BVA9507366 DOCKET NO. 93-13 110 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for a psychiatric disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C.M. Flatley, Counsel INTRODUCTION The veteran had active service from September 1976 to February 1977. CONTENTIONS OF APPELLANT ON APPEAL In essence, the veteran contends that his psychiatric disorder, identified as schizophrenia, paranoid-type, had its onset during his period of service. In the alternative, it is asserted that the veteran experienced a psychiatric disorder prior to service, which was aggravated thereby. DECISION OF THE BOARD The Board of Veterans' Appeals (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 files. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against an allowance of service connection for a psychiatric disorder. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. An episode of anxiety was shown prior to the veteran's period of active service; schizophrenia, paranoid-type, initially became manifest several years after the veteran's separation from service. CONCLUSION OF LAW A psychiatric disorder was not incurred in or aggravated by the veteran's period of active service; in-service incurrence of a psychosis may not be presumed. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Review of the record indicates that the veteran has submitted a well-grounded claim. 38 U.S.C.A. § 5107(a). The Department of Veterans Affairs (VA) therefore has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet.App. 78, 81-82 (1990). In this regard, it is noted that the veteran's service medical records have been obtained and that post-service VA and non-VA clinical data have been associated with his claims folder. The veteran's representative has requested that the veteran's in- service personnel data be obtained; upon review of the record, however, and as will be discussed in further detail below, the Board concludes that an attempt to obtain additional material is not justified in light of the remainder of the record. The Board concludes similarly with respect to the veteran's 1993 hospitalization cited in correspondence from the veteran in February 1994. Upon review of such material, it is determined that the veteran has been adequately assisted in the development of his case and that the evidence currently of record provides an adequate basis upon which to address the merits of his claim. Psychiatric Disorder In this case, a diagnosis of schizophrenia is well-established in the record. The veteran seeks to relate the disorder to service. In an August 1992 statement, the veteran described "traumatic" events in service, including an instance in which he attempted to attack a fellow soldier and was later unable to provide a statement as to the event, and a recurring dream in which, while in training, a fellow serviceman broke his back and another incident in which he witnessed an attack on another person. In large part, however, the veteran describes many post-service events which, essentially, he felt were indicative of abnormal behavior. It is important to note that the veteran's post- service incidents, for the most part, involve the veteran's actual behavior to a greater extent than do his in-service experiences such as being a passive witness to an event. In a statement received in March 1992, the veteran reported that his "...problems started..." during basic training and that he talked to a chaplain "a few times." In a December 1992 letter, however, the veteran stated that his lack of treatment in service should not negate the presence of a psychiatric disorder in service. He further indicated that he went to a chaplain one time and to a clinic one time. Although the veteran alleges that his service separation documents confirm the presence of symptomatology prior to separation, service medical records are scant, and essentially are limited to showing that no abnormalities were noted on entrance. The veteran has not alleged any treatment in service for a psychiatric disorder. Personnel data of record indicate that the veteran was absent without leave from advanced infantry training for approximately one month from January to February 1977, at which point he was honorably discharged from service under the Trainee Discharge Program. Overall, the veteran's allegation as to the incurrence of his psychosis in service is vague; he fails to substantiate his allegation with any specificity as to actual symptomatology which would place the onset of his current psychiatric disorder, identified as schizophrenia, paranoid-type, in service. The veteran's vague report many years later is consistent with the absence of documentation of any clear complaint in service which would tend to substantiate his argument. Further, the Board stresses that although the veteran later attempts to relate his schizophrenia to service, in his initial claim for benefits, received in 1992, he reported that his psychiatric symptoms began in September 1983. The veteran's statement received in March 1992, noted above, also notes that his "...illness started..." in September 1983 and that he had been treated since that time. In addition, the clinical data consistently record the onset of schizophrenia in 1983. Manifestations of the veteran's schizophrenia, for example, were initially recorded in August 1983 on hospitalization at the Martin Luther King, Jr. Hospital. The report reflects no previous psychiatric hospitalizations. It was noted that the veteran had been evaluated for similar symptomatology two years before (also several years subsequent to service), at which time he reportedly had been told that he was an alcoholic. Other evidence of record, including a report of the veteran's subsequent hospitalization at Long Beach Community Hospital in March 1992, substantiates the reported conclusion, as it reflects a history of alcoholism and shows that the veteran stopped "drinking" in 1981. The aforementioned August 1983 hospital report also notes that the veteran had not worked in two years and that prior thereto, he had maintained employment at the same company for five years; the veteran later reported that such employment was subsequent to service. Prior to the August 1983 hospital report, the record is silent as to any indication of schizophrenia and it appears that generally, the veteran functioned fairly well until approximately 1981. In this regard, the Board points out that at the time of the veteran's hospitalization, he denied all history