Citation Nr: 0000388 Decision Date: 01/06/00 Archive Date: 01/11/00 DOCKET NO. 98-12 343 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUE Entitlement to service connection for an acquired psychiatric disorder to include schizophrenia and post traumatic stress disorder. WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Peter C. Lenart, Associate Counsel INTRODUCTION The veteran served on active duty in the military from July 1978 to July 1982. In August 1997 the Department of Veterans Affairs (VA) Regional Office in Oakland, California, denied the veteran's service connection claims for post traumatic stress disorder and schizophrenia. The veteran timely appealed to the Board of Veterans' Appeals (Board). In August 1998, the veteran perfected his appeal through the submission of VA Form 9, on which he requested a hearing before a Member of the Board at the RO (Travel Board hearing). The veteran testified before the undersigned Member of the Board on July 27, 1999. The veteran's claims were consolidated into the single disability of acquired psychiatric disorder including post traumatic stress disorder and schizophrenia in the RO's December 1998 Supplemental Statement of the Case (SSOC). The veteran's appeal is now before the Board for resolution. FINDINGS OF FACT 1. There is no evidence to indicate that the onset of a psychiatric disorder was during service, or within one year following service. 2. The veteran does not have a current diagnosis of post traumatic stress disorder. 3. No competent medical evidence has been submitted to suggest that the veteran's current psychiatric disability is in any way related to his military service. 4. The claim for service connection for a psychiatric disorder is not plausible. CONCLUSION OF LAW The claim for service connection for an acquired psychiatric disorder to include schizophrenia and post traumatic stress disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Background The veteran's service medical records (SMRs) do not indicate that he was diagnosed with or treated for any psychiatric disorder while on active duty or that such disorder was manifested therein. There is no medical evidence of record indicating the presence of any manifestations of psychosis within one year of the veteran's discharge from the service. At the time he filed his initial application for VA compensation benefits in 1996, the veteran reported no treatment for psychiatric illness earlier than 1983. VA outpatient treatment records spanning from January 1983 to February 1997 indicate that the veteran had received treatment for, among other disorders, chronic polysubstance abuse and paranoid schizophrenia. Records dated in 1983 show treatment for gastrointestinal symptoms. In June 1983 it was noted that he had multiple complaints and was apprehensive and hostile; reportedly he had a "cancerphobia." The veteran's family history of cancer was noted, as was his heavy use of alcohol. These records do not contain a diagnosis of post traumatic stress disorder (PTSD). These records also fail to associate the veteran's paranoid schizophrenia with his military service. In fact, there is no discussion of the etiology of the veteran's mental illness in these records. The veteran was treated in July 1986 at the University of California, Davis, Medical Center. He was admitted through the emergency room in restraints after he had destroyed the interior of his home. Contact was made with the veteran's mother who reported that as far as she knew, he had no prior history or past treatment, although "he has been paranoid" since his discharge from the Navy 3-4 years ago. Following evaluation, an assessment of atypical psychosis was made. Records compiled the following month showed that his July 1986 hospitalization had been for PCP intoxication and polydrug abuse. VA treatment records from September 1986 indicate that the veteran was treated for a psychotic episode partly of a schizophrenic nature. He presented with a several month history of progressive anger and difficulty with impulse control. Although a long history (pre-service) of illicit drug abuse was noted, the hospital summary does not link the onset of symptoms to military service. An October 1986 outpatient assessment form apparently conducted as disability determination for Social Security benefits is of record. It notes the veteran's complaints of a "mental blowout" caused by environmental stressors. The veteran reported sleep disturbances, problems with memory, and a belief that these difficulties were the result of "some secret governmental manipulation." The examiner diagnosed the veteran with "Schizophreniform Disorder vs. Personality Disorder." A statement dated November 1995 was received from the veteran's brother who reported that the veteran had experienced mood swings and anti-social behavior since his discharge from the military. (This statement was "date- stamped" as received by the RO in November 1996.) The statement noted that there was a noticeable change in the veteran's ability to function in social settings. The statement does not indicate knowledge of any diagnosed psychiatric condition. A November 1996 statement from the veteran indicated that he felt constantly mixed-up, and that he was experiencing difficulty in transitioning from military to civilian life. A January 1997 disability evaluation by Benjamin Lubeck, M.D., indicated that the veteran was brought to a psychiatric emergency room after a violent episode. The veteran noted that he was being treated for emotional problems, which he stated began in 1982. Reportedly at that time he had not been able to get help from VA. According to Dr. Lubeck, the veteran denied that his psychiatric disability began in the Navy. He was diagnosed with a severe psychiatric disorder that was most likely schizophrenia. Dr. Lubeck did not associate the veteran's disorder to his military service. February 1997 VA outpatient treatment records indicate the veteran complained of sleeplessness, depression and of hearing voices. A July 1997 outpatient record notes the veteran's history of a schizoaffective disorder, but focuses on treatment of ulcers and abscesses that resulted from the veteran's intravenous drug use. A February 1998 VA outpatient treatment record indicates that the veteran was diagnosed with opioid dependence, but he indicated that he was note interested in receiving treatment. The veteran testified before an RO hearing officer in August 1998 and before the undersigned Member of the Board on July 27, 1999. He indicated that his military service was spent on board a destroyer. He indicated that at some point, the ship retrieved refugees. The veteran complained of isolation and confinement as resulting from his military service. The veteran indicated that he had received treatment at the VA hospital in Sacramento, and that he had been prescribed a sedative at some point in time. Concerning his claim for PTSD, the veteran indicated that he believed being out on the water was a stressor. II. Legal Analysis Service connection may be granted for disability due to injury or disease incurred or aggravated by active service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. § 3.303(a) (1999). Certain chronic conditions, including psychoses such as schizophrenia, will be presumed to have been incurred in service if manifested to a compensable degree within a prescribed period of time after service, which is one year for psychoses. The presumption is rebuttable by probative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection for PTSD requires medical evidence establishing a diagnosis of the condition, credible supporting evidence that the claimed in- service stressors actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressors. 