Citation Nr: 0000367 Decision Date: 01/06/00 Archive Date: 01/11/00 DOCKET NO. 98-05 572 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUE Entitlement to compensation benefits pursuant to the provisions of 38 U.S.C.A. Section 1151 (West 1991 and Supp. 1998) for post-traumatic stress disorder, claimed to have resulted from misdiagnosis and/or mistreatment at various Department of Veterans Affairs (VA) medical facilities during the 1970's. REPRESENTATION Appellant represented by: Disabled American Veterans INTRODUCTION The veteran served on active duty from November 1967 to July 1969, and from June 19 to August 26, 1975, with service in the Republic of Vietnam from July 13 to July 29, 1968. In a decision of July 1977, the Board of Veterans' Appeals (Board) denied entitlement to service connection for schizophrenia, essentially on the basis that the veteran's schizophrenia preexisted his second period of active service, and was not aggravated thereby. In a subsequent decision of April 1987, the Board denied entitlement to service connection for an acquired psychiatric disorder, once again on the basis that the veteran's schizophrenia preexisted his second period of active service, with no evidence of any inservice aggravation. Subsequent to the Board's April 1987 decision, the veteran, for the first time, sought entitlement to service connection for post-traumatic stress disorder, on the basis that he currently suffered from that disability, which had its origin in various "stressors" occurring during his service in the Republic of Vietnam. The veteran's claim was denied, and an appeal perfected, but in March 1992, the veteran withdrew his appeal regarding the issue of service connection for post- traumatic stress disorder. On April 5, 1995, there was received from the veteran his initial claim for compensation benefits pursuant to the provisions of 38 U.S.C.A. § 1151 (West 1991 & Supp. 1998) for post-traumatic stress disorder. It is that claim with which the Board is currently concerned. FINDING OF FACT The veteran suffered no additional disability, including the incurrence or aggravation of post-traumatic stress disorder, as a result of treatment by VA medical personnel during the 1970's. CONCLUSION OF LAW Compensation benefits for post-traumatic stress disorder pursuant to the provisions of 38 U.S.C.A. § 1151 are not warranted. 38 U.S.C.A. § 1151 (West 1991 & Supp. 1998); 38 C.F.R. § 3.358 (1998). REASONS AND BASES FOR FINDING AND CONCLUSION Factual Background A VA record of hospitalization dated in April 1975 is to the effect that the veteran was admitted at that time to a VA medical facility with a history of a recent suicidal gesture precipitated by the ingestion of approximately 50 pills of Trilafon, 8 milligrams. Reportedly, the veteran had been seen approximately 12 days earlier at the mental hygiene clinic, where he had been given Trilafon and Congentin. During the initial phase of the veteran's hospitalization, he appeared to have psychomotor retardation, and was moderately depressed. Further noted was that he was "withdrawn" and evasive most of the time. The veteran was prescribed Cogentin, 2 milligrams, twice a day, and, approximately two days later, was given Prolixin decanoate, 50 milligrams, intramuscularly. By April 25, 1975, the veteran's Cogentin was increased to 2 milligrams three times a day, and he was placed on Trilafon, 16 milligrams "at h.s." The veteran subsequently exhibited moderate extrapyramidal side effects from the Prolixin injection. At that time, he objected strongly to being given such a long-acting injection. The veteran was subsequently seen with both parents by the ward's social worker, and by late April 1975, exhibited a marked improvement in his condition. He was therefore discharged to be followed on an outpatient basis at the mental hygiene clinic. The pertinent diagnoses noted at the time of discharge were suicidal gesture by ingestion of some 50 pills of Trilafon, 8 milligrams; paranoid schizophrenia; and torticollis due to an extrapyramidal side reaction to Trilafon. In early May 1975, the veteran was once again admitted to a VA medical facility with a complaint of a "tremendous inability to stay in one place." According to the veteran, this symptom was similar to one he had experienced while on Prolixin during a previous admission. Physical examination conducted during the veteran's hospitalization was within normal limits, as were various laboratory studies. The veteran subsequently requested discharge, and to be followed on an outpatient basis. At the time of discharge, he was given Trilafon, 8 milligrams, 2 at bedtime, and Cogentin, 2 milligrams, one at bedtime. The pertinent diagnoses noted were probable side effects of thenothiazines; and paranoid schizophrenia. In mid November 1975, the veteran was again admitted to a VA medical facility, where he had been brought by his mother who wished him admitted "so that he would not hurt himself." Reportedly, the veteran had been arrested by police on the night prior to admission while wandering in a strange neighborhood, and "knocking on various doors." At the time of