Citation Nr: 0504367 Decision Date: 02/16/05 Archive Date: 02/24/05 DOCKET NO. 99-11 125 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for a dissociative identity disorder. 3. Entitlement to service connection for a major depressive disorder. 4. Entitlement to service connection for a bipolar disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD David T. Cherry, Counsel INTRODUCTION The veteran served on active duty from August 1980 to March 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), located in Oakland, California, in which the RO denied service connection for a major depressive disorder. In March 1999, the veteran presented oral testimony at a hearing. In July 2003 the Board remanded the claim for service connection for an acquired psychiatric disorder for further development. FINDINGS OF FACT 1. There is no clear and mistakable evidence that PTSD existed prior to active service. 2. The evidence shows that the veteran had PTSD in service and that she has had PTSD since active service. 3. There is no clear and mistakable evidence that dissociative identity disorder existed prior to active service. 4. The evidence shows that the veteran had dissociative identity disorder in service and that she has had dissociative identity disorder since active service. 5. The evidence shows that the veteran did not have a major depressive disorder during active service or within one year of separation from active service, and that her major depressive disorder is not otherwise related to active service. 6. The evidence shows that the veteran did not have a bipolar disorder during active service or within one year of separation from active service, and that her bipolar disorder is not otherwise related to active service. CONCLUSIONS OF LAW 1. PTSD was incurred in active service. 38 U.S.C.A. §§ 1111, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2004). 2. Dissociative identity disorder was incurred in active service. 38 U.S.C.A. §§ 1111, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2004). 3. A major depressive disorder was not incurred in or aggravated by service and may not be presumed to have been incurred during service. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2004). 4. A bipolar disorder was not incurred in or aggravated by service and may not be presumed to have been incurred during service. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2004). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS A. VCAA Initially, the Board is satisfied that all relevant facts regarding the issues decided below have been properly developed and no further assistance to the veteran is required in order to comply with the duty to notify or assist. See 38 U.S.C.A. §§ 5103, 5103A, 5107(a) (West 2002). As discussed below, the development conducted by VA in this case fully meets the requirements of the old provisions of 38 U.S.C.A. § 5107(a) (West 1991) and the new provisions of 38 U.S.C.A. §§ 5103, 5103A (West 2002). See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). On November 9, 2000, the President signed into law the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000). This law redefines the obligations of VA with respect to the duty to assist and includes an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. The final rule implementing the VCAA is codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2004). This change in the law is applicable to all claims filed on or after the date of enactment of the VCAA (November 9, 2000), and to claims filed before the date of enactment but not yet final as of that date. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002). First, VA has a duty to provide an appropriate claim form, instructions for completing it, and notice of information necessary to complete the claim if it is incomplete. 38 U.S.C.A. § 5102; 38 C.F.R. § 3.159(b)(2). In this case, there is no issue as to providing an appropriate application form or completeness of the application. Second, VA has a duty to notify the veteran of any information and evidence needed to substantiate and complete a claim, and of what part of that evidence is to be provided by the claimant and what part VA will attempt to obtain for the claimant. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Only after the September 1998 rating action was promulgated did the agency of original jurisdiction (AOJ), in November 2001, provide explicit notice to the veteran regarding what information and evidence is needed to substantiate the claims, as well as what information and evidence must be submitted by the veteran, and what information and evidence will be obtained by VA. The AOJ provided the veteran a rating decision in September 1998, a statement of the case (SOC) in December 1998, and supplemental statements of the case (SSOCs) in January 2000, October 2002, and June 2004 that included a summary of the evidence, the applicable law and regulations and a discussion of the facts of the case. These gave notice as to the evidence generally needed to substantiate her claims. The AOJ wrote to the veteran in November 2001 regarding the notification of the passage of the VCAA and the obligations of VA with respect to the duty to assist and duty to notify regarding the information and evidence necessary to substantiate her claims. Specifically, the veteran was notified that VA has a duty to assist her in obtaining evidence necessary to substantiate her claims. The veteran was notified that she should identify medical treatment and that VA would request identified medical evidence. Here, the Board finds that any defect with respect to the timing of the VCAA notice requirement is harmless error. While the notice provided to the veteran in November 2001 was not given prior to the first AOJ adjudication of the claims, the content of the notice fully complied with the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b). The veteran been provided with every opportunity to submit evidence and argument in support of her claims, and to respond to VA notices. Proper process has been provided. Pelegrini v. Principi, 18 Vet. App. 112 (2004). Third, VA has a duty to assist claimants in obtaining evidence needed to substantiate a claim. 