PSYCHOSIS

Summary

The veteran, who served from November 2016 to November 2017, appeals the denial of service connection for a varicocele and the initial denial of service connection for schizophrenia, other specified trauma related disorder, and insomnia. The veteran claims these conditions are due to service-related fears of chemical attacks during his deployment in Turkey with NATO command. The Board found the veteran's lay statements credible and consistent with the evidence of record, particularly regarding his deployment experiences and subsequent mental health symptoms. For schizophrenia, other specified trauma related disorder, and insomnia, the Board found the evidence in relative equipoise, resolving reasonable doubt in the veteran's favor to grant service connection. The Board noted that while a March 2020 VA opinion found schizophrenia less likely than not related to service, a subsequent November 2024 VA opinion from a board-certified psychiatrist opined that schizophrenia, anxiety, and insomnia were highly likely the direct result of the deployment. For the varicocele claim, the Board found the lay evidence insufficient to establish a nexus to service, as service treatment records were negative for complaints or treatment, and the etiology of the varicocele was considered outside the realm of common lay knowledge. The Board acknowledged the veteran's contention of an unreported groin injury during service but found no probative evidence to support it, thus denying service connection for the varicocele.

Rationale

Evidence in relative equipoise; Reasonable doubt resolved in veteran's favor; Favorable November 2024 VA opinion linking disorders to deployment

Full Decision Text

Citation Nr: A26028688
Decision Date: 03/31/26	Archive Date: 03/31/26

DOCKET NO. 210303-144927
DATE: March 31, 2026

ORDER

Entitlement to service connection for schizophrenia is granted.

Entitlement to service connection for other specified trauma related disorder is granted.

Entitlement to service connection for insomnia is granted.  

Entitlement to service connection for a varicocele is denied.  

FINDINGS OF FACT

1. The evidence is in relative equipoise as to whether the Veteran's schizophrenia is due to service.  

2. The evidence is in relative equipoise as to whether the Veteran's other specified trauma related disorder is due to service.  

3. The evidence is in relative equipoise as to whether the Veteran's insomnia is due to service.  

4. A varicocele did not manifest during service and is not related to 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 other specified trauma related disorder have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

4. The criteria for service connection for a varicocele have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from November 2016 to November 2017.  He also had service in the National Guard.  

The appeal arises from a rating decision dated March 9, 2020, with a notice letter dated March 24, 2020; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  In the subsequent notice of disagreement, received on March 3, 2021, the Veteran selected the Hearing review lane, and a Board hearing was held on December 3, 2024.  As such, the Board will consider evidence at the time of the March 2020 rating decision, and evidence received within 90 days of the Board hearing in December 2024.  The Board will not consider evidence added to the record between the pertinent rating decision and the December 2024 Board hearing, nor the evidence added following the expiration of 90 days from the Board hearing.  If evidence was added to the record during an ineligible period identified above, the Board has not considered that evidence.  If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence.

The Agency of Original Jurisdiction (AOJ) in the March 2020 rating decision made the following favorable findings: on VA examination in March 2020 the Veteran was diagnosed with other specified trauma related disorder, he served in NATO aligned with Turkey on Tile 10 duty, and post service medical records show treatment for a varicocele.  The AOJ in the April 2024 rating decision made the following favorable findings: service treatment records show the Veteran was prescribed medication to control anxiety symptoms.  The Board is bound by these favorable findings.  38 C.F.R. § 3.104(c).  

In May 2021 the Veteran's former attorney stated that the Veteran was withdrawing his notice of disagreement, however during the December 2024 Board hearing the Veteran disavowed the withdrawal of the notice of disagreement.  During the Board hearing it also was discussed that schizophrenia was originally developed for treatment purposes, however the March 2020 rating decision implicitly denied service connection for schizophrenia for compensation purposes and thus this issue is currently before the Board.  

Lastly, the Board finds that the Veteran presented good cause to select a new representative in March 2023, Disabled American Veterans, who represented him at the December 2024 Board hearing.   See 38 C.F.R. § 20.1304(b).  

