SCHIZOPHRENIA

Summary

The Veteran served in the United States Army from February 1974 to April 1974. The Veteran appeals the denial of service connection for an acquired psychiatric disorder, specifically seeking service connection for PTSD, schizophrenia, and bipolar disorder. The Board reviewed the evidence of record, including the Veteran's testimony from a September 2024 virtual hearing. Service records did not document pre-service mental health issues, but did note in-service onset of mental health manifestations continuing through separation, with a diagnosis of personality disorder. The Agency of Original Jurisdiction (AOJ) did not provide a VA examination during the review period. However, a private examination and opinion from Dr. DW, submitted after the Board hearing but within the evidentiary window, found the Veteran met DSM-5 criteria for schizophrenia and opined it was at least as likely as not related to military stressors. Dr. DW's opinion was considered highly probative due to its comprehensive analysis of the record, consideration of the Veteran's lay reports of continuous symptoms since service, and sufficient rationale. The Board found the Veteran's acquired psychiatric disorder was at least as likely as not caused by in-service trauma, granting the claim on a direct basis.

Rationale

No pre-service mental health issues documented; In-service onset of mental health manifestations; Private opinion found condition related to service

Full Decision Text

Citation Nr: A26026355
Decision Date: 03/24/26	Archive Date: 03/24/26

DOCKET NO. 210304-144816
DATE: March 24, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder is granted.

FINDING OF FACT

The probative evidence persuasively favors finding that the Veteran's acquired psychiatric disorder was caused by in-service trauma.

CONCLUSION OF LAW

The criteria for entitlement to service connection for an acquired psychiatric disorder have been met.  38?U.S.C. §§?1110, 1154(b); 38?C.F.R. §§?3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from February 1974 to April 1974.  The Board thanks the Veteran for his service to our country. 

A November 3, 2006, Board decision denied service connection for an acquired psychiatric disorder to include schizophrenia; that decision contained appeal rights but the Veteran did not timely appeal and that decision became final.  On October 9, 2020, VA received an Intent to File followed by a December 7, 2020, VA Form 21-526EZ requesting service connection for posttraumatic stress disorder (PTSD), schizophrenia, and bipolar disorder.  In a January 16, 2021, Rating Decision, the Agency of Original Jurisdiction (AOJ) denied service connection for PTSD and bipolar disorder.  On March 4, 2021, VA received a VA Form 10182 in which the Veteran elected the Board's review of the claim herein under the Hearing Request Docket pursuant to the Appeals Modernization Act (AMA).  38 C.F.R. § 20.301.  On September 27, 2024, the Board held a virtual hearing and that hearing transcript is associated with the claims file. 

Applicable Review Period and Evidentiary Window

The review period and the evidentiary window are distinct concepts in AMA that are not interchangeable (the review period is limited to the period considered by the AOJ [i.e., ends at the issuance of the AOJ decision on appeal]; the evidentiary window is the time which evidence may be submitted and considered for the issue on appeal).  The Hearing Request Docket only permits the Board to review the evidence of record at the time of the AOJ decision(s) on appeal as well as any evidence submitted at the hearing (including the testimony) and within 90 days after the hearing.  38 C.F.R. § 19.2(d).  If additional evidence was submitted between the dates of the AOJ decision(s) on appeal and the hearing, the Board will not consider it unless it is resubmitted during the 90 days following the hearing. ?Id; Cook v. McDonough, 36 Vet. App. 175 (2023). 

Regarding the appeal herein, the review period spans from the date of the claim (October 9, 2020) through the date the AOJ issued the decision on appeal (January 16, 2021); the evidentiary window is limited to evidence of record at the time of the AOJ decision on appeal (January 16, 2021) as well as any evidence submitted at the September 27, 2024, Board hearing (including the testimony) and within 90 days following the hearing.  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 claim, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.  Cook, supra.

1. Entitlement to service connection for an acquired psychiatric disorder 

Direct service connection may be warranted if the evidence shows: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).  Although a competent medical opinion is generally required to establish etiology, competent and credible lay evidence of chronicity and continuity of symptomology may also establish etiology.  38?C.F.R.
, supra.

1. Entitlement to service connection for an acquired psychiatric disorder 

Direct service connection may be warranted if the evidence shows: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).  Although a competent medical opinion is generally required to establish etiology, competent and credible lay evidence of chronicity and continuity of symptomology may also establish etiology.  38?C.F.R. §?3.303(b); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6?Vet. App.?465 (1994).  Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service.? 38?C.F.R. § 3.303(d); Combee v. Brown,?34 F.3d 1039, 1043?(Fed. Cir. 1994). 

