Citation Nr: 18154209
Decision Date: 11/30/18	Archive Date: 11/29/18

DOCKET NO. 16-53 662
DATE:	November 30, 2018
ORDER
Entitlement to service connection for a psychotic disorder (schizoaffective disorder) is denied.
FINDING OF FACT
The Veteran's schizoaffective disorder is not related to his active duty service and did not manifest to a compensable degree within a year of such service.
CONCLUSION OF LAW
The criteria for establishing service connection for schizoaffective disorder are not met.  38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5103A; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served honorably in the United States Army from December 1981 to December 1985.  The matter comes before the Board on appeal from a May 2013 rating decision.  The Veteran filed a notice of disagreement in August 2013.  The agency of original jurisdiction (AOJ) issued a statement of the case in October 2016.  The Veteran appealed to the Board in October 2016. 
1. Entitlement to service connection for a psychotic disorder (schizoaffective disorder) is denied.  
Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty.  38 U.S.C. § 1131; 38 C.F.R. § 3.303.  
Generally, to establish service connection, there must be lay or medical evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a nexus between the in-service injury or disease and the current disability.  See 38 U.S.C. § 1131; Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).
Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected.  If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required.  Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a).  Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  In addition, the listed chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service.  38 U.S.C. §§ 1101(3), 1112(a)(1), 1113, 1137; 38 C.F.R. §§ 3.307 (a), 3.309(a).  One such type of disease subject to that presumption are psychoses; schizoaffective disorder is recognized as one of these psychoses.  38 C.F.R. § 3.384.  
Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence).  The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).
The credibility and weight of all the evidence, including the medical evidence, should be assessed to determine its probative value, and the evidence found to be persuasive or unpersuasive should be accounted for, and reasons should be provided for rejecting any evidence favorable to the claimant.  See Masors v. Derwinski, 2 Vet. App. 181 (1992).  Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.  
It is the Board's responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied.  See Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant.  By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim.  38 C.F.R. § 3.102.  
The evidence of record establishes that the Veteran suffers from schizoaffective disorder.  The Veteran was first diagnosed with schizoaffective disorder in 2006.  The Veteran has stated that he has been hearing voices in his head that command him to do things for most of his adult life, but that he doesn’t follow their commands because he recognizes the voices are the result of his illness.  The Veteran also reports that he often has sleep troubles and has nightmares of the time he spent in Korea during his military service.  The Veteran was diagnosed with and treated for depression in/around 1991 and asserts that he had been struggling with hearing voices by that time.  According to the Veteran, he reported hearing voices but that the medical professionals treating him at that time assumed the voices were caused by his frequent and habitual usage of cocaine and alcohol.  
The evidence of record does not establish that the Veteran’s schizoaffective disorder was incurred or aggravated during his service.  The Veteran’s service treatment records (STRs) do not reflect that the Veteran had or sought treatment for schizoaffective disorder (or any mental disorder generally) while he was in service.  The Veteran was given a medical examination upon his entrance into the service, and at that time no mental disorders were reported.  Further, the Veteran opted-out of having an exit examination; the terms of this opt-out made clear that a qualified medical professional would review his service treatment records and that if that review indicated that an examination should be performed, one would be provided.  No exit examination was performed.  Accordingly, the Board can reasonably infer that there was no evidence of schizoaffective disorder at the time of separation from service.  In addition, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service.  38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307(a), 3.309(a).  However, the weight of the evidence does not establish that the Veteran’s schizoaffective disorder manifested to a compensable degree within one year of separation.  While the Veteran stated that he has been hearing voices in his head for most of his adult life, that statement alone is not sufficient to establish the onset of his schizoaffective disorder or to establish that symptoms of his disability manifested to a compensable degree within one year of separation.  Further, while medical records indicate that the Veteran sought mental health treatment in/around 1991, even if the symptoms he was experiencing at that time were consistent with a diagnosis of schizoaffective disorder, he still was outside the one-year period in which presumptive service connection would be warranted.  
The Board recognizes that the Veteran has not been afforded a VA examination for a mental health disorder.  In disability compensation claims, the Secretary must provide a VA medical examination when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim.  38 U.S.C. § 5103A; McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).  In this case, there is no evidence establishing that an event, injury, or disease occurred or that a disease manifested during the applicable one-year presumptive period.  Further, there is no indication that the Veteran’s schizoaffective disorder may be associated with his service or with another service-connected disability.   The only evidence in support of the claim are the Veteran’s assertions of in-service onset.  However, the diagnosis of schizoaffective disorder is beyond the scope of the Veteran’s lay observations.  The Veteran does not possess the requisite medical expertise to diagnose his schizoaffective disorder or to link it to service where, as her, his symptoms and diagnosis were first shown several years after service discharge.  As such, the Board can decide this claim without providing the Veteran with a VA examination.  


Because the in-service element of service connection is not met, the Board cannot find a nexus between the Veteran’s schizoaffective disorder and his military service.  As a result, service connection for the Veteran’s schizoaffective disorder is not warranted.
 
L. B. CRYAN
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	P. Macchiaroli, Attorney Advisor 

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