BVA9504759 DOCKET NO. 91-40 267 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUE Entitlement to service connection for an acquired psychiatric disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL Appellant and Jim Parker ATTORNEY FOR THE BOARD Joseph P. Gervasio, Jr., Counsel INTRODUCTION The veteran served on active duty from April 1979 to November 1985. This case comes to the Board of Veterans' Appeals (Board) on appeal of a July 1990 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA), which denied service connection for an acquired psychiatric disorder. The case was remanded by the Board in April 1993. It was returned to the Board in December 1994. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has an acquired psychiatric disorder which had its onset during service. It is pointed out that he had a suicidal gesture while on active duty and received a psychological evaluation. He maintains that symptoms have persisted from the time of service to the present. 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 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 evidence supports the claim for service connection for an acquired psychiatric disorder. FINDING OF FACT A chronic acquired psychiatric disorder (most recently diagnosed as a schizoaffective disorder) began during service. CONCLUSION OF LAW A chronic acquired psychiatric disorder (most recently diagnosed as a schizoaffective disorder) was incurred during service. 38 U.S.C.A. §§ 1131, 5107(b) (West 1991); 38 C.F.R. § 3.303(1994). REASONS AND BASES FOR FINDING AND CONCLUSION I. Factual Background The veteran served on active duty from April 1979 to November 1985. Available service medical records show that in July 1982 the veteran was treated when he slashed his left wrist in an apparent suicide attempt. He reported several past attempts. The veteran said he had been having marital problems and had cut his wrist to get attention from his wife and others and did not want to kill himself. It was remarked that a line of duty investigation was in process (attempts to find the results of this investigation were not successful). The case was closed in August 1982. The service medical records mention that the veteran was seen at an Army mental health clinic in August 1985 and was then given an extended intake evaluation and psychological testing. The records from this evaluation and testing are not available, despite efforts to locate them. The veteran waived his separation physical examination in November 1985, stating that he had no current medical problems and did not intend to file a claim against the federal government. The veteran was seen in the emergency room of Franklin Medical Center in August 1986. He was seen for increased depression related to chaos in his marriage. He had made a suicide gesture the previous night while drinking. He now denied suicidal ideation or intent and felt that alcohol was the primary problem. He was referred to the Beacon Program (a substance abuse program) of Franklin Medical Center where he was evaluated in August 1986. It was noted he had driven his car into a river in a suicide attempt while drunk. The diagnosis was possible alcohol dependence. VA outpatient records dated in and after February 1989 show treatment for depression. The veteran gave a history which included problems while in the Army, during which time he and his wife saw a marriage counselor, he was suicidal, and he saw a psychiatrist who prescribed medication. He related that after leaving service in 1985 he continued to have a sleep disturbance, periodic heavy drinking, lack of concentration, crying spells, difficulty holding a job, and other problems. The veteran said he saw a therapist from 1986 to 1987, and was divorced in 1988. The veteran was hospitalized at Franklin Medical Center in April 1989. He was referred by emergency service for treatment of depression complicated by a suicide plan and alcohol abuse. It was reported that he had been discovered by the police with a loaded rifle in his car, which was stuck in the mud, and stated that he intended to shoot his dog and then himself. (A police report concerning this incident is of record.) On interview, he reported being intermittently depressed since 1985 when his marriage had broken up. The veteran related that when he was in the Army, stationed in Korea, he and his wife were in marriage counseling, and that when stationed at Fort Hood he cut his wrist in a suicide gesture when his wife threatened to leave him. He said he had trouble keeping a job and a relationship with another girl friend had recently broken up. He said he had been on antidepressant medication in the past and felt that it was beneficial. During the hospital course, he continued to complain of depression, but his symptoms gradually improved. He was discharged in early May 1989. The diagnoses were adjustment disorder with depressed mood, and alcohol dependence (Axis I) and personality disorder not other wise specified, with dependent features (Axis II). The veteran was hospitalized at Franklin Medical Center in June 1989. He was brought to the emergency room after having jumped from a bridge into the Connecticut River while intoxicated in an alleged suicide attempt. (A police report concerning this incident is of record.) He was admitted to the hospital and stabilized over a period of days. He took several successful leaves of absence and was discharged from the hospital in July 1989. The diagnoses were rule out dysthymia, rule out adjustment disorder with mixed emotional features, and alcohol dependence (Axis I) and personality disorder not otherwise specified with borderline and dependent traits (Axis II). The veteran was hospitalized at Cheshire Medical Center in August 1989 for a complaint that he was afraid that he was going to kill himself. He gave a history of four previous suicide attempts, one in 1983 and one in 1986 related to marital problems, and two in 1989 related to employment problems. During the admission interview he expressed suicidal ideation and described symptoms of a major depression going back at least six months. During hospitalization, psychological testing showed significant depression and was consistent with alcohol abuse, with dependent personality traits. The diagnoses were major depression and alcohol abuse (Axis I) and dependent personality (Axis II). He was discharged in September 1989 to be followed at a VA medical facility. The veteran was hospitalized at a VA facility in December 1989. It was noted that he had been receiving VA outpatient treatment. He was initially admitted because he felt very depressed and suicidal after drinking and thought about lying down on the railroad tracks to kill himself. During the course of his hospitalization, he completed an alcohol dependence