Citation Nr: A21017446 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 200106-53370 DATE: October 27, 2021 REMANDED Service connection for a psychiatric disorder other than posttraumatic stress disorder (PTSD). REASONS FOR REMAND The Veteran served on active duty from March 1990 to July 1990, and March 1991 to September 1991. This case is on appeal from a November 2019 rating decision. The Board issued a decision in December 2020 that granted readjudication of service connection for PTSD and bipolar disorder and also denied service connection for such conditions. The Veteran subsequently appealed this decision to the United States Court of Appeals for Veterans Claims (Court). The parties to this appeal entered into a May 2021 Joint Motion for Partial Remand (Joint Motion), wherein they agreed not to disturb the Board's decision to grant the Veteran's request to re-adjudicate her claims on the basis of new and material evidence for previously denied claims of entitlement to service connection for PTSD and bipolar disorder. In a May 2021 Order, the Court granted the Joint Motion and remanded the noted claim back to the Board. Service connection for a psychiatric disorder other than PTSD. The Veteran contends that her bipolar disorder is related to an in-service September 1991 sexual assault. In a February 2016 correspondence, the Veteran reported that she was sexually assaulted in 1991 while she was stationed at Fort Sill, Oklahoma. She also reported that, between July and September 1991, she went on a date with another servicemember. The Veteran reported that the servicemember picked her up, "stopped back by his apartment," and sexually assaulted her. After the assault, the Veteran reported that she "told no one," "didn't go to sick call," and "tried to forget it by working all the time and staying busy." In a March 2017 correspondence, the Veteran reported that after the assault, she "became withdrawn and paranoid for a while" and "started having problems sleeping." She reported symptoms of sexual promiscuity and impulsive behavior. Further, the Veteran reported experiencing major episodes of depression, suicidal thoughts, a suicide attempt, major financial issues, and quitting a job without having another. However, she was not diagnosed with bipolar disorder until "much later." In July 2019, the Veteran submitted medical literature indicating that bipolar disorder may be precipitated by a traumatic event. In a July 2021 correspondence, the Veteran's representative referenced the Veteran's report made in July 1991 with regards to changes in her menstrual pattern. The Veterans service personnel records (SPRs) show that she was stationed in Fort Sill, Oklahoma between June and September 1991 as a Personnel Records Specialist. The Veteran's service treatment records (STRs) show that the Veteran reported a change in her menstrual cycle in July 1991 before the assault. The STRs do not show reports or treatment for psychiatric conditions, including bipolar disorder. The Veteran's post-service treatment records show that Veteran was noted to have a diagnosis and treatment for bipolar disorder from December 2015 and referred to a non-VA mental health provider in January 2016. In a Social Security Administration (SSA) February 2016 psychiatric diagnostic assessment the Veteran reported a pre-military assault which occurred when she was 16 and in 1991 when she was on a date. Moreover, she has indicated that she used to self-harm by burning herself on the arms during college. The Veteran reported symptoms of mania since 1990 and depression since 1991. The assessment report reflects that the Veteran was diagnosed with bipolar disorder in approximately 2015. Additionally, she received treatment for a mood disorder starting approximately in 2004 or 2005. The Veteran's private treatment records show that the Veteran reported sleeping problems, anxiety, increasing depression, and a history of impulsive behavior. In October 2018, the Veteran was afforded a VA examination for this claim. The Veteran reported having been diagnosed for mental health problems by a private care provider about 8 years ago. She reported experiencing depressive and manic episodes 3 to 5 years before the examination. During such episodes, the Veteran reported not being able to sleep, experiencing racing thoughts, increased activity, pressure speech, reckless spending, quick movements from one activity to another, and feelings of grandeur. Also, the Veteran reported the sexual assault while stationed in Oklahoma in 1991. Further, she reported having "difficulty in interpersonal relationships with males, difficulty trusting other, and avoided thinking of trauma." The physician reviewed the claims file. The physician attributed the Veteran's symptoms to bipolar disorder rather than PTSD. The physician opined that the bipolar disorder was less likely than not related to service. She explained that "the Veteran's diagnosis of Bipolar Disorder was not identified or treated for approximately 20 years post-discharge." Also, the physician found that there is no evidence of treatment for this condition while the Veteran was on active duty. Furthermore, she noted that "there was no evidence of a change in functioning or impairment in the Veteran's STR to reflect a 'marker' of an MST." In October 2019, the Veteran was afforded another examination. The Veteran reported a diagnosis of bipolar disorder. She also reported a history of 2 suicide attempts, resulting in a brief hospitalization. Moreover, the Veteran reported that she experienced a date rape but, "does not think about it, did not report it to her command, health care clinics or noted mental health symptoms on her discharge exam." The psychologist reviewed the claims file. The psychologist found that the Veteran's symptoms are related to bipolar disorder. Furthermore, the psychologist opined that the bipolar disorder was less likely than not related to service. The examiner noted that the veteran had symptoms of depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, suicidal ideation, and near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively. In a November 2019 medical opinion, the same psychologist found that while the Veteran met the criteria for bipolar disorder, there was no evidence that such condition was related to the Veteran's service. The psychologist explained that there were no reports of mental health issues during the Veteran's service and no consistent reports of ongoing mental health problems since military service. The psychologist concluded that the Veteran's disorder did not manifest in service and no nexus existed between military service and current symptoms. He also concluded that the Veteran's disorder was unlikely to have an experiential origin and more likely to be inherited. In the May 2021 Joint Motion, the parties found that the Board erred in relying on the October 2018, October 2019, November 2019 examinations. In this regard, the examination nor the Board discussed how the proximity of Veteran's trauma to her date of separation from service factored into the likelihood that she would have exhibited manifestations or markers of a psychiatric disability prior to separation or adequately supported the determination that the fact that her STRs did not document treatment weighed against entitlement to service connection. Therefore, the Board finds that a remand is warranted to obtain another medical examination in regard to this claim. This claim is REMANDED for the following action: Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the nature and etiology of all diagnosed psychiatric disorders other than PTSD. The entire claims file should be reviewed by an appropriate physician. Thereafter, the physician is to: (a.) Identify all currently diagnosed psychiatric disorders other than PTSD. (b.) State whether it is at least as likely as not that each disorder had its onset during service or is otherwise related to an in-service event, disease, or injury, to include trauma from the claimed in-service sexual assault. (Continued on the next page) Consideration should be given to the Veteran's lay statements of in-service military sexual trauma and the medical literature discussing the symptoms and causes of bipolar disorder submitted in July 2019. A rationale should be provided for opinions expressed. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Nevarez-Myrick, Nancy 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.