38 U.S.C.A. §§ 5107(a), 5103A; 38 C.F.R. § 3.159(c). The veteran was afforded a VA examination. Records pertinent to the current claims in the possession of the Federal government - past treatment records with the military during active service and Social Security Administration records - have been obtained. The AOJ obtained many non-VA medical records but failed to obtain all of them. The September 1998 rating decision, the December 1998 SOC, and the January 2000, October 2002, and June 2004 SSOCs informed the veteran of the evidence in the possession of VA. As for the duty to notify, a December 1999 letter and the January 2000 SSOC informed the veteran of the AOJ's efforts to obtain non-VA medical records. See 38 U.S.C.A. § 5103A(b)(2), (3); 38 C.F.R. § 3.159(e). In the November 2001 VCAA letter and a November 2003 development letter, VA informed the veteran that she may submit evidence regarding her claims. In a December 2004 letter, VA told the veteran to submit any additional evidence to the Board. In other words, the veteran was in essence told to submit any evidence in her possession that pertains to the claims. Therefore, any lack of an explicit request to submit any evidence in the veteran's possession is a harmless error. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). By the December 2004 letter, VA informed the veteran that her case was being forwarded to the Board and, in effect, that VA would not undertake any further development in his claims. Based on the above analysis, the Board finds that VA has fulfilled its duty to assist the veteran in the development of the claims decided below. In light of the above, the Board determines that no reasonable possibility exists that further assistance would aid in the substantiation of the veteran's claims. 38 U.S.C.A. § 5103A. In addition, as the veteran has been provided with the opportunity to present evidence and arguments on her behalf and availed herself of those opportunities, appellate review is appropriate at this time. See Bernard v. Brown, 4 Vet. App. 384, 393 (1993). B. Factual Background Private medical records reflect that in August 1975 the veteran, who was thirteen years old, had complaints of being in a trace-like state manifested by her eyes rolling around in her head, vomiting, screaming, and hallucinations. The initial impression was hysteria secondary to chronic emotional illness. A few days later, the impression was probable hysterical personality. Service medical records reflect that on a May 1980 enlistment examination, the veteran denied having or having had frequent trouble sleeping, depression or excessive worry, loss of memory or amnesia, or nervous trouble of any sort. She also denied having ever been treated for a mental condition. The psychiatric evaluation was normal. In November 1980 the veteran underwent a psychiatric evaluation following a suicide gesture. The referral to the mental health unit reflects that she denied any current suicidal ideations and that there was no evidence of ongoing mental illness. Upon interview, she appeared in no acute distress and was noted to be mildly anxious, which she attributed to feeling somewhat embarrassed over last week's incident. She reported a conflict with her roommate and feeling under self-imposed pressure from her school curriculum. With regard to her alleged overdose, she denied having any thoughts or plans at that time or currently of suicide, and stated that the whole situation had gotten out of hand and may have been interpreted in the wrong way. She acknowledged feeling overwhelmed with frustrations and anger, primarily due to the above-mentioned difficulties and her upcoming marriage. She stated that all she wanted was a brief period of relief from pressure. She acknowledged seeing how her actions could be misinterpreted and expressed much embarrassment for this. Past history revealed an intact family background in which she related having a good relationship with her mother and stepfather. It was indicated that her father allegedly committed suicide when she was eight years old. Her service adjustment had been marked by no non-judicial punishments, no history of conflicts with superiors, and a good relationship with her peers. Mental status examination revealed an alert, oriented, cooperative, and polite young woman who exhibited no evidence of psychosis, debilitating neurosis, or organic brain damage. There was no evidence of homicidal, suicidal, or paranoid ideation. There was no evidence of depression, loss of appetite, or sleep impairment. The impression was that the veteran exhibited some characterological traits of an immature and passive-dependent nature, manifested by low frustration tolerance and impulsivity. The examiners noted that these traits may be directly reflective of her age and not an indication of any ongoing mental illness. The examiners indicated that throughout the interview, the veteran exhibited good insight into her behavior and that her judgment was felt to be fair. The examiners reported that the center of her difficulties at that time seemed to be primarily related to an ongoing conflict with her roommate. The examiners stated that there was no further need for psychiatric evaluation at that time and that psychiatric hospitalization was not indicated. The examiners noted that the veteran was considered responsible for her behavior and fit for full duty. There were no other complaints, findings, or treatment of psychiatric symptomatology during service. On a March 1981 separation examination, the veteran denied having or having had frequent trouble sleeping, depression or excessive worry, loss of memory or amnesia, or nervous trouble of any sort. With regard to treatment for a mental condition, she admitted that she talked to a doctor a few months ago about some problems she was having. A psychiatric disorder