I recently developed a new strategy in my never-ending quest to obtain service connection for veterans suffering from severe psychiatric disabilities.
In many cases there's no evidence of in-service psychiatric problems and the diagnosis of a psychiatric disability occurs many years and sometimes decades after discharge from service.
So how does one prove service connection for a psychiatric disability when there is a large gap in time between discharge and diagnosis?
Each case is, of course, factually unique, and the circumstances of each veteran's case must be analyzed individually. So with each particular veteran we take a very holistic approach towards examining the global effects of health conditions as they may interrelate with psychiatric problems.
This was our approach in a recent case where we believe that we discovered an excellent strategy and theory to connect a service-connected mental disability.
The facts of this case are as follows:
The veteran served in the U.S. Army in the early 1970's. He served during the Vietnam era. He enlisted as an 18-year old and during his time in the service he was found on chest x-ray to have bilateral mediastinal enlargement. Unfortunately, the medical corps did no immediate investigation to discuss the cause of this abnormal finding on x-rays. Our client continued his normal duties, which were as a cook.
About three months later another chest x-ray was performed which confirmed mediastinal adenopathy and our client was admitted to the base hospital for further evaluation. They performed a liver biopsy on him and they found a non-caseating granuloma which was known to be consistent with sarcoidosis. And he was referred for further medical evaluation and follow up.
Further medical history showed that he had a history of substernal chest pain and he did experience a 30 pound weight loss in the prior one to two months before the evaluation. The medical history was positive for our client's father dying at the age of 31 due to something with his lungs and there is evidence that our client was seen by a base psychiatrist but there were no records to evaluate or document any symptoms or complaints.
The bottom line is is that during service our client was diagnosed with sarcoidosis.
Sarcoidosis is a disease involving abnormal accumulations of inflammatory cells that form things called granulomas. This disease usually starts in the lungs, lymph nodes or skin. It also affects the eyes, liver, brain, and heart.
The symptoms of course depend on the primary organ that is affected but it is not uncommon for people with this disease to have significant problems with their lungs and experience symptoms like coughing, shortness of breath and chest pain. They also may experience fever, enlarged lymph nodes, arthritis, and rashes.
In the particular case of our client he then began to experience some significant behavioral issues during service, which ultimately led to his discharge under other than honorable conditions.
Naturally, with an OTH discharge he was not eligible for VA benefits and was not able to obtain service connection for the obviously service connected sarcoidosis, which had an in-service onset.
In order to obtain service connected benefits for this veteran, we would need to establish that he was "insane" at the time he committed the alleged acts of misbehavior that resulted in his OTH discharge. But from a casual observation standpoint, there were no documented symptoms of psychiatric problems during active duty.
There simply was nothing in the records that would indicate that the veteran was being treated for or was experiencing psychiatric symptoms.
So how did we approach this case?
Well, we discovered that the evidence in favor of an in-service diagnosis for sarcoidosis was quite strong. The evidence to support the in-service diagnosis included chest x-rays and liver biopsies. The diagnosis of sarcoidosis was solid.
We then realized through research and consultation with our neurosurgical expert, that sarcoidosis also affects the brain and can produce lesions on the brain, which in turn would affect one's behavior. Therefore, we were able to establish a scientific link between the in-service sarcoidosis and the veteran's behavioral problems, thus concluding that he was "insane" at the time he committed the alleged acts that led to his OTH discharge. In other words, the veteran's alleged misconduct was really the manifestation of brain and mental abnormalities caused by lesions on his brain due to the obviously in-service sarcoidosis.
Thus, if he was insane at the time he committed the alleged misconduct, his OTH discharge is not a bar to benefits and he can still obtain his service connected compensation.
This case is another example of how underlying medical conditions affect the brain.
I have written extensively as to how service-connected mental problems in turn result in deleterious physical maladies, but this is another example of a bi-directional influence that the body has on the brain and the brain has on the body.
There is also further evidence to support the idea that good advocates need to examine the entirety of a veteran's health picture to determine possible connections between mental and physical disabilities. More often than not, veterans will discover possible connections between their mental problems and their physical health problems.
It is also important to understand that good advocacy requires a holistic approach towards assessing a veteran's health and disability picture.
A strong knowledge of medicine is required in order to spot the connections between disabilities that could be service connected on a secondary basis. As a veteran's disability attorney, I instruct my staff to always research the medical issues first before we even engage medical experts.
There must be a scientific plausibility to our claim, and that is often only determined after a full assessment of the scope of a veteran's health problems and then a full review of the medical literature.