Citation Nr: 0005026 Decision Date: 02/25/00 Archive Date: 03/07/00 DOCKET NO. 94-37 970 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to service connection for paranoid schizophrenia. REPRESENTATION Appellant represented by: Kenneth M. Carpenter, Attorney at Law ATTORNEY FOR THE BOARD Christopher B. Moran, Counsel INTRODUCTION The veteran served on active duty training from September 13, 1973 to January 18, 1974, and on active duty from January 2, 1975 to June 9, 1975. This matter initially came to the Board of Veterans' Appeals (Board) from an August 1991 rating decision of the Department of Veterans Affairs (VA) Los Angeles, California, Regional Office (RO). The RO denied the claim of entitlement to service connection for a psychiatric disorder. The veteran's hearing, scheduled at the RO in September 1995, was canceled at his request. In February 1998, the Board upheld the RO's denial of the veteran's claim of service connection for a psychiatric disorder. The veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In July 1999, the General Counsel for VA and the veteran's accredited representative filed a joint motion and the Court granted the joint motion in an Order issued in August 1999 vacating the Board's February 1998 decision. The Court has remanded the case to the Board for further action consistent with the directives of the August 1999 Order. FINDINGS OF FACT 1. The personality disorder noted in active service is not a disease or injury within the meaning of applicable legislation providing compensation benefits; there is no evidence of psychosis or disability resulting from a mental disorder that was superimposed on a personality disorder in service. 2. The veteran's psychiatric disability classified as paranoid schizophrenia was not manifested during active service nor first demonstrated until many years postservice and there is no etiologic link demonstrated clinically by competent medical evidence between the postservice paranoid schizophrenic process and any incident of active duty including on a superimposed basis in service. CONCLUSION OF LAW Paranoid schizophrenia was not incurred in or aggravated during active duty or active duty for training; and may not be presumed to have been so incurred therein. 38 U.S.C.A. §§ 101(24), 106, 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.303(c), 3.307, 3.309, 4.127 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual background The veteran served on active duty for training (ACDUTRA) from September 13, 1973 to January 18, 1974, and on active duty from January 2, 1975 to June 9, 1975. Service records show he was born on September [redacted] 1955. An historical review of the record shows that a normal psychiatric clinical evaluation was noted in a March 1973 service examination report at the time of the veteran's enlistment. The veteran reported no history of psychiatric symptomatology. A psychiatric disorder was not noted in a January 1974 service examination report. In May 1975, during the veteran's period of active duty, it was noted that he was referred for psychiatric evaluation after claiming conscientious objector status. The psychiatric examiner described evidence of immaturity and impulsivity that might in part account for his adjustment problems. The examiner also indicated a past history of previous maladjustment with a tendency toward his being 'high-strung', easily frustrated, and exercising little self-discipline. The impression was character and behavior disorder -- immature, impulsive type. The examiner specifically commented that the appellant did not require further psychiatric treatment. A June 1975 service separation examination report shows no reference was made to a psychiatric disorder. That same month, the veteran was administratively discharged from service for unsuitability, character and behavior disorder. On his VA Form 21-526, Veteran's Application for Compensation or Pension, the veteran claimed service connection for a psychiatric disorder with onset in service. He specifically indicated that there were no relevant psychiatric treatment records dating prior to or following service to support his claim. In July 1991 the veteran reported receiving treatment at the Brentwood VA Medical Center and from a civilian Doctor, EF in 1991. He submitted medical release forms. The RO attempted to obtain the identified records. A March 1991 VA mental heath clinical record shows a diagnosis of paranoid schizophrenia along with history of referential thinking 10 years earlier with multiple psychiatric hospitalizations. March 1991 private medical records from SMEF, M.D., noted a history of mental illness and treatment by VA. Thorazine was prescribed. A November 1991 statement from ZK, M.D., Comprehensive Medical Clinics and Occupational Health Lab., noted that the veteran had multiple medical conditions and that he was receiving psychiatric treatment from VA. It was noted that emotional distress was causing a gradual deterioration of his mental status. In a November 1991 letter the veteran's mother wrote that he was fine before entering service, but that in service he began to exhibit emotional difficulties. She attributed this to his inability to get an assignment he wanted, to his dislike of the training attitude, and to the lack of referral for psychiatric counseling. She asserted that she was never contacted when her son attempted suicide. In November and December 1991 letters the veteran's brother wrote that changes in his personality developed during and after training in service. He wrote that he endured great stress during