Citation Nr: 0001612 Decision Date: 01/19/00 Archive Date: 01/28/00 DOCKET NO. 94-05 638 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for an acquired psychiatric disorder, currently diagnosed as schizophrenia, residual type. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD L.A. Howell, Associate Counsel INTRODUCTION The veteran served on active duty from October 1956 to November 1957. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. By decision dated in December 1995, the Board reopened the veteran's initial claim for new and material evidence but denied it on the merits. Subsequently, the veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (formerly the United States Court of Veterans Appeals) (the Veterans Claims Court). By Order entered February 6, 1997, the Veterans Claims Court vacated the Board's December 1995 decision, and remanded the case pursuant to 38 U.S.C.A. § 7252(a). In November 1997, the Board remanded the case for additional development. In November 1999, the Board sought a medical advisory opinion, which was received by the Board and sent to the veteran in December 1999. The veteran provided additional argument in correspondence dated in December 1999 and the case is now ready for appellate review. FINDINGS OF FACT 1. The RO has developed all evidence necessary for an equitable disposition of the veteran's claim. 2. Service medical records are essentially unavailable, apparently having been destroyed at the accidental fire at the National Personnel Records Center (NPRC) in 1973. 3. The veteran has post-service evidence of treatment for nervous tension beginning in January 1958, shortly after service separation. Since 1961, he has been diagnosed with and treated for schizophrenia. 4. Competent medical evidence indicates that the veteran's currently diagnosed schizophrenia reasonably appears to have manifested to a compensable degree within one year following service separation. CONCLUSION OF LAW With resolution of reasonable doubt in the veteran's favor, schizophrenia, residual type was present to a compensable degree within one year of service; thus service is warranted. 38 U.S.C.A. §§ 1131, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.102, 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board finds that the veteran's claim for entitlement to service connection is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1999); that is, he has presented a claim that is plausible. Further, he has not alleged nor does the evidence show that any records of probative value, which could be associated with the claims folder and that have not already been sought, are available. The Board accordingly finds that the duty to assist the veteran, as mandated by § 5107(a), has been satisfied. 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 & Supp. 1999). If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (1999). However, continuity of symptoms is required where the condition in service is not, in fact, chronic or where diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (1999). In addition, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 1991 & Supp. 1999); 38 C.F.R. § 3.303(d) (1999). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection may also be established for a current disability on the basis of a "presumption" under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (1999). That is to say, service connection for a psychosis may be established based on a legal "presumption" by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. As noted above, attempts to locate the veteran's service medical records have been unsuccessful. Apparently, his records were destroyed in the accidental fire at the National Personnel Records Center (NPRC) in 1973. The only service medical records currently associated with the claims file are induction and separation examinations, an abstract of service health facilities, and dental treatment showing no evidence of a psychiatric disorder. There are, however, no service clinical treatment records whatsoever. Briefly, post-service medical evidence indicates that the veteran received private medical treatment for "nervous tension" as early as January 1958, two months after service separation, through 1961. In July 1961, he was hospitalized for schizophrenic reaction, chronic, undifferentiated type. In 1962, he was treated for paranoia and agitation. In January 1975, a VA examiner diagnosed chronic undifferentiated schizophrenia. Clinical records show on- going treatment and diagnoses of constitutional inadequacies, schizophrenia, schizoaffective disorder, borderline mental retardation, and anxiety reaction. A more recent VA examination report dated in June 1998 related a diagnosis of schizophrenic disorder, residual type, and generalized anxiety disorder. In December 1999, the Board received a written opinion from an independent medical expert. The expert was requested to offer an opinion regarding whether the veteran's treatment for "nerves" and symptoms of "nervous tension" shortly after service separation were manifestations of schizophrenia, first diagnosed in 1961. After describing the course of schizophrenia from the DSM-IV, noting that the median age at onset for the first psychotic episode was early to mid-twenties for men, that the majority of individuals displayed some type of prodromal phase manifested by the slow and gradual development of a variety of signs and symptoms, and that the course of schizophrenia may be variable, the medical expert answered in the affirmative that it was as least as likely as not that the veteran's early treatments for "nerves" and "nervous tension" were manifestations of schizophrenia first diagnosed in 1961. The Board finds, based on the evidence of record, that it was at least as likely as not that the veteran's currently diagnosed schizophrenia, first manifested in 1961, was the result of an occurrence or event incurred while on active duty. Although there is no clinical evidence of a psychiatric disability during service, the evidence is clear that the veteran exhibited signs and symptoms of a psychiatric disorder to a compensable degree within two months of service separation. See 38 C.F.R. § 4.132, Diagnostic Code 9210 (1996). Specifically, the evidence indicated that he has never been able to work due to his psychiatric disability. Further, the record reveals that the veteran has received nearly continuous treatment for variously defined psychiatric disorders over the course of many years. Finally, when asked specifically to address the issue germane to the veteran's claim, a medical expert opined that it was as least as likely as not that the veteran's early treatments for nerves were the manifestations of his currently-diagnosed schizophrenia, first diagnosed in 1961. This consistency in the records, and the medical explanation recently offered after a review of the record, coupled with the missing service medical records, provides a basis to conclude that the evidence is evenly balanced in this case. As such, the Board concludes that reasonable doubt should be resolved in favor of the veteran and service connection for schizophrenia, is in order. ORDER Entitlement to service connection for schizophrenia, residual type, is granted. CONSTANCE B. TOBIAS Member, Board of Veterans' Appeal