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303.  This may be accomplished by affirmatively showing inception or aggravation during service.  38 C.F
0 rating decision implicitly denied service connection for schizophrenia for compensation purposes and thus this issue is currently before the Board.  

Lastly, the Board finds that the Veteran presented good cause to select a new representative in March 2023, Disabled American Veterans, who represented him at the December 2024 Board hearing.   See 38 C.F.R. § 20.1304(b).  

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303.  This may be accomplished by affirmatively showing inception or aggravation during service.  38 C.F.R. § 3.303(a).  Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service.  38 C.F.R. § 3.303(d).  

For a veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for psychoses if the disability is manifest to a compensable degree within one year of discharge from service.  38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(a).

For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic."  Continuity of symptomatology after discharge is required where the disorder noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned.  38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  

Issues 1-3: Entitlement to service connection for schizophrenia, other specified trauma related disorder, and insomnia.

During the December 2024 Board hearing the Veteran testified that he has schizophrenia, other specified trauma related disorder, and insomnia due to service due to fears in service of being chemically attacked.  The Veteran explained that he was deployed in Turkey in 2016 through 2017, with the NATO command, where he was a unit armorer and in supply personnel.  He was on high alert due to possible chemical attacks and was told to have a gas mask at all times.  

The Veteran's DD 214 Form shows that his military occupational specialty was unit supply specialist.  He served in a designated imminent danger pay area and had service in Turkey from December 2016 to September 2017.  Service personnel records dated in December 2016 show that the Veteran's deployment to Incirlik, Turkey was in support of Operation Inherent Resolve.   

In a January 2020 statement, the Veteran's Company Operations Sergent stated that he was assigned to him during their deployment in Turkey in 2019.  The Veteran attended various meetings concerning sensitive information about current threats and other items in the operational areas where they were deployed.  The threats included suicide bombers and chemical attacks.  The Veteran became very worried and on edge that something would happen.  He was highly alert of the surroundings and lacked sleep due to constant worrying.  The Board has no reason to doubt the credibility of this statement as it is consistent with the other evidence of record.  

VA treatment records including in March 2019 and December 2019 show a diagnosis of insomnia.  On VA posttraumatic stress disorder (PTSD) examination in March 2020 the diagnoses were schizophrenia and other specified trauma and stressor related disorder.  

In a March 2020 VA opinion, the examiner opined that due to recent auditory hallucinations the diagnosis of schizophrenia will be given, and it was less likely than not that it was caused by service.  The examiner stated that there were no treatment records that support psychotic symptoms occurring shortly after the Veteran's deployment, instead they began in January 2019, and the Veteran returned from deployment in 2017.  However, there also is a favorable opinion dated in November 2024 regarding the etiology of schizophrenia, which is further discussed below.  

On December 3, 2024, the Veteran submitted another March 2020 VA opinion whereby the examiner opined that it was at least as likely as not that the Veteran's other specified stressor and trauma was due to service.  The examiner noted that while the Veteran did not meet the full criteria for PTSD, the Veteran did report trauma in the military and feels that his mental health is affected by this, thus a diagnosis of other specified stressor and trauma related disorder was given.  The examiner op
 began in January 2019, and the Veteran returned from deployment in 2017.  However, there also is a favorable opinion dated in November 2024 regarding the etiology of schizophrenia, which is further discussed below.  

On December 3, 2024, the Veteran submitted another March 2020 VA opinion whereby the examiner opined that it was at least as likely as not that the Veteran's other specified stressor and trauma was due to service.  The examiner noted that while the Veteran did not meet the full criteria for PTSD, the Veteran did report trauma in the military and feels that his mental health is affected by this, thus a diagnosis of other specified stressor and trauma related disorder was given.  The examiner opined that the other specified trauma and stressor related disorder was at least as likely as not incurred in or caused by the claimed in-service events.

