Citation Nr: 0513440 Decision Date: 05/18/05 Archive Date: 06/01/05 DOCKET NO. 03-27 352 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for bipolar disorder, claimed as depression. REPRESENTATION Veteran represented by: Fleet Reserve Association WITNESSES AT HEARING ON APPEAL The veteran and his spouse ATTORNEY FOR THE BOARD S. Bush, Associate Counsel INTRODUCTION The veteran served on active duty in the United States Navy from June 1967 to July 1971. He then served in the Air National Guard from September 1973 until January 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2002 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida which denied the veteran's claim of entitlement to service connection for bipolar disorder, claimed as depression. The veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing which was conducted at the St. Petersburg RO in February 2005. The transcript of the hearing is associated with the veteran's VA claims folder. This appeal is REMANDED to the RO via the Appeals Management Center (AMC) in Washington, DC. VA will notify the veteran if further action is required on his part. REMAND The veteran is seeking entitlement to service connection for a psychiatric disability, which has been diagnosed as bipolar disorder. In essence, he contends that this disability was either incurred during a two-week period of active duty for training (ACDUTRA) in March 1980 or during a drill weekend in September 1989. Factual background The Board believes that a brief recitation of certain pertinent facts will be useful. As noted above, the veteran served in the Air National Guard from September 1973 to January 1992. In the report of medical history for the veteran's enlistment examination in September 1978, and in connection with periodic examinations in February 1976, March 1977, March 1978 and January 1979, he indicated no problem with "depression or excessive worry" or "nervous trouble of any sort." On March 10, 1980, during a two-week period of active duty for training (ACDUTRA), he presented to George Air Force Base Hospital with agitated behavior with persecutory delusions, complaining that he was over stressed from working long workweeks. He was subdued with medication and transferred to March Air Force Based Hospital the following day. The impression from a psychiatrist at that facility was "adjustment reaction of adult life, of psychotic proportions. Precipitating stress: physical exhaustion, over working 80 hours a week and being called to active duty." The psychiatrist recommended that the veteran be transferred to Newport Naval Hospital to be near his family. The veteran was hospitalized at Newport Naval Hospital for four days. The clinical psychologist's assessment of the veteran at the time of his discharge was "situational adjustment reaction of adult life, of psychotic proportions, stress induced, acute, severe, recovered." Arrangements were made so that the veteran did not have to complete his two weeks of reserve duty. He was sent home, told to rest for a week, cut down to 40-hour workweeks and seek follow-up psychiatric care. In April 1980, the National Guard Bureau determined that the above-discussed events occurred in the line of duty. A psychiatric consultation was recommended in order to determine recovery and prognosis. A June 1980 psychiatric note indicated the veteran took no medication and "has apparently recovered from his acute psychotic episode." The veteran's November 1980 report of medical examination was normal and indicated that the veteran had "an acute psychiatric episode- March 1980- now recovered- requires no medication- has been discharged from care of psychiatrist." The veteran was privately hospitalized at the Kent County Hospital in Rhode Island in January 1988, again complaining that he was under a great deal of pressure at work, and that he was too tired and depressed to work. After a 13-day stay, the veteran's final diagnosis was bipolar disorder, mixed type, with psychotic features. The veteran was admitted to the Crisis Stabilization Unit at the Lee Mental Health Center, Inc. in 1989 for bipolar disorder. Outpatient treatment records from the Bay Pines VA mental health clinic dated beginning in February 2001 show the veteran being treated for chronic bipolar disorder. In September 2001, the veteran filed a compensation claim for service connection for depression, which was denied by the RO in a June 2002 rating decision. The veteran perfected his appeal of this issue with the timely submission of his substantive appeal (VA Form 9) in August 2003. The veteran and his spouse provided personal testimony before the undersigned Veteran's Law Judge at the St. Petersburg RO in February 2005. The veteran testified that he had a mental breakdown in 1989. Reasons for Remand 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 2002); 38 C.F.R. § 3.303 (2004). Active military service is defined, in part, as active duty and any period of active duty for training (ACDUTRA) during which the individual concerned was disabled from a disease or injury incurred or aggravated in the line of duty. See 38 U.S.C.A. § 101(24) (West 2002); 38 C.F.R. § 3.6(a) (2004); Paulson v. Brown, 7 Vet. App. 466, 470 (1995); Biggins v. Derwinski, 1 Vet. App. 474, 478 (1991). The Board is of the