Citation Nr: 22045474 Decision Date: 08/11/22 Archive Date: 08/11/22 DOCKET NO. 14-20 987A DATE: August 11, 2022 ORDER Entitlement to service connection for an acquired psychiatric disability, to include schizophrenia is granted. FINDING OF FACT The evidence is in equipoise as to whether the Veteran's schizophrenia is at least as likely as not related to his service. CONCLUSION OF LAW The criteria for entitlement to service connection for an acquired psychiatric disability, to include schizophrenia, have been met. 38 U.S.C. § 1131 (West 2012); 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1975 to October 1979. In a May 2018 Board decision, the Board denies the Veteran's claim to reopen a claim of entitlement to service connection for schizophrenia. The Veteran appeals to the United States Court of Appeals for Veterans Claims (Court). In a September 2019 Joint Motion for Remand, the parties agree that a remand is warranted. In a March 2021 Board decision, the Board finds that new and material evidence has been received, reopens the Veteran's claim, and remands for further development. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Here, the evidence reflects that the Veteran has a current diagnosis of schizophrenia. See September 1997 VA treatment records. Thus, the first element of service connection is satisfied. Next, the evidence reflects that during service, the Veteran experienced mental health symptoms. For example, the Veteran's service treatment records reflect that during service, the Veteran suffered from symptoms such as "maladjustment," "explosive behavior," "suicidal ideas," "and problems controlling his temper." Therefore, the second element of service connection is satisfied. Given such, the dispositive issue in this case is whether the Veteran's in-service mental health symptoms are related to his diagnosis of schizophrenia. More specifically, the Board finds the issue is whether the Veteran's in-service mental health symptoms are attributed to a personality disorder or early manifestations of his current diagnosis of schizophrenia. Based on the evidence discussed in detail below, the Board finds that the medical evidence of record is in equipoise as to whether the Veteran's schizophrenia is at least as likely as not related to his in-service mental health symptoms. In an October 1973 enlistment examination report there is no note of any psychiatric conditions upon entry into service. See October 1973 enlistment report. In December 1978, the Veteran underwent a mental health assessment. The examiner notes that the Veteran has difficult managing his temper. By September 1979, it was recommended the Veteran be discharged due to a personality disorder. The associated examination report notes that the Veteran does not have a significant mental illness but did have a personality disorder. The examiner notes that the Veteran has been experiencing more stress than what he can usually handle without exhibiting signs of maladjustment. "Now he is getting close to explode; his behavior has become passive-aggressive type; he has entertained suicidal ideation; and he was not holding any hope..." According to the Veteran, the Army gave him the option of being committed to the hospital for two weeks or discharge, and he opted for discharge. In this regard, the Veteran contends that his in-service symptoms such as "maladjustment," "explosive behavior," "suicidal ideas, "and problems controlling his temper" were early manifestations of his current diagnosis of schizophrenia. Here, the Veteran attributes his symptoms to the extreme conditions of his military occupational specialty (MOS) training and its effect on his mental state. The Veteran contends that he served both as an Amor Crewman and Tank Driver attached to the 3rd Armor Calvary Regimen and under the command of the 9th Infantry Division. While the Veteran contends that he did not see combat, he feels his experience as a crewman and tank driver was on par with what is experienced in actual combat scenarios. For example, the Veteran contends that his MOS requires an armor crewman to undergo at least fifteen weeks of training, with a portion conducted "in the field under simulated combat." The Veteran's post-service treatment records reflect that the Veteran had a probable personality disorder. By March 1998, the Veteran's VA treatment records reflect a diagnosis of schizophrenia. In a December 2020 private medical opinion, Dr. M.C. notes that the Veteran had an onset of psychotic symptoms during his service, which persisted throughout the remainder of his military service, progressing rapidly during civilian life, leading to his diagnosis of schizophrenia. Furthermore, the examiner finds that there is "absolutely no indication" that the Veteran has a diagnosis of a personality disorder." The examiner further notes that the Veteran's "precipitous psychiatric decline" stems from an initial psychotic break, while on active duty in 1979. More specifically, Dr. M.C. explains that the Veteran's training included combat simulations that approximated the level of stress experienced in actual combat. Moreover, Dr. M.C. cites to a 1976 U.S. Army study that scrutinizes the "psychological (and associated physiological)" impact of tank crews operating in such circumstances, finding these training exercises can result in common psychiatric symptoms. Dr. M.C. notes that the findings of this study are consistent with the Veteran's personal account of his military training, as he reports "all [his] training (during peace time) was about kill, kill, kill" which led him to hearing voices and wanting to kill himself. See February 2012 VA Form 21-4138. In formulating