admission, it was noted that the veteran had two prior admissions, and a diagnosis of schizophrenia. Trilafon had been prescribed, but, apparently, had been stopped shortly following his discharge seven months previously. Several days prior to admission, the veteran had been taken to a private psychiatrist, who recommended hospitalization, and prescribed Thorazine. Apparently, however, the veteran had not taken this medication regularly. On mental status examination, the veteran was alert and well oriented. He generally appeared frightened, and was extremely ambivalent about admission. According to the veteran, he felt as if he would be "roasted" or "be dead in the morning if he stayed." The veteran was obviously experiencing auditory hallucinations. Additionally noted were many apparent delusions, with the veteran stating that he thought that he could move "only as fast as everyone else." During hospitalization, the veteran was begun on Thorazine, 200 milligrams, three times a day. However, he soon came to refuse medication, and became increasingly belligerent and delusional. The veteran was, therefore, placed in "the quiet room." He was subsequently transferred to a private medical facility, and, during the course of such transfer, was neither competent nor employable. The pertinent diagnosis noted at the time of discharge was paranoid schizophrenia. On admission to a private medical facility on November 26, 1975, it was noted that the veteran's affect was "flattened and constricted," and that he had been walking about his previous hospital ward "rambling and raving." The veteran was overtly hallucinating, and refused to cooperate with ward milieu. During the course of the veteran's private hospitalization, he remained quite disturbed. He paced around and threatened staff when given his prescribed medications, and was initially managed on suicidal precautions due to strong suicidal ideation. However, no suicidal gestures or attempts were observed. During hospitalization, it was recommended that treatment with tranquilizers be continued. The pertinent diagnosis noted was schizophrenia, acute schizophrenic episode. During the period from April to September 1976, the veteran was again hospitalized at a VA medical facility. Initially, the veteran was treated on a "crisis ward" and maintained on Thorazine. In May 1976, he was transferred to an open psychiatric ward, at which time he began showing psychological gains in the form of more socialization. His thought content was devoid of any overt schizophrenic thought processes at that time, and he was no longer hypomotoric. On June 22, 1976, he complained of weakness and dizziness. Inasmuch as there was some question whether this reaction was due to heat and overexertion or Thorazine, the Thorazine was discontinued. The following day, the veteran was "better," and that medication was never resumed. On August 11, 1976, he was transferred back to the crisis ward due to regression and exacerbation of his schizophrenic symptoms. At that time, he showed some suicidal preoccupation. Noted at that time was that, just prior to the veteran's transfer back to the crisis ward, his mother had committed suicide. Treatment with Thorazine was, therefore, resumed, and Elavil (another medication) was added. The veteran subsequently made progress on the crisis ward, and was therefore transferred back to an open ward in early September 1976. Since that time, there had been no overt signs of depression, and the veteran denied suicidal ideation. At the time of discharge, the veteran was not suicidal. His behavior was within appropriate limits, and his thinking clear and organized. His judgment, however, was not good. The pertinent diagnosis noted was chronic undifferentiated schizophrenia. In December 1976, the veteran was readmitted to a VA medical facility following some recurrence of his psychiatric symptomatology as a result of his refusal to take medication. On admission, the veteran was uncommunicative and indecisive, and showed some peculiar respiration. He looked angry and withdrawn, and there was some question of depression. During hospitalization, the veteran's group and individual therapy were resumed. With a lessening of his anger and an improvement in his interpersonal relationships, he became more sociable and malleable, and easier to get along with. While initially on Haldol, this was switched early on to Trilafon, "on which he appeared to do better." Currently, he was down to 4 milligrams at noon and 8 milligrams at 9 p.m. He did, however, insist on Cogentin, 2 milligrams in the evening. The veteran was subsequently discharged, having achieved maximum hospital benefit, with improvement. He was provided with a month's supply of Trilafon, which he was to continue to take 4 milligrams in the morning, 4 milligrams at noon, and 8 milligrams at 9 p.m. He was additionally given Congentin, of which he was to take 2 milligrams in the evening. The pertinent diagnosis noted was chronic undifferentiated schizophrenia. In late December 1977, the veteran was once again admitted to a VA medical facility following his having become