Citation Nr: 18139845 Decision Date: 10/01/18 Archive Date: 10/01/18 DOCKET NO. 16-21 713 DATE: October 1, 2018 ORDER Entitlement to service connection for bipolar disorder is granted. REMANDED Entitlement to service connection for cataract, left eye, is remanded. Entitlement to service connection for cataract, right eye, is remanded. Entitlement to service connection for a heart condition is remanded. FINDING OF FACT The Veteran’s bipolar disorder was at least as likely as not incurred during service. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for bipolar disorder are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1977 to July 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision in July 2013 by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran submitted additional evidence in June 2016, and waived RO consideration of the new evidence. As such, a remand for RO review is not necessary. 1. Entitlement to service connection for bipolar disorder Service connection will be granted if the evidence demonstrates that current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first 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). In relevant part, 38 U.S.C. § 1154(a) (2012) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (“[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence”). “Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology.” Savage v. Gober, 10 Vet. App. 488, 496 (1997) (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (distinguishing between competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”)). 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; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). An August 1977 enlistment report of medical examination reflects normal evaluations. An April 1980 separation report of medical examination was also normal. In July 1980, a Report of Mental Status Evaluation documented normal behavior, and found that the Veteran was fully alert; and had level mood, clear thinking, normal thought content, and good memory. The impression was no significant mental illness. VA treatment records in July 2014 reflect a diagnosis of bipolar disorder mixed severe with mild psychotic features, rule out fugue state, posttraumatic stress disorder (PTSD), and cognitive disorder (memory loss). The psychiatrist noted that the Veteran’s problems related to his social environment, medical issues, homelessness, and unemployed. Polysubstance use disorder was in remission for over four years. In November and December 2014, the Veteran’s sisters, K.C. and S.S., submitted statements. K.C. stated that, growing up, the Veteran was a happy, family-oriented person. However, it was rapidly apparent when he was in the army that he “changed for the worse.” He was no longer close to his family, and became sullen and withdrawn. She described him as “consumed with heavy thoughts.” She explained that when he got out of the army, he was depressed and agitated, which caused his relationships to suffer, and prevented him from having a job and resulted in a divorce. She reported that when the Veteran went into the service, they were in touch constantly, and but contact diminished while he was in the service. As the years went on, he withdrew from everything and everyone he loved, and there were times that months would go by without any communication. Current phone conversations between them ranged “from exasperations, to wild outbursts, to depressed talks.” She stated that his anger and depression consumed him and she worried that if something was not done to help him he would take his life. She stated that it was clear to his family that when he went into the army they lost the brother they knew. Likewise, S.S. stated that growing up, the Veteran was always very confident, outgoing, positive, and kind. However, “that person no longer existed after his return from service,” and he was transformed into someone she no longer recognized. When the Veteran returned from service, he was often depressed and angry, difficult to spend time with, had mood swings and outbursts, and he was distant and delusional. She explained that this made it difficult to spend time with him and their relationship deteriorated to the point where they lost contact for several years. A February 2015 Disability Benefits Questionnaire from Dr. H. H-G, a licensed psychologist, reflects a diagnosis of bipolar I disorder, current or MRE unspecified. The psychologist reviewed the claims file and VA records. She noted that the Veteran started receiving Social Security Administration (SSA) disability benefits in 2015 for mental health difficulties. During the examination, the Veteran’s attention was normal and concentration appeared variable. He complained of increased trouble with short-term memory and struggled to remember basic information. His speech was normal although he was brief with his information. Thought content was appropriate and goal-directed, and there was report of overt hallucinations. The Veteran stated that he could not remember anything about his military service, but knew he was stationed in Germany and could speak German. The psychologist opined that the Veteran’s military experience continued to manifest as bipolar disorder, and that his working condition while