this opinion, Dr. M.C. reviews and discusses the Veteran's history. In December 1978, the Veteran sought counseling for history of child abuse. He had difficulty controlling his temper and injured hs one year old stepson. The Veteran's min-mental status examination was normal, and the Veteran entered group counseling with no specific psychiatric diagnosis. Unfortunately, he attended only two sessions. In September 1979, the Veteran underwent a psychiatric evaluation. His mood was tense and depressed. He was diagnosed with personality disorder, explosive type. In September 1994, the Veteran had a physical examination for mental problems, in which he notes that he has difficulty with interpersonal interactions and difficulty maintaining employment. He was referred to a psychiatric consultation. In a September 1994 psychiatric consultation, the Veteran was diagnosed with probable personality disorder, but no Axis I diagnosis. In June 1996 medical records, the Veteran reports complaints of headaches, and feeling anxious. The Veteran reports that he hears voices and expresses delusions. He had insomnia, anxiety, and was suicidal. He was diagnosed with schizophreniform disorder and schizotypal personality disorder. By 1998, the Veteran carried a diagnosis of schizophrenia. Dr. M.C. also conducts an in-person interview with the Veteran. During the interview with the Veteran, the Veteran reports a good childhood. The Veteran reports no unusual neurological, medical, or any clinical issues that would have prevented him from enlisting in the Army. After basic training, he entered advanced individual training for tanks, becoming an armored crewman. After his first tour, the Veteran reenlisted. Soon after he began having mental problems. He reports that he was involved in stressful bunker and gunner exercises with mock combat and had little sleep for at least three months because of the long hours. He became tearful, describing difficulties he had with the thought of having to kill people and engage in battle. He shares that "something went wrong in his head." He felt paranoid and unsafe. He felt that things were "falling apart." When he was given the option for additional treatment or discharge, the Veteran reports that he chose discharge. Therefore, based on the review of the Veteran's history, the Veteran's medical records, to include preservice, in-service, and post-service, and in person interview of the Veteran, Dr. M.C. opines that the Veteran has a diagnosis of schizophrenia and had symptoms of schizophrenia since his active service. Dr. M.C. notes that the Veteran did not have a mental illness before his active service. The Veteran's symptoms began during service. Notably, Dr. M.C. opines that the Veteran did not meet the criteria for a personality deficit disorder either before or after his military service. Specifically, Dr. M.C. points out that the Veteran met the criteria for schizophrenia continuous since his active service. Mr. M.C. notes the Veteran's delusions of a paranoid and persecutory nature, ongoing perceptual alternations, and auditory hallucinations are classic symptoms of schizophrenia. After his discharge from active-duty service the Veteran's schizophrenia symptoms escalated exponentially. In a May 2021 VA medical opinion, the VA examiner opines that the Veteran's schizophrenia is less likely than not a superimposed disability onto his in-service personality disorder. The examiner notes that there appears to be no clear and consistent reported or documented evidence to conclude a diagnosis of schizophrenia during active duty. In addition, the examiner notes that the Veteran was not formally diagnosed with schizophrenia until 15 years post service. The examiner notes that the details of the 15-year interim is very unclear and that the Veteran has a difficult time accounting for his history. The Board notes that the Veteran's claim has been previously denied by the RO based on a finding that the Veteran has a personality disorder. Personality disorders are not considered diseases or injury for which service connection may be granted. 38 C.F.R. §§ 3.303 (c), 4.9, 4.127. However, based on the thorough private medical report provided by Dr. M.C., he opines that the Veteran did not suffer a personality disorder during his service. In fact, Dr. M.C. opines that the Veteran's documented in-service mental health symptoms were rather early manifestations of his later diagnosed schizophrenia. In his detailed report, Dr. M.C. points out that the Veteran did not have a personality disorder or mental health illness prior to the Veteran's service. Dr. M.C. attributes the Veteran's mental health symptoms, which began during service, with the extreme stress related to the Veteran's MOS training, which he explains was simulated to be like actual combat situations. Significantly, Dr. M.C. points out the Veteran's state of mind was to "kill, kill, kill," which Dr. M.C. notes is consistent with early manifestations of schizophrenia. After review of the December 2020 private medical report, the Board finds that the December 2020 private medical opinion by Dr. M.C., which links the Veteran's schizophrenia to his in-service mental health symptoms, supports a finding that the Veteran's schizophrenia, is at least as likely as not related to the Veteran's service. Thus, the third element of service connection is satisfied. Resolving reasonable doubt in the Veteran's favor, entitlement to service connection for an acquired psychiatric disorder, to include schizophrenia, is warranted. (Continued on the next page) YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Abdelbary, 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.