Citation Nr: 18150542 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-37 472 DATE: November 15, 2018 REMANDED Entitlement to service connection for bipolar disorder is remanded. Entitlement to service connection for attention disorder hyperactivity disorder (ADHD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corp from May 1978 to July 1978. This matter is on appeal from a January 2013 rating decision for entitlement to service connection for bipolar disorder and ADHD. The Veteran asserts that bipolar disorder occurred during his time in service. In his August 2018 Appellate Brief, the Representative contends that the Veteran’s enlistment examination into the Marine Corps showed no noted defects, infirmities or disorders; therefore, the presumption of soundness applies to the Veteran and the VA must show by clear and unmistakable evidence the disease or injury existed prior to service and was not aggravated by the service. The Veteran finally asserts that the preponderance of evidence is in his favor or at least in equipoise to prevail on the benefit of doubt doctrine. Based upon a review of a May 2013 VA Examination, the Board finds that additional clarification and opinion is necessary before adjudicating the Veteran’s claim. The Veteran enlisted in the Marine Corp at 17 years old; on the enlistment examination, he states that he is in good health, on no medication, and answers “NO” to the question asking if he has any nervous trouble, depression or excessive worry. The enlistment examination finds the Veteran “Acceptable.” In the Veteran’s August 2008 Social Security Administration Disability Report – Appeal for Reconsideration, an interview with the Veteran states that the Veteran’s long history of behavioral and mental health problems “unfortunately began in his early childhood.” When asked about his family mental history, the Veteran believes his birth mother has bipolar disorder. The Veteran’s STRs shows two instances which the Veteran came in with complaints of “emotional instability” and after a “temper outburst” at the dental clinic. The records note the Veteran reported a “turbulent development history” in school and social life, including placement in a special school for “school and behavior problems”, and psychiatric treatment while growing up. The consultant treating the Veteran from these visits made an observation of “acute emotional distress”, and an assessment of “immature personality – passive aggressive” and “over anxious reaction of adolescence”. The Veteran was afforded a VA Examination for Psychiatric Mental Disorders in May 2013. The VA examiner’s opinion appears to suggest that he believes that it is clear and unmistakable that the Veteran’s bipolar disorder preexisted the Veteran’s enlistment into service. Compiling the Veteran’s relevant mental history, the VA examiner records that the Veteran reported outpatient treatment with mental health providers from the fourth grade until his freshman year in high school. In addition, the VA examiner notes the Veteran’s biological family history is positive for bipolar disorder, affecting a brother, his mother and his daughter. The VA examiner further notes the Veteran was in service for a total of 45 days, during which there is no documentation or report that the Veteran engaged in stressful activities or situations likely to aggravate bipolarity, finding no documentation of symptomology diagnosable as bipolar disorder. However, the opinion does not specifically address whether both instances in the STRs where the Veteran’s complaints of “emotional instability” and “acute emotional distress” could be considered as stressful activities or situations likely to aggravate his claimed condition. Furthermore, the VA examiner’s opinion states: “it is less likely than not that the Veteran’s bipolar disorder clearly and unmistakably existed prior to service and that it was aggravated beyond its natural progression during service.” While this opinion as a whole suggests that the Veteran’s disorder was not aggravated by his active service, the Board finds the opinion’s language unclear and falls short of the standards and specificity required in this case. As such, the Board finds the opinion inadequate and requires clarification to properly adjudicate the Veteran’s claim. The Veteran has made statements that he has been diagnosed and treated for ADHD since childhood. The May 2013 VA Examination and the Veteran’s application for Social Security disability also report the Veteran’s diagnosis and treatment for ADHD from early age. However, the May 2013 VA opinion does not address whether the Veteran’s ADHD preexisted his enlistment into active service or was aggravated by the Veteran’s service. No VA examination opinion for ADHD was provided because the VA preparer noted there was no service medical record entry or equivalent for this condition. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file all updated treatment records. 2. Return the claims file to the VA examiner who conducted the May 2013 examination, if available, for clarification and additional opinions. After review of the claims file, to include the previous findings in the May 2013 examination, the examiner is asked to respond to the following: (a.) Provide an opinion clarifying to whether the evidence clearly and unmistakably shows that the Veteran’s preexisting bipolar disorder was not aggravated beyond its natural progression during his active duty service. Please address the extent, if any, that the documented in-service instances of “emotional instability” and “acute emotional distress” may have representative aggravation of the preexisting disorder. (b.) If that examiner is unavailable, or it is deemed that a new examination of the Veteran is necessary, then the Veteran should be afforded a new VA mental health examination to determine that question. 38 C.F.R. § 3.159(c)(4). A complete rationale for all opinions expressed should be provided. (c) Provide an opinion as to whether ADHD clearly and unmistakably preexisted the Veteran’s entry into service and was not aggravated beyond its natural progression during service. (d) If ADHD did not preexist service, is it at least as likely as not otherwise related to his military service? 3. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review, if in order. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Yang, Law Clerk