was not noted. It was also noted that she was five-months pregnant. Private medical records show that in August 1982, the veteran attempted suicide because of her concern about her fitness to be a mother and her relationship with her spouse. It was noted that the veteran was in a stressful marital relationship and that she lost a child last year and was pregnant again. In September 1982 the veteran had a suicidal gesture by overdose following her learning that her spouse planned to divorce her. An adjustment disorder with depressed mood was diagnosed. In October 1991 the veteran was hospitalized for recurrent severe major depression without psychotic features. In January 1992 the veteran was hospitalized for an adjustment disorder with depressed mood. In February 1992 the veteran was hospitalized for PTSD. In November 1992, a dissociative disorder not otherwise specified was diagnosed. In March 1993 the Axis I diagnoses were dissociative disorder not otherwise specified and PTSD. The veteran underwent a private psychological evaluation in July 1997. She reported that during childhood her father molested her constantly and her grandfather molested her two times. She stated that she was treated from 1991 to 1994 for PTSD and dissociative disorder in connection with the physical and sexual abuses of her during her childhood years. She reported that the therapy also focused upon her marital problems with her first spouse, who was very controlling and abusive of her at times. The psychologist concluded that the veteran had had a chronic history of depression, suicidal thoughts, and dissociative episodes, primarily in response to the abuse that she suffered during her childhood years and then in her relationship with her first spouse. The Axis I diagnoses included somatoform disorder and rule out dissociative disorder. The Axis II diagnosis was personality disorder not otherwise specified with narcissistic, paranoid, and depressive traits. At her March 1999 hearing, the veteran testified that as a child, she received psychiatric treatment following her father's suicide. She stated that she tried to commit suicide in service because of her relationship with her then fiancé, who later became her first husband. She said that she was nervous during service, but that she did not report her symptomatology on separation from active service because the symptoms were intermittent. Private medical records indicate that in September 1999, it was noted that the veteran had a long history of depression and dissociative symptoms. The diagnoses included recurrent major depression. In a September 1999 statement, the veteran's sister reported that their father was physically abusive toward his children. The veteran's sister said that she could not confirm whether the veteran's father sexually abused the veteran, but that their father did sexually abuse her. In a September 1999 statement, the veteran's cousin reported that prior to his suicide, the veteran's father threatened his family, including the veteran, and that the family had to go into hiding prior to his death. The veteran underwent a private psychiatric evaluation in November 1999. She reported that a dissociative disorder was first diagnosed in 1992 because she "was checking out all the time." She said that at one point, she was accused of holding two doctors hostage, but that she had no memory of this event. She stated that she still "checks out, as if the lights are not on" and in the past, she had gone up to a day or two with not being able to recall the activities that she was later told that she did. She said that "someone will snap their fingers, and I am back awake, but I don't remember where I'm at." The Axis I diagnoses included dissociative disorder not otherwise specified. The psychiatrist noted that the veteran had a long history of abuse and molestation issues and had been abused in recent marriages. The psychiatrist indicated that the veteran had a history of a dissociative disorder. The veteran underwent a VA examination in August 2002. She reported that her biological father physically and sexually abused his children. She indicated her father shot at his children with a pistol. She also stated that she was raped prior to active service. She reported that she had abusive relationships with her two former spouses. It was noted that the veteran had some problems in service, but not to the extent of meeting the criteria for PTSD. Following a mental status examination, the Axis I diagnoses included major depressive disorder, recurrent; bipolar I disorder not otherwise specified, by history; dissociative identity disorder, by history; and PTSD, chronic and not military related. The examiner reported that the veteran had a horrible childhood and an adult history with numerous abusive episodes, including being shot at by her father and being sexually abused by her father and grandfather. The examiner indicated that the veteran reported starting drinking as a child and that it was quite likely that she had dissociative episodes as a child. The examiner noted that PTSD and dissociative identity disorder had been diagnosed and that these diagnoses were consistent with her history. The examiner indicated that it was likely that the veteran suffered from clinical depression from early in her childhood and that the suicide gesture during active service was more of a manifestation of existing difficulties. The examiner added that the trauma of what happened to her during active service certainly exacerbated her preexisting depression. The examiner concluded that the veteran's problems were not seen as starting during active service. In a December 2003 addendum to the report of the August 2002 VA examination, the examiner indicated that in service, the veteran had PTSD, which was related to her traumatic childhood experiences with her father primarily; a dissociative disorder; and a borderline personality disorder. The examiner noted that the symptoms of her major depressive disorder were not manifested during active