On December 3, 2024, the Veteran submitted VA medical records and a VA opinion.  In November 2024 the records show a diagnosis of schizophrenia and anxiety disorder.  In the November 2024 opinion, the VA examiner, a Board-certified psychiatrist, opined that it was highly likely that the Veteran's disorders, to include schizophrenia and anxiety are the direct result of deployment in Turkey.  The examiner noted that stress precipitates an acute psychotic break, which the Veteran experienced in 2019.  The examiner stated that his psychotic break in 2019 resulted in an in-patient admission for stabilization and has required out-patient care since then with continuing symptomology.

On December 3, 2024, the Veteran submitted a February 2024 VA opinion whereby the examiner opined that the claimed disorder was at least ast likely as not caused by service, noting that the Veteran's anxiety symptoms were subsumed by his other specified trauma and stressor related disorder.  

On December 3, 2024, the Veteran submitted a November 2024 VA opinion from the Board-certified psychiatrist who opined that the Veteran's insomnia was the direct result of the stress from deployment in Turkey.  The examiner stated that it is well-known that stress can precipitate insomnia.  The Veteran's insomnia and psychotic break in 2019 resulted in an in-patient admission for stabilization and the Veteran has required out-patient care since then with continuing symptomatology.  

Based on the above and resolving reasonable doubt in the Veteran's favor, the Board finds that the evidence is at least in relative equipoise, and service connection is warranted for schizophrenia, other specified trauma related disorder, and insomnia.  

Issue 4: Entitlement to service connection for varicocele.

In a January 2024 statement regarding the varicocele, the Veteran stated that he suffered a groin injury during service, which he did not report.  During the December 2024 Board hearing the Veteran testified that he had symptoms related to his varicocele during service.  

Service treatment records do not show complaints, findings or treatment for the varicocele.  

Medical records in March 2019 show a moderate-sized left varicocele.  In January 2020 VA treatment records show a diagnosis of left testicular varicocele.  

As a lay person, the Veteran is competent to report symptoms pertaining to his varicocele that are within the realm of one's personal knowledge and personal knowledge which comes through the use of senses.  Layno v. Brown, 6 Vet. App. 465, 469-70 (1994).  Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the etiology of the claimed varicocele falls outside the realm of common knowledge of a lay person.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007).  This is not the type of disorder that is readily amenable to mere lay diagnosis or probative comment regarding its etiology.  See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation.  Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating such disorder.  Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value.  As the lay evidence is not competent the matter of whether it is credible is not reached.  

In a memorandum in January 2024, it was determined that the Veteran participated in toxic exposure risk activity (TERA) during service.  On August 10, 202
seki, 581 F.3d 1313 (Fed. Cir. 2009).

The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation.  Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating such disorder.  Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value.  As the lay evidence is not competent the matter of whether it is credible is not reached.  

In a memorandum in January 2024, it was determined that the Veteran participated in toxic exposure risk activity (TERA) during service.  On August 10, 2022, the President signed into law The Sergeant First Class Health Robinson Honoring our Promise to Address Comprehensive Toxics Act (PACT Act).  Section 303 of this law provides that, if a Veteran submits a claim for service connection with evidence of disability and evidence of participation in TERA, then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA.  38U.S.C. §1168.  As discussed above, the Veteran contends that his varicocele was due to physical trauma as he had an unreported groin injury during service, thus subsection (a) of 38 U.S.C. § 1168 does not apply.   See VBA Letter 20-24-06, Exception to TERA Examination and Medical Opinion Requirement at pages 12-14 (June 12, 2024).  

The Board acknowledges that an opinion regarding the etiology of the varicocele is not of record.  The probative evidence does not establish an in-service incurrence and continuous symptoms since service.  Therefore, it is insufficient to trigger VA's duty to assist by providing a medical opinion regarding service connection.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). 

?

Thus, for the above reasons the evidence is persuasively against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim of service connection for varicocele must be denied.  38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  

 

 

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Mac, M.

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.