Citation Nr: 21063390 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 18-15 104 DATE: October 14, 2021 REMANDED Entitlement to a rating in excess of 10 percent for service-connected bipolar disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1989 to May 2012, at which time he retired with an honorable discharge. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision, which changed the Veteran's diagnosis from bipolar disorder to personality disorder and decreased his rating from 50 percent to 10 percent effective July 31, 2017. The Veteran's October 2017 notice of disagreement (NOD) appealed for an increased evaluation and challenged the validity of the change in diagnosis. Thus, the Board finds that the issue on appeal is one for an increased rating. In October 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript of that testimony has not yet been added to the file, as this decision is being processed under the Board's "One Touch" hearing program. A copy of the transcript will be added to the Veteran's claims file in the ordinary course of business. 1. Entitlement to a rating in excess of 10 percent for service-connected bipolar disorder is remanded. The Veteran contends that he does not have a personality disorder, as evidenced by his successful career in the Army of over 20 years. Further, he contends that the symptoms cited by a July 2017 examiner in assigning the diagnosis are based on behaviors that can reasonably be interpreted as other symptoms or otherwise attributable to another diagnosis. Finally, he contends that his service-connected mental health disability warrants a rating in excess of 10 percent, to include as due to ongoing suicidal ideation. See Statement in Support of Claim received October 2017; Board Hearing dated October 2021. The issue presented in this case requires a complex assessment of several VA regulations, to include those governing a change in diagnosis. The July 2017 VA examination upon which the change in diagnosis was based specifically found that the Veteran only had a diagnosed personality disorder, and did not have any other mental health disorders or evidence of a traumatic brain injury (TBI). However, a February 2018 medical treatment record stated it was unlikely the Veteran developed a personality disorder post-service, his service record was inconsistent with a personality disorder, and his screenings were more consistent with posttraumatic stress disorder and TBI related to his experiences while deployed. There are regulatory protections as to when a change in psychiatric diagnosis occurs. Section 4.13 governs any change in diagnosis or etiology, and instructs the rater to keep in mind the repercussions of a change in diagnosis with the aim to reconcile and continue the diagnosis upon which service connection was originally granted. If a change in evaluation occurs, "the rating agency should assure itself that there has been an actual change in the conditions, for better or worse, and not merely a difference in thoroughness of the examination or in use of descriptive terms." It also emphasizes application of § 4.125 if the change in diagnosis is made as to a service-connected mental disorder. Under § 4.125(b), it is necessary to "determine whether the new diagnosis represents progression of the prior diagnosis, correction of an error in the prior diagnosis, or development of a new and separate condition." A new examination is required if it is not clear from the available records which of the three applies. Again, these findings were not made in this Veteran's case. Thus, remand for a new examination is warranted to ensure the regulatory protections described above are properly met and to address the conflicting evidence of record. The matters are REMANDED for the following action: 1. Attempt to associate with the record all outstanding VA (since February 2018) and non-VA treatment records, to include those generated at Ireland ACH since June 2017. 2. Arrange for the Veteran to undergo a VA examination by an appropriate clinician to assess the current severity of his service-connected psychiatric disability, which was originally diagnosed as bipolar disorder and more recently has been diagnosed as personality disorder (more recent medical records indicate the Veteran has PTSD and residuals of TBI). Provide the Veteran's entire electronic claims file the designated clinician for review. The reports of any indicated tests or studies must be associated with the examination report. Following a review of the claims file and examination, the examiner should respond to the following: (a.) If the Veteran has a mental disorder other than bipolar disorder, explain whether the new diagnosis represents a progression of the prior diagnosis, correction of an error in the prior diagnosis, or development of a new and separate condition. (b.) If the Veteran's original diagnosis of bipolar disorder is confirmed, or another acquired psychiatric disorder is found to be a progression or correction of his prior diagnosis based on the same etiology, the examiner should describe the manifestations of service-connected psychiatric disability in detail. (c.) If the Veteran is diagnosed with both a personality disorder and bipolar disorder or another acquired psychiatric disorder, the examiner should differentiate, to the extent possible, which symptoms are attributable to an acquired psychiatric disorder and which symptoms are attributable to each diagnosis. A detailed medical explanation must be provided for all opinions expressed. In rendering the above-requested opinions, the examiner should consider and address as appropriate: (a.) The Veteran complained of anxiety and depression at the time of his pre-discharge claim for service connection in January 2012. (b.) A February 2012 VA examination diagnosed the Veteran with bipolar disorder. This diagnosis was prior to discharge from the military. (c.) A July 2014 VA examination indicated the Veteran should be diagnosed with a personality disorder only. The exam acknowledges diagnoses for adjustment disorder, anxiety, and depression in service, as well as ongoing medication since service. (d.) The Veteran has had alternate diagnoses while in mental health treatment since discharge, to include adjustment disorder, unspecified depressive disorder, and personality disorder with anxiety and depression. See Medical Treatment Records dated January 2013, January 2016, April 2016, September 2017, October 2017, February 2018. (e.) A VA treating clinician informed the Veteran in August 2017 that she believed a personality disorder diagnosis was correct, but bipolar disorder was also an appropriate diagnosis. (f.) In February 2018, a TriCare clinician stated she does not believe it is likely the Veteran newly developed a personality disorder after service, he would have been unlikely to successfully retire from military if he had a personality disorder in service, and his assessments in her office showed PTSD and possible TBI from his deployments. Of note, an April 2016 brain MRI showed atrophic changes and a loss of white matter, and the Veteran is service-connected for migraines that began in service. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Beeler, C. 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.