opinion that service connection is possible for psychiatric disability incurred during ACDUTRA. See Cosme-Garcia v. West, No. 96-1280, 16 Vet. App. 41, 1998 WL 224874 (April 20, 1998) [remanding a Board decision that did not address the possibility of granting service connection for the appellant's psychiatric condition based on psychotic episodes during training]. This case is a single judge memorandum decision and thus has no precedential weight. These types of decisions may, however, be cited "for any persuasiveness or reasoning [they] contain." See Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992). Verification of reserve duty dates The veteran's ACDUTRA status at the time of the January 1988 and October 1989 hospitalizations for bipolar disorder is unclear. The Board must determine whether the veteran was in a period of service at that time. The RO should therefore contact the appropriate service department to obtain the veteran's service personnel records for verification of his service dates. VA nexus opinion In essence, the RO denied the claim because no relationship has been shown between either claimed disability and the veteran's period of ACDUTRA in March 1980. The RO noted that although the March 1980 episode was in the line of duty, it was "acute and severe" and the veteran eventually recovered from it without further psychological problems for eight years. This case presents certain medical questions as to the etiology of the veteran's currently diagnosed bipolar disorder. It is unclear whether the March 1980 adjustment reaction was an initial manifestation of later diagnosed bipolar disorder. See Paulson v. Brown, 7 Vet. App. 466, 469-70 (1995) and Biggins, supra at 477 [if a claim relates to a period of active duty for training, the disability must have manifested itself during that period]. There is not enough medical evidence to make this determination. It is beyond the authority of the Board to itself answer this question. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) [the Board is prohibited from exercising its own independent judgment to resolve medical questions]. The Board believes that this matter should be addressed by an appropriately qualified physician. See 38 C.F.R. § 3.159(c)(4) (2004) [a medical examination or opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim]. Social Security Administration (SSA) records During his February 2005 personal hearing, the veteran indicated that he had been in receipt of SSA benefits for four years. The claims file does not contain any SSA records. As such are potentially pertinent to the veteran's claim they should be obtained for consideration in connection with the issue on appeal. See Murincsak v. Derwinski, 2 Vet. App. 363 (1992) [duty to assist includes obtaining records from SSA and giving appropriate consideration and weight in determining whether to award or deny VA disability compensation benefits]. This case is therefore REMANDED to the Veterans Benefits Administration (VBA) for the following actions: 1. VBA should contact the service department in order to ascertain the veteran's reserve service dates. The address is as follows: Air Reserve Personnel Center/DSMR HQ ARPC/DPSSA/B 6760 E. Irvington Place, Suite 4600 Denver, CO 80280-4600 However, if other avenues are available to VBA, those should be pursued. 2. The RO should obtain copies of the SSA disability determination letter pertinent to the veteran's claim for Social Security disability benefits, along with copies of all medical records relied upon in reaching that determination. All efforts in this regard should be documented in the claims file. 3. The veteran's VA claims folder should then be referred to a physician with appropriate expertise. The veteran's VA claims folder and a copy of this REMAND should be provided to the physician, who should acknowledge receipt and review thereof. The reviewing physician should render a nexus opinion, in light of the veteran's entire medical history, as to the etiology of the veteran's diagnosed bipolar disorder. Specifically, the examiner should opine as to when the veteran's currently diagnosed bipolar disorder initially manifested, to include consideration of his March 1980 hospitalization and subsequent hospitalizations in January 1988 and October 1989. If the reviewing physician deems it to be necessary, psychiatric examination and/or psychological testing of the veteran should be undertaken. A copy of the opinion should be associated with the veteran's VA claims folder. 4. After accomplishing any additional development it deems to be necessary, VBA should adjudicate the veteran's claim. If the claim remains denied, in whole or in part, VBA should provide the veteran with a supplemental statement of the case and allow an appropriate period of time for response. The case should then be returned to the Board for further consideration, if otherwise in order. The veteran has the right to submit additional evidence and argument on the matter the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans Benefits Act of 2003, Pub. L. No. 108-183, § 707(a), (b), 117 Stat. 2651 (2003) (to be codified at 38 U.S.C. §§ 5109B, 7112). _________________________________________________ Barry F. Bohan Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2004).