treatment program and was active in alcoholics anonymous. He was discharged in January 1990. The diagnoses were alcohol dependence, continuous; rehabilitation; and adjustment reaction with depressive mood (Axis I) and mixed personality disorder (Axis II). An April 1990 disability determination by the Social Security Administration shows that the veteran was determined to be disabled by that agency, as of February 1989, due to recurrent major depression, a mixed personality disorder, and alcoholism. Medical records used in making this determination, many of which are duplicates of reports previously of record, have been associated with the claims file. The veteran was hospitalized at a VA facility in August 1990. He had initially been admitted to another ward of the facility after a 3 day drinking episode and was transferred as he was suicidal. He was given medication for depression and transferred into the medical center's alcohol treatment program. He received treatment and was discharged in September 1990. The diagnoses were alcohol dependence, continuous; rehabilitation; and adjustment reaction with depressive mood (Axis I) and mixed personality disorder (Axis II). A hearing was conducted at the RO in May 1991. The veteran's witness, Jim Parker, his therapist at a Vet Center, testified that he believed that the veteran's psychiatric problems started at or about the time of the 1982 suicide gesture in service. The veteran testified that he had psychiatric symptoms in service which had continued to the present time. The veteran was hospitalized at a VA facility in October 1992. His chief complaint was of alcohol intoxication. It was noted on admission that he appeared depressed. He stated that he had thrown his medications away, because they were not helping him, and had apparently resumed drinking. While hospitalized, he completed a psychological test which was felt to be diagnostic of a character disorder. The pertinent discharge diagnoses were alcohol dependency, continuous, history of marijuana dependence, dysthymic disorder, and organic mental disorder, not otherwise specified (Axis I). A hearing was conducted before a member of the Board in Washington, D.C. in January 1993. The veteran and his therapist, Jim Parker (a social worker who had treated the veteran since 1989), gave testimony concerning the numerous times the veteran had sought treatment for his psychiatric condition since service. They testified that they believed the veteran's condition had its onset while he was on active duty. VA outpatient treatment records, dated from 1989 to 1993, show that the veteran has been receiving intermittent treatment for substance dependence, a personality disorder, and a variously diagnosed acquired psychiatric condition, including depression. A psychiatric examination was performed by the VA in December 1993. The examiner reviewed the veteran's psychiatric history. The doctor noted that the veteran's depression occurred originally in 1983 and seemed to be related to marital problems occurring in service. It was noted that the veteran had made suicide attempts in 1983, 1986 and 1989 and that his marriage had ended in divorce in 1988. The diagnoses were schizoaffective disorder (Axis I) and dependent personality and explosive personality disorders (Axis II). II. Analysis It is initially noted that the veteran's claim is well grounded; that is, it is not inherently implausible. 38 U.S.C.A. § 5107(a). The facts relevant to the issue have been properly developed and the statutory obligation of the VA to assist the veteran in the development of his claim has been satisfied. Id. In order to establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. 38 U.S.C.A. § 1131. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). The veteran claims service connection for a chronic acquired psychiatric disorder (essentially a neurosis or psychosis). The records since service show that in addition to an acquired psychiatric disorder he has a personality disorder and an alcohol and other drug abuse disorder. The personality disorder is not a disability for VA compensation purposes and may not be service connected. 38 C.F.R. § 3.303(c). Similarly, alcohol and drug abuse may not be service connected as it is deemed to be of willful misconduct origin. 38 C.F.R. § 3.301. With regard to an acquired psychiatric disorder, the veteran's 1979-1985 service medical records do not contain a diagnosis of such a condition. However, service connection may still be granted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Although the service medical records contain no pertinent psychiatric diagnosis, there are some notable entries. In 1982 the veteran was treated for a suicide gesture, and in 1985 he underwent psychological testing and evaluation. Details of these episodes are lacking due to incompleteness of the service records, but the episodes do suggest the presence of some type of psychiatric disorder during the time of active duty. In 1986, within the year after service, the veteran made another suicide gesture, and complained of increased depression and alcohol abuse. No clear diagnosis of a psychiatric disorder was made at that time (only alcohol dependence was diagnosed), but, in retrospect, this episode is suggestive of an ongoing psychiatric disorder. After the 1986 episode, the veteran reportedly saw a therapist until 1987, although this is not fully documented. Private and VA medical records from 1989 to 1993 show a variety of psychiatric symptoms (suicide gestures, etc.) and variously diagnosed acquired psychiatric disorders (coexisting with a non- service-connected personality disorder and substance abuse). The acquired psychiatric disorder has primarily been diagnosed as depression, although the most recent examination (the 1993 VA compensation examination) led to a diagnosis of a schizoaffective disorder (a psychosis). Although an acquired psychiatric disorder was not clearly diagnosed until 1989, it is significant that some symptoms of that disorder were present in service and shortly thereafter. Moreover, the histories provided by the veteran during the course of treatment, as well as the hearing testimony, lend support to the proposition that an acquired psychiatric disorder was present in service and since then, even if not clearly diagnosed until after service. Bearing in mind the benefit-of-the-doubt doctrine, 38 U.S.C.A. § 5107(b), the Board finds that a chronic acquired psychiatric disorder (most recently diagnosed as a schizoaffective disorder) began during and was incurred in service. Thus, service connection is warranted. ORDER Service connection for an acquired psychiatric disorder (most recently diagnosed as a schizoaffective disorder) is granted. L. W. TOBIN 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.