When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a Veteran's disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki,?24?Vet. App. 428 (2011); Jandreau,?supra.  In this case, the evidence does not indicate that the Veteran has the medical background necessary to opine regarding symptoms or diagnoses that are not lay observable; however, as a lay person, the Veteran is competent to report lay-observable symptoms and functional loss because this requires only personal knowledge, not medical expertise, as it comes to him through his senses.  Layno, supra.  Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional.  Jandreau, supra.

The Veteran generally contends that his mental health disability was caused by in-service trauma (details omitted to avoid re-traumatization) and that his manifestations have persisted since service.  See September 2024 Board hearing transcript.  Notably, all mental health diagnoses are collectively construed as a single claim for entitlement to service connection for an acquired psychiatric disorder.? Clemons v. Shinseki, 23?Vet. App.?1 (2009) (the scope of a mental health disability claim includes any mental disability that may be reasonably encompassed by the claimant's description of the disability, reported symptoms, and other information of record).

Turning to the evidence, service records did not document pertinent abnormalities upon entrance to service.  See February 1974 examination (the Veteran was rejected for service last July because of being overweight but because of "no other problems;" the clinical evaluation was normal for psychiatric conditions; the Veteran indicated 'no' to having 'nervous trouble of any sort').  However, they documented in-service onset of mental health manifestations continuing through separation.  See March 1974 record (the provider documented that, since entering service, the Veteran began having various mental health manifestations [including anxiety, fear, aggression, confusion, withdrawal, interpersonal difficulties, avoidance, suicidal ideation, and unsatisfactory adjustment]; that provider diagnosed personality disorder); see also April 1974 examination (the Veteran indicated 'yes' to having 'nervous trouble of any sort' and the provider found the Veteran to be medically unfit for service due to personality disorder).

The AOJ did not afford the Veteran a pertinent VA examination during the review period.  However, after the Board hearing (but still during the evidentiary window), the Veteran submitted an August 2024 private examination and opinion by Dr. DW, who, after reviewing the entire claims file and conducting a clinical interview of the Veteran, opined that the Veteran met the DSM-5 criteria for schizophrenia associated with his military stressors and that his schizophrenia was at least as likely as not that related to military experiences.  In reaching those opinions, Dr. DW discussed how: the Veteran entered service under presumption of soundness; the Veteran's mental health symptoms clearly began during service after experiencing in-service, mental-health stressors that caused the beginning of auditory and visual hallucinations, paranoid ideation, and history of suicidality; and the Veteran's mental health symptoms have remained continuous since, resulting in numerous mental health hospitalizations and secondary depression and chronic anxiety.  The Board finds this favorable private opinion to be highly probative because the provider comprehensively analyzed the medical record, thoroughly considered the Veteran's prob
 Veteran met the DSM-5 criteria for schizophrenia associated with his military stressors and that his schizophrenia was at least as likely as not that related to military experiences.  In reaching those opinions, Dr. DW discussed how: the Veteran entered service under presumption of soundness; the Veteran's mental health symptoms clearly began during service after experiencing in-service, mental-health stressors that caused the beginning of auditory and visual hallucinations, paranoid ideation, and history of suicidality; and the Veteran's mental health symptoms have remained continuous since, resulting in numerous mental health hospitalizations and secondary depression and chronic anxiety.  The Board finds this favorable private opinion to be highly probative because the provider comprehensively analyzed the medical record, thoroughly considered the Veteran's probative lay reports regarding ongoing mental health symptoms since his in-service trauma, and provided sufficient rationale to support his conclusions.  Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination must consider lay evidence of in-service incurrence or continuity of symptomatology since service); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (VA has a duty to provide a thorough medical examination, one which accounts for the Veteran's prior medical history and describes the disability in sufficient detail so that the Board's evaluation of the claimed disability is fully informed).  

Based on the above, the Board finds that the Veteran's acquired psychiatric disorder was at least as likely as not caused by in-service trauma.? Specifically, the record lacks evidence of clear and unmistakable mental health problems before service, in-service trauma has been conceded, and the Veteran provided probative reports of ongoing mental health symptoms since related to that trauma; further, his probative lay-reports are bolstered by the private provider's favorable finding that pertinent manifestations had persisted since service and were attributable to the in-service trauma.  Thus, the Board grants the claim on a direct basis, resolving it in full.

 

 

T. Raymond

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H. Daus, 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.