Citation Nr: 0003613 Decision Date: 02/11/00 Archive Date: 02/15/00 DOCKET NO. 97-27 852 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for a personality trait disturbance, also diagnosed as an emotionally unstable personality with a superimposed episode of dissociative reaction. 2. Entitlement to service connection for a psychosis. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant, Appellant's wife, Appellant's brother-in-law ATTORNEY FOR THE BOARD V. Marletta, Associate Counsel INTRODUCTION The veteran served on active duty from July 1961 to March 1962. This case comes before the Board of Veterans' Appeals (Board) from a rating decision rendered in August 1996 by the St. Petersburg, Florida, Regional Office (RO) of the Department of Veterans Affairs (VA). FINDINGS OF FACT 1. A personality disorder is not currently shown. 2. There is no medical evidence showing the veteran incurred a psychosis in-service. 3. There is no medical evidence establishing a nexus between the veteran's current psychosis and any in-service injury or disease. CONCLUSIONS OF LAW 1. The veteran's claim for entitlement to service connection for a personality trait disturbance, also diagnosed as an emotionally unstable personality with a superimposed episode of dissociative reaction, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed.Cir. 1996) (per curiam) (table); 38 C.F.R. §§ 3.303 (1999). 2. The veteran's claim for entitlement to service connection for a psychosis is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed.Cir. 1996) (per curiam) (table); 38 C.F.R. §§ 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Well Grounded Claims - In General In Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997), cert. denied sub nom. Epps v. West, 118 S. Ct. 2348 (1998), the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that, under 38 U.S.C.A. § 5107(a), the VA has a duty to assist only those claimants who have established well grounded (i.e., plausible) claims. More recently, the United States Court of Appeals for Veterans Claims (Court or CAVC) issued a decision holding that VA cannot assist a claimant in developing a claim which is not well grounded. Morton v. West, 12 Vet. App. 477 (July 14, 1999), req. for en banc consideration by a judge denied, No. 96-1517 (U.S. Vet. App. July 28, 1999) (per curiam). Once a claimant has submitted evidence sufficient to justify a belief by a fair and impartial individual that a claim is well grounded, the claimant's initial burden has been met, and VA is obligated under 38 U.S.C. § 5107(a) to assist the claimant in developing the facts pertinent to the claim. Accordingly, the threshold question that must be resolved in this appeal is whether the appellant has presented evidence that the claim is well grounded; that is, that the claim is plausible. In order for a claim to be well grounded, there must be (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Epps, 126 F.3d at 1468; Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). Where the determinative issue involves medical causation or etiology, or a medical diagnosis, competent medical evidence to the effect that the claim is "plausible" or "possible" is required. Epps, 126 F.3d at 1468. Further, in determining whether a claim is well grounded, the supporting evidence is presumed to be true and is not subject to weighing. King v. Brown, 5 Vet.App. 19, 21 (1993). II. Entitlement to service connection for a personality trait disturbance, also diagnosed as an emotionally unstable personality with a superimposed episode of dissociative reaction. As stated above, the first element of a well-grounded claim requires medical evidence of a current disability. The veteran was diagnosed in-service with this personality disorder in March 1962 at the USPHS Hospital in Savannah, Georgia. The veteran testified at his October 1999 video conference hearing that due to financial concerns, he did not seek treatment for any psychiatric illnesses from the time of his separation in March 1962 until 1994. Transcript of Hearing at p. 10. A March 1994 letter written by Dr. Stincer indicates that the veteran then sustained a "psychotic condition," which is confirmed by Dr. Garcia-Granda's March 1996 letter indicating a diagnosis of "psychosis [not otherwise specified] (298.9) [a reference to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)]." While the diagnoses of Drs. Stincer and Garcia-Granda both indicate that the veteran has a psychosis, there is no medical evidence that the veteran currently has a personality disorder with a superimposed condition or neurosis. Moreover, personality disorders and mental deficiency as such are not diseases or injuries within the meaning of applicable legislation and cannot be service connected. 38 C.F.R. § 3.303 (c) (1999) III. Entitlement to service connection for a psychosis As discussed in Part II of this opinion, the veteran has been diagnosed with a psychosis, not otherwise specified (298.9, DSM-IV). The Board therefore finds that the veteran has a current disability and that the first Caluza element of a well-grounded claim has been satisfied for purposes of this issue. The second Caluza element of a well-grounded claim requires evidence of an in-service incurrence of a psychosis. The veteran's service medical records show that prior to his admission to the USPHS Hospital in Savannah, Georgia, he was treated from late February until early March 1962 at the 7th Coast Guard District Medical Office (CGDMO) in Miami, Florida, where he was diagnosed with "psychoneurosis, dissociative reaction, severe." Included with this diagnosis is a narrative, which states in relevant part that the veteran "exhibited psychotic behavior, destroying office furniture" and further indicates that "the subject patient may revert to psychotic behavior at any time without warning." However, although the report refers to the veteran as demonstrating "psychotic behavior," it does not set forth a specific diagnosis of clinical psychosis. The diagnosis of psychoneurosis does not necessarily imply an accompanying psychosis. Based on the lack of a specific diagnosis of psychosis from the 7th CGDMO, in addition to the subsequent diagnosis of a personality disorder at the USPHS Hospital in Savannah, Georgia, the Board finds that the evidence does not establish that the veteran incurred a psychosis while in-service. Notwithstanding the above finding, the veteran's claim for service connection for psychosis also fails because he has not satisfied the third Caluza element of a well-grounded claim - i.e. there is no medical evidence linking the veteran's current psychosis to any in-service injury or disease. The veteran was first diagnosed with psychosis in 1994, 32 years following his separation from service. While the record contains letters from Drs. Stincer and Garcia- Granda indicating the diagnosis of a psychosis, the record is devoid of any detailed medical records from either doctor which might indicate the etiology of the veteran's condition. Absent clear medical evidence of an in-service incurrence of psychosis, as well as medical evidence showing a nexus between the veteran's current disability and an in-service injury or disease, the Board must find that the veteran's claim for entitlement to service connection for a psychosis is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed.Cir. 1996) (per curiam) (table); 38 C.F.R. §§ 3.303 (1999). The Board must again point out that its duty to assist the veteran in the development of his claim, as stipulated in 38 U.S.C.A. § 5107(a), does not arise until a claim is shown to be well grounded. The Board also notes that the veteran is free to submit new and material evidence, and reopen his claim for service connection, at any time. ORDER The veteran's claim for entitlement to service connection for a personality trait disturbance, also diagnosed as an emotionally unstable personality with a superimposed episode of dissociative reaction, is denied as not well grounded. The veteran's claim for entitlement to service connection for a psychosis is denied as not well grounded. M. W. GREENSTREET Member, Board of Veterans' Appeals