Citation Nr: 21003155 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 14-24 354 DATE: January 19, 2021 REMANDED Entitlement to service connection for a psychiatric disorder to include bipolar disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1984 to May 1987. This case is before the Board of Veterans’ Appeals (Board) on appeal from a December 2009 Regional Office (RO) rating decision. The Veteran’s notice of disagreement (NOD) was received in December 2009. The RO issued a statement of the case (SOC) in March 2014. The Veteran’s VA Form 9, substantive appeal to the Board, was received in May 2014. In April 2018 and July 2020, the Board remanded the case to the RO for further development and adjudicative action. Entitlement to service connection for a psychiatric disorder to include bipolar disorder is remanded. The Veteran contends that he currently suffers from a psychiatric disorder that began during military service. Specifically, he contends that his acquired psychiatric disorder began during service, that he received mental health treatment during service, and that he has experienced psychiatric symptoms since service. The Board remanded the service connection claim for a psychiatric disorder in July 2020 to obtain a new VA medical opinion. In this regard, the Board found that the medical opinion provided by the November 2019 VA examiner was incomplete. The examiner opined that it is less likely than not that Veteran’s diagnosis of unspecified bipolar and alcohol use disorder incurred in or was caused by his military service. The examiner referenced an NIH article and stated that “the etiology of Bipolar Disorder is most commonly linked to genetic factors and biological traits such as brain-chemical imbalances, hormonal problems, and environmental factors.” The Board determined that this rational did not address the question of whether the Veteran’s disorder was caused by or worsened beyond its natural progression in service. One of the listed etiologies by the examiner is environmental factors, which can include the military environment. The examiner also did not address whether the Veteran’s bipolar disorder began or had its onset during active military service. The July 2020 remand reveals that as no psychological disorder was noted upon the Veteran’s entrance examination, the Veteran is presumed to be sound upon entrance into service. However, the presumption of soundness does not apply to congenital defects because such defects “are not diseases or injuries” within the meaning of 38 U.S.C. §§ 1110 and 1111. See 38 C.F.R. § 3.303 (c); see also Quirin v. Shinseki, 22 Vet. App. 390, 397 (2007). Nevertheless, if it is determined during service that a Veteran suffers from a congenital disease, as opposed to a defect, VA cannot simply assume that, because of its congenital nature, the disease must have pre-existed service. That is, the presumption of soundness still applies to congenital diseases that are not noted at entry. Quirin, 22 Vet. App. at 396-397. In cases where the appellant seeks service connection for a congenital condition, VA must determine whether the condition is a disease or defect and discuss the presumption of soundness. Quirin, 22 Vet. App. at 394-397. In such cases where a congenital condition is at issue, a VA medical opinion may be needed to determine whether the condition is a disease or defect, whether the presumption of soundness has been rebutted, and if so, whether there was aggravation during service. Id. at 395. Unfortunately, it appears that the RO did not obtain the requested VA medical opinion. A July 2020 Compensation and Pension Exam Inquiry noted that the exam request was scheduled at this location because there is an addendum requires for an exam to be completed at this facility. However, in the next paragraph, it stated the Veteran does NOT need to report for the examination. Further down in the Inquiry, it states that this is a request for an addendum to the examination conducted in November 2019. An August 2020 Compensation and Pension Exam Inquiry documents that the mental disorder examination was cancelled because the Veteran failed to RSVP. There is no indication that another examination was deemed necessary by the November 2019 VA examiner or other qualified health care professional. Accordingly, a remand is necessary to obtain a VA medical opinion as requested in the July 2020 Board remand. The matters are REMANDED for the following action: Obtain a VA medical opinion with respect to the Veteran’s service connection claim for a psychiatric disorder by a psychologist or psychiatrist. Arrange for the Veteran to undergo a VA examination only if examination only if one is deemed necessary in the judgment of the individual designated to provide the medical opinion. After review of the claims file and examining the Veteran, the mental health specialist is asked to address the following: (a.) Clearly identify all psychiatric disability(ies) documented in the claims file. (b.) Is it obvious, manifest, and undebatable that any psychiatric condition, including bipolar disorder, pre-existed active service? (c.) If the answer to (b) is yes, then state whether it is obvious, manifest, and undebatable that any identified psychiatric disability WAS NOT aggravated (i.e., permanently worsened) during service or whether it is obvious, manifest, and undebatable that any increase was due to the natural progress of the disease. The examiner should address the evidence of a psychiatric disorder in service, including a suicide attempt and premature discharge from service. The examiner must address existing nexus opinions on record, including the May 2014 opinion that the Veteran began to experience bipolar disorder before or during his military service and the November 2019 negative nexus opinion (d.) If the answer to (b) or (c) is negative with respect to the documented diagnoses of bipolar disorder and with respect to any other documented psychiatric disorder (other than a personality disorder), whether it is at least as likely as not (i.e., 50 percent or greater probability) that the psychiatric disorder(s) first manifested in service or are otherwise at least in part causally or etiologically related to the Veteran’s active service, to include the documented suicide attempt and premature discharge from service. The medical specialist must consider and discuss all lay assertions, to include any assertions as to in-service events, and as to the nature, onset, and continuity of symptoms. Specifically, the Veteran contends that his psychiatric disorder began during service, that he received mental health treatment during service, and that he has experienced psychiatric symptoms since service (e.) If the Veteran has a diagnosed psychiatric disability is considered a congenital or developmental (i.e., a personality disorder), then is it at least as likely as not (i.e., 50 percent or more probable), the disorder subject to any superimposed disease or injury in service. The mental health specialist must explain the reasoning for his or her opinions including a description of the evidence relied upon and rejected in reaching such opinions. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Berry, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.