service. The examiner reported that the veteran certainly showed periods of reacting to various situations, including the decision to try to get a discharge after she became pregnant, but that there was no evidence from her military career that would suggest that she had a major depressive disorder in service. The examiner explicitly stated that the veteran's borderline personality disorder preexisting active service. The examiner indicated that he was not able to blame the military for the veteran's PTSD. The examiner noted that there were probably times under any kind of stress in the military that her preexisting conditions could have worsened, but that the worsening would usually have been temporary, based on the particular stressors at the time. The examiner stated that the primary trauma and the difficulties after she got out of the military, including a very bad divorce and other difficulties, led to the full development of her major depressive disorder. The examiner indicated that the veteran had a horrific childhood and responded with numerous psychological problems as a result of her childhood. The examiner stated that it was amazing that she was able to qualify for and enter into the military and to last as long as she did in the military without any major difficulties. The examiner added that with this many preexisting problems, there was no way that the military could be blamed for her difficulties. The examiner noted the mental health consultation report written in November 1980 and indicated that the report was consistent with her preexisting borderline personality disorder as well as PTSD and characteristics and traits resulting from her very traumatic childhood. C. Service connection Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1131. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. Service connection may be also granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for a psychosis when it is manifested to a compensable degree within one year following discharge from active service. 38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection connotes many factors, but basically, it means that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service. A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease in service. See Pond v. West, 12 Vet. App. 341 (1999); Watson v. Brown, 4 Vet. App. 309, 314 (1993). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. §§ 1111, 1137 (West 2002). Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b) (2004). In order to rebut the presumption of soundness, there must be clear and unmistakable evidence demonstrating that the injury or disease existed before acceptance and enrollment and clear and unmistakable evidence that it was not aggravated by such service. VAOPGCPREC 3-2003 (July 16, 2003). In general, service connection for PTSD requires medical evidence diagnosing the condition in accordance with the Diagnostic and Statistical Manual for Mental Disorders (DSM IV); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). However, 38 C.F.R. § 3.304(f) applies only when the claim is based on an in-service stressor. See 38 U.S.C.A. § 105 (West 2002). The veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to her through her senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, as lay person, she is not competent to offer opinions on medical diagnosis or causation, and the Board may not accept unsupported lay speculation with regard to medical issues. See Moray v. Brown, 5 Vet. App. 211 (1993); Espiritu v. Derwinski, 2 Vet. App. 482 (1992). In claims for VA benefits, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b) (West 2002); see also Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) (holding that a claimant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail). D. Analysis 1. PTSD and dissociative identity disorder Medical professionals first diagnosed PTSD and a dissociative disorder in the early 1990s. At the August 2002 VA examination, a dissociative disorder was first characterized as a dissociative identity disorder. Although the VA examiner diagnosed dissociative identity disorder by history, a private psychiatrist diagnosed a dissociative disorder in November 1999. Therefore, the Board finds that the veteran currently has a dissociative identity disorder. The August 2002 VA examiner stated in the December 2003 addendum that the veteran had PTSD and dissociative identity disorder during active service. The examiner intimated that PTSD preexisted service and indicated that based on the veteran's reporting of childhood drinking, it was quite likely that she had dissociative episodes as a child. Although the veteran misstated her history of psychiatric treatment and symptomatology on entrance into service, the psychiatric evaluation was normal. Therefore, a psychiatric disorder was not noted on entrance into service and the veteran is entitled to the presumption of soundness. A probable hysterical personality was diagnosed prior to active service. The veteran underwent a mental status examination during service in regards to an alleged suicide attempt, which found that she had characterological traits that were reflective of her age and not an indication of any ongoing mental illness. A preexisting chronic acquired psychiatric disorder was not diagnosed during service. While the VA examiner attributed the veteran's PTSD to pre-service stressors and indicated that it was not related to events in active service, he did not explicitly state that the veteran had PTSD prior to service. In any event, the question regarding service connection for PTSD is whether it began in active service and not whether it is attributable to an pre- service event. Even though the examiner intimated that PTSD preexisted active service, the Board finds that there is not clear and unmistakable evidence that PTSD existed prior to active service. As the first prong of the rebuttal standard has not been satisfied, the statutory presumption of soundness has not been rebutted. Therefore, service connection for PTSD is warranted. The Board notes that 38 C.F.R. § 3.304(f) is not applicable in this case because the grant of service connection for PTSD is not based on PTSD being related to an in-service stressor. Rather, the grant is based on the fact that PTSD began in service even though it was related to a pre-service stressor. 