Citation Nr: 18154230 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 09-47 196 DATE: November 29, 2018 ORDER Entitlement to service connection for bipolar disorder is granted. Entitlement to a 100 percent rating for a psychiatric disability (including PTSD and bipolar disorder) is granted for the entire appeals period, which begins on March 17, 1992. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is dismissed as moot. FINDINGS OF FACT 1. The Veteran’s bipolar disorder is related to her military service. 2. The Veteran’s psychiatric disability renders her demonstrably unable to retain employment, and she has totally incapacitating symptoms. 3. The Veteran has been granted entitlement to a 100 percent rating for her psychiatric disability throughout the appeals period, and she is not service connected for any other disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bipolar disorder have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for entitlement to a 100 percent rating for a psychiatric disability for the entire appeals period (starting on March 17, 1992) have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.132, Diagnostic Code 9411 (1996). 3. The Board’s grant of a 100 percent rating for the Veteran’s single service-connected disability for the entire period under consideration (starting on March 17, 1992) renders moot the matter of entitlement to a TDIU. 38 U.S.C. §§ 7104, 7105. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1979 to February 1980. This matter comes before the Board on appeal from Regional Office (RO) rating decisions. In November 2012 and February 2018, she testified at personal hearings before two of the three Veterans Law Judges (VLJs) who are deciding this case. She waived her right to testify before a third VLJ on the record at her February 2018 hearing. 1. Entitlement to service connection for bipolar disorder. Service connection is warranted where the evidence of record establishes that an injury or disease resulting in disability was incurred or aggravated in the line of duty in active military service. In May 2018, a private psychologist opined that the Veteran’s diagnosed “bipolar disorder as likely as not, began during her course of military service.” The psychologist specifically noted a relationship between the Veteran’s bipolar disorder and her in-service rape. This opinion contains a highly detailed description of the Veteran’s history and mental status examination. The rationale includes a detailed discussion of the facts of the Veteran’s case and of the relevant medical principles. The Veteran underwent a VA mental disorders examination in July 2017. Based on review of the record and interview and examination of the Veteran, the examiner opined that the Veteran’s bipolar disorder is not caused by or aggravated by her service-connected PTSD. The examiner explained her opinion through a discussion of relevant medical principles. This opinion does not, however, provide an opinion with respect to whether the Veteran’s bipolar disorder is directly related to service. The Board finds that the above evidence establishes a link between the Veteran’s bipolar disorder and her military service. Therefore, entitlement to service connection for bipolar disorder is warranted. Regardless of the RO’s actions, the Board finds that as with the PTSD claim, the bipolar disorder claim arises from the March 1992 claim of entitlement to service connection for a disability that she claimed as “ATTACKED AND RAPED.” In an April 1992 personal statement, the Veteran noted that her “condition has prevented me from being able to keep a job. I’m unable to deal with people. I have flashback[s] of my experience and I’m depressed continuously.” Because the Veteran is a layperson without medical training, she is not expected to be able to diagnose her own psychiatric disability. Therefore, a claim of service connection for one psychiatric disability constitutes a claim of service connection for all psychiatric disabilities. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The November 2009 RO rating decision had granted service connection for PTSD based on the presence in the Veteran’s service personnel records of indicative markers that suggest that a personal trauma may have occurred and on medical evidence linking her PTSD to this in-service trauma. The diagnosis of bipolar disorder has been opined to have arisen during service and has been linked to the in-service trauma. The Board therefore finds that the Veteran’s claim of entitlement to service connection for bipolar disorder arises from the claim that was received by VA on March 17, 1992. 2. Entitlement to a higher rating for an acquired psychiatric disability (including PTSD and bipolar disorder). As noted above, the claim of entitlement to service connection for bipolar disorder has arisen from a March 17, 1992, claim. VA may therefore consider the disabling effects of the Veteran’s bipolar disorder for the entirety of the appeals period. Even though the RO has not had an initial opportunity to rate the combined effects of the PTSD and bipolar disorder disabilities, the Board’s grant of a 100 percent rating for the combined psychiatric disability constitutes a full grant of the appeal that is sought and does not prejudice the Veteran. There are two sets of rating criteria that are applicable in this case. Because the criteria that were in effect prior to November 7, 1996, allow for the assignment of a 100 percent rating for the entire appeals period, the Board need not discuss the revised rating criteria. Under the applicable rating criteria, a 100 percent rating is assigned when the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community. Such rating is assigned for totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic, and explosions of aggressive energy resulting in profound retreat from mature behavior. Such rating is assigned when demonstrably unable to retain employment. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). The record reflects that the Veteran is demonstrably unable to retain employment due to her psychiatric disability. A May 1992 VA examination report reflects that the Veteran has worked in several jobs between her separation from service and the beginning of the appeals period, but that the majority of these jobs lasted a very short time because she cannot interact with others. The May 1992 VA examiner noted that the Veteran’s problems with trust and her fears regarding the in-service rape have made it very hard for her to remain gainfully employed and stated that “[t]herefore, this illness has significantly impaired her ability to make a living.” She also noted at that time that “she is unable to have relations with other people and this problem has led to many of her work problems.” With respect to her work history during the appeals period, she attempted on several occasions to work, to include attempting VA Compensated Work Therapy (CWT). None of these attempts at employment lasted more than a couple of months, and they all ended after she screamed at, threatened, and/or physically attacked coworkers or supervisors. The record further reflects that the Veteran has totally incapacitating symptoms due to her psychiatric disability. A May 1992 record reflects that she felt people on the street were following her. She testified at her November 2012 Board hearing that she does not like going out in public ever since she returned from service. She specifically noted that she is afraid that people are “going to look at me [the] wrong way and I’m going to fight them or something.” She reported that this has been pretty consistent since she left service. VA examination reports reflect that her judgment and insight have been fair to poor and that her thought processes are often reflective of tangential speech. She testified at her November 2012 hearing that she is “a compulsive shopper. I play sweepstakes and lottery and stuff like that.” Additionally, as noted in the May 2018 private psychologist’s evaluation, the Veteran has had multiple psychiatric hospitalizations and has resided at Veterans Homes for periods on and off throughout the appeals period. She has had considerable difficulties engaging with the men in the domiciliary programs, alternately making strong accusations about them based on small behaviors or engaging with them in an emotionally intense way. She has endorsed suicidal ideation at multiple points during the appeals period and has a history of suicide attempts. A June 2018 letter from the Veteran’s representative noted that the Veteran “has been an inpatient in a VA facility receiving mental health treatment since August of 2017 and currently has no anticipated discharge date due to the severity of her condition.” Thus, the Board finds that entitlement to a 100 percent rating is warranted beginning on March 17, 1992, which constitutes the entire appeals period. 3. Entitlement to a TDIU. A TDIU is considered a lesser benefit than a 100 percent rating. The Veteran is not service connected for any other disability. Therefore, entitlement to a TDIU is dismissed as moot. CHERYL L. MASON Veterans Law Judge Board of Veterans’ Appeals DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Elizabeth Jalley, Counsel