteran also seemed intelligent with quite an adequate vocabulary. The VA examiner noted the Veteran attributed his inability to work to his mental condition but is competent to handle his own financial affairs. The November 1979 VA examiner further noted the Veteran's family history. The Veteran had been thrown out of his mother's home. The Veteran then moved in with his father but had conflicts with his regarding money. The VA examiner noted the Veteran's habits to be "boozing up sometimes" but denied regular drinking. The VA examiner further noted that the Veteran smoked "pot" heavily. The Veteran provided lay statements in December 1979 regarding his mental condition. The Veteran stated that he entered the military as a "proud and confident man looking to make a start." The Veteran believed his "condition derived from determined homosexuals because there's no other explanation." The Veteran stated that "its not just a personality disorder that's just part of a coverup or conspiracy." In a January 2011 social work intake questionnaire, staff reported that the Veteran did not have a mood disorder or schizophrenia but that he did have a personality disorder. In a June 2011 psychosocial evaluation, the Veteran claimed that he was discharged for a nervous condition and he believes that everyone is out to get him because of racism and jealousy. The Veteran reported "no current or historical issue with mental health issues, suicidal/homicidal ideation." The Veteran reported a family history of substance abuse; his father drank himself to death. The Veteran reported a prior conviction of second-degree murder, which he served 18 years in prison and 2 years on parole. The Veteran stated he murdered the victim due to being robbed. When asked about his cultural background, the Veteran responded by saying "the whole world is mine." The social worker noted polysubstance abuse, a mood disorder, a personality disorder, and antisocial traits. Social work records from 2011 through 2019 consistently demonstrate that the Veteran shows no evidence of delusions, hallucinations and/or formal thought disorder. The Veteran exhibited linear speech and thought process. The Veteran has a congruent mood and good hygiene. The Veteran does not have suicidal or homicidal ideations. In an August 2019 Disability Benefits Questionnaire, the VA examiner opined that the Veteran's Unspecified Personality Disorder was less likely than not (less than 50 percent probability) incurred in or etiologically related to the Veteran's military service. The Veteran stated that he received an Article 15 for possession of marijuana because "they were trying to pin things on him" and that's "what drove him crazy." The VA examiner noted the Veteran's unclear psychiatric history in which the Veteran has had previous diagnoses of personality disorder, schizoid personality disorder, paranoid personality, and anti-social personality traits. The VA examiner opined that the Veteran does not meet the criteria for a mood disorder and was diagnosed with an Unspecified Personality Disorder. After review of the evidence, the Board finds that the evidence is persuasively against the Veteran's claim of entitlement to service connection for a psychiatric disorder. Medical evidence of record, including VA examinations, document multiple mental health diagnoses for the Veteran. STRs reflect that the Veteran was diagnosed with inadequate personality and paranoid personality in May 1978 prior to separation. Thus, there is competent evidence that the Veteran has suffered an injury or experience during active service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); see Hickson v. West, 12 Vet. App. 247, 253 (1999). The issue before the Board now remains whether the Veteran's psychiatric disorder is etiologically related to his military service. The Board finds the August 2019 VA examiner's opinion to be well-reasoned and thorough, having considered the entire record, including service treatment records, the Veteran's medical and family history, and provides specific medical evidence for the opinion rendered. The Board finds that the VA examiner's opinion is the most probative evidence of the record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Within the rationale, the VA examiner noted scientific research suggesting genetics and environmental factors, such as childhood abuse, contribute to the development of personality disorders. The VA examiner found only personality disorder and no signs of a mood disorder. The August 2019 VA examiner concluded that it is less likely than not that the Veteran's unspecified personality disorder was incurred or caused by the acquired psychiatric disability noted in the Veteran's STRs. No evidence to the contrary is of record. The Board acknowledges that the Veteran, in his lay statements, indicated that he was diagnosed with a paranoid personality and inadequate personality in service. To the extent the Veteran believes 6 months in service caused his unspecified personality disorder, the Board finds his account lacks credibility as the statements are not supported by the record. See Macarubbo v. Gober, 10 Vet. App. 388 (1997) (holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor). Service treatment records indicate that the Veteran experienced some sort of trauma prior to enlistment due to his father's alcoholism, his lay statements regarding his inability to get along with others, substance use, and his belief that other people are out to get him. The Board has considered the lay statements of the Veteran. While lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). In this case, the question at issue is clearly one requiring medical expertise and falls outside of the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 n. 4 (Fed. Cir. 2007). To the extent that the Veteran alleges that his service contributed to his unspecified personality disorder, while he is competent to describe the symptoms that he experienced, he is not competent to render a nexus opinion. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau, 492 F.3d 1372; Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Due to the Veteran's period of incarceration and desire to avoid mental health treatment, the record is silent as to mental health treatment from 1987 to 2011 when the Veteran provided new and material evidence to reopen the service connection claim. With the exception of the Veteran's lay statements and a 1979 court-ordered evaluation, there is no other diagnosis of schizophrenia. Social workers consistently describe the Veteran as having a linear thought process with no evidence of delusions or hallucinations. See Curry v. Brown, 7 Vet. App. 59 (1994) (a Veteran's version of events from the past may be of limited credibility and probative value in the absence of medical records showing treatment for the claimed disorder). However, the record demonstrates a consistent personality disorder diagnosis. The last diagnosis of schizophrenia occurred decades ago, and the record does not reflect any psychiatric treatment for schizophrenia. Thus, the Board does not find the Veteran to have an additional psychiatric disorder that is superimposed upon a personality disorder. The Board acknowledges that disability resulting from a psychiatric disorder that is superimposed upon a personality disorder may be service connected. See 38 C.F.R. § 4.27. However, the record does not reflect a subsequently diagnosed acquired psychiatric disorder that was due to aggravation during service of his diagnosed personality disorder by a superimposed disease or injury. Based on the foregoing, the Board finds the evidence to be persuasively against the claim for service connection for an acquired psychiatric disorder, to include schizophrenia. Accordingly, the benefit-of-the-doubt rule does not apply, and the claim is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102; 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Upon review of the evidence of record, the Board finds that service connection for a personality disorder is precluded as a matter of law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). In making this finding, the Board notes that personality disorders do not constitute a disability for VA compensation purposes, and therefore, cannot be granted service connection. 38 C.F.R. §§ 3.303, 4.9, 4.127. (Continued on the next page) The Board acknowledges that disability resulting from a psychiatric disorder that is superimposed upon a personality disorder may be service connected. See 38 C.F.R. § 4.27. There is no evidence of additional disability due to aggravation during service of the personality disorder (a congenital defect) by superimposed disease or injury. The evidence fails to establish evidence of additional disability due to aggravation during service of the personality disorder by superimposed disease or injury. As such, the claim for service connection for a personality disorder is denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Clevenger, Gordanna A. 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.