withdrawn, and apparently disorganized in thought. At the time of admission, the veteran was placed in an open ward, though it was promptly felt that he required a "closed ward placement." The veteran stabilized on medication, and thereafter did quite well. He was finally transferred to an open ward in early January 1978. At that time, he was calm, and felt that the medication he was receiving (Trilafon) was satisfactory. Some emphasis was placed on the need to maintain his medication following discharge. In late January 1978, the veteran indicated that he shortly wished to be released, that he had plans for living "on the outside," and that he was in agreement with his need for medication following discharge. The veteran was subsequently discharged on regular release with the understanding that he would arrange his own follow-up care. The pertinent diagnosis noted at the time of discharge was chronic undifferentiated schizophrenia. In correspondence of early June 1986, a private psychiatrist commented that he had been seeing the veteran in outpatient psychotherapy since November of 1985, and that his diagnosis was paranoid schizophrenia, in remission. Following a VA social and industrial survey in December 1988, it was noted that it was difficult to determine whether the veteran was suffering from schizophrenia or severe schizoid personality disorder. However, there was no evidence of any post-traumatic stress disorder. During the course of a VA psychiatric examination, likewise conducted in December 1988, it was noted that the veteran's diagnosis had been based on episodes of paranoid delusions in the absence of significant drug abuse. Reportedly, the veteran had experienced marked deterioration in social function. The pertinent diagnosis was paranoid schizophrenia, residual type. In September 1990, an additional VA psychiatric examination was accomplished. At the time of examination, the veteran gave a history of several psychiatric hospitalizations in the 1970's, resulting in a diagnosis of schizophrenia. According to the veteran, he was at that time extremely anxious, unhappy, an insomniac, and in a "depersonalized state" a good deal of the time. He described some irrational thinking and reactions, and stated that he felt "watched and uncomfortable" in the presence of people. In the opinion of the examiner, it was somewhat difficult, in retrospect, to be sure about the veteran's diagnosis of schizophrenia, though from the description of his symptoms, it did appear that he was not only severely ill, but that he had crossed the border into psychosis on at least a few occasions. On mental status examination, the veteran displayed no thought disorder, delusions, or hallucinations. He was moderately anxious throughout the course of the interview, but gave no evidence of acute depression. He was well oriented, and neither actively suicidal nor homicidal. The veteran manifested no disturbance of intellectual functioning, and his memory and concentration were good. His ability to think in the abstract and to calculate were unimpaired, though his judgment and insight were "interfered by the nature of his disorder." The pertinent diagnoses noted were moderate post-traumatic stress disorder; and borderline personality disorder. In the opinion of the examiner, the veteran exhibited a "significant enough stressor" to be compatible with a diagnosis of post-traumatic stress disorder, though he was significantly predisposed towards that disability, and all of his symptoms could not be attributed to it. Apparently, the veteran suffered from some severe chronic underlying disorder other than post-traumatic stress disorder, which had predisposed him toward and been significantly aggravated by the post-traumatic stress disorder. According to the examiner, this underlying disorder was a borderline personality (disorder), rather than schizophrenia, as previously recorded. In correspondence received in March 1991, a private social worker wrote that the veteran suffered from shame and a lack of self worth due to both the traumatic experience of combat operations, and the "subsequent care he received in July 1968." Following a private psychiatric examination in December 1993, it was the opinion of the examiner that there existed "no evidence for schizophrenia" in the veteran, and that his hospitalizations in the mid seventies were best explained by "developmental difficulties related to his childhood and his military experience." Additionally noted was that the veteran's "lengthy psychiatric hospitalizations" at various VA hospitals appeared to have been "a very negative experience" for him, and were now "traumatic events in his life" as he looked back on them. The pertinent diagnoses were post-traumatic stress disorder; and borderline personality disorder. In correspondence of mid March 1995, a private social worker commented that the veteran suffered from chronic and severe post-traumatic stress disorder which was a response to a "near death" experience in Vietnam, as well as "the trauma caused him in response to treatment and hospitalization and diagnosis as a schizophrenic." Reportedly, the