38 U.S.C.A. § 105. The Federal Circuit has already established that section 105(a) creates a presumption of service connection, that is, that a disability first manifested or aggravated during active duty is deemed service-connected. Sheeden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Furthermore, there is not any requirement to show a causal relationship between the present disability and the particular event or circumstance that gave rise to the in-service injury or aggravation. In any event, the statement of the veteran's sister provides credible supporting evidence that her claimed pre-service stressors occurred. While the VA examiner determined that it was likely that the veteran had dissociative episodes prior to service because of her childhood drinking, a dissociative disorder was not diagnosed by a medical professional prior to active service. Although the July 1997 private psychologist indicated that the veteran had a long history of dissociative episodes, primarily in response to her abuse as a child and in her relationship with her first husband, the psychologist did not state that a dissociative disorder actually began when she was a child. In light of the above, the Board finds that there is not clear and unmistakable evidence that a dissociative identity disorder existed prior to active service. Accordingly, service connection for a dissociative identity disorder is warranted. 2. Major depressive disorder During service, the veteran denied having any history of depression. While there was an alleged suicide attempt in service, the mental status examination in conjunction with that event found that she had characterological traits that were reflective of her age and not an indication of any ongoing mental illness. In short, a depressive disorder was not diagnosed during active service. The veteran had depressive symptomatology in 1982, but a major depressive disorder was not diagnosed until 1991. While the July 1997 private psychologist indicated that the veteran had a chronic history of depression, primarily in response to her abuse as a child and in her relationship with her first husband, the psychologist did not diagnose a depressive disorder, much less indicate when one began. In fact, the Axis II diagnosis was personality disorder not otherwise specified with narcissistic, paranoid, and depressive traits. In the initial report of the August 2002 VA examination, the examiner indicated that the veteran had preexisting clinical depression and that it was exacerbated during active service. In the December 2003 addendum, however, the examiner determined that the veteran did not have a major depressive disorder in service. The examiner also concluded that the veteran's major depressive disorder was related to her childhood traumas and post-service difficulties. The examiner did not indicate that her major depressive disorder was in any way related to events in active service. Although the veteran was married to her first husband during active service, the examiner did not attribute her major depressive disorder to any difficulties that she may have had with him while she was in active service. The Board places greater weight on the examiner's opinion given in the addendum than on the one given in the initial report because the examiner addressed the in-service mental status examination in the addendum. The Board notes the veteran's belief that her major depressive disorder is related to the alleged suicide attempt in service. However, as the veteran was not been shown to be a medical expert, she was not qualified to express an opinion regarding any medical causation of any disorders. It is the province of trained health care professionals to enter conclusions which require medical expertise, such as opinions as to causation, and the veteran's lay opinion cannot be accepted as competent evidence to the extent that it purports to establish such medical causation. See Espiritu, 2 Vet. App. at 494-95. Simply put, the evidence shows the veteran did not have a major depressive disorder during active service or within one year of separation from active service, and that her major depressive disorder is not otherwise related to active service. The preponderance of the evidence is against the claim, and there is no doubt to be resolved. 38 U.S.C.A. § 5107; Gilbert, 1 Vet. App. at 55. Service connection for a major depressive disorder is denied. 3. Bipolar disorder The VA examiner diagnosed a bipolar disorder by history. There is no other medical evidence showing a current diagnosis of a bipolar disorder. Even accepting that the examiner's diagnosis is a diagnosis of a current disability and not merely the reporting of a history given by the veteran, the examiner did not indicate in the addendum to the examination report that the veteran had a bipolar disorder in service or within one year of separation from active service. Service medical records do not show a diagnosis of a bipolar disorder in service. Also, the examiner did not otherwise relate the bipolar disorder to active service. In short, the record is devoid of evidence that shows that the bipolar disorder is related to active service. The preponderance of the evidence is against the claim, and there is no doubt to be resolved. 38 U.S.C.A. § 5107; Gilbert, 1 Vet. App. at 55. Service connection for a bipolar disorder is denied. ORDER Service connection for PTSD is granted. Service connection for dissociative identity disorder is granted. Service connection for a major depressive disorder is denied. Service connection for a bipolar disorder is denied. ____________________________________________ H. N. SCHWARTZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs