BVA9500699 DOCKET NO. 92-02 575 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to service connection for a psychiatric disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Richard V. Chamberlain, Counsel INTRODUCTION The veteran served on active duty from March 16 to June 7, 1951. This appeal arises from a May 1991 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana, that denied service connection for a psychiatric disorder. The appeal was sent to the Board of Veterans' Appeals (Board) in March 1992. The Board remanded the case to the RO in March 1993, in part, for additional development and to give the veteran the opportunity to appear at a hearing to offer testimony to support his claim. The case was returned to the Board in October 1994. The matter of competency was raised by the examiner following the last VA psychiatric examination. This matter is referred to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his current psychiatric disorder began in active service and that he was not treated for any psychiatric problem prior to service and consequently requests service connection for his condition. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence, and for the following reasons and bases, it is the decision of the Board that the evidence supports the claim for service connection for a psychiatric disorder. FINDING OF FACT The veteran's psychosis began in service and is a chronic disability. CONCLUSION OF LAW A chronic acquired psychiatric disorder was incurred in active service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION A. Factual Background The veteran served from March 16 to June 7, 1951. The National Personnel Records Center (NPRC) notified the RO in 1991 that the veteran's service medical records apparently were destroyed in the 1973 fire at the NPRC. It was able to provide a hospital extract from the Army Surgeon General's Office (SGO). According to the SGO report, the veteran was hospitalized in May 1951 at Camp Chaffee, Fort Smith, Arkansas, for a schizophrenic reaction, simple type, which reportedly existed prior to service (EPTS). The extract does not provide any details concerning the hospitalization or the medical history of the psychiatric disability. In March 1991, the veteran submitted his initial application for VA compensation. In it, he reported having been treated for a psychiatric disorder from 1970 to the present time by Dr. Louis Shirley and at a VA medical facility from 1989. In 1991, copies of photographs of various military personnel were submitted, including a photograph of the veteran. Records from Louis E. Shirley, Jr. M.D., show that the veteran was treated primarily for various medical disorders from 1968 to 1991. These records indicate that the veteran had symptoms of anxiety in 1979 and was treated with Vistaril. A clinical report from Dr. Shirley, dated in July 1991, reflects that the veteran was treated for various disorders and was bothered by depression. VA medical records show that the veteran was treated for various disorders, including psychiatric problems, from 1990 to 1993. In January 1991, he was seen at the mental health clinic with complaints of nervousness. He gave a history of being treated "for his nerves" while in service and denied any psychiatric treatment since that time. He stated that his primary complaint was difficulty sleeping and irritability. It was noted that he had marginal intellectual resources (ninth grade). He became quite tearful in describing his family situation. The impressions were alcohol abuse by history and depressive reaction, secondary to life circumstances. On examination in March 1991, the assessments included depression. The NPRC notified the RO in July 1993 that it had no additional medical records concerning the veteran. In July 1993, the RO asked the veteran to submit a list of psychiatric treatment and examinations since his discharge from service and list the name and addresses of all medical providers and dates of examination and treatment. He submitted reports of his treatment by Dr. Shirley. The veteran underwent a VA social and industrial survey in August 1993. He stated that he began having problems with his "nerves" in service. He said that he was hospitalized on a psychiatric ward and while there first experienced auditory hallucinations. He indicated that he was hospitalized for approximately one month and then was discharged from service. The social worker said that the veteran had a memory impairment and appeared to be nervous. The veteran underwent additional evaluations at a VA medical facility in 1994. On psychological evaluation in March 1994, he complained of feeling depressed all the time, nervousness, and having bad dreams. He also reported having auditory and visual hallucinations at night which had persisted for most of the last 10 years. He gave a history of treatment in service for a schizophrenic reaction. He said that he was in basic training at that time and was "on the firing line at night, when I just got too upset and scared. I started yelling and screaming. They turned on spotlights and came and took me to the hospital. I was shaking and had a terrible headache." He said that for the next month and a half he was assigned to KP duty and felt he was being punished, and that he was subsequently discharged from service. He reported that he was treated for nervousness by Dr. Shirley since the late 1960's. He indicated that his unemployment led to family conflict and depressed mood and stated "that was about the same time I started seeing things and hearing things, and having all the bad dreams." Psychological tests were consistent with a psychotic process and/or an organic mental syndrome, with extreme anxious and depressed mood. Axis I diagnoses were psychotic disorder, not otherwise specified; anxiety disorder, not otherwise specified; depressive disorder, not otherwise specified; rule out organic mental syndrome, not otherwise specified; rule out organic hallucinosis; rule out organic mood syndrome; rule out organic personality syndrome. The veteran underwent VA neurological examination later in March 1994. It was remarkable for cognitive dysfunction without focal neurological signs. Later in March 1994, he underwent psychiatric examination at the VA medical facility. He was oriented in three spheres. His mood was predominantly dysphoric and affect was anxious. He reported auditory and visual hallucination, but no apparent illusions. The Axis I diagnoses included schizophrenic reaction, chronic undifferentiated type in partial remission but significantly disabling; and dementia, probably progressing. In a supplemental statement of the case, dated in July 1994, the veteran was advised of his right to present evidence at a hearing. The record does not contain any correspondence dated since 1991 concerning a hearing. B. Legal Analysis The veteran's claim for service connection for psychiatric disorder is well-grounded, meaning it is not inherently implausible. 38 U.S.C.A. § 5107(a) (West 1991). All relevant evidence has been obtained and no further assistance to the veteran is required to comply with VA's duty to assist him. Id. In order to establish service connection for a disability, the evidence must show it resulted from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). While the veteran's service medical records are not available, he may establish service connection for a psychiatric disorder if the evidence shows that he has a chronic psychiatric disability that began in service. The SGO hospital extract shows that he was hospitalized in service for schizophrenic reaction which reportedly existed prior to service, but the extract does not provide any clear and unmistakable details to support a finding that a psychosis had existed prior to service. The paucity of evidentiary information poses a problem, but this cannot be held against the veteran. A psychosis is, by definition, a chronic illness. Apparently, its severity was such as to result in his discharge from service. Post-service medical evidence reflects that this has been a recurring problem. Manifestations sufficient to identify its existence were evidently present in service, and no sufficient proof exists in this record that this illness was manifested before service. Giving the veteran the benefit of the doubt, it appears that schizophrenia began in service and was of such magnitude as to have caused his discharge from service. Service connection is therefore allowed. 38 U.S.C.A. § 5107(b) (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). ORDER Service connection for a psychiatric disorder is granted. M. CHEEK Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.