PSYCHOSIS

Summary

The Veteran served in the U.S. Army from September 10, 1990, to December 17, 1990. The Veteran appeals the denial of service connection for tinnitus and seeks service connection for schizophrenia. The Board found evidence of a present disability of schizophrenia, with an in-service incurrence noted in a November 1990 Medical Evaluation Board proceeding indicating a schizophreniform disorder began around September 23, 1990, and the Veteran was placed on a physical profile for a nervous condition. A private psychiatric evaluation in April 2023 opined that the schizophrenia was at least as likely as not related to service, noting no evidence of pre-service psychosis and multiple records indicating its emergence during training. The Board found this opinion persuasive and granted service connection for schizophrenia. For tinnitus, a November 2022 examination confirmed the current diagnosis. The Board conceded a moderate probability of noise exposure during service. However, the examiner opined that the tinnitus, first reported four years after service, was less likely than not related to service, citing medical literature on the immediate onset of noise-induced tinnitus. This opinion was found persuasive, and the Board denied service connection for tinnitus, stating the benefit-of-the-doubt rule did not apply as the evidence weighed against a nexus. Service connection for schizophrenia is granted; service connection for tinnitus is denied.

Rationale

Present disability established; In-service incurrence demonstrated by medical evaluation board proceedings; Persuasive private medical opinion established nexus to service

Full Decision Text

Citation Nr: A25061275
Decision Date: 07/17/25	Archive Date: 07/17/25

DOCKET NO. 230308-329264
DATE: July 17, 2025

ORDER

Entitlement to service connection for schizophrenia is granted.

Entitlement to service connection for tinnitus is denied.

FINDINGS OF FACT

1. The Veteran's schizophrenia is shown to have begun in service and to have persisted since that time.

2. The persuasive weight of the evidence is against a finding that currently diagnosed tinnitus was incurred in or is otherwise related to the Veteran's service.

CONCLUSIONS OF LAW

1. The criteria for service connection for schizophrenia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for tinnitus have not been met. 38 U.S.C.    §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from September 10, 1990, to December 17, 1990. 

In the March 8, 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the January 2023 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection may be established for disability due to disease or injury that was incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R.          § 3.303. To establish service connection for a claimed disability, there must be evidence of: (i) a present claimed disability; (ii) incurrence or aggravation of a disease or injury in service; (iii) and a causal relationship between the present disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R.  § 3.303(a).

Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson.  38 C.F.R. § 3.159 (a)(2).  Competent medical evidence is necessary where the determinative question requires medical knowledge.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises.  Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159 (a)(1). 

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claim
 492 F.3d 1372 (Fed. Cir. 2007). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises.  Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159 (a)(1). 

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.            § 5107(b); 38 C.F.R. § 3.102.

1. Entitlement to service connection for a psychiatric disability (claimed as bipolar disorder).

As to the first element of service connection. An April 2023 private psychiatric evaluation (received within 90 days of the Veteran's 10182) notes a current diagnosis of schizophrenia. Thus, in that respect the first element of a present claimed disability is shown. See Shedden, supra. 

As to an in-service incurrence, the Veteran's entrance examination is negative for a diagnosis of a psychiatric disorder or any report of a history of a psychiatric disorder. An October 1990 Medical Evaluation Board Proceedings indicates the Veteran's schizophreniform disorder began approximately on or about September 23, 1990. It was noted that the Veteran was admitted to medical in his second week of training due to bizarre behavior while in his unit. In November 1990 the Veteran was placed on a physical profile for a nervous condition. This evidence demonstrates that the second element of incurrence of a disease in service is met. See Shedden, supra. 

As to the final element of a nexus, the evidence is in support of a finding that the Veteran's current psychiatric disability is related to the Veteran's in-service incurrence of a psychiatric disorder. In support of the Veteran's claim is an April 2023 medical opinion in which the clinician opined that it was at least as likely as not that the Veteran's diagnosis of schizophrenia is the result of or was incurred during service and a continuation of symptoms noted in military records. The clinician noted there was no evidence to support a finding that the Veteran's psychosis existed prior to service, and numerous records which explicitly stated the Veteran's psychosis emerged during the Veteran's initial training period in service. This opinion reflects familiarity with the record and provides adequate rationale for the opinion offered. It is therefore persuasive in this matter. Under these circumstances, it is reasonably shown that the Veteran's psychiatric disability is directly related to the Veteran's service. Thus, the final element of service connection is met. See Shedden, supra. 

Accordingly, service connection for schizophrenia is warranted. The appeal is granted. 

2. Entitlement to service connection for tinnitus.

As to the first element of service connection. A November 2022 tinnitus examination notes a current diagnosis of tinnitus. Thus, the first element of service connection is met. See Shedden, supra.

The Board is bound by favorable findings. Here, in January 2023, the AOJ has found that as a trainee, the Veteran had a moderate probability of noise exposure, and therefore exposure to hazardous noise is conceded. Thus, the second element of service connection is met. See Shedden, supra. 

As to nexus, unfortunately, the persuasive weight of evidence is against the finding of a relationship between the present disability and service. On November 2022 examination, the Veteran reported that his tinnitus began in November 1994. In the medical opinion associated with the November 2022 examination, the clinician opined that it was less likely than not that the Veteran's tinnitus was due to service. The clinician noted that the Veteran reported his tinnitus began four years after service. The clinician noted medical literature which indicates "tinnitus due to noise exposure or acoustic trauma is known to have a noticeable onset immediately or soon following the incident." The clinician demonstrated a good understanding of the Veteran's record, and offered supporting rationale for the opinion offered, that the Veteran's tinnitus (which he first reported occurring four years after service) was not due to the Veteran's service. This medical opinion is persuasive in this instance. The evident persuasively weighs against a nexus between the Veteran's current tinnitus and his active service. As such, the third element of service connection (a causal relationship between the present disability and the disease or injury in service) is not met. See Shedden, supra.

In summary, the evidence of record does not link the Veteran's currently diagnosed tinnitus to the Veteran's service, and the weight of the evidence is against this claim.
 the incident." The clinician demonstrated a good understanding of the Veteran's record, and offered supporting rationale for the opinion offered, that the Veteran's tinnitus (which he first reported occurring four years after service) was not due to the Veteran's service. This medical opinion is persuasive in this instance. The evident persuasively weighs against a nexus between the Veteran's current tinnitus and his active service. As such, the third element of service connection (a causal relationship between the present disability and the disease or injury in service) is not met. See Shedden, supra.

In summary, the evidence of record does not link the Veteran's currently diagnosed tinnitus to the Veteran's service, and the weight of the evidence is against this claim. Therefore, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Accordingly, the appeal is denied.

 

 

Michael Sobiecki

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Staskowski, Nichole

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.