BVA9503881 DOCKET NO. 92-52 977 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Newark, New Jersey THE ISSUES 1. Entitlement to service connection for diabetes mellitus. 2. Entitlement to an increased evaluation for paranoid schizophrenia, currently evaluated as 50 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant, and his father ATTORNEY FOR THE BOARD William J. Jefferson, III Counsel INTRODUCTION The veteran had active service from July 1982 through February 1984. This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Newark, New Jersey Regional Office (RO). Paranoid schizophrenia, evaluated as 50 percent disabling is the veteran's sole service connected disability. In a January 1991 rating decision service connection for diabetes mellitus and an increased evaluation for (paranoid) schizophrenia were denied. A personal hearing was held at the RO in May 1991. In an August 1991 determination, a hearing officer at the RO granted a 50 percent disability evaluation for schizophrenia previously evaluated as 30 percent disabling. The denial of service connection for diabetes mellitus was confirmed and continued. The case was remanded by the Board in November 1992 to obtain additional clinical information and for the RO to consider pertinent regulations. CONTENTIONS OF APPELLANT ON APPEAL The veteran argues that his diabetes mellitus had its onset during service, was masked by medication for his service- connected schizophrenia or is secondary to his service-connected schizophrenia. He also argues that his paranoid schizophrenia is far more disabling than the current 50 percent disability evaluation indicates. DECISIONS 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 file. 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 preponderance of the evidence is in favor of the veteran's claim of entitlement to an increased evaluation for paranoid schizophrenia. It is also the decision of the Board that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for diabetes mellitus. FINDINGS OF FACT 1. Diabetes mellitus is not shown during service or to a compensable degree within one year after service; it is first shown approximately five or six years later. 2. Diabetes mellitus is not etiologically related to the service-connected paranoid schizophrenia. 3. The paranoid schizophrenia, the veteran's only compensable service-connected disability, results in severe social and industrial inadaptability precluding him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. Diabetes mellitus was not incurred in or aggravated by active peacetime service. 38 U.S.C.A. §§ 1101, 1112, 113, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). 2. Diabetes mellitus is not proximately due to or the result of a service connected disability. 38 U.S.C.A. §§ 5107 (West 1991); 38 C.F.R. §§ 3.310 (a) (1994). 3. A 100 percent disability evaluation for paranoid schizophrenia is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 4.16 (c), 4.7, Part 4 Code 9203 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS We find that the veteran's claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is we find that he has presented claims which are not implausible. We are also satisfied that all relevant facts have been properly developed. 38 U.S.C.A. § 5107(a). I. Diabetes Mellitus The veteran's service medical records, including laboratory results, are entirely negative for any complaints, symptoms, treatment or findings referable to diabetes mellitus or psychosis. At separation from service it was reported that the veteran denied a personal or family history of diabetes or psychosis. The veteran was admitted to a private mental health facility in July 1984. He was treated for paranoia, delusional thoughts, social isolation, and insomnia. It was reported by history that shortly after service the veteran had had psychiatric problems. During his hospital course he was treated with Haldol. Haldol and Cogentin were recommended at discharge. The diagnosis was schizophreniform disorder. A medical examination was performed in August 1984. The medical examination revealed no pertinent pathology concerning diabetes mellitus. Service connection for paranoid schizophrenia was granted in an August 1989 rating decision. VA nursing records from January 1990 indicated that the veteran received an assessment for new onset diabetes mellitus. It was reported that the disorder had been diagnosed in 1989. It was also indicated that his psychotropic medications were Prolixin and Cogentin. VA laboratory findings in February 1990 reported that the veteran's glucose levels were high. A mental health clinic record in dated in February 1990, reported that diabetes had been discovered one month previously. VA clinical records through 1990 show follow-up care for diabetes mellitus. The veteran testified that at no time during service did a doctor inform him that he suffered from diabetes mellitus. May 1991 personal hearing transcript, hereinafter, T. at 2. He averred that in 1984 he had frequent urination; a very dry cottony mouth, with an insatiable thirst; and arm weakness. T.3. The veteran stated that though he though something was wrong with him he did not see a doctor. T. 4. He stated that he became nervous and had vision flashes. T. 4. The veteran testified that he began to gain substantial weight after service and his symptoms of thirst and frequent urination reappeared in 1989. T.4-6. His father testified that the veteran complained of a dry mouth after his discharge from service until he received treatment. T. 23. VA clinical records through 1993 reveal continued follow-up for non-insulin dependent diabetes mellitus and schizophrenia. His psychiatric medication primarily was Prolixin. A VA medical examination was performed in March 1994. The veteran's service and post-service clinical history regarding diabetes