38 C.F.R. § 3.304(f); see also Cohen v. Brown, 10 Vet. App. 128, 137-138 (1997); Moreau v. Brown, 9 Vet. App. 389, 394-395 (1996). A preliminary determination that must be made in a case involving a claim for service connection is whether the claim is "well grounded." A claim is "well grounded" if it is "plausible meritorious on its own or capable of substantiation." 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78,81 (1990). The initial burden of showing that a claim is well grounded, if it is judged by a fair and impartial individual, resides with the veteran; if it is determined that he has not satisfied his initial burden of submitting evidence sufficient to show that his claim is well grounded, then his appeal must be denied, and VA does not have a "duty to assist" him in developing evidence pertinent to his claim. See Slater v. Brown, 9 Vet. App. 240, 243 (1996); Murphy, 1 Vet. App. at 81, 82. In order for a claim for service connection to be well grounded, there must be competent evidence (lay or medical, as appropriate) of: (1) a current disability; (2) an in-service injury or disease; and (3) a nexus between the current disability and the in-service injury or disease. Epps v. Gober, 127 F.3d 1464, 1468 (1997); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Evidence showing that a chronic condition subject to presumptive service connection, such as a psychosis, became manifest to a compensable degree within the prescribed one-year period after service may satisfy the nexus requirement. See Traut v. Brown, 6 Vet. App. 495, 497 (1994); Goodsell v. Brown, 5 Vet. App. 36, 43 (1993). With respect to a claim for a psychosis, the veteran is able to satisfy the first criterion for a well-grounded claim, that is, evidence that he currently has schizophrenia. He has received VA treatment for mental illness in the years following his discharge. This began with treatment for schizophrenia in 1986. He was diagnosed with schizophrenia, paranoid type, in an October 1986 Social Security examination. In spite of his current psychiatric problems, however, the claim must be denied as not well-grounded in the absence of competent evidence of that schizophrenia (or other psychiatric disorder) originated during service or, as applicable, within the one year presumptive period. Medical records compiled during this period do not reflect manifestations of psychosis to a degree of 10 percent. There is likewise no competent medical evidence of a nexus between current psychiatric problems and service. Even after years of receiving treatment, no VA physician has ever associated any of the veteran's psychiatric problems with his service in the military, and the veteran has neither submitted nor indicated the existence of a competent medical opinion on this essential element of the claim. See Grottveit v. Brown, Vet. App. 91, 93 (1993) (citing Murphy, 1 Vet. App. at 81). In this case, the veteran alleges that he has PTSD as a result of serving on a destroyer at sea during his military service. However, as noted above, the veteran has not been diagnosed with PTSD during any of his psychiatric examinations. Moreover, the veteran has neither presented, nor indicated the existence of, any private medical diagnosis of PTSD. Therefore, as there is no medical evidence which represents a diagnosis of PTSD for service connection purposes, as emphasized in Cohen, the claim for service connection for PTSD must be denied as not plausible. In the absence of competent evidence that the veteran actually suffers from the disability for which service connection is sought, there can be no valid claim. See Brammer v. Derwinski 3 Vet. App. 223, 225 (1992). Hence, it is not necessary for the Board to consider the issue of the veteran's stressors, or whether he actually served in combat with the enemy. Even if these elements were satisfied, the veteran's claim would fail because he had not met the first, and most important, criterion in establishing a valid claim for PTSD. While the Board does not doubt the sincerity of the veteran's belief that his psychiatric disability exists as a result of his military service, neither he nor his brother who submitted a written statement describing the veteran's behavior has the medical training or expertise necessary to render such an opinion; hence, their lay assertions in this regard, without supporting medical evidence, do not constitute competent evidence to well-ground the claim. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 292, 294-5 (1991). A claim must be supported by evidence and sound medical principles, not just assertions. See Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). For the foregoing reasons, the Board must conclude that the veteran has not submitted evidence sufficient to justify a belief by a fair and impartial individual that his claim for service connection is well grounded. As the duty to assist has not been triggered by evidence of a well-grounded claim, there is no duty to assist the veteran in developing the record to support his claim for service connection for PTSD. See Epps, 126 F.3d at 1468. Furthermore, the Board is aware of no circumstances that would put the VA on notice that any additional relevant evidence may exist which, if obtained, would well ground the veteran's service connection claim. See McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997). The Board views its (and the RO's) discussion as sufficient to inform the veteran of the type of evidence that is necessary to make his claim well grounded and warrant full consideration on the merits. See Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). ORDER As evidence of a well-grounded claim has not been submitted, the claim for service connection for an acquired psychiatric disability to include schizophrenia and PTSD is denied. N. R. ROBIN Member, Board of Veterans' Appeals