and symptoms; his parents provided the relevant information. Subsequently, however, and in statements such as those noted above, the veteran reported a similar history to that provided by his parents; overall, the Board considers the history provided to be consistent and reliable. The record also reflects that subsequent to his August 1983 hospitalization, the veteran continued to receive treatment for schizophrenia, including during several periods of hospitalization associated with the disorder. It is significant to note that in providing his history in the course of obtaining medical care, the record reflects that the onset of the veteran's symptomatology of schizophrenia was consistently reported as 1983. A report of his August 1989 hospitalization at St. Francis Medical Center, for example, reflects no specific history of psychotic symptoms in service; pertinent history was limited to treatment of schizophrenia in 1983. A report of the veteran's March 1992 hospitalization at the Long Beach Community Hospital also reflects a long history of mental illness, noting the veteran's first hospitalization to have occurred in 1983 for disability described by the veteran as a "complete breakdown." Upon review of the entire record, the Board concludes that the in-service incurrence or aggravation of a psychiatric disorder is not established. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. § 3.303 (1994). Neither may the incurrence in-service of schizophrenia be presumed, as there is no compensable manifestation of the disorder within one year after the veteran's separation from service. 38 U.S.C.A. §§ 1101, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). The evidence of record discussed above, including the consistently reported history of the onset of his current psychiatric disorder, schizophrenia, several years after separation from service, as well as the absence of evidence of a chronic psychiatric disorder prior thereto and the failure to provide any indication of a relationship between the disorder and the veteran's period of service, does not substantiate the veteran's claim of in-service incurrence. The Board recognizes the veteran's alternative argument that his psychiatric disorder pre-existed service and was aggravated thereby. A pre-existing injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153 (West 1991); 38 C.F.R. § 3.306(a) (1994). The veteran's history as to the onset of symptomatology in this regard varies; it appears that he enmeshes symptomatology associated with an episode of anxiety prior to service and symptomatology indicative of schizophrenia, initially demonstrated several years after service. The former is demonstrated by private medical records which establish that in July 1975, the veteran complained of being "very nervous" and that the following January, he was hospitalized at Mission Hospital for complaints of a rapid heart beat of a three weeks' duration. The diagnoses were tachycardia, etiology undetermined, hyperventilation syndrome, and anxiety reaction. The Board notes that although an episode of anxiety was shown prior to service, a clear-cut entity was not shown. The initial indication thereafter of psychiatric impairment occurred many years later, and was manifested by psychiatric symptomatology of a different sort, leading to the diagnosis of a psychosis. Evidence of a pre-existing disorder, as such, is absent; evidence of aggravation of a pre-existing disorder is clearly absent. Considering, for the sake of argument, that the veteran's instance of anxiety represented a disorder, the Board stresses that the record nonetheless contains no evidence to establish that anxiety was aggravated by service so as to connect it to the initial manifestation of schizophrenia several years after separation from service. In support of his argument as to the pre-existence and aggravation of his psychiatric disorder, the veteran emphasizes proof offered by his private physician. In a January 1993 letter from Sami Khoury, M.D., it was reported that the veteran had a history of anxiety attacks, alcohol abuse, psychiatric care, and schizophrenia, and that he had initially received treatment for such symptoms in 1975 when he was hospitalized for symptomatology which led to diagnoses including anxiety reaction. The physician's statement offers nothing more than the report of the veteran's January 1976 hospitalization, discussed above, which establishes only an episode of anxiety prior to service; the record is silent as to the presence of schizophrenia prior to service. The physician also noted that the veteran had sought medication in 1988 and that he had been hospitalized in 1992 for unidentified reasons. The latter statements do not substantiate the veteran's allegation of the in-service onset or aggravation of a chronic psychiatric disorder. In addition, the physician essentially reiterates evidence which, previously noted, reflects that the veteran sought psychiatric treatment several years after separation from service. His private physician's letter, therefore, does not provide the support for the veteran's assertion as claimed. In short, the evidence of record fails to provide the etiologic link required between the veteran's current psychiatric disability, schizophrenia, and his period of service, including by way of aggravation. The Board emphasizes that, for the reasons noted above, the arguments and history provided by the veteran in this regard fail to alter the overall impression created by the data of record. The Board notes that VA law also provides that every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111 (West 1991). In this case, no psychiatric disorder was noted at entrance. The record, as noted above, however, establishes that a disorder was not present at entrance, and that a different psychiatric disorder became manifest many years after separation from service. The aforementioned regulation as to the presumption of soundness, therefore, is not for application in this instance. Lastly, the Board stresses that the evidence in this case does not represent an approximate balance of positive and negative evidence with respect to the in-service incurrence or aggravation of a psychiatric disorder. The doctrine of reasonable doubt, therefore, is not for application in this case. 38 U.S.C.A. § 5107 (West 1991). ORDER Entitlement to service connection for a psychiatric disorder is denied. V. L. JORDAN 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.