mellitus was reported. Non-insulin dependent diabetes mellitus was diagnosed. The examiner indicated that although the veteran had reported some thirst in 1984, at the time the diagnosis of schizophrenia was made, such was not convincing evidence that he had diabetes mellitus at that time. It was indicated that blood sugar test results in August 1984 were normal, and the veteran first developed classic diabetic symptoms in January 1990. The examiner opined that there was no etiological relationship between the veteran's diabetes mellitus and the service connected schizophrenia. At a March 1994 VA psychiatric examination it was indicated that while diabetes could come on temporarily with psycho-stressors and there was a correlation between anxiety and depression when diabetes was diagnosed for the first time, there was little in the literature which showed any correlation between schizophrenia and the onset of diabetes. Analysis After a review of the entire evidentiary data of record, the Board concludes that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for diabetes mellitus. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by peacetime service. 38 U.S.C.A. § 1131. Where a veteran served continuously for 90 days or more during peacetime service after December 31, 1946 and a psychosis, such as paranoid schizophrenia becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease will be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Here, service medical records are entirely negative for any complaints or findings referable to diabetes mellitus. The first clinical evidence of diabetes mellitus symptoms is in January 1990 VA clinical records, almost 6 years after the veteran's service discharge. Furthermore, a VA physician has pointed out that in August 1984 the veteran had normal blood sugar test results, which does not support a service or presumptive service onset of the disorder. We find that evidence of diabetes mellitus is first shown too remote in time to be related to his active service period or any event therein. In essence, it is apparent from the record, particularly the clinical data, that diabetes mellitus was not shown during service or to a compensable degree within one year after service. The Board has considered the veteran's and his father's lay testimony from the May 1991 personal hearing, in which it was opined that the veteran had diabetes mellitus symptomatology during and after his period of service. However, the clinical data of record shows the onset of diabetes mellitus no earlier than 1990. The veteran and his father are not competent to render testimony concerning causation, and the testimony does not establish service connection for diabetes mellitus and is not supported by the other evidence on file. The veteran argues in the alternative that the medication that he received for schizophrenia masked his diabetes symptoms or that his schizophrenia caused diabetes mellitus. Primarily, we note that the record clearly shows that the veteran first received treatment for psychotic symptoms in July 1984, subsequent to and not during his period of active service. Additionally, there is no evidence that his psychotropic medication in July 1984, the remaining one year period or thereafter for that matter, masks diabetes mellitus symptoms. Furthermore, it is imperative to note that it has essentially been opined by VA clinicians that there is no etiological relationship between diabetes mellitus and schizophrenia. Clinical data to the contrary has not been offered. We find that an etiological relationship between the service connected paranoid schizophrenia and diabetes mellitus is not demonstrated. Therefore, based on the foregoing, diabetes mellitus is not shown to be proximately due to or the result of the service connected paranoid schizophrenia. 38 C.F.R. § 3.310 (a). The Board concludes that the preponderance of the evidence is against the veteran's claim, and service connection for diabetes mellitus is not warranted. II. Paranoid Schizophrenia The RO has assigned a 50 percent disability evaluation for paranoid schizophrenia under the provisions of Diagnostic Code 9203 of the VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4. The record shows that shortly after his period of active service, the veteran began to receive treatment, including hospitalization, for psychotic symptoms later diagnosed as paranoid schizophrenia. Private clinical records show that from the mid to late 1980's the veteran received ongoing treatment for paranoid schizophrenia. He reportedly was hospitalized for paranoid schizophrenia in 1985 and 1987. At a March 1989 VA psychiatric examination it was indicated that the veteran lived with his parents and that he experienced persecutory paranoia. It was indicated that he attended a mental health facility bi-weekly. The diagnosis was paranoid type schizophrenia. An October 1989 psychiatric clinical entry reported that the veteran was well controlled on Prolixin and Cogentin. The diagnosis was chronic paranoid schizophrenia, in partial remission. VA mental health clinical records through November 1990 report some psychotic symptoms. At that time the veteran was unemployed and he continued to live with his parents. He had social interaction with neighbors, family, and friends. VA vocation rehabilitation records from January 1991 reported that the veteran was a substance abuser, that he was unable to sustain himself in ongoing work, and that he collected social security benefits. In March 1991 the veteran was admitted to a VA medical facility subsequent to prior screening for a program from a VA psychiatry service. He had had depression and suicidal ideas. His depression was due to substance abuse dependence and inability to work. The diagnoses were: Polysubstance abuse and dependence; non-insulin dependent diabetes