service and was not referred for psychiatric treatment despite clear indications of a psychiatric disorder, including a suicide attempt. He also indicated that to escape from this stress and emotional difficulty, he engaged in polysubstance abuse. In a May 1992 statement the veteran's spouse wrote that she met him in 1975, apparently after his separation from service. She described him as very lonely, distraught, and emotionally disturbed. She recounted how his mental situation had deteriorated over the years, and how, after 15 years, he sought psychiatric treatment for schizophrenia. She argued that his experience in service contributed to his psychiatric disorder. A January 1993 statement from ZK, M.D., indicated treating the veteran for various physical conditions for the past several months. It was noted the veteran was also receiving treatment through VA. In his February 1993 statement he wrote that the veteran had been under his medical care since October 1991, and that an examination of the veteran's medical records revealed that he was not suitable for military service, in part from an emotional point of view. Dr. ZK opined that the military environment appeared to have "produced an exacerbation of the veteran's previous illnesses." It was noted he was at that time receiving psychiatric care at a VA medical facility, and that this psychiatric care had a "direct relation to the trauma suffered during his military service." County of San Bernardino Department of Mental Health clinical records dating between approximately February 1994 and July 1994 noted as history that the veteran had a diagnosis of schizophrenia "at age 20" with no treatment until March 1991. He noted feeling "weird" at age 14. Coexisting personality disorder and schizophrenia were noted. The veteran essentially noted as medical history that he was last hospitalized in 1975 for schizophrenia. It was indicated that pertinent medical records of schizophrenia at a private hospital prior to 1976 were destroyed when the hospital was sold. In a copy of an undated affidavit received in February 1995, which appears to be an affidavit made by a service member at the time of the veteran's administrative separation from service, the affiant stated that the veteran seemed unable to act his age. He spoke in an immature manner, stared into the sun and picked flowers. The veteran was very untrustworthy and unreliable. He refused to do as ordered, would sit and argue with anyone in authority, and then not carry out the order. He was always going to sick bay, but was in fine shape when liberty call was sounded. He was continually trying to get out of any job he could and refused to co-operate with his superiors. He felt that the veteran would never be able to adjust to the military way of life. A May 1995 VA clinical record shows it was noted as history that the veteran reported a history of hallucinations at age 19 with a diagnosis of schizophrenia "at age 20" and no treatment until March 1991. In April 1996 the Board remanded this case to the RO for additional development of the evidence including a comprehensive examination by a specialist in psychiatry and for an opinion as to whether the veteran's current acquired chronic psychiatric disorder was initially manifested by, or is etiologically related to any symptoms clinically noted while the veteran was in active service. In a July 1996 VA psychiatric examination report shows that information was obtained from the veteran, and his claim file (C-file) with his service records. The psychiatric evaluation was for the purposes of determining the nature and etiology of any current psychiatric disability, and providing an opinion as to whether any currently diagnosed chronic psychiatric disorder was initially manifested by or was etiologically related to any symptoms noted while in the service. The psychiatric examiner noted the following: A. A medical and occupational history: Social history; the veteran stated he was born, September [redacted], 1954, in the state of New Jersey. His mother was 65 years of age and lived in Yucca Valley and his father was 71 and lived in Los Angeles. His parents were divorced when he was five or six years of age. He had a stepfather, and he was the second of two boys. Childhood history; he stated, he grew up in Puerto Rico and had bad memories. Educational history; he had difficulty adapting to school. He dropped out of school in the 10th grade. He never received a General Educational Development (GED) degree. Military history; he served in the United States Marine Corps, in the Reserves at age 17, for several years before going on active duty. Apparently, from January 2, 1975 to June 9, 1975. He was missing drills, at his Reserve unit, and in spite of counseling did not change and was therefore placed on active duty at Camp Pendleton. He said, they tried to force me to do things I could not do. "They lied to me and tortured me." I could not grasp what they tried to tell me. He apparently, received a general discharge as, unsuitable for military duty. Post-active service events to present; he married in the 1980's, and he did not remember what year. He was divorced five years earlier and there was one daughter from that relationship. Drug history; there was a history of cocaine and alcohol abuse. He denied any cocaine for the past seven years. He also denied alcohol since his vehicular accident, in which he suffered a closed head injury with concussion, in 1993. He also had a ruptured spleen and underwent a splenectomy. Work history; he had been poor. He went to barber school, sponsored