in service aggravated his bipolar disorder. She explained that individuals with bipolar disorder have noted workplace difference compared to non-diagnosed employees, and needed allowances such as schedule flexibility, autonomy, and supervisor willingness to provide accommodations. The Veteran was not afforded employment accommodation while employed actively in the military. She also noted the July 1980 Mental Status Examination. She referred to the statements from the Veteran and his family, specifically his sisters K.C. and S.S., who endorsed that his bipolar disorder symptoms began during his military service and had exacerbated since separation. K.C.’s November 2014 letter stated that before military service, the Veteran was happy and family oriented, but it was “rapidly apparent that when he was in the Army, he changed for the worse.” He became distant from his family, withdrawn, consumed with heavy thoughts, and when he left the military he was depressed, agitated, had trouble focusing, and he was distrustful and angry, which caused his relationships to suffer. S.S.’s December 2014 letter stated that before service, the Veteran was confident, outgoing, positive, and kind. After he returned from the military, “his transformation was dramatic.” He was depressed, angry, had mood swings, outbursts, and he was withdrawn from his family and “delusional.” Dr. H.H-G. opined, based on her interview with the Veteran and the claims file, that the Veteran’s bipolar disorder more likely than not began in military service and continued uninterrupted to the present. Based on the evidence of record, the Board finds that service connection for bipolar disorder is warranted. As an initial matter, the Board finds that the Veteran has a current diagnosis of bipolar disorder and meets the first criteria for service connection. While STRS are silent as to any complaints, treatments, or diagnoses of a psychiatric disorder, the Board notes that the Veteran and his sisters indicated that he was a well-adjusted individual prior to service, and that during service and immediately thereafter he had “changed for the worse.” Specifically, his sisters stated that the Veteran went from being outgoing, positive, and kind, to angry, distrustful, withdrawn, and delusional. The Board finds these statements to be competent and credible, and therefore finds that the Veteran meets the second criteria for service connection for an in-service injury or event. Therefore, the Veteran’s claim turns on whether there is a nexus between the Veteran’s service and his current diagnosis of bipolar disorder. Here, the Veteran and his sisters reported that his symptoms of bipolar disorder started while he was in the military. Specifically, K.C. stated that prior to his enlistment, they kept in touch but that contact diminished while he was in the service, and altogether stopped for months at a time after separation. In addition, K.C. and S.S. stated that the Veteran used to be happy and family-oriented prior to service, but that after his discharge he was withdrawn, delusional, irritable, distrustful, and angry, which placed a strain on his relationships. In addition, the private psychologist found that the Veteran’s military experience continued to manifest as bipolar disorder, and that his working condition while in service aggravated his bipolar disorder. She also opined that, based on her interview with the Veteran and review of the claims file, his bipolar disorder more likely than not began in military service and continued uninterrupted to the present. As the psychologist explained the reasons for her conclusions based on an accurate characterization of the evidence of record, her opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Given the private psychologist’s probative opinion that the Veteran’s bipolar disorder is related to his military service, and the competent and credible lay statements that the Veteran first started to experience bipolar disorder symptoms during service, service connection for bipolar disorder is warranted. REASONS FOR REMAND 1. Entitlement to service connection for bilateral cataracts and a heart condition The Veteran contends that he has bilateral cataracts and a heart condition due to or incurred in service. The Board notes that the Veteran has been awarded SSA disability benefits since 2015. VA has a duty to obtain potentially relevant SSA records when it has actual notice that the Veteran is receiving such benefits. See Golz v. Shinseki, 530 F.3d 1317 (Fed. Cir. 2010). Accordingly, the AOJ must contact the SSA and obtain and associate with the claims file copies of the Veteran’s records regarding SSA benefits, including the medical records upon which any decision was based. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(2). The matters are REMANDED for the following action: (Continued on the next page)   Contact the SSA and obtain a copy of any medical records used to make its 2015 decision, as well as any other records not already in the claims file. If any requested records are not available, or the search for any such records otherwise yields negative results, action should be taken in accordance with 38 C.F.R. § 3.159(e). Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Leifert, Associate Counsel