Citation Nr: 21061977 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 17-35 783 DATE: October 6, 2021 REMANDED Service connection for a psychiatric disorder, include PTSD, bipolar disorder, mixed character disorder, mood disorder, and anxiety, is remanded. REASONS FOR REMAND The Veteran served on active duty with the U.S. Air Force from June 2005 to December 2005 and with the U.S. National Guard from May 2012 to April 2015. During this time, he was awarded National Defense Service Medal, the Global War on Terrorism Medal, and the Air Force Commendation Medal, among other medals. The case is on appeal from October 2016 and May 2017 rating decisions. The claim was last before the Board in June 2019. In accordance with Clemons v. Shinseki, 23 Vet. App. 1 (2009), at that time, the Board expanded the scope of the Veteran's claims for PTSD and bipolar disorder to consider entitlement to service connection for any and all psychiatric conditions, to include PTSD, bipolar disorder, mixed character disorder, mood disorder, and anxiety. The Board also remanded the claim for further development. The Veteran contends he suffers from post-traumatic stress disorder and bipolar disorder as a result of his active service. Specifically, he asserts that he developed PTSD as a result of participating in clean-up efforts during Hurricane Katrina and that he developed bipolar disorder as a result of his active service. Pursuant to the Board's June 2019 remand, the Veteran was afforded another VA examination in May 2020. The VA examiner concluded the Veteran does not meet the criteria of the DSM-5 for PTSD. However, he was diagnosed with bipolar disorder in 2012. The examiner concluded the Veteran's bipolar disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As support for this rationale, the examiner noted the Veteran has a history of depressive symptoms prior to military service and that he has a family history of depression and bipolar disorder. Further, in a May 2013 initial outpatient evaluation, it was noted that the Veteran's symptoms of bipolar disorder began with depressive episodes as young as the age of 6 years old, when he became suicidal and planned to kill himself with a knife. However, he did not receive any mental health treatment at that time. Service treatment records (STRs) provide that at enlistment, it was noted the Veteran's high school principal had him take a psychological evaluation. However, the defects summary and significant personal and family history sections are left blank on his enlistment examination. Private medical records provide the Veteran was voluntarily admitted to the hospital in May 2012, after experiencing visual and auditory hallucinations. It was believed that his symptoms started 4-5 days prior to admission. In June 2012, he was again admitted to the hospital, in a manic state, wanting to kill himself, and was placed on a treatment hold. He was then diagnosed with bipolar disorder. STRs further provide that in March 2013, while the Veteran was on a family vacation, his private doctor noted the Veteran experienced a manic episode, was voluntarily hospitalized, and started on medication. In January 2015, he was found unfit to perform his duties of office due to being diagnosed with bipolar disorder. Thus, while there is some indication that the Veteran's psychiatric condition preexisted service, because no acquired psychiatric disorder, including bipolar disorder, was noted on his entrance examination, the presumption of soundness applies in this instance. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). At this point, the Board cannot find that clear and unmistakable evidence exists in the record that demonstrates that the Veteran was diagnosed with a psychiatric disorder, to include bipolar disorder, prior to entrance into military service. The Veteran was psychiatrically normal on his enlistment examination. Although the Veteran's service records indicate that he was referred by his high school principal for psychiatric evaluation, the results of such evaluationif such even took placeare not of record. In short, there is not clear and unmistakable evidence of any diagnosed psychiatric disorder prior to military service. Accordingly, based on the evidence of record at this time, the Board cannot rebut the presumption of soundness. See 38 U.S.C. § 1111. Therefore, the Veteran is considered sound for his period of service from June 2005 to December 2005. While the Veteran was afforded a May 2020 VA examination that addressed his 2012 bipolar disorder diagnosis, the examiner did not address the Veteran's contention that his psychiatric disorder developed as a result of the Hurricane Katrina non-evacuation and participation in the clean up efforts post-Katrina in Biloxi. Also, STRs provide the Veteran is diagnosed with anxiety disorder and that he experienced symptoms of depression, helplessness, racing thoughts, and occasional suicidal ideation/thoughts that may not be accounted for within the diagnosis of bipolar disorder. Thus, remand is necessary for a VA medical examiner to fully address the Veteran's contention and outstanding symptoms. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise). Further, given the Veteran's service following the 2012 diagnosis, it is possible his psychiatric condition was aggravated by subsequent service. In order to fully and accurately address this, clarification is needed regarding the Veteran's dates of service in the National Guard and whether such dates were active or inactive duty for training (ACDUTRA/IDT). In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. The Agency of Original Jurisdiction (AOJ) should verify the Veteran's periods of recognized Federal National Guard duty and obtain any associated outstanding personnel and treatment records. While VA has verified the Veteran's active duty service in 2005, a DPRIS document appears to show some periods of active duty or active duty for training (ACDUTRA) prior to that. (If there is recognized Federal service, a determination regarding aggravation may have to be made.) If any service treatment records are unavailable, notify the Veteran of such and of alternate sources of evidence that can supplement the available records. The AOJ should verify the specific dates of the Veteran's National Guard Service and provide the specific type of service (ACDUTRA/IDT) for the specific dates verified. Such specific dates of verified service and the type of military service served on those dates (active duty, ACDUTRA, INACDUTRA/IDT) should be place in a Memorandum and associated with the claims file. 3. Thereafter, schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) by an appropriate medical professional in connection with the psychiatric disorder claim. After reviewing the entire claims file, the examiner should: (a.) Provide a diagnosis for all current and previously diagnosed psychiatric conditions. The examiner should be sure to address whether the 2012 bipolar disorder diagnosis encompasses all the Veteran's symptoms/other diagnoses throughout the record, to include diagnosed anxiety disorder and symptoms of depression, anxiety, helplessness, racing thoughts, and occasional suicidal ideation/thoughts. (b.) Opine as to whether the Veteran's bipolar disorder diagnosed in 2012 and/or any current psychiatric disorder that may exist is at least as likely as not (a 50 percent or greater probability) related to his claimed Hurricane Katrina non-evacuation and participation in the clean-up effort post-Katrina in Biloxi and whether this caused his psychiatric disorder. (c.) For any diagnosed condition that is not found to be directly related to the Veteran's 2005 service, the examiner should opine whether such is related to any specific period of subsequent service as verified by the AOJ prior to this examination. (d.) For any diagnosed condition that is not found to be directly related to or otherwise incurred during a period of verified service, the examiner should specifically opine whether the Veteran's psychiatric disorder(s) were at least as likely as not aggravated (i.e., worsened beyond the normal progression) by any period of verified service (as found by the AOJ prior to this examination) subsequent to onset and diagnosis of that condition. The examiner should address any and all pertinent evidence of record, to particularly include the Veteran's lay statements regarding onset of symptomatology and any continuity of symptomatology since onset and/or since discharge from service. A complete rationale or explanation should be provided for any opinions reached. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Becton, Associate 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.