by his parents and opened up a barber shop that was unsuccessful. Psychiatric history: his C-file records were reviewed, including his records while on active duty at Camp Pendleton. There was a psychiatric consult, dated May 7, 1975, in which he had been referred to the psychiatrist, and by the Chaplain, for consideration of a conscientious objector discharge, as he refused to carry weapons or attend orientation meetings, as it was against God's will. That psychiatric consult stated that he was placed on active duty after missing too many drills while in the Reserves, and that he came from a broken family and dropped out of school. Diagnosis at that time was character and personality disorder, immature and impulsive type, and the psychiatrist felt that it was appropriate for him to consider conscientious objector discharge as he was unsuitable for military duty. The psychiatrist did not recommend any psychiatric treatment. It appears that he was first diagnosed with schizophrenia in 1991. He had had a previous history of alcohol and cocaine addiction. There was a note on February 17, 1994 with a diagnosis of paranoid schizophrenia and borderline personality disorder, and status post head injury from 1993. Also, in the medical records, were several triage evaluations done at Loma Linda Veterans Administration Hospital. The first one done on shows he was given a diagnosis of chronic paranoid schizophrenia and referred back to County Medical Health. He was seem again, in primary care at the Loma Linda VA Hospital on September 25, 1995 with a diagnosis of paranoid schizophrenia, to rule out substance abuse. He was seen because of paranoid thoughts, shaking, and nervousness. There were also multiple letters in his records indicating, from the family, that his difficulties stemmed from his time in the Marine Corps. It was interesting to note, a fellow Marine, while he was on active duty, stated that he had difficulty at meetings and making formations, etc., but when it came time to liberty he was always ready. He had been on Thorazine, Mellaril, and Clonopin in the past, and it was felt that he was probably on Clonopin at this time. The veteran was not considered a good historian. Following a mental status evaluation, diagnosis was schizophrenic reaction, paranoid type, chronic, severe. The psychiatric examiner's discussion and expressed opinion following his review of the evidence in the C-file and examination findings was as follows; "In reviewing his claim records, including his service records, it is quite obvious that this individual did not suffer from a psychotic process while on active duty in the Marine Corps. But, had difficulty adjusting, because of personality and character problems which are not related to his schizophrenia. Apparently, there is a long history of polysubstance abuse, prior to developing a diagnosis of schizophrenia, some 15 years after discharge from the military. Prognosis is poor. But as previously stated, there is no relationship to his character and personality problems while on active duty, to his current psychiatric diagnosis. Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §1110, 1131 (West 1991). If the disability is a psychosis and manifested to a compensable degree within one year following separation from active duty, service connection may be granted. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing active duty for training (ACDUTRA) or injury incurred or aggravated while performing inactive duty training INACDUTRA). 38 U.S.C.A. §§ 101(24), 106, 1131 (West 1991). A veteran who served during a period of war or during peacetime service after December 31, 1946, is presumed in sound condition except for defects noted when examined and accepted for service. Clear and unmistakable evidence that the disability existed prior to service will rebut this presumption. 38 U.S.C.A. § 1111, 1137 (West 1991). A preexisting injury or disease will be considered to have been aggravated by 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. § 1131, 1153 (West 1991); 38 C.F.R. §§ 3.303, 3.306 (1999). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. This includes medical facts and principles which may be considered to determine whether the increase is due to the natural progress of the condition. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. § 3.306(b) (1999). The Court has held that, in cases where a condition is properly found to have preexisted service, the Board, in considering the pertinent statutory and regulatory framework governing the presumption of aggravation, must determine: (1) Whether there was a worsening of the disorder during service; and (2) if so, whether there was clear and unmistakable evidence that the increase in severity was due to the natural progress of the disease. Crowe v. Brown, 7 Vet. App. 238 (1995). The Court has held that intermittent or temporary flare-ups during service of a preexisting injury or disease do not constitute aggravation. Rather, the underlying condition must have worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). There is no presumption of soundness at entrance into ACDUTRA because veteran status is not afforded an individual for such type of service. Only veterans are entitled to that presumption under 38 U.S.C.A. § 1111 (West 1991). Under 38 U.S.C.A. § 101(2) a "veteran" is a person who served in active military, naval, or air service. Under 38 U.S.C.A. § 101(24) "active military, naval, or air service includes active duty, any period of [ACDUTRA] during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty." Service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing ACDUTRA or injury incurred or aggravated by inactive duty training (INACDUTRA). 