mellitus; paranoid schizophrenia; depression. VA clinical records through May 1991 reveal ongoing treatment for paranoid schizophrenia symptoms, including auditory hallucinations and paranoid thoughts. In a May 1991 statement from a VA social worker, it was indicated that while the veteran had been provided with a structured program and he was compliant with medication, he remained highly vulnerable to stressful situations which could trigger decompensation remelioration of symptoms. His condition was described as severe, and it was indicated that he was socially withdrawn and isolative. The veteran testified that he had not had a job since 1987. T. 15. May 1991 personal hearing transcript. He averred that in the past he had lost a job due to mental illness, when he heard voices. T. 17. A VA psychiatric examination in June 1991 indicated that the veteran suffered from auditory hallucinations, generalized anxiety, and persistent delusions of persecutions. He was socially isolated and he had not been able to work since 1988. Paranoid schizophrenia was diagnosed. The veteran continued to receive treatment for psychiatric symptoms through 1992. VA vocational rehabilitation records from early 1993 show that the veteran enrolled in one class at a community college. It was indicated in July 1993 that veteran's condition was stable. He was making slow but steady progress. The veteran was admitted to a VA medical facility in November 1993 for paranoid feelings for two weeks and substance abuse. He had begun to feel paranoid and began abusing substances. It was reported that the drugs helped him feel less paranoid. The diagnoses were chronic paranoid schizophrenia, acute exacerbation; substance abuse. A VA psychiatric examination was performed in March 1994. It was reported that the veteran indicated that he seemed to be doing well. He was trying to go back to college, but it was going slow because of stressors he encountered when he was in school and he sometimes decompensated when he was under pressure. The mental status examination revealed that the veteran was alert and oriented. He was cooperative. He had good eye contact. His memory was good. He denied suicidal and homicidal ideation. His affect was bright. He stated he felt good. He was not depressed. He was not tangential or circumstantial. His insight was good and his judgment was fair. The diagnoses were paranoid schizophrenia and polysubstance abuse. In an addendum the examiner reported that the veteran was unable to work and have a full time job due to stressors. It was indicated that the veteran was not reliable and he had had substance abuse that complicated his illness. It was reported that at the time the veteran could be seen as 100 percent disabled. Analysis The Board has considered the entire evidentiary data of record and concludes that the preponderance of the evidence is in favor of the veteran's claim for an increased evaluation for paranoid schizophrenia. The record shows that the veteran has a long history of paranoid schizophrenia. He continues to have psychiatric symptoms which appear to be somewhat controlled with compliant psychotropic medication and therapy. According to record the veteran continues to live with his parents and his social integration is rather limited. He apparently has been able to go to college, taking limited courses and adapt in a controlled setting. However, we also note that the veteran continues with substance abuse, although it appears that it is of a self-medicating nature to help control psychotic symptoms. Concerning his industrial adaptability, the record reveals that he apparently has not been employed since 1988, and that he had to discontinue employment in the past in that his psychotic symptoms presented in his work environment. With respect to the veteran's overall clinical picture it is apparent from the preponderance of the evidence that his social and industrial adaptability is compromised primarily due to his service connected paranoid schizophrenia. We conclude that the record indicates that his paranoid schizophrenia equates to no more than severe social and industrial inadaptability, and a 70 percent disability evaluation for paranoid schizophrenia is warranted. While the veteran's social and industrial integration is severely affected, the record also indicates that his overall symptomatology does not approximate the criteria necessary for a 100 percent schedular evaluation for paranoid schizophrenia. The veteran retains some social capacity and there is no indication that the paranoid schizophrenia produces active psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability. However, it is imperative to note that the veteran has been granted a 70 percent disability evaluation for paranoid schizophrenia, his only compensable service-connected disability. The provisions of 38 C.F.R. § 4.16 (c) indicate that in cases in which the only compensable service-connected disability is a mental disorder assigned a 70 percent evaluation, and such mental disorder precludes a veteran from securing or following a substantially gainful occupation, the mental disorder shall be assigned a 100 percent schedular evaluation under the appropriate diagnostic code. Here, the record clearly shows that overall affect of the veteran's paranoid schizophrenia, precludes a substantially gainful occupation. Therefore, as provided in 38 C.F.R. § 4.16 (c), a 100 percent disability evaluation for paranoid schizophrenia is warranted. ORDER Service connection for diabetes mellitus is denied. A 100 percent disability evaluation for paranoid schizophrenia is granted, subject to the laws and regulations regarding the award of monetary benefits. SAMUEL W. WARNER 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. (CONTINUED ON NEXT PAGE) 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.