veteran "suffered and is still not recovered from the medication he received in the hospital in response to his depression and suicidal ideation." In correspondence of March 1995, a Vet Center Counseling Therapist wrote that it was his understanding that the veteran was filing for "alleged mental distress due to treatment received while in the care of a VA hospital during the period from 1974 to 1978." In the opinion of the veteran's therapist, this "experience" appeared to be invasive, and impacted upon the veteran's psychological and sociological functioning. Reportedly, during the course of the veteran's treatment at the Vet Center, it had become evident that these traumatic events had been significant. In the opinion of the veteran's therapist, the veteran displayed symptomatology congruent with that delineated in DSM-IV for post-traumatic stress disorder. Additionally noted was that the veteran was a survivor of "multiple trauma," and that his reported experiences while at the VA "most likely compounded and exacerbated any previous trauma." In correspondence of May 1996, a private social worker once again commented that the veteran's post-traumatic stress disorder was in response to a "near death experience" he survived in Vietnam, as well as "the trauma caused him in response to treatment and hospitalization and diagnosis as a schizophrenic." Once again, it was noted that the veteran "suffered and (was) still not recovered from the medication he received in the hospital in response to his depression and suicidal ideation." In November 1997, in response to a request by the Regional Office (RO), the veteran underwent examination by a board of two VA psychiatrists. At the time of examination, it was noted that the veteran's claims folder and medical records were available, and had been reviewed in detail. This review included various military documents, previous assessments, and treatment data, as well as prior compensation and pension examination reports, and the like. Following an assessment of the veteran's psychiatric history and complaints, the examiners noted that, while the veteran described certain symptoms of post-traumatic stress disorder with apparent dissociative episodes, they were impressed that the symptoms appeared to be from early childhood and adolescent experiences which predated the veteran's military service. The veteran was in Vietnam only briefly, and did not describe experiences outside the range of normal. Nor did he describe any specific stressor which could be etiologically linked in a causal relationship with post- traumatic stress disorder symptoms from military/combat service. According to the examiners, the veteran's symptoms of dissociation, depression, and other indicators of acute anxiety had been near continuous since his first hospitalization in 1974. Over the past couple of years, there had been no significant remissions of symptoms. The veteran's capacity for occupational adjustment appeared to be severely compromised, though he maintained some level of social/vocational participation through volunteer work with a legal aid society. The veteran's capacity for social adjustment appeared to be severely impaired, as evidenced by his having no significant romantic relationships in his lifetime, and his preference for daydreaming over any real form of psychosocial involvement. The veteran described a childhood and adolescent history which would explain or account for most of the symptomatology described. In addition, he described no clear military or combat stressors which would establish causal links with post-traumatic stress disorder from his military experiences. On mental status examination, the veteran was well oriented, though his motor behavior was mildly hyperactive, with a rapid personal tempo. The veteran frequently experienced difficulty in tracking topics of conversation and/or inquiry, and some difficulty in remaining on task. There was some evidence of impairment in thought processes, but no evidence of current delusions or hallucinations, or other gross indicators of psychotic processes. The veteran's mood was "low...variable." Reportedly, this had been the case over the past several years. The veteran admitted to suicidal ideation by history, as well as an attempted suicide in the remote past by overdose with drugs. He presently denied active suicidal intent or plan, and was therefore judged at low risk at the time of evaluation. Memory functions were judged intact, with both recent and remote memory showing no evidence of blocking of memory content. The veteran's speech was rapid for rate, though normal for volume and tone. Throughout the course of the evaluation, there were frequent irrelevant, illogical, or obscure patterns. Additionally noted was evidence of obsessive and ritualistic behavior such as a rigid daily routine and recurrent daydreaming on similar themes. The veteran reported that his daydreaming had become somewhat ritualized, along with his lifestyle routines. His impulse control was rated poor, as evidenced by his obtaining and rapidly quitting numerous jobs, his history of polysubstance