38 U.S.C.A. §§ 101(24), 106, 1131. Under 38 U.S.C.A. § 101(22) (a) and (c) ACDUTRA means, in pertinent part, full-time duty in the Armed Forces performed by Reserves for training and full-time duty as members of the Army National Guard or Air National Guard of any State. The law provides that congenital or developmental defects, personality disorders, and mental deficiency as such are not diseases or injuries within the meaning of applicable law and regulations for VA compensation purposes. 38 C.F.R. §§ 3.303(c), 4.9. See VAOPGCPREC 82-90. Attention is directed to the outline of personality disorders in the APA manual. Formal psychometric tests are essential in the diagnosis of mental deficiency. Brief emotional outbursts or periods of confusion are not unusual in mental deficiency or personality disorders and are not acceptable as the basis for a diagnosis of psychotic disorder. However, properly diagnosed superimposed psychotic disorders developing after enlistment, i.e., mental deficiency with psychotic disorder, or personality disorder with psychotic disorder, are to be considered as disabilities analogous to, and ratable as, schizophrenia, unless otherwise diagnosed. 38 C.F.R. § 4.127 (effective prior to November 7, 1996). For a veteran to obtain service connection for, as a single entity, personality disorder superimposed with service connected mental condition, the service-connected mental condition must be a psychotic disorder. 38 C.F.R. § 4.127, effective prior to November 7, 1996. See Carpenter v. Brown, 8 Vet. App. 240, 245 (1995). Except as provided in 38 C.F.R. § 3.310(a), disability resulting from mental retardation and personality disorders may not be service connected. However, disability resulting from a mental disorder that is superimposed upon mental retardation or personality disorder may be service connected. 38 C.F.R. § 4.127, effective November 7, 1996. Where a law or regulation changes after a claim has been filed to reopen, but before the administrative judicial process has been concluded, the version more favorable to an appellant applies unless Congress provided otherwise or permitted the Secretary to do otherwise and the Secretary does so. Marcoux v. Brown, 9 Vet. App. 289 (1996); Karnas v. Brown, 1 Vet. App. 308 (1991); Bernard v. Brown, 4 Vet. App. 384 (1993). Analysis To sustain a well-grounded claim, the claimant must provide evidence demonstrating that the claim is plausible; mere allegation is insufficient. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). The determination of whether a claim is well grounded is legal in nature. King v. Brown, 5 Vet. App. 19 (1993). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of 38 U.S.C.A. § 5107(a) (West 1991). Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). To be well grounded, a claim must be accompanied by supportive evidence, and such evidence must justify a belief by a fair and impartial individual that the claim is plausible. Where the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is required to fulfill the well-grounded claim requirement of 38 U.S.C.A. § 5107(a) (West 1991). Lathan v. Brown, 7 Vet. App. 359 (1995). In order for a claim for service connection to be well grounded, there must be competent evidence of a current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence) and of a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). In determining whether the veteran's claim is well-grounded, supporting evidence both in the form of records in control of the government and the veteran's evidentiary assertions are presumed true; exception occurs when the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. King v. Brown, 5 Vet. App. 19 (1993). In this case the evidence submitted by the veteran includes a medical statement in February 1993 from Dr. ZK with an opinion based on a review of the medical records that the veteran's schizophrenia is related to trauma inservice. Such medical statement is sufficient to well-ground the veteran's claim as it is not shown that such medical opinion is beyond the competence of the physician for purposes of well grounding the claim. The veteran's claim is "well grounded" within the meaning of 38 U.S.C.A § 5107(a) (West 1991); that is, he has presented a claim that is plausible. VA, therefore, has a duty to assist him in the development of facts pertinent to his claim. In this regard, the Board notes that the evidence of record consists of service medical records as well as post service private and VA medical records including a report of a comprehensive VA psychiatric examination in July 1996, and lay and buddy statements. In June 1996 the Board remanded the claim to the RO for further development. The Board reasoned that a February 1993 private physician's statement relating the veteran's current treatment for a psychiatric disorder to trauma suffered in service was "sufficient to suggest that his claim may be well grounded." The veteran was to undergo a comprehensive examination by a specialist in psychiatry with an opinion as to whether the veteran's current acquired chronic psychiatric disorder was initially manifested by, or is etiologically related to any symptoms clinically noted while the veteran was in active service. That development having been completed the case was returned to the Board. The veteran is advised that the Board's duty to assist the veteran is not "a license for a fishing expedition," nor is it a "one-way street." See Gobber v. Derwinski, 2 Vet. App. 470, 472 (1992) (duty to assist does not extend to determinations of whether "there might be some unspecified information which could possibly support a claim."); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991), reconsideration denied, 1 Vet. App. 406 (1991). Since there is no indication from the veteran that there are additional available outstanding records which VA has not attempted to obtain, no further assistance is required to comply with the duty to assist him as mandated by 38 U.S.C.A. § 5107(a) (West 1991). Therefore, the Board concludes that the service and post service medical records on file are complete for reaching a fair, well-reasoned determination in this case; and the duty to assist the appellant in the development of facts pertinent to his claim as contemplated by 38 U.S.C.A. § 5107(a) and applicable case law has been satisfied. Once the Board has determined that the veteran has presented a well-grounded claim, the Board must then weigh the evidence to include analyzing the credibility and specialized medical qualifications and expertise of medical professional examinations and opinions which is not considered when initially determining whether a plausible claim has been presented for purposes of well-grounding a claim. In this case, the evidence of record clearly demonstrates that the veteran has a current psychiatric disorder diagnosed as paranoid schizophrenia, a psychosis. A comprehensive analysis of the record clearly demonstrates that the veteran was seen during active service for a problem that was solely diagnosed by specialized psychiatric consult as a personality disorder. Personality disorders are not diseases or injuries within the meaning of applicable legislation; hence, no basis exists for a grant of service connection for a personality disorder. See 38 C.F.R. § 3.303(c); Beno v. Principi, 3 Vet. App. 439, 441 (1992). Importantly, the service medical records were silent for any evidence of superimposed psychosis or disability resulting from a mental disorder that was superimposed on a personality disorder in service. At this juncture, the Board points out that the law and regulations regarding the presumption of soundness under 38 U.S.C.A. §§ 1111, 1137 as well as for aggravation of preexisting disabilities under 38 C.F.R. 3.306 are not applicable to personality disorders as they are not considered diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). While service connection may be granted, in limited circumstances, for psychosis or disability resulting from a mental disorder that is superimposed on a personality disorder disability there is no competent medical evidence whatsoever that such is the case here under the provisions of 38 C.F.R. § 4.127 both prior to November 7, 1996 or after November 7, 1996. Prior to November 7, 1996, the record lacked competent medical evidence of a properly diagnosed superimposed psychotic disorder developing after enlistment, i.e., personality disorder with psychotic disorder. After November 7, 1996 there was no competent medical evidence of disability resulting from a mental disorder that is superimposed upon a personality disorder. In this case the veteran's identified psychiatric disorder is schizophrenia, a psychosis, that was first shown in 1991. Clearly, the provisions of 38 C.F.R. § 4.127 both prior to and after November 7, 1996 have no relevant application in this case. Therefore, the Board's review of the case without first remanding it to the RO for review under the old and new law is not prejudicial to the veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). Importantly, the Board notes that a comprehensive examination was undertaken by a VA specialist in psychiatry in July 1996, for the purposes of determining the nature and etiology of any current psychiatric disability, and providing an opinion as to whether any currently diagnosed chronic psychiatric disorder was initially manifested by or is etiologically related to any symptoms noted while in the service. The psychiatric specialist clearly determined that the veteran did not have a psychotic process while on active duty. Rather, the veteran was noted to have had difficulty adjusting, because of personality and character problems which were not related to his schizophrenia. This finding was consistent with the psychiatric consult inservice showing the presence of a personality disorder. At the time of the July 1996 VA psychiatric examination the diagnosis of mental disorders conformed to the American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders using DSM-III under 38 C.F.R. § 4.125. If the diagnosis of a mental disorder did not conform to DSM- III or was not supported by the findings on the examination report, the rating agency was to return the report to the examiner to substantiate the diagnosis. During the pendency of the veteran's claim the provisions of 38 C.F.R. § 4.125 were amended to reflect that diagnoses of mental disorders conform to DSM-IV. However, the Board notes that there were no changes in DSM-IV with respect to the diagnosis of personality disorders or schizophrenia that would have any bearing on the present case. Accordingly, the Court's holding in Karnas does not apply in this case. Remanding this case for a determination of diagnosis under DSM-IV would serve no useful purpose. The Board notes that the conclusions of the VA psychiatric examiner in 1996 appear to have been based on a fair consideration of the material evidence, and to reflect significant knowledge and skill in analysis of the pertinent data. The Board may not overlook the fact that in a February 1993 statement, ZK, M.D., wrote that the veteran had been under his medical care since October 1991, and that an examination of his medical records revealed that he was not suitable for military service, in part from an emotional point of view. Dr. ZK opined that the military environment appeared to have "produced an exacerbation of the veteran's "previous illnesses." It was noted the veteran was, at that time, receiving psychiatric care at a VA medical facility, and that this "psychiatric care" had a "direct relation to the trauma suffered during his military service." The record shows that Dr. ZK has been treating the veteran for physical disabilities. He noted that the veteran was treated for psychiatric problems separately through VA. The record does not suggest, nor does Dr. ZK claim to be a psychiatrist or have any competent specialized training or expertise in the field of psychiatry. The Board notes that while Dr. ZK may have reviewed the veteran's medical records, he did not identify the previous illnesses that he felt were exacerbated in service. Moreover, he did not furnish any supporting clinical data which provided an etiologic link between an identified current schizophrenic process and any specific incident of service to include identification of a superimposed schizophrenia process on a personality disorder in service. The Board would argue that the general and conclusory medical opinion of Dr. ZK, M.D., who is not a psychiatrist, lacked the degree of certainty and expertise in the field of psychiatry to contradict the opinions of the special psychiatric consult in service and the VA psychiatrist in July 1996. Moreover, the Board notes that the record contains private and VA psychiatric clinical records dated in the mid 1990's containing a diagnosis of schizophrenia "at age 20" with no treatment until March 1991. Such documents on their face appear to either place a diagnosis of schizophrenia "at age 20", during service in about 1975 (the appellant was born in 1955), or before service, and relate it to some unspecified trauma during service. Such documents, though, were prepared nearly 20 years after the veteran's service, at a time when the appellant had clearly been diagnosed with schizophrenia, and appear to be based entirely on the veteran's history as provided to these examiners. "Evidence which is simply information recorded by a medical examiner unenhanced by any additional medical comment by that examiner, does not constitute 'competent medical evidence' satisfying the Grottveit requirement. Such evidence cannot enjoy the presumption of truthfulness accorded by Robinette[ v. Brown, 8 Vet. App. 69, 75-76 (1995)." LeShore v. Derwinski, 8 Vet. App. 405, 409 (1995). In an attempt to identify the origin of a psychiatric disorder in service, the veteran points to a copy of an affidavit made by a service member at the time of his administrative separation, in which the affiant stated that the veteran was immature, was frequently reporting to sick bay, and had difficulty adjusting to military life. The appellant argues that the references to his frequent sick bay consultations demonstrates the onset of his psychiatric symptomatology. However, the affiant does not mention the purpose for these sick bay consultations, but seems to insinuate that their purpose was to avoid responsibilities inherent in his military endeavors. The document is, at best, silent on the issue of whether a psychiatric disorder was present in service, and, therefore, provides no support for a showing of a psychiatric disorder in service. Several documents prepared after the veteran's discharge provide information as to his condition before, during, and soon after service. These documents, letters from the veteran's mother, brother, and spouse, attempt to show that the veteran's mental condition deteriorated rapidly during and after his active service. His mother, brother and spouse are certainly competent to offer testimony as to their observations of the appellant during these periods. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). However, their statements do not specify the nature of any psychiatric disorder nor is there evidence of record that the veteran's mother, brother, and spouse had the requisite medical expertise to diagnose a psychiatric disorder at that time. Id. at 495. The clear implication intended by these letters is that the veteran's current schizophrenia, first diagnosed in 1991, had its origins in his active service between 1973 and 1975. The record does not show, however, that the veteran's mother, brother, or spouse have the requisite skill, knowledge, or expertise to offer testimony as to a medical conclusion, such as whether schizophrenia had its origins in service or was manifested by the behavior to which they testified. See Id. at 495. The record lacks competent medical evidence of an etiologic link between the paranoid schizophrenic disorder first shown many years following separation from active service and any incident of active service including on a superimposed basis. Overall, the preponderance of the evidence is negative and against the grant of service connection for a psychiatric disorder diagnosed as paranoid schizophrenia. The doctrine of reasonable doubt has been considered but the evidence is not so evenly balanced as to warrant an allowance of the appeal. See 38 C.F.R. §§ 3.102, 4.3. ORDER Entitlement to service connection for paranoid schizophrenia is denied. RONALD R. BOSCH Member, Board of Veterans' Appeals