Citation Nr: 0815069 Decision Date: 05/07/08 Archive Date: 05/14/08 DOCKET NO. 06-06 473 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUE Entitlement to service connection for bipolar disorder. REPRESENTATION Appellant represented by: Wisconsin Department of Veterans Affairs ATTORNEY FOR THE BOARD Christine C. Kung, Associate Counsel INTRODUCTION The veteran served on active duty from July 1987 to May 1991. This matter comes on appeal before the Board of Veterans' Appeals (Board) from an August 2003 rating decision of the Department of Veterans Affairs (VA) Regional Office in Milwaukee, Wisconsin (RO) which denied service connection for bipolar disorder. The veteran and his representative submitted a December 2003 statement stating that the denial of service connection should be reconsidered. The Board has liberally construed the December 2003 statement as a timely notice of disagreement to the August 2003 rating decision. See 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.201 (2007). The RO subsequently issued a June 2004 rating decision, which confirmed and continued the denial of service connection for bipolar disorder. The veteran requested a RO hearing in February 2006, but withdrew this request in December 2006. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND Pursuant to VA's duty to assist, VA will provide a medical examination or obtain a medical opinion based upon a review of the evidence of record if VA determines it is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4)(i) (2007); McLendon v. Nicholson, 20 Vet App. 79, 83 (2007). A medical examination or medical opinion may be deemed necessary where the record contains competent medical evidence of a current diagnosed disability, establishes that the veteran suffered an event, injury or disease in service, and indicates that the claimed disability may be associated with the established event, injury or disease in service. See Id. The veteran has not yet been afforded a VA examination to address the etiology of his bipolar disorder. Medical evidence of record shows that the veteran has been treated at VA for bipolar disorder since April 1997. He is currently unemployed due to bipolar disorder and other psychiatric and physical disabilities. VA treatment reports dated in 1997 and 1998 indicate a history of mood swings prior to the veteran's April 1997 diagnosis of bipolar disorder. The veteran has submitted several lay statements in support of his claim, and lay statements from his mother and sister describing post-service symptomatology. The record also indicates that the veteran had problems with alcohol abuse and with maintaining employment after his separation from service. In a June 2005 note, a VA social worker opined that it appeared more likely than not that the veteran's illness manifested in service. The VA social worker did not indicate a review of the claims file or service medical records. The Board notes, however, that VA medical records show that the veteran has been seen by the same social worker for evaluations, group sessions, and in-home visits since 1999 in conjunction with his mental health treatment at VA. The veteran also requested a VA examination after consulting with a VA psychologist. The VA psychologist submitted a July 2006 statement, following a brief review of the veteran's medical record. She stated that there was a lack of clarity in the medical record that needed to be addressed by a through VA examination. She noted that the interview should be at least one hour due to the veteran's anxiety, should include an interview with a family member for collateral information regarding the veteran's history, and should include a brief interview with the veteran's MHICM case manager if further clarification was needed. Although service medical records do not reflect a psychiatric disorder in service, in light of the evidence discussed above, and the "low threshold" as announced in McLendon v. Nicholson, the Board finds that remand for a VA examination is necessary to determine if bipolar disorder is related to service, taking into consideration all the medical evidence of record. The VA examiner should give consideration to the VA psychologist's July 2006 recommendations in conducting the examination. Accordingly, the case is REMANDED for the following action: 1. The RO should refer the case for a comprehensive VA psychiatric examination to determine if the veteran's bipolar disorder is related to service. The claims folder should be made available to the examiner for review prior to examination. The examiner should review the entire claims file, to include service medical and personnel records and post- service VA treatment records. In conducting the examination, the VA examiner should note and consider the July 2006 VA psychologist's recommendations in conducting the examination. The examiner should state whether it is at least as likely as not that the veteran's bipolar disorder is etiologically related to his military service. The examiner should provide a rationale for his or her opinion with references to the evidence of record. 2. When the development has been completed, the RO should review the case again based on the additional evidence. If the benefit sought is not granted, the RO should furnish the veteran and his representative with a Supplemental Statement of the Case, and should give the veteran a reasonable opportunity to respond before returning the record to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. 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 of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ S. L. Kennedy Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals 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) (2007).