abuse, and his various periods of wandering about the United States with frequent relocations. At the time of evaluation, the veteran's judgment was poor, and his insight minimal. Following psychiatric evaluation, the Board of two examiners concluded the following: A total of seven hospitalizations were reviewed by this Board of two providers from 1975 through 1976. The initial hospitalization was at VAMC in Newington, Connecticut following an overdose with Trilafon. At that time, the veteran reported complete auditory hallucinations and ascribed to feelings of thought control and paranoia, but not clearly in the schizophrenic sense. He had significant depressive symptomatology. However, on his third admission to this facility in November 1975, when he was again depressed and suicidal, there was bizarre behavior and thought content reported; he felt he was to be 'roasted,' that he was like a machine, and only moved half as fast as other people. He again ascribed to complete auditory hallucinations. He was then transferred to the state hospital where he was described as delusional, pacing, and threatening. The following year, the veteran was hospitalized at VAMC North Hampton, again depressed with auditory hallucinations, constricted affect, and response latency. He did have a negative reaction to Thorazine, and was tried medication free for several weeks without symptoms. He then regressed and medication was restarted. He had two further hospitalizations at this facility with apparent psychotic symptoms. Of note is a failure to follow through with medication as an outpatient after stabilization in the hospital, and then a subsequent regression. It is conceivable that this was only one episode of illness prolonged by poor compliance. Each episode was accompanied with significant symptoms of depression. Thus, several diagnoses could be entertained, i.e., major depression with psychotic features; schizoaffective disorder; or schizophreniform disorder that was incompletely treated. The Board of two suspects the latter diagnosis is the most correct. In 1970's jargon, we expect that it would have been considered schizophrenia and thus (the) label assigned. It does appear that the label was perpetuated, even though he did not report further psychotic episodes, based on his constricted character style. This was, in fact, the case when he was evaluated here at the Eugene Outpatient Clinic in 1989. He was then given a diagnosis of schizophrenia, residual type, based on his 'lifestyle.' In summary, the Board of two (psychiatrists) examined a young man from a very dysfunctional family who was a prime candidate for post-traumatic stress disorder. Upon his release from the United States Marine Corps, he returned to this dysfunctional family and its various stressors. He used alcohol and marijuana (self medicating?) which were further stressors, but was 'free' of substances when he had a psychotic episode related to stress in this family once again. The veteran was not medication compliant, and may have prolonged his psychotic experiences, but subsequently stabilized with clear symptoms of post-traumatic stress disorder, these related to his family experiences. In addition, the veteran has consolidated as an adult with significant character pathology, as well as an avoidant and schizoid character type. In addition, the veteran reports dissociative symptoms which may compound his difficulties. In response to the VARO's specific diagnostic questions for the Board of two (psychiatrists), the veteran does not currently have schizophrenia. As explained above, the veteran's behavior in the 1970's, during his period of multiple inpatient psychiatric hospitalizations, would understandably result in a diagnosis of psychosis at that time. As noted above, however, the Board of two (psychiatrists) finds that his most likely diagnosis would have been schizophreniform disorder that was incompletely treated, and the veteran exacerbated symptoms by noncompliance or failed follow through with a reasonable medication regime. The correct current diagnosis appears to be schizophreniform disorder with post-traumatic stress disorder that is non service connected, probably the result of early childhood and adolescent experiences. The veteran does not complain of experiencing any event in Vietnam service that was outside the range of the usual human experience there. His Vietnam experiences would not be expected to cause marked distress to anyone present, nor did his experiences constitute a serious threat to his life or physical integrity at the time. The veteran does not make this case. Based on his current diagnosis of schizophreniform disorder, dissociative episodes with depression and anxiety, and post-traumatic stress disorder that is non service connected, the Board of two examiners find(s) that the level of current occupational and social impairment is at least moderate, possibly ranging to severe, although not based on service connected stressors/events. Following evaluation, the diagnoses noted were: Axis I: Schizophreniform disorder with dissociative episodes. Post-traumatic stress disorder caused by nonservice- connected family dysfunction in childhood and adolescence; history of polysubstance abuse in the remote past, now in remission; current diagnosis of alcohol abuse, mild to moderate, in proportion with two drinking episodes per week estimated by the veteran. Axis II: Features of mixed personality disorder with avoidant and obsessive compulsive features predominant. Axis IV: Level-moderate stressors- relative social isolation, chronic unemployability with financial difficulties, dysfunctional family with inadequate social supports. Analysis The veteran's claim for compensation benefits pursuant to the provisions of 38 U.S.C.A. § 1151 is "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1998). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required in order to comply with the duty to assist him mandated by 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1998). In Gardner v. Derwinski, 1 Vet. App. 584 (1991), the United States Court of Appeals for Veterans Claims (Court) invalidated 38 C.F.R. § 3.358(c)(3), a portion of the regulation utilized in deciding claims under 38 U.S.C.A. § 1151. The Gardner decision was subsequently affirmed by the United States Court of Appeals for the Federal Circuit in Gardner v. Brown, 5 F.3d 1456 (Fed. Cir. 1993). That decision was likewise appealed, and in December 1994, the United States Supreme Court (Supreme Court) affirmed the lower courts' decisions in Brown v. Gardner, 115 S. Ct. 552 (1994). Thereafter, the Secretary of the Department of Veterans Affairs sought an opinion from the Attorney General of the United States as to the full extent to which benefits were authorized under the Supreme Court's decision. The requested opinion was received from the Department of Justice's Office of Legal Counsel on January 20, 1995. On March 16, 1995, amended VA regulations were published to conform with the Supreme Court's decision. Those regulations were subsequently revised, and, on October 1, 1997, there became effective new regulations governing the adjudication of claims for benefits under 38 U.S.C.A. § 1151. However, as of January 8, 1999, those "new" regulations have been rescinded. Notwithstanding the aforementioned rescission, it has recently been determined that all claims for benefits pursuant to the provisions of 38 U.S.C.A. § 1151 filed before October 1, 1997 must be adjudicated under the provisions of § 1151 as they existed prior to that date. VAOGCPREC 40-97 (December 31, 1997). Accordingly, the Board will proceed with adjudication of the veteran's claim for § 1151 benefits on that basis. In that regard, the Board notes that, where any veteran shall have suffered an injury, or an aggravation of an injury, as a result of hospitalization, or medical or surgical treatment not the result of such veteran's own willful misconduct, and such injury or aggravation results in additional disability or in death, disability compensation shall be awarded in the same manner as if disability, aggravation, or death were service connected. The Supreme Court has found that the statutory language of 38 U.S.C.A. § 1151 (as it applies in the present case) simply requires a causal connection between the claimed injury and any alleged or resulting disability. 38 C.F.R. § 3.358(c)(1) as it applies in this case provides that "[i]t will be necessary to show that the additional disability is actually the result of such disease or injury, or an aggravation of an existing disease or injury, and not merely coincidental therewith." Further, 38 C.F.R. § 3.358(b)(2) provides that "[c]ompensation will not be payable...for the continuance or natural progress of disease or injuries." 38 C.F.R. § 3.358(c)(3) provides that "[c]ompensation is not payable for the necessary consequences of medical or surgical treatment or examination properly administered with the express or implied consent of the veteran, or, in appropriate cases, the veteran's representative. "Necessary consequences" are those which are certain to result from, or were intended to result from, the examination or medical or surgical treatment administered. 38 C.F.R. § 3.358. The provisions of 38 C.F.R. § 3.358(c)(3) preclude compensation where disability (1) is not causally related to VA hospitalization or medical or surgical treatment, or (2) is merely coincidental with the injury, or aggravation thereof, from VA hospitalization or medical or surgical treatment, or (3) is the continuance or natural progress of disease or injuries for which VA hospitalization or medical or surgical treatment was authorized, or (4) is a certain or near certain result of VA hospitalization or medical or surgical treatment. Where a causal connection exists, there is no willful misconduct, and the additional disability does not fall into one of the above listed exceptions, the additional disability will be compensated as if service connected. As noted above, on two previous occasions, specifically, in 1977 and again in 1987, the veteran was denied entitlement to service connection for an acquired psychiatric disorder, essentially on the basis that his schizophrenia preexisted his second period of active service, and was not aggravated therein. The veteran now seeks service connection for post- traumatic stress disorder, arguing that his current psychiatric symptomatology is the result of misdiagnosis and/or mistreatment at various VA medical facilities during the 1970's. In that regard, a review of the record discloses that the veteran was, indeed, hospitalized at a number of VA medical facilities during the 1970's. However, the record is devoid of any indication that the veteran suffered permanent additional disability in the form of post-traumatic stress disorder as a result of these hospitalizations. More specifically, while in April 1975, the veteran was hospitalized at a VA medical facility for a "suicidal gesture" precipitated by the ingestion of VA-prescribed medication, the medication in question was ingested at a dosage well in excess of that prescribed by VA medical personnel. While during that same hospitalization, the veteran experienced moderate extrapyramidal side effects from a Prolixin injection, those side effects were acute and transitory, and resolved without residual disability. The Board observes that, at the time of a period of VA hospitalization during the months from April to September 1976, the veteran received treatment with Thorazine, following which he was transferred from a "crisis" to an "open" psychiatric ward. Noted at that time was that the veteran's thought content was devoid of any overt schizophrenic thought processes, and that he was no longer hypomotoric. While somewhat later, the veteran required transfer back to the "crisis" ward due to regression and exacerbation of his schizophrenic symptoms, it was noted at that time that, just prior to the veteran's transfer, his mother had committed suicide. The veteran's Thorazine was therefore resumed, and Elavil added, with the result that the veteran was subsequently transferred back to an "open" ward in September 1976. Of some significance is the fact that, on examination by a Board of two VA psychiatrists in November 1997, there was noted a failure by the veteran to follow through with medication as an outpatient following stabilization in the hospital, with resulting subsequent regression. The Board of two psychiatrists was additionally of the opinion that, while the veteran did not currently have schizophrenia, his behavior in the 1970's, in particular, during his period of multiple inpatient psychiatric hospitalizations, would have understandably resulted in a diagnosis of psychosis at that time. His most likely diagnosis at present appeared to be one of schizophreniform disorder, incompletely treated, with exacerbation of symptomatology precipitated by noncompliance or failure to follow through with a reasonable medication regime. The veteran's schizophreniform disorder (with post-traumatic stress disorder) was felt to be non service connected, and most probably the result of early childhood and adolescent experiences. Of some importance is the fact that this diagnosis (and associated opinions) were rendered following a detailed review of the veteran's claims file, including various military documents, previous assessments, treatment data, and earlier compensation and pension examination reports. The Board concedes that, in various statements from the veteran's private social workers, and from a Vet Center counseling therapist, the veteran's post-traumatic stress disorder was felt in some way to be the result of "trauma" resulting from treatment, hospitalization, and/or the diagnosis of schizophrenia by VA medical personnel. However, as noted above, the weight of the evidence is to the effect that the veteran's diagnosis (of schizophrenia) and treatment during the period in question, that is, the 1970's, was both appropriate and, to at least some degree, successful. The fact that the treatment in question was not more effective appears to be in large part the result of the veteran's noncompliance with prescribed medication, and various other factors beyond the control of VA medical personnel. As noted above, in order to warrant compensation pursuant to the provisions of 38 U.S.C.A. § 1151, there must be demonstrated the presence of additional disability as a result of hospitalization, or medical or surgical treatment, by VA personnel. Based on the aforementioned, the Board is of the opinion that the veteran's current post-traumatic stress disorder symptomatology, to the extent that it exists in conjunction with the previously noted schizophreniform disorder, is in no way the result of medical treatment, including treatment with medication, by VA personnel. Nor is it shown that the diagnosis of schizophrenia by VA medical personnel during the 1970's in any way constituted a "misdiagnosis" of symptomatology present at that time. Under such circumstances, compensation benefits pursuant to the provisions of 38 U.S.C.A. § 1151 for post-traumatic stress disorder are not warranted. ORDER Compensation benefits pursuant to the provisions of 38 U.S.C.A. § 1151 for post-traumatic stress disorder are denied. S. F. Sylvester Acting Member, Board of Veterans' Appeals