93 Decision Citation: BVA 93-12100 Y93 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 91-51 729 ) DATE ) ) ) THE ISSUE Entitlement to an increased rating for bipolar disorder, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Division of Veterans Affairs, North Carolina WITNESSES AT HEARING ON APPEAL The appellant and his wife ATTORNEY FOR THE BOARD Kay F. Mayer, Associate Counse INTRODUCTION The veteran served on active duty from September 1973 to November 1990. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a September 10, 1991, rating decision of the Winston-Salem, North Carolina, Regional Office (RO). A notice of disagreement was received on October 4, 1991, and a statement of the case was issued on November 13, 1991. The veteran's substantive appeal was submitted on December 5, 1991. A VA Form 1-646 dated December 10, 1991, was received from the veteran's representative, North Carolina Division of Veterans Affairs. The veteran testified before a member of the Board of Veterans' Appeals on March 12, 1992. By a June 22, 1992, action, the Board remanded the case for additional development. Following completion of the action sought by the Board, the originating agency continued the denial of the benefits sought by the veteran in a rating action taken on March 2, 1993. A supplemental statement of the case was issued on March 5, 1993. The case file was received at the Board on April 26 and was docketed on April 29, 1993. CONTENTIONS OF APPELLANT ON APPEAL The veteran and his representative contend, in substance, that although the veteran's service-connected bipolar disorder and manic episodes are controlled by the veteran taking lithium, the bipolar disorder calls for a higher evaluation. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991) following review and consideration of all evidence and material of record in the veteran's claims file, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim for an increased rating for bipolar disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the agency of original jurisdiction. 2. The veteran's bipolar disorder requires medication for its control, has been relatively asymptomatic in recent years and results in no more than mild social and industrial impairment. CONCLUSION OF LAW The schedular criteria for an evaluation in excess of 10 percent for a bipolar disorder are not met. 38 U.S.C.A. §§ 1155, 5107, 7104 (West 1991); 38 C.F.R. Part 4, § 4.7, Code 9411 (1992). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS We note that we have found that the veteran's claim is "well- grounded" within the meaning of 38 U.S.C.A. § 5107 (West 1991). We are also satisfied that all relevant facts have been properly developed. The veteran's service medical records indicate that he was first treated for a psychiatric disorder in April 1984 and was hospitalized at the Camp Pendleton Naval Hospital. He was treated later that month at the San Diego Naval Hospital. A report of a medical board indicates they concluded that the veteran had suffered a situational reaction of psychotic proportions that improved with treatment and that he was considered psychiatrically fit to return to duty. A reenlistment physical in September 1984 indicated that the veteran was psychiatrically normal. In December 1988 the veteran underwent a psychiatric evaluation at the request of his commanding officer, and psychological testing revealed the veteran's clinical scales were within normal limits, suggesting no significant psychopathology present. The diagnosis was occupational problems on Axis I and it was noted the veteran was not mentally ill and that psychotherapy was not indicated nor was it offered. The veteran underwent a Department of Veterans Affairs (VA) examination in February 1991 and reported a history of being in service for 17 years and having done quite well. He reported a bipolar disorder, manic type, experienced following the deaths of his mother and grandmother in 1984. He indicated that he did well until 1988 and he became manic again and was given medication and had recently again become "hyper." He was discharged from service because of an adverse fitness report due to poor judgment and poor leadership and had apparently failed to obey orders. He reported becoming manic in December following discharge with sleeplessness, hyperactivity, excessive talking and hypersexual activity. He was treated by a psychiatrist who began giving him lithium. The veteran reported this made him calmer and feel better. Examination revealed no significant psychiatric symptoms and the impression was recurrent bipolar disorder of a manic type. The veteran testified before a member of the Board in March 1992 that he was taking lithium carbonate to control the symptoms of his bipolar disorder and that he was working approximately 32 hours a week. He testified that he had been able to do his job, although he had no interest in maintaining a social life. His wife also testified. VA psychiatric treatment records for the veteran from September 1991 to July 1992 reveal the veteran continued to be treated with lithium for bipolar disorder and was noted to be stable. When seen in October 1991, the Axis I diagnosis was that of bipolar disorder. The GAF score was 65. In July 1992 he was noted to be experiencing good results with lithium with no further manic episodes. He had been employed at a fast-food business for nine months and was an assistant manager. In August 1992 the veteran underwent a VA psychiatric evaluation. He reported that he had begun working in September 1991 at a local fast-food business as a crewmember and had progressed to the level of assistant manager. Examination revealed a well- dressed and groomed gentleman who related well to the examiner. His speech was clear and coherent and without any overt signs of psychosis. His mood was euthymic and he did not exhibit manic or depressed symptoms. His judgment and insight were noted to be fair. The diagnosis on Axis I was reported as the veteran's having no clear-cut history to come to a conclusive diagnosis. The examiner noted that records from the veteran's first hospi- talization in April 1984 could have indicated a psychotic episode with manic features. The examiner indicated that that diagnosis was changed, the veteran being diagnosed as having a transient situation of psychotic proportions and a final diagnosis of atypical depressive disorder. The exami-ner currently opined that either of those two diagnoses would be appropriate. He indicated his diagnosis was possible bipolar affective disorder with a possibility that the veteran's problems during his past six years of service were result of a subclinical or mild form of bipolar affective disorder, resulting in his leaving service after 17 years. Testing performed at a September 1992 psychology consultation revealed showed the veteran had good ego strength and the profile was not suggestive of any psychopathology, although the evaluation suggested that the veteran was likely to repress emotional material. The impression was no evidence of significant psychopathology. The VA psychiatric examiner who evaluated the veteran in August 1992 reported in January 1993 that the veteran was married, working and currently asymptomatic and was only minimally affected by his psychiatric problems. An undated VA industrial and social survey revealed that the veteran was married and employed. The most recent VA psychiatric evaluations of the veteran reveal he is currently asymptomatic and in remission from his bipolar disorder. The examiner opined during the August 1992 VA examination that the veteran was only minimally affected by his psychiatric problems. Treatment records also indicate he is currently taking lithium to control the bipolar disorder and that he is stable. He has indicated that he has been married approximately 14 years and has been steadily employed since approximately September 1991, having progressed to the position of assistant manager. In October 1991, his GAF score was 65, which was consistent with not more than mild disablement. The August 1992 examination revealed a person who was well-dressed, well-groomed and who related well to the examiner with clear and coherent speech. There were no symptoms of any psychotic disorder detectable. The Board has considered the testimony of the veteran and his wife regarding their lack of a social life. However, the Board notes the veteran has been promoted by his employer to the position of assistant manager, which presumably requires effective social interaction with his co-workers and the public. The veteran has maintained his marriage and denied any social problems during a VA examination in August 1992. Based upon the veteran's ability to maintain his marriage, his steady employment and attainment of promotion to an assistant manager position, and the absence of any psychiatrically significant symptoms, the Board finds this to be credible evidence the veteran has no more than mild social and industrial impairment from his service-connected bipolar disorder. In fact, the veteran seems to be functioning well in his social and occupational relationships. Hence, an increased rating is not warranted. ORDER An increased rating for bipolar disorder is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 STEPHEN L. WILKINS U. H. ANG, M.D. DANIEL J. STEIN 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.